Chicago EMS changes moving in the wrong direction

There's no evidence that putting more paramedics on the street provides better pre-hospital care, and it may worsen it

I'm lucky to have found my passion so early in my adult life. As a field-care professional for over 30 years, I've been witness to a few revolutionary steps that shifted the industry.

System status management began in earnest in the early 1980s. The rise of large, private EMS agencies came in the '90s. Then came the introduction of evidence-based medicine in the new millennia.

Each signaled a new era of development in the professionalization of pre-hospital care.

Each change has been met with stiff opposition, as they altered all that came before. These changes have thus far withstood the test of time.

With the current revolution underway in this nation's health care system, there is an opportunity to cement these changes with system-supporting financial resources — but only for systems that demonstrate appropriate and meaningful responses to the changing environment.

Which sadly, gets us to today's report of the modifications in the Chicago EMS system that are heading against the winds of industry changes. To date, there is no study that demonstrates a greater level of advanced life support providers changes outcomes in patient mortality, morbidity, or simply level of customer service.

Indeed, there is substantial evidence that a high density of paramedics within a system weakens skill proficiency. The cost is high as well — which I wouldn't mind if we could show that it would be worth it.

Problem is, we can't.

If Chicago's EMS system didn't take a penny of Medicare or Medicaid funding, it wouldn't matter as much. If the customer-taxpayers of the community were willing to fully fund the system to the level they want, that would be their prerogative.

But neither situation is happening, and given the historical track record of public pension crisis, I'm not sure how much more residents are willing to pay for a level of service that is unproven in its ability to improve public health.

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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