How Many Words Does It Take to Describe How Your System Works?

For my master’s thesis, I spent a great deal of time figuring out how to explain the EMS system in my area  in a language that would be understood by non-EMS people.  It took 227 words:

Ambulances in the study are staffed exclusively at the BLS level. They are operated and overseen by 21 independent fire companies, which utilize volunteers and paid personnel. A private company also provides BLS ambulance service in one municipality under a contract. An ambulance is dispatched to every 911 EMS call, regardless of the severity. Each service has its own operating procedures, with some responding lights and sirens to every incident, and others respond with normal traffic to Alpha calls. Most BLS units in the study site are equipped with glucometers and can measure blood sugar levels in post-seizure patients.

A single, county-run paramedic service covers the entire county. Two paramedics are dispatched with the ambulance in QRV’s to potentially life-threatening incidents, categorized Charlie, Delta, or Echo under MPDS. When necessary, paramedics accompany patients on the BLS ambulance and continue care en route to the hospital. BLS in the study site responds alone to Alpha and Bravo calls, but may request paramedics if needed. EMTs may also cancel paramedics, and paramedics may release patients to BLS ambulances for transport after an assessment. The ambulance may also initiate transport to a hospital and rendezvous with the paramedic unit on the way. In other cases, the hospital may be closer than the nearest paramedic unit, and the BLS crew may elect to transport the patient to the hospital without paramedics.

To summarize, a BLS ambulance from a fire department or private company goes on every call.  A paramedic chase truck from another service goes on some of those calls.  In the interest of space, I deleted a whole section about how the BLS ambulances are overseen by the state fire prevention commission, and that the paramedics are overseen by a completely separate office of EMS, and that ambulance services bill for transports in addition to funds they get from the state, county, and donations, and that the paramedics are funded by state and county taxes.

The system is not necessarily bad.  Most of the time people get along on scenes, and the cardiac arrest survival rate in that county is close to Seattle’s.  It’s just complicated and damn hard to explain to the average taxpayer how it works. Other models with roots in the 1970’s are just as complicated, such a paramedic ambulance from a fire department responding with a paramedic ambulance from a private company, or a BLS ambulance from one hospital responding with a paramedic chase truck from another hospital, and I could go on.

When you call the police, police officers show up.  They may have different levels of training or specialties, but they are all identified as police officers and come from the same place.  Ditto for the fire service.  Firefighters may show up from different departments based on mutual aid agreements, but they all show up on fire trucks and are identified as firefighters.  Whether it’s a parking violation, armed robbery, smoke detector activation, or explosion, those services take far fewer words to explain who shows up.

So how many words does it take to explain how your EMS system works?  Why do we have so many different colored trucks, with people from so many different agencies, with so many different titles, have to show up for one person who has chest pain?  How many of you are happy with the current identity of EMS, willing to give up titles and turf to change it? In Canada, the UK and Australia have (where paramedics are the second most trusted profession after firefighters), everyone in EMS is called a paramedic and works for the same service.  If we want the brand recognition they have, we need to make our systems less complicated.

I’d like to add a “100 word” clause to the Field EMS Bill, stating that no EMS system should require more than 100 words to explain to the average citizen how it works.  It would have made that section of my thesis much easier to write.




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