Do we REALLY save lives?

[rescue1]

Hi all,

Maybe it's just my early semester blues hitting me, but during one of my weekly grumble sessions about one of my volunteer ambulance companies, I had a depressing thought. My college town's EMS agency is slightly old fashioned, boasting response times of around 10 minutes for calls a few miles away, and providers who barely squeak by their EMT recerts (and anyone who's taken a Maryland recert course should know you have to try very hard to fail). Yet as a friend and I were discussing the benefits of the town being served by a paid ALS service instead, I couldn't help but think...would the citizens actually be better off with a new service?

Think about it...many new studies show that with the exception of serious trauma and arrest (which is probably around 1-2% of EMS runs), response time, and even scene to hospital time, has little overall effect on patient outcomes. Other studies show that ALS may be less effective then BLS care when dealing with trauma (though some have disputed that). I've seen many patients survive serious medical issues despite the best efforts of providers to kill them with improper care. So while we sit here and talk about professionalism and increased standards for EMS, my question is...how good much do we actually do?

I know we serve as a gateway for people to enter the hospital system, serving as a triage of sorts...strokes to the stroke center, MVC victims to the trauma center, people with headaches persisting for several weeks to the local ER, etc.

There's cardiac arrest survival too...EMS is basically the only hope for out of hospital SCA victims...but they account for a handful of EMS runs.

But for the other 90% + of our calls, (discounting the headaches, the nursing home runs, and the lights and sirens to the scene at 4am to find a chronic diarrhea patient calls), do we really make a big difference? If there were no ambulance, and people were driven by family members or upstanding local police officers, how worse off would the public be?
Or if we were back in the early days of EMS, and all we have in our arsenal is a fast response time and a giant box of gauze, would our patients be worse off in areas where the hospital wasn't unreasonably far away (which by my guess is probably 80% of the country)?

Or can someone show me how higher education and training standards will lead to significant increases in patient care outcomes? Because while I am all for increased education, it's difficult for me to think about spending large sums of cash upgrading paramedics and EMTs to new, great standards while I watch a system with slow response, minimal training and outdated equipment transport alive and stable patients to the hospital every day.

I can justify my existence as a firefighter--without the FD, city blocks would burn, people would remain trapped in cars and kittens trapped in trees. My friend can justify his existence as a cop--without police, life would be a little more exciting and dangerous for obvious reasons. But without EMS? People would have to...find someone to drive them to the hospital.

I'm not trying to bash EMS, far from it. I want someone to jump up and prove me wrong and show me that EMS is good and awesome and fantastic and that paramedics with 4 year degrees will make it better. So please, tell me how great EMS is and that I'm wrong.

 

[Aprz]

I support increasing education hoping that it would reduce the number of people we unnecessarily transport to hospitals, and to manage their problems sooner rather than waiting for the ER to solve it. Our education standards and the system works, but it's not good; we can do better.

 

[Melclin]

If driving people to hospital is all EMS is doing in your area then maybe it is reasonable to question it.

To me the idea of improving education and standards is all about actually being worthwhile to the community. I think it is sometimes reasonable to question the idea of EMTs being taxi drivers with AEDs.

Its interesting, and perhaps indicative of the "company" you feel you keep, that you compare yourself to police and fire. The first people I think of when comparing paramedics to someone are other healthcare professionals. I'm not being nasty, but I think its an interesting observation. If you see yourself and being only for emergencies and life saving, CPR and car accidents and bells and whistles and blood and guts, then yeah, you might start asking questions. I'd argue that a lack of all that doesn't mean we're useless, because the bulk of work and benefit to the community can be felt in other ways (if appropriately educated).

I did a little "study" I suppose you could call it. Maybe personal audit might be a better word. I forget the stats exactly and I can't find the papers right now but I'll give you what I had written in my notepad from a while back. Basically what I did was that for about a month I categorised jobs into one of the following categories:

1. Those I felt a reasonable lay person would or should call an ambulance for.

2. Those that I felt a reasonable lay person would recognise needed to go the ED but could have got there via their own means or gone in their own time (things like lac requiring suture + tentnus at 0330, ?bowel obstruction with significantly distended abdo in an ambulant CA pt with family and a car).
3. Those that a reasonable person would not call an ambulance for and that could and should be managed through their GP or self care.

