Status Quo

We can all agree that these are goals of a perfect EMS system.

1. A paramedic on every priority one emergency call
2. A run form completed before leaving the hospital
3. A living wage for every paramedic

Ever since I have been in EMS — 24 years now — I have heard the discussions about ambulance availability, the need to leave a fully completed documented run form before leaving the hospital, and the need to improve paramedic pay.

I recently overheard an exchange between three people, one a paramedic, one a supervisor for an ambulance service and one a hospital administrator.

Here was the rub:

The hospital wanted the paramedic to not leave for the next call before they had finished writing the run form from the first call and they wanted the paramedic on the priority one emergency call.

The ambulance supervisor wanted the run form fully completed (for billing and data reporting) and the paramedic to clear the hospital quickly to do the priority one call.

The paramedic pointed out that is was often impossible to fully complete the run form, print it out and leave it for the hospital and get to the dispatched call in a meaningful time.

The paramedic said he skipped many of the boxes on the run form so he would get the form done quickly and be able to clear. He said he sometimes cleared to take the call without leaving the run form because the patient was alert and had no issue but a cut finger. The paramedic also said many times he did fully complete the run form, but the patient was still on his stretcher when the next call came in so even though his run form was done, he couldn’t clear to take the call.

The hospital administrator told the ambulance service to put more cars on the road so the paramedic could have the time to write the run form while the added paramedic did the call.

The ambulance supervisor wanted the hospital to hire more nurses so the triage lines weren’t so long and so that when the nurse heard the paramedic’s verbal report, they wouldn’t forget it immediately because they were taking care of so many patients. And he wanted the hospital to give his company more transfers so it could make enough money to put more cars on the road.

The paramedic said while you are spending more money on hiring more nurses and putting more ambulances on the road, how about kicking a few extra dollars my way because I’m not keeping up with the cost of living despite working 60 hours a week.

The bartender interrupted the conversation then, by asking if they would all like another round, which they did. On the TV over the bar there were news stories about crumbling schools, jobs moving out of state, and other bad news.

Here’s what happened. The paramedic did the best he could to leave the run forms and get to the calls so the patients didn’t suffer. Sometimes he completed the run forms, sometimes he didn’t. No nurses were hired. No cars were added. The triage lines stayed long. Calls were still dispatched before the crews had the patient off their stretcher. The paramedic did not get his raise. The three continued to drink beer together.

3 Comments

  • Brooks Walsh says:

    One thing you left out: Once the medic completes the run-form, it is faxed to the hospital, where it either is lost, buried in the warehouse of paper medical charts, or unable to be incorporated in the computerized medical record.

  • smallville says:

    Amiability is sometimes the only thing salvageable; but at least there is that.

  • Flobach says:

    When reading your three points, I thought to myself: “yes, I agree, and what’s your point?” Then I realised how lucky I have been to be a paramedic in Australia and in the uk where 1 is nearly always the case, you wouldn’t be able to clear from your previous call if you hadn’t done number 2 and number 3 hasn’t been much of an issue either (certainly not in Australia, uk pay is average but livable, with a 37.5hr week).

    What needs to change? Not only the profession needs to advance, but also the framework that it sits within (which is overwhelmingly healthcare, not public safety). But for that to happen, I believe the American public need to adopt a different mindset about healthcare and general insurance. If everyone pays in to one fund, economics of scale allow for much cheaper and better provision of healthcare. And, as we all should now working in this area, ill health and disability can hit each and anyone of us without prior notice, none of us have a magic shield of protection.

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Peter Canning

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