Evolving EMS

As a student at Georgetown University in Washington, D.C., Sabina Braithwaite, MD, MPH, decided she’d better get some firsthand experience working with sick and injured patients before she took on tens of thousands of dollars in loans to go to med school. She’d seen too many of her fellow budding doctors change majors when they discovered they were unable to deal with blood and other body fluids.

So she got some EMS training and joined the campus rescue squad, Georgetown Emergency Medical Response, cheekily known as GERMS. “The guy who started it had a real sense of humor,” Braithwaite says. She liked the work and later volunteered for nearby Fairfax County Fire & Rescue.

Braithwaite worked as an EMT for Central Virginia Ambulance Service (later Richmond Ambulance Authority) when she was a med student at Medical College of Virginia and became a paramedic during a four-year emergency medicine internship and residency. After brief stints working in emergency departments at hospitals in Halifax and Richmond, VA, she joined the faculty at the University of Virginia, where she spent the next 12 years. She also served as medical director for Albemarle County Fire & Rescue and received a master’s in public health.
In August 2010, Braithwaite became medical director for Sedgwick County (KS) EMS. She is also the EMS committee chair for the American College of Emergency Physicians (ACEP) and chair of the steering committee on ACEP’s EMS Culture of Safety project.

The following excerpted interview can be found in its entirety on the Best Practices in Emergency Services website at emergencybestpractices.com.

How did the Culture of Safety project come about, and why is safety in EMS emerging as such an important issue now?
The idea for this came out of discussions at NEMSAC, which recommended the project to NHTSA. There was a feeling that although there are many strong efforts to promote safety from every perspective in EMS, they are not well linked together and not broadly adopted, and there was a need to create a path to lead us to a place where safety permeates everything we do.

What are the central issues that are emerging?
We’re trying to create a mentality in EMS that looks for the safest way to do any given thing, whether it involves provider, vehicle or patient safety. When we go to work in an EMS system, we want to know that the systems are aligned in a way that we won’t crash the truck, we’ll give the right medication, we will be able to do all the interventions we need to do for the patient, we’ll deliver the patient safely, and we will communicate all the appropriate information to the receiving facility.

What’s holding EMS back in terms of its development as an equal partner to fire and police?
Is EMS supposed to be an equal partner to fire and police? That’s part of the struggle EMS has. There isn’t unity on where EMS belongs. What’s certain is it needs to establish itself as part of the medical professional community. Even though we operate in an environment similar to fire and police, our core function is medical care of patients—and in a larger sense, medical care of a community from that systems level.

A lot of that identity crisis issue has been talked about in various places as the field EMS bill has been developed, and a lot of high-level folks in the government have been listening to that. The field EMS bill is advocating for the primary federal agency for EMS to be housed in the Department of Health and Human Services. I think that’s a good idea. But the funding streams that have evolved to support EMS infrastructure have come from a number of different places, and part of the challenge is ensuring those funding streams continue and coalesce, that long-standing initiatives continue and that NHTSA’s leadership isn’t disrupted.

What can individual EMS agencies do to promote themselves?
In many ways the mind-set of EMS is that we function outside the hospital. We need to mature that linkage and say we are just part of what happens, that we tee things up for the hospital and we can make things happen in the field that normally happen in the hospital. What I’ve done is meet people from the coroner’s office to the hospice agencies to the organ donation people to the health department to the medical school that you wouldn’t think of as obvious partners, but that very much intersect with what we do. If we have a better understanding on both sides of what we can do, we can better serve the needs of the patients.

What types of candidates do we need to attract to EMS to help it thrive?
We need people who understand they are entering a healthcare profession and all that entails. As a healthcare professional, you have a public trust. The public has certain expectations you need to be prepared to meet.

Jenifer Goodwin is an associate editor of the monthly newsletter Best Practices in Emergency Services.