Then for each job I noted whether or not an intervention was performed. I didn't include advice/referral as an intervention but I soon realised I should have given that its own category. I also didn't include cannulation where I didn't give any drugs or fluids (it was a just in case cannulation or a line for the hospital to do bloods with).

I went to 42 jobs as the attendant during "data collection" . I was surprised at the results.

-68% of jobs I classified as one for which a reasonable lay person would call 000. (I thought it would be much less, and this felt like a bad month in the regard too, so I'd wager about 3/4 in most months).
-9% should have recognised that an ambulance wasn't needed and got to the ED themselves (but notably it was often not their fault because ridiculous advice lines, like "nurse on call" that basically tell people to call an ambulance regardless of complaint, told them too.
-23% could have been handled via GP or self care.

I performed a meaningful clinical intervention in 23% of these cases, mostly pain relief.

I got several things out of this audit:

1. We don't go to as much BS as I thought. You could make an argument the about 3/4 of what we went to actually required that we be there to assess a pt (a reasonable lay person, or even a HCP, would have called 000). Maybe we weren't required to medically intervene, but its not the public's job to know that in advance, and, at the very least, a decent healthcare assessment was required. So I don't see it as a waste and 3/4 ain't bad.

2. The intervention rate was higher than I thought - I actually got hands on with more people than I thought.

3. The number of time wasting idiots who should have known better was actually quite low when I really thought about it and circumstances surround each job.

4. Not included in the data collection but something that kept coming up again and again, was that for every single self care/GP job and for others as well, I was educating, advising and referring.

Example: To CA pt with D&V since chemo, "Oh see than Ondansetron there, that is for nausea and its better than that other one, so remember to take that next time. Now tomorrow I want you to do a couple of things. I need to you try and eat some small amounts of food. Small portions, well spaced out. Yep those ones you planned. Send husband down to the pharmacy. Get some gastrolyte, they come in icy poles too which are good if you don't feel like you can drink or eat much, and some gastrostop, and talk to the pharmacist about them, explain whats happening, they're really helpful and he'll tell how and when to take them if you need them. Now stay away from sugary drinks. I know mum always said flat lemonade when you're sick but its actually worse for your diarrhea", *write it all down + a note to the pharmacist explaining the situation and asking for his/her advice*. "Now if you feel dizzy, or you spike a fever. Head down to the ED, but its unlikely that you'll need an ambulance. Are you happy with and do understand the plan we've made?"

Other examples include spending time on the phone with pt's doctors, case workers etc and sorting out what kind of care pathway is best for them. I've found specialists and GPs are really helpful if you take the time to ask.

I went to a job once where a baby had been "throwing up blood". After a little detective work we found out that the antibiotic syrup she was on was red and she'd spit a little up. During the worrying, dad fainted and we looked him over too. After about an hour spent there, thoroughly assessing baby and then dad, treating dad, making care plans for both of them, reassuring them, exchanging favourite pasta bake recipes and having a bit of a laugh, we left. As gloried first aiders we could have transported baby and dad in a second ambulance, wide eyed, to hospital L/S, clogged up the system, adding to their worry. But as well educated healthcare professionals ourselves I'd like to think we brought about a better outcome for everyone involved. They wrote in several weeks later to thank us too which is always nice, but the point is that, yeah as a glorified first aider who drives people to hospital, we probably couldn't have added much more to that situation other than an unnecessary trip to hospital and a uselessly dangerous and expensive L/S drive. But as actual HCPs we did, not because we ourselves are so smart or wonderful or any of that crap, its just that its the way our system works and I think its one of the things that actually makes us useful. That's the benefit, not of ACLS or ALS or whatever, but of proper HCPs as opposed to drivers with first aid certs.

