Stopping Calls Before They Happen

After years of emphasizing fire prevention, the American fire service now has to deal with a lot less fire suppression. There's a lesson in there for EMS, says retired chief Jeff Lindsey, and with prevention monies likely available if healthcare reform passes, there's never been a better time for departments to get proactive in preventing harm in their communities.

Lindsey, PhD, now an assistant professor of emergency medicine at the George Washington University in Washington, DC, and chief learning officer for the Health & Safety Institute, told attendees at EMS EXPO that community injury and illness programs could help reduce their call volumes--not a new idea, but one that's never been fully embraced in EMS.

Now's a good time for it. Healthcare reform will impact EMS in a variety of ways, and getting ahead of the curve where we can is imperative. There may be opportunities in new programs, but even without those, we can help keep calls down with targeted, community-level interventions.

A natural partner for this is public health. It's the job of public health departments to help protect citizens against hazards, prevent injuries and disease and encourage healthy choices. Conceptually, public health already overlaps EMS in areas like heart and stroke disease and motor-vehicle safety, and touts common messages in areas like fall prevention, pool and firearm safety, helmet use, fire/burn education, etc. What's more, public health departments often have money, Lindsey noted, but not always mechanisms to get into the community to identify and meet needs. You, conversely, likely have inroads into the community--you're out and about, meeting people and seeing their issues at the ground level--but no money. Yin, meet yang.

Because of this ground-level view, in fact, a lot of the best harm-reduction ideas come not from management, but from the grassroots. Perhaps a medic notices he's responded to several accidents at the same uncontrolled intersection, for instance, and suggests a traffic signal for it. Maybe an EMT observes a rise in child drownings and pushes for a pool-fence regulation. Once you start looking for them, opportunities abound in virtually every community.

There are three basic steps to harm-prevention and -reduction interventions: assessment, policy development and assurance.

Assessment: Any project must begin with assessment and identification of the threat. Problems have to be quantified with data: Can you show council members this intersection's higher rate of accidents than other intersections'? Are child drownings actually up over this time last year?

Assessment begins with a systematic collection of information, which is then assembled, analyzed and disseminated. This helps you identify needs, trends and opportunities, and think more clearly about how best to tackle them. Data can come from a wide range of sources beyond your PCRs, including trauma registries, police reports, medical examiners' records and more. Public health can assist in identifying disease trends, environmental hazards and at-risk populations. Considerations to guide your efforts should include frequency, severity and cost.

When collecting data, cast a wide net. Lindsey cited one Florida community that wanted to address child drownings, but discovered that while younger children were drowning primarily in pools, older kids were more often drowning in the ocean. That's not a problem likely to be solved with a pool-fence ordinance.

Policy development: With a threat sussed out, the next step is promoting knowledge, building constituencies and setting priorities for action. This part isn't always easy; there could be multiple layers of authority to navigate and numerous stakeholders to convince to get something like a new traffic light or pool-fence law. Other interventions (e.g., starting an educational program or public-information campaign) may be simpler. You can effect change through education, enforcement or engineering.