Denver and My EMS 2.0

Also posted at Chronicles of EMS

ems2point0pinMark and I are in Denver at the Zoll Summit, but wanted to give you a little better idea about what this conference is all about.

There are a number of different learning tracks in administrative, clinical and data fields, all with dynamite speakers bringing up topics that we need addressed in modern EMS.  Many of the presentations mentioned Zoll products, that makes sense, but the way it was presented was great for us field guys to understand.

Mark and I had the opportunity to present the merits of the EMS 2.0 concept and some of the basics behind where we got the term, what it could mean and how to go about getting us there.  But even before we did that I had an educational table top discussion with fellow EMS enthusiasts Chris Montera and Steve Whitehead.  In this discussion the merits of 2.0 were challenged, the ability of firefighters to be paramedics and surgeons to be mechanics, but also the nuts and bolts of an exciting emerging concept of community paramedicine.

This concept, in every example I have been able to find, fits very nicely into MY 2.0 vision.

I’ll explain a bit more why I said MY and not THE in a moment.

The evening with Jamie Davis, Mark Glencorse, Chris Montera and Steve Whitehead, not to mention Charlotte from Zoll, ended on a more than positive note giving Mark and I fuel and insight into the ever evolving concept of EMS 2.0.

When we presented to a 3/4 full room in the clinical track, with only 2 or 3 people in the room even having a slight idea who we were or what we were to speak about, began nodding in the affirmative when I touched on the main points of EMS 2.0.

Thought I’d share.

  • Trust Clinical Judgment

For a system to operate efficiently and in the patient’s best interest we need to be trusting well educated and highly trained paramedics to make the right decisions in the field.  We have even recently seen that without a strong education paramedics make life ending mistakes.  Education is a big part of the future of EMS.

  • Alternate Transport Destinations

Does everyone need an Emergency Room? No. Then why do we take everyone there?  Still can’t get an answer from anyone on that one that doesn’t include more that ‘We’ve just always done it that way.”  Urgent Care, MD Office, Home etc.  This destination can be based on clinical impression, destination matrix and, of course, trusting our people to do the right thing.

  • Alternate Transport Methods

Break away from the outdated concept that people that goto the hospital need to be reclined on a bed in a 2 person ambulance.  BLS or ALS you are wasting a resource, an expensive one, on someone who does not need it.  Liability, as I’ve covered previously, does not enter the equation when the patient’s presentation is appropriate to be taken in by car.  A van to pick up the folks who mistakenly call for a colonoscopy is far less expensive than the ambulance twice a month.

  • Refusal of Transport

Not everyone needs to even go in to the hospital, but a mistaken definition and impression of liability hass clouded our ability to do what is right, not what they want.  Sometimes it is appropriate to leave someone at home, on the street, or at the store, who has no medical component to their chief complaint, but activated 911 because they know we’ll take them in.  Capture an accurate assessment, create a clinical decision and act on it.

But how can you enact the above concepts?  It will take time and it will be expensive…at first.  But if you realize you can cut your costs by putting Paramedics into a single unit resource instead of a dual, you cut your costs by half.  Transport to the urgent care and you don’t have to rely on the $600 payout on the $1500 transport, but the $130 payout on the $50 transport.

Three main concepts must be adopted in order for the concept to come together, I’ll cover those in a few days.  But when I presented these concepts here in Denver to the folks who make the kind of changes I’m hoping for, they nodded in agreement and sought us out afterwards to ask about specifics.  Something is happening here, there is a buzz around this crazy notion that improving EMS might just work this time around since the ground folks seem to have a voice in the discussion.

Our voice will only get louder.  But please keep in mind, Mark and I still have full time jobs and families and are still flying around the country (Mark the world) telling anyone who will listen about our desires to learn more and share what we learn with you all in real time.  But this sharing takes time to filter into the pre-conceived notions about social media and it’s power to unite a community.  Rome wasn’t built in a day, neither was the system we have today, it will take time to gather enough evidence to support these concepts and traveling to systems that have enacted portions of it is the only way I see that happening.

Stay safe,

HM

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26 thoughts on “Denver and My EMS 2.0”

  1. I think agencies can solve the frequent flyer problem without going into the very risky world of paramedic initiated refusals. Simply send a specially trained paramedic or two to the homes of frequent flyers. Problem solved without the nightmare of a 30 million lawsuit simply because a medic said some 60 year old was just faking chest pain.

