A Patient-Centered EMS Manifesto

In the June, 2013 issue of EMS World, I wrote an article titled Things Your System Should Deliver.  It is a description of what I believe our patients deserve from their EMS system.  Each item is based on evidence, and systems fail when they do not deliver them to eligible patients.

I have always been intrigued by how different the quality of EMS care is in different communities.  After working in a variety of delivery models, I have discovered that the number of people who show up, their certification levels, their competence, and treatment often depend on which side of the street someone calls 911 from.  Most of these practices are based on tradition and turf protection rather than science, and serve us more than our patients.

My article makes a case EMS systems to report the following operational performance measures:

  • Response times, starting from the first ring at the PSAP to when help arrives at the patient’s side (though not a specific goal).
  • Cardiac arrest survival using the Utstein criteria
  • The number of cardiac arrests managed by each paramedic
  • The number of advanced airways placed by each paramedic

It also makes a case for us to make the following treatments available to every patient:

  • 12-lead ECGs incorporated into a regional STEMI system
  • CPAP
  • Nebulized bronchodilators
  • Seizure medication
  • Pain medication before movement
  • Chemical sedation
  • Transport to the most appropriate facility

In the US, this would involve sending an ALS provider to every call.  This is controversial, and may not seem feasible in many communities.  Tiered BLS/ALS systems are designed to get these treatment bundles to most eligible patients, but inevitably some will be missed.  I believe this is no longer acceptable.

When a seizing patient is transported to the hospital without medication because no ALS available, the EMS system failed for that patient.

When a STEMI patient with indigestion is taken to a hospital without a cath lab, the EMS system failed for that patient.

When a patient with a hip fracture screams in pain while being carried out of their home for the last time, with no pain medication, because ALS is reserved for “real emergencies,” then the EMS system failed for that patient.

I hope this article sparks a conversation about what we are hear for, and what we need to deliver to the people we serve.

Related Posts:

Things Your System Should Deliver EMS World, June, 2013

Call 911 and Pray: A Tale of Four Street Corners September, 2011

Response Grid Ridiculousness November, 2011

EMS 12-Leads: Early and Often February, 2012

What Should the Basic EMS Package Include? April, 2012

Pain Management and Tiered Response Are Not Compatible August, 2012



  1. Barry Eberly says:

    This article is stimulating and very much on target. As always…very well done. The scenario format lays out a road map that many EMS systems could utilize to make improvements.

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