The EMS evolution we need

All levels of EMS stakeholders must bridge the gap between providers and administrators to overcome the hurdles facing the industry


This feature is part of the 2019 EMS Trend Report, an in-depth look at EMS trends in the U.S. and an assessment of how the EMS profession is changing. To read all of the articles included in the 2019 report, click here.

Reading this year's EMS Trend Report, I'm struck by the fact that there's relatively little change in how we view ourselves and our industry from the previous year. That's to be expected of course – one year usually makes very little difference in opinion-making. But that lack of change is but one sign of a looming disaster that we are facing in prehospital medicine. 

Like the Titanic that lumbers through the night, heading toward its inevitable demise while its passengers slept unaware of what laid ahead, EMS is moving toward its destiny. At this moment, I'm not sure whether it will be evolution that propels us forward through the ice field of changing environmental conditions, or a head-on strike with a disaster that sinks us below the waves of change. 

Breaking a destructive cycle

Like the Titanic that lumbers through the night, heading toward its inevitable demise while its passengers slept unaware of what laid ahead, EMS is moving toward its destiny.
Like the Titanic that lumbers through the night, heading toward its inevitable demise while its passengers slept unaware of what laid ahead, EMS is moving toward its destiny.

Each year's EMS Trend Report provides a snapshot of what we want for ourselves. Field proivders want – and need – increased pay, better benefits and safer working conditions. All professions want this, of course, but the need in EMS is becoming dire. Many, if not most, providers work more than one job in order to make ends meet. Sixty- to 80-hour workweeks are not uncommon. Fatigue is a known killer for EMS providers. Combine the mental and physical stressors related to this field, and we have a perfect recipe of a job that people love to hate and leave after but a few short years.

This cycle continues even when we are witnessing a transformative moment in our industry. The data shows an increasing number of agencies providing community health services that positively affect patient and population outcomes. The federal government is making its first steps in creating the reimbursement process that will allow these innovative practices to take hold and thrive. But EMS providers, paramedics, in particular, may be left out of this development. 

Higher educated and trained health professionals, such as nurses, physician assistants and others working in allied health are poised to take over these new positions. According to the Trend Report, most EMS providers believe that the entry-level to practice for paramedics is an associate degree. But certain segments of our industry are determined to make sure we don't get out of the ambulance driver's stereotype. While there are other voices that are advocating for entry-level degree paramedics, the path forward is anything but clear. 

Meanwhile, financial reimbursements for existing services remain pitiful. Even tax-supported systems are feeling the strain of increased call volume without increased support. While the value of EMS may be obvious to those within the industry, we've not yet clearly demonstrated that value to the public and those with the authority of allocating funds for services. Community paramedicine may shift that perception somewhat, but the paradigm won't change. 

It boils down to what we believe the function of EMS is. The age-old debate of whether we are public safety or healthcare entities continues to be a drag on the industry. The time is coming to draw clear, unambiguous lines around what we do. 

If it's public safety, then evidence supports a focus of performing time-dependent tasks really well. Training time would decrease, and retention of knowledge and skills would improve. If the paradigm is integrated healthcare, then specialist providers with deep knowledge and skillsets are needed. 

Personally, I'm not sure which way we should go. The EMS Agenda 2050 seems to point to the latter. But, being a jack of all trades and master of none has been a head-banging exercise in futility. It's resulted in lackluster performance, inadequate reimbursement, poor compensation, and the recruitment and retention of a workforce that is poorly prepared to adapt. 

Bridging the disconnect between field providers and EMS administration

The disconnect between EMS field providers and administration continues to be alarming. While no one level of administration is Pollyanna about the industry, it's clear that perceptions about what folks are doing to support the front-line EMS worker vary widely. 

An agency's bottom line depends upon the EMS provider's ability to perform at a high, consistent level. The level of support must be targeted to meet their needs. A livable wage consistent with education, training and responsibility would be a start. A work schedule that allows workers to pursue a full life would begin the process of a stable work environment that promotes recruitment and retention. 

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Mental health is an issue we are just beginning to grasp in terms of its complexity and depth. It's far too easy to be dismissive of conditions that cannot be seen or felt. Typical employee assistance programs may not have the capacity to help EMS providers deal with the pain and heartache of the job. It's the rare agency that spends the time and money to develop programs that target the stressors intrinsic in the industry. 

All of this seems obvious. Yet, the results from the 2019 Trend Report reveal an unconscious bias among managers and physicians to shift operational challenges away from environmental factors and, in a sense, shift a sense of blame to front-line providers. In other words, the problem lies within the person and not the system. Without a paradigm shift, this situation will not likely improve anytime soon – if ever. 

Meaningful change to impact providers, agencies and communities

If I seem a bit jaded about what lies ahead, I am. On one hand, I see that EMS is evolving in a way that benefits all involved, from front-line providers, to organizations, to the community we serve. On the other hand, I see us as our worst enemy, unwilling or unable to change at any meaningful level. 

While we squabble and deal with the minutia, others are exploiting the opportunities that we may end up squandering away. Fixing this situation will take sacrifice from all levels of participants in EMS, from the CEO to the front-line provider. Will we be up to the challenge?

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