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A call to arms: What EMS must learn from 2014

We ignore these unsettling trends in EMS at our own peril

As the year draws to a close, I get to put my feet up next to a roaring fire, drop a few ice cubes in my after dinner scotch and ruminate over the events of the past 365 days.

In reality, I’m at the station, trying to eat dinner in between runs and sipping my third cup of coffee, while stringing together thoughts about this past year. Such is the life of an EMS provider, right?

I know my experience is echoed across the country daily, by thousands of EMS providers who stand ready to respond to medical emergencies, 24/7/365. At least that’s what the public’s perception of EMS is. Unfortunately, that’s not always the case.

There have been several trends in the past year that, if we don’t pay attention and actively respond to them, may have serious, long-term consequences for the industry. For the record, these are my thoughts and opinions; there is no hard data or research to support my assertions. However, when commenting twice weekly on EMS news events, it’s hard to ignore some unsettling trends.

Volunteer EMS: A dying breed

Really, volunteer EMS is on life support. Every week in 2014 some region of the country was reporting a shortage of volunteer EMS providers. There have been attempts to recruit and retain staff – providing benefits, paying for training, even stipends for responding to calls. But the fact remains – it is virtually impossible to donate that much time out of life anymore.

Many Americans are busy working two or more jobs just to make ends meet. Volunteering for a few hours, or for a weekend can be doable, but to pay for the privilege of getting out of bed in the middle of the night for a minor incident isn’t in the cards for most folks.

The sad part is that this downward trend has been going on for decades. It’s compounded by organizations that are more like social clubs than professional EMS agencies. There’s something wrongwhen politics trump service; just because a volunteer organization has “always” been there doesn’t entitle it to provide poor service, or even no service.

And I just don’t buy the “we are a rural area and that’s all we can afford” argument. I’m not sure if their stakeholders agree. There are large parts of the country that are covered by regional agencies that offer reliable treatment and transport services. Fiefdoms that are local agencies must be creative in solving their staffing issues – which may mean consolidation of resources and finances.

EMS reimbursement: A trickle that is about to dry up?

Staying afloat in a career agency is no picnic either. Reimbursement from government or private insurance continues to decline, a trend that will continue unless we can prove what we do makes a difference in patient outcomes. So far, that has been a challenge.

There’s certainly a lot of interest in community paramedicine and mobile integrated health initiatives as a key to financial success. Heck, I’m one of its biggest fans. But community paramedicine is no panacea to the monetary bleeding many agencies are experiencing. There have been a fair number of stories about EMS organizations going bankrupt or getting out of the business before they go bankrupt.

And before someone gets on the bandwagon about government-based EMS, tax-paying citizens may have a say about that too. During the Great Recession, people began critically looking at the spiraling costs of public safety, notably the mounting costs of providing retirement and medical benefits to civil servants. That trend has not abated, nor have the costs gone away.

Meanwhile, most Americans believe that if they call for emergency medical service that someone will arrive promptly and render care expertly. An essential service, as it were; but the financials don’t support that.

EMS assaults: Not part of the job

Speaking of respect, it seemed like there were more reports of EMS providers being assaulted on the job in 2014 than ever. We’re no longer the knights in shining armor, coming in to save the day; more citizens treat their emergency medical responders with the same level of suspicion as they do with law enforcement. Add to that a sprinkle of alcohol and a dash of drugs, and you’ve got a recipe for a combative patient.

Despite that, most providers receive little or no training in situational awareness, de-escalation techniques and self-defense. In fact many provoke their attackers through rude or inappropriate behavior. Remember, we are supposed to be the professionals, right? So get the training, develop tolerance, and stop taking it personally. If you can’t do that, then get out. You’re not helping anyone.

Crashing ambulances: Not part of the job

If there is an epidemic in EMS, it’s crashing ambulances for simply no good reason. There is simply no data to support the use of lights and siren in the vast majority of EMS calls. Yet each week – sometimes every day – there is a report of an ambulance crashing while responding to a call, or worse, transporting a patient “hot.”

Given the size of the vehicles we use, the sound proofing in most modern vehicles, and the tendency to be more reckless when operating lights and siren, perhaps it’s a surprise that we don’t collide with other vehicles more often.

Fortunately the solution is simple. Slow down. That’s it. The need for speed is not worth the grief and sorrow when you kill someone with your ambulance – the other driver, your patient, your partner, or yourself.

Ferguson: The emperor’s clothes

This country has seen an extended period of unrest following the police-involved deaths of citizens in cities across the nation. What happened in Ferguson, Mo. is a matter of perspective, but it’s hard to ignore the influence of a nearly all-white police force patrolling a predominantly black community.

Mind you, the core issue is not about race; it’s about understanding the cultural, social, and economic norms that each of us holds as a truth. When there is a tremendous disparity between those who serve to protect, and those who are to be protected, the dynamic of mistrust and misperception is created.

We in EMS are no different. In fact, I’m willing to bet that EMS agencies are even less diverse than their law enforcement counterparts. At the same time, we serve a population that continues to have limited – or no – access to health care. Simply, we serve the poor – and most of the time that means taking care of people from a wide, diverse background.

Leveling this field is not easy. But it needs to be done. We are a community service, and reflecting its makeup is essential to acceptance. Better access to equal K-12 education, and setting expectations that being a field care provider is available to all are but a few steps in that direction.

When you look back on a year of EMS news what unsettling trends or realities do you see?

Art Hsieh, MA, NRP teaches in Northern California at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. An EMS provider since 1982, Art has served as a line medic, supervisor 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 writer, author of “EMT Exam for Dummies,” has presented at conferences nationwide and continues to provide direct patient care regularly. Art is a member of the EMS1 Editorial Advisory Board. Contact Art at and connect with him on Facebook or Twitter.