National Preparedness Month is a time for each person to reflect on his or her level of preparedness for the next emergency. This article challenges those in the Emergency Medical Services (EMS) to do the same. Whether training for Basic Life Support (BLS) or progressing to Advanced Life Support (ALS), all EMS personnel are created equal at their respective levels. They must learn the same skill sets and protocols and pass the same certification exams as all other EMS personnel within their jurisdictions. That, however, is where the “equality” ends.
After months of hard work and training, it is time to practice those EMS skills as career emergency responders, volunteers in firehouses, members of private ambulance companies, or other positions where EMS skills are essential. Despite receiving the same training and validating competencies at the local, state, and federal levels, expected standards of care vary depending on duty station and/or agencies.
Three Key EMS Paths
Generally, there are three service paths for graduating EMS practitioners: career, volunteer, and transport. Each provides different opportunities to practice the profession. Career emergency responders have the benefit of working in the profession regularly each week. The sheer volume of calls they respond to provide them with a wealth of knowledge and innumerous opportunities for practicing their skills. However, this regularity can lead to complacency and a reduced desire to learn and train beyond required refreshers. They also may have little patience for less experienced volunteers and private EMS members.
Most volunteers may not ride as frequently as career personnel, but they tend to be impassioned and have a sense of community, especially during emergencies. They also comprise a significant portion of emergency and disaster response efforts. For example, volunteers in rural and urban areas comprise approximately 75% and 30%, respectively, of the EMS providers. The passion that volunteers have and their connections to their communities, though, can sometimes obscure their ability to accept outside help and training from career and/or more experienced staff.
EMS personnel in private ambulance companies could serve as first responders or manage nonemergency (short- and long-distance) medical transports, depending on the planning and response structure of the local jurisdiction. These members may still be new to EMS, without any experience yet in responding to emergencies, or may have a background as volunteers or career personnel on the emergency response side. As such, they may require more ongoing training to maintain the same skill level as their first responder counterparts. If providing nonemergency medical transport, these members over time may lose some of the EMS skills they learned due to a lack of practice.
Maintaining Equality in EMS
Depending on the frequency of calls and the type of service provided, EMS skills can wane over time, or never fully develop. At a minimum, all EMS personnel must ensure scene safety and body/substance isolation, obtain vitals, and provide patient care within their scope of practice. However, even these core components are at risk. A volunteer eager to get to the scene may forget to do a visual sweep of the area before entering a home. A nonemergency EMS member may think that the vitals taken two hours before they arrived are adequate. A career person in the 23rd hour of his or her shift may not notice the critical difference between this “sick person” with a stomachache and the five others they had earlier that day.
The type of EMS provider – career, volunteer, or private – is not an indication of a person’s skills or knowledge set. There are undoubtedly good and bad EMS providers within each type. However, there needs to be a shift away from the stereotypical perceptions that divide the EMS profession – not just about each other, but about themselves as well. For example, “We just transport,” is not an excuse to ignore a patient. A “nonemergency” transport does not mean a patient’s condition is “nonemerging.” Conditions can rapidly change. In addition, a driver who is trained in EMS is not just a driver. Remember that.
Regardless which type (or types) of EMS position someone holds, it is critical to maintain the level of patient care he or she was trained to perform. “Use it or lose it” has two key meanings for EMS and other emergency preparedness personnel:
- Regular practice is needed to maintain what was learned during trainings.
- Ongoing trainings and learning opportunities – beyond simply the required refreshers – are needed to maintain the most current knowledge, skills, and abilities.
Whether regularly responding to emergencies or not, EMS still means “Emergency Medical Services.” Each BLS and ALS provider has a responsibility to be prepared for the next emergency or disaster – from a single patient whose condition suddenly takes a turn for the worse to a mass casualty incident. EMS is EMS, and it is time to own it.
Lessons for All Emergency Preparedness Professions
In today’s age of preparedness, it is essential that all prehospital providers maintain a competency in providing emergency care and managing trauma. Whether a public or private, career or volunteer EMS provider, all are obligated to maintain core competencies to ensure delivery of care within their scope of practice. Resources such as the National Highway Traffic Safety Administration and the Health Resources and Services Administration’s National EMS Scope of Practice Model offer the following benefits:
- Establish national standards for the minimum psychomotor skills and knowledge for EMS personnel;
- Improve consistency among states’ scopes of practice;
- Facilitate reciprocity;
- Improve professional mobility;
- Promote consistency of EMS personnel titles; and
- Improve the name recognition and public understanding of EMS personnel.
Although this article focuses on EMS, the lessons apply to anyone who is trained and certified to respond to a critical incident. National Preparedness Month is more than citizens simply having plans and building kits. It is a time for professionals to reflect on their past training and certifications:
- Do I remember everything I previously learned? If not, refresh these skills.
- Has anything changed since I learned it? Read trade publications and communicate constructively with others to find out.
- Am I working like I trained? Lead by example to promote continuity of effort between equally trained and certified personnel.
Although many differences exist between career, volunteer, private, and other EMS organizations with regard to costs, pay scales, and services offered, the level of care available from one BLS/ALS provider to another should not vary: BLS is BLS, and ALS is ALS. Providers have the responsibility of ensuring they maintain the competency expected at their respective EMS licensure levels.