HJBR May/Jun 2022

HEALTHCARE JOURNAL OF BATON ROUGE I  MAY / JUN 2022 13 here are some guidelines, some ways to get to the end result. That’s what the bot- tom line is, and here are some ways to get there. That’s the difference in a protocol and a guideline. I think that’s made a huge difference in teaching more medicine to us guys in the prehospital world, our paramedics and all, and I think that has had a significant impact on improving the treatment that we provide. Now, the paramedic, the person who has the patient in front of them, has more leeway in what to do and how to do it to achieve the end result; whereas when it was a pro- tocol, you just ran it through like a com- puter. You could almost be an automaton to run a protocol as long as you memo- rize it accurately. A guideline means work- ing with a real human in a real way where everybody’s unique — using feedback and talking to the patient, doing things, seeing how it works. On a guideline end, I’m trying to achieve a result, not just run through a series of instructions to be done with it. With a protocol, I’m running through a series of instructions and trying to rigorously exe- cute that series of instructions but without a whole lot of, “I need to think about this and do it a different way.” It adds thinking into the mixture for the paramedic who’s now not only allowed but is actually expected to think as they’re going through it. Editor How is the partnership between EMS and local hospitals, and what could be improved? Godbee I think that we have pretty good relationships with our local hospitals. I’m not sure what they think of us [chuckling], but I think we have a pretty good relation- ship, meaning we can talk to just about any- body in the local emergency rooms. Of the hospitals where we take the majority of our patients, we have very good lines of com- munication with not only their medical staff, meaning me with their doctor who is their medical director, but also with the nurs- ing staff. I worked with the nursing staff of some of the local hospitals when I was a resident, so I know them. We’re easy to talk to. They’re very good about sending us feedback, and we’re very good about talking to them about feedback. If anything happens that’s maybe not a pleasant interaction of some kind, there is someone I can directly communicate with. It’s extremely rare ... matter of fact, I don’t have any memory of anybody arguing with us about something. It’s a very professional, very productive relationship, to their credit. It’s not me because they’re the ones who are the good people that are good enough to work with us and have a good relationship with us. Editor If I call 911, how do I know if I’m going to get your group or, say, an Aca- dian ambulance showing up at my door? How is that determined? Godbee Well, if you’re in East Baton Rouge Parish, you’re going to get us because we’re the EMS for East Baton Rouge Parish. Now, if we’re overloaded with 911 calls, like the hospitals also get overwhelmed with calls, we will do what’s called “roll calls” to Aca- dian; but that’s very rare. Recently, because of the volume of calls that we have within our parish, Acadian very generously loaned us two ambulances to use in East Baton Rouge parish. To their credit, they’ve loaned it to us to use because we just need the help with having more ambulances on the field. But, like everybody else, we have a staff- ing personnel shortage. So, if you call 911 in East Baton Rouge Parish, you’re going to get us with the exception of a couple of rare occasions. Editor Has EBR seen an increase in EMS usage since the pandemic? Godbee The increase in numbers since the pandemic has been astronomical. In the nine years I’ve been the director here, our increase annually in calls was anywhere from 2-5%. In 2021, we underwent an almost 25% increase, and looking back on it, when we did the analysis, it is not simply related to the COVID pandemic. Most of the calls were not related to the pandemic. It was an astronomically large increase. Editor What do you think the increase is due to? Godbee We are still trying to figure it out. Our statistical folks are looking at it, but we’re not coming up with a reason for a tenfold increase over any previous year. I wish I could give an answer now, but we don’t know yet. Editor What is your definition of overuti- lization of EMS services? Godbee Well, I wouldn’t say “overutiliza- tion,” more “inappropriate utilization.” We all understand the jaded cynicism of people who work in public service and in the emer- gency department. It’s easy to look at it and think, “Yeah, I know, the frequent users, the frequent flyers, always calling 911 when they need a ride.” That is inappropriate utiliza- tion. But there is a certain level of sympa- thy with that, where I understand they don’t have any other options. It is 911 and the emergency department, speaking from my two roles here. It is using EMS as your bail- out, the safety net for everything, and there are people who look upon that as really good. We are the safety net. We’re always there. You can absolutely depend on us. But, then there’s the downside of it, “I need a ride to the hospital, so I dial 911.”And that is one of the, I’d say top 10, if not top five, issues that needs to be addressed within the world of EMS and prehospital care.