Rank the EMS systems of the world

thegreypilgrim

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By country.

(1) Australia
(2) New Zealand
(3) United Kingdom & Ireland
(4) Netherlands
(5) South Africa
(6) Canada
(7) Other EU countries (Germany, France, Spain, Italy, Sweden, etc.)
(8) United States
(9) Japan
(10) Israel

That's my top 10.

 
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thegreypilgrim

thegreypilgrim

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Trouble is what I deal in.
 

Martyn

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Why is USA so far down? BTW, for those who don't know, I am British but live in Florida
 

Veneficus

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Why is the US on the list at all?

Especially above Israel and Japan.

As well, listing other EU countries who have physicians on an ambulance as only just better than the US?
 
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TransportJockey

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US EMS doesn't belong on a list of the top fifty, let alone top ten.
 
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thegreypilgrim

thegreypilgrim

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I don't consider a lot of meaningful difference in (1)-(7).

Also while the EU countries are considerably better than the US system I think the physician-based systems are tremendously inefficient.

Japan & Israel are "scoop and run" (except for the Israeli units with docs on board) systems.

The only reason I have the US where it is is due to its shear capacity for response...in short we have a crapload of rigs and people...which isn't saying much.
 

jonpw52

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NYC 911 system is best in the world hands down!



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I NEED MEDICS, MEDICS!!!!!!!
 

TransportJockey

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NYC 911 system is best in the world hands down!



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I NEED MEDICS, MEDICS!!!!!!!

Lol I hope you're not actually serious. Heh. Great joke!
 

firecoins

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NYC 911 system is best in the world hands down!



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I NEED MEDICS, MEDICS!!!!!!!

Probably not. It should and could be alot better.

The US system doesn't exist as a whole as far as I am concerned. Local and state governments set the systems up.

I don't know enough about Canada or other countries to rate their systems.
 
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boingo

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I realize the glaring education differences, however can anyone show me where patient outcomes are worse in the U.S. v/s anyplace else? I'm not talking about refering to PCP or GP, I'm talking patients treated and transported to a hospital?
 

TransportJockey

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I realize the glaring education differences, however can anyone show me where patient outcomes are worse in the U.S. v/s anyplace else? I'm not talking about refering to PCP or GP, I'm talking patients treated and transported to a hospital?

On the same vein, show me where modern EMS systems affect M&M compared to countries that just toss the guy in the bed of a pickup and go.
 

Veneficus

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Also while the EU countries are considerably better than the US system I think the physician-based systems are tremendously inefficient.

You should come and see how it works before making such conclusions.
 

Veneficus

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I realize the glaring education differences, however can anyone show me where patient outcomes are worse in the U.S. v/s anyplace else? I'm not talking about refering to PCP or GP, I'm talking patients treated and transported to a hospital?

I am not sure that any such data exists. However, the ability to refer to an alternate destination and treat and release save a lot of money.

It also brings new meaning to critical care for interfacility transport. I have seen units go out with a medic and 2 cardio surgeons as well as a medic with a transplant surgeon and an anesthesia intensivist. In terms of care, these docs were also the primary physicians that took care of the patient at the receiving facility.
 

boingo

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In these other systems, not including the physician based providers, what kind of pt is being "referred" to someplace other than the ED?

I think we agree that patient outcome is very important. We base tx plans around EBM. If the U.S. medic sucks so bad, where is the evidence?

I am not interested in debating education, I'm on board, it is woefully insufficient in most places in the U.S., however I fail to see where the EU/Aus/NZ patients are enjoying significantly reduced M&M.
 
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thegreypilgrim

thegreypilgrim

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You should come and see how it works before making such conclusions.
I'd love ride out with them to see what they do and would happily reverse my initial thoughts about it.
 
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thegreypilgrim

thegreypilgrim

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I am not interested in debating education, I'm on board, it is woefully insufficient in most places in the U.S., however I fail to see where the EU/Aus/NZ patients are enjoying significantly reduced M&M.
There was a recent study on prehospital RSI in traumatic brain injury that took place in Oz which showed substantial improvement in neuro outcomes versus in-hospital RSI. I'm writing from my phone now so I can't give the citation at the moment, but I'll post it later.

