We can’t keep doing things the way we’ve always done them, or we’ll keep getting the same results over and over again.  That’s called insanity.  We have to keep moving forward.

I ran my first EMS call in the early 70s.  I’ve been involved in this profession since I was a teenage, snot-nosed, kid.  Those early days of EMS were incredible.  CPR, Hurst Tools, Advanced Life Support, and even the 9-1-1 system brought radical life-saving to the prehospital setting.  But now I have to ask, what have you done for me lately?

When I left EMS, to pursue other dreams, in 1995, some great things were happening.  We were working to raise the standard of care by requiring paramedics to have a college degree.  We were increasing the scope of practice to include RSI, 12-Lead EKGs, and a host of other procedures and medications.  Indeed, the advent of the modern trauma systems brought great changes to the way we dealt with injured patients. But some of the biggest changes were occurring in the political spectrum.

Municipalities and agencies were developing administrative rules, ordinances, and laws that would eliminate duplication of services, streamline provision of care, and assure cost-effective, high-quality ALS treatment and transport to those who most needed us.  Unfortunately, we’ve stopped moving forward.  All these ideas that were so great in the 80s, were finally passed in the late 90s, but we have failed to move into the 21st Century.  EMS is stuck in the 80s.

Don’t get me wrong, I loved the 80s – but it’s time to catch up to the times and technologies available in this century.

For instance, the mapping and communications on my phone are far better than what I’ve witnessed in most emergency response vehicles.  The triage afforded my the standard EMD protocols is not getting the right resources to the right calls in the right time.  Requiring ambulances to arrive to all Code-3 calls within a six, eight, or ten-minute window is not just unsophisticated, it is dangerous.  Also, sending multiple paramedics, from multiple agencies, to all calls is crazy.  Not only is there a breakdown of scene-management, but it causes our patients unnecessary stress.  In addition, we need to stop transporting everyone who calls 9-1-1.

Here are some ideas for us to consider as we move into the second decade of the 21st Century – and as we approach the 40th anniversary of the Paramedic Program:

  • First, we need to better triage the incoming 9-1-1 calls. People don’t need a fire and ambulance crew on every call, but more importantly, less than 50% of these incidents require a Code-3 response.
  • Second, it is not cost-effective, practical, or safe to require an arbitrary dispatch to arrival window.  We need better data, deeper analysis, and a more nuanced system of measuring our EMS delivery systems.
  • Third, we need to find a way to eliminate the duplication of services that is prevalent in so many regions.  While there are times it is good to have a lot of medics on scene, and there are definitely times you want the closest units to get their quickly, we aren’t utilizing our equipment and personnel wisely.  This needs to be streamlined.
  • Finally, we really need to find a better way to treat, and release, patients who are experiencing minor trauma or medical issues.  There is really no reason for us to be transporting everyone who calls 9-1-1.  Paramedics are perfectly capable of treating, arranging alternative transportation services, or connecting people to appropriate social services.

ems2oWhat do you think?  Is it time for us to move forward?  What are some of your ideas?

By the way, if you haven’t connected already, you need to check out EMS 2.0.  Things are starting to happen, and I’m pretty excited by the potential.  Join the conversation!

  1. Thanks for the nod!

  2. […] This post was mentioned on Twitter by the Happy Medic, John Broyles, Tyler V, Shelly Wilcoxson, Just Me and others. Just Me said: RT @johnnygage51: The Next Step: EMS 2.0: http://wp.me/p1acol-V […]

  3. Ross says:

    King County (Washington State) EMS licenses its criteria based dispatch for free. Take a look at . Medics go to calls where they are needed, EMT’s cover everything else while dispatchers are treated as intelligent beings capable of gathering and processing information.

    • Johnny Gage says:

      Yeah – good point Ross – and actually a lot of places have criteria-based dispatch, but they fear the liability of letting it work. As you said – treat the dispatchers as “intelligent beings capable of gathering and processing information.” Until we do that, we are going to continue to under-triage.

  4. Dna Scharnhorst says:

    Working in EMS for 30 years now, I have been one of those who have been both witness and participant to many of those changes you’ve mentioned. While I have run for departments as a volunteer, a part-timer and a full-timer, much of my career has been as a paramedic for a private ambulance service…and it is here where many attitudes are stuck not only in the 80s but also the 70s.

    For starters, my dispatchers are not permitted to turn down ANY run that is called in–even when another department or service might be closer. They are instructed to give priority to scheduled runs and “preferred facilities”; a practice that occasionally delays emergency response. As irresponsible as this sounds, the facilities actually accept and wait for protracted response times!

    The facilities in my area–SW Ohio–do not see private ambulances as legitimate EMS, although we are licensed as such by the State and Pharmacy boards. To such places, we are taxis, there only to pick up patients at Point A and deposit them at Point B. What this means in many cases is that the staff feel we do not require a proper report and if we dare to ask for one, we are told it is a HIPPA violation.

    My colleagues seem to accept this attitude–that we are mere transporters, taxis, or even–a dirty word to me–just an ambulance driver. Many of our Basic EMTs are uncertain how to handle any emergency calls and think that only the Paramedics are capable. The fact is, we are all–whether basic or ALS–as well-equipped as those squads found on the fire department; and in my company’s case, we operate under one of the more aggressive and liberal protocols to be found in the State!

    So for me, EMS 2.0 takes on a special significance:

    To educate facilities on what it is private service EMTs and Paramedics are capable of;

    That we ARE medical professionals and deserve such information as would assist us in giving the best possible care to our patients;

    That my colleagues–whether Basic, Intermediate or Paramedic–are trained, knowledgeable and capable professionals.

    It’s not going to be easy, but then again, no worthy cause is. Let the crusade begin.

    • Johnny Gage says:

      I’ve been discussing some of these issues with my co-workers lately. The majority agree that this needs to be grassroots – and not top-down. We, the so-called professionals, need to step up to the plate and act like professionals.

      In our attitudes, in what we accept from our colleagues, and in the way we are educated – all of this will communicate volumes.

      Just last week I had a discussion with a county regulator about the response time standard. I told her it was a bad idea based on speculation, not research. I told her that until dispatchers are given more latitude, we will continue to have an under triage and the medics will treat all calls the same.

      Until more of those we work with are willing to take initiative, we will continue to be stuck in the quagmire.

      Thanks for sharing your thoughts!

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