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, Continue reading
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.
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 standardÂ Emergency Medical DispatchÂ protocols, can be reached by phone. These calm â€śvoices of hopeâ€? 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.
TheÂ NavigatorÂ conference in Baltimore this week, sponsored by theÂ 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 likeÂ 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 â€śyou call, we haulâ€? strategy where each call ends with a transport to the hospital. For systems authorized to use it, like many in Europe,Â PSIAMÂ 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.