Where is EMS going?

Comment

Comment by Tim Soyars on January 4, 2009 at 12:09am

Robert,
I understand the struggle we have had as a profession. I have several problems with your example. First, can we say that the fire fighters have the same problem? No. Fire fighters are veiwed very well as a profession. And yet the same areas, or more, are often covered by volunteer fire departments as well as volunteer EMS. Second, you use the examples of doctors, RNs and policemen. For each of these, there is only one entry level. Not so in EMS. There is no request to lower any standard, although in some states, if they follow the national Scope of practice to the letter, that is exactly what they are doing. It is only asked to keep what is already in play. If the content need to be upgraded, then we need to do that. It would make more sense to me to drop the AEMT and keep EMT-I. While it is great to have a career EMS service in you commuity, if has to be funded by someone.

Comment by Chaplain Robert A Crutchfield on December 28, 2008 at 6:11pm

I first heard of the Dreams project in October of 2001, from Dr. Ward Cascells himself. (I think I have the name spelled right) They have developed some cool tools. The whole thing was originally sponsored through a civilian preparedness grant from the U. S. Army. Dr Cascells and some of the others have backgrounds in both civilian trauma are and battlefield trauma. The good doctor went on to head the entire military health care system.

Comment by Duncan Hitchcock on December 28, 2008 at 5:53pm

The original question as poised was to our vision of where we see EMS in ten years. At 36 years and counting, I have thought of this question often from the perspectives as field provider, teacher and administrator. While keeping in mind the amazing changes that have already transpired in the new, young and evolving sector of the health care, I'm of the opinion that changes will and must continue.

In ten years the EMS we practice today will have the benefit of expansion into the fields of true scientific based prehospital care reasearch. There will be increases in basic educational expectations and requirements for all levels of providers. Our educators will see increased requirements as to their credentials and fundamental training to function as professional institutionally based teachers. Technology will continue to impact how we do things. As the kids in middle school and high school enter this business, their familiarity with and use of technology will enhance the acceptance of technology as the norm, not the exception.

The local, national and global financial crisis will infiltrate the operational means and methods of the business aspect of this industry for the next 2-3 years. Government based agencies will be pushed to do more with less; less growth and less funding. There will be no "sacred cows" for a few years of lean and bargain basement public financed EMS. This will affect response times and patient care. Private agencies will continue to see the tightening of the federal reimbursement requirements for services rendered. Maintaining the bottem line will require the private agencies to look at expansion into other means of transporting patients relying less on fully stocked ambulances and more on stretcher and wheelchair services.

But this too shall pass.

The traditional fire service based EMS mentality and philosophy will continue to evolve towards the realization that we really are an EMS based fire service. Having worked in all three primary means of prehospital care provision (private, third service and fire/EMS), it is my opinion that the public service sector will continue to survive and expand. As will the private sector. Government funded agencies still can't grasp the concept of complete provision of prehospital care and transportation. The meat and potatoes of private agencies is still in the fundamentals of moving patients of all needs levels from here to there.

The expectations as to the knowledge and skills of emergency response personnel will continue to increase. This will require more training and education. The technician of today must become the technologist of tomorrow. Everyone how wishes to and has the abilities to should have the opportunity to become an EMT and/or a Paramedic. Everyone that enters the profession should not be forced to. But the demands for increased fundamental training and education will increase as will the demands for access to education.

Concepts such as how and whom to resuscitate, and when, will continue to be researched and debated with little change in philosophy. The marching orders will remain, "When in doubt, resuscitate." CPAP, pulse oximetery, capnography, 12-lead EKGs, Cardiac Alerts, Stroke Alerts and Trauma Alerts will be industry wide and approaching standardization nationwide. CPR will remain the fundamental but how we do it will change, again. ACLS and other prehospital drugs will continue to evolve. Old standards will pass away and new "golden saviors" will be touted.

But in ten years from now when people get sick or injured, they will still dial (punch in) 911. We, or in my case, you all will still respond, treat and stabilize and transport them to the hospital. We will do it better and smarter, with more tools and better equipment.

Comment by b leigh anderson on December 28, 2008 at 1:15pm

I am totally in line with what has been said thus far- you can look up the NAEMSE: agenda for the future document- and that's what professional organization for ems educators says about the subject....this was a big part of becoming an EMS educator- knowing these dilemmas, and asking these questions.

