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Late for the Future

My friend Mike Ward, who I met as “FossilMedic“, asked a question in a blog post back on September 10 wondering aloud “What will the fire service look like by September 11, 2021?”  Well, a few of my fellow EMS bloggers took the challenge of answering that question.  In his blog post on the subject, Greg Friese presented a mixed bag of specific predictions as he also extended the question to include EMS as well as Fire in the query.  The gadget geek known as “UnwiredMedic“, or just Christopher Matthews to some, also quickly took up the challenge focusing on the advances in technology as he usually does in his post on “the closure of another anniversary“.  Finally, Bob Sullivan focused on his trademark patient perspective in discussing provider skills and training that will be common in his view of “EMS on 9/11/2021“.  I am quite late to the fray, but hope to join these friends in making my own prognostications from my own unique vantage point on improving the efficiency of EMS.

The way I see it, in another ten years we will be past most of the in-fighting we currently experience between firefighters and paramedics about who does what more effectively or efficiently.  I hope that by the 20th anniversary of the terrorist attacks we will finally recognize that the public is both the focus and financier of our efforts outstripping our desires for shiny equipment or promoting blind union allegiance.  We face the pressures today of a changing environment where a lack of volunteers is necessarily being replaced by paid staff increasing provider costs and an aging and increasingly unhealthy population is placing more demands on emergency resources.  All while, the very foundation of the heath care system is continually being overhauled with changes to well-established financial reimbursement incentives.  The fundamental change we will witness regarding the structure of provider agencies in coming years will not be a linear progression from today, but the enhanced variation of a “punctuated equilibrium” driven predominately by rising costs and demand that are clearly out of line with our commitment of resources.

The first ten years since 9/11/2001 saw unprecedented spending in public safety at every level raising debts nationally and locally.  Now we face an economy that cannot sustain current spending patterns and will demand increased efficiency along with the increasing efficacy of evidence-based treatments.  To get more from less, we must do better.  I believe we will see the advances in technology and education that others have predicted because it will prove to improve service, but we will also see consolidation of agencies along with increased specialization.  Medically focused professionals will handle the majority of medical calls.  Savings will be realized by integrating these medical responses with advanced medical providers given incentives to improve long-term health outcomes.

A future we need and can live with.  What do you see?

Posted in Administration & Leadership, EMS Topics, Funding & Staffing, News

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The Default Solution is Always More

My wife announced that there wasn’t enough money in the checking account again.  The obvious solution to her was that I simply needed to add more money to it each month and that the problem would then go away.  Any attempts on my part to question where the money is being spent is considered completely offensive simply on face value.  There are so many details that I would just not understand.  After all, I simply need to know that we are talking about meeting the needs of our family.  How could I even consider not addressing those needs?  Do I want a child to go without an education?  Without shoes or food?  It could happen she warns, if the funds are not provided.  Oh, and I can’t reduce the family size either by letting any of the kids (or even my wife) go.  Alright, maybe I took that analogy to an extreme there at the end, but replace my wife with the fire chief or union leaders, my kids with union firefighters, and make me a politician or simply the public and the story is replayed all over the country and even across the world.  ”If we don’t have more money, someone could die!”

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Posted in Administration & Leadership, EMS Topics, Firefighting Operations, Funding & Staffing, News, Vehicle Operations & Apparatus

MCIs and “The Downwind Walk”

I never really considered doing book reviews on this blog or writing about specific horrific incidents either, but I finished reading “The Downwind Walk: A USAR Paramedic’s Experience after the Terrorist Attacks on September 11, 2001” by Steve Kanarian just hours before the shots rang out at a movie theater in Aurora, Colorado.  Let me say upfront that this will also probably not be the sort of book review you might expect, but I doubt the book will be what you expect it to be either.  The book at least, is much more than it appears.  Steve is a Paramedic, a retired FDNY EMS Lieutenant, and now I am happy to call him my friend as well.  He has given me a gift through his pain and I hope you will take it as well.

