You seem to have a very fatalistic view of EMS in general and what it stands to be made into with the right amount of progress..
I have been in the EMS game a long time.
EMS as it standstoday cannot meet the day to day demands placed on it. Even it's very mission of intervention in acute pathology is outdated.
The only 2 acute pathologies are trauma and toxins.
The rest of the modern pathology requires years and decades to create an acute event, it also takes years to manage or reverse. (when possible at all)
In my whole career of trying to advance EMS, the resistance to education has been absolute and constant over time.
If EMS is not willing to increase education for what it does every day, how do you propose to actually get them to focus on things outside the mission?
How are you going to pay?
Who will pay and why?
With all due respect, I am not interested in dreams of what EMS can or could be doing.
I am interested in how to actually effect the change. What is your plan?
You also seem to be referring to the response phase of EDMG, which is the smallest portion of the pie. albeit the most visible...
Not really, the whole thing.
Disaster pre-planning is not new to the world, nor is what is basically termed "recovery" which is not only getting things "back to normal" for society, but for very base level things like restoring an inhabitable environment.
What I am referring to is utilization of EMS in the largest phase of EDMG - recovery. Depending on the disaster, the recovery phase begins 3-7 days after initial impact
and can take decades...With a host of professions and vocations already more suited to it than EMS.
Why pay to retrain EMS providers when only a relatively handful of them will ever see or be a part of a disaster?
Recovery is where EMS stands to be made the most use of. This will require a large shift from what we know EMS responders as of today. Yes, this requires change is curriculum. EMS must move away from a vocational training model to an actual education model, which doesn't exist except from is small pockets across the U.S.
To what end?
Are you planning to use only the local EMS providers?
If you are planning to use them as a continued part of a recovery, who is paying?
Who is getting paid?
Who is covering the cost of OT and shift coverage from their initial location?
Who is traning them to use the equipment at the location?
Who is going to replace local assets if they bring equipment with them? At what rate? How will the local area cope with the loss of local assets?
Do you think anyone is really going to pay for "surge" effect equipment?
If they were why aren't they doing it now for even day to day surge?
No, there are plenty of job. They're just filled with wholly under and unqualified persons that walked into the positions because of a particular association with certain vocations like fire and LE.
Agreed, so do you plan to replace them by walking into their employer and telling them to clear out your desk?
Do you plan to go through the same experience path they took hoping they move on, retire, or die before you retire and open up a promotion?
Do you plan to somehow reverse the inevitable federal, state, and local budget cuts to supply money for disaster preparedness?
How?
EDMG is not focused on policy making, but rather apply policy and developing mitigation and recovery strategies. Again, the whole experience thing seems to go back to the idea that EDMG is primarily response. The response phase with what happens when all the other phases have failed.
In the first lecture I ever attended on rescue, the instructor said "The book tells you how to rescue somebody in the ideal situation... If the situation was ideal, nobody would need rescued."
Especially in the US, where it is much more the culture to clean up than prevent, there will always be a response phase.
To suggest with the best planning and preparation dsaster of any scale can be prevented is simply wishful thinking.
It was meant to be oversimplified. The caring for masses of people during the recovery phase is a logistical public health issue. Acute injuries, while it would be nice to address if possible, end up being a small issue to the larger picture of getting the "world" started back up to some sort of normalcy..
I don't think you undersand the scope of trauma and acute injuries in recovery.
The purpose of healthcare is to maintain wealth. Not only must people not be sick, they must be able to work. Trauma is the number 1 pathology that reduces productive life years. Whether those injuries happen during the disaster or after the disaster during recovery it doe snot matter in the practical sense, the goal of trauma care is to return people to productivity.
People who disable themselves rebuilding do not really see the difference in whether or not initial event injury or post event rebuilding. All they know is they are not functioning how they did. Which strains their ability to survive and prosper.
Refugee camps, as you mentioned from what I assume to be a rather unimaginative Harvard researcher, are public health issues. In this regard, there is no profession prepared to care for such issues as currently trained except for those public health trained persons that tacked it on after initial education (DR, RN, PA, etc).
Firstly, I did not say refugee camps. I said refugee conditions. Which unlike the buzzwords (like recovery) of lesser capable people to describe post event requirements, encompasses a much more accurate depiction of what is is actually occuring.
Whether it is a refugee camp, a war zone, or even post nuclear accident, refugee conditions, describe the challenges of having an inhabitable stable environment become and uninhabitable environment, and the challenges of providing basic necessities of life. It then moves into economic development, more encompassing public health issues like provision of long term healthcare, and finally infrastructure and social contracts of modern 1st world society.
It is fundamental building of a destroyed society, not returning a stricken part of a 1st world nation back to normal function. However, in my experience, I have found that many of the same lessons and challenges are applicable in isolated incidents in modern nations.
(I think the observation of rebuilding war torn Kosovo and how to appl that to large ans small disasters all over the world is a bit more imaginitive than trying to figure out rebuild part of the US from a tornado or flood.)
Secondly, if it takes doctors and nurses + extra education to rebuild (PA excluded as it is unique to a small amount of societies and doesn't cross borders as easily as doctors and nurses) you plan to retool US EMS training to meet this demand?
To do what? Give immunizations?
Let me point something out...
If I need to somehow supply, whether with imported or establishing local capability, (lets use conservative easy numbers) 3000 calories of food per day +10 liters of water for each inhabitant of a disaster area, is it better for me to add an extra responder that also requires those resouces or to use the minimal level of training possible to train a already stricken inhabitant, who I am already providing those resources for.
What about fuel and other transport costs? I have to get these providers there.
Not to mention pay them.
But I could give a local a meager job and a skill which will not only benefit him and the community in the future, while providing intangible local buy-in and knowledge, but it reduces the over all resources required at every level.
Which lends to maintaining these skills at a vocational level not an educational one.
but there is no one profession capable of solely providing definitive care in acute or long-term public health settings. It requires a system filled with many individuals with different skills to so such..
True, but it also doesn't help to pay for education and mobilization of resources which are simply not needed in order to give somebody extra contract income or protect their choice of undergrad.
The heart of the matter with EMS and utilization within EDMG is not in how it can operate and provide definitive care and outcomes, because no single profession is capable of such things, but with how it can be integrated into the larger health system and become part of the process. EMS is an interface of sorts that can be used to fulfill both care and logistical component. This can only be done trough an actual education process that encompasses a much broader scope of subjects than is currently provided in the current model of vocational training.
So what you are really saying is you want to retool EMS in the imagine of disaster response despite the fact a large percentage will never be involved in one to perform a function that is already being done by already greater educated people?
Sounds a bit more self serving to me than altruistic.
During the very short response phase this is true. This can be changed during the recovery phase, which is the real "meat" of the whole process.
So tell me what they are going to provide to justify the cost and resources they use that cannot already be done better or for less?
Hence the genesis of EDMG as a distinct academic and professional discipline. It's needed because the key to any discipline is in its education. What is also why EMS continues to have so many problems with identity, utilization, scope, etc.
There is what I think is the meat. You are trying to justify your value by changing EMS into a wasteful disaster response unit under the guise of advancing education.
