Should EMS drop the 'E'?

Ride to emergency department is not always solution to issues 'frequent flyers' face, yet we have few alternatives to implement

Editor’s Note:

Editor's note: The Ottawa Paramedic Service has launched a $1.3-million pilot project aimed at easing the strain on the 911 system caused by "frequent flyers."

Most urban centers have the same issue identified in this article: a very small number of 911 callers that comprise a very disproportionate number of EMS responses.

We called them "million-dollar patients" in one system where I worked, for the amount of money used to respond a paramedic unit to each scene.

Clearly a ride to an emergency department was not the solution to the issues the patient faced, yet we had few alternatives to implement.

Fortunately, an increasing number of systems are turning toward innovative community-based solutions that will increase the efficiency of the 911 system and still save money in both the short and long runs.

Even more importantly, getting the patient to the right resources provides the tantalizing opportunity to help the patient actually leave the 911 system and resume a more manageable life.

This and other community paramedic initiatives are exciting developments in our profession.

Many have advocated for some time that the "E" in EMS should be dropped, as it can hamstring our development as mobile field care providers. While I don't necessarily believe in the outcome, the concept is sound. 

Let's continue to explore what well-trained, well-positioned field care providers can do to augment the healthcare system.

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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