More field Tx, i think more of a "treat and release" will be seen- which is sorta unheard of right now.
when we get more "thingies" on the box, the more likely this will become.
and ahhhhh yes- the volunteer vs. paid game- this is such a thorn in my side as well. Do away with volunteers? well, you don't see any volunteer CEO's do you? hahaha. it's not about money, folks, the mark on what we get paid solely hinges on accredidation! we need to match the medical technician knoweledge with the academia, and then the money, and "profession" will follow.

volunteers?! i can't imagine life with out them. I love being both paid and still being able to volunteer in my community that i live!

look up the dreams program, (might not have the exact right name on this), about the whole video consult thing- it's already happening. saw that at the texas ems conference, scary and cool at the same time!

Comment by Mike on December 27, 2008 at 9:02pm

Where is EMS going? To hell in a hand basket if we aren't careful..Ha just kidding! Seriously folks, EMS is changing and will continue to until there is a vision of just what we should end up being. Presently there are many arguments about that such as are we Public Safety or Public Health, my view is we are both. We have the primary obligation of responding to emergencies as first responders and caring for those that are sick and injured. We also have the role of being primary health care for many folks without the resources to seek other care which puts us squarely in public health. With these responsibilities we see folks in their world and have a better understanding of their environment than does "based" health care. Because we do see many folks as their primary health care our responsibilities should be expanded and perhaps even increase the responsibilities of the levels of care we presently have to include suturing, prescriptions, recommendations for home health care, etc. I believe that this is where we are headed. How do we get there? First we need congressional representation as EMS, not public health or fire department we have unique differences from all other agencies. Second we need to stop being used by fire departments as "number generators" We are professional providers just like the fire fighters are. The majority of fire departments that take on EMS want the numbers and demand that paramedics become firefighters also. Some cross training is needed in all aspects of public safety but the amount of training and practice needed for both fire fighters and paramedics makes it difficult to do both jobs with the proficiency needed. I want a well trained and focused firefighter protecting me while I focus on care for the patient. The third thing we need to do is take pride in ourselves and our profession, join groups such as this and the NAEMT, NREMT, Advocates for EMS, and many more. Get in shape, (I know round is a shape) look around you the next time a bunch of EMS folks are in a group it's a large group! It doesn't look good and it's not good for you! Fourth, we need to find ways to get rid of EMS volunteers above the EMT level. I appreciate the sacrifices of the volunteers and their families but there is entirely too much training and practicing to become and remain proficient in EMS care to place that burden on folks that have real lives, jobs, families, R&R, etc. and can only focus a small amount of the time needed. (I apologize for stepping on toes here but its how I feel) Volunteerism is in a decline now due to many of the reasons stated above, it is time for the powers that be to recognize that EMS is a third service, at least we do earn some money and are not completely dependent on government money like police and fire are. It also needs to be noted that though EMS is revenue generating it is not sustaining. Overall EMS is changing and if we want to help steer it we need to get involved. Mike

Comment by Robert J. Galvin III on December 27, 2008 at 3:06pm

While there seems to be some skepticism about the National Scope of Practice Model and the 4 Levels of training, IMHO this must happen in order to improve and advance EMS on a National Level. Presently there are too many different levels of EMS providers with different scopes of practice. In order to be recognized on a Federal Level, we must have standardization when it comes to EMS Levels and skill sets. We must strive to make all EMS initial certification programs become Nationally accredited and all graduates will have a national standard set of skills regardless of the State they practice in.

Tim, I am familiar with Virginia and the extraordinary job that your State does with the number of Volunteer agencies, however, it is my opinion that Volunteerism is one of the problems that is holding back EMS from being seen as a true profession. Why pay people a decent wage when you have someone willing to do it for free. This has killed EMS throughout its existence! I do not see Rn's, Physicians, or Policemen volunteering in there respective professions yet we all acknowledge the National shortage of each. I do not see them lowering the educational standards or limiting their skills despite this shortage, why does EMS??

Comment by Tim Soyars on December 22, 2008 at 9:34pm

My big concern is the next EMS certification levels. They are making it hard for the EMT-Is to keep up. With most of our country covered by volunteers, many of which already have a career, it is harder to become a paramedic. Most of the ALS coverage is done by EMT-Is. With the cutting back on EMT-I skills or even the elimination of that level, as we know it, rural America's vounteers are in danger, and with them, thier commuities.

Comment by Annette Smith on December 22, 2008 at 6:23pm

I wonder if we will be "video consulting" with a Doc.....more treatment in the field type thing. Sounds like something out of a Star Trek episode but I can see it happening!