What is our purpose as EMS providers here on the 3^rd rock from the sun??  While the appropriate response to that question seems all to simple, the real answer is often lost in translation or perception. 

Almost anyone in our chosen life-saving profession would be quick to point out that we are here to improve patient outcomes by delivering the highest quality patient care to those in need.  Seems logical, right?  But the actions of many in the EMS biz often to not reflect that belief. 

Let’s take EMS system design as an example.  Recent articles published through EMS Network News have depicted system design challenges occurring in local communities where one faction is seeking to fragment a highly effective and efficient EMS system.  The most recent case is in Santa Rosa County, Florida where a local fire department was seeking to gain EMS transport rights for its city residents, taking those transports away from the county ambulance provider. 

Diane Wright of Fitch and Associates did an exhaustive and professional review and determined that fragmenting the EMS system by allowing the fire department to transport patients would diminish the clinical, operational and economic efficiency of the EMS system serving the entire region.  While this is a logical conclusion based on an objective review of the relevant facts, it should not have come as any surprise to the EMS system stakeholders.

Results of research conducted by the American Heart Association, the OPALS Studies, the University of Pittsburgh, and many other reputable organizations (not to mention the ground-breaking reviews of EMS systems conducted by Bob Davis in his infamous USA Today articles) continually demonstrates that paramedic skills deteriorate as patient/paramedic ratios diminish.  The highest performing EMS systems are the ones that have small numbers of highly utilized, highly skilled paramedics and a very high patient/paramedic ratio. 

However, despite this irrefutable scientific evidence, some people insist on pursuing an agenda that would result in lower patient/paramedic ratios, fewer patient encounters for paramedics, and an overall diminishment of EMS care provided to the patient.  A recent example of how this really impacts all patients was demonstrated during a recent site visit to a municipal EMS system in eastern Wisconsin.  When asked what percent of their patient transports were ALS, the EMS Officer replied… ALL.  Upon further questioning, it was revealed that per medical director protocol, EVERY patient in their ambulances gets an IV started – EVERY patient, regardless of clinical presentation.  When asked why this was done, the medical director stated it was because previously the paramedics’ IV proficiency rates were very low due to low utilization.  Therefore, to be sure that the paramedics could obtain IVs when they really needed to, they had to practice on every patient. 

I’ll let that one bake in your noodle a while……….

In addition to the clinical diminishment of care, there is the economic detriment to “fractionalization”.  Healthcare systems routinely look to regionalize their service delivery models…  Why??  So they can gain economies of scale, provide a seamless service delivery, minimize duplication of services to maintain highly proficient clinical care, and allocate overhead costs over a greater service area.  EMS is a utility-type of service delivery.  Much like an electric, water or natural gas company, there are heavy infrastructure costs to providing high quality, reliable EMS service delivery.  The more customers (i.e. patients) who can share that expense, the lower the cost for all users.  Removing patient services revenue from the regionalized service places an unnecessary economic burden on the remaining patients (or taxpayers when suddenly a subsidy is required).

The #1 typical argument used by some people about why they need their own local EMS transport agency is due to response time issues.  They may claim that “we” can provide faster response times than “XYZ” transport provider. 

Interesting concept… 

How many EMS calls really require a 2-minute faster response time?  In most EMS systems, only about 50% of the calls result in a patient transport.  Of those, only about 50% receive ALS care (unless of course you reside in the aforementioned eastern Wisconsin city) and only about 5% of the patients are transported to the hospital using an emergency mode and less than 1% are lifethreatening.  If the 1^st Responder Agency is ALS, then the care necessary for the patient is already available before the ambulance arrives.

If you ask any paramedic what ALS skills can be implemented within 2-minutes of arrival, they might mention defibrillation or intubation – maybe.  But are those not two skills that BLS providers with an AED and combutibe can perform?   Actually, remember that the American Heart Association stated in their Guidelines 2005 that there is no clinical evidence that intubation in the field has any positive impact on patient outcome at all.  In all likelihood, the honest paramedic will tell you that the first 2 – 3 minutes is barely enough time to do a patient assessment.  So then the bottom line policy question becomes would you rather have a paramedic who has treated 5 ALS patients TODAY within 8 minutes, or have a paramedic who has treated 5 ALS patients THIS MONTH in 6 minutes.  I’ll take the former thank you very much.

So, back to our original question – Why are we here??  I’d argue that deep down inside, everyone really does have the right answer – to make a positive difference in our community and the world.  The real question is, who are we focusing on?  If we all changed our view to really focus on making a positive difference for the PATIENT, then there would not be battles to fragment highly effective and efficient EMS systems.

Our one and only New Year’s resolution should be to make decisions that benefit ALL the patients who rely on our EMS systems. 

That is why we’re here….