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EMS 2.0: The Wet Blanket Post

It started in a response to Rogue Medic’s reply to an anonymous commenter, and my subsequent reply.

Happy Medic opined in his blog that EMS as we know it needs a reboot. EMS 2.0, he called it. Just a throwaway line, really, about how we need to re-think the way we’ve educated ourselves in the past, and how we will in the future.

Funny how those throwaway lines can ignite a firestorm. Since then, much of the EMS blogosphere has latched onto the concept, riffing on the ways we’re going to drag our profession kicking and screaming into the 21st century. We’re going to expand our scope of practice, broaden and deepen our education, and reinvent EMS into something its founders never envisioned.

We’re going to demand, and deserve, our rightful seat at the table with the grownups in health care, and we’re going to save lives and stamp out disease and pestilence, and who better to do it than us, right?

We’re paramedics, after all. We’re on the front lines of medicine.

[cue inspirational music here]

It would be more inspiring if it weren’t something I hadn’t seen a hundred times before. The reinvention of EMS is a meme that has been circling the various EMS internet forums and use groups ever since I first discovered the wonders of a modem back in 1995, and no doubt was hotly debated in hotel bars at every EMS conference for years before that.

It’s not a new subject.

It’s a meme with legs, however. It never quite dies, and I suppose that’s a good thing. The topic will be debated, grand ideas will be discussed, old medics will be called dinosaurs resistant to change and new medics will be ridiculed for their unrealistic idealism, volunteers will be lauded and bashed, fire service EMS will be lionized and demonized, and everyone will claim to have the answers…

… and then everyone will just drop it, because there are dialysis runs to be made, after all, and Homeless Hank needs his weekly ride to detox. We’re working too damned hard to endlessly debate these high-minded ideas.

And so the thread becomes dormant again, much like the varicella virus, lying in wait along the nerve roots of our collective psyche, biding its time until a new crop of medics can bring it to flower again, their infectious enthusiasm enough to weaken the defenses of the most jaded medics until -  BOOM! – it bursts forth in a rash of red, itchy Idealism Shingles.

And it always seems to be in a dermatome I can’t quite scratch.

Once upon a time, I was that idealistic new medic whose grand ideas were rudely extinguished by the wet blanket of reality, wielded by more experienced medics like TOTWTYTR. Some of our arguments back in the day were pretty damned fierce.

And now I find myself that older medic impelled to dash the hopes of a new generation of dreamers. On the other hand, I’m not quite jaded enough not to hope. I’m a paramedic, after all, a member of a profession still in its adolescence.

And like any adolescent, we are capable of boundless enthusiasm, hindered only by our astounding naivete. I suppose that naivete is of some use, however. Many of the greatest ideas of man came to fruition only because some genius was too damned stupid to know that what he proposed wasn’t possible.

But if we’re ever going to bring EMS 2.0 to fruition, we must first start with a little perspective. George Santayana once wrote, “Those who cannot remember the past are condemned to repeat it.”

Phrased another way, we have no idea where we’re going, unless we first know where we’ve been. Well, where we’ve been is a surprisingly short road. Napolean’s private surgeon may have invented the ambulance concept in 1792, but modern EMS as we know it stems from an innocuous government document written just 43 short years ago; “Accidental Death and Disability: The Neglected Disease of Modern Society.”

Forty three years.

That’s our entire institutional history, folks. I find it apropos that Happy Medic chose EMS 2.0 as the term for his concept. If EMS were software, we’d be a Beta release – full of promise, but still with plenty of bugs.

And much like software developers, many of our professional organizations like NAEMT do nothing to fix the problems, choosing instead to insist, “They’re not bugs, they’re features!”

Add many more features, and we’ll be the public safety version of Windows Vista: bloated and slow, prone to crashes, and a hog of system resources.

In the intervening 43 years since the EMS White Paper, our role has grown far beyond that of the BLS trauma technician envisioned in the original document. Along the way we’ve become the medical safety net for the entire health care system system.

For a huge demographic in the United States, we are their primary care providers.

Some of us may see that as the natural evolution of our profession; our role expanding in pace with our growing skills and knowledge base. And they might ask, as with EMS 2.0, where we go from here, and how far might we rise?