From the title I was expecting a journal of the messy details written by a “Forrest Gump”-type character who was always in the right place at the right time and would take me into the depths of the response that day.  What I discovered was an even more real experience than I imagined.  It was his exact experience including the hours and days of simply waiting to be of use.  Most surprising was that the greatest interest of the book for me became the continuation of his story long after the actual event and even after his final day working at ground zero.  It was the story of every first responder who is called to action at (more…)

Posted in Command & Leadership, EMS Topics, Firefighter Safety & Health, Mass Casualty Incident

Quick Thoughts from Pinnacle EMS 2012

Last year one of the Pinnacle attendees was quoted to say it was ”the most innovative and thought-provoking event of the year.”  This year I will have to admit that this truly has been one of the best conferences I have attended in a while for the quality of the discussions and relationships it has initiated.  From the pre-conference power seminars to the keynote and concurrent general sessions, attendees have consistently been challenged with new ideas relating to the future direction and operations of EMS.

On Monday, I attended the session on “Effectively Using Social Media” with Greg Friese, Carissa O’Brien, and Skip Kirkwood.  Even though I work with social technology every day, I still heard many practical and well thought out approaches such as learning to leverage social technology internally first before trying to promote it outwardly – especially as a large organization.  Aetna was a great example of how some organizations are really doing social right.  Relating it more directly to EMS services, there was talk of developing not just a social media “policy” of “dos and don’ts” but a “strategy” of what you hope to accomplish with it.  Social is also not something you simply assign to the young intern because they might be comfortable with technology, but must be directed as a strategic corporate resource.  Listening is the best way to begin, but this is not just how you need to get started in social media, but more importantly how you stay engaged.  There are several listening tools that can help you know what is being said about you and to help you take appropriate action which may, or may not, involve a “social” response.  There were several other points I found worth noting and they can be found in my Twitter feed going back to July 16.  Opposite this session was the wildly popular “Community Paramedicine” session facilitated by Kevin McGinnis, Chris Montera, Anne Robinson, Brent Myers, and Gary Wingrove.  This was clearly a topic of interest to many throughout the week.

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Posted in Administration & Leadership, Conferences, EMS Topics, Training & Development

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A Bibliography on EMS in a State of Change

Most scientists agree that earthquakes are difficult to predict, but last Thursday should have been a “gimme” regardless of how the Supreme Court would have ruled.  Independent of your perspective on the ruling, we now know how health care reform will play out – at least until the next major shift changes the landscape again.  There are some fine articles that have looked specifically into the basics of U.S. healthcare, reform and the high court, or How Health Reform Could Hurt First Responders, even What the Supreme Court’s health care decision does—and does not—mean.  Also, hospitals are seeing the healthcare ruling as a new challenge and suggest that Federal Proposals Would Limit Aggressive Hospital Collections Practices.  So I have no intention to try to argue any of those contributing factors.  There are still many other factors affecting the future of emergency health care delivery that aren’t getting as much press attention even though their impact is at least as important.  Make no mistake, reform is coming to EMS!

Steve Whitehead at The EMT Spot blogged on the 7 Myths About Fixing Our EMS Systems.  It is a well-thought out article focusing on how to improve the system, but doesn’t approach the underlying causes.  From my perspective, one of the most important influences I see making an impact is politics.  In the article Ambulance debate rough road: Government could grow, it is clear that local politics specifically regarding government is driving too many decisions.  The Mayor of Columbus appears to be favoring a significant initial investment along with an annual subsidy to expand the local fire department rather than award a contract to one of the service providers claiming no subsidy would be required.  This also brings to mind the case in Utica, New York where the city sees an opportunity to actually generate municipal revenues through an ambulance service even though they could not certify a need as the Revised bill on ambulance plan still a bad policy opinion article suggests.  Which brings me to my second primary factor of money.  There are too many differences in how EMS is funded.  Unlike the fire and police department, which are so-called “free” services paid completely through your taxes, most EMS agenices charge for their services, going through your health insurance where they can.  Some operating costs are also covered by various combinations of property taxes, usage fees, or subscription fees without any consistency between jurisdictions.  There are many ongoing debates including this one by Letter: Emergency Medical Services In Great Neck.  But as long as there are such diverging funding schemes, (more…)

