Opinion: To Wait for an Ambulance or Self-Transport – The Deplorable Price of "Progress"

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By Ken Walter, Treadwell, N.Y.

June 1972 – Facts and From Memory:
We have just moved to a small hamlet in upstate New York and I have joined our local volunteer fire department. While the fire department was formed in the late 1800s our EMS squad is relatively new. They are operating with a used Pontiac ambulance that I think started life as a hearse. For the first time it is no longer necessary to lay a sick or injured person in the box of a pick-up truck or on the back seat of a car. The approximately 15 male and female "squad" members had, I believe, all taken basic first aid training and their goal was to provide 24/7 service with a fast five to 10 minute response time, and then rapid transport to a local hospital emergency room. For those living/working in our rural community this was a major step forward into the modern world.

September 2012:
I have recently celebrated my 40th anniversary as an active firefighter. While I never joined the emergency squad, I did become one of their regular ambulance drivers. Now 40 years later whenever our tones go off for an EMS call the big question is, will there be a response and IF there is, how long will it take? How can this be you ask; what could have caused such a service response reversal? Using the classic business "80/20" rule I will allot 80 percent of the blame on the state of New York. Over the last 20 years I have witnessed a massive proliferation of rules, regulations and ever more cumbersome training requirements fostered on the EMS squads and their emergency services volunteers. Over the last 10 years this has taken a very heavy toll on the number of folks willing or able to meet the stringent requirements to maintain their certification levels – EMT, BLS, ALS, etc. Invariably whenever a potential new recruit learns of the amount of hours required for EMT certification and the ongoing training to retain their certification, their response is, "Not a time commitment I can afford to make." Worse yet is what we hear when a current EMT considers BLS or ALS status – "Way too much training time," "Much too much personal and legal responsibility" and the realization that the training has become so technical they know it will be way over their heads.

As I respond to our EMS calls, listen to other "squad" calls or communicate with others in the volunteer EMS/fire service, I continually hear this same loss of volunteer personnel lament over and over. We currently face the very real potential that waiting for an ambulance may put the patient at a high level of risk or worse yet, the loss of their life. Bear in mind New York state rules prevent us from even rolling an ambulance until there is at least one EMT on board!

We have succeeded in educating our population that the first thing to do when there is a medical emergency is to call 911 for an ambulance. When they receive a call the clock starts running as they tone out the local EMS squad. Especially during the workweek daytime hours, it is not unusual that the department cannot muster a legal crew – one with at least one EMT on board. Depending on if anyone shows up there may or may not be a request for a mutual aid response. Whether there is or a 911 dispatcher makes the mutual aid call the same scenario then may take place all over again – the inability to respond with an EMT, crew and driver. Mind you, now this all takes time, the reality is that we are talking 10-15-plus minutes and this is just to get an ambulance rolling. More often than not the 911 dispatcher will be forced to request the services of a private ambulance service. Given these services are not "local" but more regional, we regularly hear their estimated ETAs in the 20-40-plus minute range! Add it up, a response time of 30 minutes or more!

I understand that "the powers that be" in New York were well intentioned, their goal being to provide a professional level of service to those persons in need. But hey, bloodletting was equally well intentioned at one time. Regrettably, their statewide "one size fits all" approach, applicable to all New York state EMS squads, has had the reverse effect. We now have such a critical shortage of EMS volunteers that it is no longer a question of the level of service, but rather is there anyone at all to provide an EMS call response.

Now we are starting to hear calls going to 911, not to request an ambulance, but to advise them of a medical emergency in which they are going to do the transport themselves. As the stories proliferate about EMS calls going unanswered or with ridiculously long response times people are losing confidence that their need will be responded to. Clearly they understand that they can have their patient in the care of emergency room doctors before their volunteer EMS squad or private ambulance even arrives – if at all. This is certainly NOT in the best interest of the patient – as compared to ambulance transport, but now you have the added the risk of an adrenaline charged individual behind the wheel creating a secondary hazard.

At this point I should point out that while I am a 40-year fire service veteran, having been a line officer for 30 years (from chief down), as well as serving for 15 years as a fire commissioner for our fire district (five of them as chairperson), I write this opinion piece as a concerned citizen, not as an EMS provider.

The fact of the matter is this is not a dire warning of things to come; this is the reality of conditions today! There is nothing being done that I am currently aware of that will remedy this situation. Thus, it is imperative that our representatives in Albany take action ASAP to correct it. Not being an EMS volunteer myself it would be inappropriate of me to suggest specific remedies. As a concerned citizen though I have two specific suggestions: (1) Move the rules, regulations, training requirement and EMS squad certification authority down to the local county level. Thus allowing all those involved to set standards that reflect local conditions, available personnel, funding and equipment. (2) Place the immediate needs of a patient first, meaning that the number one priority of any responding volunteer EMS crew is to stabilize the patient to the best of their ability while getting them to the nearest appropriate medical emergency facility as fast as can be safely accomplished. This means responding with whatever crew can be mustered and without the need to waste valuable time trying to locate the correct New York state mandated level technician. That’s right, just like we so successfully did back before New York state got so heavily involved in determining what was best, rather than leaving these decisions in the hands of the actual first responders.

Going back 50 years or more people felt there had to be a better way than having to take a sick person or accident victim to the hospital in the back of a pick-up truck or back seat of a car. Local activism at its most productive, and thus volunteer EMS squads were born. Here we are in 2012 and worse off than "way back when." At least back then you knew you had to transport yourself and did so. Today you face the dilemma of making a decision to self-transport or hope for an ambulance that may or may not come, and even if one is available, not knowing how long will you have to wait before it arrives.