Responses to the EMS Agenda 2050
revised Straw Man Document
Alan Perry
1/14/2018
What is your vision
for ems in 2050, and how do we get there?
I think we
must all first recognize that my vision for my organization and myself, in my
socio-political environment, will likely be entirely different from the vision
of another. The reality is that this Nation is made up of individual states,
cities, towns and communities with vastly different resources and needs. I
don't view that as a negative as the authors of this document seem to believe.
EMS, as I believe we should call it, has evolved with, and adapted to, this
diverse landscape. The larger changes to the healthcare system brought about by
tort law and the affordable care act have pushed primary care relationships
between physicians and patients to a new low. As a result EMS has been
compelled to fill the void, a cycle this document will perpetuate. We have not
yet achieved the goals of the original EMS agenda and should be working to
close those gaps while recognizing the professionalism of those who choose this
profession with greater support and recognition.
Will the vision and
guiding principles in the straw man help steer the ems profession in the right
direction?
It would be
more like a hard left, socialized medicine to be specific. The hard-line on
"social equality", which I believe EMS has always striven to achieve,
seems very much like redistribution of resources. The reality is that each
community can choose now what level of EMS services that want, need and can
afford. This seems like a segway for the Federal government to gain greater
control over the healthcare system and EMS.
The document does contain some positive ideas for preserving and
promoting the workforce that are long overdue relative to hours, compensation
and safety. But ideas are just that, without a clear mechanism to overcome
outside influence, tradition and politics, it cannot be achieved. The document
condemns volunteers outright and recommends their replacement with paid staff
that most rural communities cannot afford. This will necessitate either
redistribution of resources or new taxes to fund those positions.
Integrated
and Seamless
Which
recommendations are most important or won't help achieve the vision? What is
missing that must be included?
Integration
with the rest of the healthcare system has been a long standing need. In a
monolithic organizational environment that can be easily achieved. In
communities where several different hospital systems and EMS agencies operate
it becomes much more complex. In the meeting I attended I noted that no
hospital or healthcare system administrators where present. What is missing are
the stakeholders.
Socially
Equitable
Which
recommendations are most important or won't help achieve this vision? What is
missing that must be included?
I believe
each citizen, community, city & state should be free to choose where they
live, what taxes they will be subject to, what level of EMS service they desire
and how they choose to staff and fund it. Redistribution of wealth and
resources is a game in which the losers will be taxpayers, providers and
patients. EMS in my experience has always provided the best service possible
with the resources available without bias.
Inherently
Safe
Which
recommendations are most important or won't help achieve the vision? What is
missing that must be included?
I suggest that it
is impossible to make an emergency inherently safe. The predominant injury
pattern for EMS providers are back and extremity injuries secondary to lifting
and moving patients. The very nature of the EMS environment necessitates manual
lifting and moving of patients in some circumstances. To the greatest extent
possible mechanical devices such as powered stretchers and loading systems must
be employed. This is not yet a universal occurrence, it should be a priority
until it is through enforcement of existing OSHA guidelines and availability of
grants to fund up-fitting these devices. There are many cultural barriers to
achieving inherent safety as well, many organizations still require
"lights and sirens" responses even though the practice has no proven
benefit.
Sustainable
and Efficient
Which
recommendations are most important or won't help achieve the vision? What is
missing that must be included?
Provider
compensation, as well as professional recognition are key factors to creating a
committed, professional, mobile and long-term workforce. Public education is
also a frequently overlooked/neglected component. Both of these require
significant cultural change in the way the provider and the public are viewed
by EMS administrators. The keystone in all this is funding, who will pay for it?
Reliable
and Prepared
Which
recommendations are most important or won't help achieve the vision? What is
missing that must be included?
Fire-based
EMS and third service EMS are usually the most reliable, but volunteer systems
are more scaleable when disasters strike (yet this document seeks to abolish
them). Evidence-based practices are
quickly becoming the norm already, its the hospital systems that are lagging.
This section itself is a little redundant as these subjects are closely related
to system efficiency. The idea of permitting EMS provides to function across
the hospital/pre-hospital divide is a good one, but once again where are the
stakeholders that can make that happen?
Adaptable
and Innovative
Which
recommendations are most important or won't help achieve the vision? What is
missing that must be included?
The ideas
put forth in this document regarding education across the EMS spectrum,
including leadership and administration are all good ones, as is the concept of
both educating providers in and funding research in EMS. The authors must
consider the diversity of organization types, and the significant obstacles and
resistance that entrenched systems such as the fire service will have to this
type of change. Leaders and administrators in these organizations are typically
promoted from within without regard for any specific training or expertise in
EMS.
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