It’s Not EMS Abuse; It’s EMS Use

There’s a lot of talk about “EMS abuse” by EMS providers. I’d submit there’s a lot of EMS “use.” We’ve done a good job of telling people to call 911, but we’ve failed in telling them what an emergency is, what EMS is, and what EMS can do for them.

From the days of William Shatner and his overly dramatic voice, we were told to call Nine One One. The public has an idea, that we’ve promoted, that if you call, a group of well trained professionals will show up and fix any problem at any hour. Truth be told, that’s not too far off.  With the possible exception of 24 hour plumbing and some food delivery options, we are about the only people doing that who are actually available 24/7.  And unlike those others, we don’t expect payment at the time of service.

Until we have better alternatives, involving EMS, primary care, and the public safety net, we’re going to continue to have EMS “use.” How many of us have spent the time actually educating the public about who we are and what we do?

In addition to my EMS career, I’m also an attorney. I find it amazing how many educated people have virtually no idea of what EMS does or how it works, aside from help coming if you call 911. I regularly run into professionals in other fields, even including the medical field, who don’t know the difference between an EMT and a paramedic.  We’ve done a terrible job of promoting EMS and explaining who we are and what we do.  The idea of EMS “abuse” is a direct result of our success in telling the public to “call 911 for an emergency.”  And the rest of the medical community uses us to punt to.  Call a physician after hours and their recorded message is likely to say, “If you’re having an emergency, hang up and call 911.” The challenge is that EMS and the public most likely define “emergency” differently.

Back when I was in third grade in Austin, we had a week in school called “Be A Medic Week.”  We learned some basic first aid concepts, how to call 911, and got a tour of the ambulance.  (FYI, back in the early 1980s, some of the ambulances here were still low top vans.) We need to be doing the same sort of education with the public as a whole.

It’s time to show our ambulance to the public and introduce ourselves.  This is what EMS Week should be about — not seeing which ER is providing us with free pizza. (Besides, the good pizza was already eaten by day shift or the respiratory therapists.) Let’s do some actual community outreach, promote ourselves and our profession, and educate the public and even the other healthcare professionals. Who knows?   Maybe it might lead to some increased recognition, better understanding of who we are, and maybe even some increased confidence in EMS.  Maybe even some increased pay eventually.

Right now, there are too many people who think that ambulance driver, EMT, and paramedic are interchangeable terms.  What are you doing to fix that? Fix that and it’s quite likely that current EMS “use” will correct itself.  I’m tired of people being afraid or unwilling to call us for their actual emergencies because they didn’t think we could help.

Lets have that conversation with the public about who we are, what we do, what’s on the ambulance, and how we’re trained. People should know that their EMS system, particularly if it’s staffed at the paramedic level, is often capable of providing the same care as you’d initially receive in the emergency department, will get you to the right emergency department for your condition, and have the ability to consult with a physician if needed.  Texas regulations refer to a paramedic equipped and staffed ambulance as a “mobile intensive care unit.” That’s a very appropriate description for the two systems where I’m fortunate to work. We have the training, equipment, and medications to provide assessment and care that approaches emergency department and ICU care.  I’m even more fortunate to work with colleagues who recognize that it’s a privilege and public trust to be able to walk into your home or business to care for you or your loved ones.

It’s a conversation that’s long overdue and one that I’d be proud to have with any of you.

Seriously, if you have questions about EMS, ask one of us.  And if you even think you’re having an emergency, call us.


  1. John Fekety says:

    Over the years that I have known Wes and have grown to call him a friend (not in the FB world of “friend), we have had some great conversations. In the true spirit of friendship we have often agreed and when we have disagreed we have done so as adults and professionals. You have some great points in your article, a lot I agree with, some I disagree with, and some that want to make me pull out my hair because I have tried to implement educating the public only to be shot down by “management.”

    I have to take exception to dismissing the term abuse. I would rather break in down into several categories: people who actually abuse the system, people who misuse the system, people who don’t call because they think their problem is not enough of an emergency and the people who use the system appropriately.

    In one system where I worked we had a true abuser. She would call with a complaint of abdominal pain. We would do an assessment the first few times and find nothing. She would register at the hospital and while waiting for triage leave the hospital without telling anyone. It finally got to the point where she did not even bother to register before walking out the door. The final time this happened the police followed us and caught her walking out of the hospital to meet (by their greeting) a boyfriend. That was the last time she got a free ride (paid for by the good citizens of PA.)

    Then there are the people who misuse EMS. They have some malady, such as the woman with chest pain who would not even let me examine her because she knew what was wrong and she just needed to get to the ER. By her walk, and posture I believe she had pain but certainly not sufficient to refuse an exam, much less therapeutic intervention. Then there are the people who abuse themselves, the entire medical system and EMS when they call for an ambulance to take them to the hospital because their nebulizer isn’t helping, between cigarettes – including the one they are smoking when you pull up.

    I met a woman through my current non-EMS job who for some reason we got talking about an incident with her son. She told me that one night her son was running a fever of 104 and medication only brought it down to 103. I asked why she did not call EMS because of the potential for a febrile seizure. She said that she did want to “bother” EMS because they may have been dealing with “a real emergency. I hopefully made it clear to her that her son was very sick and should have been seen in the ER and if she is ever concerned that her son had any type of serious problem she should not be afraid to call for EMS. The same goes for the elderly flu victim who does not call because they don’t want to be a bother until they are so dehydrated they are hours away from kidney failure.

    Then there are the people do call when it is appropriate – chest pain, symptoms of a CVA, acute abdominal pain, etc.

