The Future of EMS

I don't know about by 2020, but unfortunately in the future perhaps for us I imagine we will see more automation.
 
If you all had to predict, what would the Future of EMS would look like in say 2030 and 2040, what would the profession look like and where do you see the EMS profession going in 2030 and 2040.

My prediction is that by 2030, EMS could be headed in the home health care and preventive care such as medical care to keep the medically fragile from going to the hospital. Home care visits. Medication compliance for those who have medication issues. Even home health care check ins for Seniors and medically vulnerable population. I also see EMT's branching out into post hospital medical care and even medication compliance for those who are diabetics, Asthmatics and those on heart medications.
 
Kavsuvb said:
My prediction is that by 2030, EMS could be headed in the home health care and preventive care such as medical care to keep the medically fragile from going to the hospital. Home care visits. Medication compliance for those who have medication issues. Even home health care check ins for Seniors and medically vulnerable population. I
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Why do you think EMS is suited to enter into the home health arena? What skills or training do you think EMS has vs establisher LPN/RN home health roles? It's an area that is definitely needed and understaffed however not sure EMS is the solution.
 
I've merged this with the same identical thread that the OP posted a year ago.
 
Kavsuvb said:
My prediction is that by 2030, EMS could be headed in the home health care and preventive care such as medical care to keep the medically fragile from going to the hospital. Home care visits. Medication compliance for those who have medication issues. Even home health care check ins for Seniors and medically vulnerable population. I also see EMT's branching out into post hospital medical care and even medication compliance for those who are diabetics, Asthmatics and those on heart medications.
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This already exists in many systems, but predominantly powered by social workers and nurses. If we already have nurses and social workers who are trained in this why would we want to expand this into a EMS role?

Some 911 systems have tried to implement similar programs because they had repeat high volume callers and are trying to save their system money as their primary goal. These are typically staffed with APPs, nurses, behavioral health providers, et cetera who already have experience providing this care to the community.

I have called and set up follow up appointments the next day at primary care from the ED at a time in which the patient agreed to go, but surprise they skipped out on the appointment and showed up back at the ED within a week. The reality is that some patients either out of low health literacy, general laziness, or some other intrinsic factor just don't take care of themselves and won't go to regular followup. I'm a bit of a cynic when it comes to this particular topic, I don't think that those who already don't take advantage of the resources offered to them are going to be receptive to any kind of EMS home visit. I guarantee you the CHF patient was told to take their lasix and follow up, the fact that they don't take their lasix because it makes them urinate all day isn't going to changed because a EMT or Medic tells them the same thing in their home. Same goes for the respiratory patients who still smoke and don't take their controllers or the diabetics who don't take meds and have awful diets.

I have had some patients who we helped with home safety projects (installing hand rails, improving outdoor traction ...), getting rides to their primary care, trouble shooting their oxygen concentrator, blood pressure checks, et cetera back when I was in the fire service. I don't think that these really crossed into the type of home health that you are promoting, and regardless were more a function of our department's community outreach than development of a EMS role. I think that in the area of public health that EMS should be promoting things that are the closest to our specialty: when to call 911, treatment of acute hemorrhage, recognition of stokes and ACS, and so on.

The future of EMS will likely be the same as it has in recent history. Improvement of ambulance safety, development of more efficacious treatments and protocols, and the development of more efficient electronic documentation/record systems.
 
Following up on the NP/PA ideas posted. Year ago; I do not agree that we will see NP/PAs in the field. We are currently seeing this in a few select markets, but the vast majority of areas are using community paramedics. The areas that have NP/PA practitioners are also usually areas that cannot use paramedics in the community paramedic role (looking at you California), although this is changing. As this changes, NPs and PAs will go away in favor of cheaper Community Paramedic programs.

And my prediction? Is exactly what I mentioned above. We will see a large expansion of EMS into pre and post hospital care. We started as a means of transportation, and we are slowly moving into a acute/subacute role. Hospitals are reducing length of stay more and more to save costs, and are realizing the benefit of home care vs hospital care.

One hospital based agency near me is piloting their CP program as a home-based pseudo-ER. Their target patient demographic are those patients that are not appropriate for urgent care, but do not need to be admitted to the hospital, and would otherwise be classified as an ESI triage of 2 or 3. Their idea is treat in the home (with telemedicine) and save an ER trip. This is clearly in-line with the hospitals goals to save money by saving on bed time.

