I do understand Guardian of you feelings, however let's look at the true EMS, not one fictionalized as on television, magazines, or Rickey Rangers Gall Magazines. I do understand there is a far abuse of the system, again these need to be addressed by the service and set protocols in place for dealing with such abusers. (in JEMS, this month has such article). Fortunately, my system has had protocols to give permission to determine value if transport by stretcher is needed or not. After discussion with medical director, other options of transport can be explored... cab, van, wheel chair transport, etc..
But to assume the public will continue paying for EMS as it is unrealistic.
A brief history of EMS, was developed by accident, not purpose in 1965 during the re-development of issues during LBJ presidency. I believe it was #46, on things to do "reduce mortality and morbidity, in automobile accidents" thus emergency medical services was born, the initial idea was to place surgeons in ambulances.. of course this never caught on, so the next thing was to train ambulance attendants (usually funeral home) and fireman, on rescue squads, cardiac and medical was never thought of at that time.. until about 1968, when some pre-hospital treatment was done by various hospitals and FD's. Then the medical portion caught on.
I grew up watching "emergency" and yes, was a Paramedic product from it, like so many other veterans. Sure life would be nice, if it was like on t.v. were grandma and the single girls would thank-you and bring cookies responding to nothing but emergencies.. but, alas that is what script writers are for, that is television. Sorry, if that was your perception, but you should had known that during your research of a career, or at least exposure on clinicals, reality versus television.
So how much are you worth? $20k, 30K, 50k, uh.. 75k a year? Wow, that's a lot for someone to respond to only "true" emergencies, that occur very rarely.. if ever. So you spent a couple of nights a week for what 6 months, maybe a year.. with a few hundred hours of clinical.. Now, compare that with the beautician, that spent longer in training in comparison. But, that is right.. you are special and are only capable of providing one service.
Medicine is changing.. do you think ER doc's that spent 8 years, + 3-5 years in residency trained to be in fast track? Guess what that is part of the business now.. You think they like it as well? private doc's don't want to see medicaid, non-payers, or even take call.. bump to ER. We have not yet seen anything yet.. the baby boomers which turned 60 this year, will increase call volumes almost 2-3 fold.. so, yes, we will be responding more and more to non-emergencies.
The days of "checker board" and sitting around and awaiting for the emergencies in EMS and Fire Departments are OVER! The public, consumer, client, whatever you call patients.. want and demand more and will get more for their money. Medicare. (which will dictate insurance companies payment) are at this time reviewing optional payment regimes for EMS. Managers, will follow whatever will bring them money. Medicare and other insurance companies, do not and will not continue to pay $800 or more for a glorified taxi ride to a hospital. Don't believe me check the American Ambulance Association web site..
Therefore, more and more medical care will be performed (similar to homecare) in the field, by EMS to justify its' means.
This will help in several ways:
1) Triage to those, that truly need an ER visit (triage) due to the large numbers of ER patients, and lack of hospital beds.
2) Expansion of the Paramedic role as a health care provider.. really, we are medical not a public service utility. The term EMS is really changing and about dead, have you not heard of "mobile health care systems"?. This will allow those that are really serious about medical care to expand their role and secure a comfortable position to make the appropriate salary, and those that will not have to work 2 jobs, or work horrible shift hours and still provide emergency care, when and if needed.
3) Emergencies will always be a part of the system, but only part of the system; like ER.. not the general rule. ......"That is part of the problem, we are still trying to manage ER and EMS, like it was in the 70's (when Emergency t.v. show was on) and it is not like that anymore.. . and never will be, our patients are different now"..... (paraphrase mine). This comment was made by the director of San Francisco General ER, when discussing managing failing emergency departments and emergency services and the delay in care....
Generally, wake up ... the days of sitting around for the "good one" are dead. and gone. EMS, is no longer and can no longer be a system feeding off the people for the "what if theory".. I suggest to research programs such as.. "shots across Texas program" where Paramedics were providing immunizations on their downtime...again, multitasking and thinking outside the box.
Again, finances will dictate the way EMS will go. Cities are cutting back and as they should, people are tired of paying for things and they expect more for their money. As well, it is foolish to pay large amounts of salaries for those that can only provide one type of service, when they can provide more.
So to summarize it, EMS is a health care industry. It is going to have to expand and provide more to keep itself alive. The days of "emergencies and only emergencies" are gone (and actually never were there). The industry is looking to expand in any form they can to provide services to keep this business alive itself..albeit to be a municipal, county, or private system. Money, and resources have to come in to have it go out....
The choices are simple .....
p.s. I am a full time Paramedic, part time RN. I have worked several EMS systems from hospital, private, muncipal, air..even as a consultant on many State, and municipal systems, so my experience is varied.
R/r 911
