As Emergency Medical Services and Hospitals struggle with an increasing demand for services, many EMS systems work in a constant state of “over load”.

We regularly see media stories on ED overcrowding and ambulance diverts throughout the United States. As one EMS professional stated, “we are working a multi casualty incident- each and every day”. The way EMS responds to 911 requests is changing dramatically as the healthcare system evolves rapidly. Is your organization ready for that change?

Hospital systems are working diligently to increase patient capacity by adding more beds and implementing operational changes to enhance throughput. To some effect, these measures have provided relief to an already stressed EMS system in most communities.

Managing patient volume aggressively in the Emergency Department allows the EMS Agency to go back in service for the next call but where does this cycle end?

In most cities, the EMS model is one that dispatches the most expensive equipment (fire engine) and the most expensive mode of transportation (paramedic ambulance) to transport a patient to the most expensive treatment option (Emergency Department). The current state of EMS and the healthcare system can be summed up with an EMS old-timer phrase “you call, we haul”.

In response to our industry’s slow moving evolution,  I’d like to introduce two clinical terms that have been used over the years as EMS and Medical Professionals cope with the explosive demand for services.

The EMS Afterload Approach

EMS Afterload, for illustrative purposes, is defined as the management and placement of patients after they arrive at the hospital via ambulance. Many EMS systems are working collaboratively with their hospital systems to ensure that patients who call 911 have a place to go. There is an underlying sentiment that the hospitals need to be able to accommodate these patients as volume demands continue to increase.

Hospital leadership adds Emergency Department bed capacity and staffing in an effort to keep up with the demand for patients that do not require that level of clinical care. There is a tremendous focus in accommodating patients after they arrive at the Emergency Department within minutes. By only managing the afterload, EMS systems and hospitals will never achieve a system that can handle the patient demand. In my opinion, the efforts to improve capacity are merely a Band-Aid covering the underlying issue.

The EMS Preload Approach

As defined, EMS Preload is the management and appropriate medical decisions made in the interest of the patient on scene prior to transport. EMS systems need to take a hard look at their current system. As we know, patients calling 911 expect a rapid response by highly trained individuals to treat or cure their ailments. As an industry, we have done a terrific job in promoting the concept of immediate 911 access with access the highest level of care.

Unfortunately, public education on “appropriate use” of the emergent 911 system has not been our strong point. With the changes in healthcare and the emergence of managed care, patients often have no other choice but to call 911 for their medical needs. As America’s safety net, we have proven ourselves reliable but at what cost?

Many innovative EMS systems are exploring alternative dispatch protocols and alternate transportation protocols that ensure when a person calls 911 they will receive the appropriate level of response, treated in the appropriate manner and transported to an appropriate facility, as indicated by their medical condition.

Now more that ever, EMS Medical Directors and key stakeholders need to develop alternative destination protocols that encompasses the use of non emergent vehicles, transporting patients to qualified Urgent Care Clinics (UCC) and Free Standing Emergency Departments (FED) throughout their communities. These are the final few steps in meeting the needs of our patients and providing the appropriate pathway that is both cost effective and clinically sound.

The concept of delivering any alternative to what is considered a “standard of care” can make EMS professionals a little nervous. Many ask, “Why implement change to an already proven system”? My response will always be,  “What is in the best interest of the patient and the community”? We can all agree that the current model of “you call, we haul” is not efficient and does not provide the accurate level of services that patients truly deserve.

EMS providers throughout the U.S. have a strong history of providing selfless service to our communities. Now more than ever, we should become reflective, roll up our sleeves and evaluate how we deliver that service. There is no short-term solution but with innovative strategies and responsible changes, our communities and the patients we serve will benefit enormously.
About the Author
Michael Shabkie has extensive EMS and Healthcare management experience and has passionately served as a key collaborator for EMS system design  and acted as an executive advisor on operational processes for both public and private EMS throughout the U.S.  To learn more please visit Engage911 or Michael Shabkie on Linkedin