EMS Agenda 2050: A People-Centered Future

As improved technology and evidence-based research emerge in EMS, it’s not only vital to apply these new advances in the field now, but to continue envisioning additional advances and how they could positively impact the future of EMS.

EMS Agenda 2050 is a two-year project aiming to ensure these positive changes are developed and implemented, inviting providers, leaders, and even the public to contribute their best ideas to shape the next thirty years of EMS in the United States.

On January 24, an EMS Agenda 2050 webinar was hosted by Mike Taigman, improvement guide for FirstWatch and former paramedic, joined by presenters Michael Gerber of the RedFlash Group and Gam Wijetunge of the NHTSA’s EMS staff. The webinar attracted over 170 participants who provided their ideas to questions posed by the group.

Taigman discussed the central goal of the EMS agenda: to make EMS people-centered. This is intended to include both patients and providers—improving the quality of patient care as well as the quality of providers’ work environments.

The following six principles were formed by the technical expert panel of EMS Agenda 2050 as guidelines for proposed changes:

1. Inherently safe and effective
2. Integrated and seamless
3. Sustainable and efficient
4. Reliable and prepared
5. Socially equitable
6. Adaptable and innovative

Below are the questions posed to participants, followed by some of their responses.

1. What could “people-centered” really mean for EMS in the future? What would be different?
   • Diversification — include wide variety of minorities
   • Optimally healthy society where less people use emergency services
   • Make EMS a viable career without working long or multiple shifts
   • Support of provider health, patients’ families 
   • Integrate EMS into definitive health care system
   • Engage communities with education about EMS, like CPR, Stop the Bleed, etc.
   • Align EMS more with military services; create pathway for veterans
   • Allow EMS to have broader base of needs in community
   • Options that fit the patient rather than everyone getting the same ambulance ride, etc.
   • Make reimbursements patient-centered
   • Make EMS on par with fire and police in terms of pay and retirement
   • Involve community membership in assisting quality of life
   • Non-government EMS eligible for funding/grants, etc.
   • No more timing requirements — every patient has different needs, may not need to be transported in X amount of minutes
   • MIH
   • Consider tracking complete patient journey
   • Licensed paramedics to have long-term career education
      
2. What could we do from the provider perspective to increase health, safety, and joy?
   • Better preparation for initial-entry providers
   • Better compensation for providers
   • Better reimbursement
   • Establish fatigue management benchmarks for field employees
   • Mechanisms to follow up with patients, families, clinicians because many providers really want to know the outcomes
   • PTO
   • Deeper knowledge base
   • Participation in stakeholder meetings with hospitals, etc.
   • Better work-life balance opportunities via work schedules
   • Retention of volunteer services
   • Initiate stress inoculation management
   • Treat people like family; make better efforts to collect patient data
   • Focus on medicine and improving practice rather than focusing on billing
   • Educate the public — e.g. not an ambulance driver, but an EMT/paramedic
   • Lights and sirens restrictions
   • Improve ambulance crash safety
   • Implementation of better health for providers — e.g. minimum exercise and eating plans
      
3. What is one piece of cool technology that hasn’t been invented yet that you’d love to see in EMS?
   • Tri-quarters
   • X-ray glasses
   • NAEMSP talked about true pain detector, voice-based data collection
   • Field ultrasound
   • Lab app on iPhone for lab values
   • Ultrasound with computer interpretation
   • Stair chair that doesn’t weigh 90 lbs. – lighter equipment
   • 3D tomography
   • Tool or gadget to protect/warn before medical emergency
   • Live video and audio feed to receive physicians
   • Hover cots – never lift again!
   • Better education and training, not better tools – all patients should be able to stay home (think of Fahrenheit 451)
   • Productivity metrics for crew
   • Hospital that provides differential diagnoses based on age, sex, etc.
   • Health information exchange
   • Wound care
   • Injectable nanotechnology to scan and send info to hospital
   • Device that disrupts clots and coronary arteries
   • Remotely improve hemorrhagic strokes
      
