This story is emblematic for EMS systems across the country which are struggling to maintain existing response levels in a rapidly changing service environment. Manatee County, Fla., is a typical service area, with 342,000 citizens living within 900 square miles. It has both rural and urban areas of population density.
Issues of rising call volume, delays at emergency departments and suboptimal number of staffed units are cited by this article. Add to this diminishing insurance reimbursement, an increasingly overwhelmed workforce, and increasing wear and tear on vehicles and equipment, and I think one can guess where this scenario is heading.
These issues are complex, interrelated and often caused by conditions that occur far outside the EMS universe. The bigger picture is that the safety net of the U.S. health care system - EMS - is unable to keep up with the increasing numbers of people who are still unable to access health care, even in this era of the Affordable Care Act. There is an increasing number of reports of patients not able to see a primary care provider for months, if at all; many medical groups can’t or won’t accept new patients. The number of new general practitioners are not enough to offset the ones who are retiring or leaving the practice entirely.
So, people continue to defer treatment until it’s too late and finally call 911 because they don’t have any other recourse. Or, they seek very expensive care at an emergency department for a very routine condition. Call volume rises, and emergency departments can’t turn them away. Ambulances arrive, can’t off load their patients and are out of service for extended periods of time. The 911 system can’t respond because units are unavailable.
Yet simply increasing the number of ambulances won’t resolve the situation in the long run. Wholesale changes throughout the health care system are needed to bring supply in line with demand. Re-engineering EMS into a field care model that encompasses both routine and urgent service calls and routes patients away from the emergency department to an appropriate level of care or other service - and getting adequately reimbursed for that activity - will begin the long process of matching limited resources to the evolving level of demand.
Meanwhile, let’s hope EMS systems can get some relief in the short run, while plans are developed and implemented that will better service the community better in the long run. That is what makes the most sense.
