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EMS News in Focus
by Arthur Hsieh

Sometimes, EMS systems are too broken to fix

San Francisco’s EMS system is broken; as is often the case in medicine, treating the symptom won’t fix the underlying problem

By Arthur Hsieh

Emergency responders are, by nature, a reactionary group. We see a problem, and we try to fix it, right away. It’s in our collective DNA. And when things are truly an emergency, it’s the right mindset to have.

But emergency systems can’t afford to be reactionary. Things happen too slowly to be able to “fix” problems. And, as often as it is in medicine, treating the symptoms doesn’t get at the underlying cause of the issue.

San Francisco is in the midst of yet another EMS system crisis. Anyone with time in the system will recognize that this is the same issue that occurred in the mid-1990s — and the mid-1980s. Call volume is up; staffing is down; money is tight.

It’s a television show in re-runs. And the response is typical — throw more money at it, buy new ambulances, hire more people. Sadly, it’s not going to work, not in the long run.

San Francisco’s EMS system is broken, as are many EMS systems in the nation. It’s trying to apply a solution to a problem that mutated a long time ago.

Changes in patient populations, decreasing health care reimbursement, and the high cost of providing emergency response to non-emergency incidents have made the system immune to the “traditional” treatment of simply applying more of the same medicine. Compounding the issues is the rigid, inside-the-box organizational culture that plagues many of the same cities administrative leadership.

It’s simply untenable. 

It will take more than a simple fix to cure a complex problem. San Francisco and other cities will need to go after the underlying causes and make tough, dramatic and bold decisions to align their EMS systems with the need of its residents, not just today or next year, but for the next generation.

To be simply reactionary will guarantee deja vu.

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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Ron Fox Ron Fox Tuesday, July 15, 2014 5:26:12 PM Ok... agreed! We're all ears. Where do we start and what is the benchmark? I think we all agree that we have a system that is broken at best. Our biggest questions are "where do we begin the changes and who do we need to get us the help"? The future of Obama Care is really unclear but we know, coming out of the box, that it is designed to fail. How to plan for the future is made difficult by these very facts. Ideas anyone?
Haki Shakur Ammi Haki Shakur Ammi Tuesday, July 15, 2014 5:59:39 PM Head for the hills and greater pasture.
Michael MacNeil Michael MacNeil Tuesday, July 15, 2014 7:52:26 PM Another joke article. It would be nice if this allegedly credible and ground breaking source of EMS information would provide some actual informative journalism to go along with these catchy headlines they throw out there. Any suggestions on how to improve these broken systems? How about exploring the broken system, any budgetary references? Any comparable "broken" systems or failed systems to talk about? Or better yet how about a successful template to refer too? All this is apparently too much effort for the staff writers of this journalistic nightmare of a website. Wish I had never fell for the bait. I thought it was going to be something to start a real conversation. Instead this article is just more ambulance drivers complaining.
Rob Jimenez Rob Jimenez Thursday, July 17, 2014 6:06:53 PM Art, nothing is working here. You know that and you know why. And we are not going to fix every EMS system, but since you have worked here and have experience here and are using this city as an apparent example, then please toss out some ideas. Neils was a great asset to the city in so many ways as EMS-1, but we saw what the DPH (yes I am pointing my finger at them) role was in eliminating that position right? There are and infinite number of things that could be done here, but have not happened for a multitude of reasons. I would strongly suggest putting a halt on "massage therapy for the homeless" to start. In the mean time, as the landscape HAS changed, thus increasing demand, we need, at the very least, ambulances that run and people qualified to staff them. That is the minimum. Please publish a follow up article with stats and ideas for the situation you called out. We all know that it is an easy target for good reasons but please publicize the ideas for correction that I know you have. Take care!

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