What 2014 EMS developments and changes mean for EMS in 2015
Policies on Narcan, backboards, community paramedince, infectious disease training, EMS assaults and more will play significant role in the evolution of EMS
As another calendar year comes to a close, we’ve taken a look back at some of the themes in EMS over the past 12 months, and how they have impacted our jobs as health care providers.
From the widespread use of Narcan, to policies limiting the use of backboards, to taking a more proactive approach when it comes to violence against EMS providers and even expanding what EMS providers actually do, our industry has evolved considerably in a relatively short amount of time.
Here we highlight what we consider some of the most important changes in EMS over the past year, and the further impact we expect them to have on our industry as we move forward into 2015.
Narcan for everyone
Narcan, once administered by only paramedics, became widely available to anyone and everyone in 2014. With the support of rapid legislative approvals and changes to administrative codes, many states authorized all types of first responders – police officers, medical first responders, firefighters, and EMT-Basics, as well as bystanders, to administer Narcan for patients with known or suspected opioid overdose.
Does Narcan solve a previously unsolved problem?
Bag-valve mask ventilation always has been, and continues to be a treatment, for respiratory depression from narcotics overdose. Perhaps emergency care providers, at all levels of care, are reluctant to administer ventilations because of intermittent or infrequent practice or the consequences of improper ventilation from continued or worsening hypoxia, or aspiration from excess ventilation ending up in the esophagus and stomach.
Narcan, especially by the intranasal route, is an easier option for emergency responders and laypeople, but widespread availability of Narcan should at least make us pause to consider unintended consequences. We should also not be surprised that law of supply and demand impacts pricing of medications – another consequence of ubiquitous Narcan distribution.
We should look forward to more stories of "firefighters save man with wonder drug" or "police officers carry new medication." Meanwhile, it can't hurt to regularly practice your bag-valve mask skills in the months ahead. The patient might have respiratory failure from a cause not reversed by Narcan.
Backboards for no one
Just as rapidly as Narcan kits were being fast tracked onto fire trucks and into police cruisers, backboards were being yanked off of ambulances and stacked in the corner of the apparatus bay. (The potential headline, "EMT injured by avalanche of old backboards" seems ironically possible)
For years a small group of paramedics and physicians has been questioning the utility of spinal immobilization for a patient with a worrisome mechanism, but without any complaints or symptoms of a spinal column or cord injury. This small group, like a boy pushing a snowball that gradually grows as it rolls up the hill, suddenly had widespread attention this year. Now the snowball is racing downhill and services from Florida to Texas to Kansas to Missouri and all around are amending their treatment protocols.
Medicine is dynamic and the standard of care changes over time. The old EMS dogma about backboarding every patient that has fallen or been in a vehicle collision is a thing of the past. In the year ahead, replace any lingering habit to "apply spinal immobilization" for all trauma patients, regardless of their complaints or your exam findings, with spinal motion restrictions appropriate to the patient's complaint and the results of your physical examination.
Ebola: EMS specific information and training
A few EMS providers in the United States found themselves on the front lines of Ebola patient care this past year. Though only a few medics had direct Ebola patient contact, nearly all of us participated in Ebola-related training and practiced donning and doffing PPE.
Many EMS organizations and allies generated information and training programs for Ebola preparedness. Because of smartphones and social networks their resources and training materials, like this Wake County EMS video and these University of Nebraska Medical Center training aids, weren't limited to their department or the personnel that could physically attend a training session.
Technology has made it easier than ever before for training officers to create and widely distribute just-in-time training materials, as well as to participate in high-level and specific infectious disease training.
All of the hype, resource expenditure, and training time spent on Ebola preparedness will have the most impact if we can broadly apply what we have learned and practiced to all-hazards preparedness for infectious diseases, biological agents, and other types of hazardous materials.
Violence against EMS
We have long known that EMS is a dangerous profession. We are surrounded by risks; distracted driving, bloodborne pathogens, and unsafe scenes. In the past year the rate of violence against EMS providers may not have changed, but our awareness of it has. Local news outlets have increasingly reported news of violence against EMS providers, because organizations and their leaders have increasingly taken reports of violence seriously.
Pressing charges and utilizing the full weight of the legal and judicial system to investigate and adjudicate violence against EMS providers is an important step in cataloging these incidents, identifying patterns, and working to find solutions to lower the risk. In the year ahead, every EMS organization should have a policy for responding to violent acts against its providers and respond with the same vigor that a police department would respond to an officer being assaulted or shot in the line of duty.
We are not immune to the stress of the job
EMS professionals can be, and often are, deeply impacted by the stresses of responding to horrific incidents. For some it is the cumulative stress of lots of seemingly minor incidents, coupled with chronic sleep deprivation or working multiple jobs, that tugs at their mental wellness. For others it might be the ongoing nightmares from a single incident. Regardless, spotlighting the prevalence and potentially fatal consequences of mental illness among first responders is an ongoing priority for many individuals and organizations.
EMS organizations and interest groups, like the Code Green Campaign, are actively engaged in improving support for medics with post-traumatic stress disorder and other types of mental illness.
New and emerging roles for EMS
The original vision for EMTs and paramedics was rapid response and delivery of lifesaving interventions for patients with emergent medical illness or life-threatening traumatic injury. But as you know, the purview and expectations of EMS providers has changed and expanded dramatically through the decades. We are called upon all the time to respond in new and innovative ways. LAS paramedics staff a booze bus. Paramedics in Ferguson needed equipment and training for working in and around riots.
The role of community paramedicine continues to expand to more and more EMS agencies. Community paramedics are monitoring chronic diseases and working to prevent hospital readmission through programs around the United States, including in these four cities.
We can expect more gatherings of leaders from across the healthcare continuum to meet in the year ahead to continue defining the role of a community paramedic and deploying new programs.
Old and dissolving roles for EMS
Although we are regularly reminded of successful volunteer EMS organizations around the United States, the past year saw continuing signs of trouble for volunteer EMS. There is regular news about agencies that are understaffed, undertrained, underfunded, or irreparably damaged by the criminal actions of a single member.
In the year ahead, of course, we should all spread the news and success strategies of leading EMS organizations. Though we should not let nostalgia for what EMS once was prevent us from planning for new agencies, structures, or models to deliver EMS to our communities.
It might be painful to consider, but the remaining members, resources, and energy of a volunteer EMS agency might be better spent planning for and preparing for dissolution and replacement of the service, rather than another member recruitment drive or effort to convince the medical director to expand the scope of practice.
EMS; every day is the start of new year
You have likely heard the saying, "real courage is doing the right thing when nobody is looking." Every minute of the day an EMT or paramedic is doing the right thing – squeezing the hand of a lonely widow, offering words of comfort to a dying man, singing softly to a sick kid, or easing the tension in volatile incident with a joke, smile, or knowing glance.
Take a pause from your hectic schedule, non-stop media and 24-hour negative news, and attending to the suffering off others. In that moment, remember your courageous acts that went unwitnessed by your peers, patients, and supervisors. Take an additional moment to forgive yourself for missed opportunities to be courageous. In a third and final moment, look ahead. Every tomorrow is the start of a new year and a new opportunity to be caring and courageous.