EMS Panacea versus Indispensible tool

[Just Plain Ruff]

One would think EMS is a very complex subject that has been addressed in too few directions. There are many users of EMS that need to be accommodated by a good system:

1. The primary person involved and needing to be treated best is the patient. They are users of the system in their personal access via 911. Repeat calls to their homes serve as an outcome of the EMS clinicians actions, and most importantly, in defining how they view their EMS experience. The current systems seem to leave them mostly out of the design process and their use is marginalized and they are required to change whenever the others involved see a need. This not only relates to how ambulances are staffed but also how they are put into action. Patients only really care about one thing. Whether or not that EMS provider who comes into their home or to the scene of their accident and provide competent and quality EMS care. They also care that their feelings and beliefs are going to be held it the highest esteem and not be derided by a medic who thinks that their complaint is below their purveyance.

2. The crews are the next most important users of the system. Remember to include not only EMT's and Medics but also the medical director. The main issue it seems is that the routine/usage must match the flow through the tools. I suspect there is a lot of change needed in the EMS systems and in how the EMS crews use them to get the system to be ready to respond.

3. The EMS administrators are next in priority as they need to manage the outcomes and the clinicians. This is the group who has been buying the tools and thus, their needs are probably best met by the tools.

4. The insurers are next, and they need to be able to be given accurate codes and accurate billing information. The main issue seems to be standardizing the delivery of the data to the insurers from the clinical billing process to their form based input methods, etc.

5. The research community is next and I think the most important new user or stakeholder of these EMS systems collectively if we can do it right. It should be possible to get aggregate data from all patients similarly situated to evaluate what the best practices should be without doing clinical trials in many cases, or focusing what clinical trials for EMS are done based on what actually worked. And, when we can see what works, we can work on protocols that can be delivered effectively and productively in EMS Systems across the country and then weed out what does not work.

Why aren’t things going right? One reason is that most EMS System developers do not work in a EMS System setting. You need to have the developers working with the users regularly. Google does very fast development because they can put out new “beta” versions to a sampling of users very easily. You need to work directly with people in the field, office and hospitals, etc. who can tell you if the change you want to make is going to be effective for them.

I give credit to a colleague who posted this out there on the net. I modified it to fit the EMS side of things. Am I on to something? Maybe, I don't really know but Who knows.

[fiznat]

Ah, what?

Edited June 4, 2010 by fiznat

[daedalus]

I have no idea what the point of this thread is???

[Just Plain Ruff]

I have no idea what the point of this thread is???

The point of this thread was to put some of my thoughts out there on who we have to look to as our customers and stakeholders in making EMS services better.

I didn't think that people would not get the point of the thread. These were my thoughts. I'd delete it if I could but can't.

Maybe instead of not knowing what the point of the thread is, maybe you should respond with your opinions to what I posted.

Who are the main stakeholders in an ems system?

How do we involve those stakeholders in the decision making process of an EMS agency?

I think I said that what I wrote was a work in progress but maybe I didn't.

[emtannie]

Ruff, your post caught my eye… and I would like to add my opinions on why things aren’t going right in EMS. I hope I am following your train of thought in your OP.

Although I agree that the patient (customer/client) is your primary concern, the very first area that EMS breaks down is in educating the public.

Many don’t know what the role of EMS is, and in a lot of ways, I don’t think we know either. Yes, we really shouldn’t be using resources to take the “my baby toe hurts” patient to the ER, so how do we ensure we educate people so they know that? Not every patient is truly our primary concern. Some should be re-routed to other medical departments to get care, other than using EMS. In some areas, EMS provides a number of roles, from working on the ambulance, to working in the ER, to working as transport services. Once we take the “emergency” out of our duties, what are we really?

The second area that EMS breaks down is in your second point – the crews. I agree that the crews are important – after all, they are the front line, and doing the dirty work. Why then, are so many not paid a competitive wage for the responsibility they have? Given the education and skills they have, why aren’t they seen as being valuable enough to pay more to? We can get into the whole volley vs paid thing here, but some have told me on this site the wages that they make, even though they are in an area without EMS volunteers, and I cringe at the poor wages and benefits they get.

Administrators have a very difficult job, and they have to juggle the cost of providing care vs the bottom line of making enough money to provide those services. Too often they get bonuses based on saving money, rather than showing that they improved patient outcomes with their management of resources. Going back to the crews, many crews don’t feel that administration hears their concerns, and if solving their concern is going to cost money, they know that it won’t happen. As well, too many times, administration is just the person who has been around long enough to get put into a senior position, without having the education or management skills to actually perform that job effectively.

So, how do we solve this? Well, again, this is only my opinion, which is of course worth what you paid for it.

We need to improve education criteria and certification – we need to make paramedic a degree program, partly for the “prestige” and respect a degree gets, and partly to show that our educations are truly that difficult and in depth that they deserve degree status. If we decide that we still require EMT-B’s, EMT-I’s, and medics, build that into the program – at the end of the first year, you are an EMT-B… at the end of year 2, you are an EMT-I.. at the end of year 4, you are a medic… build management and supervisory, financial and accounting courses into the curriculum, so that those students eventually have the education and skills to move into management positions with more education and skills than just hanging in there long enough to be the senior person.

We need to be united, not just regionally, but nationally, so that our voice has more effect. We can then push for and work towards national public service announcements regarding EMS, and have a larger voice in fighting for quality wages and work environments. This will also help in educating the public in teaching them what we do.

We need to be part of health care, not part of the fire department. We will never be taken seriously as medical professionals as long as we are firefighters first, and medical professionals second.

EMS is a young profession – we have a long way to go… and lots of changes to make.