What is “Performance” in EMS? Part 3

This is my third installment on what really makes an EMS High Performance. The previous criteria included “Response Time“ and “Effective Care“ focusing on emergent situations, but now I want to turn to proactive outreach.

Part 3: Community Connected

When the modern idea of EMS began decades ago, the driving force related to fast response. It was simply about getting someone with some medical training to the scene of a trauma quickly. There was a wave of need and few other options at the time. Times, however, have changed the basic equation. As EMS continues to evolve we debate what our new role really needs to be. Are we primarily “public safety” as we have been or are we better viewed as an integral part of the “medical profession?” Your answer, unfortunately, may be predicated on the type of service in which you work. This isn’t part of the problem, but it is an impediment to the progress that must be made. If we were able to start all over again today by designing a new EMS system, would it resemble anything like what we have today? Of course, we don’t have that luxury. However, that sort of vision can help us steer a course through the inevitable transition that is already happening. The status quo is no longer sustainable. Between budget forces and expectations of service, our jobs will change. We can try to affect that change through the hierarchy of command, we can make a difference at the individual level through personal commitment, or we can enlist the community for the direction and support of the change THEY want.

If we examine expectations of the communities we serve through the requests they make to us, we should recognize a general shift from trauma related to motor vehicle accidents toward more purely medical “sick calls” in the home or office. A small proportion of these calls are the dramatic cardiac or stroke cases we train so diligently to address. But to the ailing patient, the perception they have can be very different from ours. But is that difference in perception only ignorance on the part of the public or a failure of ours to connect and inform them of what we can – and cannot – do.

I am encouraged by the innovation and early acceptance of “community paramedic” programs. These models allow for professional development of practitioners in the home setting while also meeting the needs of the community and still saving overall healthcare dollars. I am concerned over how these programs are funded, however. Without appropriate economic incentives for reimbursement, the developing models cannot be sustained even though they reduce overall costs since the investment shifts the financial burden to non-traditional definitive medical providers. A key to success, therefore, will be public demand for services and an appreciation for the capabilities offered. But this shift of recognition will only happen if the public becomes knowledgeable and engaged in the development process.

Even if you do not subscribe to the idea of such significant change to subsidized out of hospital care, there are other potentials for community involvement that will pragmatically improve the effectiveness of emergency care such as empowering bystanders to act. Even though a recent UK Survey Shows 9 out of 10 Would Not Use an AED if faced with an emergency cardiac arrest, it is the general public that is available to respond much faster in most circumstances than even First Responders due to their sheer numbers and proximity to witness events. In areas where the public is better trained for emergency care, patients are more likely to survive because Bystander Intervention Can Mean the Difference Between Life and Death. If we are to meet the challenge we have accepted as emergency care providers, we must realize that enlisting the help of the public through awareness and training is imperative to our mission and that a failure to inform the public of at least basic knowledge and skills is negligence on our part just as a Retirement Home Nurse Refuses to Perform CPR on Dying Woman.

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