Why social networks are crucial for the care of high EMS utilizers

EMS providers can "Identify-Report-Refer" to help improve a patient's health through strengthening the patient's social connections

SALT LAKE CITY — High EMS utilizers often have a limited social network that increases their vulnerability to personal health problems, natural disasters and other day-to-day turmoil. Michael Baker, Chief of EMS with the Tulsa (Okla.) Fire Department, described the health care system as complex and non-linear, which is increasingly difficult to navigate, and how crucial social networks are to the health care of high EMS utilizers in a presentation at EMS Today.

Baker began the presentation with a story about a patient who became increasingly isolated secondary to chronic disease, depression and addiction. The patient alienated herself from her friends and family social network and rebuilt a network with food delivery and taxi companies who were willing to bring her food, cigarettes and alcohol. The lack of a social network made the attempts at providing social services and community paramedicine futile to changing the patient's outcome.

The key function of a social network is provision of social support, which is one of the main ways social networks influence physical and mental health status. 

The key function of a social network is provision of social support.
The key function of a social network is provision of social support. (Photo/Greg Friese)

Memorable quotes on social networks

Baker studied social networks for high EMS utilizers for his master's thesis, which he drew on this research. Here are several memorable quotes from Baker's presentation.

"Social networks, not social media."

"Understanding the social networks for the people we are treating is really important for us (EMS)."

"If you don't have a social network, who do you call for help?"

"Birds of a feather flock together. We want to be with people like us. If we can work within social networks, we might be able to slow the obesity epidemic"

"A social network is a third vital sign."

Top questions on social networks for high EMS utilizers

Everyone has a social network, but their importance to EMS patients is not well understood. Baker defined social networks and how EMS providers might apply this information. Here are the answers to the top questions on social networks.

What is a social network?

A social network is not social media, like Twitter or Facebook. Social networks are connections between actors — individuals and organizations — and the ties that bring those actors together. Patients, friends, family, EMS providers, social services, hospitals and churches are just a few examples of actors. The pattern of connections, as well as the strength, between actors are often more important than the individuals who are part of the social network.

How does EMS map a patient's social network?

Social networks begin at birth and expand through life experiences. Most people are limited to about 100 social connections. It's those connections where we can share emotions, shape courses for action and create social pathways for interactions.

The patient's social network, which is a map of connections, is invisible to the EMS provider. The network structure is dynamic and connections reveal opportunities for targeting interventions to change behaviors.

Baker described a survey process to map a social network. With questions like:

  • Who are the adults you discuss important matters with?
  • Who do you socialize with? When? Where? What?  
  • What influences do these people have on your health?
  • Are any of your connections doing anything to improve their own health (i.e. quitting smoking, making it to doctor's appointments or losing weight)?

What happens when a patient loses social connections?

Patients who lose connections to a spouse, family and friends often shift their support requests to public safety. This shift puts the burden on EMS providers to lift patients off the ground, change a commode, transport a patient to doctor's appointments or monitor chronic disease conditions. A community paramedicine or mobile integrated health care program can help patient's re-form social connections with family or create new social connections to better assist with their long-term health care needs.

Losing social connections, like the death of a spouse, adds stress to the surviving spouse's health. Many EMS providers are probably familiar with stories of a wife who died a few days after her husband's death. Social isolation increases the risk of stroke. Isolation is also linked to poorer outcomes from stroke and a higher risk of mortality and morbidity.

How can EMS promote social networks?

Baker recommended several strategies to strengthen social networks. For example, neighbors checking on neighbors, especially before a severe weather emergency, can strengthen connections. A volunteer telephone care program reaches out to socially isolated individuals through regular phone calls. EMS providers, walking through a neighborhood, can distribute health, safety and disaster preparedness actions.

During the patient assessment process, EMS providers can assess a patient's living conditions, access to services and other factors which influence social networks. Promoting connections, which already exist, or creating new connections will be valuable to the patient's overall health.

An EMS provider may not always have the time, knowledge or resources to immediately solve a patient's problems from lack of social network connections. Baker recommended a three-step process.

1. Identify: Take the time on scene to understand the problem.
2. Report: Follow existing procedures to report the problem to social services or resources within the agency.
3. Refer: Enable and encourage in-depth follow-up once the field providers identify and report the problem, to refer the patient to the best resources.

Learn more about social networks

In the presentation, Baker recommended a book, an app and an example of how public safety personnel become a connection in the social network of many older adults.

Baker recommended "Connected: The Surprising Power of Our Social Networks and How They Shape Our Lives," which is an in-depth exploration of social networks by one of the foremost experts on the topic.

The Person-Centered Network app is used to screen a patient and connect the patient with available community resources. The app can map the current social network and recommend an ideal network with other actors — individuals and organizations — to assist the patient.

Baker shared the example of two police officers who made pasta dinner for a lonely elderly couple. Identifying this couple early, connecting them to other human beings can have significant long-term impacts on the couple's health.

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