Doing all this, I don't doubt that I make a reasonable difference (not in some heroic way but in the same sense as anyone else makes an actual contribution to the society they live in with their skills and expertise) some of the time.

I don't mean to waffle on about being better or smarter and so on. Thats not my point. Its just something to consider, a different system and some different ideas.

 

[the_negro_puppy]

If driving people to hospital is all EMS is doing in your area then maybe it is reasonable to question it.

To me the idea of improving education and standards is all about actually being worthwhile to the community. I think it is sometimes reasonable to question the idea of EMTs being taxi drivers with AEDs.

Its interesting, and perhaps indicative of the "company" you feel you keep, that you compare yourself to police and fire. The first people I think of when comparing paramedics to someone are other healthcare professionals. I'm not being nasty, but I think its an interesting observation. If you see yourself and being only for emergencies and life saving, CPR and car accidents and bells and whistles and blood and guts, then yeah, you might start asking questions. I'd argue that a lack of all that doesn't mean we're useless, because the bulk of work and benefit to the community can be felt in other ways (if appropriately educated).

I did a little "study" I suppose you could call it. Maybe personal audit might be a better word. I forget the stats exactly and I can't find the papers right now but I'll give you what I had written in my notepad from a while back. Basically what I did was that for about a month I categorised jobs into one of the following categories:

1. Those I felt a reasonable lay person would or should call an ambulance for.

2. Those that I felt a reasonable lay person would recognise needed to go the ED but could have got there via their own means or gone in their own time (things like lac requiring suture + tentnus at 0330, ?bowel obstruction with significantly distended abdo in an ambulant CA pt with family and a car).
3. Those that a reasonable person would not call an ambulance for and that could and should be managed through their GP or self care.

Then for each job I noted whether or not an intervention was performed. I didn't include advice/referral as an intervention but I soon realised I should have given that its own category. I also didn't include cannulation where I didn't give any drugs or fluids (it was a just in case cannulation or a line for the hospital to do bloods with).

I went to 42 jobs as the attendant during "data collection" . I was surprised at the results.

-68% of jobs I classified as one for which a reasonable lay person would call 000. (I thought it would be much less, and this felt like a bad month in the regard too, so I'd wager about 3/4 in most months).
-9% should have recognised that an ambulance wasn't needed and got to the ED themselves (but notably it was often not their fault because ridiculous advice lines, like "nurse on call" that basically tell people to call an ambulance regardless of complaint, told them too.
-23% could have been handled via GP or self care.

I performed a meaningful clinical intervention in 23% of these cases, mostly pain relief.

I got several things out of this audit:

1. We don't go to as much BS as I thought. You could make an argument the about 3/4 of what we went to actually required that we be there to assess a pt (a reasonable lay person, or even a HCP, would have called 000). Maybe we weren't required to medically intervene, but its not the public's job to know that in advance, and, at the very least, a decent healthcare assessment was required. So I don't see it as a waste and 3/4 ain't bad.

2. The intervention rate was higher than I thought - I actually got hands on with more people than I thought.

3. The number of time wasting idiots who should have known better was actually quite low when I really thought about it and circumstances surround each job.

4. Not included in the data collection but something that kept coming up again and again, was that for every single self care/GP job and for others as well, I was educating, advising and referring.

Example: To CA pt with D&V since chemo, "Oh see than Ondansetron there, that is for nausea and its better than that other one, so remember to take that next time. Now tomorrow I want you to do a couple of things. I need to you try and eat some small amounts of food. Small portions, well spaced out. Yep those ones you planned. Send husband down to the pharmacy. Get some gastrolyte, they come in icy poles too which are good if you don't feel like you can drink or eat much, and some gastrostop, and talk to the pharmacist about them, explain whats happening, they're really helpful and he'll tell how and when to take them if you need them. Now stay away from sugary drinks. I know mum always said flat lemonade when you're sick but its actually worse for your diarrhea", *write it all down + a note to the pharmacist explaining the situation and asking for his/her advice*. "Now if you feel dizzy, or you spike a fever. Head down to the ED, but its unlikely that you'll need an ambulance. Are you happy with and do understand the plan we've made?"

