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Home > Topics > EMS Management
July 15, 2014
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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 Editor in Chief 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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