EMS agencies must learn from worsening UK ambulance crisis

Cost-effective and high-quality EMS systems are possible if we first move on from the tradition-laden constraints of EMS dogma


The ambulance trust system in England has been in crisis for several years. Not enough providers, too many calls and long waiting lines at hospitals for paramedics waiting to offload patients have combined to create a national EMS system that is unable to respond to emergency calls for assistance in a consistent, timely manner. Moreover, the incredible workloads have resulted in an increasingly burned out workforce, with well-intentioned people unable to handle the stress any longer and leaving.

Of course, it's true that the U.K. and U.S. systems are entirely different from each other. But we are seeing the same pressures being placed on American systems that are gutting the trusts. U.S. hospitals have fewer beds to admit patients, causing emergency department gurneys to fill up and EMS personnel unable to handoff or offload their patients.

Many U.S. providers are unable to maintain response times due to the high volume of low acuity calls. Financial pressures from lower reimbursements that are unable to cover operating costs are causing agencies to reduce the number of ambulances available for calls.

An ambulance passes the entrance to the Lindo Wing at St Mary's Hospital in London, Tuesday, July 2, 2013. (AP Photo/Frank Augstein)
An ambulance passes the entrance to the Lindo Wing at St Mary's Hospital in London, Tuesday, July 2, 2013. (AP Photo/Frank Augstein)

Adding more ambulances is definitely not part of a solution to a complex, multifaceted problem. Changes in how health care is provided — and reimbursed — will prohibit the growth of a traditional 911-only systems.

Taxpayers aren't going to foot the bill either. Given the impending shift of political winds in the federal government, there will be little appetite by government to take on additional financial burden of public safety and health.

Frankly, it's time to re-engineer our thoughts of field care medicine. Traditional 911 system response hasn't been appropriate for the majority of calls for a long time. It's been due to the constraints of reimbursement. We only got paid if we took the patient to an emergency department.

It's what the unsuspecting public felt was "needed" as well. Countless television shows and health care advertising that reinforces the notion that one only got "better" by going to a hospital. The same shows glamorize the flashy lights and blaring sirens and the heart pounding drama of saving countless lives only to attract newcomers to the business that is so not filled with television "reality."

How do we transition the paradigm of field medicine? By embracing what works and changing what doesn't work.

An increasing number of EMS systems are implementing community based systems of care, often in conjunction with hospitals, hospice care, physicians and mental health providers. Other agencies are beginning to reconceptualize "emergency calls" so that response times to true emergencies are met. Beyond the confines of the ambulance service, large health systems are investing in more preventive strategies for the overall health of their member populations, potentially reducing the number of patients that enter the 911 system.

A few years back, it was said that a fast, cheap and high quality EMS system didn't exist. It could be fast and cheap, but not high quality. Or, the system could be of high quality, but it wouldn't be fast or cheap. I would posit that we could have a system that would have all three attributes, as long as we drop the tradition-laden constraints of EMS dogma that will keep us permanently in the dark ages.

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