Insights
Decision Time: Healthcare vs. Public Safety

Nov 10, 2004, 12:00

One of the most discussed yet unresolved issues in emergency medical services centers on the basic role of EMS in our society. Some believe EMS is a healthcare function while some cling to the belief that the provision of EMS is a public safety function.

Let�s examine the basic tenets of healthcare and public safety in order to gain 'insight' on where EMS fits, finally answering this pressing question.

Merriam Webster's dictionary defines the term 'public' as "of or relating to business or community interests as opposed to private affairs". In essence, pertaining to more than one person. Promulgating life-safety building codes, pre-fire planning, extinguishing fires, mitigating hazardous materials incidents (including auto accidents), assuring fire hydrants function properly, fire prevention education, and conducting controlled brush fires to reduce wildfire danger, providing traditional rescue services are easily interpreted as safeguarding the public. The same could be said for issuing traffic fines, arresting bad guys (especially the slime ball who burglarized my garage and stole my mountain bike this week...), controlling crowds, investigating crimes and preventing terrorist attacks. These services benefit people in general, not a specific person -hence, public safety. In this regard, it is very easy to see why police and fire departments are categorized as "public safety" agencies.

Conversely, EMTs and paramedics assess medical conditions, control bleeding, splint fractures, interpret cardiac rhythms, and administer drugs. While the services of EMS are offered to the public, medical services are provided to a specific individual -the patient! Administering lidocaine to a person suffering ventricular tachycardia does not safeguard the public in the same way that absorbing fuel from a ruptured gas tank at the scene of a car crash prevents additional public catastrophe from a resulting explosion.

Want more insight? How about the fact that EMTs and paramedics are supervised by doctors and other healthcare professionals, while police officers and firefighters are supervised by public officials appointed by elected officials. Or the fact that EMS professionals bring patients to and from hospitals or other healthcare facilities and are required to complete continuing medical education. Some EMTs and paramedics even work in hospitals, most EMS agencies are regulated by the Department of Health and invoices for EMS care are covered by - you guessed it - health insurance.

So let's finally put to rest the debate that EMS not a public safety function; it is a healthcare function, provided by healthcare providers who are supervised by healthcare professionals.

Traditional public safety agencies often have a difficult time integrating the provision of healthcare because it is a totally different type of service, especially the ambulance component.

In the past, New York City had one of the most highly respected EMS systems in the nation, provided by the New York City Health and Hospitals Corporation using hospital-based ambulances augmented by a civilian workforce. It has been widely reported that the recent integration of NYC*EMS into FDNY has been problematic at best. The current crisis occurring within San Francisco Fire Department is another example of a difficult EMS/Public Safety integration, not to mention the whole Chicago situation.

Boston EMS, one of the best performing EMS systems in the nation as reported in the July 2003 USA Today� series 'Six Minutes to Live or Die', maintains that one of the cornerstones of Boston EMS' success is the fact that it has preserved its autonomy by resisting efforts to be integrated into the fire department.

There are numerous examples of effective and successful healthcare integration into public safety agencies. In most cases, public safety agencies that have successfully transitioned to providing healthcare services operate the healthcare component as a separate functional unit with a specific healthcare focus. Among the most notable are Seattle Fire Department�s Medic One program, San Diego Medical Enterprise Services and Phoenix Fire Department's Emergency Transportation Services (ETS) program. These public safety agencies have recognized the unique differences between providing healthcare services and traditional public safety services. They also acknowledge that healthcare professionals can trump the public safety professionals in issues related to patient care. It's that acknowledgement that makes them successful. One has to know their limitations.

EMS needs to be maintained and preserved as a pure healthcare function. Agencies undertaking, or desiring to undertake this essential role must realize and embrace the differences. Failure to do so may collapse an already fragile house of cards and dilute the ability of EMTs and paramedics to effectively provide medical care to the most important component of our systems, the individual patient.


Coming upï- EMS' role in Community Health -Preventing the Next 9-1-1 Call.

11/10/04



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