A New Agenda for EMS
“Emergency medical services (EMS) of the future will be community-based health management that is fully integrated with the overall health care system. It will have the ability to identify and modify illness and injury risks, provide acute illness and injury care and follow-up, and contribute to treatment of chronic conditions and community health monitoring. This new entity will be developed from redistribution of existing health care resources and will be integrated with other health care providers and public health and public safety agencies.” —National Highway Transport Safety Administration
Sounds like a good summary of where EMS is headed, doesn’t it? Fully integrated, community-based health management stresses the community paramedicine and mobile integrated healthcare initiatives that are rapidly becoming as much a part of our industry as lights and sirens.
That paragraph by the NHTSA was published 20 years ago as a preamble to the 1996 EMS Agenda for the Future. As NHTSA seeks input for an updated agenda, the question is, has EMS kept pace with its prior plan, or are we a decade behind where we’re supposed to be?
That topic was the thrust of a May 16 webinar hosted by NHTSA’s Office of EMS. The hour-long presentation by Noah Smith and Gam Wijetunge of the NHTSA, Dan Manz (Essex, VT Rescue), Dr. Beth Edgerton (Health Resources & Services Administration) and Dr. Theodore Delbridge (East Carolina University) concluded that, while progress has been made in education and evidence-based care, lots of work is still needed to meet other 1996 goals. Here are the highlights:
Integration of services: EMS is progressing from a conduit of care to a provider of care on par with other medical professions. To transition from a stand-alone service to a teammate on the patient-care playing field means we must continue to shed parochial views of best practices and adopt national standards.
Finance: In 1996, the assumption was that agencies’ compensation would eventually be tied mostly to emergency preparedness. That hasn’t happened, fortunately, but getting paid merely for driving patients to hospitals doesn’t fully address the scope of our services, either. To seek additional financing, we should promote the value we add to other key aspects of public health, such as care of the critically or chronically ill.
Research: Although EMS-oriented research is still in its infancy, evidence-based medicine is playing a greater role in our education and protocols. Pediatrics needs special attention so prehospital providers become more proactive and less tentative about treating kids.
Information systems: NEMSIS is bringing structure to “tons of data” we’re collecting, but we’re not sharing enough of it with other healthcare entities, or even among ourselves. The podcast didn’t specifically discuss outcome-based measures, but it implied we should partner with hospitals to better manage mutually useful information.
Performance evaluation: We need to establish national benchmarks based on today’s enhanced knowledge of prehospital priorities, and rely less on antiquated intra-agency measures. Part of achieving parity with other healthcare organizations is to embrace accountability through meaningful and realistic QA/QI.
The good news is that acknowledging an enterprise’s deficiencies is the first step in mitigating its shortcomings. The consensus of the panel was that industry leaders shouldn’t be discouraged by failings of the past 20 years, and should apply momentum from EMS’s 1996 to-do list toward ongoing, evolutionary objectives.
As former NHTSA head Dr. Ricardo Martinez said, “It is important not to be held hostage to the past, but to look freely to the future.”
A recording of the May 16 webinar will be available here.
Mike Rubin is a paramedic in Nashville, Tennessee and a member of EMS World’s editorial advisory board. Contact him at firstname.lastname@example.org.