What challenges do you see paramedicine and EMS facing?

[MedicMal]

ok I'm having a brain fart, or maybe it's because I'm young and haven't had much road experience.

In the future, what challenges do you see paramedicine and emergency medical services facing?

Thought, suggestions, input?

Thanks,

MedicMal

[TechMedic05]

Ourselves.

It's tough to try to act as a professional EMT-Paramedic, being well thought out, progressive and attempting to be remotely well educated while many other prehospital providers, well, are all about the red lights, driving fast, and blood and guts. In several areas I have and do work, professionalism is a huge issue. Things like a former partner of mine driving with lights and siren through a school zone while it's being let out...for a patient who is no where near critical, and then turning to the patient's family member in the cab and saying "God, I love my job." yeah, I have issues. I guess I'm weird. And I also don't work there anymore. Silly me.

[TalkEMS]

what challenges do you see paramedicine and emergency medical services facing?

Creating a professional image for EMS.

[AZCEP]

Providing a professional level of education to providers, while departments only want to shorten the time that their employees are in class.

As others have already said, too many get into EMS to drive fast, and make noise while they are doing it. This mindset has to be eliminated, and quickly.

We will complain to anyone who will listen, how we want to be treated like professionals, but if we don't act like one, it won't happen.

[cdemt5710]

ok I'm having a brain fart, or maybe it's because I'm young and haven't had much road experience.

In the future, what challenges do you see paramedicine and emergency medical services facing?

Thought, suggestions, input?

Thanks,

MedicMal

Valid question and one that no matter how old you are or how much experience you have, should be asked on a regular basis. Its how we will be prepared to evolve as professionals.

I've seen a change in 5 years. More pressure to provide a higher level of care, more pressure to get a higher level of certification, more training hours required with less time and more media exposure, looming threats of bioterrorism, patients with home pharmacies via the internet, high tech recreational drugs, etc...etc...etc...

The biggest challenge in the US, I think, is the threat of the big Lawsuit, so there is even greater pressure to document, document, document.

[hammerpcp]

I think a big challenge that we face in this area is that our management staff has no formal education. This is responsible for many of the problems EMS systems and paramedics working within these systems face. Currently supervisors and management are just paramedics who have received a promotion for some reason or because they kissed the right ass. They have no university education, and often no management experience or education at all.

I think this is something that is already changing (although slowly) as the decision makers begin to realize that paramedic skills do not necessarily transfer to management skills. Hopefully as more education is required we will see less of the blundering that is so common in EMS today.

For example penalizing employees rather than supporting them. Managements ultimate goal should be to create a better and more efficient working environment and therefore company. By spanking employees constantly rather then encouraging and directing improvement, the opposite is achieved. The opposite being a hostile and unproductive work environment with high turn over rates and poor employee satisfaction and moral. It has been shown in study after study that happier employees miss less work and are more productive when they are at work.

I'm not sure if this answers your question but it is definitely something to consider if you plan to make EMS your career. At some point your body will give out, and it's good to have an alternate plan. A university education is a good choice.

[Dustdevil]

Excellent point. Improving the workforce is only part of the solution. Improving the management is equally important, if not more so. It is absurd that "management" of EMS comes mostly from simply staying around long enough and kissing enough arse instead of from educational and performance merit. I see no other professions where it happens like this on such a large scale. It doesn't happen in nursing, medicine, or public safety. It shouldn't be happening in EMS.

[Kenny]

In the UK a growing problem is the dispariaty between paramedics who have been trained via a degree route and ones who have been trained in-service. While in-service may take longer, it provides a better base of experience of people. The other, which I hope to pursue, does provide a great deal of knowledge in a short amount of time, but possibly limits experience? Another problem is that paramedics are being expected more and more to bridge a gap outside of hospital that doctors have left, since re-negotiating their contracts regarding out-of-hours work. ECP (Emergency Care Practioners) are slowly taking over out of hours cover, they are trained paras, but with more skills in terms of diagnosis. They can also refer above an A&E department (ER to the USA) straight to an appropiate health care service to reduce people being in A&E without need. I feel this is putting a great deal of strain onto ambulance services, in conjunction with increasing call numbers, and I can only hope patient care is not affected.

[Ridryder 911]

The problem

It is predicted that ER & hospitalizations will increase 3-5 fold, within 5-10 years. VHA and other hospital administrator representation admit that there is not enough hospital or emergency beds to be handle this situation. If you work in a busier service, can you imagine what it will be like with 3 times the number of calls ? Even if you are in a slow call volume area (i.e 5 calls a day) will you service be able to handle 15-20 a day?

You think ER's are crowded now ?... Guess what it will be like with the 3 times the number of patients (not including EMS visits) .. prediction of waiting times from 2 -8 hrs to be initially be treated. Plus, EMS diversions will be more than ever.

