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EMS News in Focus
by Arthur Hsieh

The 'E' in EMS

A new study focuses on the types of emergency department visits made in the United States that were really not emergencies

By Arthur Hsieh

Editor's note: With a newly-released study showing unnecessary visits to emergency rooms cost $ 4.4 billion annually in health care costs across the United States, our Editorial Advisor Art Hsieh takes a look in the following article at the impacts on EMS.

This article about the nonemergency use of emergency departments rings bells for prehospital providers.

The study by the RAND Corporation, a nonprofit institution that helps improve policy and decision-making through research and analysis, focuses on the types of emergency department visits made in the United States that were really not emergencies.

The numbers, unsurprisingly, were significant; the report estimated nearly 14 to 27 percent of emergency room visits could have been handled by urgent care or retail clinics.

This translates to potential savings of nearly $4.4 billion annually, based on several assumptions that you can read about in the actual report.

Looking beyond the numbers, this report echoes what many of us have seen as a trend during the past 15 years: call volume has increased, but not the acuity of the emergencies.

EMS providers in major urban centers often report that they can go entire shifts or even tours without a lights and siren transport to an emergency department.

Others have expressed frustration of being tied up on a low-end, non-urgent request for service while a critical call is being sent to a more distant unit.

While some of this is inevitable, the increased strain on resources tax EMS systems during a time when most cities are facing significant financial strain, and trying to keep units available to meet so-called critical response times.

There's another issue: The vast majority of us receive little training in the assessment and management of these lower acuity events. In addition, even fewer of us have the ability to transport or direct the patients to a non-ER resource. So, in some ways we are stuck trying to manage these cases with little ability to be successful.

As we continue to work our way through health-care reform, let's try to be proactive in dealing with these issues. Perhaps with increased training, we can better triage patients and help provide referrals. Or advocate for alternative transport destinations. There are probably more ideas out there; I'd love to hear them.

About the author

EMS1 Editorial Advisor Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook author, has presented at conferences nationwide, and continues to provide patient care at an EMS service in Northern California. Contact Art at
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