Growing up in one of the largest cities in the United States with parents who had no involvement in the fire and emergency services, it was gospel that you didn't go to the emergency room or call an ambulance unless you really, really didn't have any other choice.
That wasn't an indictment of those who worked in the ERs or on the EMS units, but rather a citizen-level understanding that the emergency medical system, even three decades ago, was overburdened, under-resourced, and unable to address the daily demands for service.
Even popular culture picked up on this theme, with heavily watched and award-winning dramas about overwhelmed emergency rooms becoming a staple of prime-time television.
My professional experiences since that time have certainly given me a greater appreciation of EMS and the broader system of emergency medical care, both in the U.S. and elsewhere. So I guess I'm not surprised at the findings of the report referenced in this story.
Still, it's important to understand the context and, more importantly, the extremely dynamic public policy environment surrounding EMS right now.
The Affordable Care Act (also known as Obamacare) has moved from the halls of Congress and the Supreme Court, through implementation in communities and hospitals of all sizes and types, and is heading to the places and spaces where fire departments and other agencies deliver EMS care. And it seems likely that we're on the cusp of, or perhaps in the midst of, some fundamental changes in how the overall system of providing emergency medical care works — or how it is supposed to work, depending on one's perspective.
This will undoubtedly lead to many challenges and opportunities for organizations, including fire departments, involved in delivering EMS. But from listening to the experts, it seems premature to identify exactly what all of those might be or to forecast the ultimate impacts of such a major change in our overall health care system.
It's vital that every fire department involved in providing EMS become familiar with what's happening in their hospital(s), region, state and at the federal level while every facet of emergency medical care is touched by potentially significant changes. This extends beyond changes as a result of the ACA to technology, evidence-based medicine, and workforce and demographic changes.
About the author
With more than two decades in the field, Chief Adam K. Thiel — FireRescue1's editorial advisor — is an active fire chief in the National Capital Region and a former state fire director for the Commonwealth of Virginia. Chief Thiel's operational experience includes serving with distinction in four states as a chief officer, incident commander, company officer, hazardous materials team leader, paramedic, technical rescuer, structural/wildland firefighter and rescue diver. He also directly participated in response and recovery efforts for several major disasters including the 9/11 terrorist attacks, Tropical Storm Gaston and Hurricane Isabel.
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