Last time I discussed briefly the importance of change in our profession.  The profession that doesn’t change and adapt with the times will soon find itself outdated, inefficient, ineffective, and maybe even replaced.  That’s why it’s so important that we consider how we can move forward and do our best to enact policies and protocols to see that our profession prospers in the coming future of reformed healthcare.  We’ve already looked at the opportunities and possibilities for improvement in our education.  Now we’ll take a look at some possible avenues that we can take in the administrative realm to direct and guide EMS.


Be Progressive and Proactive

This is one of the areas that will probably be the hardest for us because this involves venturing out into uncharted territory.  Medical directors and EMS directors have to trust their employees.  This could be tied right back into education because if we’re confident in the education and on the job training they have received then trust will be a natural by-product of that.  That being said, with the direction healthcare is headed, we need to be open to exploring new, progressive ways of delivering our services.  The possibilities are numerous.  One idea I’ve read about in the literature lately is the possibility of Advance Practice Paramedics, or APPs.  For those of you who are unfamiliar with APPs, they respond just as normal paramedics would but they have the ability to refer patients to the appropriate facility, and in some instances such as substance abusers, determine if the patient even needs to be seen in what is likely to be an already overfilled Emergency Department or could benefit more from another facility.  Now there are some risks and liabilities that come with this and that’s where you as an administrator or medical director would need to do some research and feasibility studies for your area.

Another new and innovative idea that I’ve seen being discussed is what is called MHS, or Mobile Health Services.  I actually read about this idea on JEMSConnect under a discussion board.  This is a pretty interesting idea, with some similarities to the APP, in that you no longer respond to just emergency calls but also perform routine check-ups and medical visits to at-risk patients in your response zone.  This also involved other routine medical care such as wound dressing, surgical dressing, and other treatments in the patient’s home.  This has the potential to cut back on the all to prevalent “frequent flyer” by doing some patient education and helping them find other ways to address their issues rather than activating the EMS system every time.  Again, these are just some ideas that are being tested and tried right now and I understand these would be some giant leaps for some services, but it’s good to listen to what our colleagues are trying and see how we might could implement some form of change within our own area.

More information is available on these two ideas in the links provided below.


Cut Out the Middle Man

Many areas have enacted protocols to address this already, but let’s cut out the middle man by getting the patient to definitive care as soon as possible.  If that means bypassing the local hospital to take a STEMI patient to the near by cardiac center, then let’s do it.  I believe cutting cost to the patient is going to help us all out.  Let’s be brutally honest for a moment.  Many patients we transport don’t have the means to pay for the services we or the hospital provide and many of them won’t pay for the services, leaving your agency and the hospital to eat the loss.  If we can cut back on the patient’s overall incurred debt then we can start to lessen the strain on an already overrun healthcare system.  Also, often times your agency may be called to transport that same patient to another facility, thus creating another bill for the patient that already can’t afford the first trip.  Now given there will be situations where an unstable patient needs to be taken to the nearest hospital to be treated immediately, of course there are exceptions to every rule, but it’s just another possibility to consider.


Embrace Change

I know that many people who read this may think that these changes are drastic and in some ways impossible.  Many individuals may think that it’s putting too much autonomy in the hands of the provider and that we’re not quite ready for that just yet.  That may be true but I also remind those individuals that just 10 or 15 years ago medics were having to obtain doctor’s orders to start IVs or apply monitors and look where we are today, change can happen.  Whether you’re a large municipal agency, private provider, or small volunteer squad you can’t be afraid of change.  If we remain stagnant, it will hurt us.  “That’s just the way it’s always been done” is no longer a valid excuse because the environment we operate in now is, and will certainly be, worlds apart from years past.


  It’s a great time to be involved in this profession.  We’ve got the opportunity to really make something of ourselves as medical professionals.  However, if EMS is going to improve, it’s going to take the cooperation of EMTs, paramedics, EMS administrators, and medical directors to make it happen.  Now I’m not saying that any of the ideas mentioned above are the saving grace of EMS.  Some of them might not work but we’ve got to at least explore different ways of doing things because what we’re doing now may not work in the very near future.  These are just a few ideas and suggestions for ways to improve the areas of education and administration.  I’m excited to see what the next few years holds as far as new ideas for operating and patient care are concerned.  You may disagree with some of the ideas I’ve mentioned but I think we can all agree that if we don’t change we won’t survive.  Sure EMS may still be here, but we’ll be inefficient, ineffective, without respect, operating in the red, and a far cry from what we could be.  The potential is there.  The time is now.  Let’s do it!


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