"I Hate EMS"

"I Hate EMS"

By Alan Perry
August 6, 2013

I walk into a station and overhear the Officer say “I hate EMS” at the dining room table in front of both the oncoming and off going personnel. It is an attitude I know is well rooted in some fire services, but it is not always so audible. In many tradition-bound fire departments that still think its primary mission is putting out fires, the decisions that are made with regard to personnel and monetary resources frequently bear that out. This of course affects everyone’s attitude toward any activity that is related to providing EMS to the community. From the new recruits first day in the station, and probably much earlier, these unofficial messages are sent and received, having their intended or unintended effect. It is not surprising that the EMS equipment in stations where these attitudes are the strongest are often in the worst state of readiness, would it be any less surprising to find the standard of medical care and customer service also lacking? Such statements and attitudes may appear harmless, delivered in a humorous tone, but they are indicative of a problem.

What can we do? we could just ignore it and be happy that we have a job (which I am), not rock the boat and just play out our careers dealing with whatever we are asked to do without question, which is apparently what all of my contemporaries have decided to do. You see everyone can see the same problem I see, they seem to have come to terms with it and simply accept it as the way things are. Perhaps I am looking at it wrong (again), the officer’s expression of dislike does not come from his dislike of providing this service to the public, and it is more a dislike for the way in which it is delivered. As I stated earlier these departments are tradition-bound and very slow to react to changes. They have not kept pace with current effective practices, management and training in EMS operations. I fear this is likely the case in most fire departments that provide EMS transport service. For the fire service to remain effective at providing EMS services we will have to change our attitudes and methods beginning at the top.

If you were to ask, or simply listen to the grumbling, you would find that there are at least two common problems. The first is public education; providers frequently encounter patients who do not know what an appropriate use for a 911 ambulance is, and are unaware or have no other options for care. The second are inefficient paperwork requirements; providers are frequently dealt substandard and/or outdated data collection tools and software, the least expensive option is often purchased, something that would not occur if buying a fire truck. Add long hours and inefficient staffing models to the mix and you can see why the frustration is there. All of these circumstances can be resolved by reallocation of resources and the acknowledgment that EMS is the primary service provided by the fire service today. So why not fix it? Create a first-rate EMS public education program that mirrors the fire prevention side of the house to educate, inform and involve the public in your EMS services. Purchase equipment and software that makes data collection easy and efficient, is the newest version available and will be upgraded regularly. There is absolutely no reason the same data should ever have to be entered twice. Provide GPS or good quality maps, the days of hand drawn maps are long gone.

For our EMS systems to perform and have providers who truly enjoy their work we should consider demonstrating commitment to making the system the best one possible. Aside from the obvious morale implications, and improved operational efficiencies, fire administrations must consider the ramifications of the Patient Protection and Affordable Care act (Obamacare). This legislation will begin exerting force on healthcare and transport organizations, Medicare, and insurers to reduce healthcare cost by providing more appropriate and cost effective care. This should end the era of everyone going to the ER whether they need it or not, and provide a means to bill for other more appropriate treatment and transport. Failing to recognize a problem such as poor attitudes or sweeping EMS system changes in the pipeline will spell disaster for the organization, and ironically hating EMS won’t be an option anymore because we won’t be doing it.

Making some of these changes and showing commitment to the idea of a first rate EMS system will go a long way toward changing the negative culture surrounding EMS in the fire service. Positive attitudes flow from the top down, I realize many senior officers are late in their careers; many senior firefighters are similarly excluded from having to provide EMS and have lost touch with it. The fact remains that EMS is still the predominate service offered by fire departments that provide it, therefore participation and embracing of the EMS mission is no longer an option, it should not be the reluctant burden as it is currently portrayed. Of course not every system, officer, or administration has this problem, many have already overcome it, but for those that still have this issue the time is getting short.

Be Safe,