A Bibliography on EMS in a State of Change

Most scientists agree that earthquakes are difficult to predict, but last Thursday should have been a “gimme” regardless of how the Supreme Court would have ruled.  Independent of your perspective on the ruling, we now know how health care reform will play out – at least until the next major shift changes the landscape again.  There are some fine articles that have looked specifically into the basics of U.S. healthcare, reform and the high court, or How Health Reform Could Hurt First Responders, even What the Supreme Court’s health care decision does—and does not—mean.  Also, hospitals are seeing the healthcare ruling as a new challenge and suggest that Federal Proposals Would Limit Aggressive Hospital Collections Practices.  So I have no intention to try to argue any of those contributing factors.  There are still many other factors affecting the future of emergency health care delivery that aren’t getting as much press attention even though their impact is at least as important.  Make no mistake, reform is coming to EMS!

Steve Whitehead at The EMT Spot blogged on the 7 Myths About Fixing Our EMS Systems.  It is a well-thought out article focusing on how to improve the system, but doesn’t approach the underlying causes.  From my perspective, one of the most important influences I see making an impact is politics.  In the article Ambulance debate rough road: Government could grow, it is clear that local politics specifically regarding government is driving too many decisions.  The Mayor of Columbus appears to be favoring a significant initial investment along with an annual subsidy to expand the local fire department rather than award a contract to one of the service providers claiming no subsidy would be required.  This also brings to mind the case in Utica, New York where the city sees an opportunity to actually generate municipal revenues through an ambulance service even though they could not certify a need as the Revised bill on ambulance plan still a bad policy opinion article suggests.  Which brings me to my second primary factor of money.  There are too many differences in how EMS is funded.  Unlike the fire and police department, which are so-called “free” services paid completely through your taxes, most EMS agenices charge for their services, going through your health insurance where they can.  Some operating costs are also covered by various combinations of property taxes, usage fees, or subscription fees without any consistency between jurisdictions.  There are many ongoing debates including this one by Letter: Emergency Medical Services In Great Neck.  But as long as there are such diverging funding schemes, we will continue to have diverse solutions.  We must also decide how we view EMS, is it public safety (like fire), the public health gateway in the community, or something in between.

But what concerns me most is the disagreement within the profession about what makes our services effective.  The Rogue Medic blog did an excellent post recently suggesting sarcastically that we Ignore the Absence of Evidence – Defend the Status Quo?  While that post focused on patient treatment, I think the concept extends to how we manage systems.  A point that Jonathan Washko addressed well in an article to JEMS magazine on how EMS Moves Toward New Care Delivery Methods.  While I applaud the fact that Abilene to launch new emergency medical dispatch system Monday, should it really be news that an EMS is going to concentrate on getting the right resources to respond to each call?  Economic conditions do not permit us to spend unlimited resources any longer to achieve arbitrary goals.  We must endeavor to use all of resources as wisely as possible and direct them at effective solutions.  And this challenge is not unique to the United States as there are Plans to cut ambulances across East, including in Norfolk, Suffolk and Cambridgeshire in the United Kingdom where they are already concerned that Doctor shortage will stop treatment for emergency patients.  What we need is High Performance EMS where we focus on efficiently providing effective service to our communities.

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High Performance EMS

High Performance Emergency Medical Services (HP-EMS) systems provide effective clinical care promoting positive patient outcomes and community wellness while maintaining a focus on improving economic efficiency of the system.  This site is dedicated as a community seeking to increase agency performance by promoting useful information regarding the developing trends and improvements in the efficiency of delivering basic and advanced medical care in the field.

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Comments
Jake
Static v. Dynamic: A Continuum of Cost
I whole-heartedly agree with Joey, what is our purpose? Why are we here? We are here to provide the best possible care to our patients. Part of best possible care is an expedient time-frame. I've been a dispatcher for 5 years, and I hate seeing my Medics get burned-out, but I hate even more so…
2015-07-20 07:13:24
Marcelo Bahl
Did You Watch ‘Nightwatch’ Last Night?
Hello, work in the EMS system in Brazil and whenever I can, I watch the episodes that leave recording to watch later, you show the reality of day-to-day of your city, which is very good and has no censorship as the shocking images that we see every day, because here everything is censored. One more…
2015-07-15 12:52:18
Jeffrey Hammerstein
Stop Dissing Response Times and Start Dissecting the Argument
I think that the position someone takes on this issue depends entirely on the circumstances of the particular EMS system they have in mind when they consider the question. If we're comparing a 7 minute response time to a 70 minute response time (or infinite as mentioned above), then of course it matters. That's a…
2015-07-03 11:44:45
Dave Shrader
Stop Dissing Response Times and Start Dissecting the Argument
I had meetings recently with a client in an underserved County. They have multiple tax supported volunteer organizations, and a City FD as EMS providers. The system is totally Balkanized with each agency doing it’s own thing. One agency failed to even respond to 66% of its calls last year. So, 66% of the time,…
2015-07-03 08:08:44
Surmed
Trauma Shears Dilemma
Dear Sirs, We D-MED Industries one of the leading company engaged in manufacturing and exports of Utility bandage scissors, EMT shears, Paramedic Scissors, Tactical Truama Shears, medical pouches, , medical bags and all sorts of medical scissors Our Manufacturing products range: = Utility Paramedic Scissors = EMT Trauma Shears = Tactical Shears for military use…
2015-06-25 02:40:30

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