Sunday, January 14, 2018

Comments on the revised EMS 2050 Straw Man

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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