Our nation’s EMS is a crazy patchwork of systems, agencies and regulatory bodies that is inconsistent at best and fails to afford quality care at its worst. I’m not sure if there is any other country in the world that has such a spoil of riches and yet is as threadbare.
Our system is rooted in the deeply held belief that states have the right to govern what happens within their borders. When the first influx of federal dollars for EMS was made available in the early 1970s, it was distributed to states in the form of block grants that each state could use as it saw fit. A few states created regional systems; others distributed their grants piecemeal. This lack of initial consistency is what we are paying for today in terms of unusual system designs and challenges.
Admittedly, each region is unique in its needs, and a one-size-fits-all approach will probably not work uniformly. But there should be consistency in the goals each system tries to achieve. One might be evaluating just how well each system performs, for example. Response time is just one measure — how about patient satisfaction, death reduction rates, cost efficiency, or any one of a variety of goals?
What about having the flexibility to respond to changing tactical environments? Many systems are mired in regulations that still reflect the ‘70s, not today’s rapidly evolving health care system. Old paradigms have to give way to new ones; otherwise systems run the risk of failing their primary mission — think New Jersey’s volunteer system or Idaho’s issues.
It’ll take a concerted, sustained effort by many in the profession to solve the issues at the regional, state and federal levels. Local system problems are merely reflective of what’s happening elsewhere. Hopefully the local leadership can make it work for their community.
