Why Start Now?

My question is the same.  A friend on Facebook recently noted how EMS is changing based on an article at EMS1 By David Givot.  The premise of his blogpost was that EMS is becoming more autonomous and that is a good thing because it will weed out the weaker providers, but I have to ask first off, why start now?

I don't want to be dismissive of Mr. Givot or his thoughts, but does he really think it is that easy?

First off, we aren't licensed.  Okay, in Texas there is a Licensed Paramedic level where the state charges you an extra $25 per certification cycle, but it means zero.  There are no practical differences in care delivery between a licensed paramedic, a paramedic, or a National Registry Paramedic in Texas.  All three are the same in that they function under a physician who delegates their practice - like the rest of the country as far as I know.

Second, EMS is hardly a homogenous industry.  There are many places that EMS is run by the fire department, in others county third service by a hospital district, or perhaps the county, or perhaps a for-profit entity.  Additionally, EMS includes inter-facility transport teams which are entirely for profit programs that have less interest in patient care than warm bodies to transport other bodies.

Finally, I have to ask if he is being serious.  Despite news reports a few years back about a Massachusetts company running fake recertification courses, they continue to happen.  Art Hseih had an important post on this in 2012 when he spoke about "The number of personnel involved in the fraud was significant. It spoke to the ease and comfort people had not to attend classes and yet claim they had. It was pretty easy for people in positions of authority to condone the practice and at the very least turn a blind eye."

Yet I see supervisors (and educators) continue to allow the type of behavior that should have shocked all of us, not just Lexington, Massachusetts into action.

How in the world do major companies like Rural/Metro get themselves caught up in certification scandals on issues as basic as CPR cards?  Worse, not only are these companies big and small trying to play this game, you know your company does too.  Those are issues that not only rear up their head in terms of is your card worth having, but also, will you continue to get paid by the federal government.  For some reason, the feds dont seem to enjoy paying for services, much less for services that were obtained by having crews with false credentials.

These are the issues that make people wary of public safety and make me wonder if and/or when issues of similar size will catch up with other educational and EMS service delivery entities.  These are the issues that make me wonder if EMS actually expects to catch up with the rest of medicine and I suspect the answer is no.

It would be nice for EMS responders to truly find themselves more autonomous, but despite being in our infancy as a profession, I don't see us starting off with behaviors likely to help us get there.