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“Small Is Beautiful.”
That was the title of the influential 1973 economics and philosophy primer by E.F. Schumacher, but it also appears to be a good description of what it takes to be a successful ambulance service, at least based on the findings of a new analysis by the state’s Emergency Medical Services Regulatory Board, or EMSRB.
The EMSRB, in coordination with the state’s Medical Director Standing Advisory Committee, developed nine clinical performance measures in early 2022 as a way to assess the quality of care provided by the more than 250 ambulance services across the state. Last week, the EMSRB released a list of 95 such services that achieved an 80-percent rating or higher on at least five of the nine measures.
The list included the Tower, Cook, and Orr ambulance services, which were among just five in St. Louis County to achieve that high standard.
What was interesting was that the list was stacked with dozens and dozens of small, mostly volunteer ambulance services from tiny communities across rural Minnesota. Places like Meadowlands, Blackduck, Hayfield, and Hector, or Carlton, Kerhoven, and Caledonia.
It’s conventional wisdom to assume that bigger is always better, but time and again we see that such thinking is a bit too conventional. Small organizations can be more flexible because they typically aren’t bogged down by the sometimes sluggish bureaucracy inherent in so many larger organizations. In small towns, emergency medical responders have greater incentive to follow their training because they know that those they serve will very likely be people they know.
We’ve had much local debate in recent months about the future of ambulance services in our area. Every department is facing financial and staffing challenges and we know that a new funding model needs to be found. But lost in that debate about the numbers is the human component of EMS. The purpose of an ambulance service is to provide care when we face medical emergencies, and the quality of that care is, and should always be, the primary consideration. That’s the “number” that truly counts and on that score, these three local ambulance services are top performers.
All three of these services significantly outperformed both the statewide average and the St. Louis County average performance, in most cases by significant margins. That’s a credit to the dedicated staff at all three of these small departments and shows that, despite the challenges that all ambulance services face, these departments remain focused on the right things.
Let’s keep in mind what these measures indicate. They were developed by the medical directors who oversee ambulance services and were designed to gauge the consistency with which ambulance services meet very specific targets and goals in patient care. Things like time on scene and proper assessment for medical emergencies, such as strokes, in which time is critical. It includes proper documentation in chest pain encounters through the use of electro-cardiograms. It includes proper administration of medication to children and things like properly-documented respiratory assessments.
While there has been much discussion in recent months in our region about whether area ambulance services should be upgrading to Advanced Life Support, or ALS, levels of care, the level of care available makes little difference if the basics aren’t being covered. The EMSRB’s performance measures were applied to all ambulance services, including those that offer ALS levels of care in our region, yet many of those failed to qualify for the EMSRB recognition received by three of our local services.
We point that out not to suggest that those services aren’t capable of quality care, but to note that the care being provided by some of our own local services is really top-notch. And that’s not just fluff. It’s actually documented in these performance measures.
There have been suggestions that our area would be better off shifting to a privatized regional system for EMS. It’s that typical “bigger-is-better” mentality. Yet the numbers rarely support that idea. Bigger is more impersonal, less flexible, and more bureaucratic, and that is no advantage when it comes to EMS.
It’s a challenge maintaining small ambulance services, but it’s not an impossible one, as our area services prove every day. It turns out they’re not only getting the job done, they’re performing at the top of the industry. We think E. F. Schumacher had it right.
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