Without intervention, EMS will die
EMS will continue to shrivel if we don’t change and expand the profession we love
By Arthur Hsieh
Each December, we reflect about all things EMS that happened over the past 12 months. We sure had some dramatic events, like the response to the Boston Marathon bombing, the loss of life in the West, Texas fertilizer plant explosion, and the abrupt closing of a major EMS employer.
But what I want to point out are the stories that appeared regularly throughout the year. Putting them together, there is a theme that resonates with me:
EMS is killing itself. And it will succeed without intervention.
No doubt that statement rankles more than a few of you. It should – you’re an EMS professional, right? But follow my logic and give me your thoughts on how we can prevent this suicidal gesture.
Argument 1: EMS has developed a culture of tradition unimpeded by progress.
Community paramedicine, or mobile integrated health care, has become a near-household term in 2013. There are now dozens of initiatives across the country that are exploring the use of EMS providers in non-emergency roles, ranging from post-discharge follow-up visits, vaccinations, and well-being checks to alternative destination guidelines and frequent user reduction. Insurers are looking at these roles carefully, and there is the opportunity to capture reimbursement for services that many EMS systems already perform informally.
Yet it seems that many of us rail against the evolution of our industry. “I didn’t get into this business to be a nursemaid!” seems to be the familiar refrain. It’s a “you call, we haul, and that’s all” mentality. It’s all about the guts and glory, right?
Sure, I get it – so long as people go out of their way to hurt themselves or get sick, we will have a role of providing emergency medical care and transportation. It’s just that it’s not a sustainable model. There is scant research to demonstrate the effectiveness of prehospital care on patient outcomes, and the funding is even less reliable.
To be fair, we’ve become more active on both fronts over the past few years, but mostly because of the efforts of a few hard-working, highly dedicated individuals. Most of us don’t put our money where our mouths are – joining national associations or pushing at the margins of our local system. Apathy is harmful.
So, if you want to run lights and siren all of the time and believe that is the unyielding nature of EMS, that’s fine. Just don’t get in the way of the expansion of out-of-hospital care. It is what will help us grow professionally.
Argument 2: We are literally killing ourselves for no reason.
Speaking of driving code 3, please – stop. Measuring the performance of a system by its ability to reach all patients in an arbitrary period of time is meaningless. It simply promotes ambulance crashes. Please show me the research that shows arriving at the scene of someone with flu-like symptoms within 8 minutes will improve the patient’s outcome.
Crazy? You bet. And that’s how most systems are run today.
So what’s the big deal? Crashing ambulances. Rolling over multi-ton vehicles that are inherently unstable and dangerous to operate. Combine that with little or no emergency operator training, and we are hurting or killing ourselves, our patients, and the driving public.
Instead, advocate for the technology that improves the accuracy of dispatch such as mobile video and GPS locators. Encourage greater integration of public involvement, such as app-enabled first response and just-in-time training in first aid and CPR.
More importantly, change the rules of the game. Optimize the system for the calls where time may make a difference. That doesn’t mean an ambulance on every street corner – it might mean first responders administering epinephrine or naloxone prior to transport arrival. Or keeping some ambulances available and having nonemergent calls wait until the system resources improve. Or using alternative methods of abating calls, through in-home interventions or alternative destinations.
Running hot all of the time is so 1960s. Like other fads of that era, it’s time to put this one to bed.
Argument 3: Volunteers are a dying breed.
Again, I get it. I started as a volunteer. In 1982. Even then, it was difficult to staff ambulances, especially during the day. When our society was based on one-income families with 2.5 children per household, gas was 50 cents a gallon, and you worked within a few miles of where you lived, volunteering for your local EMS service was doable.
None of that applies today – and hasn’t for a long time. The demands of multiple jobs, commuting and personal lives, combined with the sophistication of running a 24/7 operation, makes it a critical challenge to maintain staffing and operational readiness for the everyday calls, much less anything reaching a catastrophic level.
Yet as news stories about the failing systems in Iowa and New Jersey point out, we actively defend our positions, using the rationale of “we’re doing the best we can” to justify our defensiveness. I regret to inform you that “failure to respond” is not the best we can do. It’s time to be innovative and create solutions that benefit the community, not the social club.
Argument 4: Education is still anathema.
Education is power. It always has been. It’s the reason why in dictatorships, the academics are usually the first to go. They explore, expand the knowledge, ask the tough questions.
With some exceptions to the contrary, we so don’t do that in EMS. Any paramedic can tell you that he or she has put in a significant amount of time and sweat equity into their training. But what’s missing are the other parts of higher education that takes the technician to the clinician – the ability to reason, to critique, to defend, to communicate. It’s not the “paper” that the degree is printed on; it’s the process of reflection and analysis that college courses push.
And please, don’t give me the argument that we’re “different” from any other profession. That’s simply a self-fulfilling prophecy. We don’t need a degree to be a paramedic, but we do need one to be considered professionals by our colleagues.
You might think I’m ready to throw in the towel. Nah – nothing can be further from the truth. I’m really excited by what I see is the rapidly increasing rate of change in our industry. In my classroom, I see the faces of the next generation of EMS providers. They are excited and interested in a career that provides a fulfilling professional experience.
I just want our past to serve a springboard to the future, not as an anchor.