Sometime in the 1990s, the editor of the prestigious emergency medicine journal Annals of Emergency Medicine wrote a then-scathing editorial about the lack of research in prehospital medicine, and publicly called for a re-examination of EMS practice.
He suggested that taxi cabs equipped with AEDs and flashing lights could do just as good of a job saving lives as an EMS unit — and more cheaply. Many of us were critical of the article at that time, but the writing was on the wall — more wasn’t necessarily better, and EMS needed to justify what it did for patient care.
Fast forward 16 years. A recent study in Philadelphia says the survival rate of trauma patients is the same, if not better, when they’re transported to the emergency room by patrol car rather than by ambulance. After dozens of studies about rapid trauma care pointed to the concept that less-is-more results in a highter survival rate,I thought we had evolved our practice in managing critically injured patients.
That’s why it’s disappointing to see that in a very busy, urban EMS department, paramedics in 2013 are still practicing the same way they were in 1993. Intubating trauma patients? Starting intravenous lines? We should be doing better than that in these specialized cases.
There are definitely other concerns here as well. A long-standing practice of police transport of gunshot victims to trauma centers points to deeper issues surrounding EMS care. To be clear, I don’t disagree with it, since it’s probably a necessary compensatory mechanism for what ails the system. But the question is, why does it happen? And why for so long?
What do you think?
