A Change of Heart: Perspectives on Patient Care and Technology

Bryon Moore has had a rich and varied career in EMS. He became an EMT in 1979 and received paramedic training at the fabled UCLA Daniel Freeman School for Paramedicine in 1982. He went on to be a paramedic in several systems before becoming the Northern California Clinical Coordinator for American Medical Response (AMR). Bryon then was attracted to helping develop and bring new resuscitation technology to market, working for a variety of medical device companies and launching new products globally. He’s currently VP of EMS Market Development for Defibtech, a company owned by Nihon Kohden, a leading medical device manufacturer. In 2009, Bryon fell ill from a virus that irreversibly damaged his heart. A heart transplant saved his life–and changed his perspective on life.

Q: What originally attracted you to EMS?

I was allegedly speeding in my ’67 GTO on the way to classes at my local junior college. While fighting that ticket, my fellow court attendee talked about his progress toward a degree in fire science. Being 18, I thought it sounded cool, so I got my EMT certification and joined the fire department as a “part-paid” firefighter. Before I knew it, I was deep into an industry that I still love, nearly 40 years later.

I really wanted to understand the “why” of what I was being taught in EMT II school. I was full of questions: Why give that many milligrams? Why is that drug the standard? And when I explained this frustration to a buddy, he said I should go to paramedic school, daring me to become a paramedic–I took the dare.

Q: How have you seen EMS change over the years?

A: The industry was so small when I started in California; only a handful of counties had paramedics. Technology has come so far, and we can assess and treat things in ways that weren’t possible when this was a fledgling space in healthcare. Products were manufactured for hospitals and forced on the prehospital environment. Now, products are developed for EMS, and not as an afterthought. 

At the same time, I can also see the negative impact of technology, in terms of less human connection. EMS, and medicine in general, seem less personal–less comforting, less hand-holding, less looking into patients’ eyes and connecting with them as people. Instead, there are monitors to pay attention to and electronic documentation that has to be completed. These tools are incredibly valuable, but we can’t forget that this could be one of the worst days of a patient’s life and we have an opportunity to comfort them in that vulnerable moment.

Q: How did you transition from providing patient care to a career bringing innovative products to the EMS market? 

A: I don’t think the urge to care ever really leaves–you smell the apparatus floor, see the lights go by, and if someone nearby gets hurt, you to want to jump in and be a provider again. It’s what we do. It’s what we love.

But for me, the medical device industry was really intriguing because I hadn’t experienced that side of the business. Manufacturers need help designing products tailored for EMS. It’s exciting to create things that will add value for patients and make the job easier for fellow providers. I have an amazing opportunity to work with different kinds of EMS systems, leaders in resuscitation, and incredibly bright engineering professionals who are truly passionate about what we do. It’s a different role in a profession that saves lives; not providing direct patient care but serving on a team that includes engineers who create new technologies to help pre-hospital providers perform that care.

Q: How has being a heart transplant patient altered your perspective?

A: I don’t think it was just the heart transplant–it was the year-and-a-half of suffering through the disease before the transplant that changed my perspective. On multiple occasions, I thought back on patients I’d treated who were dealing with similar symptoms. For example, my low perfusion made me constantly cold, no matter the weather. The elderly deal with similar challenges and I would remember calls to their homes when the heater was blasting 88 degrees. I would try to have empathy, but it just seemed crazy and I now know that I didn’t connect enough to what they were feeling. Crews have so many other things going on that it’s hard to focus on making sure the blanket is tucked in, but those details are what patient care is all about. It’s holding their hand; it’s coaching them through a really difficult process with a bunch of strangers around them. Treatment protocols are very important, but so is that connection and basic patient monitoring parameters won’t tell you everything.

Q: What do you see as the biggest challenge today to improving sudden cardiac arrest survival rates?

I’m a big fan of the high-performance CPR model, and there are systems doing it really well to overcome some of the human factors that limit our ability to provide consistent chest compressions and other life-saving interventions. I believe mCPR [mechanical CPR] devices help bridge that gap. But, public awareness is also a key ingredient in improving survival rates–those first few minutes of bystander CPR are more important than anything that happens after that. We need to give bystander CPR the same momentum that Stop the Bleed has right now, especially delivered as just-in-time training by dispatchers.

Q: What’s next for EMS? What do you think this industry will look like in 5, 10, 20 years?

I think one of the biggest differences will be information sharing. When I was a quality assurance officer for a large EMS agency, we couldn’t get outcome data from the hospitals, which made it really hard to show the difference EMS made for patients. You’ll know EMS has arrived [as an industry] when getting outcome data on every call is the standard of care. Cardiac arrest improvement programs across the nation are one area where we see data sharing making significant progress. Due to the hard work of committed providers in a variety of EMS systems, information about the result of a cardiac arrest patient is becoming more accessible, allowing agencies to track the success of their high-performance CPR efforts and use of mCPR tools. This access to data, plus a continued focus on the people served by an EMS system–like that noted in the new EMS Agenda 2050–will help EMS continue to grow and improve.

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