If, in moving through your life, you find yourself lost...go back to the last place where you knew who you were, and what you were doing, and start from there. Bernice Johnson Reagon.

21 May 2012

The Future of EMS... Part I.


Over at modernhealthcare.com there is an article about EMS. You can go here to read it. It is a pretty good article. It highlights some real concerns about EMS and its future.

There is only one problem. Who exactly reads modernhealthcare.com?

Those of us in EMS know that things have to change. The entire “reimbursement for transport” (RFT) is a major player in the “let’s keep EMS down” problem that exists. Sure, there are other things. Things like minimal education standards. But that is another blog.

The problem as I see it is that in order for things to change with RFT, the public has to know what it is we do. All of it. As well, they need to know what we could do in order to keep them healthy and to save the country money. And in the end, help save our healthcare system.

So how do we do that? First, we need to get some friends in the local media. Here at home, that means The News and Observer (and all of its community editions), The (Durham) Herald-Sun, WRAL, WTVD (yes, even WTVD, despite their recent report on EMS), WPTF, and any of the other smaller news and media outlets. When I say friends, we have to convince them of the importance of our message. And if they don’t get it at first, we need to keep hammering it in. When we send them a press release, then pester the crap out of them until they put it out there. For other communities, you know who your local media is. Get engaged. Heck, get them engaged.

So what do we need to tell them?

First, of course, start with our second-to-none cardiac arrest save rate. But we need to tell them more than a number. Tell them what goes into achieving that number. They need to understand about the planning, education, and coordination that helps put those numbers up there. And we don’t need to do it once a year.

But what about those other numbers? You know, ‘number needed to treat’. It’s fine when we are told that in our training classes. But are we (the EMS personnel) the needed target audience? The public needs to hear this. And they need to hear it often. And they need to know how important it is to themselves and the community, not only in better health, but in monetary savings to the taxpayers, of the importance of the 
NNTT for CPAP in avoiding intubations , of proper STEMI destination programs and care for preventing death from MI’s, etc.

The public needs to know just what it costs to operate an EMS service. How many people in the community know how much an ambulance costs? Or a Stryker power stretcher? Or a LIFEPAK 15? They have no idea. And I never waste an opportunity to tell them when they marvel at my power stretcher that it costs over $10,000.00, or that the LIFEPAK 15 costs almost $20,000.00. And I tell them why it is important. To them as well as me.

But what about other stuff? Using LIFEPAK 15’s, cardiac arrest saves, and CPAP are only a small part of what we are doing now. What about all of that other stuff, where nothing more than hand holding is needed. 

They need to understand that, too.

And they also need to see and understand the really silly crap we do, like taking people to the ED because they need their toenails cut, because primary care physicians typically say “send them out to the ED” for nursing home patients in need of Tylenol, because Junior as a skinned knee and no limp, but the family members said “He needs to be checked”. And don’t forget the mental health patients that have been dumped on society by the failing mental health treatment system. And the people with no helath insurance that have no where else to turn to.

The public needs to know that. To know that we have to do something different and that it is in their bests interests, in the long term, for us to change the way we do business. And they need to see it in the way they see everything else... short blurbs in the media.

We need to let them know the benefits of community paramedic programs. Of how properly educated, equipped, and funded community paramedics can work to ease the burden on our healthcare system, our community hospitals, their families, and the citizenry at large.

They need to see that there are conditions and incidents that we can safely 'treat and release', that everyone doesn't need to go to the hospital emergency department, and some people actually do not need to go anywhere by ambulance.
But why engage the public, John and Jane Q. Citizen or Robert T. Six-pack, if you will?

Because they elect people. And those elected people are the ones that vote in state legislatures and in the congress.

But to engage the public, we have to get the message out there to them. They have to see the message and understand the message. The key term here is ‘often’.

The public needs to get the message often, not just once a year during EMS Week. And we need to get the message beyond jems.com, ems1.com, and modernhealthcare.com.

Just my three cents.