and improve their ability to work together, across jurisdictional lines or across agency, between transporting and non-transporting providers, and between 911 and interfacility EMS units. While it is true that our lack of regional coordination is a major impediment to many of our aspirations for greater quality and integration, we find a compelling argument to be that it is only by concentrating our efforts on achieving those very same high quality goals, that we have the best chance of overcoming our fragmentation challenges. It is our sincere hope that by setting high expectations for collecting and sharing data, for measuring and reporting on quality, and for protecting patients and providers, that we will produce the conditions necessary for EMS to improve coordination at the local level, reduce variation at the state level, and unify the industry at the national level. innovation centers around integrating EMS into prevention and chronic care efforts, the core mission of EMS remains its rapid treatment and transport of acute conditions such as stroke, myocardial infarction, cardiac arrest and trauma. Even in this domain, there are many opportunities for improvement. Many regions are not meeting goals for first medical contact (FMC) to balloon times for STEMI, or FMC to needle times for stroke. 87 There are huge variations in cardiac arrest survival rates. 88 Esophageal intubations are still going undetected. New technologies and evidence- based tools exist to facilitate data collection and sharing, telecommunication, training, quality assurance, and more. However, few EMS organizations (or regional systems) have taken advantage of these new approaches in large part due to the aforementioned barriers. FOCUSING ON THE CORE MISSION While much of the current discussion on
By focusing on improving patient outcomes for acute care conditions across a region larger than any one agency, political differences and competitive interests are more likely to be overcome. This can enable better cooperation among internal EMS stakeholders in everything from alignment of policies, greater interoperability of equipment to better communication during disasters, all of which is in the interest of our patients and communities. In addition, such a focus can enable mobilization of external resources (e.g. organizations interested in stroke outcomes or trauma outcomes) to facilitate transformation of EMS into a more integrated, higher quality system. Achieving higher quality in the core emergency response focus of EMS will have the added benefit of making EMS a more attractive partner to health systems and other stakeholders seeking innovative partnership opportunities. MOVING BEYOND OUR DIFFERENCES EMS systems are community health resources and the public’s safety net for emergent and chronic health conditions. Whether an EMS organization is owned and operated by a hospital, a fire department, or any other entity, the mission of an EMS system and the type of care and services it provides ought to be similar and tailored to the needs of the community. Thus EMS should support public health, disaster preparedness and population health efforts independent and irrespective of the nature or ownership of the agency. When EMS is defined by who provides it rather than what the service provides, the differences in the type of EMS organization get in the way of collaboration with other providers and between EMS organizations. Whereas a municipal third service might view themselves as public health
87 McKeown, LA. “The Numbers Game: Door-to-Balloon or First Medical Contact? Stemi Care Still Needs Work Nationwide.” In, TCTMD (2017). Published electronically March 16, 2017. https://www.tctmd.com/news/numbers-game-door-balloon-or-first-medical-contact-stemi-care-still-needs-work-nationwide 88 Girotra, Saket, Sean van Diepen, Brahmajee K. Nallamothu, Margaret Carrel, Kimberly Vellano, Monique L. Anderson, Bryan McNally, Benjamin Abella, Comilla Sasson, and Paul S. Chan. “Regional variation in out-of-hospital cardiac arrest survival in the United States.” Circulation (2016): CIRCULATIONAHA-115.
MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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