Now what EMS does not need to do is start accumulating more and more primary care responsibility, which alot of people advocate doing and in my opinion is wishful thinking at best and lunacy at worst.
I have been watching old Emergency! episodes. They represent a much more logical approach to EMS response. They also represent a much more logical patient population....
Actually, I don't think it is wishful thinking or lunacy at all.
One of the things I have studies in my career is paleopathology, which explores the historical progression of human disease.
As we progress as a modern society, the types of patients seen on "Emergency" and in the minds of many providers, worthy of an ambulance, will become less and less.
The golden days of major trauma from car accidents has been replaced by the acute MI, and a majority of patients will end up calling EMS not for this, but for acute exacerbations of chronic diseases.
In the future, more likely because of the later. There simply won't be a need for paramedics as they exist today.
So you are left with only 2 possibilities, you (collective you) will retool to perform a need, or you will be gone.
If you consider the growing number of CCT transports, that is really where signs point to the paramedic being most needed. Those are transports of serious illness for one reason or another.
As we have seen studies, as well as revise our treatment of emergencies, even today the roles performed by US medics is largely ineffective and insufficent.
As we have seen with the professional fire service, with the exception of major cities, changes in building construction and frequency of fire has all but eliminated most of what they do as fire suppresion and rescuing people from fire.
A majority of the country is volunteer because they cannot economically support what a professional fire service does today or simply do not have the need.
As I stated in my above post, EMS will have to add value by performing a service needed by modern society, or the combination of technology and economic value will reduce it to a low level tech plugging you into some stuff on your way to the hospital and perhaps administering meds by protocol. (Which honestly does not take a medic now, it only takes a medic when a decision has to be made, which in protocol medicine is often a decision to withold)
As the shift towards chronic disease continues in modern societies, paramedics will have to shift towards primary care to have a viable job. It won't matter if there is 1 on every block or 1 for every 100 blocks. The current skill set and treatments will simply not be needed.
As evident by todays standards, of paramedics neededing less training than a barber to take you to the hospital and provide treatment, as a vocation, this will not be feasable as a living in the near future. Look at how difficult of a living it can be now in a majority of places. 2 to 3 jobs to live in the lower middle class.
Personally, I would rather help morph EMS into something relevant and sustainable in the modern world, but that is just my lunacy.(I call it giving back)
In all logical prediction the future of prehospital EMS will probably look nothing like we see today, and even less like the days of Johnny and Roy, which I grew up with, and providers of that generation barely could have imagined EMS as it is today.
Ambulances will always exist because everyone has a right to a free ride to the hospital and free medical service at the ER right?? I mean, this is American after all.
While many Modern societies actually have embodied in law of providing fire and ambulance service, the US is not one of those societies. (in fact the US is falling behind many modern societies on a number of levels, but watching Rome burn is a topic for a different forum)
In no modern society is that ambulance ride free. It is just a question of how it is paid for.
As far as the transports...yes it is absolutely ridiculous to send paramedics to do the granny shuffle/renal roundup/(whatever you call it) but this is where the money lies so services will bill away.
Today.
But do you honestly believe with the current problems (read crisis) in US healthcare spending that it will be even possible to spend the money that is being spent on this for long?
As the current reforms underway unfold, those groups with political power will protect thier money at the cost of others. Hospitals have political power, nurses do, doctors do, pharm does, as you accurately pointed out, EMS doesn't.
Logically that means EMS will take the cut first and it will likely be the deepest. The days of IFT getting what it does are limited, and I expect the bottoming out of it will come in my carrer.
I think most if not every EMS provider would love to only be handling emergencies as we have come to define them, but reality is, soon those days will be romanticized like knights on horseback. There are even groups playing (competing) EMS games which strongly resemble renaissance festivals. Dressing up with props to relive the by gone days of real emergencies and archaeic treatments.
Remember the days when there were numerous cases of scury and iodine deficency?
Me neither...
Change will come. Whether we agree on how or not.
