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.