950: Emergency Medical Services | Skeptical Sunday

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1:39Welcome to Skeptical Sunday. I'm your host, Jordan Harbinger. Today I'm here with Skeptical Sunday co-host Michael Regiglio. On the Jordan Harbinger Show, we decode the stories, secrets, and skills of the world's most fascinating people and turn their wisdom into practical advice that you can use to impact your own life and those around you. And our mission is to help you become a better informed, more critical thinker. During the week, we have long form interviews and conversations with a variety of incredible people from spies to CEOs, athletes, authors, thinkers and performers. On Sundays, we do Skeptical Sunday, where a rotating guest co-host and I break down a topic that you may have never thought about and debunk common misconceptions about that topic.

2:17Topics like Reiki healing, the lottery, diet supplements, GMOs, toothpaste, chemtrails, hypnosis, internet porn, and more. And if you're new to the show or you want to tell your friends about the show, I suggest our episode starter packs. These are collections of our favorite episodes organized by Topic, and they help new listeners get a taste of everything we do here on the show. Topics like persuasion and influence, abnormal psychology, technology and futurism, crime and cults, and more. Just visit jordanharbinger.com slash start or search for us in your Spotify app to get started. Today, emergencies are inevitable.

2:51That's kind of what that means. Homeowners plan for what to do if there's a fire, there's an earthquake, there's a flood, or in your crazy Uncle Frank's case, an alien invasion. Many people stock emergency supplies in case a hurricane hits or the power goes out or some households keep a backup generator. We got like water here and some food, solar panels, whatever. We try to prepare for medical emergencies. But when things become more than just a first aid kit or an EpiPen can handle, we dial those three magical digits, 911, and we trust that wherever we are, at least in the United States, maybe Canada, help will hurry to the rescue.

3:27But is that reliable? And when you see the cost when the bill comes, are you going to have another medical emergency? What is the truth about America's emergency medical services? Today, comedian Michael Regilio is here to sound the alarm about a medical system on life support. Hey, Jordan. How are you feeling? I feel like a million bucks, which is about half the cost of an ambulance ride in the United States. Outstanding. Now, stay that way. I do plan to stay that way. Well, that's the problem. All the diet and exercise in the world can't keep you from an accident or medical emergency. And when a personal tragedy strikes in the United States, someone yelling, don't call an ambulance, is as common to hear as someone yelling, call an ambulance.

4:08I've heard several stories of someone needing medical attention, but worries in the moment that the ambulance ride will bankrupt them, which is really sad if you're sitting there clutching your chest and you're like, my debit card account is empty as you collapse to the floor. Of course. And despite popular belief, an ambulance ride is not expensive because of its advanced features or medical staff. But one of the main reasons for the high price tag is our health insurance does not cover ambulance rides. As I've mentioned in a previous episode, on our third date, my wife nursed me back to health when I snapped a rib after falling off her pull-up bar.

4:47I think it's a little ambitious that you were showing off with pull-ups on the third date. No offense, Regilio. I just think you were trying a little too hard. Actually, I was trying to do a backstretch before a hike because I was afraid I might throw out my back. Okay, I take it back. That's actually kind of sad. You actually weren't trying hard enough, it seems. Well, if you think that's sad, I spent an hour on her apartment floor, unable to move, trying to figure out how to get to the hospital without an ambulance, because like so many other Americans, I just couldn't afford it. And here's the baffling part.

5:23While researching this episode, I learned that neither can many of the EMTs who drive and work in the ambulance. That is surprising. I mean, there should be an employee discount, but that's not really the grossest part. They're actually trained medical professionals working in a high-risk environment. I see the things speeding around. They're getting bled on, vomited on, probably bitten and cut with whatever, or just punched for no reason. Absolutely. Yeah. And EMTs have a much higher risk of dying in a traffic collision than police and firefighters. Yet they make a medium wage of only$36 ,000 a year.

5:56This is despite EMTs having an injury rate three times the national average. EMTs are 10 times more likely to have suicidal thoughts or behaviors. In a nutshell, it's one tough, unappreciated job. Yeah, 36 grand. Isn't that kind of like a grocery store clerk level salary? Yeah, it is. But here's the thing. Most grocery stores offer their full-time clerks medical insurance. Many EMTs don't have health insurance. Why do some EMTs, you said most, but why do some EMTs have health insurance and others don't? I thought this would be like a standardized industry across the board. No. In some sense, there is no industry.

