Doing double duty

In honor of Labor Day, I wanted to highlight an article from Thursday's New York Times entitled "Firefighters Become Medics to the Poor." Imprecisely titled and haphazardly organized, the article nevertheless touches upon several of the major issues confronting EMS and the fire service today.

The article, which follows the Washington, D.C. Fire Department's Engine Company 10, boasts a title that suggests firefighters have not always been called upon to provide emergency medical care. In reality, Engine Company 10 is staffed and equipped for both fire and medical calls. The shift in the proportion between EMS and fire calls is a fascinating and complex issue unto itself, as is the reaction of the emergency services community to this phenomenon.

The issue at the center of the article is excellently presented: First responders are increasingly called upon to act as primary care physicians. Unfortunately the author doesn't pursue this question in any depth. What does it say about society when poor people choose to call 911 instead of going to see a doctor? Is it selfishness, an abuse of the emergency response system? Or is there a broader social statement when millions of people cannot afford to see a physician but desperately need medical treatment of some kind?

Prehospital emergency care rarely comes cheap to the patient (for more on reducing the costs associated with ambulance treatment, see my earlier post on the subject). Calling for an ambulance instead of making an appointment with a physician will not fend off a bill. The bottom line may even be more expensive with an ambulance ride since often this results in a trip to the emergency department and opens up an entirely new front of charges.

There are some people who take advantage of the 911 system, it is true. But these individuals are much rarer than those who simply see an ambulance as their only means to medical care. This may stem from inadequate or nonexistent health insurance or from some other obstacle. Whatever the case, the American health care infrastructure is in a state of crisis. No one should ever have to call an ambulance because they have no other access to health care. But as long as they do, EMS will be there.