Then again, a military commander might define many of the responsibilities we’re thinking of shouldering as mission creep. We cannot be all things to all people, and to try ultimately only lessens our effectiveness for the people who really need us.

Happy Medic gives his vision of some of the technological advances we’ll see under EMS 2.0:

“…Hospital radio reports via instant message, electronic patient care reports downloaded wirelessly on arrival, care back in the hands of the caregivers, not the bureaucrats. Alternates to automatically defaulting to transport in an ALS ambulance to an ER.”

With the exception of that last item, most of those things are easily enough done, and to my mind they represent embracing emerging technology more than an entire system redesign.

More problematic is that last goal: Alternates to automatically defaulting to transport in an ALS ambulance to an ER.

Even board-certified emergency physicians wrestle with the decision to admit someone to the hospital or not, and sometimes they make the wrong decision despite their vastly superior education. I’ll put it bluntly: paramedics are not capable of making transport/no transport decisions. We do not have the education needed to be system gatekeepers.

I’m not saying some of us can’t do it. I may be capable of making those decisions, and being right far more often than not. So may Rogue Medic, or Happy Medic, or TOTWTYTR, or many of the top tier medics in every EMS system in this country.

But then, it’s not only those medics who will be making those decisions, is it? Until every medic – even the barely competent knuckle dragger who barely passed the certification exam on his sixth try – is capable of that level of thinking, triaging patients to places other than the Emergency Department is a pipe dream.

The Fire Critic hit upon several good points in his post on the subject:

At what point in advancing more in-depth treatments, on scene surgical protocols, more advanced medicine treatments, and all around increase in skills will the Paramedics be required to go to longer schooling? This longer term in schooling might mean that many decide to go the route of a PA, Nurse Practitioner, or MD.

Exactly. Right now, medics barely have the education necessary to master their current scope of practice, much less a greatly expanded one. There are some excellent paramedic education programs out there, but for the most part, the curricula, top to bottom, is woefully inadequate.

Implementation of the National EMS Education Standards will go a long way toward addressing that problem, but even then, there may well be a ceiling to EMS education. IS there a uniquely prehospital knowledge base that is broad and deep enough to encompass, say, Master’s Degree paramedics? Doctorates in paramedicine, perhaps?

Maybe so, but color me skeptical.

At what point will this increase in overall medical knowledge require higher paying salaries?

As Fire Critic pointed out, there are already providers trained at the level to which we aspire. They call themselves nurses and physician’s assistants, and neither of them are going to work for the chump change that they pay paramedics.

You will find no one in EMS that believes they are paid what they’re worth. And you know what? Every single one of them is right. There are many EMTs whose pay is not commensurate with their training and education. On the other hand, there are thousands more knuckleheads out there who are paid far more than they are worth.

Which brings me to my next point: Even if we do significantly raise the bar for EMS education, and the salaries follow, to enjoy any meaningful increase in pay, we are not only going to have to transform EMS, but the whole friggin’ health care reimbursement system.

That’s a pretty tall order for a fledgling profession still trying to decide whether it belongs in health care or public safety, and for whom  the majority of its practitioners provide their services for free.

Make no mistake; the current debate isn’t about health care reform, despite what the politicians on either side of the aisle will tell you. No, the debate is about health care payment reform. The sticking point isn’t one of access, or quality of care, it is who will pay for it all.

Whether we foot the bill through increased insurance premiums or higher taxes, either way we’re going to pay. Pick your poison.

The only sure bets for the future of health care, including EMS, is that 1) it will cost more to deliver, or 2) we will be paid less to deliver it.

And there’s a better than even chance both will happen.  Costs to insurers and taxpayers will skyrocket, and reimbursement for services will plummet.

So the question then becomes, if we are going to reboot the system, release EMS 2.0, how will we pay for it?

The short answer is, I don’t know. And if anyone else tells you they know, they’re either liars, or running for public office.

But then, I repeat myself.

But since we’re dreaming big, and revolution is spurred by the dreamers too naive to know what is impossible, I’ll tell you what I think EMS 2.0 should be:

Less EMS.

There, I said it.