6:36There is no single federal agency that oversees America's EMTs. America doesn't have a one-size-fits-all regulated emergency response industry. We have 19 ,000 different individualized industries. Some are municipal departments. Some are managed by the fire department but staffed by private companies. And some are just volunteers. years. Okay, that explains why you see so many ambulances with different things written on the side. I've expected it to say like Detroit or San Jose EMS. And sometimes you see that, but then other times you see like King Ambulance Co. And you're like, what the what is going on?

7:11I appreciate volunteers, but I'm not sure about having a volunteer perform an emergency tracheotomy on me as I'm laying on a restaurant floor. Yeah, look, don't let the name volunteer fool you. This isn't your retired neighbor. They are still qualified. It's just that many communities can't afford full-time EMTs, so volunteers have to jump in. So it would be an honor to have one of these kind and generous souls opening up my trachea, I suppose. Uh, yeah, sure, jerk. I would imagine the job has a lot of burnout, though. I mean, it's got to be super stressful, and if you're essentially a volunteer, yikes.

7:47Yeah, absolutely. Paramedics see things every day that would haunt most people for life. They witnessed the most gruesome car accidents, mass shootings, and just bizarre and awful accidents. It takes an incredible mental toll on a person. Plus, the physical demands of the job have to be taxing. You see that a lot of people, you have to huff and puff all over the place with a lot of this stuff. Absolutely, and there's a reason you don't see a lot of older EMTs. The job is beyond taxing, and EMT is lifting and carrying people all the time. And although there are physical requirements for the EMT, there are no such requirements for the patients.

8:22EMTs have to carry people of all different sizes downstairs, no matter what. It's a tough job. Yeah, my imagination is running wild with the type of people that you and maybe one other person would have to get down several flights of stairs. I've seen, I watch a little TLC here and there. What if you had to get one of those people from one of those shows, you know what I'm talking about, onto a gurney and downstairs, you'd need like seven or eight guys to do that, fit guys to do that. I don't even know. Even then it would be hard. Yeah, right. It's not a job anyone can do well. I feel like we really are.

8:55We're asking too much of these folks. And we don't respect all they do. Look, this patchwork of systems is due because the vast majority of states do not consider emergency medical services or EMS to be an essential service. How is that? What? The vast majority of states do not consider EMS to be an essential service. I feel like I should say I heard you. I just find that fact completely insane. It seems like the very definition of an essential service is the person that comes to make sure that you can get to the hospital when you're having a medical emergency after you've stuck a fork in an electrical socket or you're choking.

9:32I mean, that's it. Fire, police and EMS. There's a reason that they were pre-made buttons on my phone in the 90s. That's crazy. Yeah. Well, with emergency medical services responding to around 30 million calls annually it is insane that we do not designate ems an essential service the story of modern ems is actually quite convoluted how so i just figured it was an offshoot of the fire department or something no it wasn't until 1968 that the first 911 call was even placed before this when there was a medical emergency people would call the police or fire department or poison control whatever seven digit phone number corresponded with their emergency.

10:12The police might show up with a paddy wagon to transport a person in need, but local funeral homes ran ambulance services. The hearse was used to transport people to the hospital. Funeral home workers were not trained in any first aid, so they administered no medical care until a person could see a nurse or doctor. This was colloquially known as scoop and scoot. Yeah, that's creepy that they would send a hearse. And I would imagine funeral home workers are not trained in first aid, they can embalm you, which is not usually what I'm going for when I call an ambulance to get to the hospital when I'm bleeding out.

10:46So why the hearse? It seems, were they cutting out the middleman? Not trying to be dark, but that's why. Well, that is pretty dark, but no, it was just funeral home side hustle. So I suppose a hearse is quite ideal for transporting people who are laying down. It's like the, one of the only cars aside from an ambulance I can think of that actually does that. Right, exactly. I mean, think of the Ghostbusters car. That was a 1959 Cadillac-Hearse ambulance combination converted into the Ectomobile. Those types of hybrids really existed for emergency services, and it was a poor system. Imagine hoping for the comfy hearse instead of the dirty paddy wagon when you need help.

