Critical thinking: Is EMS classified as public safety or healthcare?

[Tnaemt94]

EMS obviously plays a vital role in the healthcare world. It is even in the name. Emergency MEDICAL Services.

We are also in close contact and interaction with fire, rescue, and law enforcement personnel in the field. And often times, fire, rescue, and law enforcement officers are cross trained to perform emergency care (ex. FF/EMT)

But EMS on its own, not including those cross trained to perform other functions, are we also considered "public safety"? People, especially the general public, like to tie us in with police and fire. After all, we respond to emergencies and go lights and woo woo to people in peril (at least EMTs and medics that work on an ambulance out in the field). But with EMS, the services we provide are usually billed to the patient, creating more of a business-like model. While the services law enforcement provide and fire provide are included with tax revenue. Plus, law enforcement and fire focus on the public as a whole, especially on a prevention aspect, while we are focused more on the patient amd the injuries sustained more than resolving the root safety issue itself.

If you look at physicians, nurses, and allied health staff that work in the ED, they also help the public and provide emergency care too, but usually only in a controlled environment and not out in the field.

Of course, EMTs and medics can also work in the hospital setting too and not just in the field (ex. ED tech)

So are EMTs and Paramedics linked to the
"public safety" profession or not? And what really distinguishes EMS personnel from other healthcare professions that link them to public safety more so than the others?

Again, this was just a thought that came up and I started over thinking it more in depth. It does not matter in the long run anyways, I love my job as an EMT.

 

[Chewy20]

EMS obviously plays a vital role in the healthcare world. It is even in the name. Emergency MEDICAL Services.

We are also in close contact and interaction with fire, rescue, and law enforcement personnel in the field. And often times, fire, rescue, and law enforcement officers are cross trained to perform emergency care (ex. FF/EMT)

But EMS on its own, not including those cross trained to perform other functions, are we also considered "public safety"? People, especially the general public, like to tie us in with police and fire. After all, we respond to emergencies and go lights and woo woo to people in peril (at least EMTs and medics that work on an ambulance out in the field). But with EMS, the services we provide are usually billed to the patient, creating more of a business-like model. While the services law enforcement provide and fire provide are included with tax revenue. Plus, law enforcement and fire focus on the public as a whole, especially on a prevention aspect, while we are focused more on the patient amd the injuries sustained more than resolving the root safety issue itself.

If you look at physicians, nurses, and allied health staff that work in the ED, they also help the public and provide emergency care too, but usually only in a controlled environment and not out in the field.

Of course, EMTs and medics can also work in the hospital setting too and not just in the field (ex. ED tech)

So are EMTs and Paramedics linked to the
"public safety" profession or not? And what really distinguishes EMS personnel from other healthcare professions that link them to public safety more so than the others?

Again, this was just a thought that came up and I started over thinking it more in depth. It does not matter in the long run anyways, I love my job as an EMT.

Are IFT personnel public safety? No, that's not their jobs. There are departments that are owned by the public (county and city run providers). So yes, plenty departments are deemed "public safety". We still bill patients, even though their tax money goes to paying my salary and services.

What distinguishes EMS personnel from other medical providers? Our lack of education and standards.

 

[Tnaemt94]

Are IFT personnel public safety? No, that's not their jobs. There are departments that are owned by the public (county and city run providers). So yes, plenty departments are deemed "public safety". We still bill patients, even though their tax money goes to paying my salary and services.

What distinguishes EMS personnel from other medical providers? Our lack of education and standards.

There are private companies that are contracted by counties and municipalities to provide primary EMS services. They deal with the general public too, except it is a for- profit company instead of a government service. But the responsibilities are still the same.

The main difference with EMS personnel and some other healthcare professionals like nurses in terms of education (well, especially in my state) is that EMT and Paramedic education can be gained through a certificate program versus a degree path, while nursing entails a degree pathway (requiring general ed credits, longer schooling, etc.).

Here, you can tack on an associates degree of allied health sciences, where the main difference is you taking general ed credits like humanities, fine arts, sciences, etc.

 

[Chewy20]

There are private companies that are contracted by counties and municipalities to provide primary EMS services. They deal with the general public too, except it is a for- profit company instead of a government service. But the responsibilities are still the same.

The main difference with EMS personnel and some other healthcare professionals like nurses in terms of education (well, especially in my state) is that EMT and Paramedic education can be gained through a certificate program versus a degree path, while nursing entails a degree pathway (requiring general ed credits, longer schooling, etc.).