Nearly every study on prehospital RSI for TBI that took place in the US I'm aware of has shown worse outcomes unless it was part of an HEMS system with increased training of providers.
 

Veneficus

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In these other systems, not including the physician based providers, what kind of pt is being "referred" to someplace other than the ED?

I think we agree that patient outcome is very important. We base tx plans around EBM. If the U.S. medic sucks so bad, where is the evidence?

I am not interested in debating education, I'm on board, it is woefully insufficient in most places in the U.S., however I fail to see where the EU/Aus/NZ patients are enjoying significantly reduced M&M.

All of the EU systems I am familiar with are physician based.

However, I don't think you will be able to compare M&M anyway. That is defined as the incidence of disease and death.

Even death isn't that easy to figure out. If you transport a terminal cancer patient to the ED in the US, they still die. Nothing EMS does will change that. At the same time, if you have an EMS system that provides palliative service in house, the patient still dies. Are they counted as Mortality for both, not counted at all, or some combination there of? How do you decide?

Morbitity gets even more complex.

One of the big things education allows for is independant decision making. If you require a 4 or 6 year degree but still run cookbook medicine, what could possibly cause the numbers to look different?

On the other hand, if you view a patient who meets an exception to standard guidlines, and perform a medically reasonable treatment, the outcome should sometimes be better. But that "better" may or may not be 3% or more.

How do you even go about measuring treat and release or alternative destination?

There is also the issues of different resuscitation guidlines, general health of the population, and efficency of delivery. (let's face it, if you have basic AHA guidlines, a large percent of morbidly obese patients with a host of comorbid conditions and a 9 minute ALS response 90% of the time, you could not hope to compare outcomes to a guidlines with a degree of deviation, on a largely fit society, with an ALS response time of 5 minutes)

The only way I can think of to objectively measure is by cost and the US always falls way short in that measurement.

Like I have said many times, I know that many providers attempt to use EBM as the panecea of medical care. It simply is not. It is merely a tool in the box. Some studies can never be carried out. (You will never get a randomized study of people who EMS makes an effort to resuscitate vs. showing up and doing nothing to see the effectiveness) You will never be able to quantify the effectiveness of a treatment modality when a sub population responds to treatment that is outside of that being looked at. So you might see a number like: 70% of the study population responded to treatment X. But you never see that perhaps 20% of the remainder responded to Y. Are you planning to do nothing for the people who are not in the 70%?

Always remember, the studies we set up are designed to be as good as possible, I have not seen one yet that isn't far from perfect.

Really, arguing that there is no demonstrated evidence of difference in M&M looks like demanding evidence that cannot possibly be procured and then holding it as a demonstratable measure of effectiveness for the system you favor looks like a very overt bias.

It is almost as absurd as claiming parachutes don't improve survival.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/
 

MrBrown

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Brown doesnt know much about Japanese EMS but did read somewhere that thier Paramedics are quite limited in what they can do; e.g. LMA, defibrillate, adrenaline for cardiac arrest only. Japan does have MICUs staffed by Physicians if Brown remembers correctly.

As far as Brown is concerned, it depends how you look at a system as how you rate it. Brown would rate Europe at the top, Australia/New Zealand as close second, Canada third, UK fourth and the US in last place ... if we are talking generally, if we are talking flash vehicles nad nice equipment then the US is probably toward the top, if we talk funding, New Zealand is bottom of the heap. It all depends how you look at it.
 

DrParasite

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what criteria are you basing a good system? what is a bad system? what makes Israel so poor of a system? what makes Australia, new Zealand and the UK such a good system?

unless you have measurable quantifying criteria, ranking a system by which is best is a waste of time; you might as well rank them by which color ambulance is the best for patient care, because the results will be exactly as arbitrary.
 
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