EMS: Increased Emphasis on the Medical Aspect

The name Emergency Medical Services or EMS was adopted as part of a strategy to shift ambulances slightly out of the transportation field and much more into the field of emergency medical care, both in the public consciousness and in the mindset of the nation’s medical and healthcare communities.

The increased emphasis on medical responsibilities is symbolic of the goal of further professionalizing the ambulance service and staff, and is intended not only to put greater emphasis on the emergency nature of the service but also to emphasis the medical aspect – in other words, to reinforce the fact that what EMS professionals provide is more than transportation per se; they usually also represent, in fact, the first stage of medical treatment provided to victims during and after an accident or emergency.

Moreover, as EMS continues to move into the future its progress will be marked by new interactions between the paramedic in the street and the medical staff in the emergency room (ER) of a hospital or other healthcare facility. In the early days of EMS, paramedics were required to contact a hospital for approval of their care plan. That requirement is still valid to some degree, but the scope of treatments available under the paramedic’s discretion has continuously expanded. (There still are, however, some treatments that cannot be provided in an ambulance, either because of logistics and/or space limitations, or because of the medical risks involved.)

A heart attack occurs when the blood flow to the muscle of the heart is interrupted – often, but not always, by a blood clot getting stuck in an artery. In certain types of heart attacks the clot could be removed by a procedure called cardiac catheterization – more formally described as percutaneous coronary intervention (PCI).

From the first moment an EMS professional is on the scene of an accident or incident, he or she is collecting information, both by interviewing the patient and by measuring the patient’s heart functions. This is standard practice throughout the country, and in areas where paramedics are available they usually employ a large and increasing variety of advanced technologies and systems – e.g., a 12-lead electrocardiogram (EKG).

Today, cities such as Los Angeles, California, and Louisville, Kentucky, are harnessing the power of their highly trained EMS staffs to improve cardiac care. In those cities, and many others, the paramedic quickly transmits the information he/she has gathered at the scene, or while en route to the hospital’s emergency room; the ER, in turn, activates a cardiac care team, the members of which receive the patient and provide emergency cardiac care.

Unfortunately, not all U.S. hospitals have PCI capabilities available at all times, or are able to quickly get a team in place. However, the system provides a two-way flow of information, therefore – in addition to warning the hospital that it can scramble the cardiac team – specific PCI centers are designated in advance so that the paramedic can make the hospital selection knowing that the best treatment for this specific type of heart attack is available at this specific hospital.

The goal, of course, is to reduce the time-to-treatment for the patient and thereby improve outcomes by decreasing the damage done to the heart.

Thanks in large part to this new and still evolving system, EMS is moving from strictly a transportation service – with a modicum of emergency medicine thrown in – to a larger and more active component of a more comprehensive overall medical system. As the current EMS system continues to mature and evolve its model will undoubtedly affect system design in the future.

Not incidentally, the decreases in wait time for medical treatment not only save lives but also enhance them, because the treatment provided on the scene and/or on the way to the hospital often means the difference between a life in which shortness of breath and overall weakness are constant companions and a much better life – one without those debilitating symptoms.

Joseph Cahill
Joseph Cahill

Joseph Cahill is the director of medicolegal investigations for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Before that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s paramedic program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.



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