BARRIERS TO REGIONAL COORDINATION SIGNIFICANT VARIATIONS IN SYSTEM DESIGN AND CLINICAL PRACTICE It’s often been said that “if you’ve seen one EMS system, you’ve seen one EMS system.” This quip alludes to the fact that there are often significant differences in system design between EMS systems in different jurisdictions. However, the truth is that there are even significant differences in training, technology, policies, protocols, medical oversight, and perspectives of different agencies operating in the same geographic area and serving the same patients. Unwarranted variations in care in medicine have been associated with inefficient utilization of resources and lower health care quality. 83 This likely holds true for EMS as well. FRAGMENTATION OF EMS AT EVERY LEVEL Most EMS agencies serve a defined geopolitical area that is often smaller and incongruent with hospital catchment areas. In many communities, it is not uncommon to have dozens of small EMS agencies bringing patients to the same hospital. At the local level, the hyper-fragmentation of EMS service results in inadequate harmonization of patient care practices and operations between different agencies in the same or in nearby jurisdictions. If the EMS agencies in that market are unable to collaborate, it could adversely affect a community’s ability to respond to large-scale events, particularly if triage schemes, or other policies and procedures are not standardized. Further, it becomes difficult to expect the hospital to be able to participate in
innovations in the EMS arena when most proposed pilots would only impact a small fraction of their patients. Likewise, at a state or regional level (multiple counties that are served by the same hospital or specialty care resources), health plans and other health care stakeholders need to consider initiatives that serve their customers. If neither a single agency dominates the region nor is there a highly coordinated multi-agency EMS system, EMS is likely to be overlooked as a viable partner in regional efforts to come up with innovative or creative health care solutions. The tradition of home-rule contributes to a situation in which few governmental entities or agencies are willing to cede control, whether or not finances or public health or safety could be improved. Within the industry, EMS stakeholders at local, state or national levels, tend to be significantly divided across multiple planes. There are often separate labor unions for different levels of providers or officers; there are separate professional societies for EMS educators, managers, physicians, and providers; and there are separate lobbying groups based on the type of EMS organization. Perspectives offered to external stakeholders can vary dramatically between commercial, hospital- based, fire-based, public-utility, non-profit, and volunteer EMS agencies. The political infighting between these groups is often a barrier to regional coordination, interdisciplinary collaboration, and ultimately to innovation itself.
83 Wennberg, John E. “Forty years of unwarranted variation—and still counting.” Health Policy 114, no. 1 (2014): 1-2.
MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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