Restructuring Medical Assistance

[ckroll 101]

I think we are making a fundamental error in trying to recreate the volunteer model of EMS as paid service and in doing so may be missing an opportunity.

In an era when both time and resources were in abundant [relatively] supply, a system emerged where an over equipped $100,000 transport vehicle with a crew of 4 responded to every call for aid. Every town had one or two. We had, and have, people who want to help others and are willing to volunteer to do it.

I don't think it has to be the same thing. A better model might be to step back from the idea that every time someone picks up the phone and says, "I need help" that the appropriate response is a police officer, a fire truck a paramedic and a fully equipped transporting ambulance.

What is currently volunteer services might be restructured into a less emergent role of responding, evaluating, and arranging for transport or services. EMS could be restructured into a guaranteed ready response for those situations where private transport of one kind or another isn't enough.

Yes, there will be times when this results in a delay of care. That said, if EMD can identify true emergencies, a ready response capable of transport combined with a corps of lightly trained responders may be getting vital aid and transport faster.

Let us all accept that there may be a role for the 'what do you expect from volunteers?' people but that role may no longer be as the primary transport agency. Can we reconfigure a system so that volunteers can still volunteer and can provide valuable service to their community and at the same time find a way to guarantee emergency transport when emergency transport is needed?

I don't think we need, nor can we afford, to reconstruct what we have now as a paid service.

[Goose 188]

Restructuring services because volunteers can't handle or choose not to respond to particular calls seems silly to me. Though i do agree it would be great to adjust response models to better serve the community in a more fiscally and resource responsible way.

The problem with the United States is the sense of entitlement and general lack of accountability many, many, many of us have as Americans. Most would rather pass off decision making to the police officers, fire officers or paramedics and EMTs. That coupled with our over litigious nature....it's going to be a steep uphill battle.

Edited July 11, 2011 by Goose

[grumpyff 1,159]

God forbid we tell someone to take a taxi or bus to a doctors office or walk in care center because they have a cold Instead of transporting in an ambulance to the ED

[x129K 1,393]

That said, if EMD can identify true emergencies.......

It has been my experience, being an EMD since 1999, that it can not, and will not allow the dispatcher to make that determination.

You KNOW a true emergency when you get one on the phone, but EMD does not identify it. I have found that EMD over-sends in most instances, which is better to do than to under-send...I also find EMD to be less than effective in an urban environment.

[ckroll 101]

It has been my experience, being an EMD since 1999, that it can not, and will not allow the dispatcher to make that determination.

You KNOW a true emergency when you get one on the phone, but EMD does not identify it. I have found that EMD over-sends in most instances, which is better to do than to under-send...I also find EMD to be less than effective in an urban environment.

Absolutely true, but for the sake of brevity I phrased it that way. If a dispatcher thinks he or she has a true emergency, send it all. I love the idea of volunteers and I loved being one. That said, as the volume of calls increases the system needs to adjust. And we have to work with what we have. Yes,a majority of Americans are overweight, under exercised, and inclined to blame someone else for their problems. We serve them and we help them. It is our duty to respond, not to demand that they change who are. I do think we can devise a better system than the one we have.