providers, a fire department is more likely to view themselves as public safety officers. While a commercial agency or hospital-based service is more likely to identify as health care providers, a volunteer agency may be more likely to identify as community advocates. When there is too much focus on the politics of identity, it becomes hard to agree on mission, vision, and values. However, patients are indifferent to the type of agency an EMS provider belongs to and are simply focused on receiving care. While the medical needs of populations of patients may vary, it is more often the variability in resources of a community that drive the need or opportunity for EMS to provide innovative programs. It may seem reasonable for certain types of EMS agencies to decide that innovating to meet the needs of or fill the gaps in a community is optional. It is not! It should not be optional for EMS agencies to strive to improve patient outcomes for cardiac arrest, STEMI, stroke, COPD, asthma or any other condition. It should not be optional for EMS agencies to work to improve their notification process or their transmission of prehospital information to the hospital or coordination of care with the patient’s primary care physician. It should not be optional for EMS agencies to seek to improve and constantly reevaluate their community’s resilience to disaster. If the “what we do” is the same across all EMS system types, then EMS will be able to speak with a unified voice focused on the care of patients and populations. One small step that local agencies can take to build cohesion is to come together to form or participate in a group purchasing cooperative. This would both improve negotiating ability for prices of drugs, and equipment, and help bridge cultural gaps and possibly improve interoperability of technology and equipment.
POOLING DATA TO CARE FOR POPULATIONS The usual approach to EMS data is to focus on each incident and each patient encounter as unique, without considering either the longitudinal care of the individual patient, or the cross-sectional evaluation of what is occurring across a population at any given point in time. Multiple agencies working in the same county, city, or community each possess important subsets of the information needed to understand the care being provided by EMS to the population in a given geographical area. However, individually, none of them would have enough of the picture to understand all that is occurring, and would be hard pressed to address those issues unilaterally. One step communities faced with hyper- fragmentation can take to seek improved quality and a greater environment for innovation in EMS would be to incentivize, facilitate or require the sharing of information between EMS agencies, and with the local hospitals and local government agencies. By combining their data, the EMS community along with local governments and health care partners would be able to improve a region’s syndromic surveillance and situational awareness. In addition, administrative and medical oversight of EMS in a given area could be better coordinated and there could be improved operational efficiencies across a region by reducing duplication of services and unwarranted variation in care. It could also lead to a greater ability to measure outcomes and effects of new interventions and to enable more coordinated care for individuals and a population-based approach to health care. As a byproduct of coordination among EMS agencies, there may be increased willingness of health care and public safety stakeholders to collaborate with EMS on population health and other initiatives.
MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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