Other examples include spending time on the phone with pt's doctors, case workers etc and sorting out what kind of care pathway is best for them. I've found specialists and GPs are really helpful if you take the time to ask.

I went to a job once where a baby had been "throwing up blood". After a little detective work we found out that the antibiotic syrup she was on was red and she'd spit a little up. During the worrying, dad fainted and we looked him over too. After about an hour spent there, thoroughly assessing baby and then dad, treating dad, making care plans for both of them, reassuring them, exchanging favourite pasta bake recipes and having a bit of a laugh, we left. As gloried first aiders we could have transported baby and dad in a second ambulance, wide eyed, to hospital L/S, clogged up the system, adding to their worry. But as well educated healthcare professionals ourselves I'd like to think we brought about a better outcome for everyone involved. They wrote in several weeks later to thank us too which is always nice, but the point is that, yeah as a glorified first aider who drives people to hospital, we probably couldn't have added much more to that situation other than an unnecessary trip to hospital and a uselessly dangerous and expensive L/S drive. But as actual HCPs we did, not because we ourselves are so smart or wonderful or any of that crap, its just that its the way our system works and I think its one of the things that actually makes us useful. That's the benefit, not of ACLS or ALS or whatever, but of proper HCPs as opposed to drivers with first aid certs.

Doing all this, I don't doubt that I make a reasonable difference (not in some heroic way but in the same sense as anyone else makes an actual contribution to the society they live in with their skills and expertise) some of the time.

I don't mean to waffle on about being better or smarter and so on. Thats not my point. Its just something to consider, a different system and some different ideas.

Well said. I've often thought of keeping a log of the types of jobs I go to myself. I find it good that in Australia our job inst necessarily just to drive people to hospital. We can be a social worker, counsellor , community and emergency health worker all rolled into one.

 

[firecoins]

The goal of EMS, BLS or ALS is more than saving lives. A good number of my calls involve taking people to the hospital where other means were not practical. Many patients needed more involved care than putting them in the back of a car. People who required lifting over obstacles etc etc.

 

[Veneficus]

the myth of EMS and public safety

As you have discovered, EMS isn't really a public safety service.

The fire and police departments serve for the benefit of society. Whether in crime/fire prevention, intervention or investigation, they serve to keep society functioning.

EMS provides a value to individual members of a society which in turn permits them to remain (hopefully productive) in society.

The first problem with US EMS is it exists for a world that no longer does. When only a handful of people had any real medical knowledge and those people were called doctors. In those days, they also knew about all there was to know about medicine.

Some doctors came to the conclusion that people would be helped on the way to the hospital with some simple interventions. So they got together and made some stuff up they thought would help.

This made up stuff had to be simple, easy to teach to people who didn't go to medical school or have any background in science. Most of all it couldn't cause a lot of harm if applied to the wrong patient.

Thus EMS came into existence in the US.

As these new providers were taught by doctors, it became apparent they could function at a higher level. The doctors were very interested in furthering this new field and with strict oversight and criteria, ALS was born.

Having given EMS its start, these doctors either died, retired, or faded from view for the most part. For decades now EMS has had no direction and very few advocates. The old guys became the instructors, teaching outdated information and skills to the younger ones. Reliving the glory days.

But the world advanced, other healthcare professions really started embracing the new knowledge, and the doctor can no longer know it all, because there is too much to know.

But rather than embrace these changes US EMS resisted change. Prefering instead to focus and master skills.

But disease that affects people changes over time. 100 years ago if you got an infection, you would most likely die from it. In history, many of these diseases were acute in onset. Acute treatment was a valid solution.

In today's world, the diseases of our day are chronic. The largest killers develop over decades and are not responsive to acute treatment. Procedures like cardio bypass maintain function as best they can, they do not reverse disease.

So when you try to use yesterday's treatments, for yesterday's reality, you become invaluable and obsolete. As our knowledge of medicine advances, the expert opinion of yesterday is dispelled.

I can't imagine why anyone would pay for care like that. Certainly I can't imagine why anyone would respect people doing it.

