EMS on 9/11/2021


Over at Fire Geezer, Mike “Fossil Medic” Ward asked what we will look in 20 years.  I agree with much of what Greg Friese wrote about this on Everday EMS Tips, and have a few ideas of my own.  This is what I hope EMS looks like, anyway.

A Paramedic On Every 911 Call

Each ambulance that responds to 911 calls will be staffed with one paramedic.  They will be equipped to delivering 12-lead ECGs, CPAP, nebulized breathing treatments, pain medication, and sedation.  I believe certain point of care blood tests will be standard, such troponin for NSTEMIs, lactate for sepsis, and potassium levels. Ultrasound will also be used to alert the hospital of identified life threats and determining the most appropriate transport destination.

An Academy for EMTs

In 10 years, today’s EMTs will primarily be responsible for first response, emergency driving, and assisting a paramedic partner.  Managing patients on the way to the hospital will be done after the paramedic completes an assessment.  EMT education will be incorporated into a police-style academy, with an emphasis on driving, scene management, and therapeutic communication.  It will take as much effort and dedication to find work in EMS as it does now with law enforcement.

College for Paramedics

An associate’s degree will be required to complete paramedic programs.  Like nursing, frequent returns to formal education will be encouraged, and a bachelor’s degree will be required for entry-level supervisor positions.  Organizations will encourage higher education through scholarships and partnerships with local institutions.  Paramedics will be often be found taking online classes between calls.

An Advanced Paramedic On The Critical Calls

A small number of elite paramedics, who have demonstrated high levels of clinical performance and have obtained a bachelor’s degree, will respond in a QRV to high acuity calls.  These paramedics may also do critical care transports or work in aviation, and use their clinical expertise on 911 calls.  They will assist managing patients who require high risk/low frequency interventions. If we’re still intubating they will be the only ones credentialed to do it.

Advanced paramedics will also have the same education about spinal injuries as physicians assistants, and will have the same C-spine clearance capabilities.  They will be sent to minor MVCs and low-risk trauma calls, and backboards will be much less common.

Opportunities to Specialize

Paramedics will have opportunities so eek additional education in areas they are interested, and be added to those responses in addition to the closest units.  Most SWAT teams already use specialized paramedics now.  “Rescue Medics” will respond to crashes with entrapment and be on the RIT team at working fires.  Haz Mat medics will drive towards the cloud I’ll be driving away from.   “Psych Crisis” medics will have additional education about that patient population, and direct patients to the most appropriate resources.  Usually that would not be emergency department. Everyone will participate in some form of community paramedic program, and frequent 911 callers will be seen when it is convenient for us.

Performance Transparency

Every organization will be required to report their clinical performance for certain conditions.  The Utstein Criteria will be used to report cardiac arrest survival, as well as performance with STEMI’s, seizures, trauma, and difficulty breathing.  Like crime statistics, communities will be able to directly compare the EMS care in one community to another.

That’s my vision.  What’s yours?


 

 

Comments

  1. I like your dream, sir. Can you elaborate on your EMT concept?

    And is this how you imagine things working even in the most rural areas?

    • emspatientperspective says:

      Thanks Brandon. BLS paramedics in Canada, the UK, and Australia are required to complete much more education than EMTs in the US, and almost all have a two-year associate’s degree. Those paramedics are available to people in rural areas, and supplemented with volunteers. Tradition is the biggest road block from doing that here. Expanded roles for community paramedics will help offset the cost of having people available for relatively few emergency calls. Ideally regional systems would be in place, and people could be also rotated from urban to rural areas for skill maintenance.

      • Okay, what about the EMT academy? Are you imagining EMTs in more of a dedicated support role, along the same lines that fire/police play now?

        • emspatientperspective says:

          The EMT academy would supplement material not covered in most classes today that are needed for every call, and is the responsibility of EMS organizations to cover (or not cover). Emergency driving is one component that we should cover more. Patient interaction and scene management is also glossed over in most programs, and people are expected to learn on the job. Organizations that care about having good people would ensure its new members are competent in these areas before they go near a real call.

          I prefer the police academy approach to the fire academy, simply because the fire service allows more on-the-job training for probationary members. There are multiple people on each truck, and each has an experienced officer. Police officers work independently, and are required to think quickly on their own immediately after graduation from the academy. My idea for EMTs would fall somewhere between the two.

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