Tag Archives: ems

Relationships Among Health Services Organizations

 As a critical care paramedic, I am fortunate enough to experience our health care system as an active participant, caring for the sick and injured, and as a passive observer, following the pathways of the patients whom I have treated. The health care system in the United States is, admittedly, fractured (Kovner & Knickman, 2008), but there are components that serve to create harmony and efficiency within this system, and I will describe just a few of them.

The primary care physician is meant to be the coordinator of all care for his or her patients. The importance of this role cannot be overstated, as it is the keystone to “health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses” (American Academy of Family Physicians, 2010, para. 7). When appropriately utilized, the primary care physician can coordinate a patient’s care to ensure efficiency and efficacy of treatment while ensuring safe and comprehensive care (Kovner et al., 2008).

There is a growing number of specialties and sub-specialties within the practice of medicine today (Bureau of Labor Statistics, 2010b). Specialists focus on their chosen area of practice and are an asset to the general practitioner, or primary care physician, who can concentrate on the coordination of the patient’s care. The inclusion of specialists in medicine is an efficient and effective means of offering the patient a level of expertise not otherwise available. One of these specialties is emergency medicine.

Emergency departments are necessary entry points into the health care system for victims of acute trauma and illness, but often times, the emergency department is used as the primary portal for those who lack insurance or other means of accessing health care appropriately (Committee on the Future of Emergency Care, 2006; Kovner et al., 2008). These patients tend to utilize the emergency room for even minor ailments, distressing this important component of the system, causing a “nationwide epidemic of [emergency department] overcrowding, boarding, and ambulance diversion” (Committee on the Future of Emergency Care, 2006, p. 19).

Laboratories and radiology departments are great assets to providers, allowing technicians to perform tests at the behest of the physicians and only requiring the physician to interpret the results of the tests. This seems to be a cost-effective and efficient component of the system, so long as the tests are performed timely and accurately.

Pharmacists have been regarded as patient-focused consultants who can provide both patient-specific and general information regarding over-the-counter medications as well as prescription medications. In our health care system, pharmacists have a valuable role of safeguarding patients from over-medication, as well as under-medication, medication compatibility, and also educating patients to the possible side-effects of their prescribed medicines (Bureau of Labor Statistics, 2010a).

In conclusion, the safest and most efficient use of our health care system begins at primary care. Though, in emergency situations, there is certainly a need to seek immediate care by other means, patients can suffer financial challenges as well as safety issues by trying to remove the primary care physician from the health care paradigm. Not only is this unsafe for the patient seeking primary care elsewhere, but misuse of emergency departments cause unnecessary delays for truly emergent patients. The health care system in the United States is vast and can be confusing. The primary care physician can provide a safe and efficient pathway of care that will save a patient time, money, and, possibly, his or her life.


American Academy of Family Physicians. (2010). AAFP policy on primary care. Retrieved May 1, 2010, from http://www.aafp.org/online/en/home/policy/policies/p/primarycare.html

Bureau of Labor Statistics, U. S. Department of Labor. (2010a). Pharmacists. Occupational outlook handbook (2010-11 ed.). Retrieved from http://www.bls.gov/oco/ocos079.htm

Bureau of Labor Statistics, U. S. Department of Labor. (2010b). Physicians and surgeons. Occupational outlook handbook (2010-11 ed.). Retrieved from http://www.bls.gov/oco/ ocos074.htm

Committee on the Future of Emergency Care in the United States Health System. (2006). Hospital-based emergency care : At the breaking point. Washington, DC: National Academies Press.

Kovner, A. R., & Knickman, J. R. (Eds.). (2008). Jonas & Kovner’s health care delivery in the United States (9th ed.). New York, NY: Springer.