Other things I think we may see is more movement into social work with mental health. I would like to see a diversification between these social calls and the medical calls. For example have dedicated units for each type of call, where a CP team is trained and equipped for these, and a traditional Paramedic is trained and equipped to treat medical patients.
 
Please let us have alternate destinations and the ability to refuse transport (I just need more ibuprofen type calls).

I think the direction of our field will depend upon reimbursements. If agencies start getting paid for more in home care, then we'll see more, or if transport reimbursement goes down.

I don't think it makes a lot of sense to put np and pas in boxes. In the time it takes to see one patient on a scene call they could've seen two or more in a clinic.

Please God no drones. I'm tired of this drone craze.
 
Probably already mentioned but I suspect in 20 years the training required to be a paramedic will be much more akin to that of a PA (possible higher). On the other hand constant contact with higher level providers durring calls could create Paramedic drones.
 
The role of a PA/NP is no where close to that of a Paramedic.
 
in 20 years, I see many major EMS system collapsing due to the massive lack of funding to most systems, while the expectations have skyrocketed. I see more outsourcing to private companies who think they can do the job, and in 2-3 years, get thrown out on their *** when they can't deliver what they promised for the price they asked for

I am hoping that paramedics require a 2 or 4 years degree, where those degrees are 100% focused on paramedicine, which gets most of the fire service out of the ALS field. All EMS managers should have a BS in EMS management, with preference to a master in management (either MBA or MPA).

Community paramedicine will become more common, but only if we find a way to consistently fund these programs.

Unless the funding matches all these good ideas, I don't see EMS progressing much. And with all the funding cuts to EMS systems over the past decade or two, as well as outsourcing of municipal services to private entities, I don't see that happeing.
 
I think the future in the US holds several things. I think we will see blood-labs being run in the field during calls. I think we will see automated trauma kits that work like AED’s in most public places (“begin by removing the clothing. Place the orange tourniquet around the affected area...”).

I think the US will move to a completely socialist, single-payer system 20 years from now. This will mean major changes like no more CT scans for strokes and no more same-day xrays for broken bones, but advancements in improving field practitioners. Everything will be driven by making medicine as cheap as possible since it will be so unaffordable to the system as a whole. Kinda like the NHS. “Ooh, sorry that you have breast cancer, but you’re 90, so we’re not going to do anything.”
 
joshrunkle35 said:
I think the US will move to a completely socialist, single-payer system 20 years from now. This will mean major changes like no more CT scans for strokes and no more same-day xrays for broken bones, but advancements in improving field practitioners. Everything will be driven by making medicine as cheap as possible since it will be so unaffordable to the system as a whole. Kinda like the NHS. “Ooh, sorry that you have breast cancer, but you’re 90, so we’re not going to do anything.”
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I think, very unfortunately, that there's a good chance this is correct.
 
joshrunkle35 said:
I think the future in the US holds several things. I think we will see blood-labs being run in the field during calls. I think we will see automated trauma kits that work like AED’s in most public places (“begin by removing the clothing. Place the orange tourniquet around the affected area...”).

I think the US will move to a completely socialist, single-payer system 20 years from now. This will mean major changes like no more CT scans for strokes and no more same-day xrays for broken bones, but advancements in improving field practitioners. Everything will be driven by making medicine as cheap as possible since it will be so unaffordable to the system as a whole. Kinda like the NHS. “Ooh, sorry that you have breast cancer, but you’re 90, so we’re not going to do anything.”
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This was not my experience in using the New Zealand healthcare system, nor has it been for any of my family, to include my grandmother figure who had battled four seperate cancer diagnoses in that country before passing away in her late 70s from one of those, during which she received excellent and aggressive care.
 
joshrunkle35 said:
I think the future in the US holds several things. I think we will see blood-labs being run in the field during calls. I think we will see automated trauma kits that work like AED’s in most public places (“begin by removing the clothing. Place the orange tourniquet around the affected area...”).

