Healthcare is Still Sparse
Remember to plan, and train, ahead.
I was working in what I call ‘rural Emergistan’ recently when I saw an elderly gentleman who had fallen. His fall was not severe. It was not from a ladder or porch, but merely from standing. But that simple fall conspired with his advanced years and resulted in severe internal injuries requiring intervention by a specialist.
His injuries were too complex for our small hospital and he needed to be transferred to a trauma center. (In point of fact, trauma centers now have special trauma alert designations for older patients with falls. It’s an enormous, growing problem. https://www.cdc.gov/falls/index.html)
The hitch was that we had no way to send him to the other facility, which was two hours away by ground ambulance. Helicopters were not flying due to typical Appalachian weather and we didn’t have any ambulances to spare.
Ultimately, several hours into the situation, an ambulance became available and off he went, fortunately very stable at the time he left.
This scenario would seem shocking to many urban dwellers, but it is played out day after day, night after night in rural areas across the country. It is made worse by the steady, unrelenting closure of rural hospitals. https://medcitynews.com/2023/07/rural-hospital-insurance-finance/
Of course, this isn’t a problem of the US alone. Our Canadian cousins face similar problems with hospital closures, or face hospital ERs with reduced hours.
In addition to hospital closures we frequently face limitations on available specialists, like cardiologists or assorted species of surgeon. In these situations transfer is warranted but often difficult.
I’m not offering a solution to systems problems. But I am asking everyone to be careful and plan ahead. If I seem repetitive due to prior posts, I apologize. But here are a few important tips for these strange times:
1) Those who live in rural areas should consider purchasing flight insurance from regional helicopter transport services, it’s a good investment and typically inexpensive. Especially since aeromedical transport can run $30,000-$50,000.
2) For those traveling away from home, there are insurance products available that will arrange for a crew to pick you up and take you home to a hospital in your area. (Assuming there’s a bed available.)
My wife and I have used MedJet when traveling internationally, as medical transport from another country can cost almost $200,000. It was a good investment which we didn’t have to use, costing somewhere around $500 for both of us for the year.
3) Medication shortages are a problem. Simple things like albuterol inhalers or the antibiotic Amoxicillin are sometimes hard to find. (https://www.cnn.com/2023/03/22/health/drug-shortages-senate-report/index.html)
Whether traveling or not, ask your physician if you can get a little extra medication to put back. I have a son with type 1 diabetes so we are always concerned about insulin availabilty.
You never know when a storm will knock out a pharmacy or when weather or other issues will prevent you from obtaining important medications. This is especially true for seniors who have no nearby friends or family to help them.
If you are traveling, take extra medications and don’t count on 24 hour pharmacies. Or in some areas, any pharmacies.
4) When you move to a new area, be sure to find out what medical resources are available. Not all areas have hospitals, and not all hospitals are the same. Certainly most hospitals are NOT like the facilities we see on television dramas, with every specialty, procedure and service always on hand.
If you have complex medical problems, talk to your physician about what you need and about good versus bad areas to live. For some medical problems, for instance congenital heart issues in infants, time can be of the essence. A long wait for transport to another town could result in tragedy.
5) If you are traveling, the same goes. It could be very helpful to have a general idea of what hospitals are in what areas as you travel. This is especially true for those with chronic illnesses that may need to be monitored closely. It’s great to be able to call 911; it’s even better when 911 has a place that they can take you to in a timely manner.
6) I know I’ve said this before, but make sure to learn basic first aid, bleeding control (https://www.stopthebleed.org/) and CPR. Check with your local EMS service or Red Cross chapter for classes. If you are concerned about yourself or a friend or loved-one, try to get some Narcan to use for overdose. It’s a simple, life-saving fix.
7) Keep a good first aid kit with you whether traveling locally or across the country. There are so many out there! I don’t have any financial interest in this company but I have kits from My Medic. (https://mymedic.com/) They’re quite good. I keep one at home and one in my vehicle. In fact, I’ve started traveling, even when I fly, with a large gauze dressing and tourniquet in my carry-on. I’ve never had a single problem or question asked by security (Unlike the time I forgot that I had ammunition in my bag…don’t do that, FYI.)
