Administration and Leadership, Rescue & Vehicle Extrication, Training

EMS Can’t Decide Where It Belongs

Issue 4 and Volume 37.

Although it might seem like a reach, I sometimes think of Miller Lite commercials when I think about EMS. Before you think I should be sent to AA or drug tested, let me explain.

The Miller Lite commercials, it usually starts off with one beer drinker saying that Miller Lite has great taste. The other beer drinker says that Miller Lite is less filling. Soon a shouting match between the two ensues, during which one yells “tastes great” and the other one barks “less filling.” Soon other bar patrons also get into the shouting match, and it almost looks like a wild west barroom brawl without the punches being thrown. You might even remember Rodney Dangerfield and John Madden in some of the commercials.

So what does this have to do with EMS?

For years, I’ve heard one group of EMS professionals say that we’re public safety providers. Another group says we’re medical care providers. What I’ve seen is clear-cut opinions with no distinction or overlap into either camp. Unlike police and fire departments that know they’re public safety, EMS still seems to wrestle with where its identity falls. The common question has always been, “Are we medical care providers doing EMS, or are we public safety providers doing medical care?”
The arguments are sound on both sides.

The EMS Role
Public safety is commonly described as the prevention of and protection from events that could endanger the safety of the general public from significant danger, injury/harm or damage.
Doesn’t EMS provide protection to the general public, specifically regarding injury or harm? Don’t those who dial 9-1-1 for an EMS event go through a public safety answering point?

If someone is trapped in a car, injured, and has to be extricated, is that not providing public safety? I don’t see it as providing healthcare. For someone who’s injured and needs to be rescued from water, a collapse or a hazmat event, is that providing medical care or public safety?

I did a Google search and found that many public EMS agencies fall under a department of public safety in their respective communities. Others fall under the department of health. So even community leaders are divided as to whether EMS is public safety or medical care.

I always found it interesting that a lot of good ALS is provided from vehicles that aren’t ambulances but from what’s traditionally considered pubic safety agencies, such as fire engines, first responder squads and police vehicles. Finally, I find it ironic that those who say EMS is a medical care function don’t hesitate to claim that their employees are eligible for the public safety officer’s federal death benefit if their employee dies while performing EMS. But there’s valid argument from those who claim we’re medical care providers. There’s no denying that the majority of what we do is deliver medical care to someone who’s injured or ill. Our EMS education and continuing education as EMTs and paramedics is more focused on anatomy and physiology, assessment and treatment protocols than it is with how to peel a roof off the top of a car.

From a clinical perspective, we’re closely tied to hospitals, physicians and nurses. Most EMS agencies have a medical director who establishes medical protocols and procedures. Adding to the debate: EMS Agenda for the Future describes EMS as the intersection between public health, public safety and healthcare.

So what are we? Are we medical care providers doing public safety work, or are we public safety professionals doing medical care work?

Third Possibility
I’d like to offer a third school of thought. With all this said, I have come to two conclusions. First, we aren’t solely medical care providers, and we aren’t solely public safety—we’re both. The scope of what we do covers both aspects. My second conclusion is … who cares? Even if the president of the U.S. were to give a speech declaring EMS as public safety or medical care, would it change anything? If Mrs. Smith were hurt and trapped in a car after an accident and needed a rapid response, extrication from the vehicle and to be treated for her injuries and transported to a hospital, would she really care whether the people on the scene considered themselves medical care providers or public safety providers? Probably not.

We really need to worry about more important issues affecting our profession. JEMS

This article originally appeared in April 2012 JEMS as “Identity Crisis: Where EMS fits into the public safety & healthcare community.”