Im with a rural non transporting volunteer BLS first responder unit. Do you honestly think we could staff our agency with all Paramedics? So do away with EMT Basics and who replaces them in places like this?.
I think the issue is a bit more complex than this. In many countries, volunteer ambulance corps exist, and as a function of the state, medics are rotated through rural communities.
It doesn't take an EMT to drive somebody to the hospital. With the model of basic EMS first response, it means everyone goes to the hospital. Which is not a sustainable economic model.
I think it is important to seperate the fuctions of patient care and transport in EMS. A more advanced provider can decide if the patient needs to go to the hospital at all or a better place to refer them.
Obviously no one would, so instead of having an EMT there in minutes, youll have an ALS rig with Paramedics first on scene 45 minutes later. Dont worry, im sure the Paramedics can make up that extra 40 minutes because they have an extra year of vocational ed(with no pre requisites).
How many minutes more than 6? What good is a provider with only a handful of interventions that don't address most modern medical problems outside of the hospital?
As for an extra year of training, if you measure it in actual hours, an ALS provider has between 7 and 10x (depending on old or new curriculum respectfully) So the question must be reversed. Not what can an ALS provider add, but what can a BLS provider actually do?
Basing on what Ive personally observed over the past few years, in very few cases did ALS save a patient that would have died had it been BLS, and I cant think of seeing any calls where having two medics on scene instead of a medic and an EMT saved someones life. Im sure somewhere at some point it may have occured, but I havent seen it. Im sure having MDs on every rig would occasionally make a difference as well, but thats cost prohibitive, so you have to weigh the value with the cost.
Since the value of EMS in saving lives is so minimal, I am not surprised by your experience. Additionally, it has been identified in multiple studies that patients who call EMS overwhelmingly do not need life saving intervention but do need medical care. That makes a basic EMS service a very overpriced taxi.
As for having 2 medics, I agree most calls will not require 2 medics. During my time working as a medic, there were many more interpersonal issues on double medic trucks. There is also the problem of skill dilution. However, again, countries outside the US have managed to make it work. It is more of a question of system design than individual qualification.
Having an MD on the ambulance is only cost prohibitive because of the system of reimbursement. There is no data, but I am willing to bet that it costs less to have a physician who can treat/release/prescribe riding around than to initiate an emergency ambulance and the cost of an ED for majority who do need healthcare but do not need an ED.
Usually if the patient is in bad shape, its load em and go. As for pain management, does it really matter if you have two medics instead of one medic and a basic showing up in a rig?
If the patient is that bad and that far away from a hospital that actually can help and not the local doc in a box community hospital, then it isn't going to matter anyway. But again, if 5% of all EMS calls are non emergent, why are we staffing an expensive taxi in a system that costs more than it helps?
As for pain management, it is not a question of 1, 2, or 10 medics on the ambulance, it is a question of having somebody who is able to do it. 2 medics on an ambulance can control pain as well as 1. But 2 basics on an ambulance cannot.
Despite all the squawking about EMTs on here, the reason EMT Basic exists is probably because the people with MD by their name understand what saves patients is getting them to definitive care quickly, not whether the person driving the ambulance has an extra year of vocational ed.
That is an interesting tag line.
I believe that many MDs are just not interested in dealing with any part of the EMS system. I also believe that the reimburement model makes it impossible for MDs to alter the system design without changing the way it is funded, not because they approve of the system.
I think that effective stabilizing care can be borought to the patient. I think in many conditions, this immediate care may not save lives, but it is shown it reduces hospitalization length.
If having ALS providers saves every patient who used the 911 system 1 or 2 days in an ICU or inpatient ward, the cost savings will quickly be realized by the system.
"Saving lives" is a very poor measure of an EMS system. It reflects a time when we didn't know as much about disease as we do today. It reflects a time when we thought many illnesses were sudden in onset and unpredictable. Today, the value of EMS is to manage acute exacerbations of chronic medical conditions.
That sudden MI actually started as fatty streaks as a fetus. In a female, it was hormonally delayed. If a patient has their first "sudden" MI at 55, that means it was more than 55 years in the making with subclinical symptoms.
It is not like basics never had value, it is that as we learn more, the minimal service they provide becomes less and less valuable.
