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Revolution, or evolution?

Editor's note: This article is in response to the story "Ky. 911 program to ease crowded ER rooms". Hoping to ease crowded emergency rooms and trim ambulance runs, Louisville Metro Emergency Medical Services (EMS) has launched a program that aims to screen low-priority calls and divert patients from hospitals into more appropriate health care. Read the full story and tell us what you think in the member comments below.

By Art Hsieh, EMS1 Editorial Advisor

No matter which side of the health care reform debate you are, I think that you'd agree that something has to change to unload the stress of overburdened EMS systems across the country. As professionals we have known for some time that our systems, first designed in the 1970s and 1980s, are poorly suited for the demands of the current health care system. It's been my opinion for a long time that we are part of this country's "universal" health care system, along with hospital emergency departments. Nowhere in this country can you be denied access to health care, regardless of your ability to pay.

As a result, our systems have picked up not only a tremendous volume of calls in the past 20 years, but also the type of calls that we are poorly trained and equipped to handle.

There have been attempts in the past to create non urgent care EMS systems, but those attempts worked on expanding the scope of EMS folks only, in an "all or none" approach — either you provided care and released the patient on scene, or you transported the patient to an emergency department.

This article reports on a system that provides more specific gate-keeping functions on the front end of access. The call volume being diverted to non-EMS resources is currently small, but if strong quality assurance and improvement processes are in place, there would be no reason not to believe that more patients can be provided an appropriate avenue of care for their condition.

I really ponder if the step in the evolution might include the ability of EMS providers to perform an appropriate assessment and be able to safely and competently provide the same level of options for care. The article does not point out if that is currently the case with the Louisville system. It may add a complexity of decision making that the system is not yet prepared to manage, But, could it be possible? What do you think?

Art Hsieh, MA, NREMT-P, is Chief Executive Officer & Education Director of the San Francisco Paramedic Association, a published author of EMS textbooks and a national presenter on clinical and education subjects.



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