Emergency Medical System (EMS) is responsible for providing emergency medical care in cases of severe injuries and serious illnesses. The system offers medical attention to urgent medical cases in ambulances or airplanes that are medically equipped while transporting the patient to a designated health facility. The EMS system operates in union with other units of medical services that have a common goal of maintaining and enhancing the health and safety of the community members. These medical units include public safety, public health, and health care. All EMS systems have independent entities that perform vital roles in system coordination. The entities include; public and private agency organizations, networks of transport and communication, and rehabilitation facilities, among others. The Tulsa Oklahoma system is no exception of the integrated emergency medical system. In conjunction with the Tulsa fire department, the EMS system ensures the provision of quality medical service to the residents. Despite the Tulsa EMS’ service provision efficiency, the system is bound to challenges in different aspects.
Demographics of Tulsa and Its Impact on EMS System
Tulsa, the second-largest city in Oklahoma State, has a very high population compared to other cities in the region. The city’s population is about 25% of Oklahoma’s population. According to the City of Tulsa Statistics, the city has seven counties that produce a gross of $57.7 billion worth of goods and services. $51,623 on average is an estimate of household income by residents while the population’s average age of Tulsa residents is 36.8 years. As is the case in other cities of the globe, the number of aging people has greatly increased due to the rise in life expectancy (Veser et al., 2015). The Tulsa Oklahoma EMS system, just like the health care and population health sector, is medically challenged by the increased aging population resultant of frequent occurrences of chronic ailments (Oklahoma State Department, 2018). Consequently, the EMS suffers inadequate resources and scarce personnel to attend to increased medical emergency cases. I settled on the topic, EMS System in Tulsa, Oklahoma since it highlights the functionality and reliability of the medical emergency systems as well as the performance of the fire department in Tulsa.
Description of the System
According to Adkerson 2018, Tulsa EMS system established in 1977, has 356 stations and 204 ambulances currently with 10,238 EMTs and paramedics. The Tulsa EMS hospital has both ground and air transporting ambulances that have more than one licensures including ILS (Intermediate Life Support), PLS (Paramedic Life Support), stretcher aid vans, BLS (Basic Life Support) and specialty care license. All air ambulances have a PLS license which is detached from specialty care license. The paramedics and EMTs work in shifts either of 9, 12 or 24 hours depending on rural or urban settings (EMSPRO, 2019). Their work shifts include weekends, nights and holidays. The EMS system design of Tulsa, just like other system designs, includes all components that are mandatory to the EMS systems. The components comprise of performance specifications, provider levels, and infrastructure of communication, activity scene and care, support of the first responder, transport destination, and response, including the reflective medical direction. Although an EMS system should rely on the patients’ care quality, significant supporting evidence might not be displayed in all components. Since the emergency cases are random in the field setting, pre-hospital research lacks in the EMS components. Many existing practices in the EMS are neither evidence-based nor peer-reviewed; they are entirely ethical and backdated on previous historical proceedings.
The EMS system is designed in consideration of medical and trauma patient classifications. The medical patient category entails chronic and acute illnesses, whereas trauma patient category involves patients who have sustained life-threatening injuries. The EMS system has pre-hospital interventions encompassing both trauma and medical patient categories for life-saving purposes (Acher, 2010). Pre-hospital Interventions, such as the use of blind insertion airway devices, use of manual maneuvers, and timely cardiopulmonary resuscitation for the medical patient category, have proven to improve survival. However, trauma patient category has limited coverage by the pre-hospital interventions precisely, control of hemorrhage and spinal immobilization as well as airway support. Capitalizing on these interventions, the EMS system is positioned to maximize resource utilization and more importantly deliver quality medical care (Gibson, 1976). The EMS system has Emergency Medical Technicians (EMTs) responsible for initiating Basic Life Support care (BLS) and Advanced Life Support (ALS) accordingly. EMTs are capable and able to save lives conditional to what the state terms acceptable in the EMT scope of practice and the protocols of the local system (Blackwell et al., 2011). EMTs can respond to emergencies through call systems installed at the EMS center.
Challenges Faced by the EMS System1
The EMS system faces many challenges that lead to poor pre-hospital service delivery. Transportation of patients to the medical facilities by pre-hospital caregivers is one of the obstacles EMS systems face due to lack of sufficient medical resources such as ambulances and inadequate personnel. Transportation constraint is a result of increased medical emergency cases in the recent past. For instance, in England, the emergency medical cases have increased by 16% (Ebrahimian et al., 2014). The system is also facing financial challenges resulting from the misuse of EMS that consequently increases the workload of the staff. Determination of patients’ transportation to a medical facility is yet another challenge to the EMS system service providers. The EMS staff must visit and provide pre-hospital care to the patient and decide the need for patients’ transportation to the medical facility. However, transportations can sometimes be less urgent, depending on the patient’s condition. Ebrahimian et al. (2014), indicates that many EMS missions performed in countries like Britain and the U.S are dispensable. The staff must, therefore, be in a position to identify serious medical cases that require transportation to medical facilities.
Summary Problem Statement
Given the range and diversity of factors affecting the EMS staffs’ decision on patient transportation, the development of effective, comprehensive checklists and scoring systems for fast and easy identification of medical patients’ need for transportation is recommended. Transportation constraint can be addressed through an increase of medical resources such as ambulances and recruiting more qualified EMTs.
Although Tulsa EMS system is faced by many challenges such as transportation and inadequate resources and personnel, there is capacity for recruiting more EMTs and purchasing more EMS resources like ambulances. Additionally, the system can deploy the use of comprehensive checklists and scoring systems for easy identification of medical patients’ need for transport.
Oklahoma State Department of Health (2018). State of Oklahoma 2018 Emergency Medical Services Protocols. Oklahoma State Department of Health. Retrieved from https://www.ok.gov/health2/documents/2018%20State%20Protocols%20(Field%20Edition)%204-18-2018.pdf
Acher, k. (2010). Tulsa Fire Officials: Layoffs Threaten Med System. EMSWORLD. Retrieved from https://www.emsworld.com/article/10319898/tulsa-fire-officials-layoffs-threaten-med-system
Blackwell et al. (July 2011). Emergency Medical Services Evidence-Based System Design White paper for EMSA. EMSA. Retrieved from https://naemsp.org/NAEMSP/media/NAEMSP-Documents/Annual%20Meeting/MDC%20references-multi-year/MDC-OTHER-REF-36-OUDEM-EMS-System-Design-2011pdf.pdf
Ebrahimian et al. (2014). Exploring Factors Affecting Emergency Medical Services Staffs’ Decision about Transporting Medical Patients to Medical Facilities. NCBI. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4033513/.
NHTSA. What is EMS? NHTSA. Retrieved from. https://www.ems.gov/whatisems.html.
Veser et al. (2015). The Demographic Impact on the Demand of Emergency Medical Services in the Urban and Rural regions of Bavaria, 2012-2032. NCBI. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26191488.
Adkerson, D. (2018). Oklahoma EMS Service Call Summary 2011-2015. Oklahoma State Department of Health. Retrieved from https://www.google.com/search?q=oklahoma+EMS+service+call+summary+2011-2015+%2C+adkerson+2018&ie=utf-8&oe=utf-8&client=firefox-b-ab.
EMSPRO, (2019). What is a Typical EMT or Paramedic Work Schedule. EMSPRO. Retrieved from https://emspro.org/emt-ems-hours-shift-working/.