What is an EMS system?
EMS systems have multiple components that work together to benefit patients and communities. EMS systems include:
• Emergency communications centers (dispatch)
• Fire departments/first responders
• Ambulance services (ground and air medical)
• Hospital emergency departments (adult and pediatric)
• Trauma centers
• Other specialty care centers, such as burn, cardiac, pediatric and stroke centers
• State EMS offices
All of the components within the EMS system must function cohesively to best serve the patient throughout the continuum of emergency care.
Who provides EMS?
EMS personnel include emergency medical responders (EMRs), emergency medical technicians (EMTs), advanced EMTs (AEMTs), and paramedics.
EMRs receive a minimum of about 40 to 60 hours of initial education. EMTs receive approximately 150 to 260 hours of initial education, while advanced EMTs receive 400 to 500 hours.
Paramedics are required to have significantly more education, a minimum of 1,500 hours, often through a two-year college program. Many paramedics began their careers as EMTs, and after gaining on-the-job experience completed additional education requirements to become a paramedic.
Paramedics may also earn specialty certifications such as flight paramedic, critical care paramedic or community paramedic. These paramedics may care for critically ill patients being transported in medical aircraft, or by ground ambulance between facilities, such as from an emergency department to a burn hospital, or may provide post-acute patient care
EMS Stands for Emergency Medical Services–Yet EMS Does So Much More
EMS is a community lifeline that provides pre-hospital and out-of-hospital emergent, urgent and preventive medical care that may include assessment, treatment and transport by ground ambulance or air medical services.
Research has shown that many people call 911 for a range of medical, psychological and social issues for which they need treatment and support, but not necessarily emergency care.
EMS is often called to help people with chronic illnesses, such as congestive heart failure, diabetes and asthma, who lack primary care and instead rely on the emergency medical system. Others are elderly, frail, isolated and lacking social support, and they call 911 because they don’t know where else to turn. Substance abuse and mental health crises are other common reasons for EMS dispatch.
To better serve communities and patients, EMS agencies in over 30 states offer programs known as community paramedicine or mobile integrated healthcare. Designed to assess, treat and navigate patients to the most appropriate, cost-effective, sources of care, EMS partners with other healthcare or social services organizations—such as hospitals, hospices, home health and behavioral health—to provide services such as:
• Home visits to assist patients with chronic disease management or post-hospital discharge follow-up to prevent unnecessary hospital admissions or readmissions.
• Transporting patients to “alternative destinations” such as clinics, mental health or substance abuse treatment centers best suited to meet their needs.
• Connecting patients with social services and other community-based services to ensure they have basic needs met, such as food, prescriptions filled and other support, to prevent misuse of 911.
• Providing a nurse advice line for people who call 911 for non-urgent matters, instead of dispatching an ambulance crew.
• Using telemedicine to connect patients in their home with physicians at other locations.
• Providing treatment in place, such as for COVID-19 patients, to conserve resources such as ambulances, PPE, and hospital beds and avoid unnecessary, costly hospital visits for patients who can be cared for safely at home.
Studies show these programs can be effective in improving patient well-being and curbing costs. But sustaining them is a challenge. Only a few states allow payment for services such as transport to alternative destinations. Some EMS agencies have been successful in contracting with payers, including private insurers and Medicaid managed care organizations, to provide these services. But these are individual arrangements and are not widespread.
In 2019, CMS announced the Emergency Triage, Treat and Transport (ET3) Model, a five-year pilot project that enables select ambulance services to receive payment for transport to alternative destinations and for facilitating telehealth consultations. ET3 was slated to launch in January 2021. While this is a step in the right direction, ET3 still emphasizes the transport function of EMS versus reimbursement for the treatment in place that EMS provides countless times each day across the United States.
Deploying EMS for COVID-19 Testing, Contact Tracing, Vaccinations
As the country continues to fight the virus, fully utilizing the skills and qualifications of EMS personnel is more vital that ever.
EMTs and paramedics have stepped up to serve as contact tracers and to conduct COVID-19 testing, and have helped to fill labor shortages in nursing homes, emergency departments, even as school nurses. EMS professionals are also qualified and ready to help with mass immunizations.
EMS is, and will be, a cornerstone of the response to the current public health crisis, and those in the future.