Health Care Costs, Quality, and Access

It is the general consensus that the structure and organization of the U.S. health care system is fractured and disorderly. For many health care consumers, especially those who rely on governmental health assistance, there is no motivation to seek appropriate care responsibly. Many of these consumers rely on the local hospital’s emergency department and municipal emergency services for their primary medical needs. The Committee on the Future of Emergency Care in the United States Health System (2006) states “[Emergency Departments] are an impressive public health success story in terms of access to care” (p. xiv), and continues to describe how the emergency departments have “become the ‘safety net of the safety net’, providing primary care services to millions of Americans who are uninsured or otherwise lack access to other community services” (p. xv). With health care comprising one sixth of the nation’s economy, doubling in the last 30 years, the focus should be to create a model of efficient and effective delivery of care so that we, as a nation, may be able to care for our sick and injured without becoming bankrupt (Kovner, Knickman, & Jonas, 2008; Mushkin et al., 1978).

As emergency medical services are considered as the health care gateway for many, allowing the emergency medical services to refer patients into appropriate pathways (e.g. primary care providers, urgent care clinics, psychiatric services) for their conditions would allow for more directed care for the patient with shorter wait times and shorter care times overall. Unfortunately, insurance providers, including Medicare and Medicaid, do not allow remuneration for such services, requiring the transportation component to trigger payment; therefore, the only option left is to transport these patients to the emergency departments. This promotes the inefficient use of such services and continues the current paradigm of inefficiency throughout the system. Though this change would increase insurance payments to emergency medical providers, increasing the initial cost of seeking health care, this would allow the provision of selecting more efficient pathways leading to more cost-effective care. Hopefully, this paradigm would result in an overall net savings.

This is only one example of modifying a current system to be more effective and help to promote efficiency throughout the health care experience. We need to consider where we can shift roles and responsibilities within the health care system in order to promote a more usable system, one that promotes integrity, efficiency, responsibility, and efficacy by both providers and consumers. Once we realize the opportunities that efficient use of current services will offer, we can realign the services to better fulfill the needs of the population where it comes to health and wellness.


Committee on the Future of Emergency Care in the United States Health System. (2006). Emergency medical services: At the crossroads. Washington, DC: National Academies Press. Retrieved from http://www.nationalacademies.org/nas/

Kovner, A. R., Knickman, J. R., & Jonas, S. (Eds.). (2008). Jonas & Kovner’s health care delivery in the United States (9th ed.). New York, NY: Springer.

Mushkin, S., Smelker, M., Wyss, D., Vehorn, C. L., Wagner, D. P., Berk, A., … Louria, M. (1978, October). Cost of disease and illness in the United States in the year 2000. Public Health Reports, 93(5), 493–588. Retrieved from http://www.ncbi.nlm.nih.gov/

Improving Traffic Safety for Emergency Responders

The Emergency Medical Services (EMS) is an occupational field wrought with opportunities for workers to become ill, injured, or succumb to death while performing the functions of their job (Maguire, Hunting, Smith, & Levick, 2002). In the mid-1980’s, Iglewicz, Rosenman, Iglewicz, O’Leary, and Hockmeier (1984) were among the first to perform research into the occupational health of EMS workers by uncovering unhealthy carbon monoxide levels in the work area. This appears to have been the impetus for further research into uncovering some of the causes and contributing factors of illness and injury incidents, as well as safer alternatives to current work practices.

One of the more recent efforts to protect EMS workers relates to traffic-related injuries and fatalities of EMS workers while responding to calls and working on the scenes of traffic accidents. As important it is for the EMS workers to be able to get to the scene of an emergency and work without threat of injury, the safety of the community is important to consider. Solomon (1990) realized the need to improve safety in this area and recommended changing the paint color of emergency apparatus to more visible lime-green. Emergency workers were continuing to fall victim to “secondary incidents” at roadway scenes (Cumberland Valley Volunteer Firemen’s Association, 1999). An analysis of EMS worker fatalities between 1992 and 1997 reveals an occupational fatality rate that continues to exceed that of the general population (Maguire, Hunting, Smith, & Levick, 2002).

