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The National EMS Assessment: Where do we go from here?

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EMS Advocacy Article

January 03, 2012


EMS News in Focus
by Art Hsieh

The National EMS Assessment: Where do we go from here?

Old medical axiom: "You can't find a fever unless you take a temperature"

By Art Hsieh

Editor's note: The National EMS Assessment is a landmark document that offers a unique snapshot on the condition of EMS in the United States. Art Hsieh gives his impressions below.

This report is a crucial development in our understanding of emergency medical services in the Untied States. While most of us know what happens in our systems locally, it becomes a futile exercise in trying to compare apples to apples without a baseline to work from.

National level reports such as these provide key pieces of information about our industry and provides a basis to consider where we go from here.

I'm frustrated that it's taken this long to create such a document, but I recognize the complexity of the disparate data sources and the lack of cohesion and consistency among our states.

If anything, the report is yet another indicator of how little attention is paid by government to what would seem to be an essential service, expected by the public to be available and ready to respond 24/7.

The document is huge — 550 pages. I found some interesting factoids:

  • There are an estimated 826,000 licensed, credentialed EMS providers nationwide. Previous estimates ranged from 750,000 to more than 1 million.
  • Nearly 20,000 accredited EMS agencies exist, recording 36.7 million calls for service in 2009. Twenty-eight million transports were provided, almost 75 percent of the total responses.
  • Only one state monitors on the job injuries for EMS workers.
  • Only 18 states collect data about EMS fatalities.
  • Only 11 states monitor EMS vehicle crash data.

In the executive summary, the panel makes it clear that we have a long way to go in understanding how EMS is provided, and how it functions.

It is clear that it is highly variable, as most of us suspected. I find this surprisingly heartening, rather than depressing.

There are opportunities to refine, even redefine what we do as a profession, based on this preliminary report.

I for one would like to see us evolve beyond the "You call, we haul, that's all" mentality.

We have the baseline training, expertise and motivation to provide an even larger medical safety net to our communities. What do you think?

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. In the profession 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. A Past President of the National Association of EMS Educators, former Chief Executive Officer of the San Francisco Paramedic Association, and a scholarship recipient of the American Society of Association Executives, Art is a published textbook author, has presented at conferences nationwide, and continues to provide patient care at a rural hospital-based ALS system. Contact Art at Art.Hsieh@ems1.com.

Comments
The comments below are member-generated and do not necessarily reflect the opinions of EMS1.com or its staff.
Trevor Dolby Trevor Dolby Wednesday, January 04, 2012 1:29:09 AM Statistics can be dangerous. I used to develope the production statistics at an open ppit gold mine & drop them on the managers desk , daily , weekly , monthly quartely , from there they would go to corporate. the crucial question is what do the numbers mean , and usually that depends on who is looking at them & what is their agenda. You might want to say that an MI is an MI , but its not , it depends on where it happens. My county is bigger than conneticut and has two hospitals & seven ambulance stations plus one paid town ambulance that gets more calls than the other seven combined , so an MI in Gabbs is nothing like an MI in Charleston View. I'm all for studies , but you want to hope to god that the guy looking at them has some idea what it is like to run out across the sand with an oxygen bottle & a jump bag.
Alexander Kuehl Alexander Kuehl Wed Jan 4 08:42:17 PST 2012 I couldn't agree more..as long as we recognize that PROVE medical intrventions are the same evertwhere.
Alexander Kuehl Alexander Kuehl Wednesday, January 04, 2012 8:46:06 AM As usual I agree with most of your comments. Federal mandates(as opposed to funding) have scewed up EMS from 1972 on.
Anthony McDaniel Anthony McDaniel Wednesday, January 04, 2012 8:51:13 AM http://bryanhorne.blogspot.com/2012/01/national-ems-assessment.html a blog from a friend that is an emt that sums up how a lot of people in my region feel about this topic.
Donna Baer Donna Baer Wednesday, January 04, 2012 1:12:49 PM I've always looked at EMS as a project in it's infancy. Organized EMS has been on the map for less time than most major corporations, yet handles tremendously important jobs. In moving toward a transition to more uniform training of personnel, I would hope we can also have a better look at what we do and how we do it. One size fits all will never be the correct approach, but this first-ever look at these numbers provides fascinating information. It's a place to start!
Howie Meyer Howie Meyer Wednesday, January 04, 2012 2:49:48 PM I'm working my way through the report now. Unfortunately, I've already found some information that seems to be inaccurate with respect to what I know about certain states. The report and suggestions are only as good as the datat is reliable. Once I'm finished reading (that could be a while), I'll see if my first impression re some of the data is correct.
Kyle Paul Blomgren Kyle Paul Blomgren Wednesday, January 04, 2012 9:49:52 PM I've had friends tell me that expanding protocols and skill sets for EMTs is scary because it opens them up to more liability. I take the opposite approach and see it as a challenge. If we keep EMS training and education at the average levels that exist today (taking into account the wide variety in EMS education), then we will never expand. But if we see EMS education and skills as something that can be built upon and grown, then we can see EMS change. I agree whole-heartedly with Art's belief of evolving from the "You call we haul" mentality. We as an industry need to be the ones to make it happen.
Margo Santoro Margo Santoro Fri Jan 6 20:40:40 PST 2012 I agree with you, but what about the volunteers? How much more work can we take on? How many more hours of training and testing before we say enough is enough? There should be exemptions for the volunteers, or a lot of them will drop out, I know several who are done by 2014.
Kyle Paul Blomgren Kyle Paul Blomgren Fri Jan 6 20:45:42 PST 2012 After being a volunteer for 3 years, I understand the level of commitment and time it takes. But frankly, if we want to see EMS become the big player in the allied health field that we (the community) envisions it, then the volunteer aspect of EMS will start to dwindle. I love volunteers, and I think they are a vital part of our culture (heck, isn't it like 75% of the nation is covered by them?). But in order to move to the profession EMS can be, that may have to be sacrificed. Now, if someone more knowledgeable and talented than I can figure out how to keep volunteerism alive, by all means do it.
Norma Battaglia Norma Battaglia Wednesday, January 11, 2012 12:57:51 PM Education and maximizing the Scope of Paramedic and EMT Practice are key to providing autonomy, better patient care and more consistency. Decision-trees or algorhythmns result in the "you call, we haul" practice, whereas Practice guidelines allow customization of Scope, skills and service provision depending on area need and availability of Provider Levels (this allows for Volunteer and paid variation). Critical thinking skills and professional judgement must be nurtured, taught and encouraged by agencies/departments, medical directors and hospitals.
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