11:24Oh, yeah. Right. The paddy wagon for criminals who are possibly smoking, spitting on the floor, puking, whatever, urinating in there. And they're like, hey, man, this is what we got. So take your lacerated ass in there and lay on the cold metal dirty floor while we race to the hospital, because this is your only option. The very least, it sounds like we're stretching the duties of police to the extreme. True. I mean, they could be responsible for finding the guy who stabbed someone while helping the stabbing victim. Without medically trained responders, many people died on the way to the hospital who could have been saved with immediate treatment.

11:58This just wasn't an effective system for people suffering medical emergencies. Things had to change. And in 1968, they began to. Okay, I remember when I was a kid, we had the different stickers for like poison control, fire, police, and it was never a number that you could remember easily. It was always just a regular seven-digit number. So in 1968, they're using 911. Is that the big change? No. An organization called Freedom House was established. Freedom House started in Pittsburgh's Hill District, a predominantly black neighborhood. It was the first EMS staffed by trained paramedics. And notable for the time, Freedom House's staff was majority African-American.

12:36This is so difficult to believe. So we've only had trained paramedics arriving in an ambulance, responding to emergencies for like 50 some odd years. That's it. Yeah, I know. Freedom House revolutionized medical care for people at the scene of an accident and for those on the way to the hospital. They set a new standard for emergency care. Freedom House offered more than just emergency medical care. It provided the first nationally recognized paramedics training program in the country and offered career opportunities for people with no formal medical training. It even turned high school dropouts and ex-cons into skilled paramedics and dispatchers.

13:14So that's a cutting-edge program, which is interesting because it was in a low-income area from the sound of it. Yeah, it was a really cutting-edge, really interesting program. It was, and by 1972, Freedom House had 35 crew members and received over 7 ,000 calls a year. It was the leaders of Freedom House that established the National Registry of Emergency Medical Technicians. They pioneered several medical techniques, including using air casts to stabilize injured bones, allowing medics to transmit EKGs, administering Narcan to overdose patients, and performing CPR. It's so wild to think this is all so new.

13:49I know for younger listeners, They're like, 50 years, it's a super long time. But as a 43-year-old, I'm like, well, it's not really that long. I mean, we've had fire departments for, I would assume, centuries. Police also. Nobody thought we needed this before. It's just, it's insane. What an amazing success story, though. So is Freedom House still rocking and rolling? No, because when word got out that the black residents of Pittsburgh were getting better care than the rich white residents, it became a political problem. Pittsburgh's mayor dismantled the program. Wait a second. Sorry, I don't even mean to laugh because this is so tragic, but it's ridiculous.

14:26So instead of building an EMS program for everyone else based on the success of Freedom House, they just decided, hey, let's get rid of the program that's helping the poors. That's so on brand somehow. God, that's embarrassing. So staying alive was a privilege of white people, but also, hey, let's not make it too convenient. Let's just get rid. what a weird and stupid step backwards. Right. Just for the record, Staying Alive is a surprisingly dark and creepy film with a killer soundtrack. Okay, fair. The soundtrack was for privileged whites. We can get that. We can agree on that. I think we can.

15:02Look, Freedom House crew knew they were in trouble when the word came down that their ambulance's siren was disturbing people and were instructed to switch over to a bell, like on an ice cream truck. The dismantling continued, and on October 17th, 1975, the Freedom House ambulance responded to its final call. Can you imagine? Hey, by the way, we're not going to be able to come back again. This is the last day as you're loaded into the ambulance. Lucky you. While half your blood is on the pavement. What a loss. So did Freedom House ever spread out of Pittsburgh? I mean, we have EMS now, so what happened?

15:35Well, technically, no, but Freedom House set the standard by which we run all EMS services today. We owe them a great debt. Trained paramedics riding in ambulances was certainly an improvement over, well, everything we just talked about. Of course, yes. And in 1970, California Governor Ronald Reagan signed the first paramedic act into law, the Wedworth-Townsend Paramedic Act. It allowed trained paramedics to begin life-saving care on scene and federal dollars to be used for our nation's EMTs. So score one for the Gipper. I've heard of Reagan. He was not the president when I was born. I just figured that out, by the way.

