Administration and Leadership, EMS Today

EMS10: Innovators in EMS 2016 Award Winners Selected

Issue 4 and Volume 42.

The winners of this year’s EMS10: Innovators in EMS program represent some of the brightest and most innovative people working in EMS today. A panel of professional EMS colleagues and peers selected the distinguished winners, who were nominated by an individual or organization. They were chosen for displaying initiative, creative thinking, action-orientation and desire to positively impact EMS, patients and their communities.

This year’s winners have one thing in common: They all put patients first. Whether it’s developing fresh ways to teach EMTs and paramedics how to better care for patients, introducing technology that communicates with hospitals to correctly handle incoming patients or investing in the power of community paramedicine and mobile integrated healthcare, the citizens we promise to serve benefit most from these innovations.

Read on to find out how these incredible men and women are leveraging technology, policy and research to save lives and department dollars.

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Mary Ahlers

Mary Ahlers, MEd, BSN, RN, CP-C, NRP, wears several different hats when it comes to her career, but one thing remains consistent-she’s beyond passionate about education and the ability that community paramedicine has in impacting community health.

Ahlers founded several organizations and educational programs, including Paramedic Health Solutions and Mobile CE. Mobile CE offers continuing education opportunities to paramedics wishing to impact their community’s health in a game-changing way. It envisions itself as “a world leader in health education; offering the right resources and expertise, education and credentialing through evidence-based research, developing excellence in health professionals.”

She also founded the Community Paramedicine Association and Registry, the largest community paramedicine organization in the world. This nonprofit group allows community paramedics to connect with one another and to grow in their profession via educational opportunities and development resources.

Ahlers has worked in critical care transport for more than 10 years and is the clinical coordinator at the University of Cincinnati Medical Center Air Care and Mobile Care. She’s also a professor at the Unversity of Cincinnati and Cincinnati State Technical and Community College.

Although her impact can already be felt on an international level, Ahlers has extended her educational reach by helping develop Community Paramedic Technician and Primary Care Technician curriculums and career pathways.

Michael Baker

Thanks to Director of EMS Michael Baker, MA, EMT-P, the Tulsa Fire Department has been a hotbed of innovation regarding community care and frequent callers.

One of the most effective ways to help high EMS system utilizers is to connect them to resources. This idea served as the thrust behind the Tulsa Responder Referral App. First responders can use their phone to immediately flag a patient for follow-up for social or healthcare needs that could be addressed through referral to specific programs or resources. The app was an impressive collaboration between the Tulsa Fire Department, the Mental Health Association of Oklahoma and software consulting group Asemio. Once plans for the app were nailed down, it was handed off to local students who helped finalize the design as a group project.

Another innovation came from conversations with the Tulsa Police Department. Baker helped create a community response team comprised of a paramedic, a police officer and a social worker. This team hopes to tackle the issue of intellectually disabled citizens and the frequency with which they’re often in police or medical custody.

Brian Clemency

Brian Clemency, DO, MBA, FACEP, FAEMS, is committed to a research-driven approach to the debate of the backboard and spinal motion restriction. In April 2016, he published “Patients immobilized with a long spine board rarely have unstable thoracolumbar injuries” in the journal Prehospital Emergency Care. Clemency and his team of researchers dug through four years of hospital and prehospital data, examining patients who’d been immobilized. What they found was huge: only 0.5% of patients who received prehospital spine immobilization had an unstable thoracolumbar spine injury. The results of Clemency’s study became a point of interest as New York drafted its spinal motion restriction (SMR) protocol, providing a statistical answer to the question of backboarding.

After New York introduced its SMR protocol, Clemency continued his research, specifically examining how the protocol affected care. He presented “Compulsory use of the backboard is associated with increased frequency of thoracolumbar imaging,” which found that after the protocol changed, backboarding rates dropped from 52% to just 12%. It also found that lumbar and thoracic spine imaging dropped about 5% after the protocol, potentially decreasing unnecessary radiation exposure for patients.

