RANT: Standard of Care

When I became an EMT, I quickly realized that EMS could be more than it currently is. So, I became an advocate for and supporter of increased increased education. I believe in evidence-based medicine in EMS. If EMTs and paramedics are ever to be recognized as real medical providers rather than getting the proverbial pat on the head by nurses and doctors, more education and acceptance of evidence must be embraced and utilized.

In other words, I’m an advocate for the advancement of EMS.

Even though I’m retired from being an active paramedic, I’m still part of a few EMS groups on social media. A discussion ensued about the Philadelphia Police Department’s “scoop and run” policy. If you’re not familiar, essentially anyone with penetrating trauma within the metro of Philly, PA gets a ride to the trauma center courtesy of a police officer. My understanding of the policy is that this is regardless of the availability or proximity of EMS.

Let me put this into perspective: A police officer who is likely not trained as an EMT, nor equipped to provide anything besides very basic first aid, throws a gunshot or stabbing victim into the back of his car and hauls ass to the hospital.

Now, you might be saying: “But Medic, if someone has penetrating trauma they don’t need a ‘medic, they need a surgeon and a blood transfusion.” You would be correct: Definitive treatment is definitely those things but that patient may have immediate life threats that can not be managed by a medically untrained police officer and instead would require a medic. The first thing that comes to mind is airway management. Can a cop suction an airway, place an appropriate airway (NPA, OPA, ET Tube, or whatever may be indicated), and ventilate a patient? No. All the cop has is a lead foot and prayer.

So I chimed in and indicated my concerns and disagreement with such a policy. Several disagreed with me and cited studies to back up their claims. As an advocate for education and evidence in EMS practice, I support studies but I do not support non-medically trained public safety officials transporting patients who are on the edge of death simply because it’s always been done that way.

I acknowledge what the studies say but I still do not support such policies from an ethical and moral standpoint. I was accused of not being a true patient advocate or of having my ego bruised. No. It’s because of the fact that I am a patient advocate that I believe police transport of injured persons is a crock of bullshit.

First and foremost: A patient’s family member is not going to give one single fuck about what a study says if their loved one dies as the result of aspiration or of otherwise having a compromised airway.

Also, ponder the following (all of this assumes we’re talking about a medically untrained police officer without proper equipment):

Can a police officer do a rapid trauma assessment and control serious external bleeding?
Can a police officer manage an airway?
Can a police officer provide bandaging and any needed splinting?
Can a police officer initiate IV access so that a patient can more quickly receive blood?
Can a police officer provide pain management of any sort?

Can a police officer do all of this by himself while he is driving?

And perhaps most importantly: Can the officer properly restrain the patient who will be lying in the backseat of his car in order to prevent worsening of the patient’s trauma and to otherwise keep the patient from being thrown around like a rag doll?

The answer to all of this is “no.”

Fuck the studies in this case. They don’t take into account that the patients are literally thrown into the back seat of a car, unrestrained, and sped off to a hospital by a police officer who likely has no medical training beyond the department-mandated Red Cross First Aid card and is weaving in and out of traffic and, as mentioned above, throwing the patient around the backseat with no restraint. They also don’t take into account that the patient is treated as a sack of potatoes rather than as a person.

It’s unbelievable that in 2017 we still have a major city giving 1960s-level of patient care.

EMS has come a long way since its inception. We have a much higher standard of care for trauma patients that has little emphasis on “scoop and run” and an emphasis on actually beginning treatment of the patient. Police officers simply are not trained or equipped to provide this standard of care.

I’ve not been able to find out if any lawsuits have resulted from this “scoop and run” policy but I would be willing to bet that if someone died as a result of lack of proper care or as the result of being improperly transported, a jury would not be too kind to the City of Philadelphia or to that unfortunate police officer who is on the receiving end of that lawsuit.

Police officers do many wonderful and amazing things and I am grateful for what they do. However, in my experience, most cops would agree that playing EMT is not something they want to do or should do.

Let the cops be cops and leave the medical treatment to those with the education to do it properly.

/rant