ADVANCES IN EMS COMMUNICATION Significant progress is being made in the area of EMS telecommunications. The Department of Transportation has designed a transition plan for a next-generation 9-1-1 (NG9-1-1) system, 135 which establishes the foundation for public emergency communications services in a digital, internet- based society. In addition, Congress in 2012 allotted $7 billion and 20 MHz of valuable radio spectrum to build the First Responder Network Authority (FirstNet) as an independent entity within the National Telecommunications and Information Administration. The purpose of FirstNet is to establish, operate, and maintain an interoperable public safety-grade broadband network. Each state will need to provide a radio access network that can connect to the FirstNet network core. To achieve more immediate improvements, local and state governments could improve the environment for innovation by investing in wireless broadband for EMS providers on public, commercial carrier, and government (Wi-Fi, LTE & FirstNet) networks. Unfortunately, while such networks provide exceptional service for general use by the pubic, their ability to perform mission-critical, patient-critical tasks during large-scale events when the communications system is severely stressed is considered inadequate.
One example of the use of EMS data to inform community-based providers is the San Diego Community Information Exchange (CIE). In this social data exchange, certain demographic EMS data (e.g., numbers of EMS transports) are confidentially shared with participating community-based organizations (CBO). 129 Early results demonstrate that when housing providers were able to see their clients’ frequency of EMS use, they modified their approach to case management and achieved more stable housing outcomes. The CIE currently confidentially shares a discrete set of RAP community paramedic data regarding common clients with ten CBO’s, two hospitals, and the local Meals-on-Wheels. EMS data can be used to assess outcomes for a variety of other complex challenges. For example, the number of EMS transports is an accepted metric to assess interventions for serial inebriates, 130 chronically homeless, 131,132 and other frequent users. 133 In May 2016, a bill was introduced in CA which would require that homeless service providers submit annual reports on the number of ambulance transports, ED visits, hospital days and days of incarceration for all homeless children, youth, and adults. 134 If this is the metric, then at a population level, it seems intuitive that CMS or others will create value-based care incentives to states or communities that implement innovative approaches involving EMS systems.
128 “Accountable Health Communities Model.” Centers for Medicare & Medicaid Services. Last modified June 1, 2017. https://innovation.cms.gov/initiatives/AHCM 129 “CIE, a technology of 2-1-1 San Diego, Provides Context for Care.” CIE San Diego . Accessed June 28, 2017. http://ciesandiego.org 130 Dunford, James V., Edward M. Castillo, Theodore C. Chan, Gary M. Vilke, Peter Jenson, and Suzanne P. Lindsay. “Impact of the San Diego Serial Inebriate Program on use of emergency medical resources.” Annals of Emergency Medicine 47, no. 4 (2006): 328-336. 131 Larimer, Mary E., Daniel K. Malone, Michelle D. Garner, David C. Atkins, Bonnie Burlingham, Heather S. Lonczak, Kenneth Tanzer et al. “Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems.” Jama 301, no. 13 (2009): 1349-1357. 132 “United Way’s Homeless Initiative, Father Joe’s Project 25, Saves Lives, $3.5 Million.” Father Joe’s Villages. Accessed June 28, 2017. http://my.neighbor.org/united-ways-homeless-initiative-project-25-saves-lives-3-5-million/ 133 Tadros, Anthony S., Edward M. Castillo, Theodore C. Chan, Anne Marie Jensen, Ekta Patel, Kerin Watts, and James V. Dunford. “Effects of an Emergency Medical Services–based resource access program on frequent users of health services.” Prehospital Emergency Care 16, no. 4 (2012): 541-547. 134 “An Act to Add Chaper 7 (commencing with Section 8260) to Division 8 of the Welfare and Institutions Code, relating to homelessness.” California legislature . Last modified February 18, 2016. https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB2256 135 “Next Generation 911.” 911.gov. Accessed June 28, 2017. http://www.911.gov/911-issues/standards.html
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MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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