Just an idea

In certain services in EMS:

We have the ability to paralyze patients and establish advanced airways directly (we hope) into the trachea.

We have the ability to drill a needle into bone and administer medications into the intraoseous space.

We have the ability to give patients narcotics, give the patients medications that speed up the patient’s heart, slow down the patient’s heart, any of which can have the side effect of stopping the patient’s heart.

We can administer electrical “shocks” to patient’s hearts, decide if a person is past the point of being saved and terminate efforts in obvious deaths, we interpret electrocardiographs and determine patient care, we determine if patients should be flown out of rural areas or areas that are too far for ground transport. We can do chest decompressions, nasal gastric tubes and regulate ventilators.

We can do this and so much more and yet we cannot tell a patient that they should not go to the ER for that splinter in her finger (really, I’ve had this patient); we cannot tell the patient that has told us he have no chief complaint except they want to go to the behavioral unit and going by ambulance is faster in the ER for medical clearance (this one goes 3 times a year). We cannot, with all of our experience and training, tell a person that a glucose of 255 mg/dl is not an ER problem but a problem that should be examined with their personal doctor (this one also goes 3 times a year at least).

I’m not saying everyone should have this ability, by no means. I know what kind of medics are out there. Being able to tell a patient they are not in need of emergency medical services is a big responsibility, filled with possible complications. Just like half of the interventions we perform on patients. I am saying that there are some medics that should be able to do this. I’m also saying there are a lot of medics who are doing this and worse because there is a failure in policing refusals at the moment.

Will this solve all EMS problems? Of course not, in fact it might create some very new ones. Think about this before you dismiss the idea just on principle:

Can police officers tell people calling that the situation they are talking about does not need police intervention? (Have you heard of the people that call because a burger was not prepared as they wanted? That person got a ticket and then was arrested.)

Would the fire department be forced to respond to the same house time and time again if it was just to help the residence get seen faster?

Yet us, and again I’m not saying everyone in EMS but certainly a few of us, are forced to transport everyone for anything.

This has just been a thought, I have an idea that there has to be some significant changes to EMS before it becomes a reality.

Thank you for listening.

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