Back in the ’70s, when the EMS system of today was in its infancy, the needs of those it served were much different. In those days, the system was designed largely to handle traffic accidents — which, in the absence of seat belt laws, airbags, and other safety features — often resulted in much more serious injuries. But now, fire departments and ambulance companies have become a primary provider for those with non-life-threatening needs.
While non-emergency calls to 911 are increasing — the majority of those who arrive at a hospital by ambulance are low acuity (77%) — avoidable emergency departments (ED) visits are also on the rise, adding even more strain on the health care system. Often, many patients end up in the ED due to an inability to access health care services in the community. Participants in the 2022 San Diego Community Health Needs Assessment shared the underlying challenges they experienced with accessing health care services they needed. They include:
- Making an appointment with primary care or accessing their usual source of care
- Insurance restrictions and confusion — having a certain type of insurance, such as a health maintenance organization and being limited to providers that are only in network
- Need for referrals as a barrier to accessing the services or treatments they needed
- Finding the right fit with a provider, such as a primary care or mental health care professional
- Timeliness in relation to level of care, such as urgent care for after hours
Your hospitals see the effects of an overused system first-hand every day, and something has to give. As the ambulance volume increases— at the same time that more people are flooding emergency departments for things like primary care and behavioral health needs — we have to get serious about real solutions. While there will always be a need for the EMS system, it’s obvious that we must start thinking differently about how we use our emergency services, and how we encourage the proper use of emergency services.
For years now, we’ve tried various pilot programs like paramedicine or alternate destinations. But these are simply stop-gap measures that often take years to get off the ground, perhaps only to run for a short time or limited time until the funding dries up or the legislation sunsets. There is opportunity for innovation and change — something that is long term and meaningful — but if we’re not really fixing the issues that are at the heart of the problem — like reimbursing ambulances for transport to places other than a hospital — we’re just putting a BandAid on a gaping wound.
We can keep doing things the same way, “because that’s just how we do it,” or we can start to get serious about how to use our limited resources within the EMS system and save it for what it was really designed for: major injuries and life or death emergencies.