Friday, March 28, 2008

Quod Me Nutrit, Me Destruit - The Sequel

Greetings from the 9th fastest growing metropolitan area in the country. Wow.

Although I'm pleased at the amount of opportunity and vitality that abounds around the Grand Junction area, you'll have to excuse me if I don't exactly pull a major muscle group celebrating.
There are things about this growth spurt that don't lend themselves to preserving the quality of life that even relative newcomers to the area such as myself feel may be eroding away.

I'm a city dweller; I come from a comparatively big city back east, one that lost population according to the same Census Bureau report that cited Grand Junction's boomtown status.
I enjoy quiet, out of the way places as a diversion, but I am most in my element when I'm around people and community.

From the first time I saw Downtown Grand Junction 13 years ago, the sense of community that exists in the city center, from live theater and music, a source of independent cinema, to the Farmers' Market in the summer, has to me been a positive example of how growth of the local community helps that community to renew and nourish itself.

I've also seen the flipside of this kind of growth, as manifested by increasing traffic problems (the Riverside Parkway cannot open soon enough) and the gradual replacement of open space with mostly bland, unimaginative housing. I also work in a profession that typically sees the negative aspects of increased population and growth before others do, such as intolerance, impatience, intoxication, ignorance, and recklessness.

In a previous post, I wrote about the nature in which the City of Grand Junction is choosing to grow, and the ramifications that some of that growth has affected and will continue to affect both routine
and critical service delivery by our various local governments and governmental entities. This includes many special districts that provide specific municipal services, such as sewer service, mosquito control, and Fire and Emergency Medical Services.

My career over the last 25 years began with and has always involved some level of interaction
with EMS agencies and hospitals. I've worked in both, at the same time, and can attest to the symbiotic relationship that exists between hospitals, which largely function within insular, credential-driven bureaucracies under constant review from the regulatory and reimbursement sectors (read government and insurance companies), and public sector EMS, which owes a dual allegiance to both this health care bureaucracy and the taxpayer, who depends upon and demands a quick and professional response when needed.

The further out from the urban core you get, the greater the probability that these critical services will be provided largely by volunteers. The benefits are limited, the risks considerable, and in a growing metropolitan area the expectations and workload are increasing. Several variants of the Mesa County Commissioners have recognized this dichotomy in a fairly
responsible and straightforward way. They passed and published their version of the Code Of The West, which states in part:
1.1 - You may find that emergency services response time is longer and their services may be more expensive. Sheriff departments are usually dispatched from a municipal central location, fire departments are most often staffed by volunteers, as are many ambulance services associated with them. Mesa County can boast some of the most up-to-date training and equipment in the state, but distance from dispatch and road conditions will always be a consideration. Rural Mesa County is a true extended community. Please remember that fewer tax dollars will require more in the way of volunteer effort; your volunteer time and monies are needed by your fire department, EMS and others. Plan on being asked and on serving.
They also passed an EMS Ordinance and related Rules and Regulations, which went a long way toward assuring that the entire county was covered by EMS services, that a paid medical director would oversee the health care side of their operations, and that all services would have to be licensed and meet minimum standards to operate.

No symbiotic relationship is without components that detract from that co-existence, and the relationship between Health Care and Public Safety that is the hallmark of any successful EMS system is often strained by unreasonable or unprofessional approaches from one or both sides.

While it was unfortunate that an example of such strain made its' way onto the pages of the Sentinel this week, it was probably a good thing that it happened. Public Safety agencies that know what they're doing take the scrutiny of the general public and the news media generally in stride; they operate in a professional manner, are proactive in their operational planning, and are mindful of their limitations and responsibilities.

I don't intend to imply that Health Care doesn't embrace these values, but the daunting nature of how hospitals operate does not at times lend itself to operational flexibility and public accountability. Information is truly a vital commodity to health care organizations; it sets the stage for accurate diagnosis and treatment, allows for the all-important coding of that diagnosis
and treatment so as to obtain the greatest available reimbursement for their services, and has largely made a profession all its' own out of medical records management and security, especially in the age of HIPAA, for which I will save my consternation about for another time.

In this context it really doesn't surprise me much that Mesa County's EMS Medical Director would throw down a gauntlet to the various EMS agencies in the county to provide complete and accurate electronic documentation of patient care rendered while on the scene and on the way to the hospital.

That there may have been a perceived threat to those agencies' ability to legally operate was surprising. That the majority of the agencies would adopt a united front, openly challenge the order, and perhaps make the debate public is even more surprising, but also appears to have been highly effective.

I waited to write about this until after the Fire Chiefs' Association meeting last night, where a
reported compromise was reached between the Medical Director and those Fire Departments that provide EMS services under his license and authority. Not having been there, the compromise sounds more like D├ętente than an agreement in principle, but I have the following observations nonetheless:
  • ER Docs: You're right in your push for electronic documentation that can be effectively distributed and managed across the varying layers of the Health Care bureaucracy. You need to recognize the limitations that many EMS providers have as far as the ability to deliver patient care information in an electronic format, and meet their responsibilities to the citizens of their respective districts. Sounds like you've done that.
You can help these agencies, and yourselves, by working together to leverage the power and flexibility of today's Internet and data infrastructure to develop solutions for the timely delivery of the electronic information from the provider's station, or even on the way back from the hospital using existing commercial or private mobile data systems. You represent those with the biggest stake in the timely availability of this information, and coincidentally may have the deepest pockets as well. Be prepared to help some more, with funds, equipment, and/or expertise.
  • EMS Providers - You're right that you need to get back into your service area and maintain operational readiness. Working with the Medical Director to get his ERs the information they need, in a format they can effectively use, is a good thing. It's been recommended that you move toward economies of scale in supply procurement and other things.
I honestly don't know how far along you are, but the formal development of more cohesive relationships between providers to assist in the location of available funding, the procurement of equipment (how about one laptop per ambulance?), and the development of a patient data management system that transcends not only the health care bureaucracy but the walls of the hospital itself can be the beginning of an information delivery system that facilitates much more than just writing the trip sheet.

You're getting busier all the time, and don't think that no one is noticing. As the call volume of EMS agencies around Grand Junction increases, so may the interest of private ambulance companies who may have access to additional investment capital to do what you may not be able to do unless you work together more closely.

You know as I do that a profit motive doesn't necessarily translate well into the essential mission of Public Safety; there are at least two private companies that may still be licking their wounds from the battle to cover the Grand Junction District, and from all accounts the good guys won. Work together to get the information needs and the service delivery issues resolved for the benefit of all concerned. Don't tempt that wounded animal.
  • We The People: Growth is a troublesome thing if not managed effectively. There are a lot of your friends and neighbors who donate a lot of mental and physical capital toward making sure that the existing public safety infrastructure remains viable and responsive to increasing community needs.
If you live in an outlying area, heed the Code of The West and get involved. If you are a city dweller like me, support those who toil to keep us safe and prepared for the unavoidable emergency situations that can and will befall a growing area like ours.

And Oh Yeah, be nice to your Dispatchers. They tell these people where to go. :-)


In keeping with the theme of growth and its' potential pitfalls, I have been recently enjoying the motivational parody site They feature humorous take-offs on those motivational posters and plaques sold by companies like Successories and others.

One of the most impressive features of this site is the ability to design your own poster using this basic format, and even have it printed professionally, etc.

I was thinking about growth and its' less pleasant effects when I caught my first glimpse of this site. Here is the result:


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