Why EMS agencies must embrace MIH before starting a program

Community paramedicine is a way of viewing prehospital providers’ roles, and departments that simply jump on the bandwagon will likely struggle


A department that isn’t already embracing MIH concepts will struggle to do so simply by creating a new community paramedic. MIH is not a certification, a line in the budget, or a medical procedure; it is a way of viewing prehospital providers’ role in the healthcare system and their responsibility to the people they serve.

From the headlines it’s clear that EMS leaders across the country have embraced mobile integrated health care (MIH). What’s not clear is whether they are embracing the principles behind it or simply jumping on the MIH bandwagon.

Some cities and counties across the country have developed fantastic programs. Yet there’s a danger that too many departments will follow them and create MIH programs simply to create programs. They will add community paramedics, who will try to prevent unnecessary ambulance calls and hospital readmissions. Both are worthy goals, but before rushing to create new positions, programs, and protocols, EMS agencies can utilize the concepts of MIH in their daily operations. Through training and education, departments can empower every EMS provider to provide more patient-centered care on a daily basis.

Assisting with basic medical and social needs

In one department where I serve, providers are regularly recognized with nominations for "Call of the Quarter." Every three months, the "winners" are chosen from the nominees by a group of local residents. Typically, the stories are dramatic — the patients that most closely resemble what we see on television shows and in the news: cardiac arrests, horrible traumatic injuries, rapid sequence induction (RSI) intubations.

One quarter, we nominated a pair of paramedics who didn’t start an IV or push any meds. They found an elderly patient, at home, who didn’t have an acute problem. Instead, what the patient needed was assistance with basic medical and social needs. The nominees spent an hour in the patient’s home, making phone calls to physicians’ offices and family members. In the end, they helped the patient much more than if they had simply taken him to the emergency room. They also won the Call of the Quarter award.

This was MIH at its finest hour, even though the paramedics involved may have never heard that term before. The providers didn’t take these actions because of the Affordable Care Act or changing reimbursement schemes. The department couldn’t bill for the services and there was no carefully calculated estimate of costs that were avoided. But I can’t remember hearing many stories during my years in EMS that made me more proud to be associated with an agency.

As EMS leaders struggle with how to implement MIH programs, they should first ask: "Are we doing everything we can with our current resources, personnel, and protocols?"

A department that isn’t already embracing MIH concepts will struggle to do so simply by creating a new community paramedic. MIH is not a certification, a line in the budget, or a medical procedure; it is a way of viewing prehospital providers’ role in the healthcare system and their responsibility to the people they serve.

But having the right attitude is not always enough. Agencies can measure their dedication to the principles of MIH — providing the right service, at the right time, for the right price—and should be doing so whether they have an MIH program or not. For departments looking to start a program, these measures may be critical in showing policymakers that we are already performing these interventions on a daily basis, but without the training, education, and resources we truly need.

Expand data collection efforts

The importance of collecting data has become obvious to most EMS leaders, but those databases need to include more than response times and survival rates. A simple start toward MIH would be for EMS agencies to begin tracking how frequently their providers make referrals to adult protective services, local aging assistance programs, and other social services. Measuring these and other referrals allows agency leadership to report them to policymakers and show the street-level providers that management values these interventions which, although not as glamorous as intubation, can often make a bigger difference in patient’s lives.

Measuring quality means measuring how people’s lives are improved; rather than the number of advanced skills are performed. It doesn’t take a community paramedic program to start demonstrating how MIH interventions are improving the health of the population.

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