Now What Do We Do?

Did you catch the headline several months ago? You might have, but probably by now you have forgotten about it as more priorities happen in your life or since you can't do anything about it - or maybe you did not concern yourself with it.

Kathleen Casey-Kirschling became the first baby boomer to sign up for Social Security benefits. Born in Philadelphia at 12:00:01 A.M. on Jan. 1, 1946, she is generally considered the first baby boomer. A baby boomer is generally classified as any person who was born between 1946 and 1964. After World War II, the United States, as well as other ally countries experienced an unusually high spike in birth rates as many servicemen and servicewomen returned from war, got married and started families.

Now those children have grown, gone through adulthood and are approaching more advanced years. Approximately 80 million American children were born between 1946 and 1964 who could qualify for Social Security and Medicare over the next 22 years. Some 3.2 million baby boomers will be the first wave who turn age 62 this year. That equates to about 365 an hour. Five years from now, in 2011, they'll turn 65 and will be eligible for Medicare.

What does all this mean to us who work in fire-based EMS systems? Plenty!

First, as people grow older, their demands for health care increase. And as demands for health care increase, so will demands on EMS systems. Can your EMS system handle the additional strain of more EMS calls each day? It all depends on where you are located. Departments in Arizona and Florida, where many seniors retire to or spend winter, over the next two decades can expect their call demand to gradually increase each year, level off and then start declining. But will your EMS system survive during the runup before the EMS calls start to fall off?

Then there is the issue of Medicare money. The payment to hospitals from Medicare already exceeds what it takes in. In 2019, without the intervention of Congress, the Medicare fund will go broke. If you bill for EMS services, this will definitely impact you, since you probably bill Medicare for your services. Depending on where you are located geographically, probably about 30% to 45% of the patients you transport are Medicare beneficiaries. Can your EMS system still function without the reimbursement it receives from Medicare? Many private ambulance companies that do not perform 911 services will probably have to go out of business without Medicare funding, since the majority of patients they transport are Medicare beneficiaries being transported from one facility to another. Can your EMS system also take up the void created when the private ambulance company in your community goes out of business?

Some of you are probably thinking, "I will be retired within the next 10 years and will not have to worry about this." Well, think about it - if you are retired, you may need to tap into the EMS system. Will it be available to you or will your local EMS system be strained trying to handle the call load?

And probably some of you are thinking, "I don't have to worry about this. I can only do one run at a time anyway and that is for someone in administration to worry about." Again, think about it - if you are young enough, you may be the administration of the future and you will have to worry about it then as more and more citizens complain about longer delays, your firefighters complain about the run volume, and you will need extra budget money because of the additional wear and tear on your vehicles and equipment.

Society is already adjusting to this baby-boom phenomenon. Many larger cities are already dismantling school buildings that were built to accommodate all the children, while at the same time investors are building more assisted-living centers, retirement communities and nursing homes.

What can we do now? First, try to get more firefighters to obtain paramedic certification. We are already behind the curve as many communities report paramedic shortages. What will it be like in the future when there is an increased call demand and there are not enough paramedics to respond? The only alternative is to send basic life support vehicles, which may not be the level of care required for the situation.

I do not mean to sound like Chicken Little and warn that the sky is falling, but you don't need a crystal ball to see what the future holds for our EMS systems. Even if Medicare is funded fully in the future, the increased call load for EMS systems will be a challenge. As science-fiction writer William Gibson wrote, "The future is here. It's just not evenly distributed yet." Are you now thinking of what is to come?