Reply to the Kaiser

Life Under the Lights, a well known EMS blogger, has posted a quagmire. He is challenging his belief in the current model of EMS in the United States. I started writing a reply, but it turned in to a soap box moment. Go read his post, then if you want to can read my reply below.

Chris,

You have issues, but being a hypocrite is not one of them. Regardless of what we want to believe EMS is still there mainly to bring the patient to the care. All the interventions we do are for stabilization purposes. How many service out there will actually allow you to treat a patient and release them? There are a few, but the majority of the systems require transport to “definitive care” at a hospital.

The entire health care system in the US is predicated on the idea of *treating* symptoms. We do VERY little on the prevention end of the spectrum (yes that is a pandora’s box of issues). How many fires do you prevent by extinguishing one? NONE. The fire service is doing an excellent job at PREVENTION through a variety of means. How many crimes to you prevent by arresting people? NONE. The law enforcement are very active at prevention. Why does the entire medical system (from doctors, hospitals, insurance companies, Ambulance services) think we can improve public health by treating symptoms?

You want to bring the care to the patient? So do I, we need to bring the public health office to the patient. Community Paramedic programs are starting to gain acceptance, bringing health checks, medication compliance, education to the community. There will ALWAYS be a need for an EMERGENCY medical service, but few interventions actually affect patient outcome (STEMI programs are a shining example of EMS improving patient outcome).

We need to stop thinking in the confines of a system built in the late 1960s and 1970s, that has stagnated in the “Taxi cab with lights and sirens” stage of development.

Ambulance systems are not intended to be a one size fits all. Germany also employs a physician based ambulance service. An ambulance crew consists of a physician and a paramedic. London Ambulance employs physicians on their HEMS wing (pun intended). I cannot say that physicians have no role on the ambulance. The system we have has not been designed for physicians to respond on or with an ambulance.

We have allowed paramedics to have a scope that is very narrow, but highly technical, to reduce the need for physicians on scene. Study’s have shown that paramedics are just as good at ECG interpretation as emergency physicians. Paramedics are also proficient at intubation, IV administration, and diagnosing specific, emergent life threatening problems.

Each EMS system needs to be tailored to the community it serves. We need to dissuade the notion of “Emergency only” when we think of ambulances. How many communities asked paramedics to administer H1N1 vaccinations not that long ago? Is that an “emergency” service? Paramedics are part public health, part public safety. Lets stop thinking only in terms of bringing the treatment of symptoms to the patients, and lets bring prevention to the masses.

</Soap Box Rant>

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About Joel

I am a paramedic, firefighter and I work for an organ procurement organization. All stories related to work have been altered to HIPPA standards and for the protection of those involved. The personal stories are different. Photography, flying, aviation, hiking, camping, travel, geocaching, amateur radio are a few of my hobbies.
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2 Responses to Reply to the Kaiser

  1. Tj says:

    A well written response which is made on one assumption – release.

    The phrase ‘alternative care pathway’ is being used here in the UK more and more now. STEMI, Stroke, trauma, diabetes… hey, diabetes? Yep. Have a hypoglycaemic pt you’ve put right, used to be see, treat and discharge if the BM was above 5. Now we’re told the gp has to be notified. This care pathway enables a holistic picture to be made by the ‘family’ doctor. We also screen for high bp, AF and diabetes which are all significant risk factors for stroke.

    It’s only one of several care pathways which enables us to safety net pts without transporting them to ed. Why is this good for the Paramedic profession? It enables community healthcare professionals to see the advances we have made from being ambulance drivers to technicians to professionals in our own right, IF the Paramedic has had suitable education to write the job up in a professional medical style.

    Until all our paramedics (in the western sense) have at least diploma degree education, it is unlikely this standard will be set *across the board*.

    All the best,

    Tj

    @meditude

    • Joel says:

      Interesting, my services (I’ve worked in 3 services) have always been allowed to treat and release diabetic patients. One service has to call online med control to get permission to release without transport.

      There are very few cases when we can transport to alternate locations. Strokes, STEMI, and trauma are the only times we can bypass the closest hospital for definitive care.

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