Even with all the innovative research Clemency is spearheading, he still works tirelessly as an EMS fellowship director at the University at Buffalo and a medical director at American Medical Response.

Scott DeBoer

Scott DeBoer, RN, MSN, CPEN, CEN, CCRN, CFRN, EMT-P, understands that medics are always learning. But there are certain times and places where lessons really stick, and oftentimes it’s not actually in a classroom. To make learning dynamic and therefore more effective, DeBoer has created a book of easy-to-understand tear-out posters designed to hang where education really gets done, such as bathrooms, bulletin boards and break rooms.

His book, Peds Pearls: Tear-out Tips, Tricks & Treasures from the Trenches, focuses on the medical field he’s most passionate about-pediatrics. After working as a flight nurse for 30 years, DeBoer wanted to share with others the wisdom he’s acquired over the years in a quick-to-read way. Medics who don’t reguarly encounter pediatric patients can easily ascertain the tricks of the trade without learning them the hard way.

DeBoer’s innovative approach to medical education is engaging and successful, as evidenced by his prolific work; he’s written eight books, co-authored more than 100 articles and has given more than 1,000 presentations on pediatric emergency care in five different countries.

Sanjaya Karki

Sanjaya Karki, MD, MBBS, is continuing his mission to make highly advanced emergency healthcare available and accessible in Nepal. Just four years ago, he helped establish helicopter EMS in the country, successfully advancing the level of medical attention citizens could receive. Now, he’s helped establish the country’s first ever hospital-based ground EMS.

Karki took a substandard ambulance and outfitted it with two AEDs, two mattresses, a portable ventilator, syringe pumps, lifesaving drugs, a folding stretcher, a spine board, CPR board and more. The ambulance crew is made up of physicians and paramedics, and the vehicle is able to be tracked by the hospital at all times.

Through a hotline and an in-house dispatcher system, 24/7 emergency care is now available to all citizens.

Since the program’s start in March 2016, Karki and his team have safely transported hundreds of people in the Katmandu valley and have taken several patients hundreds of miles outside of Katmandu.

With no available government funding for the project, Karki made it happen with the generous help of the Grande International Hospital, which also now houses Nepal’s first ever EMS department.

Looking ahead, Karki hopes to continue training local medics and team up with other hospitals to establish more EMS departments.

Brett Patterson

As the Chair of the Medical Council of Standards for the International Academies of Emergency Dispatch (IAED), Brett Patterson oversaw what his colleagues are calling “the most advanced medical dispatching protocol in the history of prehospital care.”

Patterson combed through a whopping 496 submitted proposals for the organization’s Medical Priority Dispatch System (MPDS) version 13.0. Because these proposals went through his hands before anyone else’s, Patterson had to research and evaluate the evidence behind each submission before presenting them to a council. Then, Patterson led the council through an intense vetting process that spanned several months, involving even further research and evaluations.

Critical prehospital measures that Patterson and the council ushered in include the ability to give over-the-phone instructions for naloxone, a new fast-track for dispatchers to start CPR earlier and faster, and a new instruction series for miscarriages so that dispatchers may talk patients through emotionally and physically difficult situations.

Patterson also oversaw the effort to “culturalize” the dispatch protocol in 21 various languages and dialects to be used in 45 countries worldwide.

Brenda Staffan

Brenda Staffan is a champion of change when it comes to the successful management of low-acuity 9-1-1 calls so that the patient’s health is a priority but unnecessary resources aren’t used.

Staffan is the program director for the community health division of the Regional EMS Authority (REMSA) of Reno, Nev., where she’s overseen several innovations that have led to better patient care and millions of dollars in savings. These include REMSA’s 24-hour nurse health line, which helps direct low-acuity 9-1-1 callers to resources that may better help them.

This non-emergency phone number is estimated to have avoided 653 unnecessary ambulance rides and generated more than $5 million in savings over a span of 2.5 years.