Perversely, EMS has been the victim of its own PR success. We’ve spent decades exhorting the public to call us, even for the most trivial of issues. Call 911, and Johnny and Roy showed up on your doorstep, and nobody they treated ever died.

Heartburn? Could be angina. Best call the paramedics.

Dizzy? Could be a stroke. Call the paramedics.

Witness an accident? Don’t move the victim. Call the professionals who know how to do it.

Drive yourself to the hospital? What if your heart stops while you’re driving? What if you black out? Best err on the side of caution and call the medics.

I don’t begrudge the non-emergent calls I do, even the most trivial ones, because we have conditioned several generations of Americans that they shouldn’t ever feel ill, or suffer pain, or be inconvenienced in any way, and that the wonders of medicine will cure all their ills, and that despite the fact that Grandma hasn’t spoken in seven years, or moved in three, send her to the hospital anyway, because maybe this time the Fluorescent Light Therapy she gets in the ER will magically make her whole again.

And until we can convince Joe Sixpack, Suzy Soccermom and Tyrone Rockslinger that no, they in fact don’t need to go to the ED for their viral syndrome, and that no, they don’t need narcotic painkillers when Tylenol will do, and that no, the ambulance isn’t free, even if they never receive a bill, and that yes, Walgreen’s has the same home pregnancy tests that the ER does, at a tenth of the price, and that Grandma is suffering, and there is nothing that medical science can do but prolong her pain…

… then not a damned thing will change about the delivery of EMS in the United States. We first have to change the public’s expectation of health care, and that’s a task that will take generations to accomplish, if ever.

What we need is an army of guys like Chopper:

If people took his advice to heart, every EMS system in this entire country could deliver top-notch care with 1/5 of their current personnel, trucks and equipment. ED overcrowding would be a thing of the past. Health care costs would plummet, and the cost savings would be enough to drastically increase reimbursement to primary care physicians, enough so that accepting Medicare or Medicaid patients would no longer be a money-losing proposition.

Poof, there goes the problem of access to primary care.

But the problem is, America isn’t going to harden the fuck up, at least not until future generations are raised to expect less than their parents are getting now.

So until that day comes, I believe EMS 2.0 is going to involve not giving the public what they want, but what they need.

That means more EMTs, and less paramedics. As noble as the sentiment may be, every EMS call does not deserve a paramedic. In point of fact, not every EMS call even deserves a response, but we’ll leave that can of worms unopened until we can totally overhaul our tort system.

Educate the EMTs better, and train and equip the paramedics as exquisitely as you want. Use a third service, tiered response system, with the vast majority of care delivered by an extensive cadre of EMTs. Keep only a few paramedics on duty at any one time, and develop an effective medical priority dispatch system (not the current one), that assures that paramedics only get sent to paramedic level responses. In one fell swoop, gone is the paramedic shortage, and gone is the EMT glut.

Your EMTs become medical care providers they were trained to be, instead of ambulance drivers and stretcher fetchers, and your paramedics avoid the rust-out that inevitably follows skill dilution. Medical directors, with a much smaller cadre of ALS providers to oversee, feel more comfortable with expanded skill sets. Heck, maybe they’ll even, you know, provide some medical direction to the medics’ initial education programs.

Make the EMT not the entry-level EMS provider, but the default EMS provider. If a community wants the luxury of paramedics, then let them subsidize it with their tax dollars.

EMS systems become smaller, and leaner, but demonstrably more efficient. There will still be paramedics, only they’ll be a much better educated, more elite class of provider than the current version. And their reduction in numbers, and the cost savings from training and equipping less of them, will allow higher salaries for the ones that remain.

That’s EMS 2.0 as I see it.

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Comments - Add Yours

  • http://www.firegeezer.com Mike "FossilMedic" Ward

    AD:

    Good points. I can see your vision of a smaller, leaner and more experienced paramedics in busy urban areas.

    Pity so many fire departments are trying to put a firefighter/paramedic on every rig.

    Mike

  • Sigivald

    Add many more features, and we’ll be the public safety version of Windows Vista: bloated and slow, prone to crashes, and a hog of system resources.

    That's deeply unfair… to Vista.