Across the pond, in the United Kingdom, efforts were also underway to improve the visibility of police vehicles by considering various paint design schemes, including the Battenburg design: alternating blocks of contrasting colour (Harrison, 2004). Harrison concluded that the half-Battenburg design showed promise as it increased visibility and recognition of police cars in the United Kingdom, and the United States National Institute of Justice was considering research on the efficacy of the Battenburg design here in the United States to promote officer safety. EMS administrations are known for paying special attention to the bandwagon, that is they frequently make changes based on inconclusive and sporadic evidence. This is the case with recent ambulance designs.

Many ambulances in the New England, as well as other parts of the country, are being designed with the half-Battenburg markings applied to the sides of the vehicles in attempts to improve the safety of EMS workers. Unfortunately, we may find that these markings might have an unintended effect of confusing other drivers and causing more problems. A recent study found that Harrison (2004) was correct in that the Battenburg design assisted British drivers in quickly identifying British police vehicles, but the “effectiveness of the ‘Battenburg’ pattern in the UK appears primarily related to its association with police vehicles in that country” (Federal Emergency Management Agency, Department of Homeland Security, 2009, p. 6) having little effect on the recognition potential of American drivers.

Perhaps with the evolving data, we can begin using an evidence-based approach at helping the EMS worker perform his or her job safely at traffic scenes.


Cumberland Valley Volunteer Firemen’s Association. (1999). Protecting Emergency Responders on the Highways: A White Paper. Emmitsburg, MD: United States Fire Administration.

Federal Emergency Management Agency, Department of Homeland Security. (2009). Emergency vehicle visibility and conspicuity study [Catalog No. FEMA FA-323]. Emmittsburg, MD: United States Fire Administration.

Harrison, P. (2004). High-conspicuity livery for police vehicles [Publication No. 14/04]. Hertfordshire, U.K.: Home Office, Police Scientific Development Branch. Retrieved from http://scienceandresearch.homeoffice.gov.uk/hosdb/publications/road-policing-publications/14-04-High-Conspicuity-Li12835.pdf

Iglewicz, R., Rosenman, K.D., Iglewicz, B., O’Leary, K., & Hockmeier, R. (1984). Elevated levels of carbon monoxide in the patient compartment of ambulances. American Journal of Public Health, 74(5).

Maguire, B.J., Hunting, K.L., Smith, G.S., and Levick, N.R. (2002). Occupational fatalities in emergency medical services: A hidden crisis. Annals of Emergency Medicine, 40(6), 625-632. doi: 10.1067/mem.2002.128681

Solomon, S.S. (1990). Lime-yellow color as related to reduction of serious fire apparatus accidents: The case for visibility in emergency vehicle accident avoidance. Journal of the American Optometric Association, 61, 827-831.


Living in such a small community as I do, there is little need for grassroots organizations to assist in the health and welfare of the community. Most of the organizations that are available in my community are business-based, healthcare focused institutions.

Day-Kimball Hospital (http://www.daykimball.org) is the center of healthcare and wellness in Northeastern Connecticut. Partnering with the community, Day-Kimball Hospital provides a host of services through its many facilities to provide outreach programs which help to make a healthier community. Employment and volunteer opportunities are available within the hospital for those with a desire to help promote health and wellness within the community.

There are two other local agencies, United Services (http://www.unitedservicesct.org) and Quinebaug Valley Youth and Family Services, which have partnered to provide a community-centered approach to the psychological welfare of adults, adolescents, youths, and their families. United Services, Inc. also provides employee assistance programs to workers of participating local businesses. Providing psychiatric consultation services for addiction and recovery, family violence, and family structure support, these agencies promote social change as both entities themselves and through their contact with members of our community.

The town of Killingly, Connecticut, also offers a Little League program where children can learn to play baseball and softball while learning the values of sportsmanship, loyalty, courage, and commitment. This program helps to promote social change through encouraging positive mentor relationships at a young and impressionable age. Little League is also an outlet where interested parties can help through sponsorships, umpiring, coaching, or just attending games and showing support for the program and the kids.

