Myth Busting EMS: Time to Evolve Our Approach

Academy of International Mobile Healthcare Integration

In a world where EMS is rapidly changing, it’s clear that outdated practices can’t keep pace with the evidence-based advancements reshaping our profession. During the recent Academy of International Mobile Healthcare Integration (AIMHI) webinar Myth Busters: Emergency Medical Services Delivery–Expectation vs. Reality, industry experts weighed in on how EMS systems must adjust to overcome inefficiencies and face the staffing and economic crises head on. Their message was clear: it’s time to bust some longstanding myths about EMS and embrace smarter, more effective strategies.

The Bottom Line Up Front (BLUF)

1. It’s time to move beyond outdated performance metrics and focus on outcomes that actually matter.
2. Prioritize resources where they’re truly needed. Smarter deployment means better care.
3. Saving lives doesn’t always mean rushing everywhere—safety comes first.
4. Let’s align our expectations with the science.
5. Efficiency plus expertise equals better patient care. Not every EMS call needs an ALS response.

Busting the Myths

Myth #1: Faster Response Equals Better Outcomes

For decades, we’ve lived by the stopwatch, but Kevin Mackey, medical director of Sacramento Fire Department, tackled this myth head on. Mackey explained how the obsession with rapid response times stems from outdated cardiac arrest protocols—when getting there fast was paramount. But today, with public defibrillators in Costco and gyms, most emergencies don’t need lights and sirens blazing within minutes. Mackey drove home the point that modern research shows that the four- and eight-minute benchmarks have little to do with patient outcomes in the majority of cases.

Doug Kupas, medical director of Geisinger Health, supported this by emphasizing that response times are a narrow measure that overlooks the true quality of care. As Kupas put it, “We’ve got to start focusing on outcome-based metrics that actually tell us something about patient health.”

Myth #2: Lights and Sirens Should Be the Default

How many times have we hit the lights and cranked the sirens because it’s what we’ve always done? Turns out, we’ve been doing it wrong. Kupas and Mackey both pointed to studies showing that the time saved by using lights and sirens is minimal—just 30 seconds to two minutes. But the risks? They’re huge.

John “JP” Peterson, executive director of Mecklenburg EMS, shared how his agency flipped the script on this. After cutting lights and sirens use from 75% of calls down to 25%, they saw a 15% reduction in ambulance crashes—all without affecting patient outcomes. In Peterson’s words, “It’s about safety, for both crews and the community.”

Myth #3: Every Call Needs a Paramedic

The belief that a paramedic must be on every call is another sacred cow of EMS that’s long overdue for retirement. Kupas challenged this notion, explaining that sending ALS on every call isn’t just unnecessary—it dilutes paramedics’ skillsets by spreading them thin. “We need to concentrate paramedics on high-acuity cases, where their expertise is truly needed,” said Kupas.

Mackey added that EMS can take a cue from other parts of the healthcare system, like trauma centers, where specialized care is concentrated to ensure proficiency and better outcomes.

System Redesign: Public Education is Key

Peterson and Chip Decker, CEO of Richmond Ambulance Authority, both emphasized that changing the system doesn’t just involve a tweak here or there—it requires a complete redesign, especially when it comes to public education. Mecklenburg EMS implemented a tiered response model, prioritizing advanced resources for the most critical cases while allowing lower-priority calls to receive non-emergent responses. Public buy-in was crucial, and they spent significant time engaging local governments, community groups, and the media to ensure everyone understood why these changes were necessary.

Decker echoed these thoughts, stressing that aligning community expectations with evidence-based EMS practices isn’t just smart—it’s essential. He emphasized that EMS system redesign often requires political support and stakeholder engagement to make lasting changes.

Tom Wieczorek, director of the Center for Public Safety Management, put it bluntly: many of the challenges EMS systems face stem from outdated perceptions driven by the media and public expectations. “We need to educate the public on what modern EMS really looks like—because it’s not just about getting there fast,” said Wieczorek. It’s about quality care and safe, efficient service delivery.

Key Takeaways

1. Focus on Outcome-Based Metrics:
   It’s time to stop chasing the clock and focus on what matters most—patient outcomes. Performance metrics should reflect the quality of care delivered, not just how quickly we show up.
2. Reduce the Overuse of Lights and Sirens:
   Lights and sirens should be reserved for the most critical cases, where every second truly counts. Otherwise, the risks far outweigh the benefits, both for EMS crews and the public.
3. Implement Tiered Response Systems:
   Progressive EMS systems are adopting tiered models that ensure the right resource is dispatched to the right call. This not only improves efficiency but also enhances safety and reduces costs.
4. Reevaluate the Role of ALS:
   Not every call requires a paramedic. By concentrating paramedic expertise where it’s needed most, we ensure that the right level of care is available when it truly matters.
5. Public and Political Engagement is Critical:
   The future of EMS will be shaped by public perception. Engaging with communities and educating political leaders on the realities of modern EMS will help pave the way for meaningful, sustainable change.
6. Data-Driven Decision Making:
   The numbers don’t lie. EMS systems that adopt data-driven approaches will see improved resource allocation, efficiency, and patient outcomes. It’s time to let the evidence lead the way.

Conclusion: The Path Forward

The Myth Busters webinar was a clarion call for EMS leaders and systems across the country. The time to challenge the status quo is now. By embracing evidence-based practices, reducing reliance on outdated metrics, and educating the public, we can ensure that EMS continues to evolve in a way that meets the needs of both patients and providers. The future of EMS lies in smarter, data-driven approaches that prioritize patient outcomes over outdated beliefs.

So let’s shed those sacred cows and embrace a new era of EMS—one where expertise and efficiency drive our success.

The AIMHI webinar is available on demand, as are links and references used in the webinar, via https://aimhi.mobi/ondemand/13420011