“Your scientists were so preoccupied with whether or not they could, they didn’t stop to think if they should.” – Jurassic Park
This month the NAEMT released a series of infographics on what is being called EMS 3.0. One of the things the infographic spotlighted was community paramedicine, an idea I used to support strongly. I used to think community paramedicine was the future of EMS now I think it is simply bad brand extension, like Crystal Pepsi was.
When talking about EMS 3.0 the NAEMT states that EMS must expand our services to include the following: post discharge follow up, preventative care, nurse advice, chronic disease management and support. Make no mistake about it; these are all very real healthcare gaps that currently exist in communities. The issue is who should try to fix these gaps. I don’t know who should fix this or how they will go about it, what I do know is it is the wrong thing for a national EMS advocacy group to endorse at this time.
EMS needs to provide quality EMS 1.0 before adding other roles to it. We have major cities that have issues providing even the most fundamental 911 EMS services and we want to go right past that and do something else. It would be easy to sell community paramedicine to idealistic paramedics by using hyperbole and using emotion, I should know as I was one of them. . Endorsing mastery of the fundamental principles is not a sexy position, it will not generate buzz on social media, it won’t even make an exciting presentation at a state level EMS conference and it sure won’t sell advertising space but it is what we owe our patients and what they deserve.
We need to define ourselves before we add more to our plate. Are we members of public safety? Are we health care professionals? Should we simply be a bunch of protocol following ambulance drivers? Who should be in charge of us? The NHTSA? Doctors? Perhaps it is time we govern ourselves? What exactly is it we do? Do we take patients to the hospital, do we keep patients out of the hospital, do we make sure patients are healthy and compliant with their medications? Are we adrenaline junkies who fight death or are we the equivalent of home health and do things like fall prevention? Are we specialists who focus on emergency medicine or are we generalists with a holistic approach to health care? Are we all of those things or maybe none of them?
How many EMS services you would say are truly excellent and provide high quality patient care? I’m not talking about a service where there are some excellent providers, but ALL of the providers are excellent. A service where every patient is guaranteed to get excellent patient care regardless of what provider shows up at their house that day.
I used to think my service was excellent. Then I tested that hypothesis [read about it here] and found out we are in fact not excellent. I used to think my service was ready to take the next step and embrace community paramedicine. My goals have changed, I no longer want to be the most cutting edge service I want to be the service that every single provider is great at the meat and potatoes of EMS. I want to feel confident that any member of my service can show up and treat my family and I feel good about it and I can back that opinion with facts.
For the sake of argument let’s say you believe there are services that qualify as excellent, what metrics are you using for that? Can you back it up with facts? Some services boast about cardiac arrest rates and while those numbers are important they need to be viewed with the understanding that cardiac arrests are a very small percent of overall call volumes.
A large majority of EMS providers that think the best treatment is a diesel bolus, that we do not diagnose and that we must follow protocols even when it means performing unethical acts. Many of the treatments we do in EMS have no basis in science and little to no evidence that they work or change outcomes, and some might be outright harmful.
There are a lot of good ideas in the NAEMT’s EMS 3.0 ideology, but community paramedicine is not one of them. As much as I want to be progressive and embrace the notion of EMS 3.0, we need to make sure that EMS 1.0 is an excellent product we can deliver before we can take that next step forward.
Read more about EMS 3.0 and the NAEMT stance on community paramedicine here: