The Ambulance at the Bottom of the Hill
Gene Gilchrist
Louisville, Kentucky
The residents of Great Town would live nowhere else. Its qualities were innumerable. As this reputation spread, the town grew with permanent residents and visitors.
There was one problem in Great Town and that was that the town was accessible only by car, down a steep mountain face, and a very winding road. Naturally, cars would sometimes go over the bank and tumble to the bottom. It happened more frequently in inclement weather. Great Town maintained an ambulance service at the bottom of the hill to transport the injured to the local hospitals. As the resident population and visitors grew there were more accidents and the ambulance service was overrun.
Great Town officials debated their options. A well-intentioned ambulance company offered to manage the service as it was a reimbursable event; they could make money. The company committed to meeting current and future volume. The hospital supported this proposal knowing that the sooner they received the accident victims the better the clinical outcome. Of course, these accidents required clinical interventions that were highly reimbursed by insurance. Town administrators recognized the improved clinical outcomes. They also projected the cost savings to the town by not managing the ambulance service, eliminating their liability risks for ambulance transports, projected additional hospital services and hospital revenue, projected more revenue for town businesses (ambulance, hospitals. doctors, hotels and so on), better paying jobs, and more payroll taxes.
A small group of townsfolk proposed prevention - - improvements to the road such as wider roads, better signage and striping, lower speed limits, better lighting, barriers at the curviest parts. Town analysts noted that these proposals would involve additional cost from construction, additional upkeep costs, continuing liability for the ambulance service, the loss of all those jobs from the ambulance company proposal, and that this approach had not been tried before. Great Town outsourced the ambulance service.
Today great towns across America are focused on crime. Inertia brings the usual proposals – more police, more judges, more jails, stiffer penalties, fewer guns/more guns. These and other proposals are worthy and should be debated.
Meanwhile, back up the hill, alcohol and other drug use, abuse, and addiction is the cause of a great deal of that crime. Research from the National Institutes for Health, NOVA Treatment, and Alcohol Rehab Guides among others estimate that alcohol and drug abuse accounts for or is involved in:
40% of homicides
40-60% of overall violent crime
30-40% of domestic abuse
37% of sexual assaults
27% of aggravated assaults
15% of robberies
And to be clear, most of this crime is not committed by members of drug related organizations. Most of this crime is committed by people with a medical condition called substance use disorder; alcohol or other drug abuse or addiction to the lay person.
This is not an argument against the ambulance at the bottom of the hill. Any amount of crime is unacceptable and town officials should focus on dealing with crime. It is an argument for improving the roads at the top of the hill. It is an argument for saving life and limb by avoiding the accidents in the first place. It is an argument for investing in prevention, intervention and clinical support for those suffering from substance use disorder.
Transporting car crash victims after the accident, like managing crime after it happens, will eventually fail unless we treat the causes like unsafe roads at the top of the hill or in the case of crime, alcohol and other drug use abuse and addiction. There are other measures to be taken to prevent crime. They, too, should have our attention. In the case of substance use disorder there are established, increasingly evidenced based approaches that we know will work.
