Couple of Quick Thoughts

While perusing social media this morning, I noticed a couple of things that bear repeating.  Again.

The same professional EMS committee members are now taking public input on “EMS Agenda 2050.” yet we can’t always even get the core mission of EMS right — namely getting people to a hospital — ideally the right hospital and with the patient in no worse (and hopefully better) condition than we found them. I’d like to fix EMS 2018 before we turn EMS Agenda 2050 into another document forced upon us by the same people who largely created the current mess.

Everyone continues to look for a single silver bullet that will fix EMS.  Education. Increased reimbursement. The latest equipment.  Some buzzword usually involving “data.”  EMS in the United States is a local responsibility provided for in a variety of models.  Imposing and implementing one “magic solution” won’t work.  What works in a compact city like Boston with multiple academic medical centers in a small area isn’t going to apply well to rural Nevada where a small hospital is an hour’s drive.  The reason why our nation’s Founding Fathers embraced federalism is in recognition of the simple truth that one size fits all solutions from a central government rarely work. (See also: IRS, “Affordable Care Act,” and the Post Office.)

The only thing I see more than people in EMS routinely advocating for us to take people to destinations other than hospitals are stories of EMS getting refusals wrong and a patient getting sicker or dying. I say this after seeing, just this week, an article about a child whose parents called EMS to take their child to the ER for the flu, EMS obtaining a refusal, and the child ultimately dying.  Was EMS responsible?  We don’t yet know at this point.  But I do know that taking a patient to definitive care is a large part of what we do.

Most ER physicians will tell you that the hardest decision they make is the decision to admit a patient. That’s coming from a physician with access to labs and imaging and specialist consults. I’m not ready to trust someone with (at most) two years of education, minimal diagnostic equipment, and a short assessment to make the decision that going to the hospital isn’t a good idea.  Yes, there are obvious cases that we can consider “abuse” of the emergency care system. But the lawsuits will result (and they WILL happen) from the patient with vague symptoms who’s relying on the judgment of the lowest common denominator of providers who just wants to get back to their station.

And that brings me to my final thing worth repeating today.  An EMS system is only as good as its worst provider on their worst day.

Feel free to refer back to this post in 2019.  I’m sure it will remain just as relevant.


  1. “you call, we haul, that’s all”

    I’ve been doing this since 1977. Somewhere around the mid 80s, working in a big city, on a very busy time, with a significant portion of transients needing our assistance, we were pretty quick to decide they didn’t need us to provide care and transport.

    Now, 40 years later, I’ve discovered that a refusal, and chart take longer than a simple transport and chart. In fact, I tell my students to let someone at a higher pay grade make these decisions. Just take them to the hospital – and while you’re with them, be compassionate, kind, and medically caring. Treat them as if you were treating your Mom or Dad.

  2. With respect, I don’t think it’s fair to blame the participants in the EMS Agenda project for “the current mess” in EMS. I got an email from them soliciting input in about 1994, when they were developing the original document. Nope, I said. Like so many of us, I figured I was too busy.
    Today I believe it’s guys like me who are responsible for the current mess in EMS.
    The current team is developing a 2050 document, all right, and they’re asking for input from anybody who has ideas. I’m sure they’d embrace yours, especially considering your very special background. But one thing’s for sure. If we’re all satisfied with the notion that EMS is just the fire service’s junior varsity, that’s all it’ll ever be.