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Issues and Challenges Discussed by Medical Directors at Eagles Conference


Medical directors attending the 16th Annual Gathering of Eagles in Dallas conducted a lively roundtable of issues being confronted in their systems.

JEMS Coverage of 2014 Gathering of Eagles

This information is valuable for EMS systems of any size to review, consider and address. Issues discussed included:

  • More attention to crew “time on chest” during resuscitations and avoiding interruptions;
  • With the legalization of marijuana in some states, systems in Colorado and Washington State are finding people becoming patients by now trying other drugs. There is also an increase in the number of “agitated” patients being encountered in the field;
  • Pressure to reduce call volume and get more patients to other sites other that the ED;
  • Shortage of paramedics and new EMS leaders – Referenced by several systems;
  • Obtaining reimbursement for Community Paramedicine and having it adopted/accepted in fire-based EMS systems;
  • Identifying the right patients at the right time and getting them to the “right” resources;
  • The expense of placing the same monitor/defibrillators on ALS engines is now becoming an issue. Some systems are exploring use of AEDs with screens on first response units because the number of times the “full system” is needed is not high;
  • Hospital relations with EMS providers, particularly in light of the ACA and hospital overcrowding;
  • Getting first responders to document care and findings better;
  • Budget cuts and shortages are limiting what can be done in EMS systems, particularly in training, equipment replacement/updating and quality assurance;
  • Continuous blurring of the lines between the system and government administrations and labor unions;
  • The ability to do effective QA with limited staff, funding and data resources was pointed out as a key need. The need for the seemless and timely integration of data was referenced by multiple medical directors;
  • Need for better education and treatment of pediatric patients;
  • Instilling pride back in EMS providers, particularly in systems that do not fully appreciate EMS;
  • Use of technology and negative news to help EMS systems solve system woes. Bad publicity can force politicians to correct (and fund) system issue;
  • Except for patient identification data, the news media is now able to request and get key data, including CARES data from EMS agencies. So, with technology and increased reports and data – comes the requests from agencies and media outlets that want to see and report on the information/data;
  • Community Paramedicine is here to stay and brings with it extra personnel demands and issues such as increased tasks without increased staffing, limited budget support and crew acceptance. In some systems, the focus on CP program development to diverting attention (and funds) away from basic system needs;
  • Use of checklist for care and operations is increasing;
  • Need to return to basics and not just rely on devices and technology to “assess” the patient;
  • Critical need for electronic data recordkeeping;
  • Need for exchange of data between hospital and EMS systems;
  • Active Shooter management, policies and integration issues, particularly in their Police & EMS integration;
  • STEMI transfers – Hospital are demanding valuable ALS resouces to transfer STEMI and stroke patients when, in some cases, BLS units could handle the task;
  • Intranasal Narcan delivery by police and firefighters (There is a national push for this by responders who arrive on scene before EMS);
  • ED turnaround problems continue and need closer monitoring and attention;
  • Medical oversight for dispatch;
  • Consistency in approach to patient refusals;
  • Use of video laryngoscopes and capturing the data from them for QA review and documentation;
  • Employee and command officer turnover and grooming of new medics and managers;
  • Need for more nurturing of new EMS managers;
  • Limited funds to bring people in for continuing education;
  • Keeping providers interested in learning and delivering continuing education in more entertaining and acceptable ways;
  • Airway management and monitoring (particularly failure by crews to use waveform capnography) continues to be an issue;
  • Looking at how much a “minute costs” and determining where response intervals can, and should, be expanded by using more BLS resources/units and redeploying ALS resources; and
  • Hospitals are now (because of the ACA and patient satisfaction demands) paying closer attention to prehospital EMS and patient care.


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