NEMSMA, Leaders Tackle EMS Problems

Leadership panel at EMS World Expo gathered top minds

Rarely has it been so challenging to lead an EMS system. The chiefs, managers and others who head them face a daunting landscape of dangers to their people, pressures to their finances and uncertainties about their role in healthcare moving forward. To help them suss it all out, the National EMS Management Association (NEMSMA) hosted its annual Administrators, Managers and Chiefs Forum Wednesday at EMS World Expo.

Hosted by NEMSMA President-Elect Troy Hagen, director of Idaho’s Ada County Paramedics, the forum brought together five top EMS leaders to dissect the issues of the day and field questions from attendees: NEMSMA President Skip Kirkwood, chief of Wake County (NC) EMS; Chuck Kearns, director of strategic development at Illinois’ Superior Ambulance Service; Keith Wesley, MD, medical director for Minnesota’s HealthEast Medical Transportation; Gary Ludwig, deputy chief of the Memphis Fire Department and chair of the International Association of Fire Chiefs’ EMS Section; and Matt Zavadsky, director of public affairs for Ft. Worth’s MedStar. Around 40 EMS leaders sat in.

Much of the discussion focused on the advent of community paramedicine and the expanded roles EMS can play as U.S. healthcare is reformed. There are undoubtedly enormous opportunities to seize for systems that are able, but as Zavadsky noted, the window is limited: Lawmakers and local leaders, crunched with unfunded liabilities and the need to maximize resources, are as open as they’ve ever been to new approaches that can save money and add value, but that won’t last forever. Whatever your role is to be in the new order, now’s the time to define it. “You can help them make logical decisions today that you couldn’t five years ago,” Zavadsky said. Kearns urged forcing the issue, adding, “We need to be the change agents.”

Among those new roles, there are places for EMS in emerging accountable care organizations (ACOs), coordinated groups of healthcare entities that join to deliver care (hopefully of higher quality and at lower cost) to groups of Medicare beneficiaries. Ludwig noted there are already 138 ACOs registered in the U.S., and some are already making good use of EMS: In the St. Louis area, for instance, one service is working with a heavily penalized hospital to prevent costly readmissions. Similarly, MedStar is participating in one through a deal to supervise discharged patients in their home settings.

Opposition to such roles for EMS has come from nursing and home healthcare quarters. In Minnesota, the first state to license community paramedics, advocates blunted that by convincing doubters the medics would serve as an adjunct, not a replacement. Now, having seen the program in action, home health nurses have come to support it. “Don’t worry about the opposition,” Wesley advised. “Just ask them, ‘What’s your alternative?’” He added that unit-hour costs for the community medics has been about two-thirds that of nurses.

Kirkwood took a different approach when Wake County created its advanced-practice paramedics. Because this is an innovation, he suggested, don’t bind it by rules from the outset. Instead, tailor it to your community’s needs. Wake focused on things that ate up its unit-hours (psych clearances, for instance), and worked to avoid spurring opposition and fears for turf. Understand your system and work on building relationships.

The other major issue that arose was workforce safety. Provider assaults are common, Kirkwood noted, and have been ignored too long. As part of the solution, NEMSA is launching a violence initiative. Ludwig observed that the fire service has drawn lessons from the aviation world, which has worked to determine what causes planes to crash, then systematically fixed its problems and reduced its crash rate. Zavadsky noted EMS has done poorly at teaching its personnel how to be healthy, and promoted the NAEMT’s forthcoming fitness initiative.

Initiative, for what it’s worth, was cited by Kirkwood as the most pressing issue facing EMS today. The roles we play in healthcare and how they’re funded may change, but reactive as EMS folks can be, we do too much sitting back and waiting, rather than stepping forward and engaging to help drive those changes.

This, most leaders will agree, is an excellent time to change that too.

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