The Great Debate: Public Safety or Public Health

The debate of whether EMS “belongs” to public safety or public health can seemingly go on and on. Its resemblance in practices emanates within both disciplines and its objectives in responses holds ties to both institutions. So what “is” EMS…is it public safety, or is it public health?


The answer is that there is no clear answer. It’s a gray subject to discuss with evidence pointing toward both institutions. Because of this, EMS often faces an identity crisis.


In many state organizational structures, EMS falls within some form of department of health services. Looking at EMS’s inception, however, it began as a transportation department initiative. Since the advent of 9/11, EMS has melded into a form of homeland security/health services/transportation project at the national level. While its designation is a debatable topic, we can save that argument for a later date.


Looking locally, where does your service fit into the mix? more often than not, fire-based EMS services often resemble a public safety entity, while hospital-based services fit into the public health model. The growing third-service model of EMS, or the existent stand-alone private EMS service model, often faces a dilemma of its own. Much of its identity is based on its call volume. A service with more 911-based calls often relates more to the public safety model, while a primarily inter-facility transport-based service relates to public health systems.


Nevertheless, it is rather uncommon to see the opposite identity present. A fire department will not likely associate itself with the public health label, and a hospital-based service will not likely title itself as a public safety primary entity. In the end, does it really matter? Is this division within our identity not really that big of a deal…or is it causing more harm than good?


As a growing profession, we lack the traditions that both the fire service and the medical/healthcare services bring to the table. After all, EMS is barely a half-century old. Lacking such traditions, however, can be played to our advantage as we strive to identify ourselves in the future. Being a younger “generation” of public safety and public health professionals can be to our advantage…especially if we see our job as just that…a combination of the two (and not a division of just one).



PUBLIC SAFETY


Often partnered with the fire service, EMS gets much of its public safety roots and identity from the big red trucks that follow the ambulance to a variety of calls. Cross-trained firefighters and EMTs/Paramedics have taken many of the traditions of the fire service and melded them into our EMS system. The use of a rank structure with “chief” titles, the co-dependence on one another during responses, and the shared title of “fire department” or “fire/rescue” is commonly seen throughout our country. What’s unique about the fire-based EMS system is that it’s hardly that anymore! Rather, now the pendulum has swung and the overwhelming majority of fire department responses have shifted towards EMS calls. Where this system and identity is failing is in its association: these services continue to operate as fire-based EMS systems when they should clearly transition into EMS-based fire departments.


Riding the coat-tails of the fire service has been to some benefit to the EMS field, however. The introduction of various state and national grants, funding sources, and tax district opportunities has allowed for more money to circulate in the EMS industry. In addition, the combined services that such departments offer can allow for full-time staffing of a minimal amount of units on both the fire side, and the EMS side, when a separation in services may otherwise prove to be cost-prohibitive in full-time staffing.


While money does talk, this service model is not the best option for many communities. In addition, the staunch association with public safety-only functions is showing to be a hindrance to the evolving field of EMS. Identifying your service solely with public safety operations excludes it from potential relationships with local hospitals, decreases its funding options through inter-facility transports, and dissociates it from the growing trends of evolving patient care through community-focused pre-hospital care.


While responding solely, or primarily, to 911-based calls more aligns your service with a public safety system, it should not discount the relationship it needs to share with its public health counterparts.



PUBLIC HEALTH


The onset of Community Paramedicine and Mobile Healthcare Initiatives (MHI) has proven that EMS does have a role in public health. More common with hospital-based and inter-facility focused services, the public health identity and model has both a number of advantages and disadvantages behind its identity.


A lack of federal funding options can limit a service’s financial resources to increase staffing levels, update equipment, or even expand into the 911-response market. Additionally, a decreased association with the fire service can hinder its relationship with other public safety entities and create a dissociated local network with divided services that could otherwise be more efficient through increased communications and public relations.


On the flip side, however, the growing advantages and associations with public health entities has opened up the market for public-private partnerships, hospital-based 911-response and intercept services, and increased local continued education through a closer relationship with more medical staff and educators.


Embracing a public health identity has also aided EMS in the introduction of public immunization clinics during flu seasons, the newly-introduced market of community-/home-based care, and the evolution of in-hospital Paramedic staff.



EMBRACING BOTH


Embracing both public safety and public health identities is essential for today’s EMS organizations. Structuring one’s service to model both concepts promotes a more progressive future through increased market options, diversified funding solutions through additional sources, and expanded scopes of practice through a widened horizon of patient care practices.


While maintaining a 50/50 balance may not be realistic for many services, or even a true solution to the identity crisis facing EMS today, certainly striving to maintain a 60/40 relationship toward one end of the spectrum is more feasible. Along that line, maintaining a 90/10 relationship with an overwhelmingly strong lean toward one side will likely lead to a lack of progress, a decreased growth, or even a system failure in many services because of such strong resistance to change.


Today’s EMS demands professionalism, critical thinking skills, appropriate transport decisions, and access to advanced care procedures and follow-up care that weren’t of importance fifty years ago. EMS is 911-response, inter-facility transports, ALS-intercept services, public education, emergency preparedness, tiered-response systems, and critical care transport options. EMS is public safety and public health. Denying one and relating solely to the other is selfish, ignorant, and lacking progress. EMS is both…the question here is, what is your service?

Randy Bowers

CEO Bowers Emergency Services/Bowers Signature Services

4 年

It truly is time to refocus from Public Safety to Community Health. Although I work for a small service we are actively cross training EMTs,Paramedics and Community Paramedics into other roles in order to better serve our community

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Skip Kirkwood, MS, JD, NRP (Ret.)

Retired Chief Paramedic - EMS System Director - Educator - Consultant - Advocate- Navy veteran

4 年

This debate is a waste of energy.? There is no law that says it is an "either/or" choice.? Just like the Marines are "naval infantry," EMS is "public safety medicine."? Trying to force us in to one box or another is a waste of time, or reflects that the discussants are using the two terms as surrogates for something else.

Graham Judd

Paramedic, MBA, Doctoral Candidate, EMS educator

5 年

We are the Public Health wing of Public Safety.

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Robert Conrad

Currently posted in Nome Alaska, ER and its getting really cold. I see the Bering sea every day and its amazing.

6 年

From being involved in both for so many years I've come to the conclusion that one is not necessarily exclusive to the other.? What I mean is, there are education and experience opportunities to be gleaned form both disciplines.? Both disciplines have strengths and weaknesses based on the types of calls generated. An example might be, do you really want a fire service moving patients on ventilators from LTACS to hospital emergency rooms? Do you really want CCT nurses running scene calls in an EMS system? The answer is no to both questions so how do we parse this out. We can start by calling EMS what it is and utilizing it for that, emergencies. Further, we can stop expecting paramedics to pound down more information based on the remote “prospect” and getting certain calls such as vent calls. Lastly, we should support private services who employ RN's who run very specific types of transport calls and unless they have experience and training to do so, stop asking them to go to scene calls when paramedics are available. Unless we are ready to promote an RN/Paramedic or PA/Paramedic model in all EMS systems, we must accept the reality of the two separate and distinct practices. With all due respect.

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Jermaine C. Fairley

Medical Administrator | Certified Antiterrorism Specialist | International Security Graduate Student | Counterterrorism Researcher | Cultural Awareness Consultant

6 年

Great points! I have been looking into Master degree programs that focus on both Public health and Public safety. I have found a few! Master of Public Health w/ a concentration in Public Security, Master in Health Security, Master in Disaster Medicine and Management and Master in Public Health w/ a concentration in Bio-Security. In today’s society, the first responders in the field, should have knowledge in both.

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