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Hidden Costs
We had to extricate a driver from a crash early this morning. Two people, both intoxicated (possibly also meth included) crashed into a tree on a rural road. The passenger was transported by ambulance but it took us over an hour to cut the driver out. As often happens, his feet were trapped under the dashboard. Typically, we can push the dashboard up with hydraulic tools but, in this case, he was pushed into a tree in exactly the wrong spot. We had to winch the car away from the tree and still cut it to bits to get him out. The driver had broken his right femur, tibia, and fibula, and had a concussion and serious chest injuries. The passenger was almost as bad.
Now, for the hidden costs: three fire departments took part with hydraulic tools (Jaws of Life). Two of the responders were from the county seat and are paid, but the other seven were volunteers. Two fully staffed ambulances were on scene from our county; I believe that only people who are not residents of the county get billed for services but ALS ambulance operations are not cheap. There were five LEOs helping (deputies and one trooper), and one medical helicopter. The helicopter is the only piece of the response which will probably be completely paid for. Keep in mind that all of the deputies tied up were unavailable for any other duties, just as was true for the four pieces of fire apparatus, all because someone wanted to drive home after imbibing. We talk about the cost of this stuff all the time but rarely consider the second-order costs.
Or the third order costs from those first-responders having to see this kind of stuff, having to go through the tension and frustration as it’s not as easy to get them out as first thought. And then the inebriant may very well die, and it won’t have seemed worth that much effort. And over time, seeing enough of these will burn out some of those first responders.
Better living through chemicals.
When you work an accident scene like this you have to be aware of the possibility of another intoxicated driver coming by that focuses on all the flashing lights and will run right into you.
Yes, we had apparatus blocking both ends of the road (2 lane state highway) and landed the helicopter in the middle. A week ago someone hit a ladder truck (basically, a million dollar vehicle) that was blocking for an accident scene at night (different county). Some communities are using obsolete engines as blockers so the cost when one gets hit isn’t so high.
Our county is trying to go to a paid fire department set-up, and already shifted from volunteer to paid EMS about a decade ago due to the sharp increase in calls caused by the oil and gas drilling boom here in West Texas. But funding is hard and even getting paid workers is tough locally because if you can work a fire or EMS job, you can probably work oilfield for more.
That’s means you have to do out-of-area hirings, who may work on rotating basis, and at the same time you at the very least have to provide affordable housing, or their costs are going eat up whatever extra $$$ they’re offered for moving out to the area.
And that doesn’t even get into the problems of distance — two neighboring counties wanted the local EMS to cover the northern part of their county … but they didn’t want to pay extra for it, even as the number of calls there rose. So the local EMS just stopped covering those areas, and forced the two counties to find other options, which for a while, included an ambulance service that was 60 miles away from one, and 115 miles away from home base from the other.
One of the counties has contracted with their own EMS provider, while the other …. is getting TxDOT to finally complete a Farm Road that will cut the distance to the oilfield areas in half from their central EMS station. I’d think 57 miles for an ambulance call would still be a little dicey if you have an accident or medical emergency, and our county is now building an EMS a station to be built near the other two county’s northern area. Then it would be up to them if they want to subcontract or just wait for the new highway to be completed sometime in the late 2020s.
We are very fortunate in that we still have a robust volunteer complement. One of the women in the vehicle with is actually an MD (anesthesiologist) who volunteers as a medic for us. Of the six we had there was a pilot, an FAA instructor, the doctor, an engineer, a stay at home mom and guy who is a paid firefighter/paramedic for a city fire department. But with a rapidly aging population it’s getting harder and harder. We are looking into community paramedicine as a partial solution.
Tex, do you guys have critical incident peer support/a chaplain?
Among those second order costs is what responding to these things—even when they are (YAY!) successful—requires of our first responders.
Or non intoxicated driver running right into you. The new lights the emergency services uses are a hazard in their own right.
My first reaction is, can people really be that dumb and not paying attention? But then I remember what I see out on the roads every time I leave the house.
It worked out here until the boom. Then you needed more EMS crews (and equipment for those crews) than the local population could provide due to the jump in call volume, and currently with the fire department, the problem is a lot of the volunteers have oilfield jobs that might have them 25-30 miles out of town when a call comes in. So response time to get a truck out of the fire hall is impacted, and sometimes, workers will just drive to the site and meet the fire truck there, if they can get one person to the hall as a driver.
The rural oilfield calls also stress the vehicles, which often have to leave paved roads to go to sites, though thanks to the same boom, valuations are up to where the new Emergency Service Districts can set 10 cent per $100 in valuations property tax rates for fire and EMS and collect most of the $$$ from oilfield vaulations. So the people using the service are basically paying for it, and can fund the vehicle repairs and new purchases (the city and county swear that they’ll offset the 20-cent jump in property taxes by cutting their own taxes next year, when they no longer are financially supporting the fire and EMS services. We’ll see when the budgets are drawn up this summer….)
We do, thank you. So far I haven’t had to make use of one. As long as I feel that we did our best I’m usually OK. I had one 15 year old boy who was in cardiac arrest that bothered me months after the call, but I got over it. I reminded one of the young medics last night that he didn’t crash the car. The hardest ones are little kids when parents didn’t belt them in. Those are tough.
Your post is spot on. Most people do not realize what it takes to be a first responder, and what the attendant costs are. Back in the day, we did not have a Jaws of Life, we used a hand pumped porta-power that was a lot slower. I remember having to cut a driver out of a 1955 Ford pick-up and trying to hurry because of injuries. Couldn’t use a hot saw though, because the behind the seat gas tank was seeping! God looked after us that night!
Is that a road where I’m likely to be riding next week? This week I’ve learned about the Eagle Ford Shale in Karnes County. When the wind was from the north I rode south to some historical destinations in that county that happened to be right where there was heavy oil field traffic. I hadn’t known about that. I cancelled one destination, as it got to be a bit much. Now that the wind is from the south I’ve switched to destinations further north, and there is a lot less oil field traffic.
Karnes is the biggest oil producing county in the Eagle Ford, though it’s actually down a little from where it was 10-12 years ago. I had to drive through it several times going down to the coast the past few years, and the awfulness of its roads were on par with the worst of the oilfield-damaged roads in the Permian Basin (and to get this back on the topic of hidden costs, a ton of calls on oilfield-damaged roads also wears out fire trucks and ambulances really fast).
A man I knew in Cypress, TX was a Fire Department EMT. He had as a goal to be a life-flight EMT. Finally, he made it! He was so happy. I think it was about a year – maybe two – later he quit, he had just seen too much.
A very capable ER Doc I know retired at 55 for the same reason. He told me that in 26 years of work he had seen about a thousand deaths and a similar number of maimings, that enough horror was enough.
In my 31 years of active practice I have never seen a death at work; I have only sympathy for my colleague.
The first few years of doing this, I saw so many unexpected home deaths with attendant family misery that I began to think that no one went easily or smoothly. The reality is different but it took me a while to adjust my thinking.
PSA: keep your DNR orders legal, current, and available to emergency responders.
More than most active-duty military officers ever see during a career, even if in the combat arms. PTSD would not be a surprise after a life like that.
You said we talk ab the costs of all this stuff but not the secondary costs.
what stuff are you referring to? I’m confused
Primary costs: Those injured or killed while driving under the influence of an intoxicant or those injured or killed by them. Their medical costs, funeral costs, lost lives are frequently discussed.
Secondary costs: Costs associated with the rescue that are not directly attributable in a budget, nor recoverable from insurance. As Tex listed above, this can be volunteer time as well as cost for full-time, professional first responders. It also includes opportunity costs where if so many people were not tied up at this site caused by negligent use of intoxicants, police and others could have been elsewhere.
Tertiary costs: Emotional fatigue and wear and tear on the responders as demonstrated by Doctor Robert above in talking about his friend the ER doctor. It’s hard to keep doing this work after seeing this type of thing too often.
For example:
1. 5 officers at an accident scene are not patrolling and preventing any number of other problems.
2. A state highway closed to traffic for 2 1/2 hours. Luckily from 1:30 to 4 AM so not much of an impact.
3. Two ambulances out of service for 2+ hours. Third crew had to move from outlying station to cover larger town in the interim, increasing response time at assigned location.
4. Firefighters and apparatus tied up for hours on scene. Had a house fire started, for one example, response times increase.
Family members are now insisting that the driver wasn’t drinking. We’ll see.
(Washington County Sheriff’s Office)
This wreck happened last night in Washington, County, Oregon.
From the Oregonian:
He’ll have to pass on the invitation to attend the 2020 Nobel Prize ceremonies.
The penalties for Intoxicated driving are just not high enough
Does any state charge residents for the financial cost of recovery efforts?
I volunteered for 25 years with a local rescue squad. My local area has 5 volunteer departments each with their own district to look over with lots of mutual aid.
As you can imagine, there’s some politics involved, and I don’t miss that.
Probably the biggest hidden cost not mentioned so far, and this especially impacts the volunteer, is the training that is expected. It takes training to do a vehicle extrication. And if you’re keeping up on vehicle extrication the way you’re supposed to, it means keeping up with the foibles of the line of new vehicles that car manufacturers are putting out yearly. And how about those electric vehicles? How do you deal with the battery bank?
You want to go medical in the back of the ambulance? Lots of drugs to keep up with. It’s ever changing.
Yet, I would say I got more positives out of my time volunteering than negatives. The fellowship, pride of service to the community are top examples. Once you get past the first couple of years where the adrenaline rush no longer has an effect, you are on to becoming a more useful member of the squad, and after about ten years, you’ll find yourself mentoring newbies coming into the squad.
Great stuff.
I used to live in a county that sent bills out. But I don’t remember them having bill collectors.
And in Pensacola my insurance was billed for life flight. But that was 10-15 years ago.
In the deal to privatize our city’s EMS service, part of the agreement included giving the company the fixed-wing air ambulance transfer contract as well, since the ground-based service was the financial loser, and they planned to make their costs back through billing of the air flights to insurance companies and Medicaid/Medicare. (which later led to questions about whether or not they were doing too many air flights just to do the higher-cost billings than ground transport would have cost. The explanation was that with the oil boom, the higher volume of calls and the limited personnel resources, using an ambulance for ground transfers would take it out of local service for at least 3-4 hours. It was a valid problem, but now that the local EMS has it’s own dedicated property tax funding system, it will be interesting to see if there’s pressure to buy another ambulance just for ground transfers to regional medical centers).
The company also handles the past due collection efforts, where it’s been noted that even though average household incomes are more than double their levels of a decade ago due to the oil boom, they still have problems collecting medical bills both from EMS and ER use, because even when people have more money, they’re not changing their past patterns of not prioritizing medical bill payments.
A lot of the people who are that careless don’t have enough to lose.
Arahant, that’s an excellent point. The horror is compounded by the fact that in most cases, my buddy was working hard to keep the patient alive and intact, so the 1000 deaths constitute 1000 body-blow failures for him. I have long been grateful that he was not working when my late first wife came out of the ambulance DOA.