The EMS mess?

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Krishna008

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Hey everyone, I came across this article while searching for EMS field research. The original article was titled "Get Serious about Health Care Spending" by Greg Henry MD in a 2008 issue of Emergency Physicians Monthly The tone of the article is pretty cynical. He pretty much devalues EMS entirely. I think there may be some truth to what Dr. Henry mentions but to be honest, I could not find the article in its entirety. All that i found was the excerpt in quotes. I would really like to hear what people think of this. He basically takes a huge dump on EMS -___-.

http://www.ems1.com/ems-products/aeds/articles/429787-Evidence-based-EMS/
 
regarding the quote

s a so-called necessary health care expenditure, I think EMS is the largest hoax ever foisted on the American People. There is no data, not one study, which shows that anything beyond the intermediate level — basic EMT with defibrillator capabilities — does anything in the long run to change the health care of the United States. The problem is this: it is a hidden cost. Do you realize what it costs for a fire department to simply keep everyone current with their ACLS cards? This is what Casey Stengel would call a long run for a short slide. This has become a local government power base and the numbers are not even figured in to the overall health care costs in the United States.

Pretty intense statement.
I would be very suprised if ALS did not improve at least some outcomes for medical patients. Consider patients in severe respiratory distress (eg asthma attacks, COPD, allergic reaction, airway burns with distress). I am not aware of a study(but if anyone finds one, please post it here),

Also it disregards people who need pain management but their morbidity or mortality rate remains the same. Not to mention people who have a STEMI who are treated pre-hospital then taken directly to the cath lab as a result of ALS.
 
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ExpatMedic0 said:
In fact, after 1 minute of searching here is one study. Guess that pretty much shoots down everything he had to say since his claim is that not even one study existed.
http://journals.lww.com/jcardiovasc...rehospital_diagnosis_in_the_management.4.aspx
Click to expand...


Considering he published that article in 2008, it certainly is a bit off on it's own. I don't have statistics for how many paramedics/ALS transports there were then, but I'm sure it has increased a good deal. Along with that, training and ALS equipment has improved. To top it off, exactly how long ago was the end of his 21 year stent directing an ER and was it in a rural or metropolitan area?

He does make some mildly valid points, but again, these articles are pretty much dated the day they're published.
 
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The study I posted was also from 2008, and there are likely many others
 
He makes some valid points. People, even on this forum, are very quick to discount many elements of EMS (back boarding, code 3 transport, ACLS drugs) People say that ALS doesn't help outcomes then they turn around and say that BLS is a waist. Helicopters are more dangerous then they are worth. All of these things have studies that give evidence that many of the things we do in EMS do not affect pt outcomes. However, since the 60's when EMS started, I believe that EMS as a system has helped many people. So if we are helping people, there must be something that we are doing right. I do agree , however, that our protocols are not as backed by science as they should be. In NJ ( where I am from) we still fully backboard basically anyone involved in any trauma. There have been cases in my town where they fly one person and the other person involved in the same accident goes by ground and end up beating them to the hospital. EMS needs to use science to regulate protocols and not just what we have always done.
 
The burden of proof is on those who believe that unsubstantiated or demonstrably harmful interventions are beneficial.

Public services like EMS exist not simply to "save lives." If saving lives was the only objective constraint, then the system would be very different. There are multiple binding constraints, primarily cost constraints and the positive impact conditional on said cost-related objective.

For example (pulling numbers out of nowhere): if we're given a budget of $1MM, and we have convincing evidence that providing service A $30,000 per QALY while item B cost $200,000 per QALY, we'd be remiss to choose option B.

My bottom line is that EMS needs more rigorous evaluation of cost-effectiveness throughout the modalities and various implementation of EMS systems before we start saying what's "good" and what's "bad."
 
First and foremost let me take a quick moment to thank all of you for everything that you do. This job is thankless and, even being in the industry myself I like to always take a moment to thank all the men and women in EMS. With that being said here is my take on the whole "mess".

As with any new industry there is always going to be growing pains. As there has been in EMS or any industry for that matter. This new convergence of treatment and transportation, has members of the public generally miffed at what we as EMS providers do. This also includes physicians and other hospital staff alike. We also don't also understand our self's. We don't even know where we fit in, whether it is in health care or public safety. This allows for great misunderstanding about our profession.

I believe that part of the misconception with EMS is that we are a glorified taxi service. Which can not be any further from the truth. We provide an invaluable service to the community's that we serve. We provided comfort for those that don't have comfort. We provided a shoulder to cry on when it is needed. We do CPR on a spouse that is never going to breath again, and then right after that take a "drunk" to the same hospital to get a sandwich and a bed because they need a place to stay for the night. Yes we do treat other illness and I believe that in a good amount of the time we make a "medical" difference in patients outcome, but I think the best way of making a difference is providing our patients comfort and rapid assessment. This means pushing pain medications when needed, pushing Zofran to a patient with nausea, warm saline to a cold elderly patient. Holding a dyeing patients hand while they spend their last minuets with you. This is how we make a difference. We also do this by knowing what is wrong with our patients with good assessment ability.

I also believe that education is the answer to a lot of our problems in EMS. I feel that the EMT and EMT-A programs are a short fall of the development in strong EMS system nationwide. I understand that a vast amount of Patients that access the EMS system do not need "ALS" treatment, however having a clinical provider that is highly educated is an important element in development of a profession. Just as nurses have come from where they came from Diploma programs, to now having doctorate in their fields. We need to strive to become more like "them" when it comes to education.

Concluding I don't think that EMS is a "mess". I think it has growing pains just like any other industry. We need members of this community to stand up and fight for us, just as any other profession has. We have some good people in our corner, but we need a few more. As always stay safe, keep learning and never give up. You can and will make a difference in peoples life's.
 
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Thank you very much for your input Zule. That was very perceptive and eloquent. It was also very inspiring and I truly appreciate it. I must say that the article that my thread was concerning discouraged me quite a bit. Im about to start medic school so that article was the last thing i needed to read. Your response encouraged me and then some.
 
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