EMS Insights From VFIS: The Duty to Innovate
Content sponsored by VFIS, the largest provider of insurance, education and consulting services to emergency service organizations such as fire departments, ambulance and rescue squads.
Innovation will continue to accelerate EMS into its next generation. Cadillac ambulances, Lifepak 5s and other relics are genuine artifacts of an ever-changing industry. Modern emergency vehicles and state-of-the-art equipment have grown in sophistication and safety. Enriched classrooms and virtual educational opportunities now enable EMS providers to perform more advanced techniques. With global collaboration and the exceptional collection of data, managers make calculated decisions now more than ever—making the 21st century an exciting time for those in EMS.
Today’s Quality Assurance and Performance Improvement
With innovation, the role of quality assurance and performance improvement continues to grow in importance and complexity. Evidence-based medicine and data-driven operations have become the foundation of progress in EMS. The National EMS Management Association is currently developing an EMS quality assurance credential intended to recognize the growing role of data collection and analysis in the field.1 As processes and technologies are changed or created to improve these metrics, the potential for innovation is endless.
Ronald Reagan once said, “If not us, who? If not now, when?” In doing so, he captured the spirit in which innovators must immerse themselves to excel.2 A healthcare provider becomes an educator by proxy, each with an ethical obligation to share the knowledge and skills they possess with their colleagues and the people they encounter. It is our role as EMS professionals to be patient advocates and further the profession by consistently raising the bar and continuously improving.
Building Innovation Within an Organization
Innovation doesn’t manifest on its own. Leadership within an ESO can employ the following three steps to help build innovation in their organization:
- Inquire and investigate: Ask questions without accepting the status quo.
- Continuous improvement: Strive to raise the bar on a consistent basis.
- Promote culture change: Push for improvement and innovation through diversity.
Seattle and King County (Wash.) have incorporated these key points to more than double their survival rate for bystander-witnessed cardiac arrests since the millennium. This achievement did not come easily. Their record-setting performance is attributed to an intricate dissection of hospital systems, coordination of prehospital responses and a regional emphasis on community education.3 Their leaders leverage technology to collect and analyze data to study the effectiveness of clinical and operational alterations. The collaborative efforts of the many individuals and groups involved reflect a progressive culture leading a commitment to save lives.
Technology can add a myriad of data-collection capabilities, serving as the foundation of continuous quality improvement initiatives. The daunting tasks of selecting which metrics to monitor, setting performance indicators and configuring reports require careful consideration. Many technology solutions on the market also require a detailed evaluation of both functionality and feasibility before selection.
The Kanawha County (WV) Ambulance Authority had upgraded virtually every aspect of its operation since its inception 40 years ago, except the way its vehicles were driven. A horrific ambulance crash in 2014 prompted an internal investigation aimed at identifying ways to prevent future crashes.
The service implemented drive cameras and driver monitoring systems to address this need. Once selected, the system was installed and configured, and data was analyzed with regular reports. Through data analysis and a comprehensive emergency vehicle driver training program, the return on investment became noticeable.
“As the benefits of this new technology are being realized in the workforce,” transport coordinator Larry Cole says, “our next hope is that this culture of safe driving extends to each employee’s personal off-duty driving habits, [contributing to] a safer community as a whole.”
This thorough implementation of a drive camera and driver monitoring system is an example of a successful merging of technology, data, education and culture change.
Overcoming the Risks
Innovation does not come without risks. The initiatives in Washington and West Virginia could have spurred grave mistakes and costly failures, but the presence of risk did not deter adoption of these new concepts and technologies. Careful planning, coordination and execution are instrumental in confronting and reducing preventable risks, and innovative efforts should be pursued with strategic planning, including the establishment of clear goals and processes.4
The innovative process “must be organized and managed in the right way…and under the right conditions” to reduce unnecessary risk.5 Through a calculated evaluation of risk, the potential benefits can be weighed in both the selection of and investment in innovative initiatives.
Research in EMS has hit a number of stumbling points both legally and ethically.6 In clinical studies obtaining informed consent for participation is a concern that continues to be navigated. For this reason it is necessary to consult legal counsel in reviewing proposed studies. An innovative clinical practice may deviate from the existing standard of care or local protocols, requiring the approval of the EMS medical director. A strong relationship with the medical director is key to a successful EMS innovation. In any study utilizing human subjects, an ethical review by an independent ethics committee or institutional review board is necessary. While these steps may appear to be impedances, a well-vetted idea reduces the risks of participating in the process.
Investing in the Future
EMS innovation is an investment in the future of the field. A significant amount of time, money, effort and expertise have established the systems that dependably answer the 240 million 9-1-1 calls made in the United States each year.7 Continuing to evolve to meet society’s needs now and in the future is critical. There is not much of a choice—innovation is the duty of the EMS industry.
1. National EMS Management Association. Quality Assurance and Performance Improvement Committee, 2017.
2. Reagan R. Second inaugural address, Jan. 21, 1985.
3. American Heart Association News. Cardiac arrest doesn’t have to be a death sentence. American Heart Association News, http://news.heart.org/cardiac-arrest-doesnt-have-to-be-death-sentence/.
4. Pope A. What’s the Risk of Innovation? CMS Wire, http://www.cmswire.com/social-business/whats-the-risk-of-innovation/.
5. Nagji B, Tuff G. Managing Your Innovation Portfolio. Harvard Business Review, https://hbr.org/2012/05/managing-your-innovation-portfolio.
6. Weber MJ, Gerber M. Why Research Is Important in EMS. EMS World, http://www.emsworld.com/article/12071610/ems-research.
7. National Emergency Number Association. 9-1-1 Statistics, https://www.nena.org/?page=911Statistics.
Justin M. Eberly is an education and training specialist for VFIS, responsible for the national delivery of educational and training programs, curriculum development and information analysis. He is an active EMT in Cumberland County, Pa., and currently serves in a variety of local emergency management roles, including training officer.