Two Views: The New Normal

Two Views is a column from veteran EMS technologist and critic Jonathon Feit that examines current industry issues from the perspectives of both frontline personnel and leadership/management.

The Crew View

In July David Ebarle of the Oakland (California) Fire Department posted on social media that he’d reached out to a large emergency service agency’s non-9-1-1 line but sat on hold for 20-plus minutes and “never did get to a dispatcher.” A comment on the post said the agency “needs better pay for their dispatchers to prevent them from leaving for other higher-paying departments!”

That same day Business Insider reported on criminal involuntary manslaughter charges against a Pennsylvania dispatcher who allegedly declined to send an ambulance to a patient in crisis. The article cited Paul Werfel, a highly regarded attorney and director of the paramedic program at New York’s Stony Brook University Hospital, saying the matter seemed rare but we were only hearing one side. “I wouldn’t be surprised if this goes forward, as far as it can go,” Werfel said, “but I also wouldn’t be surprised if there’s a huge amount more of the story that we’re not hearing.”¹ 

Back in May 2022, Indianapolis Fire Department Captain Jeff Quinn described a situation in which “high turnover rates from overworking, high injury rates, and [a] health crisis for those working in EMS…leads to poor morale and low performance to further the demise.” (His article has since been removed, but little on the Internet is ever really gone.²)

New care models—from community paramedicine and ET3 to specialty ambulance subscription services—have emerged as market-based pressure valves to relieve a sector in transition. One cannot help wondering whether Leon Price, the dispatcher in the Pennsylvania case, is a canary in the coal mine—a first of many, indicating troubles ahead—and whether his travails will be thought of later as the moment when change caught hold.

I recall discussions about the need for an economic upheaval from my earliest days in mobile medicine more than a dozen years ago. The irony is that this challenge is hardly limited to the ambulance services. The commenter on Ebarle’s post noted a similar feeling inside PSAPs. A Google search for nurse strike raise found news articles from 2021 and 2022 that described threatened or consummated threats to strike by nurses in California, Oregon, England, and Australia over the size of proposed wage increases or lack thereof. Fire-based EMS isn’t exempt either; I’ve partnered with fire services whose response and transport volumes rose by double digits without an increase in personnel or a meaningful rise in wages.

Mobile medical professionals aren’t alone when it comes to desiring more and faster economic advancement. And yet collectively wanting for something does not promise we’ll get it. We should reflect on Ebarle’s anecdote, Quinn’s article, and Price’s case seriously, not as aberrations but as likely parts of the new normal for a while.

Management Memo

The rock/hard place paradox is that a lack of people, vehicles, and time conflicts with legislative stalling for reasons far removed from the provision of care—yet few legislators are courageous enough to break the cycle. (Consider the now-long-defunct 2012 Measure Q in California’s Contra Costa County, which threatened to close 40% of fire-based EMS stations during a drought because some residents were upset about pension-related issues.^3,4)

The funny thing about “keeping up with the Joneses” is that their life seems amazing...until you learn they were trying to keep up with you. Memes floating about the Internet read, You may think the grass is greener on the other side. But if you take the time to water it, yours would be just as green. Mobile medical professionals may feel like the “redheaded stepchild” to nurses…but nurses feel that way relative to doctors, and doctors feel that way compared to insurance companies.

Perhaps the grass isn’t greener anywhere. Maybe it’s actually brown everywhere as our connected society navigates inevitable economic climate change. It will hurt. Some patients and providers alike will be sacrificed, but they will be catalysts for change. (The tragedy of seismic socioeconomic shifts is that change-makers often earn their legacy without being given a choice.)

One of my partner-clients confessed, “It will take a death for people realize that something has to give. I just hope it won’t be one of my patients.” Amen—but how unfortunate that we should risk any lives, health, or properties at all.

References

1. Balevic K. A 911 dispatcher was charged with manslaughter after refusing to send an ambulance for a woman who later died. Experts say there’s ‘never a time not to send an ambulance.’ Business Insider. Published July 17, 2022. www.businessinsider.in/international/news/a-911-dispatcher-was-charged-with-manslaughter-after-refusing-to-send-an-ambulance-for-a-woman-who-later-died-experts-say-theres-never-a-time-not-to-send-an-ambulance-/articleshow/92927376.cms

2. Quinn J. Faces of Death: Private Ambulances. Journal of Emergency Medical Services. Published May 22, 2022. Wayback Machine, https://web.archive.org/web/20220527215849/https://www.jems.com/commentary/faces-of-death-private-ambulances/

3. Feit J. Measure Q’s Fail in Contra Costa. Medium. Published December 12, 2013. Accessed July 19, 2022. https://medium.com/beyond-lucid-technologies/measure-qs-fail-in-contra-costa-71466841b71e

4. Ballotpedia. Contra Costa Fire Protection District parcel tax, Measure Q (November 2012). https://ballotpedia.org/Contra_Costa_Fire_Protection_District_parcel_tax,_Measure_Q_(November_2012)

EMS World columnist Jonathon S. Feit, MBA, MA, is cofounder and CEO at Beyond Lucid Technologies and a frequent contributor to multiple EMS platforms. Visit www.beyondlucid.com.