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Comment by mijamo | Hacker News Reader

The US will always amaze me. If you don't have enough ambulances to cover the interventions then just buy more ambulances. And what kind of ambulances should be used should be up to medical professionals, not yourself. It is fairly common in many countries for hospitals to use regular taxis instead of usual ambulances when they know it will be fine, but it should not be your call as a patient.

I guess in the US the incentive of the hospital is just to bill you as much as possible so it makes things different. In many places the incentives of the hospital are just to keep you in good health and do not overspend their budget ...

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I'm not in the U.S but when I took my emergency medical lifesaving class here in Denmark (too long ago to really be useful anymore) the guy doing the class said that there are a limited number of ambulances in Copenhagen and they will refuse to do some things if they are in use (at the time I think it was 10 ambulances) I would expect it is the same everywhere - if you are not in immediate danger don't use an ambulance because the number of ambulances and medical technicians are calculated to handle the number of emergencies expected.

then again one time I helped an old lady when she biked home drunk, fell over and got a concussion and they sent an ambulance.

However in my experience the incentive of the hospital in the U.S is to bill you as much as possible.

> the incentive of the hospital in the U.S is to bill you as much as possible.

And it's worth nothing that this is very much how non-profits operate too. Without making any claims of efficiency there is a wink wink nudge nudge in the US system that overbilling wealthy and insured patients is how we cover costs for patients who cannot afford it.

> If you don't have enough ambulances to cover the interventions then just buy more ambulances

There are enough ambulances to cover legitimate needs. Why then waste money by using ambulances to transport people who would be just fine in a Lyft? That money could be better spent on actual patient care. No matter how much money you're willing to spend on healthcare, using it efficiently is always better than wasting it.

> what kind of ambulances should be used should be up to medical professionals, not yourself

Having medical professionals decide whether an ambulance is appropriate, instead of patients, is one of the main things the article is slamming Tesla for doing.

> Having medical professionals decide whether an ambulance is appropriate, instead of patients, is one of the main things the article is slamming Tesla for doing.

Medical professionals who are under orders to ignore their medical judgement and always treat patients as lightly as possible.

Also, deciding for yourself not to take an ambulance is one thing (even if questionable). Being forbidden by your employer to call 911 is something completely different.

> Having medical professionals decide whether an ambulance is appropriate, instead of patients, is one of the main things the article is slamming Tesla for doing.

TFA says Tesla managers made a policy to not involve emergency services. They are not entitled to make either a policy or a decision in this regard.

In other countries making such a policy is flat out illegal, telling subordinates to not involve emergency services is illegal and following such directions from superiors is illegal as well.

" If you don't have enough ambulances to cover the interventions then just buy more ambulances. "

No, this is kind of a naive position.

The OP's comment is to a great extent valid.

Ambulances and their staff are extremely expensive.

Do you think in Brazil, France or Japan money just grows on trees and you can just magically buy more stuff?

Medical systems the world over are failing under understaffing and over demand - and a considerable amount of the demand is small stuff.

There are many people in socialized systems who go to the clinic/hospital with great frequency - any old thing: see the doctor. It's hugely, hugely expensive. In some cases it's merited, and I understand it's a moral dilemma because often you don't know if something is serious ...

But Emergency care in particular is bonkers expensive, even by cost not profit ... and there's no getting around it.

If people need to call an Ambulance, then get one.

But if you don't need one, get in a car and go or have someone drive you.

It doesn't matter what 'system' it's in because everything associated with 'Emerg' is very costly to the system, and it will always be a very scarce resource.

I wouldn't let anyone at my company decide for me though - if I needed one I would call.

Tesla might need a union.

> Do you think in Brazil, France or Japan money just grows on trees and you can just magically buy more stuff?

No, but even Brazil can buy more ambulances.

Also in Brazil, you have paramedics that can ride motorcycles and can be sent to the site of an injury first, to stabilize the patient, provide immediate care, and prepare for the arrival of a proper ambulance. Since they are bikes, they can better navigate traffic jams and can get to the site more quickly. If it turns out that an ambulance ride is NOT required, then it can be canceled. There are some paramedics in cars for a similar function, except cars can carry more equipment.

These are trained paramedics who have seen their fair share of injuries. I'd trust them much more than a company health clinic doctor.

