Can EMS systems embrace injury prevention as a core value?

N.C. advanced practice paramedics recognized, awarded for promoting injury prevention and safety

As I write this, I’m flying back from the 30th anniversary of the EMS Today conference, held at the beginning of March in Baltimore. Oh, how it’s grown! In 1982, the first EMS Today drew about 125 dedicated people to the Muhlenbach Hotel in downtown Kansas City, along with a dozen exhibitors. Now, with close to 3,500 participants, it’s an impressive, international affair, with 170 educational opportunities, dozens of organizational meetings and some 257 companies exhibiting.

The late Jim Page created EMS Today under the auspices of the nonprofit ACT (Advanced Coronary Treatment) Foundation. I was one of the team members Jim enrolled to help develop the conference. Jim’s vision was to make it an event where EMS leaders (and aspiring leaders) could challenge the status quo, share insights and focus attention on a patient-centered approach to EMS.

In 2002, on the 20th anniversary of EMS Today, I was proud to stand on the stage with Jim and announce the first inaugural Nicholas Rosecrans Award for Excellence in Injury Prevention and Safety. The award, born in the tragic, preventable drowning of a little boy and the enlightenment of the paramedic who worked the call, Paul Maxwell, is true to Jim’s vision. It recognizes leadership and best practices in individuals or EMS agencies that promote injury prevention and safety for the greater good of the community.

This year’s award went to Wake County (N.C.) EMS for its innovative Advanced Practice Paramedic (APP) program. Accepting on behalf of the program and director Brent Meyers, M.D., Skip Kirkwood, Wake County’s EMS chief, explained that the program was the right thing to do in terms of patient care, eliminating preventable 911 calls, reducing costs to the health care system overall and providing a new career path for the paramedics who want to keep doing what they love: caring for people.

Here is how the Wake County program works:

APPs are specially trained to deal with the most sensitive patients, preventing emergencies in some high-risk patient populations, and seeking further care for those patients who may be better served at locations other than EDs. With greater experience in critical care interventions, they augment a paramedic-level ambulance response, responding in small, non-transport vehicles to the scene. APPs engage in preventive home-visits designed to decrease medical crises and improve the overall well being of patients. They also identify and place mental health patients and substance abusers in facilities more appropriate for their care than the emergency department.

I asked Skip if the 14 paramedics enlisted as APPs appreciate the public health and injury prevention aspects of their role as much as the critical care interventions. He said, “I can tell you this—they consistently report the most job satisfaction of all of our paramedics.”

The goal with the Nicholas Rosecrans award has been to promote the idea that injury and illness prevention is central to the mission of EMS, just as fire prevention has been adopted by the fire service. That means injury prevention needs to be institutionalized in training, budgets and especially system design.

As Skip described the program, “It aspires to be where community policing and fire prevention intersect with EMS.” That sounds about right to me.

Keith Griffiths can be reached at

To view an informational video about Wake County’s Advanced Practice Paramedic program, visit

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