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From the May 2010 Issue | Thursday, April 29, 2010


Meeting of the MINDS
The industry’s best and brightest forecast the future at EMS Today 
Once again the EMS Today Conference & Exposition, held March 2–6 in Baltimore, didn’t just take the pulse of the industry; it was several steps ahead of the beat.

During sessions, leaders in political advocacy, ambulance safety and clinical care highlighted key developments that will improve patient care and outcomes as well as make providers’ jobs safer.

JEMS Editorial Board member William K. Atkinson, PhD, MPH, MPA, EMT-P, discussed what health-care reform would mean for EMS in a session titled, “Understanding Where We’ll Fit in the Obama Healthcare Plan.” (Read “Health-Care Reform & EMS,” below, for his top 10 insights.)

Larry Wiersch, MS,
and JEMS editorial board member Wayne Zygowicz, BA, EMT-P, EMS division chief for Littleton (Colo.) Fire Rescue, showed their audience the latest in safety innovations coming from Europe. These included cots and cot mounts that are crash tested to 10 g, Mercedes-Benz ambulances with no side-facing seating and extremely high-visibility clothing that’s lightweight and durable.

For the second year in a row, the EMS 10: Innovators in EMS honored the industry’s most forward-thinking visionaries. They include: Dr. Mickey Eisenberg, whose book, Resuscitate! How Your Community Can Improve Survival from Cardiac Arrest, addresses a critical regional imbalance of survival; Eric Longino, who developed an apprenticeship program to address a local paramedic shortage; T. Robert Mayfield, who created a septic alert system to help providers better identify high-mortality septic shock; Geoffrey Miller, who spearheaded the development of the nation’s only National EMS Health Surveillance System; Dr. Paul Pepe, who introduced estrogen’s possible role in resuscitation; John Pringle, who linked prehospital and in-hospital electronic patient data; Terence Ramotar, who introduced solar panels to charge ambulance equipment batteries; Dr. Robert Boyd Tober, who created a program that has dramatically increased return of spontaneous circulation (ROSC) rates; and Matt Zavadsky, who cut unnecessary 9-1-1 use by having advanced practice paramedics provide preventive and routine care.

One EMS 10 honoree, Dia Gainor, EMS chief for the State of Idaho, was also recognized with the prestigious 2010 James O. Page/JEMS Leadership Award. Gainor’s national influence, through such work as the “EMS Educational Agenda for the Future: A Systems Approach,” has helped lay the groundwork for the EMS of tomorrow.

The second-annual John P. Pryor, MD, Street Medicine Society Award, named for the EMS physician and JEMS Editorial Board member killed in Iraq Dec. 25, 2008, was given to JEMS medical editor, Edward T. Dickinson, MD, NREMT-P, FACEP, for his commitment to EMS. This commitment has been demonstrated by his continued participation in prehospital care, his part in developing the first fire-department-based paramedic service in Chester County, Pa., and his ongoing and enthusiastic education of field providers.

JEMS Editor-in-Chief A.J. Heightman opened the show with his inspiring story about obesity and weight loss, and Gordon Graham closed it with his ruminations on risk versus reward.
And, of course, no EMS Today would be complete without the JEMS Games. The team of Cumberland County EMS/Duplin County (N.C.) EMS took home the gold in the final scenario, which featured a bus crash with an entrapped patient, among other minor and critical injuries and distractions. Sussex County (Del.) earned the silver, and REMSA from Reno, Nev., was awarded the bronze.

A lot will change in the next year, and you’ll want to experience it all in 2011. The next EMS Today is already set for March 1–5 in Baltimore. Mark your calendar.

