It is unique from my perspective. I have 17 years with major metro fire/ems department. We have crested into the hundreds of thousands 911 call volumes. People have literally stopped thinking and just call 911 for every minor inconvenience.

A massive number of calls are simply untreated low-grade fevers where the patient was unaware of the fever. I am OBLIGATED and MANDATED to send them to the ED if they request transport. Furthermore, I am LEGALLY bound to offer transport to the ED. I have ZERO authority to tell them to take a fever reducer and call back if that doesn't fix their medical concern.

We are taught to use differential diagnosis in paramedicine. However, we are not allowed to diagnose per medical guidelines from the medical director. Working with this dichotomy has made the entire pre-hospital care system complete bullshit. Based on what I see in the ER, the entire system is on the precipice of complete failure. This collapse is unique and new due to the absurd volume of patients and bullshit policy that has not changed.