Saturday, October 4, 2008

Socorro: No 'medic' emergency

Lack of paramedics no cause for concern according to officials

Argen Duncan El Defensor Chieftain Reporter, aduncan@dchieftain.com

Although Socorro recently came under fire for having no paramedics in its ambulance service, city officials and doctors have said the service is adequate for most cases.

The situation first came to light last week when an Albuquerque television station aired a piece about the city's "missing medics."

Intermediate Emergency Medical Technicians — who also serve as firefighters — operate Socorro's ambulance service, which the city government runs and funds.

Intermediate EMTs use automatic defibrillators, start intravenous medication, give certain drugs, resuscitate patients, install a particular type of breathing tube and remain in contact with the hospital. Paramedics use more sophisticated breathing tubes and defibrillators, manage IV drips, give more medications and read cardiac monitors.

Adequate or not?

"The ambulance service is adequate for the community needs for community response and transport to Socorro hospital," said Dr. Eileen Comstock, who directs the service.

The only thing Socorro's intermediate EMTs can't provide is transfer to other hospitals under certain circumstances, she said. When someone needs such a transfer, Socorro General Hospital uses an air evacuation service, sends qualified hospital personnel on the ambulance or calls Living Cross Ambulance Service from Los Lunas.

Air transport costs significantly more than ambulance transfers if patients pay.

"I think our guys do a very good job for the training that they have," said Dr. Allen Bassler, who works in the emergency room.

However, he believes paramedic's higher level of expertise would provide better care.

The current service is adequate for short transports, he said, but the time to bring a patient in from 15 or 20 miles out of town is a long time for intermediate EMTs to care for someone who is very sick without being able to do more for the person. Bassler said such situations are hard on ambulance personnel.

A question of need

About 10 years ago, Comstock said, Socorro General Hospital conducted a survey to see how many cases would have had better outcomes if a paramedic had treated a patient who was picked up in an emergency and taken to the hospital. They found none.

The hospital is planning another survey to see if the situation has changed.

Fire Chief Joe Gonzales said Socorro EMTs don't get enough calls requiring paramedics' expertise to justify hiring them.

"I'd say less than three a year, to be honest with you," he said.

Socorro's ambulance service covers as far north as Walking Sands rest stop, as far south as the rest stop near I-25 Mile Marker 115, as far east as Carrizozo and as far west as Datil.

Also, Gonzales said if paramedics didn't use their higher expertise often, they wouldn't be able to maintain those skills well.

Mayor Ravi Bhasker said the city could raise taxes or divert resources from other areas if people wanted paramedics.

"I have not had family members or the public come into my office and say, 'Why don't we have paramedics?'" he said.

Problems with hiring

Comstock said the paramedics issue has been "a sticky situation" for years.

For one, she said, paramedics receive higher salaries and have longer training.

Bhasker, also a medical doctor, said the city would have to have four paramedics if it had any, because of requirements that personnel offer the same service on every ambulance call. That arrangement would mean a $200,000 to $250,000 increase in costs, he said.

Bhasker said not providing the same service every time could open the city to litigation, and Comstock said it wouldn't be fair.

Also, if Socorro paramedics were handling out-of-town transfers often, Comstock said, the city would have to hire even more to provide the same level of care while other paramedics were out of town.

Both Bhasker and Comstock said recruiting paramedics to Socorro would also be difficult.

A possible solution

PHI Air Medical helicopter service of Albuquerque is working with Socorro General to station a helicopter and crew at the hospital. PHI approached hospital administrators because Socorro would be a beneficial location to serve the state.

Comstock said PHI paramedics could provide transfer services to Albuquerque in the helicopter or Socorro ambulances, but wouldn't go on community calls.

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