Let`s Fix It Before It Breaks

     A number of prognosticators suggest that healthcare in the United States will experience major challenges in upcoming years. Some of these will occur as a result of financial challenges, our aging population, increasing healthcare costs, and decreasing health insurance coverage and reimbursement. The EMS profession will also experience all of these challenges, as well as those associated with recruitment and retention of personnel. EMS has lacked an appreciable career ladder since its inception and loses many qualified and dedicated individuals to other careers.

     At the same time EMS is experiencing these challenges it is also being exposed to increased education and training requirements. The National Registry of EMTs has sent a letter to paramedic programs indicating it will only test paramedics from nationally accredited programs beginning in 2013. Increases are being suggested with the new National Standard Curriculum to include more clinical requirements. Federal, state and local governments are also increasing regulations to obtain and retain licensure/certification.

Brainstorming our Future
     At the Firehouse Expo to be held in Baltimore this July, representatives from a number of interest groups will be asked to participate in a brainstorming event hosted by EMS Magazine to review the 1966 white paper Accidental Death and Disability: The Neglected Disease of Modern Society, which is the influential report published by the National Academy of Sciences about the development of the EMS system in the United States. This group will review where we were in 1966, where we are now and where we should be heading as a profession. Areas the group will look at include funding, staffing, expanded scope of practice, diminishing the scope of practice and partnerships with other healthcare fields, as well as partnerships with other funding sources such as health insurance and private industry.

     Specific considerations focusing on career paths might include incorporating EMS into other healthcare fields. For example, in order for a person to become an emergency physician, nurse, physicians' assistant, etc., they would first have to spend a specified number of years of service as an EMS provider. Besides helping EMS, this may also assist individuals in identifying early on whether a career involving sick and injured people is a good fit. Another solution could be that EMS providers who have mastered paramedicine could go back to school and become prehospital paramedic practitioners. Besides increasing retention, this could help reduce overcrowding in emergency departments, reduce the costs of emergency healthcare, and bring medicine to the underserved in rural, as well as urban settings. Accessing alternative funding such as from businesses, individual subscriptions or even tax dollars would also be up for discussion.

     Finally, this group will look at recruitment and retention to examine whether we are marketing to the right people and whether our training and education meets the needs of the patient population we are serving. We often hear that we are heroes who save lives. Though this sounds dramatic and alluring, it is a very small portion of what we actually do. Emergencies might be the exciting portion of our job, but responding to them is not the bulk of what we do. Recruiting and training for the tasks we perform most of the time, though not as exciting, may draw the type of individual who is more likely to remain in the field of EMS.

     After 42 years, it is clearly time to review the past and prepare for the future. The mentality in EMS is often to fix things after they are broken, so this may be a perfect time to be proactive and fix the system before it breaks down.

If you would like to submit points for discussion at the Baltimore meeting, e-mail nancy.perry@cygnusb2b.com, or submit your comment via the EMSResponder.com forums under White Paper Revisited.

Douglas R. Smith is a founding partner of Platinum Educational Group. He is a past president of the Society of Michigan EMS Instructor Coordinators, as well as the Chair of the NAEMSE Endorsement Committee. He is also the recipient of the 2003 Michigan Asoociation of EMTs' Michigan EMT of the Year award.

Joseph A. Grafft, MS, is the CFO and senior instructor for Customized Safety Training, LLC, in Stacy, MN. He is a past-president of the National Association of EMS Educators and served as the EMS Manager for the Minnesota State Colleges & Universities—Office of the Chancellor, Fire/EMS/Safety Center. He began his EMS career in 1960 when his father had him participate in a junior rescue squad and received his REMT-B in 1974.