Here, you can tack on an associates degree of allied health sciences, where the main difference is you taking general ed credits like humanities, fine arts, sciences, etc.

So why are you even asking in the first place when you answer yor own questions? It's pretty black in white of what a public safety entity is.

Anyone that is doing 911 is trying to keep the "public safe".

 

[Tnaemt94]

So why are you even asking in the first place when you answer yor own questions? It's pretty black in white of what a public safety entity is.

Anyone that is doing 911 is trying to keep the "public safe".

I am distinguishing the two in terms of education, not in terms of classification.

Now I am starting to get lost and confused...haha.

My question is why are EMS personnel grouped with public safety more so than other healthcare professions? In other words, are prehospital EMS personnel considered public safety?

It is this artical that really got the ball rolling:

One of the biggest issues facing EMS is that we’re not sure what we really are. Is EMS health care? Is EMS public safety? Is EMS public health? In its recent publication, the National Institutes of Health determined that EMS actually has components of each of these ( see Figure 1 ).[1] The responsibilities of each of these three disciplines are diverse. Can we do all three well? This question makes me reflect on my days as a medical student, learning about medical ethics. You respond to an auto versus tree collision. En route to the hospital, the patient admits to having a crack cocaine addiction and dropped his crack pipe while driving and hit the tree. He tells you he’s on probation for possession of a controlled substance and being arrested again will ensure that he’ll be incarcerated. He says, “Please don’t tell the cops.” Do you keep what he tells you in confidence or do you report it to authorities? You’re transporting a 27-year-old male to a hospital after he was found beaten in a hotel room. En route, he tells you he was having an extramarital homosexual relationship with a man with whom he works. He asks you not tell his wife what happened and asks you to lie and say he was beaten outside the elevator of his office. His wife meets you at the hospital and begins to question you, tearfully, about what happened to her husband? What do you tell her? You pick up an EMT who works for a neighboring ambulance service. While off-duty and in his private vehicle, he was struck from the rear by a drunk driver. En route to the hospital, the EMT pulls a small baggy of marijuana out of his pants and asks you to throw it out of the ambulance. Do you throw it out? Do you tell the police? An elderly patient has end-stage COPD. She has been on oxygen for 6years and weighs 80 pounds. She has been intubated and placed on a ventilator seven times. The last time, she was on the ventilator for 17 weeks. She’s in respiratory failure and pleads with you not to intubate her. Your service does not have CPAP. The nursing home staff seemed to indicate that everything possible should be done. Should you honor her requests and let her die? Should you intubate her as “the rules say”? In EMS, we have to make decisions in the best interest of our patients. Thus, there may not be any rules or laws to guide us — only moral and ethical principles. Sometimes, the rules and laws may actually conflict with what’s best for the patient. Law enforcement officers can always cite the law as the moral determinant of what to do. But I would maintain that the best law enforcement officers are those who enforce the laws through moral reasoning. Thus, instead of writing a public intoxication citation for a chronic inebriate (Stage 4 reasoning), they give the person a ride to a detox center or shelter (Stage 5–6 reasoning). I realize that this is an extremely complex issue. But before we determine what EMS truly is, we have to look at the ethical and moral decisions EMS personnel have to make — for that’s truly who we are. In the overall scheme of things, EMS personnel are much more like physicians than public safety officers. Thus, I think that EMS should be more health care and less public safety ( see Figure 3 ). The best EMS systems I’ve seen are those where EMS is a part of the healthcare system (e.g., Australia, United Kingdom). I think fire departments do a very good job of bridging this moral gap. While fire departments enforce laws (e.g., building codes and fire-lane violations), they primarily serve to protect individuals and their property. In my opinion, they do a great job. Fire departments, although considered “public safety,” have less trouble straddling moral EMS issues than do police departments. This is why the concept of EMS as part of a public safety department (fire, police, EMS) has failed in most communities. In summary, before we can address EMS’s identity issue, we must first critically examine our moral and ethical thinking and constraints. References National Academies of Science, Institute of Science: “Emergency Medical Services: At the Crossroads.” The National Academies Press: Washington, D.C., 2006. Kohlberg L: "The claim to moral adequacy of a highest stage of moral judgment." Journal of Philosophy. 70:630–646, 1973. "

 

[Chewy20]

Public safety are people actually out in the field.

