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EMS Week: EMS Engagement Is Key to Improving Patient Outcomes

Posted on Wed, May 18, 2016
EMS Week: EMS Engagement Is Key to Improving Patient Outcomes

By Cheng-Teng “Bill” Wang, MD

This EMS Week, we celebrate the courage and dedication of those men and women who serve on the frontlines of healthcare. Our EMTs, paramedics, first responders, dispatchers, critical care transport nurses and staff, EMS physicians and countless other staff that support this critical infrastructure, regardless of the weather or time of day, provide timely and essential medical care to our communities. It’s paramount we don’t forget them, relegating them to the back of the queue of celebrations that dot our calendar and schedules. Instead, we need to engage our EMS providers, supporting them and providing succor in their time of need.

With EMS still being a relatively new denizen in the house of medicine, its identity and place is still being established. Only during the past decade or two are more consistent national standards and guidelines being developed, like the EMS Agenda for the Future and the National EMS Education Standards. Even in emergency medicine, EMS has only recently become a fully recognized and accredited subspecialty. As such, EMS providers and agencies come in all forms and structures depending on the needs and resources of the community, showing the adaptability and resiliency of EMS. As the adage goes, “If you’ve seen one EMS system, you’ve seen one EMS system.”

The form and function vary from state to state, region to region, whether it’s a municipal service, private agency or volunteer organization. Even then, nationally EMS falls under the auspices of the National Highway Traffic Safety Administration as opposed to the Department of Health and Human Services where other healthcare services reside. It’s from such delineations that spawned the cringe-worthy and oft detested moniker of “ambulance driver” as opposed to EMS provider.

As healthcare professionals, we owe it to our colleagues to treat them as healthcare providers and not just chauffeurs. With the changing paradigms in healthcare, EMS is developing a more critical role. Instead of bringing patients to hospitals for emergency care, EMS is bringing that care to the patient. Additionally EMS is becoming more than pre-hospital care; the advent of mobile integrated healthcare over the last few years has brought out-of-hospital familiarity and care to the community even after discharge.

Engagement with local EMS services becomes ever more critical as reimbursements decrease from a shrinking pool of healthcare funding and more of it becomes at risk as it is tied to performance measures (the validity and value of such being a wholly separate discussion). However, that interaction does not need to be as complex as mobile integrated healthcare systems such as those developed in Minnesota, Texas and North Carolina.

Ultimately, EMS providers are strong patient and community advocates; they are often a part of the communities they serve, with family members, friends and loved ones in that same community. They want the patients they care for to have good outcomes as well as a comforting and reassuring experience when they are at their most vulnerable. That comes down to trust in the medical care that a facility will provide as well as the respect and courtesy they receive from the hospital staff.

Hospital and emergency department staff need to recognize the pride that EMS providers take in delivering care. Encouraging and recognizing the good work they do and what they are capable of goes a long way in developing that trust. Having simple necessities such as beverages, clean restrooms and maybe even a rest area to provide respite from the outside elements. Expediting the flow and care of patients coming in with EMS as opposed to ED staff ignoring or even growling at them is even more important, especially since the hospital now has EMTALA responsibility for that patient regardless of whether a report was given or a treatment area assigned.

Involving local EMS services in different clinical care programs and protocols also is critical to engagement. With time-sensitive and resource-intensive conditions such as cardiac arrests, STEMIs, strokes, traumas and sepsis, early recognition and activation of processes are the key. Studies have shown time and again that EMS is fully capable of recognizing these conditions and at times even at the forefront of care (such as with the mobile CTs in Houston and Germany for stroke care or even EMS bringing patients directly to CTs in the setting of suspected strokes). Integration with EMS streamlines notification and activation processes, and coordinates care for the patient, with many treatments often able to be initiated even before hospital arrival. Resources such as treatment space, hospital staff, laboratory services and radiology services can be reserved and mobilized.

The quality assurance and review aspect of care is equally as important as the operational aspects. Without measuring and analyzing the processes, improvement of a given protocol is then just guesswork. Sharing performance data (using HIPAA-compliant as well as hospital- and state QA-compliant methods) allows both sides to further progress. The data provided also allows for feedback to the EMS providers involved with the care of a patient, further reinforcing the positive performance or allowing for remediation and improvement. Providing the final outcome of the patient also generates a better sense of teamwork between the EMS providers and hospital staff. This becomes even more powerful at hosted recognition events when patients with good outcomes are available and able to meet the entire team.

So during EMS Week, start the outreach to the local EMS services. Recognize the work they do and the sacrifices they make. However, remember that this week is just the beginning, and efforts should not stop just because the week has ended. Engage your EMS providers, learn their names, and work with them to provide better care to your patients and community. You never know when it may be you or your loved ones who need their services – why not make the care truly great?

Bill Wang, MD

Cheng-Teng “Bill” Wang, MD, is the EMS medical director for Jersey City Medical Center EMS and National Parks Services EMS for Statue of Liberty/Ellis Island. He is the associate director for the Department of Emergency Medicine at RWJBarnabas Health - Jersey City Medical Center. He also serves as the chair for the New Jersey EMS MICU Advisory Council.
 

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EMS Providers: An Extension of the ED in the Field

Posted on Mon, May 16, 2016
EMS Providers: An Extension of the ED in the Field

By Albert Ritter, MD, FACEP
 
It’s National EMS Week and we are reminded of the contribution our partners provide in the pre-hospital setting.
 
Twenty-four hours a day, seven days a week, whether it’s steamy hot or freezing cold, on the side of the highway with tractor trailers rushing by or in the third floor walk-up apartment. Some are volunteers serving their communities on their time off from a day job.
 
EMS providers in our communities, both paramedics and basic EMTs, should be viewed as an extension of our care into the field. The care they provide in the first few minutes of a medical emergency or traumatic injury can make the difference between a good outcome and a bad outcome. Good communication and a congenial, respectful, relationship between pre-hospital providers and emergency department staff is essential for patients to receive the best possible treatment. This kind of relationship encourages a dialog that directly benefits ED staff, the healthcare facilities we work in, and ultimately our patients.
 
Pre-hospital medicine is evolving and becoming increasingly more complex. EMS providers are being tasked with more responsibility in the care of patients experiencing sepsis, STEMI, CVA and trauma. The appropriate use of therapies such as TXA and CPAP and changing standards for pre-hospital activation of cath labs, stroke teams and spinal motion restriction are critical to good care. By maintaining an open and friendly dialog and providing education, we can influence how this care is provided to our patients and ensure that standards are met and maintained. I’m always impressed by the curiosity and interest EMS providers show regarding educational opportunities, whether provided in didactic settings or as informal anecdotal feedback regarding a patient. It’s crucial to provide this teaching in a supportive and educational manner that’s appropriate to their level of training.
 
Another aspect of maintaining good relationships with our EMS partners is that they are the best advocates for our facilities within the communities we serve and with local government. This can be extremely helpful for community outreach and with public health initiatives such as stroke and heart attack recognition and CPR programs. The providers also instill confidence in our patients that they will receive the best of care on arrival, relieving a lot of anxiety and improving patient cooperation.
 
Finally, this is a group of committed individuals who often work in really difficult conditions to treat and transport our patients. In many communities, they are volunteers who train and care for patients on time off from work and away from their families. They deserve our thanks and our appreciation.
 
Albert Ritter, MD

Albert Ritter, MD, FACEP, is an attending emergency physician at Morristown Medical Center, Morristown, N.J., and is medical director of Atlantic Ambulance Corporation, operated by Atlantic Health System.
 

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