I think the US will move to a completely socialist, single-payer system 20 years from now. This will mean major changes like no more CT scans for strokes and no more same-day xrays for broken bones, but advancements in improving field practitioners. Everything will be driven by making medicine as cheap as possible since it will be so unaffordable to the system as a whole. Kinda like the NHS. “Ooh, sorry that you have breast cancer, but you’re 90, so we’re not going to do anything.”
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I’m sorry you had such a bad experience, my grandfather received excellent treatment from the NHS when he had terminal Lung Cancer. I also received great treatment from the nhs in the past aswell. It’s very similar to medical system in the us in the context that some people have bad experiences, some have good expieriences. There is no perfect system, but we should still shoot to achieve the best for patients and employees in healthcare alike.
 
Clearly the NHS isn't ideal since there are many private hospitals in the UK that people pay for out of pocket, and Canada isn't a whole lot better since so many of their citizens come down here for treatment. I wouldn't say that our system is better by any means, but socialized health care isn't even close to a perfect system. I do know quite a few Canadian military service members who got stationed down here and have no problem vouching for how much better the access (but certainly not the cost) is here in the US.

I suspect that we will end up with a medicare for all type system, and the heath systems (whether they be academic, county, for profit, private non-profits, and so on) will still be competing for patients.
 
Peak said:
Clearly the NHS isn't ideal since there are many private hospitals in the UK that people pay for out of pocket, and Canada isn't a whole lot better since so many of their citizens come down here for treatment. I wouldn't say that our system is better by any means, but socialized health care isn't even close to a perfect system. I do know quite a few Canadian military service members who got stationed down here and have no problem vouching for how much better the access (but certainly not the cost) is here in the US.

I suspect that we will end up with a medicare for all type system, and the heath systems (whether they be academic, county, for profit, private non-profits, and so on) will still be competing for patients.
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So I’m confused are you comparing the US system to the UK system or the US system to the Canadian system. Like you stated there is no perfect system. But it varies across all systems. The access may have been better for those Canadians compared to where they’re from in Canada, with where they were based in the US. Access across US varies from state to state as in the UK from county, and I’m sure the same applies to Canada.
 
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SSMTB said:
So I’m confused are you comparing the us system to the UK system or the us system to the Canadian system. Are you saying one is better than the other or both have their flaws?
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They are the two western systems that I'm the most familiar with, and to be honest probably have the most similar culture to the US. My point isn't really about which one is better since they are both inherently pretty flawed, which again isn't to say that the US healthcare system is better than either.

While there are examples of socialized healthcare systems that seem to be excellent (such as Germany, Switzerland, Norway, and Sweden among others) I think that those countries' citizens tend to have a very different sense of personal responsibility and resource stewardship that to be honest too many selfish Americans would ruin and drive a system like that into the ground.

I really like Japan's health care system, and I think that it is probably one of the best in the world, but it isn't truly socialized and would never fit the American culture.

While there are many reasons that healthcare is too expensive in the US, a lot comes from the habits of the healthcare consumer. Everyone wants a VIP treatment in the hospital, and wants to go to the ED so that their minor complaint can be treated immediately. The US also has some of the highest required training for their physicians, nurses, advanced practice providers, pharmacists, and so on that our population would never tolerated reducing the training requirements for. We would also need to figure out a way to better pay for drug development, a large portion of our drug costs are related to the privatization of drug development research (not that drug companies don't make a insane amount of money too). I'm also a bit dubious that for-profit systems are inherantly the problem, as the two hospital systems that directly compete with us are both non-profit and both charge substantially more than we do for our similar referral patients; this isn't true across every system in the US so I admit I do have some bias from my personal experience.
 
Good answer I agree with pretty much everything you said, and I edited my original post as you actually answered my question a bit in your first post and I hadn’t realized . I would like to reiterate the idea though that each healthcare system varies through out each country, and can also vary with such factors as patient demographic.
 
SSMTB said:
I’m sorry you had such a bad experience, my grandfather received excellent treatment from the NHS when he had terminal Lung Cancer. I also received great treatment from the nhs in the past aswell. It’s very similar to medical system in the us in the context that some people have bad experiences, some have good expieriences. There is no perfect system, but we should still shoot to achieve the best for patients and employees in healthcare alike.
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I’m only referring to the last year or so, since the NHS is in collapse and covering less and less. There’s an article a day about things which are no longer covered.
 
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