First let me start off by saying that while I might not be the biggest fan of EMS, and I originally got my EMT just to get a paid firefighting job, I do see its necessity in our society. I wouldn’t say I necessarily enjoy my tours on the ambulance but I don’t loathe them either. In fact I actually upped my EMS certification level this past year to that of EMT-Enhanced or as I like to refer to it “ALS light”. As an enhanced provider I can start IV’s, and give several life saving drugs (D50, epi for anaphylaxis, Benadryl, albuterol, atrovent, aspirin, nitro, and narcan) which “enhance engine company response and allow for a higher level of patient care in the initial stages of an incident. I thought this was the perfect class and level for me as I really don’t have the desire to ride AIC on the ambulance but we are frequently awaiting arrival of an ambulance while on the engine company standing there doing nothing. So I thought this was a pretty cool skill to have.
We already have a very progressive EMS system in my department as it is, but we have made leaps and bounds the last few years, months, and even weeks. We have gone from BLS providers being oxygen givers and vital takers, to now expecting them to acquire a 12 lead EKG (not interpret just gain it so that once the ambulance arrives they can interpret it), give aspirin to chest pain patients, and soon to be coming placing patients on a C-PAP machine. Along with this has also seen an increase in ALS responsibility such as RSI, more emphasis on capnography, and now even the placement of G-tubes for intubated patients. There is even an organization near us using nitrous oxide for pain relief in the field.
My question is when does our service begin to transition from “Emergency Care” to “Primary Care”? To be honest I feel with a certain group of our population this has already occurred, as they constantly call us for things that a primary care doctor should be contacted for first. Is this increased care level helping or hurting? Right now I would say that the skills and responsibilities added are for the better, I don’t know how we lived without RSI and C-PAP before and I can honestly say that placing just about every patient with chest pain on a 12 lead EKG while daunting has probably saved a lot of lives, but where does it end?
Where does it end? Is there the chance that we one day do non emergency service calls for our frequent fliers? Some larger agencies have already started this, so I would only assume its a matter of time before it trickles down to our medium-sized system. What other skills are we going to start doing? Are we going to start doing blood draws in the ambulance? Are we going to progress to more invasive trauma care?
I personally think that this is just the tip of the ice berg and I am not confident that this will increase our patient care. In fact I think it could be detrimental not only to patient care but to the Fire and EMS service as a whole. Think about it you’re a paramedic performing skills in your ambulance that PA’s and Doctors are doing and making 3 times less money. Why would you not take this valuable experience and get paid. We have actually already seen this in my fire department several times. While not to disparage any remaining providers but when your most talented go on to become PA’s and Doctors what does that leave behind? Typically people who just go ALS for the incentive money and not for their desire to perform at a higher level.
I seriously think we need to decide on a business model and a core set of skills for EMERGENCY medical services, not just allow anyone with a OMD license to up our skill level. There needs to be separation from hospital and ambulance, Doctor and Paramedic.
What do you think? Is this something you’re experiencing in your department? Where do you think the line should be drawn? Or should a line be drawn at all? Leave some feedback in the comments section or email me with your thoughts.