EMS Dead Horses

We spend a lot of time beating the proverbial dead horse.


The trade mags and webpages and forums are full of those dead horses.

More recently we’ve seen a new article pop up in JEMS attempting to answer the question if we diagnose or merely form an impression. We seem to rehash the debate every 8-12 months.

My answer is yes we do in the legal sense of the word, but Medicare doesn’t pay us like they pay doctors for diagnosing a problem and fixing it. We get paid for transport and whatever we do during transport at significantly lower rates. The article in question seems to make an attempt to answer why we don’t get paid that way.

If you could answer that question it would be one for the ages. The answer to me is pretty obvious that in the eyes of the politicians that make the laws that we all have to follow to stay in business and out of prison that an ambulance has one purpose and that is to transport, and they assume that when someone calls 911 that they have a life threatening emergency that REQUIRES transport.

They don’t take into account that perhaps 10% of EMS calls in a certain place are really on emergencies, and most calls that result in transport are non-emergent or a result of neglect of a chronic condition. They assume that all 911 calls result in transport, even though most calls could do with a bit of education (albeit temporary) and maybe some advice. But we don’t get paid to give out advice.

Not to mention a service that gives out advice and not a transport is sometimes open to civil liabilities when they get it wrong, which the fear of liability in leaving them there often spurs transports even for routine complaints that a hospital can do nothing to help like common colds and minor orthopedic injuries.

Any program to reduce non-emergent 911 calls would also require overcoming cultural obstacles. It is a relatively known fact that in places with high levels of generational or ingrained poverty that non-emergent 911 calls are often the only way perceived by that community to gain access to health care. So far, programs focused on education against that obstacle have been unsuccessful, and probably the only solution is direct and consistent intervention.

See? Plenty of dead horses beaten in any discussion about solving problems that faces the ways and reasons we get reimbursed as well as any problems we have regarding unnecessary transports and civil liability. The only way we are going to remove the beaten horses is to fix the problems, and with the way the power brokers in Washington are playing and us chasing our tails over semantics and identity, they are topics that will likely never get fixed.