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,
REFERENCES:
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)