16:10I had to go all the way back. Turns out I was a Carter baby this whole time. I never knew. Yeah, well, and then take that point you scored for the Gipper and remove a point because by the time he was president Gipper, Reagan decided cutting budgets and deregulating services was the way to go. So he cut federal funding and oversight of EMS, which pushed responsibilities back onto the states. OK, so the 80s weren't just bad for fashion. Got it. Are you saying that that picture of me in a Miami Vice inspired Dayglo green shirt with white parachute pants isn't awesome? No, it's awesome. I'm just saying the fact that you're wearing that outfit right now is a bit odd, but let's continue.

16:47Yeah, you got me. Okay, look, with the onus of funding on the states, as well as the decision to designate EMS an essential service, we find ourselves in the situation we are in today. Many of the EMS programs in the United States are suffering and unable to provide the services they intend. So that sounds incredibly dangerous, literally life-threatening to anybody who would need emergency medical care. You know what's more affordable than an ambulance ride, Michael? Literally everything, but also the fine products and services that support this show. We'll be right back. This episode is sponsored in part by 1-800-CONTACTS.

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20:26Now for the rest of Skeptical Sunday. So what is being done to keep these services going? Because obviously we're not going to get rid of ambulances, right? Right. Well, we'll see. As I research this, there's a lot of problems with what's going on right now. EMS particularly in rural areas have to fundraise. So your friend that has a GoFundMe to pay for his recovery after a car accident is competing for the same dollars as the paramedics that rushed him to the hospital. Ugh, so it sounds like nobody cares about care. Look, it's a vicious cycle. Because EMTs are so underfunded, the cost of those in need is outrageous.

21:05They must recoup their costs somehow, and very often EMTs only get paid when they bring a patient to the hospital if If they show up and the patient won't go, the MS eats the cost. Oh, wow. I didn't realize people could turn down paramedics who arrive on the scene. I mean, I guess they can't kidnap you, but do people just go like, no, I'm not getting in that ambulance? Yeah. In fact, my wife slipped in the shower and was knocked unconscious. I called 911, and amazingly, they walked her out of the bathroom, took her blood pressure, and said, you need stitches and an MRI immediately. Let's go. Even right after being knocked out, she had the sense to say, no thanks, I'll get a ride.

21:43She signed a waiver, they left, and I drove her to the ER. It significantly cut our costs. Wait, so your wife fell in the shower and knocked herself unconscious. What number date was that, by the way? It was actually supposed to be the day I proposed. It's a sore subject, if you know what I mean. When you guys say you fell for each other, you ain't kidding. But really, though, it almost seems like each of you is competing to be the biggest klutz in your relationship, Mr. Snap-a-Rib while stretching. How do you... Look, this is true, but situations like this incentivize paramedics to bring people to the hospital when unnecessary, which brings us to another industry colloquialism called You Call, We Hall.

22:25So that's catchy. In fact, I once knew a law firm whose slogan was We're not happy until you're not happy, which is so hilariously accurate. But You Call, We Hall sounds a little bit like... I don't know, chattelesque? Yeah, it does, yeah. So the revenue stream for many EMS is patients. By law, they must accept Medicaid and Medicare, despite those prices being set very low. To understand today's EMS, we need to understand that private insurance companies play a little game with caregivers, where they offer a smaller amount than they're being billed and say, take it or leave it. EMS isn't required to accept private insurance at all, so many just don't accept it.

23:05But in some cities, all EMS ambulance services are out of network for all insurers. So everyone gets a bill. You get a bill. And you get a bill. And you get a bill. That's like EMS Oprah. You get caught! You get caught! Everybody gets caught! Right. And that's how you get a surprise$3 ,000 bill. Which explains why people are yelling, don't call an ambulance. Which is why there's a recent phenomenon called Uber ER. People are calling an Uber instead of an ambulance. So this isn't actually an Uber feature. It's just instead of calling an ambulance, you call an Uber and you, what, hold napkins over your bleeding leg?

23:47And you're like, hey, man, ER, Kaiser Permanente. And you just pray that Pradeep is cool with that. I hope they're not using the Uber pool. Imagine sharing a car with somebody who's just like bleeding from their eyeballs or something. I mean, even if they use an UberX, I doubt the driver is excited to pick up a person with explosive diarrhea. Man, too far, Vigilio. Gross. Look, it's just a bad idea to be sick or hurt in the back of an Uber trying to Google which hospital has a trauma unit. And the lack of funding has led to the rise of private for-profit EMS companies. That's what you mentioned.