What is the next “Low Hanging Fruit” of EMS 2.0 and of US Healthcare Reform?

It can be as simple and stupid as the IV set you're using. Too many providers around here (especially the departments that pre-spike their bags) use whatever IV set their fingers touch first. Then, often they transport to a hospital that uses a completely different set.

Since we restock from the hospital, the IV set that is used by Hospital A ends up on the top of the pile in the cabinet, and on the next transport, to Hospital B, the bag is spiked with Hospital A's drip set.

So what happens at Hospital B?

The entire IV set, bag and all, is thrown out- ESPECIALLY if Hospital B uses a needless set and Hospital A doesn't. JCHAO requires any drip be on a pump- even a saline drip if the rate setting is important- and the drip sets are sold to the hospitals by the companies which sold them their IV pumps- and wouldn't you know it, only Acme IV tubing fits Acme pumps.

Since most of these EMS IV lines are KVO at best, and the busiest departments are the ones with the shortest transport times, we have dozens and dozens of IV bags- many with barely 100cc of fluid used- being trashed on a daily basis.

Dozens of sets, every day, multiplied by thousands of hospitals across the country…..

It sounds like a stupid thing to worry about or pay attention to. But I'm willing to bet it represents millions of dollars. Possibly many millions.

At my last job, where on any given day I could transport to half a dozen different hospitals, I took pains to make sure I had at least one drip set- and even their individual locks- from each hospital on my truck. It makes the nurse's job easier, which helps them remember you (in a positive way), and saves money.

Sorry it took so long for me to get around to comment on this. Time flies when your buried by shift bids, closing hospitals, and non-compliant CSS.

I think that one of the major low hanging fruits are those under the influence of alcohol. It is extremely rare, at least in the city, for anyone to spend time in the LE “Drunk Tank”. This is because they get sent to the hospital via ambulance, where they tie up a bed, receive a potassium enriched IV, and are released the next morning after a Yule time feast of green eggs and red jello.

Of course, there are those who will point out that those under the influence have a tendency to acutely bang their heads which could lead to a cerebral hemorrhage and eventual death which is separate from the liver failure induced by chronic abuse which, by the way, will also eventually lead to death. To those who would hold those few as a reason to over treat so many, I would have to say that at some point people need to accept responsibility for their own actions.

If we're going to continue getting called out for those who enjoy the spirits, then at least let them RMA/AMA if they want irregardless of what we assume their mental capacity SHOULD be as opposed to what it ACTUALLY is.

At least, that's what I would strive for.

One thing I noticed was how many times I’ve had to transport patients to the hospital for less than 5 minutes for a Foley Catheter placement. In Iowa it was required as part of my Paramedic program. And even before that as an Army Medic I learned how to do it during my Medic school. Now, here in Wisconsin, it isn’t even touched upon. How much money would it save to allow a crew to show up and place a Foley in the 450lbs Vent Dependent patient versus transporting that same patient using a critical care crew w/vent, bariatric cot, and assist crew? All because the nurse at the nursing home couldn’t get it, or ran out? We already do the same thing with IV starts. It reaches back to the problem with inconsistent education standards across the entire profession.