Wednesday, January 17, 2018

No More Agendas

No More Agendas
Alan Perry
January 17, 2018

EMS Agenda for the Future vs. Agenda 2050

Having read and studied the original EMS Agenda for the Future, as well as the subsequent implementation guide. I observe that most EMS systems still have not achieved those goals, I am finding this new attempt at creating a vision for EMS suspect. The Agenda 2050 is heavy on "social equity" but has thus far only produced fantastical ideas for how EMS could be with no clear or realistic pathway to complete the original agenda or this one. Perhaps it just an "Agenda" that does not have the welfare or effectiveness of EMS as the primary objective. One question asked early on was "does EMS describe what we do?”. This was in the context of all the new variations of EMS spawned to deal with increasing call volumes, decreasing resources, and the "care gap" created by the ACA and the current political, legal and social climate. The idea that EMS is part of the broader healthcare industry is concerning to me, as it should be to you. The first word is EMERGENCY! EMS is an essential public service just like Fire and Police spawned to react decisively in times of crisis. Mobile integrated Healthcare, Community Paramedicine, and anything else not dealing with true emergencies rejects that idea and places the service in the realm of public health and social work. I'm not belittling those professions, but EMS needs to be good at one thing, as do Police, Fire, Public Health and Social Services.

Fantasy vs. Reality

The addition of new and existing technology to the arsenal of EMS could indeed produce fantastical change in the way EMS is managed and applied. If only cost, tradition and politics where not barriers. Who will pay for it? How will the cultural changes occur?, Who will be willing to give up power and influence to make it happen? It seems that most of the envisioned changes do not consider these obstacles, in fact we were told to disregard all obstacles while developing the ideas for this initiative. The first reality is that EMS systems are diverse with widely varying needs, populations and resources. The second is that getting all of the stake holders, even within a small region, to agree on standards of care, staffing, compensation, and funding streams for these far-fetched visions, will be next to impossible. The only way I can see this occurring is by compulsion through legislation and or compensation from a larger political body (ie: Federal Government). This will inevitably come down to wealth redistribution, higher taxes, and more Federal involvement in EMS to achieve "social equity". Is this really what we want or need?

Agendas vs. Best practices

High quality, high-performance EMS systems of various designs exist out there already. They developed independently of anything other than local need and available resources. We need look no further than organizations such as the Richmond Ambulance Authority, Medstar-Fort Worth, Mecklenburg's MEDIC or King County EMS to see what localities can do when they engage in proactive measures to improve the quality of emergency medical care available to their citizens. Most of these are our shining examples of how we should proceed –let’s call it our evidence base. The majority of EMS systems are locally based volunteer, third service, non-profit or fire-based. Each entity, and their management team, has a vested interest in maintaining control over their piece of the pie for political or monetary reasons. Many, especially municipal and fire-based systems, have no pressing incentive to change practices. There is no competition and until the public demands more there is little incentive to, or consequence for failing to change. Shaking EMS free of this traditional feudal system will be the biggest challenge in my view, and our greatest obstacle to implementing evidence based practices for managing and providing Emergency Medical Services locally or regionally.

Private, third service or Fire service?

System design is only one component of the broader concerns for EMS. It is one that is driven by the needs of the locality, region and the States. I do not believe there is any one perfect design, only an ideal combination of resources provided to providers and the community that will make it efficient and effective. We know what providers need; support, training, reasonable hours and compensation that is fair. The community needs; Good stewardship, effective, efficient and compassionate care. Resources are a big part of the puzzle. In rural areas with a small tax base a volunteer system may be the only option the community can muster. Large metropolitan areas may be served by a fire-based system or have regional agreements with taxing authority than can acquire and maintain significant resources. It should come as no surprise then, that there will be significant differences in the design and capabilities of EMS systems across this nation which reflect the collective personal choices of those within those borders. The disparity of these two extremes is a major theme put forth by the facilitators of the EMS Agenda 2050 which portrays this as social inequity. Our forefathers, and I believe most sensible adults of all creeds and colors, would agree that each of us is entitled to live and work in a place of our own choosing, taking into consideration things like quality of life, accessibility to resources we think we need, tax burdens and government influence on our daily lives. It’s called freedom not social inequity.

Connecting the dots

If you are reading this article you are biased. You probably work in EMS or a related field or are in school pursuing a career as a provider. You already know how to fix EMS where you are, the truth is that most people have no idea what the big deal is because it typically does not affect their daily lives. When they do intersect with EMS it is usually brief and at the worst time in their life. Hollywood has not done us any favors but they probably reflect what most people think EMS is. Who’s fault is that? Like any other distorted story it starts with a lack of real information, when information is lacking the imagination takes over, public education can solve that problem. Healthcare is big business, EMS is at the bottom of the food chain, just ask any nurse or Medicaid billing specialist. It’s yet another perception problem from those we should consider our peers. We need to stand up, speak up and start the long process of educating the public and our allied healthcare partners. Before you do that though, do a gut check. To be considered a professional, you and your organization must look and play the part. You will get nowhere fast if you can’t demonstrate value, commitment and professionalism in everything you do. Study the research, do your own, and look at other systems and what works for them. Find your weaknesses and strive every day to improve your service. Set goals and reach for them, remember that they must be realistic and achievable.

Be Safe,


EMS Agenda for the future (1996)

EMS Agenda Implementation guide (1998)

EMS Agenda 2050 Straw Man version 2 (2018)

EMS and Home Healthcare (NAEMT)

What is EMS (NAEMT)