If you look at EMS in other nations, they struggle to build a modern and valuable service.

They focus on what helps today. Sometimes it is the treatments of yesterday, but rarely. Sometimes they act as the gateway and direct people to the most appropriate resource. (In the US they have to make protocols to take trauma patients to the trauma center and not the nearest hospital. Why do you think those rules need to be made, seems rather intuitive doesn't it?) Sometimes these modern providers can solve the patient's problem at home, teach them how to self-care for pathologies. They are the house call, the first resort at a reasonable cost, for patients to even determine if they need to pay for higher levels of care.

These modern paramedics provide help for modern diseases in the modern world. The very money and other resources they save justifies their value to society at large.

In these modern nations, in order to provide this service, it takes years of education, not hours. It takes educated people, not skilled people.

These nations enact laws mandating that municipalities provide these services, both for the patient and because of the money it saves society at large in everything from healthcare costs to productivity hours.

The question these nations face is not "why would anyone pay for paramedics?" The question is " How do we fund these paramedics because the money they save society is far greater than what they cost."

Who wouldn't pay for that?

It is not really a point of saving lives or reducing pain and suffering. As public health experts discovered as far back as Ancient Rome, a healthy society is a productive society. A productive society is a wealthy society. That wealth makes a better quality of life for all levels of the social spectrum. It doesn't give all levels of society the top quality lifestyle.

So to answer your question directly:

Why should you pay more for an educated provider? Because you get more.

Why should you pay more for the current level of provider? You shouldn't, because what they deliver doesn't justify the cost now.

The pain management argument is moot. Ask any working person without insurance if they would rather suffer an hour or 2 in pain or pay $600 to relieve that pain faster.

A couple hours of pain is a small price to pay when relief of that pain causes you to miss your rent, or electric bill, your ability to cloth yourself, or pay for gas to get to work.

For any population, a paramedic who can treat your ankle sprain and cost you a couple hundred dollars and send you on your way (maybe cost shared from taxes) is worth far more than a paramedic who takes you to a place where you have to pay $1000 or more for the same.

But in order for a paramedic to do that, it doesn't take xrays or labs, etc. It takes education.

 

[Ramis46]

I think that you also have to look at it from not just our point of view but from a culture in general. What i mean is I wor for a small rural Hospital based system. On any given day we see alot of the "BS" the chronic headache, Back Pain, or the CP call that we all know is anxiety, or someone just needs attention. We know as EMS providers that people know the system and that they read stuff on the internet and know that we can't deny them transport to the ED. That means they can (in our system for the most part) bypass any wait time and for the most part with Iowa's health care system don't have to pay for their taxi service.
That being said though the acutal calls we attend to that are true emergencies, I feel that our training is great. Granted some of the skills should be practiced on a more regular bases. But the thought of more educations, We have more CE than nurses by almost 3 X. As often as we have to go back to BLS, ALC, ACLS, PHTLS, PEAR, PALS, (and/or whatever other class we have to take.)

 

[DrParasite]

Maybe it's just my early semester blues hitting me, but during one of my weekly grumble sessions about one of my volunteer ambulance companies, I had a depressing thought. My college town's EMS agency is slightly old fashioned, boasting response times of around 10 minutes for calls a few miles away, and providers who barely squeak by their EMT recerts (and anyone who's taken a Maryland recert course should know you have to try very hard to fail). Yet as a friend and I were discussing the benefits of the town being served by a paid ALS service instead, I couldn't help but think...would the citizens actually be better off with a new service?

taking a couple things into play: college towns typically have a healthy population of aged 18-30year old people, who outside of doing something stupid (fall, injuries, minor trauma, or drunks) will be pretty healthy.

urban/poorer cities tend to use EMS as a taxi service, since they don't want to go to the doctor or can't afford a ride.

but while I always joke about EMS is about saving lives, it's more about making a difference. sometimes going out at 3am to check the vitals of a 70 year old lady, telling her she is going to be ok, and keeping her company for 20 minutes can make all the difference in her day.