I have volunteered most of my life through the volunteer fire departments in my area, and I still do. I am an active member of the South Killingly Fire Department where I serve as a mentor and instructor in Emergency Medical Services. As an experienced paramedic, the least that I can do for my community is to ensure that those who will come after me are trained appropriately and to a high standard. Though my full-time job requires me to provide the same service in the same area, I enjoy a different role with South Killingly Fire Department which allows me the freedom to help others in a different manner than usual within the same occupational field.

Volunteering with others instills teamwork, dedication, and other core values that lend especially well to the promotion of positive social change. I am glad to help.

Communicate Clearly – Streamlining the Communication Process

In my current profession, I am tasked with responding to disaster areas and treating the afflicted and displaced. I must communicate my intent and direction clearly and with a presence of authority. Understanding the various communication modes and methods that different people utilize and respond to, perhaps across cultures or socio-economic backgrounds, will allow me to streamline my communication processes to directly impact the most people in the most efficient manner possible.

Previously, I stated that I only have one long-term personal goal: leave a positive mark on the society in which I live. My attention to this goal is unwavering and will never change. Technology being what it is today, effortless communications across lines previously drawn is paramount in improving society. I value improving the lives of others: individuals and society as a whole. I feel I have already met the outcome objective of Walden University which is one of the reasons why I chose to enroll here. Apparently, others share many of the same goals.

In college, I have found a chance to interact with a variety of people from a variety of backgrounds without ever really knowing who they are. Not unlike a double-blind study, the results of the discourse are authentic to the environment. I found this to be quite interesting and attempted to hone my communication skills in such ways as to be a benefit for as many of my classmates as possible. I will never know if I have succeeded in this, but I feel the intent and the experience will stay with me far longer than the results. Being able to communicate clearly with yourself, however simple a task that may seem at first, allows one a clearer understanding of one’s needs and allows for the development of a plan for attaining those goals that meet these needs. That is being true to one’s self!

Professional Networks – The Internet, EMS, & Social Media

In the emergency medical service arena, there are a number of online networks designed to provide support for EMS personnel. Most of these networks are listservs or discussion groups aimed at bolstering education and best current practices.

I first started in EMS as a route to become a firefighter, but after working for a short time as an EMT, I decided that I enjoyed the practice of medicine much more than fire suppression. It was about this time that I formed a goal to be the best that I could be in this industry. There is an inherent problem with this: most in EMS feel that they are the best at what they do. I had to figure out a benchmark to compare myself to.

Searching the internet, I found a small group of EMTs, paramedics and physicians who promoted teaching as learning. This group also debated best practices constantly. Most importantly, all were welcome to contribute. Partaking in many discussions over the years has broadened my knowledge and has made me keenly aware of many of the problems facing EMS that I was going to have to deal with. This group has helped me to grow as an EMT, motivated me through my education as a paramedic and instilled in me some of the virtues of being an effective educator and a mentor within the EMS community. This same group has helped turn inexperienced and insecure providers into authors, consultants, researchers, managers, and educators. These truly were the best and the brightest in the field. Many of group participants were only known to me by their email address or the initials with which they signed their posts, but now, after meeting and forming in-person relationships, I count many of them among my friends and colleagues.

This only outlines one of my professional networks. I truly understand the value of professional networking, and I have promoted this within the educational environment in the past. Networking among colleagues, whether professionally or academically, encourages teamwork and collaboration. It also encourages a healthy competitive nature in the participants which translates to more overall growth. In the academic arena, students are able to rely on other students’ expertise in some areas while, at the same time, providing expertise in others.

The new online social networking venues (LinkedIn, Facebook, MySpace, et al.) appear to be replacing the listservs of old. These applications provide the user a broader, more personal sense of their social and professional network. Opening one’s self up to your colleagues in this manner can only encourage more personal growth and professionalism.