EMS, and medicine in general, is experiencing a period of unprecedented change. As new payment structures introduce challenges, new roles for providers emerge. The 2020 Vision series attempts to envision how these changes will evolve over the next several years. For this month’s installment, we visited with J. Brent Myers, MD, director and medical director of the Wake County EMS System in Raleigh, N.C., a system known for progressive provider safety and mobile integrated healthcare. Myers identifies three challenges facing EMS today: patient movement, non-emergency calls and ambulance design.
Every EMS provider lives in fear of a serious back or knee injury, and the problem of provider injuries is only getting worse due to rising obesity levels. Wake County has made significant strides in this area. “There’s an old mantra that you must carry the stretcher to the patient’s side—that’s gone in our system,” Myers says. Instead, Wake County emphasizes other ways to bring equipment to the patient; it also employs power cots across the system. “The actual lifting of the patient is done mechanically, rather than on the backs of our providers,” Myers says.
But he emphasizes that reducing provider injuries isn’t simply about buying new equipment: “You can’t just buy the technology; you have to change practice—there has to be an educational arm, a protocol, a policy to guide how it works. It has to be a complete paradigm shift.” Wake County not only provides training specific to lifting and moving patients, but also integrates refresher training into other programs, such as hazmat training.
When It’s Not an Emergency
Another area that Myers identifies for improvement and change: “The ability to determine what is truly a time-critical medical emergency as early in the request for service as possible, so that we don’t needlessly go through the streets with lights and sirens and put ourselves and the public at risk.” He notes that providers are twice as likely to be injured while moving as other public safety professionals. “And if there is an ambulance accident, we are twice as likely to injure the traveling public as we are to injure ourselves.”
As a result, about 20% of Wake County calls are currently dispatched without lights and sirens, although any provider can upgrade the response en route if new information coming from the scene warrants doing so.
But Myers believes the idea of non-emergency response is much larger than lights and sirens—it will be integral to the EMS provider’s role in 2020. Medical emergencies, Myers notes, are only about 5–10% of EMS responses; 80% are for unscheduled medical care that doesn’t constitute an emergency. “So we have to design our system to do that,” he says. “We’re going to be able to do basic labs on scene. The notion that we have to send someone who’s had a suicidal ideation to a hospital to have a Tylenol level drawn is asinine. We can do that on scene and take you straight to mental healthcare. It’s very exciting to me, because between now and 2020, we are going to become part of the healthcare system.”
A Safer Ambulance
And at the center of all these changes: ambulance design. “Right now if you want to help your patient have a sip of water, in most ambulances you have to be unrestrained as a provider to do that,” Myers says. He believes the ambulance industry must implement design changes—moveable seats, different monitor locations, etc.—that allow providers to move but also keep them restrained. “We can’t design a perfect seat in a perfect spot—we need to be thinking about movement and restraint,” he says. “Certainly by 2020 we should be able to do that.”
Ambulance design will also be shaped by the adoption of mobile integrated healthcare. “We’re going to have to design our ambulances with the notion that we might be taking a critical patient to the hospital or we might be taking four people to the clinic,” Myers says. “Today, when we’re transporting patients who don’t need to go to a hospital, we are still putting them on a stretcher, because we don’t have another option in our current ambulance design. We need to move beyond that so we truly are a mobile healthcare practice—treat you where you are or transport.”
The Culture Component
Although Myers envisions massive changes reshaping EMS, he nevertheless recognizes that there can be no change without people. “In an organization, there are about 10–20% that are ready to change, 70% that you can convince to change, and 5–10% that resist,” he says. “It’s take some internal education, but [at Wake County] we are slowly changing the notion that ‘If you call, we haul.’ Right now, we are paid to do things to patients, rather than do things for patients. That’s the change that’s coming.”
You can help shape the future of EMS. Go to www.jems.com/2020vision to watch a clip from the interview with Dr. Myers and other videos from systems that are changing the way ambulances are designed and the way providers deliver care. Then join in the discussion on the EMS 2020 Vision group on LinkedIn: http://linkedin.EMS2020vision.com.