There ARE alternatives. Ambulances are a limited resource everywhere, but you can work around the issue.

In Switzerland the system is actually pretty good - ambulances are private companies, it cost +-500$ to get transport to hospital.

Horrible cost on the first glance, but if you actually talk to doctors (my fiancee is one), you realize most of the system is under constant overload. If they have emergency call, it can be (and often is) something trivial, when taking a cab for 5% of the costs would be more appropriate. But you have tons of crazy people (not crazy enough to be in asylum, but enough to wreak havoc on everything and everybody around them) and hypochondriacs. Polytoxicomans that effectively can't be helped.

We're not talking about a drive by a specific vehicle, but locking of 2 highly trained professionals that can't be used for any other emergency, with vehicle full of life-saving equipment. Which can easily mean another ambulance has to come from afar if needed, which can be fatal/debilitating in number of cases.

So its not about US as much, its about making system effective, because resources (people, equipment, ambulances) are scarce and you need to prioritize, or people will die. These things can and should be improved, but until they are, doctors and everybody else need to work with what they have.

In Switzerland the system is actually pretty good - ambulances are private companies, it cost +-500$ to get transport to hospital.

This is not true for the entire country. Emergency services are usually organized on a local level.

For example: In the city of Zurich emergency services are run by the city (which also serves 17 additional communities). It's very much a publicly owned and operated enterprise.

In addition there are private services, but on a very limited manner. For example: The orthodox jewish community runs its own ambulance service.

Details, in German, can be found here : https://www.stadt-zuerich.ch/pd/de/index/schutz_u_rettung_zu...

Much of US ambulance staffing is done by EMTs that start with less than 200 hours of training.

https://www.nremt.org/rwd/public/data/maps

(the circle thing that should be a table)

EMTs spend most of their time picking old ladies up off the floor and feeding blood thinners to people who are having heart attacks. You don't need a combat medic to do that job.

no, but the other 5% of people who have been obliterated in a car crash would like for one of the EMTs in the vehicle to be a combat medic I'm sure.

Right. My point is that when assessing the level of resources the US devotes to ambulances, there's room to argue about whether the responders are highly trained or not. Paramedics certainly are, I'm not sure about (especially newly licensed) EMTs.

That's half true... (or maybe 3/4 true, more accurately).

There are two "halves" to EMS in the US. One half is 911/scene response, the other half is interfacility transports. It's pretty common for interfacility transport companies to staff most of their rigs with EMTs, since those patients tend to be low acuity, and just need to be moved from one hospital to another.

Companies that do 911 response generally staff their ambulances with an EMT and a paramedic. Paramedic training is several thousand hours of classroom and clinical time.

So while it's true that overall EMS is mostly EMTs, in the area we're discussing (ambulances that respond to 911 calls) paramedics are much more common. Granted, that's only a $3-5/hr difference in most places, so it's not a massive difference in cost.

"Horrible cost"

Actually $500 is cheap. It'd be a no brainer if it were that cheap in the US.

I think 'Ambulance no Ambulance' almost has to be kind of a moral decision, not a cost one: if you don't need it, don't use it because it's a scarce resource that will always be scarce.

Do you read Reddit and post their complaints like its reality?

The US has no problem with ambulance quantities, but why take an expensive taxi ride?

Even if it was 'free', its not really free.

I completely agree that the US medical system is corrupt, https://www.opensecrets.org/lobby/top.php?indexType=s

But you have seemingly no understanding of how insurance works or how deductibles work.

In the US the normal procedure is to call 911 as an ass covering exercise.

There’s a lot of downsides to that when a true emergency isn’t happening.

> If you don't have enough ambulances to cover the interventions then just buy more ambulances.

But then we'd have to (melodramatic pause) raise taxes!

(Audience faints en masse)

The cost isn't so much the vehicle as staffing and maintaining it — ambulances, in order to be effective, have to have both an EMT and a driver on the clock.

Generally a paramedic and an EMT (who swap who's driving depending on the acuity of the call)

I think what's being missed in this specific situation is that Tesla has doctors on staff 24/7 to look at and access/deal with any injuries. Surely if it was something they can't handle they would refer them to a hospital, and if need be have an ambulance transport them.

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