Are doctors etc. taking care of the public? Sure but they are not considered "keeping the public safe". They are not in the streets preventing things from happening or keeping stuff from further hitting the fan when an event has occurred. That's the way I see it anyways.

Just the way it is. Police, Fire and EMS have always been called public safety due to actually being seen by everyday people going on with their day, and knowing that those entities have their back if they need it. You don't get a hospital when you call 911.

I would group EMS into both fields. Just due to our interactions and relationships with the receiving hospitals.

 

[Tnaemt94]

Public safety are people actually out in the field.

Are doctors etc. taking care of the public? Sure but they are not considered "keeping the public safe". They are not in the streets preventing things from happening or keeping stuff from further hitting the fan when an event has occurred. That's the way I see it anyways.

Just the way it is. Police, Fire and EMS have always been called public safety due to actually being seen by everyday people going on with their day, and knowing that those entities have their back if they need it. You don't get a hospital when you call 911.

I would group EMS into both fields. Just due to our interactions and relationships with the receiving hospitals.

But tow truck drivers and wrecker services are also in the streets. They also respond to accidents and are seen in the general public. They help stranded motorists in harms way. But they aren't classified as public safety.

Idk...my mind is just on a roll over thinking this.

 

[escapedcaliFF]

If you asked hose monkey based fire ambulances they would respond slowly in grunting tone they are "public safety."

 

[cruiseforever]

But tow truck drivers and wrecker services are also in the streets. They also respond to accidents and are seen in the general public. They help stranded motorists in harms way. But they aren't classified as public safety.

Idk...my mind is just on a roll over thinking this.

Minnesota considers these part of public safety on the roads.

When traveling on a road with two or more lanes, drivers must keep over one full lane away from stopped emergency vehicles with flashing lights activated — ambulance, fire, law enforcement, maintenance, construction vehicles and tow trucks.

 

[Tnaemt94]

Minnesota considers these part of public safety on the roads.

When traveling on a road with two or more lanes, drivers must keep over one full lane away from stopped emergency vehicles with flashing lights activated — ambulance, fire, law enforcement, maintenance, construction vehicles and tow trucks.

You are talking about in terms of the "move over for stopped emergency vehicles" law.

I am talking about I general. Is EMS classified as public safety and how so? And how are EMS personbel more related and linked to fire and law enforcement more than any other healthcare professional?

In other words, how are we seen as "brothers and sisters" to police officers and firefighters?

 

[Chewy20]

You are talking about in terms of the "move over for stopped emergency vehicles" law.

I am talking about I general. Is EMS classified as public safety and how so? And how are EMS personbel more related and linked to fire and law enforcement more than any other healthcare professional?

In other words, how are we seen as "brothers and sisters" to police officers and firefighters?

You're thinking way to hard about something that does not matter. What police and fire think of EMS is usually a city by city basis. Who cares.

 

[Jim37F]

Can we not be both at once?

 

[escapedcaliFF]

Sure can.

 

[EpiEMS]

The public health role is definitely the most under appreciated, but EMS, today - yes, including IFT - is primarily operating in a public safety model:

- Responds to the scene when called?
- Trains primarily to respond to emergencies?
- Paramilitary in organization?
- etc.

The list goes on and on.

 

[Tnaemt94]

The public health role is definitely the most under appreciated, but EMS, today - yes, including IFT - is primarily operating in a public safety model:

- Responds to the scene when called?
- Trains primarily to respond to emergencies?
- Paramilitary in organization?
- etc.

The list goes on and on.

I think the difference is this:

Let's say a medic unit responds to a report of a pulseless and apnic patient. Upon arrival, the patient was found to be in cardiac arrest. If this patient dies, there is no danger to anyone else. Yes, there is emotional damage attached to it. But the death of a person does not put other lives in danger. Therefore it is not really a matter of a public concern but a concern to the individual.

Versus if there is a structure fire with other surrounding homes and occupants. That fire threatens the lives of other people, therefore, it is a safety matter that can ultimately affect other people.

Same goes with an armed and violent person that can threaten the lives of other people. Law enforcement plays a role in subduing that person and as a result saves others lives.

Does this make sense?

