Members of the EMS1.com Editorial Advisory Board shared their predictions and advice to help communities get EMS services ready for 2019’s challenges.
#1 Develop Climate-Ready EMS Services
Climate change in the form of worst-ever flooding, hurricanes and wildfires have caused significant loss of life in 2017 and 2018, disruption of services and evacuations of hundreds of thousands of people, according to Greg Friese, EMS1 editor-in-chief, educator, author, and paramedic.
Friese recommends agencies recommends apply the when/then approach to department strategic planning for staffing, capital investment purchases and station building and remodels:
- When a community is threatened by rapidly encroaching wildfire, then a mandatory evacuation order needs to be conveyed to all residents.
- When storm surge exceeds all known records, then personnel need equipment and training to rescue hundreds or thousands of citizens stranded in their homes and on the roadways.
- When floodwaters make one or more stations inhabitable for personnel and apparatus, then plan to implement temporary stations.
- When officers, paramedics and firefighters lose their homes to a natural disaster, then make sure their families have shelter and communication with their loved ones for as long as it takes to rebuild their homes.
“Now is the time to create and practice a mandatory evacuation communications system that warns citizens to flee for their lives. Now is the time to plan, equip and train for the rescues associated with severe weather events. Now is the time to plan for major operational disruptions.”
#2 Prioritize Mentorship
According to Kris Kaull, vice president of marketing, Pulsara, EMS1.com co-founder and paramedic, the top things that will impact EMS are:
- Standardizing the name “paramedic”
- Requiring degrees for EMS
- Clinical research
- Community paramedicine
- Wellness/resilience
- Mentorship
“The biggest change? Mentorship. The need for mentorship has reached a critical level and will be the hot topic of 2019. Exciting changes are just around the corner. We will see key players joining the EMS mentorship initiative in 2019. We can no longer afford to do things the way we always have. We need to be as intentional in mentorship as we have been in education and documentation.”
#3 Shift to Value in Reimbursement
2018 was a good year for the development of EMS on the community paramedic front. The upcoming year, however, is the the time to now focus on global payment for community paramedicine for the field, said Chris Cebollero, EMS leader, author, paramedic and advocate.
“Many MIH programs are getting funding from grants, and local pilots with payers, we now need to focus our efforts to getting this new service line a standard payment for home visits. All the dominos are set, we just have to flick that first domino and they will fall in our favor.
Community paramedicine programs have been in existence in our career field for over a decade. It is now time to get on the train of the community paramedicine transition. 2019 will be a breakout year for payment for our career field.
If you have an MIH/CP program, ensure that you are collecting outcome metrics along with patient satisfaction scores. For agencies that are looking to develop a program, start off by looking at your own frequent flyers and determine how to guide them to the resources necessary to improve their quality of life. There will be tons of questions in the initial development of your program, so find a mentor program to assist you in learning the ins and outs of developing and running a successful program.”
#4 Communicate Technology Changes Clearly
2019 will present more emphasis on automation, from dash cams that send info in real time to automated inventory systems, believes Ann Marie Farina, president of The Code Green Campaign and paramedic.
“To be prepared for these advances, clearly communicate with staff well in advance of any changes. Change is easier for people to accept if they know that it is coming and understand why it is being implemented. Communication is key to getting staff on board and reducing their stress levels. The less agencies communicate with their staff, the more change will be resisted.”
#5 Incorporate Legal Education Into to Narrative Documentation Training
Providers have become more inclined to assume that the other modalities of the ePCR make narrative documentation unnecessary.
“Nothing could be farther from the truth,” said David Gifot, defense attorney.
Gifot predicts that licensure agencies will be more likely to penalize providers where documentation is in question in 2019. Civil litigators will deficient narrative documentation against provider/defendants and provider/witnesses at court or depositions.
“It is no longer enough to train your people on documentation. In 2019, as I see it, narrative documentation will only improve when providers have a better, stronger, more usable understanding of why they are writing a narrative and what it should include. A fundamental working understanding of how the law applies to them and their narrative documentation personally will, ideally, provide the kind of motivation they need to be better at it.”
#6 Take Recruitment and Retention Efforts to a Higher Level
Gustavo Flores, director at Emergency & Critical Care Trainings LLC, physician and flight medic said that regardless of a paramedics advanced education level, an ever-expanding breadth of knowledge and skill is required of EMS providers.
“I suggest EMS systems and educational institutions innovate in recruiting and training the next generation of EMS providers so that we can attract an audience that matches the realities of the job and the great expectations every stakeholder has of how EMS adds value to patient care and outcomes.”
#7 Reevaluate Stroke Treatment
Growth in the availability of thrombectomy and an increasing use of telemedicine technologies calls for EMS agencies to re-evaluate their stroke treatment and transport protocols, according to Catherine R. Counts, health services researcher.
“The place where EMS can probably make the biggest impact is their ability to truly put the system in system of care. While every hospital and healthcare conglomerate is incentivized to provide services to these patients, the reality is that there aren’t that many patients to go around.
As with any other type of high acuity, low volume patient population (trauma, cardiac arrest, etc) EMS has the chance to control the threshold at which we transport patients to specific hospitals. In fact, we have an obligation to our patients to make sure they are taken to a facility that offers them the best chance for a full recovery. So, if this means dictating a specific accreditation, 24-hour neurosurgery availability, or mandatory participation in QI/feedback to the EMS agency, so be it.”
