I had a great conversation with a fellow EMS blogger last night over Skype. We discussed several ways to implement changes to our “broken” ems system and how EMS 2.0 could not only fix our industry, but improve healthcare as a whole. All was good as we were fixing the world and saving lives all through the wonders of internet phone calls. This was of course, until we came to a shocking realization of what EMS 2.0 could actually mean for us as an industry. I’ll get to that in a minute.

If you have worked in EMS for any period of time, you are no stranger to 911 abuse. People using 911 to seek routine, non-emergent medical care have tied up paramedic ambulances, increased costs and delayed response times. The “you call we haul” system that we have in place decreases liability as everyone is transported to an ER physician, but it doesn’t exactly use resources efficiently. As Justin Schorr mentioned on the Happy Hour, “putting more paramedic ambulances on the street is like putting more tow trucks at a dangerous intersection. We need to fix the intersection”.

Everyone has probably heard this rant from me or any of my fellow EMS bloggers at some point in time. Regardless of the specific solution we have in mind, we can all agree that we want patients to be routed to appropriate care. Not just the ER via paramedic ambulance. One thing me and @Jeramedic discussed was the possibility of using advice nurses in conjunction with EMS dispatch to properly route these people to appropriate care. A tactic that HMO’s have been doing for years. Here is a great article on a service that has already attempted to implement such a system.

So now for the scary part.

Let’s say that one day we woke up and our dreams came true. Patients are being routed to appropriate levels of care. Paramedics have the ability to refer non-emergent patients to urgent cares, clinics, etc. Now our ALS ambulances are only being used to transport the truly ill and injured patients to the ER. Sounds great right? We have successfully decreased the workload on our EMS system. There is only one problem. What are we going to do with all those paramedics that were once responding to 12+ calls a day? If we are only transporting truly emergent patients, wouldn’t that significantly decrease the demand for paramedics? Would this leave a bunch of paramedics looking for work?

I’ll use the fire service as an example. Over the years, fire prevention and regulations have worked so well that fire departments aren’t exactly putting out fires anymore. At least not very often. They damn near prevented themselves out of jobs. Is this what we are doing to EMS?

Fire departments did a great job of overcoming this problem by integrating fire suppression with EMS response. It has done wonders for fire services around the nation. This is actually a great example of how we as EMS professionals can use EMS 2.0 to our advantage and not only advance our career, but increase demand. Programs like community-based paramedics, and advanced-care paramedics would open up a whole new world of opportunity for EMS professionals to advance in the profession. This would also be an opportunity to increase educational standards, scope of practice and improve EMS salaries. You would see EMS turn from a stepping-stone job to a life-long career.

If you haven’t had a chance to listen to Episode 88 of the EMS Garage, you should do so now. We had some great discussion on this very topic. Hopefully Justin will hijack another show in the near future so we can get further into this discussion.