The elephant in the emergency room

It is difficult for me to expose what most of know, as reluctant as we may be to admit it, as truth. EMS is held together not by highly trained professionals willing, trained and eager to respond to medical emergencies , but rather by billing, revenue and opportunity to increase wealth. Those of us who have chosen EMS as our livelihood are reticent to speak up, knowing that by doing so we are only hurting ourselves and future Paramedics and EMT’s. Providing rides to medical appointments is perfectly legitimate, unfortunately, we are not being honest about the work we do, which makes us part of the problem. Operating under the illusion of necessity is no way to run a business, and make no mistake; EMS is more of a business than it is a public safety agency. Our very name implies something that we are mostly not; Emergency Medical Responders.

It took some time for me to realize that we had lost the war. For the longest time I truly believed that my job as a person responding to 911 emergencies was of utmost importance to the citizens and taxpayers of this great nation. It wasn’t until those very citizens and taxpayers beat me down did I become a taxi driver who charged ridiculous rates for my services.

Of course, my service could charge anything they want; the people who call 911 for stubbed toes during blizzards have zero intention of paying anyway, but I digress. Somehow, the nation’s 911 system has been turned into a socialized transportation program that entitles people savvy enough to utilize the resources at their disposal the right to beckon trained and courteous medical professionals to their homes, places of employment or anywhere they may be.

And we, the providers happily go along with the debacle. It is far easier to give in, and take the people who call us in than to argue, explain, lecture or refuse transport. It’s a game we play now, and I call it “Getting Through the Shift.”

90% of 911 calls are for non-emergencies. Of that 90%, maybe half probably would benefit from some kind of professional medical evaluation and treatment, but could find the means to get them to the treatment they desire on their own. The other half would be just as safe if they opened their medicine cabinets, used peroxide, aspirin, Tylenol and a band-aid. Of course, many believe that the government should provide these things. The local pharmacy charges for band-aids, but 911 does not-unless you are dumb enough to pay the bill.

Here are a few random examples of 911 calls we respond to every day, everywhere:

My Cramps are “extra bad.”elephant

I tasted nail polish remover and it’s eating my tongue

I broke up with my boyfriend and feel sad

I’m tired.

I took some vitamins and now I can’t stop kicking the wall.

The Oxycontin isn’t working!

My tooth hurts.

I need a breast reduction.

I think I’m hurt

I had a nightmare and I’m scared, real bad.


These examples are nothing new to those of us in the trenches, and the people we complain to. But there are vast amounts of people who have no idea just how badly they are being taken advantage of. When resources are squandered, and real emergencies happen, people die. It’s all fun and games taking people to the hospital in an advanced life support vehicle for foot pain-until the cardiac arrest happens while you are tied up with a non-emergent person.

While the nation’s EMS crews are running around town like idiots, caring for people who have no business calling 911, other people are dying, and that is a fact. It is absolutely absurd how we allow so much of the populace to squander our vital resources.

One popular answer to the problem is add MORE resources to cater to an abusive public. A common complaint heard among overworked EMT’s and Paramedics is “we need more crews.”

Truth is, we need less crews answering fewer 911 calls.

I answered 911 calls for nearly 25 years. When I left EMS, my truck responded to well over 6000 calls a year. Maybe 500 of those rescue runs made a difference in the person who calleds overall health and well-being.

The rest? We made absolutely no difference at all. And the beat goes on. Until it doesn’t, because the closest ALS unit is busy transporting a perfectly healthy but crying infant to the ER.


  • Bill Atkinson says:

    The world is not a perfect place and never will be.

    Much of healthcare – in any setting – is about taking care of the person, not just their immediate need. This said, mental health issues are everywhere across society and this is often reflected through 911 calls for issues real or imagined.

    People often reflect their environment and while it is easy to judge or complain about being called out for reasons non-emergent or even imaginary, EMS is certainly not the only healthcare sector that deals with sure matters routinely. In fact, one proactive and innovative approach to non-emergent needs has been the rapidly developing mobile integrated health (MIH) movement. MIH allows for a non-emergency response and a first-hand assesment of “patient” needs. Importantly, the MIH platform (while still being clinically and operational defined) allows for a very different “response” to the issues you have identified.

