2017 may very well be one of the most tumultuous years for EMS. Against the backdrop of a highly charged national political landscape, field care professionals saw an array of changes as well. While some of the events highlight the success of an industry on the cusp of change, others demonstrated that we continue to be dragged down by boorish behavior.
Community paramedicine comes of age?
Mobile integrated health and community paramedicine may have come of age in 2017. With numerous initiatives showing good results in terms of patient outcomes and cost effectiveness, attention is now focused on reimbursement for field services that don’t result in ambulance transport.
MIH guru Matt Zavadsky wrote about various models of compensation, but cautioned about the slow pace of change in federal reimbursement schemes, especially Medicare. On the other hand, a major private insurer will begin providing reimbursement for MIH services beginning in January 2018.
MIH-CP isn’t without its growing pains. San Diego had to suspend its program due to staffing shortages, and Dallas is hoping that ongoing reduction in frequent user calls will help improve revenue. But it appears that more and more departments are adopting MIH-CP and expanding services to their communities.
Patient transport beyond ambulances of today
As the demand for ambulance transport continues to rise, agencies throughout the nation are increasingly challenged to provide prompt service. A large urban study showed that transport by private vehicles resulted in better outcomes for trauma patients, rather than waiting for an ambulance. EMS providers spoke to the study’s issues and to the role of ambulance transport.
Shared car services in EMS transport continued to evolve in 2017. Cities are looking into the viability of using services such as Uber to transport non-emergent patients. In some cases, EMS agencies are working directly with these services as a way to reduce EMS call volume. What the risks associated with this level of triage are is not yet clear, but the potential to direct the right patients to the right level of service and reduce unwarranted stress on existing EMS resources is promising.
2017 also showed that EMS was not limited to four wheels. The idea of drones carrying medical payloads, such as defibrillators, may come to fruition both here and abroad.
Are we getting hurt unnecessarily?
Speaking of technology, public safety experts have already started the discussion on driverless ambulances. With rapid development of automated automobile technologies in areas such as assistive braking and collision avoidance, the promise of fully automated vehicles serving both consumer and EMS is not very far away.
These technologies won’t address what’s happening today. EMS personnel continue to be injured while working in their units. Vehicle design and a lack of safety culture contribute to lack of seatbelt usage while in the passenger compartment. Ongoing driver training is a must for all EMS providers, yet many do not receive any meaningful training before sliding into the driver’s seat. Better built ambulances are also necessary for the safety of both patient and provider.
Overall, injuries plague EMS providers. A study conducted jointly by NHTSA-EMS and NIOSH found EMS workers suffer physical injuries at a rate of four times the national average. The top five causes of EMT/paramedic injuries are:
- Motion injuries,
- Hazardous exposures,
- Slips,
- Trips and falls, and
- Violence.
Better situational awareness training, more ergonomic equipment and a philosophy of carrying only those patients who medically require it will improve those statistics. Going home at the end of the day should be everyone’s goal.
EMS and the opioid epidemic
It’s estimated that more than 90 Americans die from an opioid overdose every day. With potent drugs like fentanyl and carfentanil being mixed in, or even replacing heroin, along with a record number of prescriptions for powerful narcotics, patients are not only difficult for EMS providers to resuscitate, they also are a risk to their health as well.
EMS systems have been overwhelmed with the number of overdose runs; a few well-meaning but naive legislators have even offered suggestions that would cut off EMS services to repeat overdose patients. The truth is, addiction is a disease, not a choice. Efforts to curb opioid use are underway, and the availability of public access naloxone and safe injection sites may reduce the size of the epidemic.
Human foibles can equal bad EMS behavior
While it may come as a surprise to some, EMS providers are human. As such, we are prone to making the same mistakes in judgment as others, such as making inappropriate remarks in social media or posting patient photos on social media.
As EMS professionals, we are held to a higher standard in our communities. That responsibility requires refrain and professionalism while on the job.
The #metoo campaign brought a lot of attention to sexual harassment in the workplace, with all types of famous people losing their jobs over allegations of inappropriate, and sometimes illegal behavior.
EMS saw its fair share as well. Whether it’s inappropriate touching, sexually assaulting a patient or secretly recording a female co-worker in the bathroom, sexual harassment is just wrong. A just culture that promotes safety within the workplace must be the goal of every EMS agency.
