In one of my previous blogs, I talk about how the fire service has done an excellent job of reducing the number of fires in their communities through the efforts of their fire investigators, inspectors, and prevention personnel and programming; collectively called, Fire Prevention. Considering that 90% or more of the calls for service each year for most fire agencies are not fire in nature, but instead a combination of emergency medical and public assist calls, isn’t it time we establish something like an Emergency Medical Services (EMS) Prevention Division? Humor me and read on:
EMS Investigations: a team of highly-trained, specifically-certified people dedicated to investigating why a particular person or facility or neighborhood is having a particular set of problems such as: respiratory illness, frequent falling, medication errors, transportation barriers, lack of housing or food security. This team compiles their information into a meaningful report and passes the information onto the rest of the team for further action. If there are facilities that are mistreating their patients, or people that are committing elderly abuse, or if there are barriers to accessing primary care or housing or food or transportation, these issues would be well documented, empowering effective advocacy and accountability through the various channels for correction.
EMS Prevention: a team of highly-trained, specifically-certified people dedicated to preventing illness and injury in our communities armed with data from first response documentation and the EMS Investigations reports. They would provide targeted education and training to the community, such as: how to prevent diabetes, heart disease, strokes, drownings, falls, vehicle accidents, and more. Rather than fire exit drills they would be providing healthy diet, exercise, and rest modules. Rather than teaching CPR at local pools, they would be mandating and facilitating the installation of pool gates and safety alarms to prevent drowning in the first place. They would be testifying before the legislature regarding unsafe practices in nursing homes and assisted living facilities, ensuring patients receive the care and attention they deserve. They would advocate for a more comprehensive public transportation model that didn’t require 2-hours and 8 bus changes to get somebody to their job, each way. They would advocate for affordable housing and against food deserts and lack of primary care.
EMS Inspectors: a team of highly-trained, specifically-certified people dedicated to ensuring neighborhoods, apartment complexes, medical facilities, nursing homes, assisted living facilities, and schools are following the best practices identified through the EMS Investigations findings…that people are safe from medication errors, fall risks, and healthcare and social service practices more interested in profits than patient outcomes. Just as Fire Inspectors have the authority to assess fines and close unsafe buildings, EMS Inspectors could be so empowered.
This is Mobile Integrated Healthcare (MIH) in Fire Services. MIH is simply using patient-centered, mobile resources in the out-of-hospital setting for improved community outcomes. The Fire Service is well-positioned to provide these services for three main reasons: 1. publicly funded services have an obligation to do the right thing regardless of reimbursement or financial profits; 2. preventing illness and injury in the community is the right thing to do; 3. if you do nothing, it’s only going to get worse and our current models can’t support that.
What are your thoughts about an EMS Prevention Division a.k.a. Mobile Integrated Healthcare in the Fire Service? Leave your comments below:
Sarah J McCrea-Dameron 
Sarah
I enjoyed the discussion. For us in Arizona it is convincing the hospitals and insurance companies of the benefit of the program. Until we switch to a value stream in AZ healthcare, MIH programs will not see sustainable program funding. City Councils not think that they should support the costs alone.
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Agreed, we are experiencing the same challenges in Southern Nevada. I suppose that is part of the discussion though…Fire Prevention programs do not have sustainable program funding, but they are funded because we see value in preventing unnecessary fire damage and fatalities. We struggle to fund them well enough to meet their potentials, but they have been funded well enough to make a difference. How can we articulate the value, or the Return on Investment (ROI), of MIH programs to inspire Councils and Commissions to support them? This is also part of a bigger conversation around healthcare being a right or a privilege.
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Chief,
Very innovative thinking here. With a fire/EMS and software background, I thought about a lot of your ideas in terms of introducing new software.
There’s a book called “Crossing the Chasm” which outlines the adoption of new, innovative software. One of the principles there is to look at adopters of a particular concept on a bell curve. The first 2.5% are innovators, followed by 13.5% deemed the “Early Adopters”. Subjectively, the entire bell curve can be thought of in the fire service as the range from “progressive” fire/EMS services, to the ones who look to the progressive departments to adopt their practices, to the departments that only change due to mandates.
With that in mind, introducing a groundbreaking/disruptive/innovative concept is irrevocably tied to a PR/marketing campaign that communicates the value of the proposition. A software company is met with success when they find a product/market fit, communicate the need it serves, and (most importantly) execute using best practices that will be modeled by the “Early Adopters”, “Early Majority”, and “Late Majority”, respectively. A poor implementation of MIH or an campaign that does not communicate the success of the program will be to the detriment of the industry as a whole.
When the first few MIH systems start, part of their plan should be how they are going to communicate their success. A handful of MIH/community paramedicine services have already seen tremendous success. Our constituents and taxpayers will likely have more buy-in when they see success as it relates to their needs. Rather than listing the “features” of the MIH service, we should be communicating how it is going to improve the quality of life tenfold for our constituents. In the fire service, when we lobby for a new fire engine, our proposal to the city council is never “it’s an E-One with a Detroit Diesel and Allison transmission powering a 1500GPM waterous pump, dual cross-lays, LED scene lighting, and extra compartments for EMS supplies”. The value proposition to them is “when you call us for a medical emergency, this engine will be able to respond and provide critical interventions approximately 1.5 minutes faster because we’ve added advanced life support equipment in these extra compartments. Additionally, based on our research, our firefighters will be able to extinguish fires 30 seconds faster with a new hose configuration and reliable pump. While this sounds like a short time, this will result in the best chance for us to save occupants, reduces property damage, and even have the ability to lower insurance rates city-wide”. Similarly, our value proposition with MIH should communicate the quality-of-life improvements the service will offer. For example, a taxpayer cannot afford 24/7 home healthcare for their aging parents that have experienced multiple polypharm issues in the past due to dementia. The MIH service has the ability to address these social and medical needs as part of a taxpayer-based service.
Fire and EMS departments can start making changes at minimal cost by implementing some of the strategies you listed above. I love the idea of EMS Prevention. A little or no-cost solution would be to analyze NEMSIS data, pair it with hospital notes/discharge info, and send an existing ambulance to follow up. As an example, a service could analyze falls in their community. After reviewing notes and call info, crews can follow up on the social conditions of a household, check for safety hazards, and ensure the patient has the proper accessibility once they’re home. This requires no extra equipment, licensing, or staffing. An EMS coordinator can generate a weekly list using ePCR software, reach out to medical direction with the list, and provide the list to crews. In between calls, crews can make a follow up. The most important part of this is to communicate with the community about how the department is seeking to improve the overall health of the community, leveraging social proof of other successful services, while also describing the success of their own implementation.
Just a few of my thoughts surrounding this. I don’t doubt MIH will reach critical mass and become the standard for fire and EMS departments, but how it will be implemented will be defined by the innovators and early adopters.
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So many excellent points! Thank you for your thoughtful comment. Looking forward to future communication with you on this important topic.
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