We Can’t Control Who Calls Us, But…

We can control how we respond to those calls.

About a year and a half ago I attended a screening of the film Firestorm, a documentary about the low-acuity calls that paramedics in the city of Los Angeles respond to.  Ambulances and fire trucks went screaming lights-and-sirens to each call and transported most of these patients to a crowded emergency department.  It puts huge stress on EMS systems ready to break and is frustrating for the people transporting these patients.  If only people would call 911 when they have a true emergency…

I think we forget how small EMS is a part of the big healthcare picture.  Our funding and education methods enable this transport everyone no matter what system to continue, and at some point we become part of the problem.

When we signed up for this, we were trained to treat a few life threatening emergencies and take everyone else to the hospital.  Then we found out that very, very few calls meet this definition of an emergency, so most of what we do is transport. But no matter how many “911 abuse” lectures we give people, they continue to call and we continue to bang our heads against the wall.

As a profession, we have not demonstrated the ability to safely determine which patients do not need to be transported to an emergency department. A few progressive services have gone out on a limb to better manage low acuity patients.  Wake County, NC and MedStar EMS have Advance Practice Paramedic Programs.  In both programs, clinically excellent paramedics work outside of traditional settings to find better places to treat low-acutiy patinets.

Wake County EMS Chief Skip Kirkwood wrote about future opportunities recently in EMS World Magazine.  In order for anything to change, there must be a culture shift.  The best paramedics would need additional education to respond to the least serious patients. We would have to work closely with other health care and social service resources.

And of course, we would always have to work in the best interest of the patient.


  1. “The best paramedics would need additional education to respond to the least serious patients”

    Well said. I like that.

  2. Carmon Thomas says:

    Sounds like the pendulum may be swinging back to house calls. Would it be more efficacious to have an MD on board? Or a paramedic/nurse practitioner/physician’s assistant?

    • emspatientperspective says:

      Any EMS provider would certainly need additional training, though I don’t think a master’s level practitioner is necessary. Resgistered nurses already visit and care for patients who are discharged from the hospital, and I believe a program can be successful with existing paramedics.

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