Dr. Ronald Roth, an associate professor of emergency medicine at the University of
Pittsburgh and the medical
director for Pittsburgh’s 911 system, described these arrangements (such as
between Kaiser Permanente and AMR Pathways)
as “the wave of the future.”

“There are some 911 centers where if you call and you meet certain criteria, they
won’t send an ambulance,” Roth says. “They might send you to a non-emergency
number, a
nurse online or get you referred to a clinic.”
__________________________________________________ ________________

I became certified with the NAEMD at the first "International Conference of EMD" in
Salt Lake City, December 1988. Dr. Jeff Clawson himself taught the bulk of the
pre-conference EMD course, and I remember vividly these words during the course:

"If your EMS system permits a 'no send' policy, you are asking for nothing but

What has changed since the days of Dallas and Poughkeepsie, the litigation that
arose from the calls in those cities, and the advent
of EMD from the Aurora letter to the first DOT guidelines, all the way to version 1.0 of
the MPDS?

Several terms come to mind in an attempt at summation; "Managed Care", "Pathway
Management", "Patient Choice", and "Money Talks".

The recent mainstream media publicity regarding the arrangement between Kaiser
and AMR Pathways is heartening, especially when that includes the necessary and
appropriate criticism of the arrangement from the IAFC as well as EMS and Fire
officials from the metro Denver area.

This coverage is much more comprehensive than the anemic efforts in trade
journals (Mike Spivak's meager attempt in a recent issue of EMS Magazine is an
example). The best coverage of the issue so far has come from the Denver
Business Journal (

One of the fundamental beliefs that I hold dear when faced with lunacy such as this
is that the best EMS systems are those that recognize their EQUAL responsibilities
to Public Safety and Health Care, and maintain that highly symbiotic relationship with
a close eye on balance between the two.

Another belief that I hold is that the needs of the citizen remain paramount as an
operating standard for any successful PSAP. Sorry to say it, but third-party payors and
HMO's are WAY down on the list.

I live in an area where the predominant local HMO is committed to the Prudent
Layperson standard, and the Fire Department is delegated by legislation with the
authority over the provision of EMS. Given the competitive and pluralistic nature of
EMS in other areas of the country, I guess I have it pretty good here. My experiences
here over the last 4 years have reinforced another fundamental belief, that a profit
motive is incompatible with efficient and responsible public safety operations. EMS

I hope that my colleagues on this list will look closely at the trends illustrated by the
recent media coverage, and monitor closely the activities of your private sector EMS
and HMO's or Managed Care Organizations. Make sure your voice is heard loud and
clear should similar attempts to subjugate access to EMS surface in your area.

If this type of activity is "the wave of the future", then I am due for a career change. I'll
do that before I have to work in an environment that mocks the essential values and
ethics that brought me into this form of public service. After 10 years as an NAEMD
certified EMD, I let my certification lapse for these reasons.