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Roundtable: Experts reflect on findings, trends from the 2018 EMS Trend Report

Our EMS expert panel identifies actions EMS leaders can take to improve clinical and operational performance, and to advance the profession


The third annual EMS Trend Report explores changes in recurring and emerging trends in pre-hospital medicine.

This feature is part of the 2018 EMS Trend Report, an in-depth look at EMS trends in the U.S. and an assessment of how the EMS profession is changing. To read all of the articles included in the 2018 report, click here.

The third annual EMS Trend Report explores changes in recurring and emerging trends in pre-hospital medicine.

We asked EMS1 editorial advisors and contributors to review the survey results and offer their reactions and insights into how the responses reflect current healthcare trends – and what EMS leaders can learn from the data.

The panel includes:

  • Brooke Burton, quality director
  • Chris Cebollero, EMS consultant
  • Catherine Counts, Ph.D., health services researcher
  • James MacNeal, DO, EMS physician
  • Vincent D. Robbins, president, National EMS Management Association

1. Which finding surprised you the most?

Brooke Burton: Most of the answers were right in line with conversations going on at both local and national levels. One thing which stood out for me was how many vehicles are still responding with lights and sirens to all calls. Our ability to collect industry data and outcome information has proven the benefits of this practice don’t outweigh the risks in many cases. I hope more focus on safety (both patient and provider) will cause the practice of red lights and sirens response to be closely evaluated and changed in the future.

Chris Cebollero: There were two findings that surprised me. First, in a time where we continue to see recruitment and retention issues, I was amazed to see that the top two responses to the question “Which two factors do you find most satisfying about working in EMS?” were patient interaction and community service. These responses make me optimistic that these attributes are still a foundation for our career field.

Second, the responses to the statement, “Mobile Integrated healthcare/community paramedicine is the future of EMS.” Ten years into the transition of EMS to MIH/CP, I am surprised at how many people, especially EMS leaders, do not believe MIH/CP is the future of EMS. This movement is not going away as we are entering the day of private payer reimbursement.

Catherine Counts: The broad agreement that the general public doesn’t understand what exact services an EMS agency can provide makes sense. The average caller knows that if they call 911, they will receive treatment for what they perceive to be an emergency. However, I would argue those results are as reflective of what we think we should be doing as they are of what we actually do. If EMS agencies transport patients for toe pain, the public will likely continue to call 911 for toe pain until alternative treatment models are implemented and enforced. It’s a self-fulfilling prophecy.

James MacNeal: I find it surprising that 25 years after I got my EMT and paramedic certification, we still think that having a degree will improve our compensation. Degrees are great if you want to be in a leadership position, but to assume that requiring every paramedic to obtain an associates or bachelors can improve compensation – that is flawed logic. The only thing they will incur is student loan debt making the career even less appealing.

Reimbursement and compensation will only increase when we convince society that we are a vital and irreplaceable piece of the overall healthcare system. All of those hospital resources are great, but they are meaningless if we don’t invest in training, support and direct EMS-minded physicians in building EMS systems of care.

Vincent Robbins: I have to admit, none of the results surprised me very much. They were all what I’m seeing around the country and in my discussions with leadership.

2. How do the findings of the third year of the EMS Trend Report align with other trends in EMS and healthcare?

Brooke Burton: Concerns around recruiting and retention seem to really align with EMS and healthcare in general. The current emerging workforce is challenging, not only for EMS, but for most industries. Employees are more mobile and less likely to stay with the same agency or even in the same profession for as long as previous generations. The current climate of work-life balance in the general workforce is challenging to achieve in our industry. I believe EMS will need to get more creative and accommodating in the future if we hope to attract and keep talented, dedicated field providers and top managers.

Chris Cebollero: The findings of this report are in line with what we are seeing in current-day EMS. As leaders, we have to make sense of this data as individual organizations and not as a career field. Knowing where the trends are in year three, we should address the needs, and make certain that we can influence years four and five.

Catherine Counts: Whether the focus is on safety, recruitment or retention, most of medicine has started to realize that a culture of accountability without blame is the best way to get there. I am excited to see EMS keeping pace with other brick and mortar healthcare entities on this topic.