I can justify my existence as a firefighter--without the FD, city blocks would burn, people would remain trapped in cars and kittens trapped in trees.

really that's your argument? what if I told you all fires go out eventually (even if they end up running out of fuel), people who remain trapped in cars is just an example of darwinism, and I have never seen a cat's skeleton in a tree? doesn't that just blow three big holes in the justification of your existence as a firefighter?

My friend can justify his existence as a cop--without police, life would be a little more exciting and dangerous for obvious reasons.

ask your friend how often he has drew his gun in his career. now ask him how many times he has fired his gun in the line of duty. bet the first number isn't that big, and the second number is less than 3.

so maybe those reasons aren't what you think? or rather, they aren't as common as you think?

But without EMS? People would have to...find someone to drive them to the hospital.

right. but what if they couldn't drive? what if they didn't have a car? what if they didn't need a hospital, just needed someone to check them out? or if you are 30 minutes from a hospital, and having an asthma attack and lost your inhaler, how long can you hold your breath for?

basic things that save lives: Heimlich maneuver for choking victims, bleeding control, airway control for unconscious people, and CPR/early Defib. much of the rest of what we do doesn't save lives, but makes for a much more comfortable existence for the patients (splinting, carry downs, even much of the ALS stuff, the patient would still survive the trip to the ER most of the time, just end up in worse shape long term without ALS care).

I'm not trying to bash EMS, far from it. I want someone to jump up and prove me wrong and show me that EMS is good and awesome and fantastic and that paramedics with 4 year degrees will make it better. So please, tell me how great EMS is and that I'm wrong.

I think FFs do have a role in the world I think cops do as well. EMS isn't about saving lives (but we defiantly do more than the FD, just when we save a life, it isn't cool or sexy or able to be publicized due to pt confidentiality laws) or being great, it is just a field that serves a need to help the public.

I don't know if 4 year degreed paramedics will save more lives than 2 years degree paramedics, or diploma paramedics. or masters degree paramedics. but while I do think more education is rarely a bad thing, I think the city needs to decide what level of service it wants for it's taxpayers.

 

[EpiEMS]

Under the assumption[/URL] that a reasonable cost per quality adjusted life years (QALY) is anywhere from £20,000 (according to the UK's National Institute for Health and Clinical Excellence, which decides quite a bit about what treatments the NHS will pay for) up through $100,000 (see http://marginalrevolution.com/margi...lue-of-life-and-the-value-of-health-care.html), an intervention that might be reasonable to implement are public AEDs (http://www.ncbi.nlm.nih.gov/pubmed/14656838) or perhaps calling for HEMS for serious trauma cases (http://www.ncbi.nlm.nih.gov/pubmed/9326865).

More research on cost-effectiveness is key to improving outcomes — deploying dollars properly is just as important as deploying providers. From a business of healthcare perspective and a policy one, the question isn't "Does EMS save lives" but "Is EMS saving lives in a cost effective way? If not, where should the money go?"

 

[Veneficus]

More research on cost-effectiveness is key to improving outcomes — deploying dollars properly is just as important as deploying providers. From a business of healthcare perspective and a policy one, the question isn't "Does EMS save lives" but "Is EMS saving lives in a cost effective way? If not, where should the money go?"

If I could just comment on the part I didn't quote?

Compared to all of the estimates I have seen over the last 10 years, the QALY article is grossly underestimated.

Now the quote.

I don't think you can change the efficency of EMS without changing the entire US healthcare system.

That is a tremendous task that as far as I can see is going to require a total collapse of it first.

As it stands, the US is the only country I know of where spending is not tied to some measure of effectiveness.

A very good example is the cost an quality of life studies of hemodialysis vs. peritoneal. (there are many and citing one does not do justice to the argument.)

The long and short of it is that while peritoneal dialysis is only usuable for a short period compared to hemodialysis, the quality of life maintained is the same for both during the peritoneal dialysis effectiveness period.

After that, the hemodialysis pt basically becomes a medical cash cow until they finally die from complications.

