Who can see the future

[Just Plain Ruff]

To PIggy Back on another current thread regarding the past.

What do you think is the future of EMS in the next 5 years?

The next 10 years?

What do you see in the next 20 years?

[island emt]

RETIREMENT

[Just Plain Ruff]

Fully taxpayer funded pensions?

[ERDoc]

If we are talking about the US, I see bad things coming in 5-10 years as the IAFF tries to further justify its existence and take more control over EMS. I think after that we might see things start to swing the other way as the EMS subspecialty in Emergency Medicine becomes more prevalent and more board certified medical directors start to pop up and push for improvements in the field.

[Just Plain Ruff]

yeah, the day of the mom and pop service are gone.

It's either fire based ems or the big alphabet services. One or the other and if you are lucky to be working for a small independently owned services, count yourself lucky until the alphabetasaurus sets his eyes on your company.

[island emt]

I see a lot of consolidation and regionalization in the coming years.

Even the small town rural services are finding it hard to continue providing service as in the past.

Expenses go up and receivables go down,with insurance carriers wanting a fixed discount for services.

[WolfmanHarris]

Here in Ontario I'm really not sure. There are some exciting things in development that I hope come to fruition, but the legislation and regulatory environment makes these less than guaranteed.

1) Self-regulation. The Ontario Paramedic Association will soon submit an application to the Health Professions Regulatory Advisory Committee (HPRAC) for the Creation of a College of Paramedics. Self-Regulation will open the door to setting our own standards for education and a more adaptable scope of practise.

2) Community Paramedicine. With a publicly funded health care system finding efficiencies and novel ways of providing service is theoretically easier to justify since the system as a whole saves money. Many services are starting to explore various solutions to shift away from the transport everyone paradigm. The early stage programs mirror a lot of what's been reported in various publications: visits to frequent callers, referrals, follow-up visits, etc.

My service is exploring a few different options and have four staff devoted full time to developing community Paramedicine. The options being explored are an Expanded Scope of Practice for Paramedics, treat and release of nursing home patients with follow up by NP or MD the next day (traditionally we have transported 100% of these patients), and selecting experienced ACP's and sending them to Physician Assistant School and utilizing PA-Paramedics in the field.

The PA-Paramedic program is probably the most interesting. Details are still scarce at this point but it creates a new step in our career path. Also exciting is that the University has apparently agreed in principle to recognize the three years of College training an ACP has as meeting the usual prerequisite for two years of University in any discipline.

3) Longer injury free careers. We have had tracked stair chairs for three years, we have a very open policy for requesting lift assist, power cots have hit all the trucks and power lift is on the way in the new year. We've been aggressively pursuing no-lift policies and equipment where possible and promoting health and wellness across the board. Our service is far from the only one embracing this shift and I think that's going to be a huge career extender.

4) Longer careers. I think has already started. Since the download to the municipality in 2000 and the enhanced education requirements we have seen dramatic increases in pay and benefits. We have a great defined benefit pension. As services grow and embrace new ways of providing service new job opportunities are created away from the Ambulance which help alleviate burnout and extend careers. All in all I think the medics in the earlier stages of their careers are no longer entering with an eye to FD or PD and have a long career in mind when they sign up. I can easily see reaching retirement while still being with this employer.

[BAYAMedic]

I echo the improvements of assisted cots and increased use of stair chairs. I have heard rumors of street rigs getting ISTAT machines to have a non stemi cath lab activation with troponin elevations.

BAYAMedic

[Just Plain Ruff]

The Istats are nice but CLEA (I think, not sure of the acronym) would need to be involved to allow that since it is essentially a lab test. Hospital based EMS systems are best suited for this type of test and the rolling out of these things. Once these are rolled out in several systems and shown to be effective in patient care pre-hospital, then I would look for them to be a standard of care within the next couple of years.

They are pretty much idiot proof if the ones that I've used would be used.

[ERDoc]

Do you see a use for any other labs in the field using a system such as the istat? If so which ones and why?