MedicWest Still Transporting Patients
In February, the North Las Vegas Fire Department (NLVFD) asked the city council to make a change in the city’s EMS transport contract, specifically to name them the sole transport agency for motor vehicle accidents and other serious injuries. The proposal has since been removed from the table. Currently, MedicWest (owned by Emergency Medical Services Corporation, as is AMR) has the contract for all city transports. NLVFD responds to all EMS calls, frequently with an ambulance. If MedicWest is unable to respond, NLVFD transports.
NLVFD EMS Chief and JEMS Editorial Board Member Bruce Evans says the department wanted to be able “to transport the sickest and most timely incidents,” because studies are showing how critical minutes can be. He says the fire department’s response time goal is less than six minutes and MedicWest’s is 11 minutes, 59 seconds.

AMR Operations Manager Chad Henry says the city is looking at budget cuts and the fire department’s proposal was to increase revenues and save some jobs.

Tensions ran high until the issue was resolved, but Henry says that has dissipated. “We are deeply committed to a good relationship with North Las Vegas Fire and the other departments in the valley. We appreciate the working relationships and will continue to work in the public’s best interest,” he says.

James O. Page Collection Launches at UCLA
You can now read articles, speeches, correspondence and more from JEMS founder James O. Page at the Louis M. Darling Biomedical Library at UCLA, thanks to the James O. Page Charitable Foundation and the Physio-Control Inc. The physical items can be accessed by appointment only, but digital files are archived at jamesopage.org, where scanned files are being continuously added. Eventually, the collection will be expanded to include the archives of other EMS pioneers, according to JEMS founding editor, Editorial Board member and James O. Page Charitable Foundation Chairman Keith Griffiths.

Quick Takes
Highlights from the Eagles

At the 2010 EMS State of the Sciences Conference in Dallas, the “Eagles”—a group of U.S. metropolitan municipalities’ EMS medical directors—presented the latest trends in EMS and discussed where the industry may be headed. One popular topic covered that always proves challenging to EMS providers: cardiac arrest.

JEMS editorial board member Corey Slovis, MD, FACP, FACEP, FAAEM, introduced the top 10 research articles of the year. One validated three criteria for the termination of resuscitation (TOR) in a cardiac arrest call:

1.  The cardiac arrest isn’t witnessed by an EMS provider;
2. The arrest has a non-shockable rhythm; and
3. The patient has no return of spontaneous circulation (ROSC) prior to transport.

Slovis believes providers should discontinue unsuccessful resuscitative efforts. He recognizes that choosing not to transport cardiac arrest patients won’t always be an option but believes that this decision is something every system should start thinking about.

TOR isn’t the only difficult factor in a cardiac arrest call discussed at this year’s conference. Learn more at jems.com/eagles2010.—Lauren Hardcastle

EMS Insider
Health-Care Reform & EMS
After more than a year of debate, the health-care reform bill has been signed into law. Now, the real work begins as lawmakers, consumers, physicians, hospitals and EMS providers—among many others—begin to interpret the very complex provisions included in the bill. The final package touches all aspects of health care.

I will discuss those in further details right here in coming months, but for now, I have 10 observations I think will directly impact EMS providers right out of the chute.

1. This health-care package ultimately represents payment reform.
2. Access, cost and quality matter now and will continue to matter in the future.
3. There will be a new focus on primary care (back to the basics).
4. Outcomes measurement, as well as clinical and system performance comparisons, will become common practice.
5. Complete, timely and secure use of coordinated and interlinked clinical information systems will become the expected standard for all health-care providers.
 6. Workforce development will become increasingly important for all health-care organizations.
 7. Demand for services will increase, but reimbursement will ultimately decrease over time.
 8. Nearly all citizens will eventually have some form of insurance, whether it’s public or private coverage. However, undocumented residents will likely, if the bill stays as is, have no formal coverage available—even if they want to purchase it.
 9. Health-care provider consolidation will continue to be the trend, with physicians increasingly becoming formally linked through contractual or employment relationships with hospitals or larger health-care systems.
10. Innovation in process, care delivery and technology, as well as overall leadership, will take on growing importance in organizations that expect to be successful in a reform environment. When possible, organizations should take advantage of the pilot projects allowed under the early phases of the formal reform process to develop and expand innovative approaches to address access, cost and quality.

