Why you should care
Because consistency is king when it comes to emergency care.
If you’re dialing 911 for a medical emergency, you’re not going to care how the ambulance gets to your door — you just want it to arrive quickly, and for rescuers to work together and diagnose correctly. It’s no surprise that some cities are faster, more efficient and overall better than others in doing this. The real shocker is less about mortality and more about data. According to University of Washington professor of emergency medicine Mickey Eisenberg:
of U.S. medical emergency systems report performance data.
So what, right? Just as long as that aforementioned ambulance shows up? Unfortunately, that abstract-sounding lack of performance data has a very tangible result: inconsistent emergency services. With dozens of systems available and insufficient data to adequately compare them, cities can’t build emergency response systems of consistent quality. And “inconsistency” is a word no one wants to hear in the same sentence as “ambulance” or “medical emergency.”
You see, depending on the municipality, firefighter-centric systems and paramedic-centric systems, as well as every hybrid in between, can offer different types of service — that makes sense, given the lack of data on the major systems. But some numbers do exist: Nonfire emergency calls to fire stations make up the vast majority of 911 calls and have quadrupled in 35 years, says the National Fire Protection Association’s Ken Willette. In Los Angeles, 91 percent of 911 calls are for medical emergencies, as of 2014. That means a lot of firefighters are getting calls about a lot of problems that are not fires. Many fire stations do have at least one person trained in basic medical science. But Willette says other fleets have firefighters who are actually trained to the highest paramedic expectations, including cardiac and trauma certifications.
The jumble of who can do what can be unhealthy for firefighter-paramedic goodwill — collegiality can be shaky in some districts, due to what is essentially politics. And North Carolina emergency medical service (EMS) chief Skip Kirkwood says that paramedics sometimes feel slighted because they’re paid less than colleagues. “Paramedics get a raw deal compared to guys who run half as many calls as they do,” he tells OZY. To be sure, this is bigger than the two groups of key first responders. EMS systems have to juggle a ton of conflicting interests and a ton of different agendas — including those of politicians, workers’ unions and even insurance companies. And Arthur Kellermann, dean of the U.S. military’s medical school, says communities can’t offer the best possible emergency services until — you guessed it — they have actionable data. For everyone to have consistent care, regardless of the city, systems will have to reflect public demand for change to be real and lasting. And there is hope, in the form of good systems that already use data. For instance, Seattle’s Medic One program treats firefighters and EMTs equally and sets clear statistical performance goals, with paramedics working only on life-and-death scenes and firefighters on smaller medical emergencies. Go, team!