The Answer

The public expects EMS to respond to their emergencies in a timely manner, be well trained, well equipped and competent.

EMS is also expected to provide transport to emergency rooms for persons who choose to call 911 for routine medical emergencies.

EMS has the capability to provide inter-facility transportation, and does so in a timely and professional manner.

Community Paramedicine, or mobile integrated healthcare is gaining momentum, and many EMS providers are scrambling to gain a foothold in the field.


Expecting an EMS provider to perform at an acceptable level in the four main categories is unrealistic. I propose an new model of EMS, with four  separate divisions under one federal umbrella. To do so, we need to start.

Here’s my suggestions:

emsEMS becomes a Federal Agency with four separate divisions

  1. 911 Teams
  2. MTT Teams
  3. IFTT Teams
  4. Community Paramedics


EMS personnel responding to 911 emergencies (911 Teams) will have at their disposal federal guidelines to follow*. If the person who called 911 is in danger of loss of life, disfigurement or disability within one hour of EMS arrival they shall be treated and transported. 911 Response Teams will be provided by local fire departments, not because they are better than privately run companies, it is simply logistically and accountability more efficient. There will be no fees for these services, funding will come from local property taxes.

If the person who called 911’s medical problem is not emergent, Paramedics on scene will activate a Medical Transport Team (MTT Teams). The MTT can be provided by private ambulance companies or government services. The patient will billed for services. The Affordable Care Act makes sure all Americans have coverage.

Persons needing inter-facility transport will be handled by the EMS’s Transport Division, (IFTT) which will be staffed by EMT-level providers. If an emergency occurs during transport a 911 team will be dispatched. The patient will billed for services. The Affordable Care Act makes sure all Americans have coverage.

Persons needing medical assistance in an emergent, but not life threatening, disabling or disfiguring manner will have access to Community Paramedics.

*Federal guidelines will be clear, less than 1000 words and printed in all known languages. The basis for the guidelines will revolve around “The Golden Hour” – if a person is in danger of losing their life, permanent disfigurement or disability within one hour of 911 team arrival, those teams shall treat and transport without delay using existing protocols.


That’s it, that’s my idea. It took me twenty-five years to develop, had to get burned out, disillusioned, disgusted and hopeless to put it together. If the best and brightest among us cannot come up with a 1000 word detailed description of what constitutes a life threatening, disfiguring or disabling emergency, clearly stated that all persons who call 911 can understand then forget the whole thing and carry on with business as usual, because we all know how great that is working.


If you think I’m on to something, please share. If you think I’m an egotistical ass hat but think it might work given enough political juice by way of a hundred thousand or so signatures, please share.

If you think this idea is ridiculous, thanks for reading.



  • Frederick Mikkelsen says:

    The way things are now “Rescue Squads” do all of the above, even when the call is frivolous. Separation of services would make vital calls more able to save lives. That is how it looks to me.

  • Josie Benson says:

    It’s an interesting thought. I could see people getting upset when the 911 team says they aren’t going to take a patient though. For instance, are medics going to walk out on a person in 8/10 pain who has no life-threatening emergency? They would give painkillers, yes? And why wait for another team to show up instead of transporting directly?

    Would IFTT be equipped to handle emergent calls? If one sector is extraordinarily burdened, can another fill in?

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