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Gathering Empirical Evidence


As a former street paramedic, Mary Meyers, MHA, EMT-P, understands the difficulties that EMS providers face each day, particularly working in an unpredictable environment.

That’s why she turned to mathematics—statistics to be specific.The self-confessed “math phobe” is currently a research specialist with Centura Health and a member of the newly formed Denver, Colo., hospital-based Center for EMS Quality, Integration and Research. Her statistical analyses and research are providing the kinds of evidence-based, empirical knowledge needed to make real strides around pain management, infection control, suicide prevention and quality assurance.

Her journey from being a paramedic to getting a doctorate in health services research is unusual to be sure, but it’s a path that’s having a tremendous effect on the EMS community. Her influence could have far-reaching implications and meaningful improvement for patient and prehospital care of the future.

EMS & Hospital Care
“I think EMS care definitely affects hospital care, which is the main thrust of my research,” she says. “So many people like to think that EMS doesn’t really do any patient care that affects anything. Just get the patient to the hospital, and we’ll take care of them. But I don’t see things that way. I see the prehospital provider making a big impact on patient care in the long run, and I think that’s going to become more apparent in the years ahead.”
Her areas of research center squarely on the premise that EMS care not only affects patient outcomes, but also hospital processes and procedures.Take pain management, for instance. Right now, hospitals are being held to standards they’ve never been held to before, and as a result, their reimbursements are based more and more on patient satisfaction scores, she says.
“If a patient arrives at the ED and hasn’t had good care in the prehospital arena, like receiving pain medication, then what [state of mind] is that patient going to be in at the ED?” she asks. “What kind of scores are they more likely to give the hospital? To the patient we are one big system, and if one part fails them, this will affect their perception of the entire system.”

The importance of this, she stresses, is not just in giving proper patient care, but also in thinking about the reimbursement and penalty ramifications for hospitals. And EMS may have a direct role in that.

A Different Approach
Meyers and her team also have taken a somewhat different approach to researching and analyzing infection control issues, specifically by scrutinizing how well EMS providers clean their stretchers and equipment after they drop off a patient. “The reason we are doing that research is because equipment that is not disinfected can make prehospital providers sick, and it can make their patients sick,” she says.

And because hospitals don’t get reimbursed for patients who get hospital-acquired infections, eliminating cross contamination from unclean equipment is paramount. “Our patients could become very ill, and hospitals will have to eat all those costs of care, so they are extremely expensive infections,” she says.

Hospital-acquired infections are becoming a center of real debate, given the money—and reputational risk—that is at stake. Meyers believes hospitals are going to be casting a critical eye in the search for the origin of those infections. “Hospitals are going to be wondering if a patient acquired an infection from prehospital care and then saying it’s not fair that they have to take the complete hit for the cost of that infection,” she says. “So they may try to roll that back out into the field and force the EMS provider to pay for part of the costs. Or, the EMS provider could be penalized for causing such an infection. That easily could happen because these infections cost billions of dollars, and they are hitting hospitals pretty hard.”

Tracking ED Times
Another area that Meyers sees as having great impact on EMS is in the tracking of median emergency department times. The longer a patient stays in the ED after arrival, the more at risk a hospital will be for not receiving full reimbursement. “Paramedics can easily influence and cut down on those times with prehospital care, labs, blood draws, screenings and interventions,” she says.

Several years ago, Meyers became curious about whether pre-notification times that paramedics provided to EDs actually cut down on door-to-balloon times. Such is the life of an inquisitive researcher. She found out that it did. She also found the same thing was true of people having strokes.

“When EDs receive advanced notification, on say STEMIs for example, then that cuts off a whole lot of time, because the ED can mobilize the cath lab, can get the cardiologist in the ED sooner, and prepare the ED quicker,” Meyers says. “This automatically cuts down on door-to-balloon times. And now there are studies out that confirm early notification by EMS decreases door-to-CT times for stroke patients.”

Meyers has devoted the second half of her career to these important, in some cases groundbreaking, research studies. So it’s an ironic twist that some of her most impactful and potentially life-changing research is rarely published, for a variety of reasons. Perhaps it’s the nebulous nature of the subject matter. Perhaps it’s because concrete conclusions are difficult to determine. Whatever the case may be, Meyers continues to work with the subject matter in an attempt to find answers that will help save many lives.

“Colorado has one of the highest suicide rates in the country, and no one has been able to come up with a plan to stop it,” she says. “There are no effective national suicide prevention strategies or tactics that work. We do a lot of peripheral research around suicide, and what we’ve learned is that it’s extremely complicated and difficult to predict. That’s why no one’s been able to stop the suicide rate.”

Suicide Research
But Meyers is determined, through research and data mining, to try to root out some of the factors that may play a key role in why people commit suicide, so that effective strategies can be developed to address this growing problem.

To begin, she started to think about public health agencies and how they track death statistics (because death certificates are issued by counties). Then she talked to some paramedics in a particular fire station in her area and they mentioned they had a high rate of suicide calls. She checked into it and found that to be true.

“I talked to another big fire department, which is adjacent to this other one, and they also have a high rate of suicides and suicide attempts,’ she says. “Then I started looking at the other areas around them and they had hardly any.”
Puzzled, she realized that analyzing suicide rates by county skewed the numbers. “Why can’t we drill down these suicide hotspots into fire districts and even fire stations?” she asks.

She hasn’t had time to delve into this research quite yet, but it’s on her list. She hopes by breaking down the geography of suicide calls into something manageable, trends will emerge. Narrowing down a suicide hot spot could reveal useful information about the age groups, schools, incomes or other important demographics that could lead public health investigators to question the underlying patterns that contribute to these suicide rates.

Why is this so important to Meyers? Because she believes emphatically that paramedics are some of the best people in healthcare in identifying suicidal patients. And she has the research to prove it. “They see that patient in their own environment, and they can see what’s going on before that patient has a chance to mask anything in the emergency department,” she says.

“Paramedics are extremely perceptive, and they always advocate for the patient. People have a very favorable view of paramedics and are not intimidated by them, so they tend to open up a lot more with paramedics, and that’s why they’re so good at picking up on suicide ideation. I think it’s an untapped resource in a lot of ways.”

If you haven’t guessed by now, the core of Meyers work centers on her love of EMS and her desire to make the job and lives of paramedics and EMTs more rewarding and easier, all while still casting a light on the critical role they play in healthcare.

“I think EMS is a discipline that’s in its infancy with its importance to the medical community and patient care,” she says. “EMS is now at the dawn of recognition of how important it is, and its importance is going to be increasingly recognized; and I want to be at the forefront of that recognition.”


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