You've gotta love HMOs

I just finished my recertification in ACLS, Advanced Cardiac Life Support. This is basically emergency cardiovascular care - to be used in worst case scenarios only.


The basic set-up is this: You follow your ABCs (airway, breathing and circulation), fixing problems as you go (if you can) and attempting to keep blood flowing while someone else is drawing up meds and starting IVs and getting the defibrilator charged up.


This is the format -


If you encounter someone down you shake them to see if they're alert...


"Annie, Annie, can you hear me?"


...then you holler for someone to call for help


and then you start your process...


A) Airway. Make sure it's open. If not get it open somehow. Position them to maximize airflow.

B) Breathing. Extend neck if necessary.Give rescue breaths before starting CPR.

C) Circulation. Check for a pulse. Chest compressions, 100 a minute, giving two rescue breaths after each 30 compressions.


Short, sweet and to the point. But as anyone who has had anything to do with the American healthcare system lately can attest, the HMOs have screwed everything up. Not just for the patients, but also for the doctors and the nurses and the social workers and the mental health screeners and so on and so on. It all comes down to the almighty dollar, and if the care itself falls through the cracks so be it. For the most part, people in medicine don't think much of HMOs.


So it should come as no surprise that some disgruntled medical type (not me this time) came up with the HMO version of ACLS...


Advanced Cash Liability Survey


A. 1) Attorney
2) Airway

B. 1) Bank Account
2) Billing
3) Breathing


C. 1) Cash on Hand
2) Checking Account
3) Credit Cards
4) Court Date
5) Circulation


If an unconscious patient is encountered, follow the sequence below:

1) Shake patient and ask: "Annie, Annie, are you insured?"

2) If no response, position patient to open pockets. (Listen for loose change while positioning patient)

3) Extend neck. Open mouth and look for gold fillings. ( If time allows, check airway.)

4) Palpate neck for gold chains and necklaces. Note: Carotid pulse may be an incidental finding.

5) Palpate pocket for wallet. (Tell bystanders you are checking for femoral pulse.)

6) If insured, call for help immediately.

7) If uninsured consult your policy manual.

8) Traditional CPR is optional at this point.

9) If no response to CPR, proceed to ACLS


Any questions?