The overall increase in funding is great news and mirrors trends elsewhere. However, public safety is only so protected from the wills of city and county budgets. Is administration planning for the next downturn?

James MacNeal: The trends align well with what is going on in healthcare – shrinking reimbursement, difficulty finding properly trained workers and an aging population. It should also be noted that many who were surveyed have many, many years in EMS. We are on the front end of an incredible turnover in the labor pool for healthcare. Accelerated training programs and simulation technology will be a necessity to ramp up the new workers in a rapid and safe manner.

Vincent Robbins: The trends reported were pretty much in alignment with EMS and healthcare, although community paramedicine has not caught on in New Jersey. That would be a major difference.

3. What actions do you recommend to EMS leaders based on the findings of the report?

Brooke Burton: Think outside the box. With the technology advancements in EMS over the last decade, we have a great opportunity to utilize data, in ways we never could before, to drive our practices clinically and operationally. The ability to improve our individual services and EMS in general is limitless. Focus on continual data-driven improvement and work to implement, mandate and fund systems that will assist us in better collection and utilization of patient outcome data and general operational data.

Chris Cebollero: One best practice would be for the leaders of every organization to schedule meetings with their leadership team and workforce, and discuss the results of this report. From there, develop organization-specific goals and programs to improve the organization. Next, make certain you are involved in the future editions of the EMS Trend Report for the future of our profession.

Catherine Counts: This report does a good job highlighting the discrepancy between the perspectives of managers and field personnel. I agree with the authors of the report that management should do more to gauge how employees are doing either via formal or informal measures.

But I’d also argue that effective communication needs to go downstream as well. Managers may be doing everything in their power to elicit change, but if the providers that work for them don’t know about these efforts, even at a superficial level, creating buy-in is that much harder.

Mental health is, hopefully, becoming a priority in a majority of agencies, but until the changes are implemented at the field provider level, in a way that’s accessible to all, line level staff won’t know that administration is prioritizing it.

James MacNeal: Continue to advocate for protected time for EMS medical directors to spend time in the field with EMS providers. They are the link between pre-hospital and hospital care. They can help EMS providers demonstrate their clinical value and cost savings to hospital systems. Continue to advocate for increased reimbursement. Continue to allow the scope of practice to be determined based on local needs, and allow providers the autonomy and skill set to care for their patients. No one likes knowing what to do, but not being allowed to do it. Train providers like you would want them to care for your family members. They should revert to their training, not have to rise to the occasion.

Vincent Robbins: We need to get even more active and aggressive in raising concerns about adequate funding. Payers, including Medicare, need to adequately reimburse for the services we provide.

About the panel

  • Brooke Burton, NRP, FACPE, is the quality director for Gold Cross Ambulance in Salt Lake City. Brooke has over 20 years of EMS experience working as a paramedic in rural to super urban environments and specializes in performance improvement. Brooke is a board member of the National EMS Management Association and the recipient of the American Ambulance Association 2016 award for Best Quality Improvement Program.
  • Chris Cebollero is a nationally recognized emergency medical services leader, best-selling author and advocate. Chris is a member of the Forbes Coaching Council and available for speaking, coaching and mentoring. Currently, Chris is the senior partner for Cebollero & Associates, a medical consulting firm, assisting organizations in meeting the challenges of tomorrow.
  • Catherine R. Counts, Ph.D., MHA, is a health services researcher with Seattle Medic One in the Division of Emergency Medicine at the University of Washington School of Medicine. She is a member of the National Association of EMS Physicians and AcademyHealth.
  • James MacNeal, MPH, DO, NRP, began his career in emergency medicine as a paramedic. He holds an American Board of Emergency Medicine/Emergency Medical Services certification and completed an EMS fellowship at Yale University. He is EMS medical director of Mercyhealth.
  • Vincent D. Robbins, FACPE, FACHE, is president and chief executive officer of MONOC, New Jersey’s single largest EMS and mobile healthcare shared service hospital cooperative. He also serves as president of the National EMS Management Association, sits on the Board of the SAVVIK Foundation, and is the representative for hospital-based EMS systems and chairman of NHTSA’s National EMS Advisory Council.
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