Q&A: Jay Fitch on the past, present and future of EMS

On the 10th year of the Pinnacle EMS Leadership Forum Fitch reflects on the era of big data, community paramedicine, and EMS provider health and wellness

More than 30 years after founding Fitch & Associates, Jay Fitch, PhD, continues to be as passionate about improving EMS as he ever was. Fitch started the firm in 1984, after serving as a paramedic in Charleston County, S.C., and an EMS system leader in St. Louis and Kansas City.

In 2006, Fitch & Associates founded the Pinnacle EMS Leadership Forum, where leaders and innovators from EMS systems of all types could gather to network, share best practices, and learn from each other. 

This year’s Pinnacle will be held August 3-7 on Amelia Island near Jacksonville, Fla., and will feature sessions on some of the most critical topics facing EMS leaders today. Gregg Margolis, from the U.S. Department of Health and Human Services, will tackle the link between value and reimbursement. Chiefs who faced Ebola in Dallas and civil unrest outside of St. Louis will describe how their agencies responded to those difficult situations. And Fitch himself will present “Teaching the Elephant to Dance: Leading Organizational Change.”

Jay Fitch, PhD, addresses EMS leaders and innovators at the Pinnacle EMS Leadership Forum.
Jay Fitch, PhD, addresses EMS leaders and innovators at the Pinnacle EMS Leadership Forum.

The conference will also feature the perspectives of leaders from outside of EMS, including Howard Putnam, the former CEO of Southwest Airlines, whose keynote address is titled “Some Play the Game, Others Change the Way the Game is Played.”

With this year marking the tenth Pinnacle conference, EMS1 asked Fitch to talk about how the conference has evolved, how EMS is adapting to the "Big Data" era, and what other issues EMS leaders need to have on their radars.

Q: How has Pinnacle changed over the last decade, and how does that reflect changes in EMS? 

A: In 2006, several Pinnacle sessions focused on system status management and other deployment issues—topics that are still relevant to today’s service, but that are not as hotly debated. That first year featured a debate between Dr. Bryan Bledsoe and Mike Taigman on the merits of system status management. So clearly some things haven’t changed—Bryan and Mike still haven’t settled that argument. 

At that first Pinnacle, sessions like "Translating Data into Work Plans" and "QI Methodologies in Deployment" enforced the concepts of using data to drive decision-making, which is something that you’ll see at Pinnacle this year as well. One thing that has changed is the expansion of that use of data. In recent years, we’ve had sessions that talk about clinical performance indicators, using technology to enhance real-time data analysis, and much more. This year, we have sessions on performance measures in both EMS and the fire service, and almost every talk will emphasize the importance of using data to measure effectiveness and make decisions.

One thing that has never changed is that Pinnacle brings together EMS leaders who want to learn from each other, hear new ideas, share successes and failures, and come home with ways to even better serve their communities. Fire chiefs sit next to owners of private ambulance companies and realize they face many of the same challenges. Quality improvement coordinators from rural hospital systems share best practices with their colleagues in big city public EMS agencies. 

Q: You bring up the increasing use of data in all aspects of EMS. Is the EMS community where it should be in terms of technology and data collection and analysis?

A: We’ve made some huge improvements over the last several years, but EMS is still far behind the rest of the health care community. Agencies struggle to fund the technical systems we need to have in place to properly collect the information we need to measure and improve EMS systems. Only the largest EMS agencies have dedicated data and performance analysts. Many are trying their best, but have to settle for having part-time quality improvement managers who don’t receive the proper training or education.

Q. Is there data supporting mobile integrated healthcare (MIH) and community paramedic (CP) programs? Are they here to stay?

A: Many of these programs are still in the pilot phases and it’s hard to say what MIH and CP programs will look like in a decade or two decades. But they will exist. The current health care environment is one that is thirsty for ideas that take full advantage of all types of medical provider, especially those who can help keep patients out of the hospital. EMS can certainly play a huge role in that. 

The last few years have been the pilot stage, where we’ve seen some programs succeed and now hundreds of agencies nationwide launching programs to try to replicate their success. Over the next few years, we’ll see some of those programs succeed, but I think many will also struggle—that might be where we learn more about the future of MIH. We’ll find out whether small departments can have the success that large departments have had, and we’ll see exactly what funding mechanisms work, and which don’t. 

What will truly be interesting is to see if Medicare and Medicaid make any changes to how they reimburse EMS, especially in light of the six Centers for Medicare and Medicaid Innovation (CMMI) grant programs that involve EMS. At Pinnacle, we’ll hear from the leaders of REMSA, the Reno EMS system that has recently had its CMMI award extended for a fourth year. Clearly they’ve impressed Medicare and Medicaid enough to continue the program, but for others to be able to replicate that success, Medicare and Medicaid will have to make fundamental changes to how they reimburse EMS. That may take years.

Q: Data and MIH/CP get a lot of attention in EMS these days. What other issues facing EMS should we be worried about?

A: I think the health and safety of our own personnel and our patients is sometimes still not discussed enough. This year, we’ve seen far too many stories of patients and providers hurt in ambulance crashes—some because the driver fell asleep at the wheel. Fatigue has clearly been linked to an increase in the chance for medical errors and vehicle collisions—I think we’ll likely find out some day that it’s also the reason for such high rates of other medical issues in public safety personnel, from cardiovascular disease to depression. 

Along with fatigue, we simply cannot afford to ignore our own mental health struggles any more. Working in EMS can be the most rewarding job in the world, but it can also be one of the most stressful. We need to do more to help each other by talking about depression and post-traumatic stress disorder. The community must work harder to develop a public safety culture that encourages employees to speak to their colleagues and their supervisors when they struggle with these problems. One more EMT or paramedic suicide will be one too many.

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