Staffan has also developed and gotten approval for community paramedicine Current Procedural Terminology codes that may be used for Medicaid reimbursement in Nevada. In addition, she successfully negotiated with a commercial insurer to cover REMSA’s core community paramedicine services such as the nurse health line and patient transport to urgent care, alcohol detox centers and behavioral health centers.

Staffan has also worked with the University of Nevada, Reno to measure and produce outcome data that numerically shows the value of REMSA’s community programs. This third-party-validated information has helped gain support from governments and other organizations.

Jonathan Washko

Jonathan Washko, MBA, NREMT-P, AEMD, is the face of innovation at Northwell Health EMS in New York, where he serves as its assistant vice president. You’d think it’d be enough to be in charge of a department with more than 600 employees, 135,000 calls per year and a $40 million budget that serves all five boroughs of New York City and all of Long Island, but for Washko, that’s just one part of his passion to better EMS for both employees and patients.

Washko developed New York’s largest mobile integrated healthcare and community paramedicine (MIH-CP) program. In August 2016, he and his team published an outcomes-based paper in the Journal of the American Geriatrics Society that highlighted the success of these programs in patients with multiple chronic conditions. The study found that only 22% of patients needed transport; the rest could be examined and treated in their homes by MIH-CP paramedics. By proving the program’s effectiveness, Washko has inspired others to further research and develop innovative MIH-CP programs that put the patient first.

Washko has also worked to improve employee engagement and satisfaction by leading a team to tackle issues associated with workload management and work-life balance through the development of innovative custom software solutions and processes.

Siegfried Weinert

Siegfried Weinert, MSc, EMT-I, EMD, is recognized for his incredible coordination of EMS activities, not across cities or counties, but across entire countries. As the project manager of the dispatch center 144 Notruf Niederoesterreich in Lower Austria, Weinert was tasked with organizing medical collaboration between the federal state of Lower Austria and neighboring regions of the Czech Republic.

For more than a year, Weinert led cross-border communications that had to effectively manage differences in languages, agency organization, social climates, administration, histories, education and EMS procedures. The intense work resulted in two contracts between the Czech regions of South Moravia, South Bohemia and Lower Austria.

The contracts promise that citizens who need medical attention in either country will be treated by the closest ambulance, even if it must cross borders. This makes the patient the priority, instead of politics and bureaucracy. This type of collaboration is extremely beneficial to people who live in rural border towns, who Weinert believes deserve the same level of prehospital medical treatment as those who live in cities.

Weinert’s work has only just begun. He’s now working on drafting cooperation contracts between Lower Austria and the Czech region of Vysočina, which has no direct border with Lower Austria but can be reached quickly by Austrian ambulances.

James Woodson

James Woodson, MD, FACEP, and his visionary platform is propelling prehospital and hospital providers into the future. The technology not only makes the jobs of providers simpler, it also has the real potential to reduce treatment times-an equation for better patient outcomes.

Pulsara works like this: EMS sends information about the patient, including photos of the patient’s driver’s license, hospital face sheet, medication list and ECG strips, to the receiving hospital. The ED can then prepare to treat the patient according to their medical needs while the patient is still in transport.

The receiving facility can communicate with the ambulance crew to learn more about the patient prior to arrival. Pulsara is HIPAA-compliant with no data actually stored on the mobile device.

Medical errors result in over 400,000 deaths each year, with 80% of those errors occurring during transitions of care. Streamlining communication between ambulances and hospitals simply improves patient outcomes. “I could write a book on why he deserves this award,” Robert Dickson, EMS medical director at Montgomery County (Texas) Hospital District, says. “This technology has improved the lives of many patients already, and will continue to change the landscape of healthcare communications.”

Conclusion

These EMS10 winners are extraordinary examples of what the future of EMS can and should look like. Let their pioneering and tenacious spirits encourage you to pursue innovation in your day-to-day work and serve as a reminder that when you put the patient first, incredible success can blossom.