Look in the June issue for the debut of “EMS Insider National Health-Care Update,” a monthly column in which Dr. Atkinson will detail the impacts of health-care reform on EMS. For more top-level EMS analysis, visit www.jems.com/emsinsider.

William K. Atkinson, PhD, MPH, MPA, EMT-P, is the president and CEO of WakeMed Health & Hospitals. He has devoted more than 30 years of his career to improving our nation’s emergency medical and prehospital care system.

Pro Bono
Be Smart about SOCIAL Networking

For many of us, the day starts when we wake up, grab a cup of coffee, check e-mail and sign on to Facebook to check the “live feed” and communicate with our “friends.” Use of social networking media is now ingrained in our society and has become a routine aspect of our daily lives—so routine and easy to use that people sometimes post things before thinking about their potential impact. And EMS employees are getting disciplined and even fired for “inappropriate” use of social networks both on and off duty. Here are some tips to help employers and employees stay out of trouble:

Know your rights: All employers can generally regulate on-duty conduct, and they may also regulate off-duty conduct to the extent that it’s necessary to protect the legitimate business interests of the organization—like its good reputation in the community.

All employers may be subject to anti-discrimination laws when monitoring network sites. Monitoring by employers should only be for a legitimate business purpose, such as investigating a report that patient information was posted on an employee’s site. Employees of private organizations have no constitutional rights to free speech because the Constitution protects us only from abuses of the government. Employees of public agencies have some First Amendment rights to speak out about matters of “public concern”—like general safety issues that could affect the public—but this right is limited by the government’s right to maintain order, discipline and staff morale, its reputation and other business interests.

And let’s not forget about defamation and slander, because people are getting in trouble for posting defamatory comments and other statements that could harm the reputation of others. In some cases, these comments can be the basis for a lawsuit against the person who made them. We forget that social networking sites may be a public forum where you just can’t always say what you want to say and get away with it!

The best rule of thumb is one your mother likely taught you: If you’re going to say anything about anyone else in public, you’d better make sure you say something nice.

Know the rules: Employers generally have the right to absolutely ban use of company computers for any purpose other than business. An employer may also restrict employees from using their own equipment while on duty. In short, when you’re on the clock, your employer pretty much owns your time and can control how you use it. Your organization should have a policy on use of computer equipment, social networking sites and other electronic media so it’s clear what’s considered acceptable conduct and what’s not. Staff should know what the rules are before being disciplined. Without a clear policy communicated properly to all, “knee jerk” reactions can occur. These usually lead to overly harsh discipline and an “overreaction” by management. As JEMS founder James O. Page often professed, discipline should never be applied without due process.

Social networking sites are a great way to stay in touch with friends, family and others. But the proper use of this instantaneous medium comes down to using plain old common sense. We need to think before we hit the “send” button. If you have any concern about what you want to post, don’t post it. Your gut instinct is usually correct. You certainly don’t want an inappropriate post on Facebook or Twitter to jeopardize your career.  

Pro Bono is written by attorneys Doug Wolfberg and Steve Wirth of Page, Wolfberg & Wirth LLC, a national EMS-industry law firm. Visit the firm’s Web site at www.pwwemslaw.com for more EMS law information.

One in a Million
Congratulations to Bryan E. Bledsoe, DO, FACEP, EMT-P, JEMS Editorial Board member, JEMS.com columnist, EMS visionary and author, on surpassing the 1 million textbook milestone.

EMS Memorial Service June 26 in Colorado Springs, Colo.: www.nemsms.org/EMS Week happens May 16–22: www.acep.org

In Brief: American Heart Association has new ECC pediatric courses: http://americanheart.org/cpr




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Related Topics: Administration and Leadership, Leadership and Professionalism, Patient Management, Jems Priority Traffic

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