EMS Manifesto

EMS Manifesto

The Ideal EMS system DOES exist

By Alan Perry
March, 2012

I have traveled, seen and studied localities and state EMS systems that are highly functional, produce excellent patient outcomes, and support the provider’s needs and professional aspirations. Because I have seen this, and know it can work, I will no longer accept any argument that asserts that it cannot be accomplished due to political, monetary or structural difficulties. It simply is not true. The only impediments to creating such a system are the organizations involved and the will of their leadership. Systems such as these require integration, cooperation, coordination and dedication by individuals, and across several levels of government and private business to achieve that goal. They also require that each organization take the mission of health care delivery seriously, and support the needs of the patient by supporting the needs of the provider. The basic principles are outlined here.

Make excellent patient outcomes the priority

·      The ultimate measure of system performance are patient outcomes, many provider, administrative and system problems negatively affect this.
    The system must establish and publish patient care goals and outcomes and make them available to providers and the public.

Constantly seek to improve the level and quality of service

·     Continuous quality improvement requires feedback to each provider, and each organization about their performance whether positive or negative.

·       It requires sharing of patient outcomes across organizations and honest evaluation by all providers involved.

·       Strengths and weaknesses need to be identified and managed through planning and setting achievable goals.

Integrate the healthcare system

·       Patients, providers, hospitals, clinics, public health, mental health, community services, insurers, state and federal agencies need to develop a coordinated care approach to health care to avoid duplication, miscommunication and inappropriate or excessive use of the system.

·       Conduct joint training on topics shared across organizations such as CPR, ACLS, PALS, hazmat, mass casualties and case reviews.

·       Share clinical experiences among related fields, ER staff on medics, EMS staff in the ER, to build a healthcare team.

Support your providers

·       Provide continuing education that exceeds requirements.

·       Develop EMS specific career development programs.

·       Encourage and support acquisition of new skills and knowledge.

·       Provide adequate feedback on patient outcomes.

·       Reinforce value of good work.

·       Publicly promote the value of EMS.

·       Allocate sufficient resources to prevent provider burnout.

Change the organizational climate

·       EMS is a noble profession, treat it like one.

·       Stop creating an atmosphere where EMS duties are undesirable and avoided.

·       Allocate sufficient human and physical resources to achieve reasonable unit utilization.

·       Promote the value of increased levels of EMS certification.

Involve the public

·       Public education and prevention programs are powerful tools

·       Conduct EMS public education with the same intensity as fire safety programs

·       Develop community first aid and CPR programs to build public confidence, understanding, and support for EMS programs.

·       Encourage the public to take a more active role in EMS in their community fostering more appropriate and timely reaction to such events.

I have a vision of a patient making a single call, which is answered by a healthcare provider. These providers give appropriate advice, schedule a doctor’s appointment, or arrange appropriate transportation if needed to an appropriate level of care facility. The transport agency is given a full report via mobile data terminal complete with address and previous call history. The patient is subsequently transported to whatever facility is best suited to deliver the best care whether it is a physician’s office, a clinic, a dialysis center or a hospital. The crew is provided feedback on the effectiveness of any treatment provided, and the diagnosis and outcome of each patient. In this way patients get the best care possible. Inappropriate entry into the EMS system is minimized and providers are utilized in the most efficient way possible. The cost of health care services would be reduced by using such a system, a savings that would be substantial and support development of the system.

These concepts are not new, many of them are espoused in various national documents attempting to bring EMS to the next level. In my opinion these processes are taking way to long, the fundamentals are sound, there is no reason to wait for our future to be realized.

It will take efficient systems that value exceptional patient outcomes, and uphold the needs of their providers, to meet the challenges we face. If we do not rise to meet the challenge someone else will and we will find ourselves accepting change that we had no part in designing. I prefer to have some input, please join me.

Alan Perry

AAS, BS, NREMTP