Improving EMSWhite Paper

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[. . .] In a drug trial this is more serious, given the side effects which can occur, but even with an EMS agency, there is always an opportunity cost of time and resources with an ineffective treatment, when a patient receives treatment that is not beneficial. "The core value of the NNT is its straightforward communication of the science that can help us understand the likelihood that a patient will be helped, harmed, or unaffected by a treatment" ("The NNT explained," 2014). It is a source of information for those in charge of budgeting the agency and also a way for an agency to make a case that certain aspects of the care it provides do, in fact, save lives.

Q6. Is a high "cost per transport" indicative of a poorly managed EMS system? Why or why not?

High cost per transport is not necessarily in and of itself an indication that an EMS system is poorly managed. An EMS that serves a community with many critically ill or elderly patients may have a high rate of cost per transport. Or, an EMS that serves a rural community that is very far away from the local hospital may likewise have a high cost per transport, due to the fact that it must provide more essential professional medical care on the way over to the facility. The overall competency and treatment protocols of the unit must be viewed holistically, versus focusing on a single metric. Unfortunately, in these cost-conscious times, it is upon this single metric that EMS units are likely to be judged.

The cost per transport must be evaluated in light of the kinds of cases the system manages. For example, if there is an excessively high cost per transit relative to other EMS services in nearby counties for the same type of complaint, for the same relative transit time, this should be a red flag. Cost per transit cannot be analyzed as an average figure. It is also worthwhile to review standardized operating procedures for all complaints, to see if cost per transit can be reduced without compromising patient care. But this does not necessarily mean that the current system is 'bad' or substantially lacking in comparison to other EMS systems in the area.

A final factor is staffing and financing. An under-staffed agency may actually have higher costs per transit simply because of less available resources and less familiarity when dealing with serious complaints. But given the organizational resources, the EMS may still be 'making do as best it can' and is not necessarily staffed with incompetent personnel.

Q7. List four things that matter to citizens when asked about their community EMS system. Should those considerations be the only ones that matter to EMS system leaders, or are there other factors to be considered?

First and foremost, citizens are concerned about expedient response times. Given that response times can indeed affect patient health, this is a worthy consideration. Patients are also likely to be concerned about the training of personnel, to ensure that they are capable of dealing with a wide variety of complaints. They are likely concerned that the EMS has the technologically-sophisticated materials to deal with various medical issues while transporting patients. They may be also concerned about effective use of financial resources, given that their tax dollars are indirectly funding such services.

All of these are worthy considerations, of course, and cannot be ignored by EMS personnel as EMS is designed to service the public's needs -- and the fact that the public often has sensible concerns regarding the use of its resources. But effective medical care is not something that can be decided via a popularity contest. Ultimately, the EMS unit's main task is to preserve life rather than satisfy the needs of the public like a politician. Often, the issue becomes one of prioritization. The agency must determine the most critical factors that contribute to better medical care even if the public may prioritize speed of response time over the quality of care dispensed by the team (to cite one example). The public's opinion should be taken under advisement, given that it may highlight critical and even unforeseen deficits but this does not absolve the EMS squad from conducting research itself to determine the optimal factors to enhance to provide better service and to realize the EMS objectives and goals to individual patients, not simply the public at large.

Q8. Many of today's EMS system leaders appear to believe that investment in selecting the right employees is not beneficial. Describe three reasons why EMS personnel should be selected with the same care as our communities select law enforcement officers.

No matter how good the technology on board, an EMS squad is no better than the personnel at hand. EMS personnel must be willing to make great personal sacrifices of time, energy, and even their own personal safety to preserve the lives of others, just like law enforcement personnel. This demands a tremendous personal commitment from the staff. To ensure the staff will be 'at the ready' when needed and take their training seriously EMS personnel must be selected with care.

EMS personnel must also be capable of being trained. They must have the necessary mental and physical capacities to react quickly at a moment's notice, whether this involves managing a heavy patient or knowing how to put their training into action when confronting a life-and-death situation. As with law enforcement officers, people's lives are dependent upon the effectiveness of a well-trained EMS staff member.

Finally, EMS expertise over time enhances quality care. EMS personnel should be along for the 'long haul.' The department loses time and money when there is a high rate of attrition by people who cannot take the high levels of stress required by the position. Training new staff members is very costly. It is better to initially select the right type of people who will thrive in a pressure-cooker environment than to have a revolving door of people who burn out quickly. Thriving in the environment of a busy EMS squad takes a certain type of personality: someone with high levels of personal resilience and emotional hardiness who can deal with traumatic stories day in and day out.

Q9. Describe and discuss one significant danger in contracting out essential public safety services.

Privatization of essential city services seldom solves the financial woes of the community in question. "Many cities experiencing budget crises look to the private sector to take over public services, theoretically a lower cost" ("Municipal services," 2014). However, quality is often compromised and little money is saved when contract cost overruns and hidden costs arise, including the administrative costs of "seeking proposals, evaluating bids and monitoring the work. Hidden costs for the community can include reductions in wages and health benefits under private contractors, which drive more people onto public assistance and bring down wage and benefit standards in the field and in the community" ("Municipal services," 2014).

The inferior service quality, while of concern for all essential services, is of course particularly worrisome for EMS and other safety personnel, given that lives may be lost due to the inferior quality of service. This complaint is typical of many communities, not simply one or two. "The companies that provide these services must make a profit, so cutting corners on the quality of a service is a common way for the company to lower its own costs and retain more revenue" ("Municipal services," 2014). Quite simply, a private company has an obligation to make a profit, unlike a publically-provided, not-for-profit service which is solely committed to improving the welfare of the public. Instead of asking what services are necessary to improve health and safety, the company is all too tempted to ask 'what sorts of services can we cut corners on to save money.' In the long run, this can put the public at risk.

Q10. What did you learn about the single greatest obstacle to progress in the EMS systems of the United States of America?

According to Criss (1994), thirty years ago, the lack of available data about how to provide high-quality care to patients was the greatest obstacle to improving EMS systems in the U.S. "EMS still lacks meaningful data that demonstrates the effect of out-of-hospital care on illness and trauma" (Criss 1994). This lack of data is due to both financial and logistical issues remains: keeping track of such information is costly, although it can save money in the long run, given that it permits more effective use of resources over time. Studies such as those of Blackwell & Kaufman (2002), although valuable, tend to be very limited in scope and focus on a single type of EMS delivery method or location, versus giving a more holistic perspective upon potential improvement. The NHSTA identified quality improvement with a basis upon quantified system results as one of the key building blocks for EMS improvement in the future in its report… [END OF PREVIEW]

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