The Emergency Medical Services system is a complex world incorporating the latest techniques and ideas in healthcare with emergency response, technical rescue, and efficient and safe transport to definitive care. Through hundreds of years of progression and developments in both healthcare and training, EMS today has come to be an efficient and truly life-saving service. The emergency medical provider in the prehospital arena is a highly trained and capable individual entrusted with the care of those people who are extremely sick or critically injured at their most vulnerable times.
Among those in prehospital healthcare, there are several tiers of provider. Generally speaking, in the United States, healthcare professionals are classified as First Responders and Emergency Medical Technicians, at the Basic, Intermediate, and Paramedic levels. Each has a very important and unique function, and often heavily rely on each other on a daily basis. The EMT-Paramedic (“paramedic” here on) is the most highly trained prehospital care technician, and is capable of providing lifesaving techniques on par with some nurses and doctors in hospitals.
The care provided by paramedics is most commonly called Advanced Life Support, or ALS, in the United States. While there is an abundance of EMT-Basic (“EMT” here on) providers in practically every community, frequently there are fewer paramedics, especially in the large majority of rural areas in most of the US. ALS is a valuable and sometimes difficult to obtain service in many places, where most of EMS is provided by EMTs on the local fire or rescue service. Often, however, there is a need for specialized and emergent care that exceeds the abilities of even the best EMT.
This creates a need for ALS services that are easily accessible and relable for local rescue organizations. Presently in the United States there are several forms of ALS services. Examples of such include fire department-based, third service-based, third service or private intercepts, and hospital-based ALS. Each has its advantages and disadvantages for the system it provides, and some work better than others for their respective systems. This paper will be an exploration of and argument for the advantages of having a hospital-based EMS system in a suburban and rural setting.
The hospital based EMS system runs on the principle that ALS services are activated when certain types of calls come into a local emergency communications center, or when a need for ALS is determined by EMS already on scene. Such needs are determined by the emergency call-taker or EMT based on the patient’s condition, such as chest pain, difficulty breathing, unconsciousness, or significant trauma. Once the need has been determined by EMS on scene or their dispatch center, a call is placed to the hospital-based paramedics to respond to the scene or intercept with the EMTs en route to begin advanced patient care.
Once the paramedics have met up with EMTs already caring for the patient, the healthcare team moves with the patient to the hospital. Sometimes the patient care needed exceeds the local hospital’s abilities, and the patient is transported directly to a specialized facility, but most often the patient is transported to the hospital from which the paramedics came for definitive or stabilizing care. The patient is then transferred to emergency room staff, and the paramedics give a detailed report on the patient’s condition and their interventions en route.
Sometimes, EMS crews (both basic and paramedic) will stay on with a patient in the ER and assist the nurses and doctors until the transition has been completed. This continuation of care even after transport and arrival at the hospital is an important argument in basing EMS providers out of the hospital. As EMS is essentially an extension of the emergency room out to the patient at home or in the community, EMS providers should be considered part of the healthcare team.
Unfortunately, some of the old stigmas of “ambulance drivers” associated with emergency healthcare in the 60’s and 70’s still remain, even among some who work in the hospitals. Because of this, EMTs and paramedics are often not considered “healthcare providers” on par with nurses and doctors, but the reality is that EMS has made great advances in healthcare technology, training, and knowledge base, and should be considered an integral and necessary part of the healthcare team.
To base paramedic services in a hospital is to recognize the importance of unifying that team, and strengthen the relationship and ease patient transition between the prehospital realm and the emergency room. The advantages in integrating ALS into the ER are not restricted to serving the patient’s ease of entrance into the hospital. All parties benefit, from the outlying local rescue services, to the paramedics themselves, to the ER staff and doctors involved.
Local EMS providers know that the care that is so essential to their friends and neighbors is coming from a well-trained and respected ALS system; the paramedics gain from being hospital employees and its associated benefits; ER staff have extra hands when necessary and receive patients who have already been triaged and received essential care; and physicians at the hospitals know that not only can they keep a critical eye and lend a guiding hand to ALS providers, but they can easily incorporate new technology and ideas into prehospital care.
As a medical professional, an EMT-Paramedic receives a great deal of education in the various illnesses and injuries the human body can endure, and also has the means to treat any number of conditions with which a patient might present. This education is in many ways equivalent to that of a Registered Nurse, and encompasses skills that in some cases only Physicians generally perform. With this education comes great responsibility, and the value of the services provided as well as the liability of his employer should a paramedic make a mistake is high.
Thus, the costs associated with operating an Advanced Life Support system are much greater than those with First Responder or Basic Life Support providers. These costs often exceed the financial capacities of smaller fire and rescue departments, and so they cannot provide locally-based ALS. The need still exists in every community, however, so a smaller town must find the resources elsewhere, either by contracting with another town or private ambulance service to provide paramedics when needed, or to rely on the hospital-based ALS service to come to their aid.
Often, the latter is the most financially sensible choice, and local rescue services can take comfort in knowing that the paramedics responding are highly-trained professionals who are well-respected within the EMS community. Also, due to the lower call volumes of many suburban and rural departments, it is often hard to justify having around-the-clock ALS services within the department. For the organization it would be far too expensive, and for the paramedic, a lack of calls leads to atrophy of skills from non-use. As a hospital employee responding into the community, the paramedic has several advantages.
Most hospitals are facilities dedicated to the latest advances in research, technology, and patient care. Thus, every part of the hospital is constantly seeking to advance and educate its employees on the latest ideas. The modern hospital is a hub of continuing education, which is essential to every healthcare professional. As a member of that hospital’s staff, the paramedic has available to him or her constant opportunities to gain new knowledge and advance his or her awareness of the latest developments in patient care.
This education is not limited to classes to refresh one’s skills, however. An important part of a paramedic’s job is to evaluate his or her own performance on a constant basis. This is most frequently achieved through analysis of calls as a group discussion, with the medical director of the service, to learn about what was done well and what could be improved upon. Being in the same facility also makes the medical director more accessible to the paramedic, in cases of difficult calls or questions about protocol, for example.
The benefits for the paramedic of being a hospital employee also extend into the administrative and financial realm. Hospitals are places devoted to health and well-being, and providing the best possible care to the patient through those means necessary. This means that the administrators governing the hospital-based EMS system have healthcare in mind primarily when making important decisions, and are more apt to provide better funding than would a municipal government, limited to taxes for income and not appreciating the significance and need for good and well-funded EMS.
In addition, the pay and benefits to a hospital employee generally are better than in the municipal or private EMS system, providing a solid living for paramedic employees. Emergency rooms at times become frighteningly busy places, with a volume of patients frequently exceeding the department’s resources. This is made especially difficult by the fact that hospitals are having an increasingly difficult time adequately staffing enough nurses to handle the amount of patients needing care. In situations such as these, to have skilled paramedics in the ER when not out on calls is of great benefit to ER staff.
Professionals familiar with the environment, able to handle the stresses of the busy department, and who are able to assess and triage patients, begin patient care, and help treat immediate illness and injury are a welcome addition to outnumbered staff. Busy ER staff can also appreciate a patient who arrives by ambulance who has been stabilized, with IV access, EKG taken and interpreted, and blood drawn for lab work, reducing not only tasks that need to be completed as part of patient care, but also allowing for more immediate care in the case of critical, time-sensitive patients.