socialized health care and ERs

[seaworthy]

One of my more conservative friends told me that one reason that socialized health care sucked was that in an ER, the person with the greatest chance of survival was treated first- i.e. if a person with a broken leg and a person with a gunshot wound came in at the same time, the person with the broken leg would get treated first. This sounds like a load of crap to me. It undermines the entire system of emergency care. Most serious health problems like severe injuries or heart attacks can only be successfully treated with immediate care. Yeah, the person with a gunshot wound is more likely to die than the person with the broken leg, but if you leave the person who's been shot to wait, they're almost certainly going to die from blood loss or shock or something. And what's the point of going to the ER if you know you're probably going to sit around bleeding to death while the kid who cut their knee open gets stitches?

Please tell me this is not true.

[friedo]

I don't understand how his argument could possibly make sense. What benefit is there of treating the broken leg guy first?

[Shrinking Violet]

Purely from personal experience in A&E (UK), and watching lots of "Trauma - Life in ER" (or somesuch) on Discovery, I'd say your friend has it back-asswards. Those more likely to die are treated first.

Isn't that what "triage" is all about?

[vd]

He is completely full of it. I've been in a socialized ER with my son and his broken leg. We certainly did not go first.

In fact, I was just reading an article today...

The level of a patient's condition is measured using a nationally recognized system known as the Canadian Triage Acuity Scale. The triage nurse assigns each patient a priority level, which allows optimal use of available resources.

Level 1 (resuscitation) is the most acute, followed by Level 2 (emergent), Level 3 (urgent), Level 4 (semi or less urgent) and Level 5 (non-urgent).

[RealityChuck]

It's a silly statement -- "socialized health care" describes dozens of different systems and can be set up to do whatever the government wants it to do. Does he mean socialized health care in Canada? In Sweden? In the UK? All are run differently.

It's unlikely that an ER would do this sort of backwards triage (for one thing, it'd be against the Hippocratic Oath). Even in the US, people in ERs are treated solely on a basis of need, and a life-threatening situation puts you into the first empty examination room.

Socialized health care does make it difficult to get elective surgery, but those are people who can wait. If it becomes a life-threatening matter, they are usually moved up the list.

[toadspittle]

Originally Posted by friedo

I don't understand how his argument could possibly make sense. What benefit is there of treating the broken leg guy first?

Sounds conspiracy-ish ... he's probably arguing that those heartless socialists structure their ER this way so that it costs them less (i.e., the expensive, dying patients--well, die--while the less-critical, less-expensive cases get treated).

[friedo]

Originally Posted by toadspittle

Sounds conspiracy-ish ... he's probably arguing that those heartless socialists structure their ER this way so that it costs them less (i.e., the expensive, dying patients--well, die--while the less-critical, less-expensive cases get treated).

Yeah, but private hospitals want to save money also. But they still have a moral (and legal) obligation to treat the most-injured first. So I still don't see how it makes any sense.

[toadspittle]

Originally Posted by friedo

Yeah, but private hospitals want to save money also. But they still have a moral (and legal) obligation to treat the most-injured first. So I still don't see how it makes any sense.

Ummm... of COURSE it doesn't make any sense. I was trying to come up with some sort of reasoning that would support such a nutcase belief. The most obvious scenario, IMO, is that the holder of said belief thinks

- socialized medicine is EVIL
- therefore, the people running it are heartless and EVIL
- they, being EVIL, are immune to the "moral (and legal) obligation to treat the most-injured first", something protected here in the privatized US of A, by god. HERE, we would never do such a thing (by god) but there, where the system is EVIL, and the people are EVIL, they don't mind letting a few sick and injured people die just so they can keep costs down.

[Mops]

In most countries with socialized healthcare hospitals do not get allocated a fixed budget, but charge the mandatory insurance scheme that the patient is a member of, or the state healthcare authority (whatever applies in that country) for the medical services they have rendered.

In a fully privatized healthcare system hospitals charge the patient or his insurance company for the medical services they have rendered.

So the hospital's economic interest with regard to the patients is the same (with the exception that in the first case the hospital does not risk not getting paid by an uninsured indigent patient).

[Spiny Norman]

It's pure BS, of course. Ask your friend to name a country with socialized medicine that operates on that principle. I'm from Denmark, pretty much the definition of socialized this and that, and our ERs sure as hell prioritize the badly hurt victims (not that we have that many gunshot victims, heh) over lightly hurt ones.

On the other hand, now that somebody brought up triage: In the event of a disaster scenario - earthquake or the like, hundreds of patients arriving with life-threatening conditions, swamping the ER - triage takes on another meaning.

In that case, every ER in the world, socialized medicine or not, will start focusing on simply saving as many lives as possible. That does sometimes mean that the badly hurt patient who would tie up the operating table for 5 hours will be prioritized lower than the less hurt one whose life can be saved in 20 minutes. Obviously, the patient that's badly hurt may wait so long that he/she dies. Because, in the final analysis, working on a complex case for 5 hours while 10 other people who could have been saved bleed to death leaves you with 10 dead victims instead of one. Still, resources are only being allocated to critical cases.

No-one is going to do stitches or look at sprained ankles.

[drachillix]

Originally Posted by Spiny Norman

That does sometimes mean that the badly hurt patient who would tie up the operating table for 5 hours will be prioritized lower than the less hurt one whose life can be saved in 20 minutes.

Depending on the patient count and hospital capacity many unsalvageable cases will not even see the ER.

[Hari Seldon]

I don't know if MASH is still being rerun, but that gives a pretty good idea of triage in emergency situations (which real ERs do not often face). Basically, ERs all run the same. Treat life-threatening situations first and then turn to the others. Gunshot wounds, with the danger of gangrene are generally high on the list.

Just to correct a common misconeption, Canada does not have socialized medicine. Doctors are still entrepreneurs with fee-for-service practices. As it happens our family doctor practices alone, although most now practice in some sort of group practice. He also has an arrangement with a private clinic that will take his patients on weekends, when he is on vacation, etc. What Canada has is universal government health insurance. As far as I can tell, it is operated far more eifficiently than the crazy quilt of private plans in the US. My daughter-in-law, a physician in the US, spends an inordinate amount of her time fighting with insurers over treatment. This doesn't happen here.

[kinoons]

Originally Posted by drachillix

Depending on the patient count and hospital capacity many unsalvageable cases will not even see the ER.

This is how triage is taught to paramedics to initially deal with a large MCI (Multicausality incident):

Green -- least need for care -- if they can walk, talk, and make sense, they are green.

Black -- we are taught that those who are obviously dead (decapitation, exposed brain matter, ect...) and those who do not breath after their airway is opened are considered dead and left where they sit.

Red -- If you are breathing very fast, have a very rapid or slow heartbeat, or are not awake and appropriate, we're going to do our damnest to save you, and get you to a hospital as quickly as possible for treatment.

Yellow -- Patients who are not likely to die in the immediate future (next 10 minutes), but do have injuries that need to be treated.

It should be noted that patients who are not being actively treated need to be constantly triaged, as they may change categories.