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Thursday, March 02, 2006

Open Letter to Peoria Medical Society---January 6, 2004

Jan 6, 2004

Subject: Open Letter to Peoria Medical Society

Peoria’s new city manager, Randy Oliver, is organizing a commission to study emergency medical services (EMS)in the city of Peoria. The editorial board of the Journal Star pleads for a fiscally responsible decision regarding these services. As physicians, you need to insist that both fiscally and medically responsible choices are made for the pre-hospital patient.

The EMS services in Peoria are provided by two agencies. Advanced Medical Transport (AMT) provides the only advanced life support service and transport of patients. This company is supported by Peoria’s three hospitals and governing boards. AMT grosses over $7 million per year and desires a ten year contract to remain the only paramedic and transport agency in Peoria. The second agency is the Peoria Fire Department. The fire-fighters can provide only basic life support and are not permitted to transport patients. The firefighters arrive quickly at the scene of an emergency and are enormously supported by the citizens of Peoria.

The Peoria Medical Society needs to consider the following questions: Who will compile and interpret the statistics regarding local EMS care? Where are the run sheets covering the past ten years located? What EMS issues will be analyzed?

For example, what is the response time for the Peoria Fire Department versus AMT to the scene of an emergency? How much time elapses from the 911 dispatch call until the electrical shock is administered to a patient in full cardiac arrest? When AMT arrives at the scene and begins their advanced life support, have the patients waited longer than necessary? What percentage of Peorians survive and walk out of the hospital after suffering a cardiac arrest? Are Peoria’s trauma patients transported quickly and efficiently with the “scoop and treat” philosophy? How does Peoria compare to other cities in the United States and Canada that have state-of-the-art EMS for their citizens? And might it not be responsible and medically important to allow the Peoria firefighters to advance their skills (such as improved airway control and IV medication administration)to improve patient outcome?

The most important question is: Can Peoria’s EMS system be studied in an independent and unbiased fashion? The same doctors, administrators, and boards of directors that made questionable decisions ten years ago are still in absolute control today. Can individual board members answer any of the quality of care questions posed above?

Thus, you the Peoria Medical Society, need to do exactly what the first sentence of your mission statement professes: To promote the health and general welfare of the Peoria public. Peoria’s pre-hospital patients have never been in a more perilous situation. Encourage city manager Oliver’s study to ask the correct questions and answer them using scientific rigor. Then and only then will fiscal and medically appropriate decisions be made regarding EMS in Peoria.

John Carroll, M.D.
During the following year, I sent the president of the Peoria Medical Society a couple of letters regarding my concerns regarding the dysfunction of the emergency medical systems in Peoria including the fact that Peoria Fire Department paramedics could not secure the patients airway with a tube in an emergent situation. He assured me that the system was working well and told me not to reproduce his letter. See the following post:

Subject: Peoria EMS
Dear Rich,

Your May 18, 2005 letter stated that if I have any additional specific information regarding the health or general welfare of the public in Peoria to communicate with the Board of the PMS and that the Board would be happy to reconsider its position.
Please explore the following situation to confirm or refute its accuracy. Secondary and tertiary information is not as good as primary. I wish I could say this was primary, but it is not. It is just what I heard.

A very good source recently told me that a PFD firefighter spoke with Rick Miller, Peoria's current project medical director. The firefighter was very concerned about the lack of airway control on 3 recent 911 calls in Peoria. The firefighter apparently advised Dr. Miller that there could be an "explosion" if this news got out or if the problem persists. In one of the cases a man collapsed at a restaurant and CPR was started by bystanders. However, in the end, the resuscitation proved to be futile. (The firefighter involved actually cried when the man died.) Dr. Miller allegedly told the firefighter that the PFD could begin intubating patients if they were qualified (ILS/ALS), if they asked AMT's permission first. (Correction: AMT has to ask the PFD to place the tube, according to Dr. Miller.) If this is true, I wonder what will happen when AMT is late arriving at the scene?

As a physician and surgeon you understand very clearly the importance of an early, secure airway. Why haven't the PFD firefighters that are ILS or ALS trained been able to use their intubating skills for patients in the field in extremis? These same PFD firefighters/paramedics do use their ALS skills when they moonlight in surrounding communities without asking permission first. ..

Rich, in Joliet, the municipal fire department has 189 firefighters with 140 of them certified paramedics. They give advanced life support at the scene and do not need to ask their local private ambulance company permission in order to do so. Why is there so much difference between Joliet and Peoria? Joliet is only 2 hours from here and about the same size as Peoria. Are the citizens of Peoria more resistant to hypoxic conditions than the fine people in Joliet?

Please let me know what the Boards position is when you reconsider this important EMS issue in Peoria.



(Rich Anderson, MD, President of the Peoria Medical Society, answered this letter. In general terms he stated that everything was fine with the Emergency Medical System in Peoria. He also advised me not to reproduce his letter.)

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