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Roundtable: How to prepare for the changes in store for EMS

Climate change, connectivity, value-based reimbursements will shape the coming year in EMS service and delivery


We asked EMS leaders from the EMS1 Editorial Advisory Board what 2019 will bring for EMS. Here, they share their predictions, as well as tips for agencies to be prepared for the changes ahead.



From making strides in combating the opioid epidemic, to growing adoption of prehospital assessments like point of care ultrasound, to adopting alternative patient transportation models, 2018 has been a year for change, growth and optimism in EMS.

We asked EMS leaders from the EMS1 Editorial Advisory Board what 2019 will bring for EMS. Here, they share their predictions, as well as tips for agencies to be prepared for the changes ahead.

Now is the time to plan for how climate change will impact your community

Climate change will literally be a hot topic for EMS in 2019 and beyond, though I doubt it will receive the attention it deserves from field providers and EMS leaders. Worst ever flooding, hurricanes and wildfires – all a result of climate change – have caused significant loss of life in 2017 and 2018, disruption of services and evacuations of hundreds of thousands of people.

It’s very likely that changing weather patterns, severe weather events and catastrophic natural disasters will be the new norm for fire, EMS and law enforcement. Though few of us will be directly impacted, there will be far-ranging impacts on all of us because of the interconnectedness of transportation networks, resource allocation decisions, and costs of housing and commodities.

Apply the when/then approach to your department’s strategic planning for staffing, capital investment purchases and station building and remodels:

  • When our community is threatened by rapidly encroaching wildfire, then a mandatory evacuation order needs to be conveyed to all residents.
  • When storm surge exceeds all known records, then our personnel need equipment and training to rescue hundreds or thousands of citizens stranded in their homes and on the roadways.
  • When floodwaters make one or more stations inhabitable for personnel and apparatus, then our plan to reposition into temporary stations will be implemented.
  • When officers, paramedics and firefighters lose their homes to a natural disaster, then we will make sure their families have shelter and communication with their loved ones for as long as it takes to rebuild their homes.

Now is the time to create and practice a mandatory evacuation communications system that warns citizens to flee for their lives. Now is the time to plan, equip and train for the rescues associated with severe weather events. Now is the time to plan for major operational disruptions.

Climate change is no longer a question of “if.” It’s just a matter of “when” climate change will directly impact your community.

Greg Friese, EMS1 editor-in-chief, educator, author, paramedic

Be intentional in EMS mentorship

The top things that will impact EMS are:

  • Standardizing the name “paramedic”
  • Requiring degrees for EMS
  • Clinical research
  • Community paramedicine
  • Wellness/resilience
  • Mentorship

The biggest change? Mentorship. The need for mentorship has reached a critical level and will be the hot topic of 2019. Exciting changes are just around the corner. We will see key players joining the EMS mentorship initiative in 2019. We can no longer afford to do things the way we always have. We need to be as intentional in mentorship as we have been in education and documentation.

As EMS evolves, the conversation is beginning to change into more “big picture” discussions. While clinical topics will continue to have their place, we – as a whole – are questioning the health of the EMS community. By health, I’m talking about the Pulse of EMS (pun intended).

Are we healthy as practitioners? Conversations about wellness, resilience and mental health are becoming more common. And, are we healthy as an industry? We’re challenging how we treat patients, where we take patients, and “who” we are.

Mobile integrated health and community paramedicine continue to take center stage and EMS’s role in the community will evolve.

Kris Kaull, vice president of marketing, Pulsara, EMS1 co-founder, paramedic

Value based service bolsters community paramedicine

2018 was a good year for the development of EMS on the community paramedic front. As we move into 2019, we have to now focus on global payment for community paramedicine for the field. Many MIH programs are getting funding from grants, and local pilots with payers, we now need to focus our efforts to getting this new service line a standard payment for home visits. All the dominos are set, we just have to flick that first domino and they will fall in our favor.

Healthcare has been moving towards a valued based service model for some time; however, there are hospital systems that are hanging on to the concept of fee for as long as they can. EMS leaders need to shift their mindset and prepare today for the inevitable shift in showing value for reimbursement.

Community paramedicine programs have been in existence in our career field for over a decade. It is now time to get on the train of the community paramedicine transition. 2019 will be a breakout year for payment for our career field.

If you have an MIH/CP program, ensure that you are collecting outcome metrics along with patient satisfaction scores. For agencies that are looking to develop a program, start off by looking at your own frequent flyers and determine how to guide them to the resources necessary to improve their quality of life. There will be tons of questions in the initial development of your program, so find a mentor program to assist you in learning the ins and outs of developing and running a successful program.

Chris Cebollero, EMS leader, author, paramedic and advocate

Automation and connectivity will impact inventory, practice

I think that we’re going to see more automation in EMS, from dash cams that send info in real time to automated inventory systems. Even if they aren’t widely adopted in 2019, I think we’re going to see such systems advertised and promoted more.

We’re getting to the point of universal connectivity. Everything is a “smart” device that is able to be connected to something else. It won’t be long before charting software is able to send a needed item inventory to an automated supply dispenser.

