“If you can’t fly then run, if you can’t run then walk, if you can’t walk then crawl, but whatever you do you have to keep moving forward.”
Driven mostly by the needs of the community, EMS, in its roughly 40 years of existence in the United States, has evolved substantially. From Cadillac ambulances and the famous TV show Emergency to pre-hospital ultrasound and community paramedics, the profession continues the march of progress. As before, EMS once again finds itself at a crossroad, attempting to navigate a sea change within the health care and societal landscape.
Everyday providers find themselves having to straddle the gap between public safety officers and agents of the health care system. Along these lines, it seems more and more like ambulance services are morphing into one of three models of EMS delivery – large commercial services, fire-based services and hospital-based services. Each model wishes to fulfill the goal of providing high quality pre-hospital care but has its own nuances, difficulties and considerations. In many areas of the country there currently exists a tug-of-war between different models for dominance. Areas that have not seen this conflict directly, certainly will in the future as pressure on the health care system mounts. This lack of solidarity makes it difficult to imagine and shape future models of health care delivery.
One group attempting to lead the transformation are the EM and EMS leaders at Mount Sinai Health System and UC San Diego, who have partnered together to identify and address “the regulatory, financial and technological obstacles to improving our nation’s EMS systems.” Through their collaboration, the group hopes to “create a pathway for the widespread implementation of best practices and delivery system reforms in emergency medical services across the U.S.” What this is likely to look like is a consensus document that expounds best practices and a role for EMS within the health care ecosystem. It would be hubris not to recognize that one of the greatest features of EMS is its flexibility to adapt to the vagaries of every local. Still the profession desperately needs a vision of where to grow towards and this group is uniquely positioned to produce that vision. Their efforts would not be possible without a grant from HHS. Importantly, the folks running the project want your input (survey). Only by participating can we not just improve the lives of others, but our own lives as well.
A few things are for sure. EMS in the future will be proactive rather than reactive. Much as the fire service has done in reducing the number of fires through new building codes and better education, EMS will play a role in reducing pain and suffering by targeting likely candidates for readmission, helping patients understand their medical conditions, and providing preventative care. Providers, from EMTs to paramedics, will be expected to have greater knowledge, perform more sophisticated procedures, work as part of complex medical teams and handle a larger scope of responsibilities. (This is on top of all the hats EMTs and paramedics normally wear.) And last but not least, the path forward will be difficult, as it should be, as nothing that isn’t worthwhile is ever easy.
EMS Innovations Grant Website
UC San Diego Press Release (Jan. 7, 2015)
Mount Sinai Health System Press Release (Jan. 7, 2015)