8)Frankly, if you or anyone in your family or friend group has the interest, he or she should go to first responder training or become an EMT or paramedic. Or take it to the next level and become a nurse, nurse practitioner, PA or even physician. We’re going to need people who care and who are trained as the system spirals further out of control. It’s worth it if only to act as a help and advocate for the people you love, for the family, clan or tribe to which you belong.
Healthcare is in a difficult place. People live longer, people are sicker, addiction and overdose issues are growing. And slowly, steadily we’re losing hospitals, medications and medical professionals.
The problem is complex. But we can only control so much.
What we CAN do is plan ahead to care for ourselves and our loved ones. And the occasional stranger we find along the way.
At least it’s a start.
Edwin
PS Regarding the Emergistan Reference, here’s some background. I write a column called Life in Emergistan for Emergency Medicine News. It began with this insight:
I'm 72. Five years ago, I decided to move to a large city with several medical schools and teaching hospitals. I have CHF afib and mild Type 2 diabetes. Health care was not the only reason for that move but it was a major factor.
Ed-I’m passing this along as I feel it highlights your two recurring themes , grace and absurdity
Her courage and impact were breathtaking, yet overlooked and ignored for the constant triviality of our increasingly unserious and unspiritual world. How do we turn this around? Perhaps by one person at a time being inspired by the likes of her and not Miley Cyrus, Oprah Winfrey or Elon musk. As for the paradoxes of faux Christianity, I would argue there is an even greater duty than to be passively spiritual or oblivious to the evil around us. I don’t know exactly ‘what Jesus would do”, but this is one fallen Catholic and now committed secular humanist who would encourage Christians to step up and actively heal the world rather than being focused of doing well by doing good, a peculiarly self serving, reverend Ike, Babbitt like ah-murican distortion of what Christ really preached. Perhaps We need fewer ‘Christian’s’ with a capital C and more chritians with a lower case c …..fewer televangelists building mega churches and getting wealthy, fewer people attending church aNd more becoming missionaries etc. , less tithing to support established church bureaucracies -even if benign- and more donations for orphaned children in Ukraine.
The world hasn't just become wicked...it's always been wicked.
The prize doesn't always go to the most deserving.
Irene Sendler
She Died 12 May 2008 (aged 98) in Warsaw, Poland
During WWII, Irena, got permission to work in the Warsaw ghetto, as a plumbing/sewer specialist.
She had an 'ulterior motive'.
She KNEW what the Nazi's plans were for the Jews (being German).
Irena smuggled infants out in the bottom of the tool box she carried and she carried in the back of her truck a burlap sack, (for larger children).
She also had a dog in the back that she trained to bark when the Nazi soldiers let her in and out of the ghetto.
The soldiers of course wanted nothing to do with the dog and the barking covered the infants' noises.
During her time of doing this, she managed to smuggle out and save 2500 children/infants.
She was caught, and the Nazi's broke both her legs, arms and beat her severely.
Irena kept a record of the names of all the kids she smuggled out and kept them in a glass jar, buried under a tree in her back yard.
After the war, she tried to locate any parents that may have survived it and reunited the family.
Most had been gassed. Those children she helped got placed into foster family homes or adopted.
Last year Irena was up for the Nobel Peace Prize.
She was not selected.
President Obama won one year before becoming President for his work as a community organizer for ACORN
Al Gore won also --- for a slide show on Global Warming.
I admire Barack Obama and surely global warming is arguably the issue of our times.
But seriously? These men should be embarrassed to have been chosen over this woman.
In MEMORIAM - 63 YEARS LATER
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It is now more than 60 years after the Second World War in Europe ended.
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Now, more than ever, with Iran, and others, claiming the HOLOCAUST to be 'a myth'.
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