Jonathan Beyer
Appearances
Revisionist History
Running Hot
It is a high-risk procedure. When are we going to do it? When the risks are outweighed by the benefits.
Revisionist History
Running Hot
So cardiac arrest, people choking, respiratory arrest, things where seconds could make a difference. Yep, that is worth the risk to try to get someone there quicker. But other things like, well, she fell and broke her hip. Okay, that's an emergency and that person needs to get to a hospital. I don't doubt that. Is the three minutes going to make a difference in that person's outcome? No.
Revisionist History
Running Hot
When I instituted the change, I didn't really have much of a problem. 911 didn't have a problem with this because it just was a difference in coding for them. It didn't affect them. The medics themselves really liked it because the medics were like, yep, most of these things we are going on are not priority.
Revisionist History
Running Hot
Except... What ended up happening, and I'm not exactly sure how this got out, it went through all the proper channels on my side, like medical control in the hospital in the county, so that was okay. Um...
Revisionist History
Running Hot
But it started getting publicized, and I don't exactly know how, but it started showing up on the hospital Facebook page about Berrien County Medical Control is killing people with slow responses. And, oh boy.
Revisionist History
Running Hot
Literally, they were out on the bluff overlooking Lake Michigan, just interviewing people walking by going, what do you think about ambulances coming to your house slower? And of course, people exploded.
Revisionist History
Running Hot
It's like, I can't believe this. And, you know, this is terrible. Of course, I want an ambulance there fast. And the hospital started getting a lot of flack. Some of it was very nasty. So people started on Facebook attacking the hospital. Oh, this is Lakeland just killing patients again. You know, just very bad vitriol.
Revisionist History
Running Hot
to 2 a.m. shift. And at 8 a.m., I got a call from the administrative assistant to the CEO of the hospital. Hi there, Dr. Beyer. It's 8 a.m. What are you doing at 8.30? I'm like, and I'm still waking up because, again, I've had four hours of sleep. And she's like, Dr. Hamill, at that point, the CEO of the hospital, would like to speak to you.
Revisionist History
Running Hot
And I'm met by them and the hospital attorney and being shown this Facebook page. And they're like, what did you do? This is terrible.
Revisionist History
Running Hot
I showed him some of the studies. He's like, your science is sound. You go next time, do a press conference. I had a press conference, which is what you saw online.
Revisionist History
Running Hot
And once that went out, all complaints disappeared in six weeks. And I've heard not a thing since then. In fact, we right now are the leader in Michigan for the lowest rates of lights and sirens used in the state of Michigan for EMS. Hmm.
Revisionist History
Running Hot
I have like four jobs because it doesn't everyone. And I'm like, right now I'm at the Berrien County Health Department.
Revisionist History
Running Hot
I am not speaking on behalf of the Berrien County Health Department.
Revisionist History
Running Hot
There is no evidence that lights and sirens helps anybody. There's plenty of evidence that it hurts people.
Revisionist History
Running Hot
I started life as a paramedic before I got demoted to doctor. I was a paramedic for 11 years. And when I was a paramedic in the Philadelphia area, we responded lights and sirens to everything. Like, you called 911, we just left. You know, there we go. When I got here to Michigan, they had two sets of priorities, priority one and priority two.
Revisionist History
Running Hot
There are more calls for service than there are ambulances. So we have to find some way to prioritize that.
Revisionist History
Running Hot
And a lot of these triggers for things were like, if you ever complained of shortness of breath in any way, shape, or form, it made it a priority one. The problem is shortness of breath, or do you feel like you're having trouble breathing, an incredibly subjective question. And so the medics were coming to me complaining, it's like, why are we getting priority one dental pain?
Revisionist History
Running Hot
Because the person's like, I have a tooth pain. Oh yeah, it's making it hard to breathe. We were about 50-50 for priority ones, which were lights and sirens, and priority twos, which were not lights and sirens, speed of traffic.
Revisionist History
Running Hot
So when you drive your car, you're used to things like red lights, everyone's going to stop. Once something interferes with that, the chances of an accident increase.
Revisionist History
Running Hot
I started going, why are we responding to dental pain priority one? So myself and I have a residency program here and I had a couple of my high-performing medics and another EMS physician and myself, we spent a couple of weeks going through hundreds of these determinant codes going, does that really need priority one?
Revisionist History
Running Hot
For most disease processes. Cardiac arrest is one that I would put in the, that time makes sense. Because in cardiac arrest, for every minute that you go without CPR being done, there's about a 10% increase in mortality and decrease in survivable brain function.
Revisionist History
Running Hot
I tell the medics, and this is how I presented it, is consider lights and sirens a medical therapy. For every medicine that you give, there is an indication, and there's a contraindication. If I were going to say, I'm going to give you epinephrine, well, why would I give you epinephrine? And the benefits have to outweigh the risks. So I wanted to think of lights and sirens that way.