HJBR May/Jun 2022

DIALOGUE 12 MAY / JUN 2022 I  HEALTHCARE JOURNAL OF BATON ROUGE   go. If the person says, “I want to go to Hos- pital A,” it’s not just wrong, it’s actually ille- gal to take them to Hospital B. That’s called kidnapping. The only exception is if the patient is unable to make the decision. Then we can always default to what the family wants. If the acuity nature of the patient, how severely injured or ill they are, means they’re unable to talk to us, then yes, we will make a decision on their behalf based on the best interest of the patient. But it does answer a question that EMS providers all over the nation get asked all the time. It’s a question we don’t understand how to answer because it doesn’t make any sense to us in the pre- hospital world: when emergency depart- ment people ask us, “Why did you bring that patient here?” I’m an emergency doctor, and I under- stand the motivation for that question. But to an EMS provider who’s working prehos- pital, that question is a nonsense question, so I’d like explain to people that if you ask one of the paramedics, “Why did you bring that patient here,”and they look at you with this dumbfounded look, it’s not because they don’t know how to answer the ques- tion, it’s because the question doesn’t make any sense to them. We brought the patient here because that’s where the patient asked to come. I often want to try to help educate local emergency providers and explain to them that you don’t need to ask the para- medic why we brought the patient to your hospital. You need to go ask the patient, “Why did you choose to come to this hos- pital?”We brought them there because they asked to go there. Editor Can emergency rooms be on divert? Godbee Potentially. It depends on the com- munity agreement. Our community here in East Baton Rouge has a “no divert” pol- icy, and I’ll explain it to you this way: if you have hospitals that are allowed to go on divert, which we used to have here, what happens when everybody goes on divert? Everybody’s getting overloaded, particu- larly lately. So, everybody in the commu- nity is now overloaded with patients, and what happens if every hospital goes on divert? That’s the extreme, I understand, but do understand that if that happens, now nobody’s on divert. That’s what it essentially means. Editor When did the option to divert change? Godbee It was over 20 years ago that we went to nobody going on divert because it isn’t beneficial to the system as a whole. The community got together and made the deci- sion that we’re not going to divert anymore because it doesn’t help, and it doesn’t do any good to have less than everybody on divert because then all the other people are just getting stacked up to where it’ll force them to have to go on divert, too. So, I’ll explain in a little more detail. If nobody’s on divert, no big deal. If every- body’s on divert, that’s the equivalent of nobody being on divert because obviously paramedics can’t drive around the city fish- ing for a hospital bite; that’s not going to work. What happens is ... what if you have five hospitals and two of them are now on quote, “divert”? Well, that means the other three are getting overwhelmed because all that volume of the other two hospitals on divert is now going to the hospital that is not on divert. Editor How has EMS protocol changed over the years, and how has that affected outcomes? Godbee Here in EBR parish — this is more unique to us, but I think this is going to become far more general in the future — we’ve changed the word “protocol”to the word “guidelines.” What I mean by that is ... if you kind of go back historically speak- ing, and I hope all the old guys who hear me say these two names will immediately identify with who I’m talking about ... The 1970’s show, “Emergency!”, that had John Gage and Roy DeSoto as the two paramedics in LosAngeles, I watched religiously during most of my high school and college years. It had a lot of impact on what I do now, par- ticularly wanting to become a prehospital provider. That show actually is a very good historical insight into how our profession started as paramedics in the early 1970s. If you watch the show, when Johnny and Roy showed up on a scene, the first thing they did was set up their radio and the telemetry to talk to Rampart Hospital, and that was pretty much what it was. In those days, the paramedic literally was the eyes, ears, and hands extender of the doctor in the hospital, because you were constantly talking to the doctor in the hospital. We’ve advanced a long way from that time. What came next, historically, was (was or is) “protocols.”Here’s the terminol- ogy difference — and I’m not semantically hair-splitting here, this is in all sincerity, and there really is a significant difference of the word I’m about to use: a protocol is some- thing that says, “You will do the following things in the following order in the follow- ing way.”That’s a protocol, and that’s the way paramedics worked for decades. Well, as we all pretty much understand, medicine isn’t that easy. There are some things that can be that algorithmic, but medicine is not that easy. So, a protocol is doing the following things in the following order in the following way, and that truly was the way we worked for decades. A “guideline,” which is what we have shifted to, particularly here in our parish, is: here’s the end result I want you to achieve. There are multiple ways to get there, and