    I agree more than whole heartedly that there has to be a great deal of education between both other medical professionals and the public. I was studying an anatomy book (when I thought about pursing an RN license) and a woman who noticed the book asked me what I was studying. I explained that I was a paramedic and I was thinking about becoming a nurse. She was delighted to hear that and said she was a clinical instructor at one of the local hospitals. She very proudly told me that on the rehab floor they let the students be very hands on by doing things like letting the students suction patients with trachs. The devil on my shoulder won the battle with the angel and I told her that my paramedic class was very hands on to prepare us for doing things in the field such as intubating patients, doing manual defibrillation and cardioversion and administering opiate drugs without a doctor’s order. She was so taken aback that all she could say was “That’s very interesting.” before she walked away. It is no wonder why nurses on the floors other than the ED call us ambulance drivers when their instructors don’t have a clue what we do. I had a situation where I transported a patient from a local hospital who had a positive nuclear stress test and spent the night in the intensive care unit. When we got the patient to his room there was no cardiac monitor. I told the nurse that the patient needed to be on a cardiac monitor. To keep it short, she said that it was not needed and when I refused to move the patient to the bed, went to her supervisor then called the Director of Nursing who said I should leave the patient until they could find a monitor. Since the patient was still on my stretcher I told her I had not transferred care and I would not do so until she brought in a monitor or a doctor ordered me to leave the patient without being on a cardiac monitor. She returned shortly with a monitor that just appeared on the floor. When we moved the patient to the bed, I asked her to sign the form acknowledging transfer of care. She curtly told me she would not sign anything for me because of the way I treated her. I asked the patient’s wife to witness the nurse’s refusal to sign and she gladly did while thanking me for taking such good care of her husband. And while I am rambling I will provide another instance of a nurse and a doctor that had no clue what a paramedic can do. I was dispatched to a local nursing home for an unidentified problem. When we arrived the nurse told me that the patient had to go to ED to get an IV because she needed IV antibiotics. When I was confident that she need just an IV and not a PIC line, I asked the nurse that if I put in the IV did the patient still have to go to the hospital. I offered to put in the IV if it saved the woman from a trip to the ED. She looked at me with a wide eyed looked and said, “Can you do that?” I assured her I could and did so. She was ecstatic when I went to get her signature and not only did she thank me but the patient’s doctor who was there thanked me profusely for not having to have the patient transferred to the ED.

    Although most schools, if not all at this point, require nursing students to spend a day with an EMS service, that day could be one of those rare days that the unit does not leave the station except for food. The ride-along time should be for a week not just a day, and for medical school students as well as nurses. Wes’s point about using EMS week as a time to educate the community is great. How many kids in elementary school know the phrase, “Stop, drop and role.” but would be unable to do a simple thing like abdominal thrusts to save another student or a teacher who has an occluded airway? We can still enjoy the cookies, brownies and other treats our colleagues in the ED provide us, while still doing more.

    And there is the need for public education. We miss great opportunities to not only provide services to the public, especially the older population (as my years increase there is an inverse proportion to my use of the term elderly) who live in various communities. We could offer blood pressure checks and during that time offer to help the people make a list of medications and their medical history. I have also seen various brochures that provide safety tips. We can educate the people exactly what services we can perform and the need to call immediately call for certain conditions. When I have advocated this idea to management the best reaction I received was “That is something to think about” and quickly dismissed to outright refusal to consider it because that was not our job and the belief that we could have potential legal liability if something happened and the patient or family blamed us. Although initially I could not fathom what consequence could result from doing a public service I then recalled many populations, including older people, spend a lot of time watching TV. Interspersed with all the other ads are the ones ads assuring them that if anything bad happened to them it was someone’s fault and they can collect money as the result.

    So, the bottom line is like so much in EMS, we can identify the problem but what will we do to fix it? Several years ago I read a statement that we need to stop using the excuse that EMS is still in its infancy and the problems we face are the result of growing pains. In truth, we need to get over that, put on our big boy and big girl pants and do something to educate everyone about our profession.

  2. Larry Lutz says:

    It’s not ambulance use if you call 911 for your annual trip to the ED to ensure your medicaid benefits don’t expire. Or the three days in a row I took three different persons to the hospital with a combined 44 transports over three weeks. I was treated like an object of disdain because I couldn’t “unclog” a woman’s stuffy nose. In 16 years of EMS service in one of the busiest systems around I have noticed several things. First, the people who take little to no care of themselves expect us to work miracles. Second, Medicaid is a fraud and people use it fraudulently. Third, the fact that I as a paramedic can make life altering decisions based on education and training, but can’t tell someone an ambulance isn’t necessary is ludicrous. Lastly, as long as we have for profit private EMS companies we will continue to shuttle these folks wherever the heck they want to go.

    Profit driven companies care only about billable numbers. Those that say otherwise are spitting in your face and claiming it’s rain. It’s not about patient care. It’s not about up to date protocols. Certainly it’s not about researching new techniques or finding the best data to support any kind of update. As long as private EMS companies allow the general public to think of us as Ambulance Drivers, they can pay us a wage commensurate with that title.

    The fact we don’t have an organization who stands for EMS nationally we will continue to falter. Nurses have a national stronghold because they demanded one. Our two organizations, NREMT and NAEMT, have done little to progress the cause of EMS and her clinicians. I may be totally off here and in the minority. I don’t think that’s the case. We have a generation of selfish individuals who abuse the system and in turn burn out some of the greatest talent EMS has to offer.

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