Article Review - You might need an ambulance…
In "You might need an ambulance, but your state might not see it as ‘essential’," Nada Hassanein delves into a critical issue facing emergency medical services (EMS) in the United States, which is primarily the lack of essential designation and adequate funding in many states. The article sheds light on the challenges faced by EMS agencies and the implications for patients, especially in rural areas.
Hassanein begins by highlighting the common expectation that when someone dials 911, an ambulance should arrive promptly. However, she unveils the stark reality that most states do not categorize EMS as an "essential service," leaving them without the guaranteed state support necessary for their operations.
The article underscores the significance of recognizing ambulance services as essential, especially in the context of the ongoing COVID-19 pandemic, a decline in volunteerism, and the shortage of healthcare facilities in rural areas. EMS professionals have advocated for this designation and sustainable funding for years, emphasizing the urgency of the matter.
Hassanein provides a comprehensive overview of states that have taken steps to designate EMS as essential, including Pennsylvania, Hawaii, Indiana, Iowa, and others. She also mentions states with pending legislation, such as Massachusetts and New York. These efforts, although varied in their approaches, represent a positive trend towards recognizing the critical role of EMS.
One of the article's strengths is its exploration of the financial challenges facing EMS services. Unlike police and fire departments, EMS lacks dedicated federal oversight or funding. The article rightly points out that EMS agencies often rely on Medicaid, Medicare, and local government funds, which are insufficient to cover their expenses, especially in rural areas.
Furthermore, the piece highlights the declining pool of volunteer EMS workers due to an aging volunteer force and limited interest from younger generations. It emphasizes the financial burden on EMS agencies, which must cover expenses like ambulance costs, medical equipment, staff wages, and long-distance travel to reach rural medical centers.
The article features quotes from paramedics and experts, providing valuable insights into the complex issues surrounding EMS funding and essential designation. For instance, Mark McCulloch, deputy chief of emergency medical services, offers a historical perspective on EMS advocacy efforts.
Dia Gainor, executive director for the National Association of State EMS Officials, emphasizes that the federal government has not taken the initiative to oversee EMS comprehensively, making it a state prerogative. This insight helps readers understand the fragmented funding landscape in EMS.
The article raises a crucial point about the lack of essential EMS services in rural America, resulting in longer distances to access life-saving care. It references a study by the Maine Rural Health Research Center and the Rural Health Research & Policy Centers, which identifies areas with limited access to ambulance services, especially in the South and the West.
Finally, the article concludes with the story of South Dakota, a state where EMS is not designated as essential. State Rep. Eric Emery, who serves as a paramedic and EMS director, highlights the challenges faced in ensuring timely responses to critical calls in remote areas. His efforts to push for essential designation in his state provide a hopeful note amidst the challenges discussed throughout the article.
In addition to this review, IPS consultant, and Chief of EMS for Medical Rescue Team South Authority (MRTSA), Joshua Worth added that, "‘essential service’ is only the tip of the iceberg when it comes to the issues facing EMS. As this designation alone does not force or change any of the funding and revenue streams for EMS agencies. PA Title 35 designated EMS as an essential service, but few agencies saw any change on the local level to provide sustainable funding through Taxes, Fees, and Assessments. EMS Leaders need to make concerted efforts to increase their open and transparent communication with their local legislative bodies and without using fear tactics. Focusing on hard tangible data like patient outcomes, readiness costs, and current reimbursement data can provide a picture that makes sense to municipal managers and councils.”
“With no single federal agency or lobbying body at the helm, EMS is a massive ship with a small rudder. Until EMS has a unified voice and vision we will continue to see slow progress towards the issues with culture, recruitment and retention, and professional recognition. Paramedics are not in control of our future. Physicians, bureaucrats, and politicians are. Until we can take back our profession, we will continue to see struggles. The advancements made in countries like the UK, Canada, and Australia reinforces the need for paramedics to be in charge of Paramedicine.”
Worth, on the topic of funding, added, while “funding is an issue, it is not the only one and money is not the golden ticket to success as an EMS agency. I have seen many well funded agencies struggle with recruitment and retention. Continuing to chase the dollar won't fix the EMS profession, it won't force us to be recognized as professionals or medical providers. We need standardized entry requirements, a strong educational system, unified professional representation, and yes sustainable funding. But without all of these pieces the system will still face significant challenges.
Although "You might need an ambulance, but your state might not see it as ‘essential’" by Nada Hassanein is a well-researched and informative article that addresses a critical issue in healthcare infrastructure, it does miss a few points. However, these issues vary state to state as EMS is not overseen by a single government entity–and works on a state level where each state has a different approach. Within this review, it conveys the challenges facing EMS agencies, the financial burdens they encounter, and the implications for patients, particularly in rural regions. These inclusions of expert perspectives and real-world examples can only enhance the article's approach and provide readers with a comprehensive understanding of the topic.
