EMS1: EMS on life support: the alarming gap between expectations and reality

This article originally appeared on ems1.com

By Richard (“Chip”) H. Decker, III, President, AIMHI

What should you expect when you call 911 for an ambulance? For decades, the expectation has been to see an ambulance racing down the street with lights flashing and sirens blaring as Paramedics and Emergency Medical Technicians (EMTs) rush to the scene of a medical emergency. In reality, time is a factor in a small percentage of the calls EMS respond to and a large portion of calls to 911 today aren’t for medical emergencies. The idea of fast equates with quality was pushed by the Emergency Medical Services (EMS) profession, as some emergencies, such as cardiac arrests and strokes, depend on rapid responses for the best outcomes. While time is a factor for these emergencies, they make up a small number of EMS responses. Still, EMS response times are what many localities look to as the key measure of the success of their EMS system with the expectation that all calls to 911 are emergencies and need a quick response. EMS today plays a larger role in healthcare and emergency preparedness, often providing services for which there is no compensation. The gap between expectations and reality has strained EMS systems nationwide, impacting response times, financial sustainability, staffing and patient care. If the gap between expectations and reality isn’t closed, the problems facing EMS and the essential service it provides to the public could hit a breaking point. In some places, it already has.

Recently, a joint statement from national and international healthcare and civic organizations called on localities to modernize how they measure an EMS system’s success beyond response times. While speed is helpful in some cases, in most responses it can do more harm than good. A 2020 study published in the National Library of Medicine, looking at nearly 6 million calls from almost 1,200 agencies across the country, showed less than 7% of 911 calls for EMS dealt with potentially life-saving interventions even though lights and sirens were used to respond to calls 86% of the time. Another study published by the National EMS Quality Alliance found it was more dangerous to the crews, patients and the public to use lights and sirens that often. In reality, fast does not equate with quality for most 911 calls. EMS systems are being evaluated and sometimes replaced because of an outdated metric. We must ask ourselves, are we doing what’s best for patients or changing for the sake of change in hopes ambulances will arrive more quickly?

At its inception, the expectation was EMS would be used for medical emergencies. In today’s reality, EMS is a catchall. Many EMS responses aren’t for emergencies and sometimes do not require any medical assistance at all. At times, patients could be better served with a visit to an urgent care facility, a virtual visit with a doctor, or a response from a behavioral health professional or social services. Research published earlier this year, looking at nearly 2 million EMS responses, found 27% of the responses fell into this category. As call volume for these types of calls has increased, many EMS agencies have been stretched thin. As a result, callers get angry when an ambulance doesn’t arrive in minutes.

What is most troubling, is sometimes it is the patients who are suffering a life-threatening emergency that are having to wait longer. If we aren’t amplifying and using options more appropriate for patients than a call to 911, we are putting those who need lifesaving help at risk.

In February, a bipartisan group of legislators in Minnesota declared an “EMS Emergency,” asking for a $120 million infusion to address short-term funding challenges and strain on current EMS systems, with providers saying EMS in the state was on the brink of collapse. An industry media tracker has identified thousands of media reports on the economic crisis in EMS nationwide.

The reimbursement and funding models for EMS need to be restructured so agencies have access to consistent federal, state and local funding and are paid for services beyond the transportation of patients.

Additional funding is essential but we must also reset expectations so they’re more in line with reality. Failure to change will lead to more expensive alternatives, could result in lower quality care and could drive any current and future EMS employees away from the profession. That’s where we are headed if we do not close the gap between expectations and reality. We know the problems, now is the time for all of us to have an honest conversation about the solutions.

About the author

Chip Decker serves as the CEO of the Richmond Ambulance Authority (RAA) located in Richmond, VA. His duties extend to administering the high-performance system design to deliver clinical excellence in the most economically efficient way possible. He currently serves as the Board President for the Academy of International Mobile Healthcare Integration (AIMHI) and is an Affiliate Professor with Virginia Commonwealth University’s (VCU) Department of Health Administration, School of Allied Health. He currently serves as a member of the Virginia Public Safety Foundation’s Board of Directors and remains an active member of the Virginia Association of Governmental EMS Administrators (VAGEMSA).

He was a member of the Virginia EMS Advisory Board, past-Chairman of the Advisory Board’s Transportation Committee and also served on the Old Dominion EMS Alliance (ODEMSA) Board of Directors and the Richmond Metro Council. His experience in EMS spans over 40 years and includes both volunteer and career positions.

Chip is the recipient of a number of awards in recognition of his dedication to the EMS field. These include an ODEMSA Award for Excellence in EMS, recognition for outstanding service from the Virginia Attorney General for his work in response to the Pentagon following the 9/11 attacks, and a commendation from the Virginia Office of EMS. He is a life member of the Tuckahoe Volunteer Rescue Squad and received Henrico County’s Division of Police Meritorious Unit Citation for his service as Senior Volunteer Medic and member of their S.W.A.T. team.

About the Academy of International Mobile Healthcare Integration

The Academy of International Mobile Healthcare Integration (AIMHI) represents high performance emergency medical and mobile healthcare providers in the U.S. and abroad. Member organizations employ business practices from both the public and private sectors. By combining industry innovation with close government oversight, AIMHI affiliates are able to offer unsurpassed service excellence and cost efficiency.