Sometimes the obvious is difficult to comprehend.
Why can’t my system make common sense choices like this from Medic999:

“Its obvious that something is bothering her sufficiently to call 999, and in all likeliness, a further GP would just send her to the hospital anyway. I told her that I would run her up to the hospital myself, in the car, to get her checked out further. “

He can cancel the ambulance and transport appropriate patients in his car.

Am I the only one stateside thinking this is the right way to do it? A scaling system that can adapt to the changing call as it develops?
The American model is locked into a BLS before ALS mentality and it is hurting the system.

Benchmarks set to reach BLS patients faster than ALS patients simply because more of your resources are BLS is just silly. Yes, I said silly. We should be striving to reach the ALS patients within 6 minutes or less and let the scratched fingers and sick evals wait a little longer. They waited all day to call anyway.

My system has these same benchmarks and they were set in place when a BLS system was augmented with a smaller than curent day ALS force.

But now the volume is catching up and demand for ALS resources by BLS units is overwhelming the system everyday.

What is the solution, though? Adding ambulances is just like parking tow trucks near a problem intersection and waiting for the accidents to happen. We know what is causing the increase in call volume, why not nip it in the bud, where it starts?

The “patient.”

Patient is defined by Webster’s as both a noun and an adjective. But today, the two couldn’t be more opposite.

As an adjective, patient means enduring difficult situations with an even temper; Capable of calmly awaiting an outcome or result; not hasty or impulsive.
That is most certainly not the modern clientel of EMS services. They call demanding a level of service they do not need or understand, only so they can seek attention from an advanced system, the hospital, which they may or may not need. And all of it has to happen right now, no question, no delay, let’s go.

But the noun, patient, means one who receives medical attention, care, or treatment. “Receives,” not requests, or identifies with, but “receives.”

Does that mean I have not made patient contact until they receive care? Is calling 911 legally, technically, recieving care? Yes, unfortunately.

Why can’t I rely on my training and ability to assess people for illness and/or injury and define them as something other than a patient? Could that cut down on our call volume?
Absolutely. Would it spark a tidal wave of legal questions? Most certainly.

So where does it leave the average American EMS professional? En route to the hospital, that’s where.

WAKE UP friends! Our systems are about to be swamped with baby boomers hitting retirement and expecting the level of service they had to maintain for 40 years. If you thought we’re busy now, just wait 10 years.

Reading Medic999’s stories and then reading mine, I keep seeing distinct differences in the level of care provided by the systems. Medic999 is able to cancel an ambulance and refer the patient directly to the appropriate service, based on his professional assessment. That’s what we’re already doing, except the hospitals hold the keys to the services our clients need. We just move them from A to B, sometimes intervening.

If appropriate, again based on a professional assessment, they just need a ride, Medic999 can put them in the car and take them, leaving the ambulance available for a more serious call.

It makes so much sense it hurts to think about it.

So what is standing in the way? Profit. I can’t refer patient #1 to the rehab unit at St Farthest because they have a different insurance, who needs to have a referral from the patient’s primary care, who isn’t at St Closest either, but in a completely different HMO. And I can’t refer patient #2 to their general practitioner because, surprise, they don’t have one. Their only access to medicine at all is me, as a ride to a doctor, who is legally required to listen to them, clogging up a bed in an EMERGENCY room.

There needs to be a complete re-thinking of the way EMS is delivered in the US if any of it is going to survive the rapid increase in volume that is coming.
We can’t keep adding ambulances, we need to look for other ways to address the issues we face.

Help. We need help. We need a solution that can deal with the expectations of our clients, while still providing a competent, professional service that meets the needs, not the desires, of that client.
The UK system isn’t the answer, it can’t be so long as insurance companies can restrict access to services. But what about the fast car model?
Wake County EMS is having success with a variation of the FRU with their Advanced Practice Paramedic role, a design that interets me a great deal.

But in the end it really comes down to liability and cost. 2 things a Paramedic and EMT in the field have no control over. Sure if I can tell someone who doesn’t need an ambulance to take the bus I can save money, but increase liability. We can take everyone who summons us, regardless of the reason, which eliminates liability, but increases cost.

Enough. The fire based model won’t last long if it relies on an ever shrinking fire system and can’t survive in the private sector with the increase in volume and decrease in benefits.

Enough. We are no longer a group of certificate wielding drivers, we are licensed professional Care Givers.

Enough. The EMS systems can’t be governed by organizations that refuse to adapt to the changing landscape that is the modern patient, or citizen with a medical complaint.

Enough. We need those ambulances to stay in service for when the call comes in, the rare call, where we can actually use our advanced skills to make a difference.

“I’m sorry,” I had to tell the woman lying on the floor of the grocery store after fainting, “We don’t have anymore anbulances to take you in right now.”
After not 10 minutes prior being forced to summon an ambulance for a man who skinned his finger, who demanded transport.

We’re better than that. Now let’s get out there and do somethign about it, before it’s too late.

Humbly submitted,
Your Happy Medic

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