  • emtbernice

    I responded in a post on my blog. I'm hoping I am coming across how I hope I will…

  • http://www.999medic.com Medic999

    Hi AD,

    Very interesting post, its good to see different view points on this concept of EMS 2.0.

    I would like to discuss one point though :

    “I’ll put it bluntly: paramedics are not capable of making transport/no transport decisions. We do not have the education needed to be system gatekeepers.”

    I know its different over here in the UK, but we have been doing this in my service for the past 5 years now. There are still issues with it, the main one being what you alluded to. I don’t believe that all Paramedics should be able to ‘Cat C’ a patient (that’s our term for respond not convey). It shouldn’t be an automatic developmental opportunity 1 year after qualifying as a qualified paramedic (total of 3 years service). As you say there are some of us who are very good (read, SAFE) at doing this and there are some who will just never choose to do it. They don’t want the responsibility of making that decision and then will default to the standard transfer to hospital.

    The incidence of things going wrong with leaving patients at home are incredibly small, but it does sometimes happen, and in the vast majority of these cases, it has been proven that ‘at the time’ the patient was assessed there was no evidence of a significant health problem i.e. sometimes sh&t happens, and people deteriorate after you have left the scene.

    At the end of the day, even those who don’t want the responsibility, still use it sometimes, you don’t need years of experience to tell the patient who stubbed his toe that he doesn’t need to go, or the kid who called because he was thirsty and had a hangover etc etc. Lets be honest, in these cases we used to get them to ‘refuse transport’ anyway by giving the lines of “Oh, there is a 6 hour wait up at the hospital” etc etc.

    Paramedics can make transport/.no transport decisions. You do it already (in your head) but you just cant action what you would want to do)

    But then there comes the issue of funding. If you don’t take the patient to the ER, will their insurance pay anything out to the Ambulance company?

    When I suggested this in a post a while back, one of my readers stated that their ambulance company would go bust over night if they achieved similar to our respond not convey rate of almost 30%.

    I think this is a big part of EMS 2.0. Once the public start to realise that calling an ambulance does not necessarily mean a definite trip to the hospital, people start to think more about the reasons they are calling.

    This is one tiny bit of a huge puzzle, but I think it is an important part.

  • tclemans

    Hi Kelly. Thanks for the writing this point. I agree highly with less EMS and that the number 1 problem is reimbursement. The Seattle area Medic One system does much of what you advocate here.
    - only send medics to call that actually need them
    - only transport a very serious and critical patients
    - pay them well starting pay (starts day 1 of training) is around 75K/year + benefits
    - demand excellence training is around 3000 with an asshole physician in charge and the half-time medical director for each system knows each one of the 60ish paramedic in his program (1 of 6)
    - make the tax payers pay for it, medics including transports are funded by a levy

    I personally think EMS2 is all about focusing solely on emergency patients. The holy grail of EMS2 to get to a point where EMS only serves people having a real emergency and no one else. The system for care giving for the non-emergency patients should not be EMS.

    BTW Kelly and anyone else can freely edit the working draft for EMS2 at http://docs.google.com/Doc?docid=0AdeRgox8e2lTZ

  • http://thehappymedic.com the Happy Medic

    AD – Excellent article, as usual. Your last 1/3rd I agree with 100%. i envision a system where my current role is obsolete. it already is, but they refuse to listen. we indeed are the gate keepers, but those in control refuse to let us close the gate when we KNOW it is not needed.

    What you envision is a lean, accountable, well trained EMS delivery system. I like it.

  • http://davidkonig.com Dave Konig

    I think this is a big part of EMS 2.0. Once the public start to realise that calling an ambulance does not necessarily mean a definite trip to the hospital, people start to think more about the reasons they are calling.

    I often wonder why we, as industry professionals, spend so much time on trying to not do what we are intended to do, which in its most basic form is treating onscene and transporting to a healthcare facility. I don't think the “transport/no transport” decision making ability is as vital to the next step of “EMS 2.0” as you believe.

    I think the most vital part is to realize that in the majority of the systems we are not successfully doing the basics 100% of the time, and the first step is to improve upon what we already do.

  • http://davidkonig.com Dave Konig

    I agree with alot of what you say here, including the continuous calls for the “next level” amongst EMS Professionals, who then go right back to doing things the old way.