There is another group that is as concerned with this dilemma as well.. and actually are studying remedies, more than the health care system and unfortunately, it is not to increase care or save lives... rather save trillions of dollars.

The insurance company has the best predictors and most accurate trends than even most health studies..Insurance companies have been studying the increasing numbers of emergency responses, ER visits & of course admissions. Think of it this way... for every chest pain you run ... EMS costs $$$?...... ER (lab, radiology, meds, etc)visit $$$$ ?, admission to ICU for rule out $$$$$$$?.. now, multiply that by thousands a day. Or alternative possible non-cardiac chest pain tx @ home, monitor, lab, continuous ECG monitoring, video monitoring.. $$$ See patient tomorrow at HMO/PCP for follow-up.. 0$$

EMS will have to have a major paradigm shift... the role & the responsibilities of the Paramedic will have to drastically change, either that EMS will be a thing of the past as we see it now.

Baby boomer mean age is 60 years of age in 5 -10 years will be 65 -70 years of age. These will be the highest population group ever in the U.S. With this increase response and ER visits , I predict the role of the Paramedic will be, to see whom gets to be seen, rather than transport to be seen. As I mentioned insurance companies has been studying on how to decrease emergency visits and as well as admissions.

Alternative pre-hospital care such as Physician or physician representative (P.A./N.P) is still being studied and considered. Most patients can truly be treated at home, and many of the test is the result of malpractice results not the need for true diagnostic capability. If the standards of the medical community change.. the standards of the litigation will change as well.

If there is no place to transport patients, what will EMS do ?

EMS will have to expand their role in providing health care in a more broad expanded role as well. Insurance (including Medicare) will not be able to continue to pay $500 > for a glorified taxi ride. The same is true, even if it is not paid or is volunteered, the increased run volume will deter interest.

Emergency Medicine on the Move

As any on this forum is aware , technology is ever changing. Even the LP 12 is blue tooth capabilities, and has more capabilities than most are aware of. Examine what some EMS is testing now.... video transmissions, ultra sound, bed side blood-lab testing, etc.. still new, but definitely will be there.

Education in EMS

With the advancement of technology, and responsibilities the education will have to increase. Review other health care professions. Majority of the RN programs less than 25 years ago were diploma or technical trained. What happened? That profession became aware very soon their education level was poor and negligent. To be recognized as a profession, increasing litigation of law suits against nurses, increasing responsibility, increased number of patients, standard education had to be placed at a collegiate level. Volunteer nursing associations basically disbanded, do to the increasing demand of education, and the patient load. Yes, it still exists, but barely. The same will be true in EMS... it can't be stopped.. it is just the law of supply & demand. It is better to prepare the community for the change, and prepare the system as much as can be.

What happens if we don't accept change?

Well like every other profession and people.. resisting change is normal. Denying that it will happen will not change the out come... the facts are there. There is more people alive now, than was ever on planet earth since its beginning. Now, the highest level of population will be needing medical care more than ever.

EMS has a good chance to actually grow. Refusing to accept and modify changes.. EMS may be only be for transports only. Medical care may be provided by outside sources non EMS related. As I discussed, insurance companies are studying and evaluating alternative methods today. Like I discussed, Physicians & there extenders, are placing continuous monitoring devices, rule out non-life threatening medical problems, saving millions daily.

Let's remember most emergency patients do not have private insurance and those that do only a percentage is received for payment. People whom get shot.. stabbed , etc... usually do not have full coverage.. thus a major financial problem for EMS. Alternative, funding has to be explored to off set expenses. Again, we are back to the traditional role of the Paramedic needs to be explored and changed with education.

So who knows what the true future is ?...nobody, knows. But, we can say that there is a crisis arriving, we are not prepared for it. Burying our head in the sand is not the answer.

R/R 911

[cosgrojo]

Excellent point. Improving the workforce is only part of the solution. Improving the management is equally important, if not more so. It is absurd that "management" of EMS comes mostly from simply staying around long enough and kissing enough arse instead of from educational and performance merit. I see no other professions where it happens like this on such a large scale. It doesn't happen in nursing, medicine, or public safety. It shouldn't be happening in EMS.

When I was in college.... many moons ago... I was per diem at the same company I work for now. I was a business major, and I wrote a paper about the management/business pratices of major EMS companies. My professor almost made me re-write the paper because he thought I was being overly dramatic, because in his estimation there was no way a company, let alone an industry, could survive long term with those types of business practices. And since EMS has been around for a while, I must be exagerating. I'm surprized that this particular topic doesn't come up very often, because EMS is by and large, shoddily run, and badly managed by people who don't know what "management" means.

Luckily for me, a fellow classmate happened to work in EMS as well and was able to corroberate my facts... so I didn't have to re-write my paper.