How the US created an ambulance crisis
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زیرنویسها (185 segments)
DownloadLet me ask you a question. If you called
for an ambulance, how long is too long
to wait? 10 minutes? 15? Maybe you're
having a heart attack or you were in a
car accident or some other serious
condition? 18 minutes. The gold standard
is 8 minute response time. So, from the
time you call 911 that the ambulance
shows up. But if you live in any of the
red areas on this map, you might be
waiting longer. These are ambulance
deserts. areas that were outside of a
25minute drive time. That's Yvon Young,
one of the authors of this paper, which
sought to map the position of every
ambulance station in the entire US. They
found that roughly 4.5 million people
live in ambulance deserts. 4.5 million
people who, if they had a stroke or were
suffering cardiac arrest, might not make
it to a hospital in time to survive. It
makes sense that in a more spread out
area, an ambulance will take longer to
get to you. But there's more to the
story than just geography. The rural
ambulance crisis is a product of our own
design. So in addition to Ivonne, I
talked to some of the people overseeing
that frontline response to ask how can
we fix
it. Hey there, just popping in to say
that this is the first of three videos
that we're doing on how emergency help
gets to remote locations. Rural areas
often struggle to get the same level of
service as more populated regions. We
wanted to explore what those challenges
look like and what can be done to make
things better. And we're grateful to
T-Mobile, our sponsor, for supporting
this video. T-Mobile has invested
billions in getting 5G coverage across
the US, and they're committed to
supporting first responders and their
families with exclusive savings. So, if
you want to learn more about that, check
out the link below. T-Mobile didn't
dictate the content of this video, but
their support did help make our
reporting possible. Now, back to the
video. If your house is on fire or you
are scared for your safety, you might
call 911. And for the most part, you'd
get a response that wouldn't cost you
any money out of pocket. In most places,
the fire department and the police
department are considered essential
services. The government has to provide
those for its population and it funds
those largely through taxes. EMS and the
majority is not considered an essential
service. So, your town has no obligation
to provide an ambulance service. Without
the same government funding, payment
must come in another form, and that's
reimbursement by insurers or payment
from individual patients. EMS is really
reimbursed like they're a taxi service.
We only get reimbursed if we do the
transport. That is transported from the
scene and taken to a hospital because
that's where insurance and personal
information can be established through
paperwork. If an ambulance responds to a
call and that person doesn't want to get
taken to the hospital, there's personnel
on that ambulance being paid. There's a
service that's being provided, but
there's no reimbursement for it. And
this is the tricky thing about ambulance
services. All of the costs of running
it, like gas, medicine, personnel, all
that has to be paid for and ready to go
at all times in case a call comes in.
But regardless if one call comes in or
100 calls come in, those costs don't
change. Which means the best case
scenario for keeping these services
funded is for them to make as many trips
as possible. Otherwise, they're just
sitting there burning money. And this is
where geography factors in. Here in the
city, we could be to a call in under
five minutes, spend 5 10 minutes on
scene, be at the hospital in 5 minutes,
and back in service in 25 minutes. In
some of the other counties that we're
servicing, it could be a 35minute ride
just to the hospital. That's an hour
hour plus that your unit's out of its
area. Cities also generally have more
calls because they have more people and
more incidents in sparsely populated
remote rural locations. They're only
doing 30 runs a year, so it's pretty
hard to break even. That low volume of
calls also makes it hard to pay
emergency workers who work around the
clock, which is related to another thing
commonly true of rural emergency
response. I mean, if people can't make a
living off of it, then we're reduced to
volunteers.
Volunteers are an essential part of EMS
response in rural areas. The overhead
costs of running an ambulance are high.
So, rural communities often rely on
unpaid non-professionals to save on
those personnel funds. We have set up
this system where your CPA, your plumber
might also be your EMT when you call
911. But in recent years, the volunteer
base is declining. It's just hard to
recruit people working two and three
jobs. And a lot of the members that are
still holding down the fort and
responding to a lot of the calls are
members that have been there from the
beginning. All that the lower volume,
less reimbursement, and shrinking
volunteer pool, that's what adds up to
slower response times. There are areas
of the state where you do not want to,
you know, have an accident because
there's no one no one will be coming, at
least not in a timely manner. The sticky
situation we find ourselves in with EMS
is ultimately about resources and the
issues of distributing them. The study
that we did in North Dakota, we not only
looked at ambulance deserts, but we
looked at if we could place them
wherever we wanted, what would be the
optimal set of locations. And we were
able to show you could serve the whole
state with fewer number of ambulances
and cover the whole state. The problem
really is is that these ambulances are
organized by community goodwill. You
can't tell these communities, "Oh,
sorry, you've got it in the wrong spot.
You need to move south 10 miles." Part
of the solution might be that we need to
start thinking about EMS designation as
an essential service. Some places have
started ambulance tax districts where
local taxes do pay for EMS. The
community I live in just started an
ambulance tax district. They're paying
to make sure that there's 24/7 coverage.
For me, it's cost about $180 a year.
Robert's teams have started operating in
some ambulance tax districts.
significant reduction in response times
and significant reduction in mutual aid
where they had to rely on other
communities to back them up. Ultimately
though, experts think the problem will
require largecale change. We need to get
the reimbursement rates up so that we're
actually getting paid for the level of
service that we're providing. Until they
change the reimbursement of those
services, we will continue to be in
crisis.
If you're ever in that situation where
you need to dial 911, you don't want to
have to worry about the system being in
crisis. The service that's being
provided is just as critical and crucial
as police and fire. So, it's time to be
recognized for that and give us avenues
of recruiting and training and funding
that's going to allow us to address that
EMS crisis.
Key Vocabulary (50)
toward
"Go to school."
belonging
"Cup of tea."
also
"You and me."
inside
"In the house."
specific
"That book."
A third-person singular pronoun used to refer to an object, animal, or situation that has already been mentioned or is clear from context. It is also frequently used as a dummy subject to talk about time, weather, or distance.
Used to show who is intended to have or use something, or to explain the purpose or reason for an action. It is also frequently used to indicate a specific duration of time.
A function word used to express negation or denial. It is primarily used to make a sentence or phrase negative, often following an auxiliary verb or the verb 'to be'.
A preposition used to indicate that something is in a position above and supported by a surface. It is also used to indicate a specific day or date, or to show that a device is functioning.
A conjunction used to compare two things that are equal in some way. It is most commonly used in the pattern 'as + adjective/adverb + as' to show similarity.
Used to refer to the person or people that the speaker is addressing. It is the second-person pronoun used for both singular and plural subjects and objects.
Used to identify a specific person, thing, or idea that is physically close to the speaker or has just been mentioned. It can also refer to the present time or a situation that is currently happening.
A coordinating conjunction used to connect two statements that contrast with each other. It is used to introduce an added statement that is different from what has already been mentioned.
A third-person plural pronoun used to refer to two or more people, animals, or things previously mentioned. It is also commonly used as a singular pronoun to refer to a person whose gender is unknown or to someone who identifies as non-binary.
The word 'we' is a first-person plural pronoun used to refer to the speaker and one or more other people collectively. It is used as the subject of a sentence or clause.
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And what can be done about it. Thanks to our sponsor, T-Mobile: http://t-mobile.com/FirstResponders Here's a pretty obvious statement: In the more rural, spread-out parts of the US, an ambulance...
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