Editor’s note: This article was originally posted by the California Health Report. It is reposed here with permission.
By Jodi Ravel
When dialing 911 for a medical emergency, the expectation is clear: Licensed healthcare providers, typically paramedics and emergency medical technicians, will arrive within minutes at your location, any time of the day or night. They will provide emergency medical care, administer medications and, if needed, offer translation services, support family members and provide transportation to a hospital.
It’s remarkable, really.
In 2021, fire departments alone responded to 25 million medical calls, up from 5 million in 1980 — highlighting the vast scale and importance of emergency medical services (EMS). Few other services offer this level of immediate personalized response — certainly not Amazon, UPS or food delivery services.
Yet EMS respond to far more than just life-threatening emergencies. A significant portion of 911 calls request aid for other physical, mental and social needs. For instance, in California, about 10% of calls in 2021 were for traumatic injuries, while over 85% involved non-emergency issues. Paramedics and emergency medical technicians manage chronic diseases, evaluate mental health crises, assist vulnerable populations, intervene in substance use situations, and provide disaster response. They also offer medical support at large public events, such as concerts and sporting events.
Despite these responsibilities, emergency medical services are often overlooked in healthcare reform discussions. By providing care in communities, these services address longstanding barriers to healthcare access, including limited mobility or transportation, financial constraints, lack of insurance and fear of interacting with the healthcare system due to immigration status.
Moreover, EMS plays a key role in alleviating the burden on hospitals by reducing overcrowding in emergency rooms and ambulance patient off-load times. They also provide care for unhoused individuals and people requiring behavioral health interventions — services that emergency departments are often ill-equipped to handle.
Recognizing this call to action, EMS providers have started exploring new models of first response. Innovations include the training and licensure of community paramedics, who understand the social determinants of health and can screen for behavioral health issues in the field. Another is mobile response teams that include mental health, social service and peer support professionals. Some 911 call centers are triaging patients into different response channels depending on the situation.
These channels include police, fire, medical emergency, nurse-consult for healthcare, mobile crisis teams, and connections to 211 social services and 988 mental health professionals. Community paramedics are also experimenting with visiting patients at home after they’re discharged from the hospital, to monitor recovery and manage lower-acuity needs.
|More: How 211 integration can elevate your 911 operation
While emergency medical services are not intended to replace primary care, they are a high-quality, efficient and essential component of the healthcare system. A compelling opportunity exists to shift lower-acuity and preventive care services from expensive medical clinics and hospitals to community-based EMS care. If integrated strategically, this shift could optimize care, reduce inefficiencies, improve patient satisfaction and enhance health outcomes across communities.
How can we move forward? Transitioning to a healthcare system that embraces and reimburses community-based EMS care is complex, but the foundation is already in place. Emergency medical services are already a highly professional, regulated, data-driven, and nimble system across the country. To move this shift forward, six key areas warrant investigation and investment:
- Improve the sharing of privacy-protected medical records across systems for continuity of care, including ambulances, medical offices, hospitals, pharmacies and social service agencies.
- Expand public and private reimbursement to allow for a broader range of care and providers in community settings.
- Broaden the scope of practice for paramedics and emergency medical technicians, allowing them to provide more care autonomously or through adaptive methods for medical oversight.
- Redefine who is considered a “first responder” and provide corresponding education, training and licensure requirements so that more people are qualified to provide emergency care and receive appropriate reimbursement and wages.
- Enhance dispatch system coordination to integrate multiple resources and responses, such as from 911, 988 and 211.
- Expand the range of community locations to which ambulances can take patients for care, beyond hospital emergency departments.
Emergency medical services are a vital but often underappreciated pillar of the healthcare system. By recognizing the capabilities and exploring innovative models, we can build a more responsive, efficient and equitable healthcare system that improves the health and wellbeing of our communities.
ABOUT THE AUTHOR
Jodi Ravel holds a master’s degree in public health and serves as a program officer with the CARESTAR Foundation, a philanthropic organization reimagining emergency and prehospital care in California by elevating community voice and power.