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Life in the ED, just like life on an ambulance, isn’t all blood and guts and lifesaving (actually, probably less so–EMS arrivals make up 15% of ED visits [table 4] but result in over 40% of admissions [table 23]).  While I certainly didn’t go into EMS thinking it was all adrenaline, all the time (unlike some commercials would have you believe), I also didn’t expect the number of non-urgent calls to 911.  Worse yet, I wasn’t really prepared to handle them.

It’s our own fault in both cases, really.  Both the EMS system and the ED have been victims of their own success, handling “anyone, anything, anytime” so well that people expect them to function for just about any problem, but in most cases, EMS education hasn’t kept up with the demands as well as it could have. 

Before the first day of residency, a future ED doc has spent weeks looking at kids’ eardrums, diagnosing chlamydia, managing high blood pressure, and any number of other non-urgent medical tasks of the sort that show up in the ED.  By comparison, I remember very little from paramedic school about (and my memory is confirmed by the number of pages in the text dedicated to) dealing with families after a death pronouncement, how to tell people to care for wounds that don’t require transport to the ED, how to connect people who need a social worker (not an ambulance) to a social worker, and any number of other small things that I learned how to muddle through by trial-and-error.  I definitely didn’t learn a single thing about non-emergency transports, isolettes, balloon pumps, or ventilators.

As much as incorporating how to handle a non-emergent ambulance call would help new medics as they practice, the bigger effect might be on changing the expectations of those going into EMS.  One of many factors in EMS personnel turnover seems to be the Bill Brysonesque “it wasn’t what I expected,” and letting people know up front what EMS is really like might direct more of the right people into the job.