From the practical point, dialysis you get at home while sleeping, sounds like it allows better selectivity in spending life how you like than going to a dialysis center 3 days a week and getting a protocol based filtration. You lose at least those 3 days.

The cost difference between the 2 is also disproportionate. Guess which one costs more?

 

[Shishkabob]

The reason why studies 'show' EMS has little overall effect on patient outcomes is because the vast majority of the calls that EMS is called for are non-emergent, not legitimate use of 911. (Note, I did not say non-legitimate medical complaints, but 911, which is intended strictly for life and limb threatening emergencies) When most of your calls are for things such as a broken toe or the flu, of course you'll have little if any impact on patient outcome. It's not the fault of EMS, it's the fault of uneducated civilians misusing 911. EMS is evolving to be out of hospital medical care, gaining things that can help patients more in that realm, but again, that is not the intent of 911, and should be separated as such.




However, you cannot doubt that calls that 911 was intended for, you know, true time sensitive medical emergencies, (cardiac and respiratory arrest. severe allergic reaction, decompensating CHF, hypoglycemia. narcotic overdose, status asthmaticus), EMS either helps greatly, or is the most notable cause of survival. Granted, it's a "team effort" for survival, but alas, without some of the prompt interventions that EMS does out in the field, without a doubt, some of the patients would otherwise be dead.



A real, life saving call is rare, but they happen, and I can say without a doubt I've saved atleast one in the past year.

 

[Mountain Res-Q]

I think I understand the route of your question, and while I agree with everyone's lengthy (and correct) responses, lets see if I can sum this up:

QUESTION: Why do we need a higher level of education to provide this level of service?

ANSWER: With a higher education, maybe you wouldn't be providing that level of (dis)service!

The same could have been asked of Civil War medicine; why does a Civil War Surgeon need any level of education to hack away limbs? With a higher level of knowledge and education that is no longer the standard of care. It is called progress. In regards to EMS, the United States is often operating in a "Civil War" mindset, and maybe some portions of the States are operating in the Dark Ages. Education is the only way to make progress; that and we kill all the bureaucrats! EMS becomes something more when we stop trying to make it akin to Fire, Law, or the Postal Service, and a sub-specialty of the medical field; which requires a higher level of education than is presently encouraged.

You assume that the existence of EMS can only justified by the lives saved. Reality check; lives are never saved. Best case scenario, you can prolong a life; they still die eventually. Worst case, you simply help in a way that can not be easily quantified; either physically, mentally, or emotionally. How do you justify the existence of Law Enforcement? By the number of tickets written? The number of bullets fired? Or the amount of crime prevented or solved? I would say, the last! But how do you quantify that impact? For EMS, if the standard is "lives saved", then how do you justify the existence of many aspects of the medical field? I think your criteria when comparing EMS to Fire, Law, or any other Medical Profession needs some modification. Also, I think your experience in your region and with your service has jaded your perspective; a reflection of what some would call a "Civil War System" and not the reality of EMS elsewhere or the potential capability that has not been seen in much of the U.S.

 

[Brandon O]

I see my life is 90% relieving pain and distress, 9% improving outcomes and reducing morbidity, and 1% saving lives. If you can be okay with that, this job makes much more sense.

... shortly after they put me to work, I began to realize that my year of training was useful in less than ten percent of the calls, and saving someone's life was a lot rarer than that. I made up for this by driving very fast, one call to another -- at least I looked like a lifesaver -- but as the years went by I grew to understand that my primary role was less about saving lives than about bearing witness. In many cases the damage was done long before I'd been called, and there was little I could do to reverse it. I was a grief mop, and much of my job was to remove, if even for a short time, the grief starter or the grief product, and mop up whatever I could. Often it was enough that I simply showed up. . . . Calling 911 is a fast and free way to be shown an order in the world much stronger than your own disorder. Within minutes, someone will show up at your door and ask you if you need help, someone who has witnessed so many worse cases than your own and will gladly tell you this. When your angst pail is full, he'll try and empty it.

Bringing Out the Dead

 

[firecoins]

As you have discovered, EMS isn't really a public safety service.