  2. I think agencies can solve the frequent flyer problem without going into the very risky world of paramedic initiated refusals. Simply send a specially trained paramedic or two to the homes of frequent flyers. Problem solved without the nightmare of a 30 million lawsuit simply because a medic said some 60 year old was just faking chest pain.

    1. Wow. Where to begin? What is this Specially Trained Paramedic going to do?

      Sounds like a case for a proper assessment, clinical judgement, and determination of the appropriate clinical pathway. No one has mentioned leaving chest pain patients home except you.

    2. Wow. Where to begin? What is this Specially Trained Paramedic going to do?

      Sounds like a case for a proper assessment, clinical judgement, and determination of the appropriate clinical pathway. No one has mentioned leaving chest pain patients home except you.

    3. I’m with Mack. What will these paramedics do during the home visits? Indeed, there are some frequent fliers that would call less often if we dropped by for social visits alone. The number might be reduced by a few more percentage points if we check and make sure their meds and vitals are as they should be. EMS has already evolved into a form of social work, so having a non-emergency crew do that sort of thing wouldn’t be alarming to me.

      But unless I’ve been reading HM’s posts wrong… EMS 2.0 is so much bigger than reducing frequent fliers. Simply put, it’s about doing the right thing. For at least a couple of decades, fire & EMS services have been hammering “Dial 911″ into people’s heads. Well, they listened. And so when they don’t know what do, they dial those three digits. We need a plan on how to respond. From the fire side, the answer isn’t to always send a fire engine. On the EMS side, the answer certainly can’t be to take everyone to an emergency room.

      If everyone has a different problem, how can it be that the solution — emergency response and transport to an emergency room — is the same for all of them?

    4. I’m with Mack. What will these paramedics do during the home visits? Indeed, there are some frequent fliers that would call less often if we dropped by for social visits alone. The number might be reduced by a few more percentage points if we check and make sure their meds and vitals are as they should be. EMS has already evolved into a form of social work, so having a non-emergency crew do that sort of thing wouldn’t be alarming to me.

      But unless I’ve been reading HM’s posts wrong… EMS 2.0 is so much bigger than reducing frequent fliers. Simply put, it’s about doing the right thing. For at least a couple of decades, fire & EMS services have been hammering “Dial 911″ into people’s heads. Well, they listened. And so when they don’t know what do, they dial those three digits. We need a plan on how to respond. From the fire side, the answer isn’t to always send a fire engine. On the EMS side, the answer certainly can’t be to take everyone to an emergency room.

      If everyone has a different problem, how can it be that the solution — emergency response and transport to an emergency room — is the same for all of them?

  3. I think agencies can solve the frequent flyer problem without going into the very risky world of paramedic initiated refusals. Simply send a specially trained paramedic or two to the homes of frequent flyers. Problem solved without the nightmare of a 30 million lawsuit simply because a medic said some 60 year old was just faking chest pain.

  4. This is not a “frequent flier” problem, but a public education problem. Sending 3 people out into some systems would be a drop in the bucket in others. The point is to give the practitioners in the field the ability to do what is right for the patient.
    Paramedic initiated refusals can indeed be a amine field, but coupled with education standards and capturing a complete assessment, it makes perfect sense.
    The common misconception is that the patient knows what is and is not an emergency. FALSE. The patient knows what is and is not normal for them, but defining their situation is not their specialty, it’s mine. if I find a hospital will not benefit the patient, why am I forced to take them to one, frequent flier or not? Because no one yet understands how an advanced EMS education can benefit their system. I’m working on that pre-conception now.
    There is a dynamic solution to what ails us and most of it revolves around the care takers taking care of things before it gets out of hand and remarkably expensive.

  5. This is not a “frequent flier” problem, but a public education problem. Sending 3 people out into some systems would be a drop in the bucket in others. The point is to give the practitioners in the field the ability to do what is right for the patient.
    Paramedic initiated refusals can indeed be a amine field, but coupled with education standards and capturing a complete assessment, it makes perfect sense.
    The common misconception is that the patient knows what is and is not an emergency. FALSE. The patient knows what is and is not normal for them, but defining their situation is not their specialty, it’s mine. if I find a hospital will not benefit the patient, why am I forced to take them to one, frequent flier or not? Because no one yet understands how an advanced EMS education can benefit their system. I’m working on that pre-conception now.
    There is a dynamic solution to what ails us and most of it revolves around the care takers taking care of things before it gets out of hand and remarkably expensive.

