An ambulance ride to the hospital may not necessarily be the best way to improve patient outcomes in every circumstance. Community integrated paramedicine is the use of paramedics outside their customary public safety emergency response and transport roles to meet community needs and provide patient-centered health care services. To be successful, EMS providers must be allowed to practice to the full extent of their scope of practice. For example, paramedics trained to give intramuscular injections should be permitted to administer vaccines to their communities without onerous regulatory barriers. All evidence-based calls for medical assistance need attention, but not all of them are medical events that require the typical 9-1-1 emergency response. Local officials should employ proven outcome measures, rather than process measures, to evaluate the effectiveness of their EMS systems. The use of outcome measures allows agencies more flexibility to find innovative solutions to the local health challenges that best match needs to resources. For example, many cities rely heavily on response times to each and every 9-1-1 call for medical assistance as a measure of EMS quality, even though research suggests little correlation between response times and patient outcomes in most circumstances. Focusing on response times alone forces EMS agencies to place an emphasis on “getting there faster” instead of investing in system improvements and innovations that can truly improve quality of care. If regulators and local officials were to instead use outcome measures, agencies would be free to explore innovative ways to improve patient care that may be much more effective and less expensive than decreasing response times. Furthermore, investing in EMS innovation frees valuable public safety resources to respond to emergencies where there is demonstrable benefit to a quicker response.
Scott Somers, PhD Former Vice Mayor, Mesa Arizona City Council Professor of Practice, ASU College of Public Service Senior Fellow, GW Center for Cyber and Homeland Security COMMUNITY HEALTH CARE GROUPS Mobile integrated health through community EMS is rapidly emerging as a solution to prevent avoidable emergency room visits and hospitalizations. Patients who can be stabilized in their home through an escalated means of intervention are less likely to experience emergent symptoms, and with proper support and follow up through home health organizations and other community-based organizations, can remain out of the hospital. It will continue to be important to integrate the management of the care across the continuum so that appropriate care interventions, treatment, support, and education can be applied at the right time in the right setting.
We are encouraged by the development of programs in this space and look forward to
continued collaboration between EMS and home health and community-based organizations, as well as those organizations who are responsible for the payment for services and ongoing support of the patients they serve.
Scott A. Vasey Senior Vice President, Strategy Visiting Nurse Service of New York
HEALTH PLANS As we continue the evolution from volume to value-based health care, health plans should recognize the opportunity that exists within the EMS community and services they provide to greatly assist in this shift. Value, as measured by health outcomes relative to total cost incurred, can be easily achieved by utilizing and rewarding EMS agencies for assisting in the care of some of
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MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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