Commentary, Community Paramedicine and Mobile Health, Coronavirus

COVID-19 as Catalyst: Bridging ‘Archipelagos of Success’ Across Mobile Medicine

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Some readers will recall a time before Facebook, YouTube, even Google Maps: The “dark ages,” when weighty Thomas Guides required page-turning to find your car on the map. Some readers will also remember Nintendo, that most classic video game console. When video games didn’t work, everybody knew that the solution was blowing into them. Did anyone stop to wonder, “How does everyone know to do that?” before Facebook, Twitter, or Instagram to spread the word?

Complex schools of science such as “semiotics” (the study of signs and symbols) study how ideas pass through time and across civilizations. The word “meme” is now used to describe funny videos with snarky captions cycling about the internet. When Richard Dawkins, Oxford University professor emeritus, coined the term in his 1976 book called The Selfish Gene, he saw memes as “mental genes.” Like their chromosomal counterparts, memes gets passed down and around through generations, mutating along the way. They comprise a society’s oral tradition, or a population-scale game of “Telephone.”  In a 2013 interview with Wired magazine, Dawkins called memes “anything that goes viral. In the original introduction to the word ‘meme’ in the last chapter of The Selfish Gene, I did actually use the metaphor of a virus.”  


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Ideas and viruses—nothing can be more relevant to the mobile medicine [fire and emergency medical services (EMS)] industry amid COVID-19. And yet, between April and June 2020, Fire Engineering published two articles: “Should We Be Thinking of a Long-Term COVID-19 Medical Surveillance Program for First Responders? and “Growing Concern Regarding the Need for Post-COVID First Responder Medical Surveillance.” Such a surveillance system already existed; I wondered why neither of the articles’ authors seemed to know that. Over the course of just five days, a crew exposure tracking system was deployed in March 2020 by the Los Angeles County (CA) Fire Department (LACFD).

By its own estimates, the LACFD is among the largest fire services in the world, so the deployment was covered in the trade press and on social media, not only because of its embrace of innovation and the encouraging results of its contact tracing efforts but also because of its unique public-private partnership that paired a massive public health and safety organization with a tiny startup.

Unfortunately, it was predictable that the authors had not heard about the LACFD’s work. There is so much noise in the mobile medicine (fire and EMS) market that breakdowns in awareness of solutions to growing challenges is real and risky. On January 29, 2020, the term “islands of success” came up during the first “Pre-Hospital & Hospital Data Integration Listening Session Summit” in Washington D.C., after the annual meeting of the Office of the National Coordinator of Healthcare Information Technology. Islands survive independently, creating their own worlds, leading to a multitude of species in Darwin’s evolutionary model (or to a wheel reinvented dozens of times). In our industry, the reverberating effect of isolationism is a lack of knowledge: community paramedicine (CP) programs have died because of a failure to cross-pollinate, since an insufficiently diverse number of CP/mobile integrated health care programs are featured at conference after conference and in article after article. Too few models mean too few chances to learn.

Similarly, agencies have suffered the injustice of noninteroperability with hospital-side electronic record systems because the methods for data sharing are not popular topics in mobile medicine, although they are standard fare at health integrated technology conferences. And yet this author would estimate that fewer than a dozen of the attendees to the EMS “listening session” attended the main conference over the preceding two days, where the methods for data sharing were explained in actionable detail.

A quote from The West Wing says, “Decisions are made by those who show up.” If mobile medicine wants a seat at health care’s table, we have to show up. Right now, we’ve set ourselves at a separate table.

Without cross-pollination and a way to discover innovations already in process (but beyond the immediate view), our industry is subject to “vaporware” and “snake oil.” This will be inconvenient to companies and agencies alike; “an ePCR [electronic patient care reporting] is an ePCR” is hogwash that denigrates enormous investment of time and intellect. Isolationism also reduces force readiness; the industry’s countless associations run listservs featuring leaders exchanging help. Folks are saying, “that’s good!” but the groups are insulated. How many members of one group or listserv participate in others and report back? How many members of any association—nursing, policing, nonprehospital academic medicine, or even business—look for ideas beyond mobile medicine?

In a discussion leading up to the drafting of this column, Fire Engineering Editor in Chief Bobby Halton noted that our industry is not comprised of islands but more accurately of archipelagos of success, the difference being that archipelagos form ecosystems integrated around one another. A chain of interconnected islands where birds, seeds, and ideas mingle like emergency medical and fire services sans politics. A robust effort is happening now to bridge the islands. In mid-April 2020, during the apogee of the COVID-19 crisis, retired chief Anthony Correia convened an online-offline working of dedicated current and former mobile medicine practitioners across all levels and service types (public EMS, private EMS, nonemergency medical transportation, hospital-affiliated EMS, fire-based EMS, and community paramedicine) without regard for payment model and included corporate allies spanning ePCR and health information exchange, legal, billing, and human resources.

The group raised a flag called the “Vision for the Future of EMS & Fire” and expanded from 10 people meeting on Friday morning to 40 people by the third week, each investing two hours to brainstorm the future of an interconnected, mutually reliant mobile medicine industry; no rank, dues, or allegiances. Respectful debates recognizing that “smart people can disagree” without having to secede and build a new association. Passionate altruism spurred engagement on Facebook and Linkedin. Now, approximately 300 practitioners to date have lent brainpower to sharing ideas that can be brought home to improve safety, morale, and agency performance. The group does see value of establishing an overarching voice, like the Health Information Management Systems Society has done for health-tech by incorporating every interest group while providing a platform for dialogue. Most of all, the “Vision” group is a steamship off the archipelago to a mainland where a seat at health care’s table is waiting for us.