    I think the problem with that is two fold. We don't set achievable milestones on a national scale and we aren't content with accepting what our role actually is and therefore are always looking to make it more glorious. I think if we actually accepted our role as transporters and sought policies and best practices to improve on that instead of trying to become gatekeepers and primary care providers, we might actually succeed on the first level and be able to look to the next.

  • Ambulance_Driver

    Mike: In a perverse way, both EMS and fire suppression are victims of their own success; Fire did such a good job in fire prevention education and improved building codes, there are very few fires to repsond to any more. EMS did so well at promoting ourselves that people call us for everything. The result is that in the departments that run both, the EMS/fire suppression call ratio is around 80/20. And personally, I think departments are trying to put a firefighter medic on every rig not for better patient care, but to justify firefighter jobs.

    Medic999: The hurdles to overcome with paramedic-initiated refusals in the U.S. is twofold: Education, and reimbursement. Generally speaking, you guys across the pond have a more extensive education, and are thus more qualified to make such decisions. Some EMS systems over here, such as Seattle as Tim Clemans pointed out, far exceed the minimum standards for education and medical oversight. There are others, but they are the exception in American EMS, not the rule. Secondly, our reimbursement system is almost exclusively weighted toward transport. Your reader was correct. If an EMS system over here had a 30% non-transport rate, either they would go broke very quickly, or the personal injury lawyers would drive them out of business. The unlikely event of something going wrong isn't the problem so much as it is convincing 12 people who were too ignorant to know how to avoid jury duty that it was a sound decision.

    Dave: Good point, and one I've made before. Until we master our current practice, expanding our role is just putting the wheeled conveyance ahead of the domestic ungulate. (Today is Ten Dollar Word Friday)

  • totwtytr

    Good points, all. Some people (mostly in EMS as it happens) don't get the concept. All ALS systems have been shown time and again to have skill retention problems, high turnover, and a high rate of medical error. Still, some people insist on advocating for more of it, in hopes that will improve the situation. It's like public transit, the more of a failure it proves to be, the more people insist that “if we pour more money into it, it will work”. It won't and we'll continue to waste time and money.

  • http://www.999medic.com Medic999

    Hi Dave,

    I would go with the opinion that treating on scene and transporting to a health care facility is not what were are intended to do all of the time. Yes of course, it is the appropriate end dispostion for those patients who require hospital admission, but for those who truly do not need to go to the ER, then are we doing the best for our other patients who may need our assistance but we are unable to give it due to transporting a case who does not require any further treatment or assessment.

    As I said there are many steps to be taken, and having the ability to use the limited resources available for the benefit of the patients that actually require skilled BASIC and ADVANCED pre-hospital care, is one of them.

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  • Kelly

    I echo AD's sentiments regarding “wet blanket” syndrome. As a 20+ year veteran of nursing I enjoy the enthusiasm of the newer folks but also realize that in some capacity it's already been discussed, debated and forgotten at some point in time because there were more pressing matters– like taking care of people rather than waxing philosophical about the state of the “art.” :)
    I like the idea of a “leaner” EMS but would like to throw out there that other healthcare professions should also throw their collective hats into this particular ring; paint with broader strokes on this idea. In my opinion, the problem comes with obtaining consensus. Collectively (and generically speaking) it's pretty damned difficult to get 5 nurses, 5 doctors and 5 EMS staff to agree on the “proper” way to tape an IV for the love of all that's holy (or to interpret a flippin 12 lead the same way) much less buy in for a collective “do over” for healthcare/professional “reboot.” If you ask me consensus is the key to our collective healthcare futures and that requires arbitration—not ego and what I fondly refer to as “peeing on trees” syndrome. ;) If we can manage to keep the patient at the forefront of the collective vision and remove ego from the context of the dialog (“I know more than you do,” etc. ad nauseum) we'd be taking major strides towards our goal for “version 2.0.”