Posted in Administration & Leadership, Dispatch & Communications, EMS Dispatch, EMS Topics, News

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Demystifying the Current Drug Shortage Problem in EMS

The following post is co-authored by two special guests:

Jonathan D. Washko, BS-EMSA, NREMT-P, AEMD and Scott Matin, MBA, NREMT-P

In a recent meeting held in Washington DC, sponsored by the Department of Health and Human Services (HHS) and the Assistant Secretary for Preparedness and Response (ASPR), the EMS industry and other key industry players were invited to learn more about why the current drug shortage situation exists. Those that attended the meeting were fortunate to be addressed by a panel of experts from the FDA, HHS, drug manufacturers, drug suppliers and a variety of EMS providers and industry trade Associations.

How did we get into this situation?

It became quickly evident that the problem being experienced by the EMS industry along with other emergency health service providers is due to a variety of unmanaged but tightly integrated series of manufacturing, regulatory, supply chain and end user processes and practices that have come together in a perfect storm to produce the situation we find ourselves in.

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Posted in Administration & Leadership, EMS Health & Safety, EMS Topics, News, Patient Management

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HP-EMS Profile: Cetronia

Growth in both the industrial and residential populations has dramatically changed the Lehigh Valley of Pennsylvania since 1955 when the non-profit ambulance service, Cetronia Ambulance Corps, first began its all-volunteer BLS services.  In response to the communities need for an increase in public health and safety services, Cetronia has grown to include ALS service, 24-hour dispatch, and non-emergency medical transportation.  Additionally, Cetronia provides billing services, community outreach, education, special events coverage and special operations teams.  The diversity of their fleet allows the most appropriate level of service for the customer’s need from a doctor’s office visit to a critical care transport.  Cetronia continually strives to understand the medical needs of its communities and remains “Always Ready” to accommodate any pre-hospital emergency care and medical transportation needs.  This attitude of adaptation is not new to Cetronia, rather a continuing legacy of a truly innovative EMS system and a commitment to providing “Health on Wheels™” for its residents.

In recent years, Cetronia recognized the enormous challenges facing the EMS industry including severely diminished reimbursement rates.  Since EMS billing specialists must be ready to meet these ever-changing reimbursement and additional compliance issues with competency and expertise, Cetronia has maintained their own team of nationally certified ambulance coders who offer an exceptional blend of ambulance billing experience, knowledge, and customer service to ensure fiscal stability and the organization’s continued success.

The increasing demand for healthcare services which threatened their ability to maintain response times is another example of what motivates their mindset of continual improvement.  Choosing to be a  (more…)

Posted in Administration & Leadership, Dispatch & Communications, EMS Dispatch, Profiles, Technology & Communications

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Response Time Zero

The best possible response time for any emergency is immediate.  This is no simple theoretical goal, but a physical reality everywhere that a Public Safety Dispatcher, using standard Emergency Medical Dispatch protocols, can be reached by phone.  These calm “voices of hope” quickly perform an initial triage to determine the type of medical or trauma situation being reported, dispatch appropriate emergency services as necessary, and provide quality instruction to the caller before any additional help arrives on scene.National Academies of Emergency Dispatch

The Navigator conference in Baltimore this week, sponsored by the National Academies of Emergency Dispatch, celebrated the efforts made in the last 33 years since Dr. Jeff Clawson developed a set of protocols in an attempt to reduce the number of Code 3 medical runs through proper resourcing and to promote dispatching as a profession.  Now there are 65 million emergency calls for service each year to just over 3,500 Public Safety Answering Points (PSAPs) worldwide where the best are recognized as Accredited Centers of Excellence (ACE).