  6. Lets also not forget that frequent fliers can be sick and injured too. Years ago, we had one FREQUENT caller who was brought in with a complaint of hip pain. Now, when I say frequent, I mean this was the kind of guy who made two or three trips per day to the hospital. The crew made him stand, and the ER triaged him to the waiting room. Hours later, after his constant complaining, the ER decided to evaluate him further, and found his hip to be broken.. OOPS.

    This frequent caller was actually hurt.. Sure, it falls into the boy who cries wolf scenario, but you cant just focus on frequent fliers. Its a public education, and point of entry issue that needs to be tackled from many different sides.

    Scott

  7. Lets also not forget that frequent fliers can be sick and injured too. Years ago, we had one FREQUENT caller who was brought in with a complaint of hip pain. Now, when I say frequent, I mean this was the kind of guy who made two or three trips per day to the hospital. The crew made him stand, and the ER triaged him to the waiting room. Hours later, after his constant complaining, the ER decided to evaluate him further, and found his hip to be broken.. OOPS.

    This frequent caller was actually hurt.. Sure, it falls into the boy who cries wolf scenario, but you cant just focus on frequent fliers. Its a public education, and point of entry issue that needs to be tackled from many different sides.

    Scott

  8. This is not a “frequent flier” problem, but a public education problem. Sending 3 people out into some systems would be a drop in the bucket in others. The point is to give the practitioners in the field the ability to do what is right for the patient.
    Paramedic initiated refusals can indeed be a amine field, but coupled with education standards and capturing a complete assessment, it makes perfect sense.
    The common misconception is that the patient knows what is and is not an emergency. FALSE. The patient knows what is and is not normal for them, but defining their situation is not their specialty, it's mine. if I find a hospital will not benefit the patient, why am I forced to take them to one, frequent flier or not? Because no one yet understands how an advanced EMS education can benefit their system. I'm working on that pre-conception now.
    There is a dynamic solution to what ails us and most of it revolves around the care takers taking care of things before it gets out of hand and remarkably expensive.

  9. Wow. Where to begin? What is this Specially Trained Paramedic going to do?

    Sounds like a case for a proper assessment, clinical judgement, and determination of the appropriate clinical pathway. No one has mentioned leaving chest pain patients home except you.

  10. Lets also not forget that frequent fliers can be sick and injured too. Years ago, we had one FREQUENT caller who was brought in with a complaint of hip pain. Now, when I say frequent, I mean this was the kind of guy who made two or three trips per day to the hospital. The crew made him stand, and the ER triaged him to the waiting room. Hours later, after his constant complaining, the ER decided to evaluate him further, and found his hip to be broken.. OOPS.

    This frequent caller was actually hurt.. Sure, it falls into the boy who cries wolf scenario, but you cant just focus on frequent fliers. Its a public education, and point of entry issue that needs to be tackled from many different sides.

    Scott

  11. I'm with Mack. What will these paramedics do during the home visits? Indeed, there are some frequent fliers that would call less often if we dropped by for social visits alone. The number might be reduced by a few more percentage points if we check and make sure their meds and vitals are as they should be. EMS has already evolved into a form of social work, so having a non-emergency crew do that sort of thing wouldn't be alarming to me.

    But unless I've been reading HM's posts wrong… EMS 2.0 is so much bigger than reducing frequent fliers. Simply put, it's about doing the right thing. For at least a couple of decades, fire & EMS services have been hammering “Dial 911″ into people's heads. Well, they listened. And so when they don't know what do, they dial those three digits. We need a plan on how to respond. From the fire side, the answer isn't to always send a fire engine. On the EMS side, the answer certainly can't be to take everyone to an emergency room.

    If everyone has a different problem, how can it be that the solution — emergency response and transport to an emergency room — is the same for all of them?

