Sometimes we get caught up in the hype and altruism of the profession. We just go about our jobs, not digging deeper into how things are changing or what the reality is that we need to be discussing.
Last year was the 50th anniversary of the 1966 White Paper “Accidental Death and Disability: The Neglected Disease of Modern Society,” the landmark paper often cited as the birth of modern EMS. Even though we have made much progress, there are some things that we seem to either revert back to or stick our head into the sand and ignore. With this in mind, I would like to address four things that we in the fire service/EMS community need to start discussing.
The four issues
1. Providing EMS is not cheap: When you look at the budget for EMS in most communities, it is a pittance compared to other city services; however, if you were to ask a citizen to rank how well funded they want their EMS system if they or a loved one needed it, most assuredly, they would say they want it ranked very high. Unfortunately, it is usually not a part of the average citizen’s discussion. But when they call 9-1-1, they expect to hang up the phone and look out the window and see a fire truck or ambulance pulling up.
Properly funding and dedicating the right amount of resources to any EMS system needs to be part of the discussion. The problem is how many people in your community will use the EMS system in 2017? Less than 5 percent of the population? Just like fire services, the majority of citizens in your community do not think about something they may never use. But if their streetlight is out or the trash isn’t picked up, they are on the phone to their councilman or alderman in a heartbeat.
2. Any town or city can face an active shooter incident: The problem is that many EMS systems are still sticking their head in the sand, believing that it can’t happen to them. The website gunviolencearchive.org tracks mass shootings. In 2016, there were 383 mass shootings of four or more people in the United States, resulting in 454 deaths, and 1,541 people wounded. Cleary, not everything gets reported in the papers or TV.
EMS systems need to be better prepared and trained for active shooter incidents and mass shootings, including ballistic protection for those providing care on the scene.
3. We don’t save everyone: Contrary to the TV shows where virtually everyone survives the most tragic of events because of CPR and defibrillation, we all know the truth. Communities that brag about 35, 40 and even 50 percent survival rates from cardiac arrest are doing a disserve to citizens when they skew the data to create glorious patient outcomes. The reality is that EMS has been poor when it comes to addressing preventive issues that could change patient outcomes, such as mass saturation of AEDs in public places and even homes. The other part is to have mandatory training with CPR and AED use for citizens and any students graduating high school.
Imagine if AEDs were as abundant as sprinklers and fire alarm systems in public buildings. Of course you would not need AEDs every 130 square feet like a sprinkler, as you would in ordinary constructed buildings, but how about an AED at least every 250 feet apart of any given floor in a public building?
4. Expect tighter scrutiny for reimbursement purposes: Hospitals are going through it, and some say EMS is coming soon. Some officials at the federal level are pushing it. Reimbursement from Medicare, Medicaid and, in some cases, private insurance will be based on the quality of the care delivered to the patient. Exactly how that will look and how that all will be flushed out is yet to be determined. But one thing among many that hospitals are currently measured on is patient satisfaction. If the patient is surveyed and they do not think they had a good experience, it will not bode well for reimbursement. So for those of you who mouth off to patients when you think the call does not constitute an emergency, you’re going to have to change your temperament.
In sum
I am sure if you were to conduct a poll, there would be different opinions on what we need to start discussing. But I do predict that the future firefighter/paramedics who are born in 2017 will have self-driving ambulances one day. I’m curious what you think. Send me your thoughts.
