The Changing Landscape of EMS

Posted by Patrick Lickiss on Aug 10, 2010 in Current Events, EMS 2.0, Politics | 2 comments

We are truly working in EMS in an exciting time.  For one of the first time since the advent of prehospital medicine, our industry is poised to make huge leaps forward.  With the advent of new technology and the ability to share ideas between practitioners across the country and around the world, the EMS 2.0 movement has the potential to revolutionize the way we do our jobs.   As with all revolutions, however, this one will leave some of our coworkers behind.  The “old school” way of providing care is no longer considered best practices (if it ever was) and those providers who are unwilling or unable to keep up will find that they have a diminishing role in the field.  The role of EMTs and paramedics as providers of emergency care will still remain an important aspect of the job, but preventative, community based care will become a new emphasis.  One of the major sticking points of this revolution, however, will be finding a way to bill for these new services.

When looking realistically at scopes of practice for EMS practitioners in the US, it is unlikely that the current scopes will change drastically.  Areas that allow procedures like Rapid Sequence Induction and surgical airways will likely continue to do so, and regions which don’t (here’s looking at you, California) will likely not add these procedures.  While some medications may be added, they will only be approved for limited numbers of patients in limited agencies.  Take thrombolytics, for instance.  With the current model of EMS research, very few systems would be able to enroll a sufficient number of patient to prove whether paramedics could effectively evaluate and provide thrombolytics in the prehospital setting.  While small scale studies may convince the medical director of the county or agency performing the study, it is unlikely that medical directors around the country will take progressive steps based on those limited results.  These factors all combine to result in a largely static scope for the foreseeable future.

Given that scopes of practice will likely remain static, the only expanding arena of care for the prehospital provider is into preventative medicine.  Community-based public health programs could benefit directly from the incorporation of paramedics and the experience we bring to the table.  Experience with standing orders and working independently gives prehospital providers a leg up on current public health practitioners.  The ability to perform home visits for check-ups, basic diagnostics and vaccinations could prove invaluable for an ailing and broke healthcare system.  The idea of universal healthcare is one which sounds great in theory, but loses some of its luster when you realize that the current healthcare reform programs do not include provisions for public education campaigns.  Providing everyone with insurance sounds like a great plan, but politicians seem to forget that many currently uninsured patients have used emergency rooms as their only contact with a physician, sometimes for generations.  Theses patient have not had a general practitioner and have no experience  with receiving care in that setting.  Staffing paramedics in public health roles could help to bridge the gap between these patients and a standard general practitioner.  In this way, new, non-emergent  services are being provided in a familiar way, namely through the 911 system.

It has been said that one of the most difficult aspects of a community paramedic program is finding a way to make it a sustainable business model. While grants are available for trial programs, these generally do not last forever.  In the end, providers need to be able to bill and be reimbursed for services rendered, including preventative ones.  What Kaiser Permanente figured out years ago (and what seems to escape Washington) is that it is not only better for patients to practice preventative medicine, but in many cases it can be cheaper.  The unfortunate side of healthcare reform is that while insurance companies have large amounts of lobbying dollars at their disposal, EMS has basically none.  With the formation of organization like the International Association of EMS Chiefs, however, there is hope that EMS will not be left behind during the pending healthcare reforms.

What is certain, however, is that EMTs and paramedics need to make their voices heard to ensure that our role continues to expand and that funding sources become available to facilitate that expansion.  For the next few years, it will be up to all of us to expand our knowledge base and skill set so that when new opportunities present themselves we are able to seize them.  Keep reading the many great EMS blogs available and encourage your coworkers to do the same.  Subscribe to a few podcasts and keep current on news related to EMS.  When the time comes, write letters and make phone calls to your representatives and members of key committees in Congress.  As I’ve said before, the future of EMS is in the hands of the providers, make sure you are able to make it a profession you can be proud of.