Zulikram Hossain

John L
ENG 1020
Nov 20, 2015
Emergency Crisis

Abstract
The purpose of this research is to explore and highlight the many issues and fallbacks of the Emergency Medical Services (EMS) system in the
US. The issues explored here will be EMS levels of training, Advanced Life Support and Basic Life support, and how they affect patient survival rates, as
well as the issues concerning transport times and how that affects patient, alongside patient survival rates in EMS transport against Non-EMS transport.
The vast majority of this research comes from peer-reviewed researches alongside scholarly articles and some newspaper articles to give the backbone to
this essay. This is all in hope to highlight what the EMS system in the US is lacking and maybe some insight on what factors to focus on.

The Emergency Medical Services (EMS) system here in Detroit is flawed. This research
dedicated to particular flaws in this system allows for patient deaths which includes the limitation of
care between Advanced Life Support (ALS) and Basic Life Support (BLS) and how those limits affect
patient care. Other factors of this essay will include transport times in major cities like Detroit and the
affect transport times have on patients as well as an insight into Non-EMS transport of patients and if
EMS is really necessary. The goal here is to shed light on the faults of the current systems and some
insight on possible reforms.
Basic Life Support (BLS) and Advanced Life Support (ALS) are the two most common levels
of EMS providers used in the US. Though subgroups of each may exist in some states, in most, the
National Registry of EMTs allow for only the two major levels of providers. ALS providers, EMTParamedics (EMT-P), are trained in school for approximately a year and then over five hundred hours
of clinical hours. In comparison BLS providers, EMT-Basics (EMT-B), are only trained for six months
in school and then only 48 hours of clinical hours. The levels of training between the two allows for a
big gap in what each can and cannot do. As a result of this many private EMS companies use EMT-Bs
to transport stable hospital patients from hospitals to homes/nursing homes and they reserve

Paramedics to do the work of rescue or take 911 calls. However, this isn't the same in city EMS
systems where Basics and Medics often work in the same truck only doing rescue calls.
So when it comes down to it, question is how much of a difference can ALS personnel make
with all that extra training? What really matters, quality or quantity and is BLS still adequate to take
care of patients in critical conditions? A recent study by JAMA Internal medicine shows that indeed,
BLS is not only as adequate for patient survival but rather more patients survived through BLS
transport than they did with ALS. This research studied the 380,000 cardiac arrest patients in the US (of
which only 10% survived). Afterwards, they kept records of calls answered by either ALS or BLS
crews and studied the mortality rates of their patients. Their results read "Survival to hospital discharge
was greater among patients receiving BLS... 13.1% for BLS VS. 9.2% of ALS..." (JAMA Internal
Medicine, 196). The research also goes onto say that "BLS was associated with better neurological
functioning among hospitalized patients..." (Jama Internal Med, 196), which means that those cardiac
arrest patients were well oxygenated and taken care of to the point where they saw less neurological
harm. This goes to show that in EMS, the lower level is more than sufficient enough to take care of
critical patients. In this case, this should mean the push for more basic personnel since schooling is
much less and they're just as qualified to tend to emergency patients.
Moving on to a different subject which is Non-EMS transport. The question of is EMS truly
needed or are city governments spending money on something that is unnecessary? It's not completely
heard of a city without its own emergency services, however. For example, Allen park does not have its
own EMS system but rather they have private ambulance services take care of their rescue calls. But
what happens when there is absolutely no EMS but rather opt for non-EMS transports for
trauma/critically injured patients? There's been plenty of odd real life examples of police transporting
such as a Detroit Free Press article reporting a patient who was shot by the police and due to slow EMS
response times, the unqualified police had to get the patient to the hospital. The patient in this case did

not survive. However, a legitimate study shows something interesting. Tucked away in the archives of
surgery, is a study which focuses on comparing trauma patients mortality rate between EMS and nonEMS transports. The test was conducted using a total of 103 patients (38 non-EMS, 38 EMS matched,
27 random EMS). The results read "No significant differences were observed between the seriously
injured matched EMS and non-EMS groups regarding mortality, length of hospital stay, days in the
intensive care unit (ICU), complications, or infections." (Jama Surgery archives, 315). Not only were
those results shocking but the research also concludes "Although time intervals were similar among the
groups overall, more critically injured non-EMS patients (ISS 13) got themselves to the trauma center
in less time than their EMS counterparts... 15 minutes vs 28 minutes..." (Jama Surgery archives, 315).
This study sheds a light on care versus transport times and really makes a strong case that quick
transport times are more beneficial to trauma patients than pre-hospital care.
Transport times may prove to be the absolute vital part of EMS. Not the care, but how quickly a
crew can get the patient to the ER may be more important. Time and time again it's evident that
response and transport times can mean the life and death of a patient. John Falcone of the American
Surgeon led a study which looked at EMS transport times between 2008 through 2011 of trauma
patients. There was an average of four minutes of prehospital time increase between the years. Despite
this, the research concludes " none of these (times) reached a level of statistical significance."
(Falcone, 1280). Though the four additional minutes in that particular study may not be significant, the
average response time (transport time not included) of 20 minutes is significant. The longer the
response times, the longer the transport times, the shorter a patient's life must be. It's an easy concept to
understand but a hard concept to implement in a weak system. For example, the Detroit Free Press
reports that "A year ago, the average response time was 20 minutes" (Detroit Freep). It doesn't require a
study to confirm that within 20 minutes a critically injured patient or a trauma patient can die before
care even gets to them let alone time to transport.

The issues regarding EMS are numerous. But a couple of things can be confirmed here. More
personnel is never a bad idea, and according to studies more personnel in the form of EMT-Basics are
more than welcome. Even more importantly, response times and transport times (specifically in
Detroit) must be improved. Prehospital care is only effective once it's coupled with fast response times,
otherwise, as shown above, Non-EMS transport can rival survival rates of trained crews. Adding more
crews and improving response times however are much easier said than done, especially when dealing
with a financially broken city. The true conflict of these issues are beyond the EMS system and into
more of the lines of the city's treasury. However, times are getting slightly better. The economy is
picking up slightly and as a result the quality of care on both the ends of prehospital care and hospital
care should go up rapidly. Response times should decrease and mortality rates should increase
alongside more personnel in the field.

Work Cited
Gannett Co, Inc. "SLOW EMS LED POLICE TO TRANSPORT VICTIM" Detroit Free Press 1 Sept
2000: A1. Print.
Falcone, John "National Emergency Medical Service System Metrics: Concerning Trends in
Prehospital Times for Acutely Injured Patients" The American Surgeon 79.11 1218-1220 Web. Nov.
2013
Edward E. Cornwell III, MD; Howard Belzberg, MD; Karen Hennigan, PhD; Cheryl Maxson, PhD;
George Montoya, MA; Anna Rosenbluth, MA; George C. Velmahos, MD, PhD; Thomas C. Berne,
MD; Demetrios Demetriades, MD, PhD "Emergency Medical Services (EMS) vs Non-EMS Transport

of Critically Injured Patients" Jama Archives of Surgery 135.3 315-9 Web. Mar. 2000
Prachi Sanghavi, BS; Anupam B. Jena, MD, PhD; Joseph P. Newhouse, PhD; Alan M. Zaslavsky, PhD
"Outcomes After Out-of-Hospital Cardiac Arrest Treated by Basic vs Advanced Life Support" Jama
Internal Medicine 175.2 196 Web. Feb. 2015
"New Paramedics to Help Detroit Improve 911 Response Time." Detroit Free Press. N.p., n.d. Web. 23
Nov. 2015.
n.p Michigan.gov. State of Michigan. Web. 2015