  12. Babies get fevers, antibiotics don’t work within the hour, and going to the ER to prove a point during an argument doesn’t make you right. So many within the public are beginning to see EMS as simply an extension of ER services. How many times have I heard, “I’ll get seen faster if I go with the ambulance.” when I’m on scene? I haven’t met an insurance company that rubber stamps ‘approved’ for full payment to service providers simply because the patient claims their insurance will pay for it.
    Unfortunately, this public mentality isn’t isolated to EMS and won’t be easy to remedy. Kids won’t pay attention? Give them a pill. Need to lose weight? Try this latest fad. Want to be famous? Get your own ‘reality’ show. Had a cough for two weeks, can’t sleep, but don’t want to make any of your family drive you to the hospital while Simon in on TV delivering the ugly truth? Call an ambulance! It’s free! No waiting!
    911 works… when it’s used properly. Paramedics are selfless… when they are being used properly.

  13. Babies get fevers, antibiotics don’t work within the hour, and going to the ER to prove a point during an argument doesn’t make you right. So many within the public are beginning to see EMS as simply an extension of ER services. How many times have I heard, “I’ll get seen faster if I go with the ambulance.” when I’m on scene? I haven’t met an insurance company that rubber stamps ‘approved’ for full payment to service providers simply because the patient claims their insurance will pay for it.
    Unfortunately, this public mentality isn’t isolated to EMS and won’t be easy to remedy. Kids won’t pay attention? Give them a pill. Need to lose weight? Try this latest fad. Want to be famous? Get your own ‘reality’ show. Had a cough for two weeks, can’t sleep, but don’t want to make any of your family drive you to the hospital while Simon in on TV delivering the ugly truth? Call an ambulance! It’s free! No waiting!
    911 works… when it’s used properly. Paramedics are selfless… when they are being used properly.

  14. Babies get fevers, antibiotics don't work within the hour, and going to the ER to prove a point during an argument doesn't make you right. So many within the public are beginning to see EMS as simply an extension of ER services. How many times have I heard, “I'll get seen faster if I go with the ambulance.” when I'm on scene? I haven't met an insurance company that rubber stamps 'approved' for full payment to service providers simply because the patient claims their insurance will pay for it.
    Unfortunately, this public mentality isn't isolated to EMS and won't be easy to remedy. Kids won't pay attention? Give them a pill. Need to lose weight? Try this latest fad. Want to be famous? Get your own 'reality' show. Had a cough for two weeks, can't sleep, but don't want to make any of your family drive you to the hospital while Simon in on TV delivering the ugly truth? Call an ambulance! It's free! No waiting!
    911 works… when it's used properly. Paramedics are selfless… when they are being used properly.

  15. another way to look at this: ultimately it can be traced all the way back to basic education, which indirectly affects development of basic life skills and common sense, but unfortunately this country years ago forsook education, and it seems to have decided that it prefers to glamorize the stupid and the uneducated while demonizing the “elitist” thinking people who “go to fancy schools.”

  16. another way to look at this: ultimately it can be traced all the way back to basic education, which indirectly affects development of basic life skills and common sense, but unfortunately this country years ago forsook education, and it seems to have decided that it prefers to glamorize the stupid and the uneducated while demonizing the “elitist” thinking people who “go to fancy schools.”

    1. The uneducated are easier to convince, we see it every 4 years when a large group of people votes against their best interests for goodness knows why. it can all be traced back to a basic education. Well said “medic.”

    2. The uneducated are easier to convince, we see it every 4 years when a large group of people votes against their best interests for goodness knows why. it can all be traced back to a basic education. Well said “medic.”

  17. another way to look at this: ultimately it can be traced all the way back to basic education, which indirectly affects development of basic life skills and common sense, but unfortunately this country years ago forsook education, and it seems to have decided that it prefers to glamorize the stupid and the uneducated while demonizing the “elitist” thinking people who “go to fancy schools.”

  18. The uneducated are easier to convince, we see it every 4 years when a large group of people votes against their best interests for goodness knows why. it can all be traced back to a basic education. Well said “medic.”

  19. The uneducated are easier to convince, we see it every 4 years when a large group of people votes against their best interests for goodness knows why. it can all be traced back to a basic education. Well said “medic.”

  20. The uneducated are easier to convince, we see it every 4 years when a large group of people votes against their best interests for goodness knows why. it can all be traced back to a basic education. Well said “medic.”

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