The healthcare profession is multifaceted in its approach to public service. Evidence-based medicine is evolving, with increased studies and emerging diagnostics equipment, medication and technological advancements. It’s not surprising that the clinical practices of the past are not always deemed relevant and appropriate in today’s healthcare settings.
Preventative medicine is rapidly growing in its popularity, with inoculations, health initiative and screenings becoming increasingly popular among employers and educators in the United States and worldwide. Because of its many intricacies, the policies and procedures of the medical community are not always common knowledge, and perhaps they ought to be. So, without further ado, let’s delve into the topic, shall we?
The earliest recorded ambulances date back to the late 1400s, when soldiers used carts to transport wounded men away from the battlefield and move them to a treatment area. Ambulances were manned by civilians with no medical training and intended for rapid transport. In the late 1860s, hospital-based ambulances managed patients during epidemics, and in 1952, they restructured ambulances to include CPR and cardiac medications for the management of cardiac arrest patients. Prior to that, ambulance caregivers were typically untrained and unregulated. Prehospital transportation emphasized the rapid transport of patients to a higher level of care.
In 1966, Federal regulations and legislative efforts standardized the training for medical professionals, introducing the Emergency Medical Technician.
Since then, prehospital care has developed into varying levels of training and interventions based on state and local regulations. Some examples of these include ground transportation, air medical, and critical care modalities. Specialized care became popular in the prehospital setting as nurses and personnel with advanced training became more prevalent. Fast-forward to present day, and ambulances are everywhere.
Prehospital transportation has developed from war-time transportation to a more convenient method of medical care. According to the Utah 911 committee, about 10-40% of 911 calls are non-emergent. The National Association of Emergency Medica Technicians estimates that approximately 20% of all medical calls in 2008 were not life threatening. This means that of the thousands of calls per year, nearly a quarter of them do not require life-saving interventions in the prehospital setting. This results in increased costs for public services and longer ambulance response times.
Initiatives, such as community health programs and public education, can mitigate this problem. Studies show that between 5 and 8% of patients can account for 20% of EMS calls. Often, these result from lack of resources, education and coordination on the patient’s behalf. Many individuals do not have a primary care physician, or a means of transportation for medication refills. Medication side-effects or other chronic concerns can cause improper or excessive use of Emergency Medical services. Community health providers are trained practitioners that are dispatched to patient homes to assist with these types of issues, decreasing the instances of 911 necessity and usage and providing patients with the resources and help they need.
Community education initiatives like “Stop the Bleed” and “Hands Only CPR” are effective in schools and workplaces. Educating and empowering civilians to recognize the signs and symptoms of certain emergencies can increase the patient’s survivability because of immediate bystander intervention.
Despite these valuable resources, misconceptions still exist among the public. For example, many people believe that taking an ambulance to the hospital guarantees faster care. However, because of overwhelming patient numbers and varying degrees of illness or injury, hospitals are required to triage every patient, regardless of their method of transportation. This means that whether you arrive via an ambulance or by private vehicle, medically trained staff will triage you at the hospital and categorized based on your presentation and vitals assessment. Critically ill and injured patients will take precedence over those who are stable or with mild complaints, as the critical patients require immediate emergency intervention.
Another misconception is that prehospital medical personnel use lights and sirens on every call. This is termed “code driving”, and though providers are trained and monitored for road and vehicle safety, code driving increases risk of injury and is reserved for critical responses and patients.
Often, patients and patient families are (understandably) anxious, and under the impression the emergency personnel will “scoop and run.” Though this was the method of the original ambulance, prehospital transport has improved in the last century, and they often perform interventions on scene to maximize patient outcomes. For example, in cardiac arrests, they encourage medical providers to maximize their scene time by remaining on scene with the patient and performing vital interventions prior to starting transport. This is what’s called evidence-based medicine, or policies and practices put into effect based on conclusive evidence and data showing improved patient outcomes. Simply stated, sometimes it is best to remain on scene a few extra minutes and treat the emergency.
Provider safety is a hot topic among EMS providers and agencies, and for good reason. Did you know that healthcare workers make up 50% of the victims of violent crimes in the workplace? That means that of the two million people experiencing workplace violence every year, one million of them are healthcare workers.
Policies such as “staging” on dangerous calls can mitigate these numbers for violence in the field. For those unfamiliar with the term, “staging” refers to the relocating of an emergency apparatus to a safe location until the scene of the emergency is deemed safe by law enforcement. To onlookers, it may look peculiar- but this is a widespread practice used within the prehospital emergency profession.
In summary, Emergency Medicine and prehospital care have adapted to modern communities, implementing resources, training, and education to maximize patient and provider safety and improve patient care. Protocols can vary from county to county, and depend on the medical provision and oversight, as well as the state and federal regulations. Scientific studies are underway and new information is emerging, changing the face of medicine. Though EMS is intended as a resource for emergencies, it has the propensity to be overused and viewed as a convenience in some cases, and not used appropriately. This results in higher costs (increasing taxes), longer response times, and provider burnout. Public education, resource management, and programs like community health are integral to minimizing the instances of 911 misuse and improving medical services for our communities.
About the author:
Ashley Brandt is a paramedic and an author living in north Texas. Ashley has been working in EMS for eight years and loves her job! Ashley has five published books and is currently under contract for a sixth.
More of Ashley’s work is available at: