Street medics and EMS

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Facilitator: Greg
Time: 20 mins; 1825-1845
Actual time:
Learning Objectives:
Materials: 2 Readers

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Critical thinking story: meet Stacy

Facilitator:

¹ Stacy is a fictional character. Imagine he got to Denver from Oakland a week and a half ago. He stays at the 24-hour foreclosure defense vigil in the front yard of an elderly woman in the Montbello neighborhood. Stacy is hotheaded and easily hurt. He hangs with a crew of travelers he met at the vigil and feels like they're family. They're always together and share everything. A few days ago, Stacy got overwhelmed and yelled and punched one of his friends in the face, then disappeared. He came back late last night wearing a Denver General hospital wristband.

Despite the late hour, Sugar sat down by the bar-b-q grill and got to know Stacy. Stacy said he was in the hospital with an asthma attack. He said he was one of the "real occupiers" with Occupy Oakland -- he'd lived in Frank Ogawa Plaza and seen Scott Olsen get shot in the face with the tear gas canister. When "they" kicked him out "because of some bullshit," he skipped town and visited Occupy people all over the country and got drunk a lot. He said he got kicked out of the Tar Sands Blockade in Texas a couple months ago and they called the police on him. He didn't want to talk about who had wanted him to leave or why. He told Sugar he's a medication-dependent diabetic and gets bad asthma attacks when he's upset. He hates cops and jail is a bad place for him.

Today the sheriff and the movers were supposed to come to put the elderly lady's stuff on the curb. Members of the Colorado Foreclosure Resistance Coalition set up tents and a food table at the vigil at 9 this morning, and pretty quickly the Denver Police arrived. By noon, 100 police in all-black riot gear with black sticks blocked off the street, outnumbering the protesters. A few of the cops had shotguns, the rest had big cans of pepperspray strapped to the fronts of their uniforms. Everyone started chanting "Shame!" and "The whole world is watching!" Stacy was really worked up and screaming at one of the shotgun-holding cops. "Fuck you, pig!" He was screaming. "You can't take our home!" Stacy was acting drunk, but hadn't been near alcohol. A police lieutenant pointed at Stacy and said, "He's first." Stacy started wheezing so bad he couldn't yell anymore and bracing his hands on his knees, but he stood his ground belligerently and flipped off the lieutenant.

Corporate emergency medicine

What it is

Facilitator says

² Corporate emergency medicine is a business model that's less than 50 years old. It is poor peoples' gateway to biomedicine -- a system which treats billable conditions (mostly by using manufactured drugs and surgery to suppress symptoms or improve diagnostic test results).

If you call the ambulance or walk in to the hospital Emergency Department like Stacy did, you'll wait, fill out a lot of paperwork, and see at least 5 different strangers, each for a short period of time. The process will end with a prescription, a referral, or hospital admission -- and a bill. In cities, an ambulance ride averages about 1,500 USD, and Emergency Department visits average about another 1,500 USD. Backwoods evacuations can cost more than twice as much.

What Stacy needs

Facilitator asks

What options can corporate emergency medicine offer to Stacy? Probe for answers like these:

• EMTs and hospital staff can save Stacy's life with oxygen and an albuterol nebulizer.

• They might decide he's crazy because of his lifestyle, and give him a psych referral.

• They can monitor his blood sugar, and give him some orange juice to get it up.

Facilitator says

Biomedicine can wait until Stacy drops, and then save his life.

Facilitator asks

What can't corporate emergency medicine offer to Stacy? Let students briefly discuss. Some potential answers:

• EMTs won't try to keep Stacy from getting arrested.

• Emergency Department staff don't have time or resources to attend to Stacy's emotional, mental and spiritual well-being or how those things impact his health.

• They can't strengthen his respiratory system.

• They can't promote health in his broader community.

Facilitator asks

What does Stacy need right now? Let students briefly discuss.

The Lazy Medic's Code

Facilitator says

The Lazy Medic's Code in short: If we can prevent it, I won't have to treat it.

Critical thinking story: Ms. Malva's trips to the hospital

Facilitator:

³ You move into a new apartment and notice that every Friday night, and many Saturday nights, an ambulance comes to the building sometime between 8 PM and midnight. Being a nosy neighbor, you try to stay alert to see who keeps going to the hospital. One night you see them carrying your downstairs neighbor out of her apartment on a gurney, so you decide to get to know her when she comes back.

Your neighbor's name is Ms. Malva, and she went on SSDI last year after she got disabling arthritis in her hands from working with lead solder for 30 years. Her daughters never come visit her and she gets migraines and can't sleep, and her heart races with anxiety when the bar she shares a wall with plays loud music all night Friday and Saturday. When the pounding music comes through her wall, she turns up her TV, takes her prescribed anti-anxiety and sleep medications, and sits in her bed in pain until she can't take it anymore and calls 911.

You like Ms. Malva, and start visiting her more often. She tells you about her trips to Ecuador when she was younger and hilarious stories about her boyfriends over the years. You go home and realize that her migraines are almost a form of protest; that she is lonely and the bar's music is too loud, and the best solution our society has to offer is the equivalent of 10,000-20,000 USD worth of emergency medical care a month, and a medicine cabinet full of habit-forming drugs.

Facilitator asks

As a good neighbor, what lazy medic stuff can you do for Ms. Malva? Encourage students to briefly discuss and come up with creative answers, like:

• With the landlord's permission, help her put up about 50 USD worth of soundproofing.

• Make a regular date to come by her house to eat dinner and watch TV on weekends, or to work on your homework at her kitchen table.

• Help her with apartment-hunting for a place that sucks less and is closer to her daughters.

• Go with her to the senior center, so she can see if it sucks or not.

Facilitator says

We live in a weird world, where this stuff is the lazy medic's alternative to the norm -- and the norm is hundreds of thousands of seniors falling back on the emergency medical system to treat loneliness and loud music from the bar next door. Likewise in protests, never tolerate complicated treatment when simple prevention is easier and more dignified.

Street medicine

Brief medic scope and ethics

Facilitator says

Street medics establish and restor safety in protest environments made unsafe by systems of repression. We don't "treat patients" so much as create conditions for health and healing in the midst and aftermath of crisis.

Roger Benham (street medic and Wilderness EMT)

⁴ "My perception of action medical is that we bear a similar relationship to the movements we serve as combat medics do to their units. That is, we exist to enable organized groups of comrades to achieve their objectives. That sets us apart from conventional EMS, which exists to stabilize, package and transport patients to more definitive care. We might do that sometimes, sometimes we might just patch somebody up so they can get back out into the street or the forest. I would argue if you're doing something else, you might be a medic, but you're not being an action medic."

Anti-authoritarian and anti-hierarchy

Founding Principle #2 of Common Ground Health Clinic

⁵ "Certifications, skill level & experience will be respected in regards to patient care. They will not translate into hierarchy of duties or division of labor. Everyone can clean toilets, organize supplies, wash dishes, & pick up after themselves" (Common Ground Health Clinic was started by street medics in New Orleans a week after Hurricane Katrina).

Facilitator says

Medics who can muster social clout use "authority drag" when needed to access, evacuate, and advocate for patients.⁶

Brief medic history

Facilitator:

National first aid systems in most of the world came out of the medical corps of popular and liberation movements of the 1950s and 1960s. This was also true in the United States, where street medics were operating and training medics in Mississippi and New York City at least four years before the first statewide EMS program was established (in Maryland).⁷

Annie Hirschman and Doc Rosen on the origins of street medics

Annie Hirschman

Action medical was started by a bunch of doctors from the Medical Community for Human Rights who were already professionals by the mid-sixties and were involved in the civil rights movement.

When the peace movement [against the Vietnam War] hit the streets, it became clear that there were nowhere near enough medical professionals willing, able, and available to do medic kinds of work, to take care of things like head injuries from nightsticks and particularly tear gas. And the physicians themselves really didn't know how to do this unless they had been in the streets and had figured it out. What we needed in the streets was how to take care of the big stuff first -- we should go over what to do for big bleeding, or big life threatening not breathing. And then bandaids were easy.

Look at medical history [in America]: it wasn't until the late '60s or early '70s that people started thinking in terms of paramedics or in terms of emergency medical technicians -- people who knew CPR and first aid and could be first responders. The best you could do in a place like Chicago in the 1960s were firefighters, who were terribly enmeshed in the police department and were basically told, "Don't go there."

It was our goal to have everyone have some rudimentary knowledge of first aid so that if something happened and there wasn't a medic in arms' reach, they could start taking care of things until the medics got there.

Doc Rosen

I don't remember us specifically talking about it but we made a decision to start teaching lay people. And we became the first trainers because we basically created the training. The whole thing was just fabric from our vivid imaginations at that point. There was no precedent that we could come up with.

And actually there were people within the Medical Community for Human Rights that were against teaching anyone who was not a professional. At that time if you went to a demonstration you would see all these people in white coats with stethoscopes around their necks.

Annie Hirschman

Early on the professionals felt fairly strongly that it would be wrong message to look militant. They felt that as medical professionals that their title and their white coat would protect them [from police]. Unfortunately that did not turn out to be true. The big one where it became so clear was Chicago in '68.

Mayor Daley literally got on TV and said they must be planning violence, they brought their own medics, get the medics.

Many traditions in street medicine

Annie and Doc represent only one tradition in street medicine. Street medics have many stories and many traditions. Street medics today are the result of convergent evolution at major moments of social change like:⁸

• Mississippi Freedom Summer.

• The movement to end the war in Vietnam.

• National movements for self-determination.

• Second-wave feminist self-help collectives.

• The early days of the AIDS crisis.

• Direct action for nuclear disarmament.

• Direct action ecodefense.

• Indigenous survival and resistance efforts.

• Anti-globalization movements.

• Hurricane Katrina's aftermath.

• Anti-austerity movements.

This is your history and your community if you want it, and right now is a new major moment of social change. What are street medics becoming? That is partially up to you.