To be prepared for these advances, clearly communicate with staff well in advance of any changes. Change is easier for people to accept if they know that it is coming and understand why it is being implemented. Communication is key to getting staff on board and reducing their stress levels. The less agencies communicate with their staff, the more change will be resisted.

Ann Marie Farina, president, The Code Green Campaign, paramedic

Training and education on ePCR narrative documentation

Re-emphasis on and tougher scrutiny for ePCR narrative documentation, I believe, will find itself spotlighted in 2019.

As ePCR platforms have become the norm, providers seem to have become more lazy about documentation. Rather than providing a full, descriptive and useful narrative, the drop-down choices, check boxes, and fill in the blanks have caused providers to lose sight of the value and importance of the full narrative. Providers have become more inclined to assume that the other modalities of the ePCR make narrative documentation unnecessary. Nothing could be farther from the truth.

As licensure agencies and civil litigators become more aware of the deficiencies – as they have in 2018 and certainly will in 2019 – both will be more inclined to capitalize on them. Licensure agencies, I believe, will be more likely to penalize providers where documentation is in question. Worse yet, civil litigators will use more and more deficient narrative documentation to either hit provider/defendants harder and dig deeper into agency pockets, or use those deficiencies to deeply embarrass and discredit provider/witnesses in court or at depositions.

Training and education are different, but both important. EMS providers can be trained to do most anything; however, education is what gives any training meaning. Training providers to administer a drug, for example, was never as important as teaching them why the drug is indicated in the first place. It is no longer enough to train your people on documentation.

In 2019, as I see it, narrative documentation will only improve when providers have a better, stronger, more usable understanding of why they are writing a narrative and what it should include. A fundamental working understanding of how the law applies to them and their narrative documentation personally will, ideally, provide the kind of motivation they need to be better at it.

David Givot, defense attorney

Innovate in recruitment and retention

Where should we set the education bar for EMS? Should paramedics have an associate degree or a bachelor in science? As EMS struggles with recruitment and retention, will a call for higher education levels bring the unintended consequence of luring potential students to more lucrative professions within the healthcare arena? Or is this a necessary step in the professional ladder in the house of medicine?

Regardless what you think about how much better a paramedic will be after completing an associate degree or bachelor degree, the reality is that we’re requiring an ever-expanding breadth of knowledge and skill out of our EMS providers.

I suggest EMS systems and educational institutions innovate in recruiting and training the next generation of EMS providers so that we can attract an audience that matches the realities of the job and the great expectations every stakeholder has of how EMS adds value to patient care and outcomes.

— Gustavo Flores, director at Emergency & Critical Care Trainings LLC, physician, flight medic

Putting the system in system of care

I suspect systems of care around stroke will be the next big topic, particularly as it relates to LVOs. While it’s always been a big topic in EMS given how critical these patients are, growth in the availability of thrombectomy, a widened last-known-well window to 24 hours, and an increasing use of telemedicine technologies intended to create efficiencies means that every EMS agency should be re-evaluating their stroke treatment and transport protocols.

The place where EMS can probably make the biggest impact is their ability to truly put the system in system of care. While every hospital and healthcare conglomerate is incentivized to provide services to these patients, the reality is that there aren’t that many patients to go around.

As with any other type of high acuity, low volume patient population (trauma, cardiac arrest, etc) EMS has the chance to control the threshold at which we transport patients to specific hospitals. In fact, we have an obligation to our patients to make sure they are taken to a facility that offers them the best chance for a full recovery. So if this means dictating a specific accreditation, 24-hour neurosurgery availability, or mandatory participation in QI/feedback to the EMS agency, so be it.

Catherine R. Counts, health services researcher

Provider mental health is in the spotlight

For me, two things stand out as coming events of 2019; increased focus on crew welfare and wellness, and technological innovation.

In recent years, provider mental health has been a focus. With advocacy groups like The Code Green Campaign leading the way, EMS leaders have begun to shine a spotlight on the problem of provider mental health. Awareness of the incidence of depression and PTSD among EMS and public safety professionals has made our profession aware of the problem, and the next step will be the institutionalization of mental health programs. More robust EAP programs, peer support and better coverage of mental health in employee benefits is next, and some agencies are already taking those steps.

Although we are mentally and emotionally tired, we can’t ignore the physical fatigue that is far more common. Industry leaders have trumpeted the need for fatigue mitigation policies, shorter shifts, and mandated crew rest, and many larger EMS agencies have begun to implement those changes.

And while groups like The Code Green Campagin are crowdsourcing mental health support, we’re also crowdsourcing EMS care and technology. POCUS is becoming more and more affordable, as is video laryngoscopy. We have EMS agencies partnering with Uber and Lyft to handle those non-emergent transports, and smartphone apps like PulsePoint and Pulsara are increasing connectivity and empowering citizen first response. Cardiac monitors like the Tempus ALS incorporate more robust connectivity in a small, affordable package, EMS agencies are using Alexa in their ambulances, and we’re connected to an extent that we never have been before. Expect that trend to continue into 2019 and beyond.

Kelly Grayson, paramedic, educator, conference speaker and Inside EMS co-host

What do you see as the big issues EMS will face in 2019? Email your predictions to