  • topv7051

    For Dave,

    The problem with accepting our role as transporters is that transporting everything IS the problem. The “E” in EMS denotes “EMERGENCY”, which 90% of our calls are not. 911 EMS ambulances and fire apparatus should not be responding to doctor's offices to transport patients across the street to a hospital because the doctor wants them admitted for tests. Which means that many times the folks who have an actual emergency have to wait while 80% of the ambulances on duty are unavailable transporting people who could have taken a cab. Any substantive change to our profession has to fix this. The reason why so many providers have poor skills-and attitudes-is because they so rarely see the need to improve them. After all, if 90%+ of your patients could have taken a cab, nothing you do in the ambulance is going to make a difference.

  • dhdoyle

    Here's my suggestion for EMS 2.0:
    Background – I live in Wyoming where most ambulances are crewed by volunteers and where medics are rare outside city limits. A rural ambulance may have a radius of 90 miles and crews of 1 First Responder and 1 EMT are quite common. I have been a citizen responder more than once where I had to keep things together for 45 minutes until the crew's pagers went off, they drove to the barn, rolled out and drove 20 miles to the location. Paramedics (vehicle or airborne) are usually the 3rd responders, sent to back up the rural service, if necessary.

    YOU may be an urban PARAMEDIC, but WE are not! So…

    How about curing the disfunctional EMS community where the more-trained personnel crap on the less-trained that they take over for? I've been reading your blog for a while, but I'm not sure that I recall ever reading about a case where you arrived to find a Firefighter/EMT or citizen covering ABCHS, interviewing, taking vitals and taking care of business. Care to guess what my “thank you-to-ass chewing” ratio is?

    1. Let's quit acting like EMS is a real food chain.
    2. Let's think about life outside the asphalt jungle.

  • Ambulance_Driver

    Dhdoyle,

    I feel your pain. For 10 of my 15 years in EMS, I worked for a system that covered 962 square miles of rural parish with two ambulances, with a trauma center often 45+ minutes away. I've only been an urban paramedic for 5 years.

    You don't read about rural first responders doing the job in my blog, because most of my blog comes from my current career. There are stories like that in my book, however.

    You are right, though. There are way too many medics out there who don't give their volunteer first responders the credit they deserve, and rarely thank them.

    I'm not one of them, though.

  • http://profiles.yahoo.com/u/VHB7MHG47HJEAEVVHP63FFO4NE stephan

    That was a very interesting thought and well stated. In the EMS management degree I am working on I did research on which systems were better at saving people; Time and again I found that the systems with less medics and community involvement actually had higher save rates then systems with more medics.

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  • http://www.lifeunderthelights.com Ckemtp

    AD, you didn't throw a wet blanket on us “Idealistic” (It sounds better than “Naive”) young pups. Looking at your comment section here, it looks like you achieved what Happy and I have been trying to achieve for a while now:

    People having a discourse about the future of EMS.

    I agree with a lot of the older medics that have spoken up condemning the rampant idealism. They've been there and seen it happen time and again. I have too, although I've only been doing this for just longer than a decade.

    The problem is, this time, I won't let it die in the mire of defeatism and day-to-day drudgery. I play in this sandbox too. It's time to sift out the cat detrius and really work on solutions.

    I don't think that you're willing to let improvement die either, as evidenced by the things I've read as a regular visitor to your home on the net and by the fact that you choose to write about this stepchild of a profession on an almost daily basis.

    No person, idea, or concept can attain real respect unless it can withstand naysayers and challenge. Keep challenging us. This may be the time where everything works.

  • perlhaqr

    But the problem is, America isn’t going to harden the fuck up, at least not until future generations are raised to expect less than their parents are getting now.

    I'm not sure the future generations need to be trained to “expect less”. They just need to be trained to better recognize when they really need the gold standard service.

    I think making those narcotic painkillers available in the vending machine might help, too. Fuck 'em, if people wanna crunch oxycontin like smarties, let 'em. At least they won't be clogging up the ED and the EMS pushing for those pills.

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  • http://davidkonig.com Dave Konig

    I understand what you're trying to say Medic999, but I think there is an oversight into the understanding that we are not intended to treat onscene and transport to a health facility… which is our training. We are trained for X number of hours with Y number of clinicals and Z number of rotations on how to treat and transport a patient. How many hours are spent on training someone to not transport a patient? My last refresher spent 15 minutes on the RMA subject, and I remember my originals spending perhaps 2 hours on the topic which is less than 1% of the training time.

