Administration and Leadership, Columns

EMS Physicians Can Help Close the Gap Between EMS & Other Public Health Agencies

Issue 4 and Volume 40.

In considering the first person to interview for this column, the choice was an obvious one for me because my mentor, David Persse, MD, has helped guide me over the past 20 years. In 1996, he provided me with sound advice and support as we launched the EMS service at Rice University. Persse now serves as both the physician director for the Houston Fire Department and as the health authority for the city’s public health department. He’s been a leader in the merger of EMS and public health in this country and is innovating new pathways to enhance the role of EMS in the healthcare industry

Dr. Persse, with the subspecialty of EMS at its commencement, how do you see the role of technology enhancing the interactions between patient, paramedic and physician?

“Technology is going to completely revolutionize EMS in America and around the world. When I started as an EMT, the most complicated technology we had was the radio. Today, in Houston, we’ve just introduced a portable CT scanner mounted in our mobile stroke unit, and we’re using telemedicine technology to allow field personnel to immediately connect with an emergency physician who can then interview and visually examine the patient to decide how to most efficiently resolve the patient’s issue. This includes the physician quickly and electronically setting up a same- or next-day clinic appointment and non-emergency transportation as well as social work or public health follow-up.

In the future, I predict we’ll see mobile devices similar to our current day ECG monitor/defibrillators that will perform multiple bioassays (a procedure for determining the concentration, purity or biological activity of a substance) to include diagnostic capabilities as well as high-fidelity monitoring of critical physiologic functions such as central pressures, core temperatures, O2 tissue extraction, central nervous system activity, etc. This information will be easily and continuously transmittable to allow both the introduction of critical care capabilities by the paramedic as well as to better inform the receiving facility of what the patient will need upon arrival. I hope this will all return EMS to our roots of a very close and mutually productive relationship between the EMS physician and the field care providers.”

As a pioneer at navigating the intersection of public health and EMS medicine, what do you see as the future of this relationship?

“I’ve always felt EMS is as much a form of public health as it is an emergency response system. If you want to put your finger on the pulse of your local community’s health status, look at your EMS records. EMS touches every disease and injury pattern that exists in your community, in every neighborhood, for patients of all ages, within every income level, every education level, every culture, every lifestyle, for acute or chronic, medical or social problems; regardless of the patients’ ability to pay or preferred hospital choice. The Centers for Disease Control and Prevention define public health as the science of protecting and improving the health of families and communities through promotion of healthy lifestyles, research for disease and injury prevention, and detection and control of infectious diseases. In most every community, EMS is a central repository for much of the information needed by public health practitioners to achieve their goal.

Unfortunately, EMS and public health haven’t been known to share their data and combine their efforts. We’re now seeing significant improvement in the collaboration between the two across the nation. As an example, we’ve recently published data showing communities with some of the worst air pollution problems in Houston also have the highest incidences of EMS responses for asthma and cardiac arrest, which can be temporally related to spikes in certain pollutants in the air. Our health department has responded to this information by working with the authorities to implement stronger restrictions on certain air pollutants, and we’ve initiated widespread CPR training programs within neighborhoods identified as being at highest risk.

Just imagine the potential for improving our local community’s health once EMS provider agencies and local health departments join forces!”

What advice do you have for paramedics and EMS physicians in regard to better engaging their community in population-based health initiatives?

“I think many paramedics across the nation have already begun to broaden their vision of their scope of practice, especially with the advent of the community paramedic. Board certification in EMS is a major step forward for EMS physicians to become reengaged with field personnel and field operations. Because of the way EMS developed in the United States, physicians were left out of the progress and failed to stay as engaged as our physician mothers and fathers (Caroline, Copass, Nagel, Grace, Criley, etc.) were. Today, much of what should’ve been a close and cultivating relationship between EMS medical directors and field personnel has been replaced with state-level bureaucracy and protocols. As paramedics become more engaged in caring for their communities beyond emergencies, so must the new breed of EMS physician see that the overall health of their community is also part of our responsibility. To this end, physicians and field personnel alike should make contact with their local public health department to seek ways to identify the gaps in the health care system, and work together by combining resources to achieve real progress in improving lives. I believe this is the future of EMS.”