The 10/90 Theory

I have this theory about EMS that we respond to 10% of the population for 90% of our calls. While I have no statistical data to back up the actual numbers, I do believe that we respond to a narrow margin of system abusers, frequent callers, and high-risk patients for a majority of the calls that we run.

A perfect example of this is an adult care facility, one that we respond to on a daily basis. Almost every patient living at one of these facilities is high-risk due to their medical history. We know many of these patients by name because we run on them so often, we know their medical histories, their primary care physicians, and their dog's name. This small population accounts for a high margin of calls.

System abusers and frequent callers are just as bad. I grew up in a household where I never went to the hospital. The thought of calling an ambulance for anything was just unheard of. But I can't tell you how many times I go to a frequent caller's home because they believe they are having a medication reaction (they aren't) or that their blood pressure is too high (it's not).

It is not unusual for me to run half a dozen calls in a shift and have 5 out of the 6 be patients I have seen before... frequently. 10% percent of the population 90% of the time. The other 90% of the population is too healthy to need an ambulance, will drive themselves to the ER in a crisis, or understands what the purpose of an ambulance truly is: a means of emergent transport.

My paramedic preceptor and I had talked about this during my internship and it continues to be a topic of conversation when we help Ms. Jones back into bed for the fourth time in a week.