    The argument that not transporting those who “don't need us” makes units available for those who “do need us” is trying to provide a solution while not fixing the problem. In that case it is as simple as the problem being demand, and the solution being to match that with adequate resources.

    The fact that we are trying to compensate for inadequate resources by not performing what we are trained proves that we have either not provided an adequate argument to our true value, or that we are over valuing our own services.

  • http://davidkonig.com Dave Konig

    I have to wonder though, topv7051, as to who exactly determines what is and what is not an emergency. Sure we have EMD that will set a priority on the call for a response based on the information provided… but would the people who call for the “non-emergencies” agree?

    The perception of the average citizen calling 911 (or your local emergency access number or point) is that they are indeed having an emergency. Who am I, as an EMT that is paid to respond to their calls for help, to tell them different?

    For a comparison, if you go to McDonald's and order a #1 Value Meal, does the cashier have the right to tell you “Oh no, you don't want that. You want the #3!”? The answer is, or should be, no. So why do EMTs and Paramedics, who at the basic atomic level work in a service industry, get to do the same thing?

  • roguemedic

    The post is EMS 2.0 by emtbernice at I Just Call It As I See It

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  • http://ambulancesboomstickscoffee.blogspot.com Jim (firefighter4884)

    AD,

    The tiered system that you describe sounds similar to the way the NJ runs their system currently.
    The county where I grew up, and initially got involved in EMS only had two ALS units on duty during the day, and only one at night. The county where I went to school had a total for 4 ALS intercept units on duty during the day, and two at night.

    I've since moved to Indiana and I'm working within a system that has an medic and a an EMT on every ambulance that does emergency response, and it seems like the medics spend the majority of their time driving trucks around while the EMTs do non-emergency transports.

  • http://ambulancesboomstickscoffee.blogspot.com Jim (firefighter4884)

    AD,

    The tiered system that you describe sounds similar to the way the NJ runs their system currently.
    The county where I grew up, and initially got involved in EMS only had two ALS units on duty during the day, and only one at night. The county where I went to school had a total for 4 ALS intercept units on duty during the day, and two at night.

    I've since moved to Indiana and I'm working within a system that has an medic and a an EMT on every ambulance that does emergency response, and it seems like the medics spend the majority of their time driving trucks around while the EMTs do non-emergency transports.

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  • JC

    Toronto EMS is actually implementing the changes you talk about towards the end of your post. More BLS for most calls, and ALS where needed. It's not quite a direct comparison, since up here our BLS providers come out of a 2 year college program, with ALS medics having another year of education on top of that (after experience). From JEMS: http://www.jems.com/news_and_articles/columns/H

  • JC

    Toronto EMS is actually implementing the changes you talk about towards the end of your post. More BLS for most calls, and ALS where needed. It's not quite a direct comparison, since up here our BLS providers come out of a 2 year college program, with ALS medics having another year of education on top of that (after experience). From JEMS: http://www.jems.com/news_and_articles/columns/H

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  • http://www.facebook.com/people/Sean-Johnson/842449453 Sean Johnson

    “Harden the Fuck Up”,,lmao,,,I’ve always referred to it as the Oprahfication of the American society. 

  • http://www.facebook.com/profile.php?id=100003701562206 Corin Meehan

    Well written. I agree that we have shot ourselves in the foot by pushing the use of EMS for “anything” to the point of ridiculousness. I also cringe every time I hear people going on about expanding the roles of EMS and whatnot. I have an idea. How about raising the bar on how we provide Emergency Medical Services? Yeah EMS, what we’re supposed to be doing already…why does everyone want to expand our role, when we have providers and systems across the country that perform at subpar levels in the areas that we are already supposed to be responsible for? Not that there aren’t great providers nationwide, I’ve had the fortune to meet and work with many of them, but I also see many providers that have no business being in the back of an ambulance at their current level of competency and/or knowledge and skill bases. I could go on and on, in much more detail and articulation, but I’m probably preaching to the choir…or maybe not…which is why I’ve given up on EMS forums online!

    In my 22 years as an EMS professional, I have not seen overall improvement in core skills, knowledge, and service delivery across the board. In some areas, I have actually witnessed decline.