Are You Embracing The New Frontier in Lifesaving?

Since modernization of the current EMS model in the early 1970s, we have made tremendous progress in refining our craft. The clinical and operational practices of our current responders have progressed dramatically since the days of MAST pants, Cadillac ambulances and Advanced Red Cross first aid certificates. However, we must begin to look at the bigger picture regarding the effect of our progress. Research has proved the current EMS model saves countless lives. Through evidence-based medicine, we adjust and tweak our systems to improve our effect on morbidity reduction in our communities.

Taking into consideration the advances of our systems and the evidence of our effect on mortality, we must determine how we can expand our services to the community and affect death and disability in a different way. Many systems across the country are addressing this with injury- and illness-prevention programs.

Some of the programs are needs-driven, based on analysis of calls/injuries in a local area, while others are simply a desire to do more for the community. Many services are enacting programs that are considered universal prevention initiatives, while others have developed long-term programs that also meet specific issues in their geographic area.

A number of services have adopted free defibrillator programs and CPR education for their citizens, free public healthcare screenings, and regular discussions with citizens regarding the day-to-day work of emergency medical services. Programs like these address broad-spectrum issues like sudden cardiac arrest, public understanding of how the EMS system functions, and overall health of the citizen base.

The Phoenix Fire Department, a fire-based EMS service with a diverse population of more than 1.5 million, has initiated an injury and illness prevention model to save lives. "We take every opportunity to promote our message of safety," says Deputy Chief Frank Salomon, and the department's mission serves that statement well.

The Phoenix EMS Prevention Program is a needs-driven model that incorporates continued re-evaluation of its own statistics to identify the public's need for education. For example, when the department noted a significant number of drowning-related fatalities of children during the summer months, it developed a program to install fences around pools, along with a program called Are you watching your kids around water?"

Use of community non-profits, expanded use of media outlets and general public education have resulted in a decrease in both drowning incidents and fatalities. This outreach also includes a fall-prevention program, car seat initiatives, home safety checklists and much more. Most important, the programs are targeted to specific age groups to allow for a more tailored message.

"It must be age appropriate," says Salomon. This rings true in any educational experience.

The Manheim Township Ambulance Association of Lancaster, PA, is a private, non-profit service covering an equally diverse 40,000 people in Lancaster County. In 2009, it developed an illness- and injury-prevention approach that is evidence-driven, aiming to serve the needs of its core population. The fall-prevention program, "Prevent Falls Before Calls," provides free "fall-risk" assessments performed by EMS providers and gauges risk of recurrent falls similar to the assessments performed at extended-care facilities. The patients deemed at risk are referred to DME companies, visiting nursing associations and other private companies. During this time, families and other guardians are consulted to allow EMS to become part of patients' long-term care planning. This program was developed due to a high geriatric population and a call volume that reflected more than 10% of the service calls to be fall trauma-related.

The fall-prevention program, in addition to free AED installations, public education in senior centers and compressions-only CPR training has resulted in a decrease in target calls in just a few short months. Much of the prevention message is also media-driven, through traditional media coverage, blogging and social media with the recently established Eastern Pennsylvania Chapter of the Sudden Cardiac Arrest Association, managed by the Ambulance Association. "We are leading EMS in a new direction, becoming a larger part of our patients' healthcare team," says Dave Smith, the association's director of operations.

Okaloosa County, FL, under the direction of Director of Public Safety Dino Villani, has taken a similar needs-driven approach to its public education and prevention initiatives. As a major tourism capital, the county's residential base of 190,000 swells to well over 1 million visitors and beach-goers from May to September. The county is also at the apex of the Florida panhandle, making it vulnerable for some of the worst weather events in the country.

The county's 20,000 EMS calls for service each year have been significantly reduced by the "beach safety" unit, a group of lifeguard-trained EMTs and paramedics that handle medical and traumatic emergencies on the beach, and provide beach-safety education regarding compliance issues, flag warning systems and general water safety. This is in addition to frequent hurricane and pandemic flu exercises, pre-established hurricane shelters, a significant county-wide defibrillator program and a code red weather notification system, which are just some of the citizen-involved prevention and education programs being operated in the county system.

Many organizations have difficulty beginning their programs due to a number of factors, including staffing, finances and simply designing their systems to concentrate on routine day-to-day operations. Understandably, it can be difficult to identify a direction for establishing a program in your area, as the needs of every organization are very different and hinge on your community at large.

The British Columbia Injury Research and Prevention unit developed a widely accepted injury-prevention and evaluation cycle, which illustrates the cycle of injury prevention program development. Taking the "Haddon's matrix" and "Evans-Stoddart" models into consideration, the IPEC defines each step of the evolving process of injury- and illness-prevention.

Step 1: Are Injuries a Problem?

Evaluate your community's specific injuries and illnesses to determine core problems. Compare the targeted issues, their effect on morbidity and mortality rates, disability and how these issues affect your community's economic growth. From this information, determine the injuries or illnesses you would like to target with your program.

Evaluate call volumes and the nature of injury/illness to see where your community trends. If you're seeing heavy cardiac and respiratory outcomes, educate your community on healthy living and smoking cessation, while providing defibrillator and CPR education.

Step 2: What Are the Injury or Illness Risk Factors?

In order to understand the direction of your prevention program, you must understand the causes of your target injuries and illnesses. These target issues might be from a single cause, or from multiple causes having both direct and indirect effects.

Gather and analyze available data for your target demographic, as well as specific information regarding the suspected causes. If you notice specific instances of motor vehicle accidents in the younger demographic, consider education-based driver-safety programs, sober driver initiatives and teaming up with the MADD or SADD organizations in your area.

Step 3: Implementation

The most difficult part of any process is putting the plan to work for you. Plan out the steps needed to reach your goal, find needed funding and implement the plan.

Tap into local finance sources, foundations and civic groups for financial backing, as well as to generate support for your cause. Then get to it.

Step 4: Are Your Programs Effective?

Any good answer to an identified problem must be evaluated. Did we complete all of the planned steps? Did we reach each age-specific audience? Have we changed behaviors of our target demographics?

This evaluation phase is identified as the time where we ensure the program we’ve developed has remained according to plan and reached its goal points. The phase is much like the traditional provider CQI model, where you look to see if you’ve reached the target demographic.

Step 5: Are Your Programs Efficient?

Are you achieving the best results with the least number of committed resources? How are you quantifying short- or long-term effects on morbidity and mortality?

Given every service's limited number of available resources, efficiency is key in the long-term life of your program. Continually evaluate each step to allow for long-term improvement. This is your "fine tune" phase, as you've been there and done it.

Step 6: Monitor and Reevaluate

Were you effective in changing the target issue? Did you address all of the risk factors? What else needs to be addressed?

This is the end of the evaluation process, and is your re-assessment and re-implementation phase. Continued re-assessment is the key to long-term success of the program. While continuing to refine our approach to clinical and operational public safety, the future of lifesaving truly stands with creativity. How can your organization save lives and affect long-term outcomes with something besides diesel and medicines?

Start small, plan and implement your program, and continue to re-evaluate the end result. Even the smallest programs have some effect on your customer base and are worth taking the next steps. Let's walk together as an industry into a new endeavor and show our communities new ways to avoid personal medical catastrophe.

James Weber, EMT/AS, is a training coordinator and author from Lancaster, Pennsylvania. His work is concentrated on injury- and illness-prevention, community organization and development, and expanded use of laypersons in the public safety model. Contact him at jweber@manheimtownshipems.org.