AVOIDING PITFALLS FILL UNMET NEEDS
is true across most clinical conditions. Several evidence-based consensus guidelines 29 have been developed that help establish basic standards that every EMS agency should seek to achieve. Yet the implementation of these guidelines and other best practices has proved difficult and may be due in part to a multitude of factors including a large number of small agencies, lack of involved medical direction, limited data collection and few resources dedicated towards quality improvement. Indeed, these are the same barriers that we have described elsewhere in this document as inhibiting innovation at large. In particular, EMS education will play an important role in improving the quality of EMS care. Thus, as a national EMS industry, we should strive to reduce unjustified variation between EMS systems. Doing so will take significant effort across all parts of the industry but will create the substrate for a far greater future for EMS – one in which the care we provide is high quality, consistently reliable, and determined by medical evidence, and where new ideas can be rapidly tested and the best ones can be disseminated to provide the greatest help to our patients. INNOVATION FROM EVERY PERSPECTIVE The following section contains perspectives from a number of stakeholders within and beyond the EMS industry, addressing challenges to and opportunities for innovation. EMS PROVIDERS EMS responders are intensely creative people. We spend every shift adapting and innovating to some degree. No two patients are exactly alike. While commonalities exist, there is no cookie-
Innovation in EMS often seeks to fill gaps in the way health care is delivered to communities. As such it is sometimes seen as conflicting with the interests of other providers, such as home health care or nurses. The current system provides enough gaps in patient care that EMS leaders should focus on providing services that are not currently offered by any industry before competing over turf with fellow health care providers. Many leaders in EMS innovation have found that coordination with home health care and nursing agencies has produced valuable allies in improving the way EMS and the system as a whole cares for its patients. QUALITY FIRST, THEN INNOVATION While in some cases, promoting a new innovation can be synergistic with improvements in operational performance or clinical quality, if not they can sometimes be in conflict or compete for limited resources. While it is the clear and expressed purpose of this document to promote innovation at the local level, an agency should not prioritize the development of new modalities of providing care over the implementation of known best practices and evidence-based care in its system. In most communities, it will take as much or more of the same entrepreneurial spirit, leadership, passion, strength, resources, and collaboration to move current EMS practice to what has been proven more effective elsewhere than it will to test some new innovation that is as yet unproven.
REDUCE UNJUSTIFIED VARIATION Today, there exists a significant amount of
unjustified variation in the quality of care delivered between EMS agencies. This has been most well described in the cardiac arrest literature but
29 “National Model EMS Clinical Guidelines.” National Association of State EMS officers. Last modified October 23, 2014. http://nasemso.org/Projects/ModelEMSClinicalGuidelines/documents/National-Model-EMS-Clinical-Guidelines-23Oct2014.pdf.
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MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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