Basically fire and law enforcement protect the lives of the public as a whole, while EMS personnel protect the patient(s)

 

[Tnaemt94]

Here is the article I was referring to

http://www.jems.com/articles/2007/08/should-ems-be-part-public-safe-0.html

 

[Tigger]

I think the difference is this:

Let's say a medic unit responds to a report of a pulseless and apnic patient. Upon arrival, the patient was found to be in cardiac arrest. If this patient dies, there is no danger to anyone else. Yes, there is emotional damage attached to it. But the death of a person does not put other lives in danger. Therefore it is not really a matter of a public concern but a concern to the individual.

Versus if there is a structure fire with other surrounding homes and occupants. That fire threatens the lives of other people, therefore, it is a safety matter that can ultimately affect other people.

Same goes with an armed and violent person that can threaten the lives of other people. Law enforcement plays a role in subduing that person and as a result saves others lives.

Does this make sense?

Basically fire and law enforcement protect the lives of the public as a whole, while EMS personnel protect the patient(s)

Both fire and law enforcement do most of their "protecting" via prevention, not response. Both of your examples show the stereotypical roles of both agencies, but discount the fact that both of those incidents are incredibly rare and that both agencies devote significantly more time and resources into preventing them.

Which is something that EMS is also in a position to do. What caused the patient to die? Chronic condition exacerbation that could have been prevented with an outreach program? A traffic accident in which the patient was unrestrained? Where was EMS in the annual seatbelt campaign? EMS can do a lot more than just protect the individuals, it's just whether or not the industry is willing to make changes to do so. The focus on individual patients is going to make EMS much less relevant as healthcare progresses. Adapt or die.

 

[Tnaemt94]

Both fire and law enforcement do most of their "protecting" via prevention, not response. Both of your examples show the stereotypical roles of both agencies, but discount the fact that both of those incidents are incredibly rare and that both agencies devote significantly more time and resources into preventing them.

Which is something that EMS is also in a position to do. What caused the patient to die? Chronic condition exacerbation that could have been prevented with an outreach program? A traffic accident in which the patient was unrestrained? Where was EMS in the annual seatbelt campaign? EMS can do a lot more than just protect the individuals, it's just whether or not the industry is willing to make changes to do so. The focus on individual patients is going to make EMS much less relevant as healthcare progresses. Adapt or die.

These examples are very stereotypical. Although I am making a point that during a scene of an emergency, the duties of leo's and fire pertains to everybody, while the duties we perform mainly benefit the patient.

Although, we do have a responsibility to the general public in the fact that anybody can be a patient at any given time. And that we respond to the needs of the general public, like law enforcement and fire does. While hospital personnel are resposible for the patients they receive at their facility. So, we have more of a response role, while er staff have more of a receiving role.

So in a way yes we can be linked with law enforcement and fire in the public safety category I guess in that aspect, but again during an emergency situation we have the ultimate responsibility to the patient or anyone injured or acutely I'll in that present moment.

The examples you provided are examples of public education. But I have seen hospitals get proactive with public education too, not just EMS personnel. I am talking mainly about emergency situations and our role to the public, or really the patient rather.

 

[RedAirplane]

The categories of "public safety" and "healthcare" aren't universal laws of Physics. They're bins assigned names by humans to put things in. You could call EMS Shirley instead if you wanted to I guess.

 

[EpiEMS]

I think the difference is this:

Let's say a medic unit responds to a report of a pulseless and apnic patient. Upon arrival, the patient was found to be in cardiac arrest. If this patient dies, there is no danger to anyone else. Yes, there is emotional damage attached to it. But the death of a person does not put other lives in danger. Therefore it is not really a matter of a public concern but a concern to the individual.

No question that this is health care. But it is also a "public safety" response - they were accessed via the 911 system, they responded in an emergent fashion, the response was to an acute incident, and they probably worked with other public safety functions. What makes this different from rescuing a stranded window washer or responding to an emotionally disturbed individual threatening self-harm?

Versus if there is a structure fire with other surrounding homes and occupants. That fire threatens the lives of other people, therefore, it is a safety matter that can ultimately affect other people.

These represent a mere fraction of FD responses. Even in the case of a structure fire, isn't the FD *primarily* there after occupants have already evacuated? And isn't the main value add to protect property adjacent to the incident?

Basically fire and law enforcement protect the lives of the public as a whole, while EMS personnel protect the patient(s)

EMS protecting patients is no different than the police responding to a burglary or the fire department to somebody stuck up a tree.