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Guest Editorial: Public Health or Public Safety? The Answer Is Finally Revealed

Over the last 40 years or so, I’ve had the opportunity to have the “public health or public safety?” conversation with some of the most remarkable people in prehospital care. Unfortunately, some of them have passed on, and I miss those spirited discussions. It is with the memory of these conversations that I revisit the public health vs. public safety question.

I realize my opinions may not be the most popular or politically correct. As I pontificate, I will likely tick off some people. Those who truly know me know I speak my mind no matter what, and I am first and foremost a paramedicine professional. 

The first EMT textbook (the “Orange Book”), published by the American Academy of Orthopaedic Surgeons in 1971, aptly stated the initial goal of our profession: Emergency Care and Transportation of the Sick and Injured. Today EMS has expanded beyond simple emergency care and transportation and become a profession of paramedicine practitioners who provide numerous levels of healthcare outside the boundaries of hospitals and physician offices.

This evolution from emergency care to paramedicine has birthed specializations in critical care, community paramedicine, and mobile integrated healthcare. Each of these is rooted in the desire to provide the best evidence-based healthcare possible to the people who need it most. 

Paramedicine is an integral part of healthcare systems because we provide healthcare to the public when they need it, where they need it. Paramedicine is the safety net of public health and for many the entry point to the healthcare system. 

Paramedicine is defined by a clinical standard of care and provided under the direction of physician medical directors. Therefore, paramedicine practitioners are by definition healthcare providers and, through our actions, public health providers. 

It is important that we understand that the platform used to deliver paramedicine is just that: a delivery platform. Delivery platforms vary across the country and include third-service municipal systems, hospital-based systems, private providers, aeromedical providers, and fire-based systems, to name just a few. 

So the true answer to the question is this: Paramedicine practitioners provide public healthcare, delivered through varying platforms, one of which happens to be public safety-based.

In tribute to my colleagues who have passed, I close with one of my favorite quotes from a man of true grit, Academy Award-winner John Wayne: “I’m responsible only for what I say, not what you understand.”

John Todaro, BA, NRP, RN, TNS, NCEE, CHSE, is assistant director of the Center for Experiential Learning & Simulation at the University of South Florida College of Nursing in Tampa. He is a member of the EMS World editorial advisory board.

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