The title of this post was taken from the comments of my previous post and I have to comment on the idea that just because something happens first means it caused the second thing to happen. When I looked up the phrase "post hoc ergo propter hoc" it was defined as a common logical fallacy. We in EMS tend to follow this fallacy in many cases. The fact a patient signed a refusal or was referred to other care and died later doesn't mean that the referring person made a mistake. The flip side of this is also true because something didn't happen first doesn't mean that it could have prevented the second thing from happening if it had been done. I personnally think that we are not at the level in EMS today that we can reliably allow many EMS providers to routinely not transport patients that they don't feel are in need of an ambulance. I say that for many reasons and want to enumerate them in order to spark discussion.
This post at Life Under The Lights talks about an EMS crew that may have made some serious mistakes in patient care because it seems they didn't take the time to do it right.. I don't think this patient could have made an reasoned decision about the situation that quickly and neither could the paramedic. I link to the post so that others can learn for themselves and to illustrate what I am talking about. We cannot grow to the level we aspire too if situations like this can happen far more often than they should. They should never happen, but perfection is impossible with human beings involved. Too often we make the expedient decsion instead of the right decision for the patient. Whether that is because we are worried about being available for the next big call or because it is the end of a very long shift and we are ready to go home doesn't really matter, neither reason is justified. Many things on this call could have or should have been different. I was not there and am speaking only on what I have read but it makes my point that if we don't take the time to do it right we do it wrong.
I live in a small city and our firefighters do a great job with the resources available. The next town over has a smaller population and has six ambulances to the cities three. Only two are manned at any one time, and the third is available only by taking another piece of apparatus out of service. I mention this because our current economic climate is causing many towns and cities to curtail services and slash budgets. I wonder how often a person signs a refusal because someone, somewhere is more worried about getting a unit available than making the best decision for the patient. Often the person making the decision is a politician far removed from the ems call or patient.
I am currently an EMT studying to be a paramedic and one of the things that amazes me is the level of training that I am recieving. I think there should be a paramedic on every ambulance, there are far too many things that an EMT can overlook simply because he doesn't know or doesn't care because he has been volunteering for twentyfive years and doesn't care as much as he used to because he doesn' have the drive or passion he used to have and nobody else is offering to help.
So to wind up what has become a long post, there are many reasons that we transport everybody and some are financial and some are just part of the culture of how we provide EMS. Alot of why has to do with the level of training and resources available to the majority of EMS organizations. I am a volunteer and do not say this to disparage volunteers but the industry is in dire need of professionals, note I did not say paid professional but I seriously doubt that most volunteers are able to rise to the level that is needed, they may be willing but not able, but that is a topic for another day.