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Slicing the PIE: Applying Triage Methodology for Innovation

PIE overall recommendations

Over the coming year EMS World, in conjunction with the National Association of EMTs, will provide detailed implementation strategies for key recommendations of the Promoting Innovation in EMS (PIE) project. The PIE project utilized broad stakeholder involvement over four years to identify and develop guidance to overcome common barriers to innovation at the local and state levels and foster development of new, innovative models of healthcare delivery within EMS. Each month we will focus on one recommendation and highlight the document’s actionable strategies to continue the EMS transformation. Find Part 1 at and Part 2 at

More than 55 participants in the Promoting Innovation in EMS (PIE) project agreed on over 250 actionable recommendations for removing barriers to EMS innovation. They categorized these into seven main themes:

  • Legal and regulatory;
  • Financial sustainability;
  • Education;
  • Regional coordination;
  • Interdisciplinary collaboration;
  • Medical direction and oversight;
  • Data and telecommunications.

With such a rich body of work, determining which of the recommendations should or could be acted upon was a monumental undertaking. Dr. Kevin Munjal, one of the PIE Project leaders, granted the National Association of Emergency Medical Technicians’ EMS 3.0 Committee permission to begin the work of transitioning the recommendations into actionable steps EMS practitioners, agencies, regulators, and other stakeholders can take to achieve the goals of the project (Munjal serves as a technical advisor to the EMS 3.0 Committee). 

But with over 250 recommendations, which ones should the committee work on first?

Committee members decided that approaching this task was perhaps similar to applying a triage methodology for a multiple-casualty incident: evaluating each recommendation and determining a priority to “treat.” Several committee members—some appointed by NAEMT and others serving as representatives of other national organizations, each with a strong passion and/or expertise in their subject areas—volunteered to undertake this triage effort:

  • Financial stability—Dr. Jose Cabanas, Jonathan Washko, Matt Zavadsky;
  • Telecommunications—Kevin McGinnis, Jonathan Washko;
  • Education—Reg Allen, Bryan Nelson, Jason Scheiderer, Chris Shimer;
  • Legal and regulatory—Jason Scheiderer, Gary Wingrove;
  • Interdisciplinary collaboration—Jerry Overton, Matt Zavadsky;
  • Medical direction and oversight—Dr. Jose Cabanas, Dr. Greg Mears, Jerry Overton;
  • Regional coordination—Dr. Greg Mears, Bryan Nelson, Jerry Overton. 

The committee outlined criteria for applying the triage/scoring methodology to help identify the recommendations that could be addressed first:

  • Feasibility score—The likelihood of the recommendation being implemented, maintained, and sustained. 
  • Value score—The value to the profession. Does the recommendation position EMS to demonstrate enhanced value to our stakeholders?
  • Alignment score—The extent to which the recommendation aligns with the EMS 3.0 mission.

To assist with the scoring process, we converted each of the 250 recommendations into a scoring worksheet tool committee members used to rate each of the recommendations in the categories they volunteered to review.

Once the committee members completed their scoring in late December, individual scores were aggregated for each recommendation to develop final overall rankings. The full EMS 3.0 Committee reviewed these in late January.

Next on the agenda for the project implementation team will be for the committee to develop strategies to assist the EMS stakeholders (associations, groups, and agencies) best suited to act upon the recommendations and help bring them to fruition. This series of articles in EMS World is an example of methods for dissemination of the strategies that can be employed to help with actual implementation of the top recommendations based on their feasibility, value, and alignment with the future vision of the EMS 3.0 transformation.

The EMS 3.0 Committee

The goal of the NAEMT EMS 3.0 Committee is to develop and implement actions to help prepare EMS practitioners and agencies to succeed in the emerging accountability-driven healthcare system, including:

  • Creating tools and resources to educate EMS and other healthcare stakeholder groups on the components of EMS 3.0 and valuable role of EMS in achieving our nation’s healthcare goals;
  • Identifying and publishing best practices as well as challenges faced in implementing the EMS transformation;
  • Actively participating in efforts to secure long-term funding to support the full range of EMS 3.0 services; 
  • Providing advice and guidance to the board on current and emerging healthcare information issues that impact the EMS transformation, including: performance and outcome measures (clinical, operational, financial, and patient outcomes); EMS information standards and integration with healthcare IT; and legislation and regulation that impacts the EMS transformation. 

Committee members are:

  • Matt Zavadsky
  • Jonathan Washko
  • Greg Mears
  • Bryan Nelson
  • Jason Scheiderer
  • Mark Babson
  • Gary Wingrove
  • Melissa McNally

Technical advisors and liaisons are:

  • Kevin Munjal, MD, Mount Sinai Health System, NAEMSP MIH Committee cochair, technical advisor;
  • Doug Kupas, MD, Geisinger Health System, Pennsylvania EMS medical director, technical advisor;
  • Jacob Keeperman, MD, NAEMSP liaison;
  • Jose Cabanas, MD, NAEMSP liaison;
  • Jerry Overton, IAED liaison;
  • Kevin McGinnis, NASEMSO liaison;
  • Jim DeTienne, NASEMSO liaison;
  • Chris Shimer, IAFC liaison;
  • Chad Deardorff, IAFC liaison;
  • Aarron Reinert, AAA liaison;
  • Reg Allen, AAA liaison;
  • Mike Touchstone, NEMSMA liaison;
  • John Todaro, NAEMSE liaison;
  • Joelle Simpson, MD, AAP liaison.

Over the next several months we will dive more deeply into how the report was generated, the major recommendations it contains, and what work should be undertaken to help bring them to fruition. 

Matt Zavadsky, MS-HSA, NREMT, is chief strategic integration officer at MedStar Mobile Healthcare, the exclusive emergency and nonemergency EMS/MIH provider for Fort Worth and 14 other cities in North Texas. 

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