Secondary Care and the point we interface with them…the Emergency Department (ED) door… is a challenge.  Having served my time in senior management in both the East Anglian and the East of England Ambulance services, I truly have my ‘ambulance delay medal’!  Many a time, I led the joust with hospital staff to free vehicles and crews from excruciating delays that stopped us getting to the next call in good order.  From my international perch, I can see that delays / waits / queues seem to be the scourge of countries with socialized healthcare systems. A scan of international websites show that the United Kingdom's (UK) problem is repeated in Canada and Australia, New Zealand, where the ‘fee’ is already, injected by commissioners at the top end, removing the incentive to move the patient on. The key, in my humble opinion, lies in the incentive part of the equation. 

In the United States, it is very evident that market forces are clearly at work.   The absence of nationalized health care allows private, hospital or hospital chains to vie for paying patients.  Draws such as TV and newspaper advertising highlighting services combined with the promotion of ‘rockstar’ like physicians to bill boards and web sites displaying current emergency department wait times abound.

Major sponsorships also place hospitals in the public eye from underwriting the local marathon to our beloved Rider Alert Motorcycle safety plan.  In fact without the input of Bon Secours Virginia (Hospitals) we would not have been able to launch our version of the International award winning CRASH Card.   

Keeping ambulance services mobile is also key to maximizing income, from ensuring rapid reception of crews and their patients to keeping well stocked ‘EMS rooms’ where crews can grab chips and a soda on their way out to the next call. The general idea being the better we are treated and the quicker we are released, the sooner we can return with the next patient.

In the Richmond area alone, three hospital groups control eleven hospitals, from a level one trauma center to the smaller community hospital; four groups if you count the Veterans Administration (VA) Hospital that caters exclusively for serving and retired servicemen.  The competition to attract ambulances laden with insurance rich, fee paying patients is intense. We always transport to the closet appropriate facility, but there is, from time to time the challenge that we are taking more patients to someone else’s ED. Our response is always to back up with data driven answers assuring equitability of service delivery.

The UK could perhaps learn a major lesson in the way Ambulance Staff and First Responders are celebrated. Every year in the US, a week is nationally designated as EMS week, usually following on from Police week. In the course of those seven days crews dine most places for free, receive gifts and goody bags from hospitals for doing a great job and most touching of all, are simply thanked for their service by everyone, and I mean everyone, from hospital worker to civilian on the street.  The latter is reward enough, but going to the gym with your new bag, sporting a hospital’s logo….or enjoying a BBQ outside the local ED door is also very welcome.  It doesn’t take much and it has a very positive effect.

In summary, the relationships between pre hospital and ED are very good.  One of the reasons we are generically titled Emergency Medical Services (EMS) here and not  just ‘ambulance’ services is that we embrace medicine on the street and the life saving continuum of care at the front of the hospital collectively and together form the strongest link in the chain of survival.