Today the Des Moines Register released its special investigative report on the Iowa EMS System. I am very disappointed in the report to say the least. I am not going to sit here and say there are no issues with Iowa's EMS system, because there are but the report does very little if anything at all to point out the positives. The report really focuses on nothing but negatives and it is disheartening to read to be quite honest. If you know nothing about the EMS system or have never interacted with any of Iowa's EMS personnel you would think we are nothing but criminals trying to take advantage of our patients.
Are there problems with Iowa's EMS system? Absolutely, there are issues that need to be addressed. The Bureau of EMS is short staffed and underfunded. Like a majority of us in the Fire and EMS world, the Bureau is being forced to do more with less. The Bureau does not have the staffing to adequately provide oversight to the entire state and until the Legislature realizes this we are going to continue to have issues with the system. I agree that there needs to be more uniform and mandatory guidelines for EMS in this state. The state is working to bring more uniformity though. Up unit the last few years the number of different certifications available in the state of Iowa varied from the rest of the country. An Iowa EMT-Basic had a different scope of practice than an EMT-Basic in another state. The State of Iowa decided to adopt the national standard for certification levels and scope of practice in Iowa. We are in the process of transitioning from 8 or 12 different certification levels to 4. The scope of practice for those 4 levels will be the same in Iowa as they are throughout the country. This is a positive step forward for the state. It should make the certification and recertification process easier for both providers and the Bureau.
The biggest frustration I had with the report is the fact that the report basically seems to portray all EMS personnel as bad people. Should there be mandatory background checks for all individuals who apply for EMS credentials, I believe so. We are in the business of trust so I think it is important that we are properly vetting those that seeking credentials. Right now the process runs on the honor system requiring those seeking application to be honest and forthcoming if they have a criminal history. A majority of the folks applying for credentials are honest and self report to the Bureau but there are always the outliers that will always try and circumvent the system. Its frustrating but these folks are not limited to the EMS world. Unfortunately this report focuses on only these individuals. The reporter focuses only on a small percentage of the 12,000 + EMS providers in this state. The majority of providers are upstanding citizens and doing the job to help their fellow citizens. It is only a small percentage of us that are in this job for the wrong reasons. We do not all seek to take advantage of our patients or steal from our services. The reporter seems to use a broad brush to paint the entire EMS field in a negative light. Its disheartening and quite honestly its just not accurate.
In a perfect world we would be able to make all fire and EMS personnel paid staff but given the fact that the majority of this state is rural it has to rely on volunteers. The make up of this state requires us to rely on volunteers. The vast majority of EMS providers in this state are volunteers and doing this job because they want to help. Unfortunately it is becoming more and more difficult to maintain a steady staff of volunteers. Today's society is changing, people are busier and priorities have changed. A lot of people become volunteer firefighters and EMTs because they want to help or think it will be fun but then they realize the time commitment this job requires. Calls come in at the least opportune times and the amount of training that needs to be done to maintain skills and certifications quickly chases a lot of those folks away. There were a couple of mentions in the report that some volunteers want the number of continuing education hours lessened or dropped for volunteers. I understand where they are coming from but I cannot support that stance. I think we should do everything we can to promote volunteerism and try and keep as many of our volunteer EMTs and firefighters as we can but reducing the continuing education requirements is not the answer. There are so many things that change from year to year in EMS that it is imperative that EMTs stay on top of things and keep their skills up. The public deserves the best trained EMS personnel possible. If folks want to continue in this profession they must realize that the learning will be an on going process.
While I appreciate the fact that the Register wants to bring to light the problems and issues with the EMS system in Iowa I wish they would not have used the broad brush to paint this picture. The majority of EMS services and EMS providers in this state are doing a great job. It would have been nice to see some time given to the folks that are on top of their games and doing things right. I understand this approach doesn't give you the shock factor and doesn't sell papers. Unfortunately the media these days seem more interested in selling papers and attracting eyes to screens than they do portraying the whole picture. While a lot of this information needed to be brought to light, its not the whole story. Are there problems? Yes. Are there bad people out there providing EMS care? Yes, but they are the minority. I just hope that the general public doesn't decide to lump those of that are doing things right in with the bad folks.
