Another great episode of EMS Office Hours accompanied my workout today, and of course it stimulated some thoughts. Here are some of them:
First, more isn’t always better. I know some people who love the AutoPulse, but they have no idea how many patients walk out of the hospital after having it put on.
Josh mentioned the disconnect between EMS managers and street-level providers. It seems like we promote people who don’t want to take care of patients anymore and/or are hungry for power. That’s a bad combination. In the ED’s I see the big shot doctors and nurses, who have their own offices and are quoted on the news, occasionally perform the roles of regular staff members. They seem to enjoy treating patients, so I don’t know where our disconnect is.
Finally, much of the discussion was based on the different treatment available in different communities. In 2008, the Eagles published a paper outlining some performance benchmarks. Some of the highlights include:
If a pulmonary edema patient does not get CPAP and NTG, their EMS system failed.
If a NRB and BVM are all that’s available for a patient with bronchospasm, their system failed.
If a STEMI patient does not get a 12-lead ECG, ASA, and direct transport to a PCI center, even if they did not tell the dispatcher they were having chest pain, their system failed.
If a patient seizes all the way to the hospital without getting a benzo, their EMS system failed.
This does not cover everything, and the Eagles acknowledge that, but it’s a start. Now is the time for us to educate the public about what is available from their EMS system, to demand that systems measure how often that treatment is delivered – and not delivered- when it should be, and to publish the differences between systems. Knowing what to measure, and being transparent about it, is the key to fixing this mess we’re in.
Another fine job guys, well worth the listen here.