“What’s an epidemiologist?” is usually the first question I get asked when people inquire about my career. If someone happens to know what an epidemiologist is, they usually ask if I work with viruses like Ebola or the flu. They might even reference a few movies like Outbreak, Contagion, or World War Z. I must admit, I wouldn’t mind single-handedly saving the world from a rare and horrific disease, but in the real world, epidemiology is a little less glamorous.
Epidemiology is “the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems”1 When looking at epidemiology through the lens of EMS, these health-related states can include illness, traumatic injuries, violence, and even environmental exposures.
As an epidemiologist, one of my goals is to use EMS data to identify risk factors and help lessen the impact of the above-mentioned health issues. For the foreseeable future, we aren’t capable of eliminating the burdens of disease or injury; however, there’s always room for improvement.
Some of you may be familiar with the name John Snow, and I’m not talking about the dashingly handsome character from the HBO TV epic Game of Thrones. I’m referring to the John Snow who’s known as the “father of epidemiology.” Snow was a London anesthesiologist by trade in 1854, but is most famously known for his work during a cholera outbreak.
During the outbreak, he began collecting information on individuals with cholera, such as their residence and where they worked. Snow marked these locations on a map, as well as the location of water pumps, because he believed water was a source for the spread of cholera. At the time, proper management of sewage was non-existent and often dumped in the river where the possibility of cross-contamination with drinking water supply was certain.
This information was used to identify the relationship between cases of cholera that were clustered around “water pump A” on Broad street. Snow presented this information to officials, who removed access to the pump. Shortly thereafter, the outbreak ended.2
Patient Information: One Piece of the Puzzle
The patient that you just assessed, treated, and transported in your ambulance is much more important than you might realize. The information you collected about the patient is a snapshot in time of a patient’s health and life overall. This information can answer the questions of who, what, when, where, why and how.
Their information is a tiny, yet crucial, piece of a much larger public health puzzle, and one piece can fit into several different puzzles about disease, injury, violence and other health conditions.
Let’s say you went to a yard sale and bought a brown bag labeled “1,000-piece puzzle.” You have no idea what the puzzle picture is of, but you‘re feeling adventurous and you buy it for a dollar. You start working on the puzzle; it takes you days to get it all sorted out and put together, and you discover that you’re missing pieces. You feel frustrated and disappointed, since you invested so much time on it.
If you’re just missing a few pieces, it’s not that big of a deal—you can still tell what the picture is of. But, let’s say you’re missing a lot of pieces. Then, the picture becomes unclear; you can barely tell what it’s supposed to be.
It’s similar to the concept of voting or donating blood: One person choosing not to participate doesn’t matter that much, but if we stop participating as a cumulative bunch, the tables will be turned for better or worse.
This is why complete and accurate patient records are so important, not just for that patient, but for the greater population. As an epidemiologist, I ask that you help me by ensuring data records are accurate and complete, so that I can help you to solve these puzzles.
Just Scratching the Surface
EMS providers are as close to superheroes as we’re going to get—you rescue patients, provide medical treatment, perhaps even save a life, and then you transport your patients to the hospital.
The data you collect on a patient has the potential to identify a flu or food poisoning outbreak, an environmental exposure leading to respiratory distress incidents, or even help identify a bad batch of drugs, leading to several overdoses in one night. Through prehospital data collection and with the right tools, all of this can be identified quickly.
Data collection efforts and technology are just starting to scratch the surface with the possibilities of prehospital data. The ability to combine prehospital data with patient outcome data on a national scale can drastically change patient care and ultimately improve patient outcomes.
In the short amount of time I’ve been part of this community, I’ve immersed myself in topics such as opioid overdoses and naloxone, prehospital sepsis screening, and EMS provider mental health. There are endless topics that can be studied using epidemiology, which can ultimately improve services and patient care.
As we all know, superheroes don’t do it all by themselves; at some point, they must work with a team. Let epidemiology join your team. Epidemiology can help you find the missing puzzle pieces, and we can sit down together to complete the puzzle, strengthen it, and save lives.
Prior to this year, I focused on helping prevent injury in soldiers, and my professional knowledge of the EMS community was minimal. As I’ve spoken with colleagues, paramedics, medical directors and other EMS epidemiologists, I remain in constant amazement at how much there is to learn.
Within this community, I’ve learned about the strengths, commitment and struggles you face, and I’m humbled and impressed by all of you, and your work, which often goes under-recognized. I personally thank all of you for the work you do; I’m honored to be part of this community.
1. Last JM, editor. Dictionary of epidemiology. 4th ed. New York: Oxford University Press; 2001, p. 61.
2. Snow J. Snow on cholera. London: Humphrey Milford: Oxford University Press; 1936.