The Future of EMS: Upward & Outward

As early as the late 1980s, there have been factions making moves to try to advance emergency medical services (EMS) from ambulances to other medical arenas. This is not surprising – with the cost of healthcare climbing, many healthcare systems have stretched their payroll dollars by moving the skilled work to the least expensive staff member who possesses the experience and capabilities needed to legally carry out the responsibilities required.

Because of their broad range of skills – administering medications, performing limited surgical procedures, and carrying out numerous diagnostic tests – paramedics are often in demand in many areas of healthcare. Moreover, after collecting relevant information, they can use their own knowledge and skill sets, rather than simply relying on a medical “cookbook” of rules and regulations, to form a diagnosis, act on the information developed, and modify both the diagnosis and the plan as the situation develops. Even more important to some healthcare managers is that paramedics can perform all of these (and many other) tasks for a much lower cost than is typical compensation for similarly skilled healthcare staff.

In some situations, paramedics are already stretching the boundaries of their roles. Many remote locations such as oil rigs use paramedics as their primary care providers, for example. Because transport to a hospital may be several hours away, having a care provider on-site who can handle routine sick calls and minor injuries is critical to ensure continuing operations. Even more important, of course, is having on hand a healthcare provider who is capable of dealing with life-threatening emergencies.

The Gradual Evolution of “New Traditions” 

Even traditional EMS systems have used EMS staff in nontraditional venues. The New York City Fire Department, for example, has at times permanently deployed EMTs both to major transportation hubs and to various corrections settings that lack transportation vehicles. The principal role of these EMTs, usually, is to assess and stabilize patients. Because the overwhelming majority of cases do not require transport, moreover, using an ambulance would probably result in the ambulance being held on scene, “just in case,” when the actual need for transportation has not been determined. Expanding the role of EMTs permits the system to keep the relatively scarce transport-capable resources available for other and more urgent requirements.

Many paramedics also fulfill duties in emergency rooms of some hospitals – hospitals in Florida and Tennessee are the prime example – as adjuncts to the physician and nursing staff. It seems inevitable, therefore, as the cost of healthcare becomes a greater determining factor than the political forces aligned against this model, that more facilities will in all probability shift to similar allocations of their workforces.

One of the less obvious advantages of this model is that it gives EMS staff greater opportunities for professional advancement. Prominent among the traditional barriers to retaining EMS staff is that, after an emergency medical technician attains the status of paramedic, there frequently are no more rungs higher on the local professional ladder. At that point, therefore, paramedics who seek to advance their professional careers usually have the choice only of training new paramedics, or supervising them.

Of course, both training and supervising are important responsibilities that are absolutely necessary for the future of EMS systems – but in reality there are not enough openings at the top for everyone qualified in those skills to reach the highest rung of their professional ladder. For that reason alone, allowing paramedics to use their skills in the hospital setting not only encourages them to stay within their current career paths but also, particularly in the case of hospitals that also operate ambulance services, to remain with the same employer.

In the foreseeable future, as expanded roles become the norm, technologies that are traditionally exclusive to the emergency room will become increasingly familiar to paramedics. In addition, as the nation’s medical community at large grows more and more accepting of advanced technologies in the hands of paramedics, those technologies will eventually make their way into the traditional EMS setting – the ambulance. The end result is that on-scene responders will increasingly become better trained, as well as better equipped, for future emergencies – and that evolutionary change will represent a major advance not only for all healthcare professionals but also for the patients, and the communities, they serve.

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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