of response to large events. EMS of the future should improve its victim tracking and use technology to seamlessly coordinate the movement of patients to nearby hospitals and create a single portal for patient information querying. EMS leadership at the scene needs greater fluidity and reliability in the communication between EMS, hospitals, and other public safety agencies. In light of the growing number of active shooter and other domestic terrorist events, enhanced training, communications and personal protective equipment will be essential to assure safety in the increasingly militarized environment in which EMS providers find themselves. For disease surveillance and other purposes, EMS data integration with public health could improve efforts around investigative epidemiology and disease outbreak detection. EMS could also improve emergency preparedness and community resilience through community or personalized in-home education, especially for the elderly and homebound. innovative models of providing care that expand the role and increase the value of EMS systems to the community, to patients, and to the health care system. 19,20 The EMS Agenda for the Future published in 1996 envisions EMS treatment to be a part “of a complete health care program,” with “finances … linked to value.” 21 In 1997, Neely et al. articulated the Multiple Option Decision Mobile Integrated Health Care EMS has long been interested in pursuing
Point model which allows for an EMS call to be responded to with a variety of transportation options and to a variety of destinations. 22 In 2001, a brief article in the Rural Health News described the idea of a “community paramedic” that would “integrate with the larger health care sector.” 23 In 2006, the Institute of Medicine recommended detaching reimbursement for transportation from the assessment and medical treatment rendered by EMS and the funding of demonstration projects to explore alternatives to existing models of care. 24 In recent years, all of these innovative ideas and efforts around expanding the role of the EMT and paramedic have manifested in a movement under the banner of mobile integrated health care (MIH). While the precise definitions of this term is not entirely agreed upon, we will use the definition recently laid out by the National Association of Emergency Medical Technicians (NAEMT) as follows: [MIH] is the provision of health care using patient- centered, mobile resources in the out-of-hospital environment in a coordinated manner with physicians, hospitals, and other providers. 25 The promotion of new and innovative models of EMS care in which existing health care resources are being redeployed to better meet patient needs is thus very much in line with the goals of the ACA and is now beginning to attract the attention from health care systems, payers, and providers beyond the EMS community.
19 Frank Pasquier, Health Care Access: Innovative Programs Using Non-Physicians (Washington, D.C.: United States Government Accountability Office, 1993). 20 “Discussion Paper on Development of Community Paramedic Programs.” Joint Committee on Rural Emergency Care (JCREC), National Association of State Emergency Medical Services Officials, National Organization of State Offices of Rural Health. Last modified December 2010. https://www.nasemso.org/Projects/RuralEMS/documents/CPDiscussionPaper.pdf 21 Ibid. 2 22 Neely, Keith. “Demand Management: The New View of Ems?” [In eng]. Prehospital Emergency Care 1, no. 2 (1997): 114-8. 23 Rowley, Tom. “Solving the Paramedic Paradox.” Rural Health News. 8, no. 3 (2001): 1-6. 24 “Emergency Medical Services at the Crossroads.” In Future of Emergency Care Series edited by Gail L. Warden. Washington, D.C.: Institute of Medicine, 2006. 25 “Vision Statement on Mobile Integrated Healthcare & Community Paramedicine.” National Association of Emergency Medical Technicians. Last modified February 28, 2014. http://www.naemt.org/Files/CommunityParamedicineGrid/MIHVision022814.pdf.
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CHAPTER 1
MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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