But not all calls requesting service are equal.  Using the Medical Priority Dispatch System (MPDS) protocols, automated through software like ProQA, the initial triage phase is automated to provide a standardized format for carrying out the practice of priority dispatching.  The acuity of the call is determined to categorize the dispatch response.  Increasingly that response may include the possibility of alternative service endpoints in certain systems reforming the traditional “you call, we haul” strategy where each call ends with a transport to the hospital.  For systems authorized to use it, like many in Europe, PSIAM provides a secondary level of triage, commonly performed by nurses, for any lower acuity incidents that should not require an ED visit.  This is a dramatic departure from the norm in the US and one that will require vertical integration of healthcare providers starting with EMS, the practical gatekeepers to a significant amount of healthcare in the community. Recognizing EMS as healthcare providers is also a shift in thinking from the prevalent public safety mindset and one not taken in current healthcare reform.

The first link in the chain of the emergency response system, however, is the Emergency Medical Dispatcher.  These are the true First Responders who are immediately present at the scene providing care even though they cannot see or physically be present with the patient.

Posted in Dispatch & Communications, Emergency Communications, EMS Dispatch, Technology & Communications

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Quick Thoughts from the Esri EPC/DevSummit 2012

The importance of the intersection of Geographic Information System (GIS) technology and Public Safety may not seem very obvious to some at first glance, but GIS has a lot to offer beyond just mapping in improving the efficiency and effectiveness of systems to create a High Performance EMS.  (See my previous post on GIS for EMS for more details.)  Over the last few days, Esri has hosted their business partners and developers in overlapping conferences to highlight upcoming feature functionality in new releases of their market dominating ArcGIS software family.

Of the highlights important to public safety professionals is an upcoming release of a comparatively small footprint, easily deployed, core GIS product that will be called the ArcGIS Runtime.  Unlike their ArcView product, the runtime software is actually a developer tool distributed through partners or developers within industry focused applications.  When it is released this summer, developers will use their unique knowledge of public safety functions to build applications much smaller than previously possible.  This new deployment will also allow these applications to
be stored on a USB memory stick and installed as easily as plugging in the device and opening the application.  Data to support the map layers in the application can also reside on the USB device or come from web services like ArcGIS Online if network connectivity is available.  Probably most importantly, this runtime can dramatically improve the deployment of mobile applications to vehicles over wireless networks or directly to laptops through portable memory devices as new computers are added in the event of a disaster response.  In the past, GIS has proven to be a very useful tool in managing disasters but its installation requirements has been a costly and time-consuming impediment.  This limiting factor will be mitigated once the new generation of applications are available on this platform later in the year.

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Posted in Conferences, News, Technology & Communications

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Quick Thoughts from the EMS Today 2012 Conference

This was my first time at the EMS Today conference produced by JEMS and I have certainly not been disappointed by the promise of quality education, networking, and new products.  The ride-along with BCFD EMS, described in my post yesterday, help set the tone for a genuine learning experience.  Whatever your level of experience or interest in EMS there was something for you here in Baltimore.

The pre-conference courses began on Tuesday and the ones I observed were excellent varying from the “Back to Basics Skills Lab” by Bill Justice that was attended by many young, new EMS professionals to the “EMS Field Training and Evaluation Program” led by Troy Hagen and Skip Kirkwood that opened up many new questions for me about how EMS functions today and what we need to do to improve it.  Others I would have liked to attend included Advanced Airway Management, EMS Street Survival, and a workshop on best practices for delivering and tracking training by Greg Friese with CentreLearn.

The “Global Climate of EMS” session led by Jerry Overton was a great way to start my day yesterday by forcing me to take a hard look at how our EMS systems are designed in the US and how they compare to the rest of the world.  Some of the sobering statistics can be found in my past tweets by @hp_ems or by searching the #EMStoday hashtag.  But more importantly, Overton challenged the core model of EMS based on a 7:59 response time and automatic transport to the hospital ED created as a result of the 1965 Medicare legislation.  Some of his suggestions included “Alternate End Points” for appropriate care and nurse triage in the PSAP to determine response alternatives.  While the legal concerns surfaced quickly, the reply from places doing it cited cost savings and more appropriate care as a positive return.  This was a discussion that continued with a lively dialog over lunch at the EMS Leadership Lunch & Learn.  Interestingly, the session I attended between these talks was on “Culture Change from the Ground Up” by Fire Chief Gary Ludwig who had a very different premise.  (more…)

Posted in Conferences, EMS Topics, Training & Development

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