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Where EMS Is Headed


There’s a fascinating piece of history in one of the towns I grew up near. The town is right on the Mississippi River, and back in the beginning of its own industrial revolution in the 1870s, it employed an ingenious power system for the factories in town. Maybe this is too geeky for EMS, but I’m fascinated by what they did. They found a way to take the power from the flow of the river, to translate it into rotational energy using a water wheel and transmit that energy to the factories around town via a system of belts and wheels rotating over the streets.

This was before electricity was commonly used and before the invention of the electric lightbulb. These belts provided energy, which ran the machines inside the factories. The people who figured out how to use this system, which was fairly common at the time, were really smart people who created an ingenious solution to a common problem.

A Foundation
Thinking about this gets me thinking about the beginning of EMS and how it’s grown and developed into the profession it is today. The people who developed the framework for modern EMS systems were also really smart people. They saw a problem, thought about solutions and devised a structure that every community could build on to take care of the problem in a similar yet unique way. They saw that “accidental death and disability” was truly “the neglected disease of modern society” and wrote the EMS white paper of the same name laying the ground rules for everything we do today. Before their efforts, we wouldn’t have recognized the ambulance services of the time.

These really smart people identified that there was a problem and affected an ingenious solution, which created the profession that I love. Their solution saves countless lives around the world every day. It’s an amazing accomplishment when you think of it, and I’m in awe of what our EMS forefathers were able to accomplish.

And now, as a paramedic with a decade or so of experience on the streets, I find myself asking a question I asked early on in my career: Have we stagnated as a profession?

Challenges of EMS
I’m a paramedic and a person who truly loves what I do. I’ve been out there riding ambulances for about the last 12 years, give or take, and I can’t get enough of it. Some years ago, I started writing down my thoughts about EMS on a free blogging site on the Internet, and today you’re reading my first column on JEMS.com. Writing my blog has been a ride to say the least. I’ve always written from the front of my ambulance, often times more literally than not. I decided that I had to change EMS because I simply couldn’t change my love for it. I believe in what we do out there and in who we are as a profession, and I say that the spirit in which our profession was created is not dead. The spirit of really smart people working together to identify and solve common problems has not gone away.

But I didn’t always feel that way.

Before I started writing about EMS and networking with EMS providers from around the country—and the world—I wondered if EMS had stagnated. I watched as my coworkers and friends struggled with common problems, such as long hours, insufficient pay, improper use of the EMS system and the career progression problems that plague the profession. I watched good and caring people get burned out and leave for greener pastures. I worked my insane hours alongside other people working insane hours, and in fact, I still do.

I still see the problems. What’s changed is that I now believe we can solve them by evolving from our water wheels to our electric lightbulbs. We have the brainpower, and we have the heart; we simply need to harness the collaborative power of all of the concerned EMS people out there who are yearning for a better solution to enhance our patient care across the spectrum.

EMS is more important to society than how they compensate us for doing it. I personally make less money than the manager at my local fast food joint. I make life and death decisions, which you may agree is different from selling hamburgers. This has got to change. EMS needs to find new sources of revenue to shore up our collective business model. The “fee for transport” model has failed, and raising taxes to cover every expense isn’t an option for the majority of jurisdictions. We need to offer new billable services and work with health-care payers to get those services reimbursed.

EMS can “save” health care. By providing a broader scope of preventative and primary care services, as well as developing new treatment pathways away from the simple “ambulance to emergency department (ED)” pathway we use exclusively now, we can improve access to primary care across all patient populations. The ambulance-to-ED model we use now is the most expensive form of primary care. We have to develop alternatives and convince those that pay for our services (e.g., Medicare, Medicaid and private insurance) that it may be cheaper, and in some cases more effective, to take the patient to an Urgent Care Center or simply to treat and release. The British have been doing it for years with their “front loaded” model. The data is there; we simply have to harness it.

So I invite you to share in helping to hone ideas into workable solutions. Together we can fix this. Together we will come up with our own ingenious solutions and graduate from the waterwheels and into the electric light.



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