Since modernization of the current EMS model in the early 1970s, we have made tremendous progress in refining our craft. The clinical and operational practices of our current responders have progressed dramatically since the days of MAST pants, Cadillac ambulances and Advanced Red Cross first aid certificates. However, we must begin to look at the bigger picture regarding the effect of our progress. Research has proved the current EMS model saves countless lives. Through evidence-based medicine, we adjust and tweak our systems to improve our effect on morbidity reduction in our communities.
Taking into consideration the advances of our systems and the evidence of our effect on mortality, we must determine how we can expand our services to the community and affect death and disability in a different way. Many systems across the country are addressing this with injury- and illness-prevention programs.
Some of the programs are needs-driven, based on analysis of calls/injuries in a local area, while others are simply a desire to do more for the community. Many services are enacting programs that are considered universal prevention initiatives, while others have developed long-term programs that also meet specific issues in their geographic area.
A number of services have adopted free defibrillator programs and CPR education for their citizens, free public healthcare screenings, and regular discussions with citizens regarding the day-to-day work of emergency medical services. Programs like these address broad-spectrum issues like sudden cardiac arrest, public understanding of how the EMS system functions, and overall health of the citizen base.
The Phoenix Fire Department, a fire-based EMS service with a diverse population of more than 1.5 million, has initiated an injury and illness prevention model to save lives. "We take every opportunity to promote our message of safety," says Deputy Chief Frank Salomon, and the department's mission serves that statement well.
The Phoenix EMS Prevention Program is a needs-driven model that incorporates continued re-evaluation of its own statistics to identify the public's need for education. For example, when the department noted a significant number of drowning-related fatalities of children during the summer months, it developed a program to install fences around pools, along with a program called Are you watching your kids around water?"
Use of community non-profits, expanded use of media outlets and general public education have resulted in a decrease in both drowning incidents and fatalities. This outreach also includes a fall-prevention program, car seat initiatives, home safety checklists and much more. Most important, the programs are targeted to specific age groups to allow for a more tailored message.
"It must be age appropriate," says Salomon. This rings true in any educational experience.
The Manheim Township Ambulance Association of Lancaster, PA, is a private, non-profit service covering an equally diverse 40,000 people in Lancaster County. In 2009, it developed an illness- and injury-prevention approach that is evidence-driven, aiming to serve the needs of its core population. The fall-prevention program, "Prevent Falls Before Calls," provides free "fall-risk" assessments performed by EMS providers and gauges risk of recurrent falls similar to the assessments performed at extended-care facilities. The patients deemed at risk are referred to DME companies, visiting nursing associations and other private companies. During this time, families and other guardians are consulted to allow EMS to become part of patients' long-term care planning. This program was developed due to a high geriatric population and a call volume that reflected more than 10% of the service calls to be fall trauma-related.