Spend enough time in an ambulance or in any Paramedicine station and you’re likely to hear about abuse of the 911 system. As crews run more and more calls they are apt to point to abuse by those calling 911 as the reason why they are so busy. When asked by the oncoming crew how their night went a Paramedic ending their shift might remark, “It wouldn’t have been bad if I wasn’t responding for every stubbed toe in the county.” There’s a lot to unpack in the meaning behind such a statement, but the truth, as is often the case, isn’t as readily apparent.
To start, let’s go back to 1968 when the 911 system in America was created. While the 911 system has come to be viewed as a social safety net, or rather, the cure to all of American society’s ills, that’s not why it was created. The reality of the 911 system is that it was created as a direct response to civil rights protests as they reached a head in 1967. President Lyndon B. Johnson’s administration wanted to develop a quicker way for police to respond to quell and crush civil rights protests. To that end, the National Advisory Commission on Civil Disorders was formed and the predominantly white cisgender males on the commission came up with the idea of a universal emergency number. 911 was born and while it did serve its intended purpose as the years passed American residents started using it for every possible circumstance one could think of, including medical emergencies.
Initially, there was a slight hiccup. People weren’t calling 911 as often as they should for medical emergencies. They were choosing to transport themselves or to wait out their emergency until it was too late. That’s where education on 911 began, specifically, the public was hit hard with the idea of calling 911 for any medical emergency. In the past 20 years, 911 call volume has, according to widespread reporting, increased by as much as 250%. We wanted more people to call 911 in the 1980s and 1990s and it’s clear as day that we have succeeded in that goal.
Most discussions of this issue stop at this point, it’s easy enough to pin increasing 911 call volume on people overusing 911 itself. I often advocate for people to take a step back and think about how the healthcare system actually works in the United States of America. If an individual does that it’s hard to come away thinking that the 911 system is being abused. Rather, it becomes abundantly clear in a very rapid fashion that people are simply utilizing 911 as they’ve both been told and forced to do.
The Paramedicine field has pushed for people to call 911 and that is what they have done. At the same time, the American healthcare system funnels individuals into utilizing 911 as a means to get transport to hospitals that will serve as their impromptu primary care provider. We’ll dig deeper in a moment, but that is as pure a distillation as you will find of the healthcare system working exactly as intended.
Take, for instance, the single parent of two children in an urban setting. The gas station they work at doesn’t offer health insurance and they can’t afford any of the available Affordable Care Act plans they research during the open enrollment period. They don’t make enough money at their job to pay for all of their families’ amenities. Taking time off isn’t an option, they don’t have any sick time or personal days to utilize. Their boss has told them point blank that if they take a day off to take their child to the doctor they will be out of a job. At the same time, the laborer in question does not own a car and it’s quite a distance to any sort of public transit, which also costs money. With all of these obstacles in their path, the laborer takes the only action they know will get their child to the hospital. They call 911 when they’re at home after their work day has concluded, and wait for an ambulance to take them and their child to the hospital where they can find a doctor who will have to see them.
The above scenario is all too common. When Paramedicine professionals come across these sorts of situations they ascribe the label of abuser to these individuals. They refuse to look at the totality of the situation and recognize that the healthcare system has worked exactly as intended. By not having universal healthcare, America has a system in place where the haves get the care they need and the have-nots struggle to find adequate care. The have-nots recognized this some time ago and leaned heavily on 911 to help them overcome the obstacles preventing them from getting the care and treatment they need and deserve.
I would ask any Paramedicine clinician reading this article to reframe how they think of our “frequent fliers.” Try and remember that your patient with mental health issues keeps calling 911 multiple times a day because they have no other recourse. The system does not offer them anything that could be considered meaningful or impactful treatment for their condition. The person who can’t afford to take off time to go to the doctor or who knows they will lose their job if they do has no recourse but to keep calling 911. The system isn’t broken, abuse isn’t taking place; the system is working exactly as the bourgeoise intend for it to work.
Lead photo courtesy of Unknown – Charlotte County Sheriff’s Office
