An Open Letter to Houston County, TN Commissioner George Jeram

Credit: WKRN-TV Nashville
Credit: WKRN-TV Nashville

Dear Mr. Jeram,

I have been following with great interest the ongoing saga involving Houston County EMS and the mandate that you helped to craft which prevents them from effectively doing their job. This policy, while you may have intended it well, endangers patients and can very possibly cause great harm to them.

The policy where Houston County EMS providers are forced to call doctors at Houston County Community Hospital is dangerous.

I believe, however, that this policy is borne out of two things: Ignorance and desperation to try and save your county hospital. As for the ignorance portion of this equation, please allow me to educate you.

On a typical ambulance crew you will find two levels of providers: An Emergency Medical Technician (EMT) and a Paramedic. I am not sure of the specifics of scopes of practice and protocols for Tennessee so allow me to speak in general terms. An EMT is someone who has completed what is typically a semester long course and passed skills and cognitive testing certifying they are competent to render care at the basic life support level. EMTs can perform a variety of functions including obtaining vital signs, administering medications such as oxygen and oral glucose, performing various procedures such as applying a traction splint for a fractured femur, perform defibrillation by using an automated defibrillator and even more. Many patients require only this level of care en route to a hospital.

Paramedics have completed the EMT course and certification and have also completed a technical program (often leading to an Associate’s degree) through a hospital, community college or other institution of higher learning. Paramedics typically take two years to complete all of the requirements for their education and certification. Paramedics are educated in things such as anatomy and physiology, pathophysiology (disease process), a variety of medications, cardiac rhythms and their treatments, and airway management. Paramedics can initiate IVs, administer various medications such as Morphine and Valium (often without consulting a doctor due to standing orders), intubate (placing a breathing tube in a patient’s trachea) and perform many other invasive procedures. In some places, paramedics can even initiate and maintain chest tubes, surgical airways and more.

In short, EMTs and Paramedics do much more than simply throw someone on a stretcher, take a blood pressure, and drive 80 MPH to the closest hospital. There was time when that was the normal… 50+ years ago. A lot has changed and now EMS crews are able to keep a patient stable until they reach an appropriate facility for definitive care.  Typically they do not have to call a doctor for orders or to “find out what’s going on” because they have already determined that and are treating the patient. Perhaps you were simply not aware of the capabilities of EMS providers. I would encourage you to ride a full shift with Houston County EMS in order to see it up close. I’m sure they would have no problem letting you see what they are capable of.

As for the second part of this issue. A Google search reveals that you are a member of the committee which oversees Houston County Community Hospital and have fought hard for the hospital by encouraging your elected state officials to provide more funding for the hospital. A store by WKRN also reveals that the hospital is in serious financial trouble. I admire that you are willing to do anything in order to help the hospital stay open but this policy related to EMS is not the way to save your hospital.

As I mentioned, this policy is dangerous. If a patient is having a heart attack they need to be transported to a facility with a cath lab as soon as possible. If EMS is forced to transport to the local hospital first, this only serves to delay care. The patient can have a significant impact on their health up to and including death because of this delay. If there is nothing the local hospital can do in order to fix the heart attack, stopping there is a waste of time.

I am no longer a full time paramedic but I work part time in a county that does not have a hospital within its boundaries. The nearest hospital from here is at least 30 minutes away by ground depending on which part of the county the scene is in. If a patient is having a heart attack, stroke, or has severe trauma then we have to call for a helicopter to transport the patient to a facility further away with more capabilities. We do not transport simply because the hospital is nearby. We make a decision based on the best interest of the patient. Your EMTs and Paramedics should have the same ability. That is part of their job.

I hope that this policy is reconsidered soon and rescinded. While I will not presume to speak for your local EMS providers, I know I would not work at an EMS with such a policy and would immediately resign. I could not ethically or morally be employed for a service with policies that will not allow me to render the best care or to ensure that my patient receives the best care once they leave my cot. This policy not only hamstrings your EMS crews but is also a disservice to the citizens of Houston County.

I highly doubt you will ever see this post, Mr. Jeram, but I hope that someone is able to convince you that while this policy may have good intentions it is most assuredly flawed. For the sake of the citizens and EMS providers of Houston County, I hope this policy is changed.

Rev. Jonathan Tullos, BS, NRP

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