    One need only visit any physician’s office, “emergency department” or hospital – in the US or beyond – to recognize that people have very different views of what constitutes a need for help. And the reality is: Everyone doesn’t have the same upbringing, education, resources, smarts or understanding as the person to their right or left.

    I have been actively involved in EMS and most major aspects of healthcare development and delivery for over 40 years. Every single day I see elements of need (real or imagined) that go unmet. However, more often than not – I see hundreds of thousands of people who are receiving help that is meaningful and truly needed. Do I see abuse of EMS and overall health care too? Of course I – like every other “insider” – do. It sometimes makes me mad, but more often it makes me sad.

    No person is perfect. No society is complete. No job is without complications. And not healthcare provider beyond frustration and occasional anger.

    Education, experience and commitment are key elements that help define someone as a professional. However, the true definition of a professional is their ability to help bring about meaningful and needed change.

    EMS has come a long, long way over he past 50 years. But like any and every profession, it still has a very long journey ahead of itself.

    Thanks for your commitment to EMS. What you do makes an important difference – even if it doesn’t always feel that way. Your talents, experience and – importantly – understanding of the reality, are much needed and appreciated.

    – William (Bill) K. Atkinson, Ph.D, MPH, MPA, EMT-P
    Raleigh, North Carolina

  • Michael Morse says:

    Thank you Bill, great insight, hope you don’t mind if I share this.

  • Ben Chlapek says:

    Nice. Very nice, gentlemen. Always nice to see a couple of subject matter experts in our profession tell it like it is.

  • David Slifka says:

    Michael, having been in the EMS industry for 42 years, I share many of your thoughts and frustrations. Serving in all aspects of the field through executive management, I would like to think I have seen and heard all. However, nothing could be further from the truth! Like yourself, I have encountered cases very similar to what you mention. Even a case involving a response to a male subject having a heart attack, just to learn the husband and wife were having a marital argument. To make a long story short, the husband was an ER physician!

    Like most, my reasoning for getting into this field is because of my passion and commitment to helping others and hopefully making a difference. Unfortunately, along with the aforementioned challenges in your article, cause on to question the importance of our service. Sure, I have had many patients express their gratefulness for the care we provide, but there are so many who do take advantage of the system.

    Other concerns I hear in our field pertain to, feeling underappreciated and perhaps underpaid, especially in comparison to the nursing industry.

    As much as these have a tendency of eroding our spirit, we also should take a moment to reflect on perhaps other contributing factors, such as:
    * Are we as an industry, “dysfunctional?” What I mean is,
    regardless of our EMS model, i.e. volunteer, paid,
    municipal, fire-based, large, small, etc., do we play well
    with others? If not, could this be a reason as to why we
    are perceived by the community and healthcare
    industry as being unprofessional?

    * Do we take the time to educate the public as to what
    we do in our community? Many services are involved
    in community events.
    * Each day, can we truthfully profess the same level of
    passion as was the first day we entered this arena? Or
    have these and many other issues caused us to
    become more cynical?

    Yes, in a world so full of divisiveness and hatred, our jobs become more challenging, causing us to question our worthwhile. However, we must keep in mind, there is much light throughout. Remember, there are so many people out there who appreciate us not necessarily for the medications and procedures we give, but simply for the compassion, we have to offer. A simple gesture as a kind word and holding a hand goes so far in professing what we do.

    Yes, with all of the drama, politics, and other challenges that come along with our job, we cannot help but to feel beat down. However, we need to reach down deep and find the strength to continue moving forward.

    Thank you for your years of service.


    • Michael Morse says:

      Thank you Dave, I understand, really I do, some daysIm on top Of The wave, others getting pounded into the surf. I’ve written tons about my EMS career, good and bad, I think people think I’m nuts because of the contrasting thoughts. I’ve seen your name often over the years, nice to finally make an aquaintance!

      • David Slifka says:

        Michael, EMS definitely has many hills and valleys. Anyone who believes it’s a life of glamour and getting rich is unfortunately misinformed. Your contrasting thoughts accurately reflect the reality of what this profession is really like. It’s a pleasure making an acquaintance as well!

  • Mr618 says:

    And then we have this, which MAY help explain our frustration to those who frustrate us…

    Or maybe not.

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