Some Thoughts on EMS Today

Now that I got my charger fixed for my Netbook I can finally share this post that I wrote on my train ride back from EMS Today 2014.  Enjoy!!

Here I sit on the train ready to head back home after another series of adventures at EMS Today.  Although the vibe at this year’s conference was different than years passed, the one factor that remains constant is there are a number of people who are extremely motivated to do more than just spend their 40 hours on a truck, collect a paycheck, and go home.  For the most part, the people who attend these conferences are doing so in the hopes that they become better clinicians both for themselves as well as their patients.

Lines were drawn in the sand at this year’s EMS Today conference and the goals and direction was apparent from the get go.  The major focus of many of the classes was what some call community paramedicine which others have termed mobile integrated healthcare.  There were  a number of classes about branding, data, attitudes, and expectations that should be important to a service as well as a paramedic as they prepare themselves to provide care outside of the traditional “emergency” environment so many of us are active in today.  While the classes and churiculum are great, however, I want more.

This year’s conference marked the 8^th major one that I have attended dating back to EMS World EXPO in Dallas in 2010.  I have seen a number of fads come and go.  I remember just a few years ago when the exhibit hall was full of venders looking to sell everyone on the importance of their products when it came to prehospital ultrasound, something that a lot of us thought might have a practical use in the field.  For the past two or three conferences, community paramedicine has been showing up more and more.  I remember last year, when NAEMT’s EMS on the Hill Day was canceled, Chris and Anne Montera (then known as Anne Robinson) along with a team from MedSTAR in Texas lead by Matt Zavadsky held a half day workshop for the NAEMT delegates to talk about what many felt was going to be the next evolution of EMS in the United States today.

So here we are, a year later, hearing more of the same, just like we heard at the past two conferences.  Here we are hearing about how we are doing further harm to our patients by strapping them down to backboards.  It is time to try and figure out why things are not changing and evolving faster.  The people giving these lectures are not some Tom, Dick, or Jane who walked in off the street with a powerpoint in hand.  They are medical directors, they are Eagles, they are well respected leaders within the EMS community who have done a ton of research to help back up their positions, yet services are still reluctant to push forward.

Granted, mobile integrated healthcare is a pretty big undertaking.  There is a lot that still needs to go into it like fee structures, and figuring out how much of what kind of additional training is adequate.  Important battles though, like the debate over backboards or finding some unified banner for all of us to stand under still rage on.

Are the problems that I experienced with an evolving system in Massachusetts the same in other places?  Here is a prime example of what I am talking about.  Despite the existence of evidence that CPAP was beneficial for patients, and could ultimately make a difference for patient outcomes, Massachusetts’ Office of EMS and their physicians council were reluctant to approve it as a treatment modality until a service got a special project waiver and moved to everyone that CPAP not only worked, but it worked in Massachusetts, as if the air was different, or our CHF patients presented differently.

I guess my ultimate gripe is while I love the message, I want to hear more stories of battles won.  I want to see us adding to the almost 400 community paramedic programs already in existence around the country.  Did you know there were that many?  Because I sure as heck did not.

To our leadership: it Is time for push forward with fresh ideas.  To the medical directors: It is time to support ideas that are backed by evidence to help us add to or in some cases subtract from the treatment we provide in the best interest of our patients.  To the government: If we are not going to clean up the mess that has already been started, can we at least try and prevent it from getting worse?  Let’s get together and figure out a better way to financially support prehospital care that does not involve the act of transporting a patient to the hospital.  And finally, for the providers: Prepare yourself for tomorrow.  Train.  Read.  Practice.  Big changes are on the horizon, and it is our responsibility to be ready for them before they happen.