Merigian Studios

Blog

A Big Problem Being Back of the Herd

For eight years, I was the medical director of the Memphis Fire Department. During that time, I had the honor of working at the Pentagon eighteen hours after the disastrous plane crash on 9-11. It was an honor digging bodies out from the mountains of rubble and debris. Our country mourned together for a brief moment in history, probably in the same fashion when the Japanese attacked Pearl Harbour.

As medical director, I made sure the City had ambulances to transport medical emergencies. I became public enemy number one to both Baptist and Methodist hospital systems. They were derelict in their duties. What Duties? Making sure their emergency departments could handle the volume of patients that Memphis Fire brought to them daily. I discovered that our ambulances were being sequestered in the hospital parking lots because emergency department staff refused to admit patients into their emergency department. There were times when the entire Fire Department fleet was out-of-service. 911 dispatch notified me several times a week during a several month stretch in 1999. The area hospitals refused to increase their nursing staff and physician pool. To improve their profit margins, hospitals routinely held patients in their emergency departments for two or three days. Hospitals refused to cancel elective surgical admissions to free up beds for emergency patients.

I reported the hospitals to the Federal Government since they were in breach of standards set by the Department of Human Services for emergency care. I had a direct line to the West Tennessee regional investigator. We were on a first-name basis. What happened when I turned these administrators in? Nothing. They improved their operations just long enough to maintain Medicare and Medicaid funding, then reverted to the same old tricks.

One incident stands out firmly in my mind. One of our City ambulances drove forty-five minutes around Memphis doing CPR and Advanced Life Support on a man who had a full cardiac arrest. Every hospital refused to accept the patient. When dispatched notified me about the problem, I told the paramedics to drive into the Baptist East Emergency Department and transfer care to the Emergency Department. When they arrived and unloaded the patient, a nurse met them at the entrance and shouted, "You can't bring that patient in here!" They wheeled the patient by her, transferring care quickly during her tantrum. She was furious. My men were exhausted. The patient died.

Ultimately, I resigned as medical director. The politics of the position were tiresome. The doctor who took over after me worked in one of the area emergency departments. He never rocks the boat, ever. He is too enmeshed in the healthcare system to make a difference.

Incidents like these still happen today without an outbreak of a pandemic. Long waiting times in emergency departments are commonplace. Many of the physicians staffing the emergency departments are internal medicine, pediatrics, medicine-pediatrics trained.  A few of them completed an Emergency Medicine specialty residency training program, but it's probably only a hand full. As long as a physician attends a weekend workshop on Advanced Cardiac Life Support, Advanced Pediatric Life Support, and Advanced Trauma Life Support, they will be allowed to work in an Emergency Department. Merit badge medicine is here to stay.

COVID-19 will bring the City and County Ambulance system to its knees. Not only will the hospitals and clinics in the area be overwhelmed, so will the financial burden of an unprecedented recession. All non-essential services will grind to a halt. All essential services will operate at a snail's pace. Emergency medical conditions like heart attacks, strokes, severe lacerations, acute unrelenting asthma, intractable seizures, diabetic coma, and a whole host of other deadly emergencies will go untreated if our emergency staffs and ambulance systems are out-of-service.

I do not sound the alarm of panic. I am just painting the canvas with bright enough colors so that everyone can see the messy masterpiece through the darkness and misinformation. People are reporting news from Asia as if their overseas' experience of the viral infections possibly tapering off is going to change our Memphis experience. I believe that when eighty-percent of China's population is infected, the infection rate or new cases will taper off: herd resistance. We are far from that occurring in Memphis or Shelby County.

Another twist in this story is the unpredictability of the severity of the infection. There are young people (thirties and forties) dying from the disease and older adults (seventies and eighties) surviving from the disease. I think there might be two strains instead of one; one of the two is much more virulent than the other. If possible, scientists should delve deeply into the nuclear structure of the virus and develop testing that could discriminate between the two.

What about the idea of a golden drug to save the world? Poppycock. We are afflicted with a number of diseases that maim or end the lives of thousands of Americans and people worldwide. Hepatitis C and HIV maybe the two viral illnesses that may be considered to be cured by antiviral drugs. It depends on your definition of cure. No one has found the cure for influenza A or B; these viruses are associated with tens of thousands of deaths per year. It’s taken forty years to come up with a drug called Tamiflu. The medicine reduces the symptomatic duration of the flu by thirteen hours. The drug does not prevent death from the flu. Emergent drug trials, vaccine development, and monoclonal antibody therapies are all in the works for COVID-19. None of those will render any positive change in our current public health crisis, but it will help the public perception: we are doing something to combat the virus.  

We need testing to assess the viral infection rate of our population. I believe we have at least 15,000 unconfirmed infections or more in Tennessee. Physicians are mostly testing and reporting patients admitted to the hospital to ration test kits. Our office received five test kits this week. We need 500. Tennessee’s governmental leadership is too slow to take measures to reduce the slope of the peak of the virus. Another iteration of the ignorance plaguing the State's citizens, county and municipal officials, elected legislative body, and the Governor's office. We are way behind the decisions of Cuomo and Inslee, Governors of the State of New York and Washington, respectively. Both of those Governors are leading the way for the rest of the county with both Tennessee and Mississippi way back in the herd. Does anyone realize what happens to the stragglers in the herd?

So who will lose if the infection rate accelerates beyond our ability to care for all illnesses, not just those infected with the virus? What you don't know can kill you.

Doc

 

 

Share |