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EMS needs to adopt a “collaboration presence” in a changing health care environment

Command presence is well-suited to leading teams in emergency situations, but much of health care requires collaboration among experts


Dr. Ed Racht, chief medical officer for American Medical Response, explained that collaboration is different than teamwork during the closing presentation of the 10th Pinnacle EMS Leadership forum.

Image Greg Friese

JACKSONVILLE, Fla. — The necessity for collaboration in a new era of health care integration was the subject of the closing presentation by Dr. Ed Racht at the 10th Pinnacle EMS Leadership forum.

Collaboration is the action of working with others to produce or create something. Racht explained collaboration in health care with humor, enthusiasm and passion. Racht, chief medical officer for American Medical Response, explained that collaboration is different than teamwork. Each person is responsible for applying their expertise when it is needed.

The presentation pointed out barriers to collaboration in EMS because of culture, command and control, and command presence. These characteristics are well-suited to emergency response, but may not be as applicable to the health care environment as it transitions from volume to value.

Since change is happening in health care it is time for EMS to look at what we are doing and how we are doing it. The biggest change in health care for EMS, according to Racht, is how the payors – insurance, Medicaid, Medicare – perceive what it is that EMS does. Rach’s expectation is that EMS is becoming “ENS or Emergency Navigation System” and will be called upon to navigate or guide patients to the appropriate level of care.

Racht closed by asking if it is just as critical for EMS to have a “collaboration presence” to work with health care partners? In a collaboration presence experts will work together, contributing each participant’s expertise, to build or accomplish something together. For example, Racht shared the collaboration between AMR, Grady EMS, Dallas Fire-Rescue, and many others to prepare for and transport an Ebola patient in October, 2014. “Collaboration, you bet it was collaboration,” Racht said.

Memorable quote: What is collaboration?

“Collaboration is working with someone to a common goal. It is intuitively good. But EMS unintentionally frowns upon collaboration.”

“Collaboration is the new MO we all need to know. It doesn’t come naturally, but we need to work on collaboration.”

Key takeaways: Collaboration is changing health care

  • Collaboration means individuals need to shine. Additional expertise needs to be at its best at the time it is needed.
  • The public expects EMS to manage anything which exposes us to the critique of colleagues.
  • Cultural sense that reputation needs to be earned can impede collaboration.
  • Collaboration is widespread in other areas of health care, such as system of care for a specific disease condition. EMS, although a part of some systems in care, is lacking in participating in health care collaborations.
  • Collaboration allows health care systems to manage things they haven’t historically been able to manage.
Greg Friese, MS, NRP, is the Lexipol Editorial Director, leading the efforts of the editorial team on Police1, FireRescue1, Corrections1 and EMS1. Greg served as the EMS1 editor-in-chief for five years. He has a bachelor’s degree from the University of Wisconsin-Madison and a master’s degree from the University of Idaho. He is an educator, author, national registry paramedic since 2005, and a long-distance runner. Greg was a 2010 recipient of the EMS 10 Award for innovation. He is also a three-time Jesse H. Neal award winner, the most prestigious award in specialized journalism, and the 2018 and 2020 Eddie Award winner for best Column/Blog. Connect with Greg on LinkedIn.