The fire and police departments serve for the benefit of society. Whether in crime/fire prevention, intervention or investigation, they serve to keep society functioning.

EMS provides a value to individual members of a society which in turn permits them to remain (hopefully productive) in society.

.

I would disagree with that. What your describing is very much a public service. Many fire calls affect one house or less than that. Many Police calls that affect one person.

We benefit society which sometimes means saving lives. Sometimes it means other things.

 

[Tigger]

I see my life is 90% relieving pain and distress, 9% improving outcomes and reducing morbidity, and 1% saving lives. If you can be okay with that, this job makes much more sense.

I can't come up with a better way to sum up my thoughts on my job. My job is not to save lives. I am able to do so should the situation arise, but if you can't break the mindset that lives are more often than not saved by being in the right place at the right time, EMS will wear on you. If you can accept that you're job is attempt to relieve pain and suffering (and yes BLS can certainly do this), you'll be alright.

 

[patput]

The service I am affiliated with covers an area of nearly 500 square miles, and we see anywhere from a call every 30 minutes to a call every 2 days, but generally we fall in the middle, 4 or so a day. From my limited experience and talking to the medics that have been around for a while the majority of the calls in our district are BS calls. I know for me probably about 25% of the calls we go to patients will sign off. The next 70 or so percent will go to the hospital for something they probably never needed to call 911 for in the first place, and the last 5% I feel like we actually make an impact in someones life. The use of ALS techniques here for those 5% are definitely prominent though, and I feel that if it had been only a BLS provider some of them could have turned out differently.

 

[Shishkabob]

I can't come up with a better way to sum up my thoughts on my job. My job is not to save lives. I am able to do so should the situation arise, but if you can't break the mindset that lives are more often than not saved by being in the right place at the right time, EMS will wear on you. If you can accept that you're job is attempt to relieve pain and suffering (and yes BLS can certainly do this), you'll be alright.

I don't think anyone has an illusion otherwise... HOWEVER, the reality is:

EMS is 90% acting as a taxi for the lame and lazy, 9% helping those who truly need more than just a ride, and 1% making life or limb saving decisions.

 

[Brandon O]

I can't come up with a better way to sum up my thoughts on my job. My job is not to save lives. I am able to do so should the situation arise, but if you can't break the mindset that lives are more often than not saved by being in the right place at the right time, EMS will wear on you. If you can accept that you're job is attempt to relieve pain and suffering (and yes BLS can certainly do this), you'll be alright.

The nice thing is, if you just figure that you're here to help people however you can, it relieve you of the constant burden of asking "is this really a proper use of 911?" Should the homeless guy really have called for an ambulance? Does it reveal some deficit in his personhood? Is it a good use of finite system resources?

I have no idea; determining that isn't my job, or at least isn't my job while I'm working the road. But will it make him any happier? Sure, it's warm and they have food there, that's probably why he called. Sounds good, let's go dude, what kind of music ya like?

("But what if he's drug seeking, Mr. Preceptor?" "Dang, then he needs this stuff extra bad.")

 

[Mountain Res-Q]

EMS is 90% acting as a taxi for the lame and lazy, 9% helping those who truly need more than just a ride, and 1% making life or limb saving decisions.

"[EMS], my dear friends, is 93% perspiration, 6% electricity,
4% evaporation, and 2% butterscotch ripple." -Willy Wonka (1971) :rofl:​

 

[Tigger]

I don't think anyone has an illusion otherwise... HOWEVER, the reality is:

EMS is 90% acting as a taxi for the lame and lazy, 9% helping those who truly need more than just a ride, and 1% making life or limb saving decisions.

Most people that have some time in EMS don't have said illusion. But for people that are just starting out, it can be tough. I had a partner recently that would figure how far away the emergency calls that the medics were getting and then call dispatch to see if they needed "assistance." I know of a guy who carried a scanner to buff city calls while working for a private so that he could be first on scene to save a life.

Some people will struggle to find that tiny bit of satisfaction from readjusting the sheets under a patient to make them a little comfortable or even just holding their hand.