“Leadership is the intentional communication of values.” So said Alan Craig, VP of clinical strategies for American Medical Response. The setting was the seventh annual Pinnacle EMS Leadership Forum, held this past August in Florida. His session on compassion fatigue among EMS practitioners was a call for EMS leaders to understand this phenomenon and be proactive in designing strategies to counter it.
Craig was among nearly 500 participants, faculty and sponsor representatives who attended this year’s event, the largest in its history. His session was among dozens of workshops and presentations aimed at leaders from every size and type of service. From sessions on the implementation and funding of community paramedicine, to new paradigms of care uncovered at a giant art festival in the desert, to shifts in thinking about response times, to updates from Reno on its federal innovation grant, the theme that ran through the conference is the potential of community paramedicine and mobile integrated healthcare to transform EMS.
All that was a lead-up to the closing remarks by Ed Racht, M.D. He made a powerful case that EMS is sitting on the edge of history, much as it was 40 years ago when the TV show Emergency! introduced the nation to the idea of EMS.
“I’m not sure I could say this three or four years ago,” he told the group, “but EMS is healthy right now. We don’t have all the answers, but we’re finally asking the right questions.” Questions such as, Are we making a difference? What does the evidence show about effectiveness? How can technology make us better? and How can we integrate with the healthcare system?
EMS is positioned well, he said, but what about the rest of healthcare? Not so much—traditional healthcare is broken and needs to be fixed. The triple aim of healthcare reform is improved patient satisfaction, more effective care and better value. And right now, in our dysfunctional system, Racht noted, that’s not happening: 5% of patients eat up 50% of healthcare costs. “Who sees that 5% all the time?” he asked. “We do. They get sick and need unscheduled healthcare, they often have mobility impairment, trouble getting to primary care, or trouble maintaining medications. We see them and transport all the time. But we could be helping to manage them all the time.”
He warned that using the term “EMS” in this new environment could be risky. Healthcare systems see EMS, emergency departments and emergency physicians as the most expensive way to deliver care. The traditional notion of an EMS response, with an army of responders arriving lights and sirens in big red trucks, doesn’t send the message of nuanced care equal to the situation.
He also warned EMS leaders not to make their case based on unused capacity. That slippery slope could undermine our ability to get properly financed.
Is EMS at the healthcare table, he asked? “Yes, and now is the time to learn and share, to advance our profession,” he said. His biggest fear is that EMS leaders will not come together and realize that the time for action is now. The rest of healthcare is not waiting, he said. Get moving.
