The Greenbay Press Gazette is reporting that due to legislation signed into law last month, ambulances in Wisconsin will no longer be required to have two Emergency Medical Technicians (EMT) in order to operate. Current Wisconsin law requires an ambulance crew to be comprised of at least two EMTs. Under the new law an ambulance crew must have at least one EMT and one Emergency Medical Responder (EMR) in order to be in service.
Petitioners for the change include the Oconto County EMS Council and the Wisconsin Towns Association. Seeing an EMT staffing shortage, the two groups convened a Task Force to investigate alternatives. This was the alternative they chose to put forth and promote. The new law automatically applies to services where the largest single village, town, or city has a population of under 10,000. Services can apply for a waiver if the largest community being served has a population between 10,000 and 20,000.
The part, to me at least, that is so bothersome about this is that it seems the only acceptable method the Taskforce could come up with to solve the problem was to lower the standard. Staffing shortages occur for a variety of reasons. It could be an indicator of a population without easy access to training, a symptom of apathy towards this type of work, or the organizations do not provide enough value to entice people to perform it. Knowing EMS as intimately as I know it, my guess would be on that last one.
Instead of looking to improve the working conditions, the pay, and the benefits to entice people to become EMTs and perform this kind of work the organizations have sought to lower the standards which, in turn, lowers their costs and increases their profit. Despite what you may have heard otherwise, capitalism in healthcare is alive and well.
I think it is important to clarify that my own state, New York, does NOT require two EMTs on an ambulance. Although this not a requirement, in the garages I have overseen I have exceeded the State requirements in staffing and ensured that there were two EMTs. I did this for three very specific reasons:
- The classroom time and training will only get you so far, for a lot of EMTs the best way to learn is to actually do. For that reason we would pair people together based on “experience” level with the more seasoned EMTs taking the newer ones and actually showing them how to perform their job
- Both personnel being EMTs assigned to an ambulance provided me with maximum scheduling flexibility for unforeseen circumstances, such as sick personnel or an ambulance breaking down. I didn’t have to worry about whether or not they needed to be EMTs. Ironically, not all EMTs were cleared to drive the ambulance (partially because historically EMTs are notoriously horrible drivers) so I did have scheduling issues when I had a non-driving EMT and really needed one that could drive
- While most of the calls one EMT could handle if need be, there were those occasions when there would be more than one patient or a situation where two skilled providers were needed to ensure a positive outcome. Although those times were rare, they also seemed to be the most high profile. Even if it went bad, qualifications were never questioned
Right now it seems that the agencies involved biggest problem is just getting staff onto the ambulance to begin with. To that end, I both understand and appreciate their plight, but I just wish they would have found another way. At the very least, if it’s good for the rural areas then it should be good for the urban areas too, and it should have gone state-wide instead of to a small segment of the services. The fact these agencies are providing coverage to the smallest segment of the population effectively relegates the rural citizens to seemingly be not as deserving of the same level of care as the urban citizen. This is not a new dilemma, but rather one that we see over and over again when dealing with response times.