4. Inherently safe and effective: What would be the components of a truly safe EMS system – safe for patients, families, public, and providers?
   • Hygiene practice improvements
   • Less moving of patients, less chance of injury to patients and providers
   • Airbags for patient compartment
   • Shifts designed to minimize responder fatigue
   • Continue reduction of lights and sirens
   • Training in behavior health crises – tool for safe restraining of uncontrollable patients
   • Harm reduction for patients engaging in risky behavior
   • Real-time monitoring
   • Quality focus check and just culture
   • Safety culture
   • Crew resource management – preplanning with PCP, PHCP, families
   • Safe response set of guidelines of what makes sense for use of lights and sirens
   • Automobile technology that recognizes approach of emergency vehicles
   • Safety management systems similar to air crew industry instituted for all EMS agencies
   • Automatic referral and notification
   • Crash study focused on patient compartment of ambulance
   • Improve initial screen techniques
   • Ability to summon social workers to scenes to assess living conditions
   • Better mental health training for patients
   • Configure back of unit to decrease risk of secondary devices harming patients and providers
      
5. Integrated and seamless: What outcomes could we create for patients in the future with full integration?
   • Data and ability to get info – big focus on having all the data you need presented in useful, easy-to-digest way at bedside
   • Integrate with HMOs and health plans
   • Becoming mobile outreach – intercede medical issues
   • Seamless electronic reporting to hospital
   • Ability to pull up historical data
   • Self-monitoring and self-care for patients – wearable medical devices
   • Full integration with health record
   • Track patient’s journey from call to discharge
   • Nationwide MIH-CP
   • One database of HPI in your state that all health care providers can access
   • Reduce medical errors – especially medications and patient injuries
   • Automatic drug interaction determination built into EPC software
   • Consistent patient data
   • Reduce burden on ER
   • Integrate with community health
   • Move paramedics and EMTs into ERs and ICUS to continue care into definitive care
   • Standardize national competencies for all systems
      
6. Adaptable and innovative: How do we create a culture of innovation in EMS?
   • Identify and reward ideas that improve service delivery outcomes
   • De-regulation – let profession govern itself rather than compromise with slow-moving government; Reduce government micro-management on EMS not seen in law and fire
   • Make funding more available
   • Move EMS to nonprofit, public safety-based model
   • Retire theory of ‘That’s the way we’ve always done things’
   • Do not let budget limit goals – think outside the box
   • Put EMS in forefront instead of secondary part of fire service
   • Accept risks, allow mistakes
   • Allow time and space to provide ideas and feedback
   • More conferences and expos to show innovation of EMS
   • Leaders have to change first
   • Incentive for EMS to try new technology
   • Keeping up with modern standards and guidelines—they are our guard rails
   • High turnover leads to less opportunities for future innovation
   • Just culture – encourage terminal degrees
   • Registry of EMS researchers so services can connect with academic resources
   • Randomized controlled trials
      
7. Reliable and prepared: How do we better prepare EMS providers to serve patients and communities?
   • Sea change in provider mindset – understand how day-to-day operations can affect long-term care and disaster management
   • Learning new technology to make adaption easier
   • Larger commitment similar to replicas allowing cross-border responses
   • Know how much time to spend on preparedness on MCIs and large-scale responses
   • Organization of resources, stock additional buses and ambulances for MCIs
   • Community of operations (COP) planning
   • More mutual aid and training with other agencies
   • More risk analysis
   • Consider how EMS rules change in post-disaster recovery
   • Make standardized documents about age, environmental hazards, common illness
   • NEMSIS training for all responders, even at EMR level
   • Look for gaps that exist in communities’ capabilities and be part of the solution
   • Avail ourselves of research and solutions to problems
   • Exercise drill involvement – offer at regional conferences
   • Scenario planning
   • Ongoing community risk assessments
   • Provide for chronic care support
   • Nuclear power plant disaster training
   • Climate change – wildfires and hurricane training
      
8. Socially equitable: What does socially equitable EMS look like to you?
   • Workforce diversity is essential
   • Better education in equity and epidemiology
   • Work groups that mirror communities we serve
   • Providing research to show there is a gap that can be addressed locally to escape the “not me” thought process
   • Increase understanding of cultural differences
   • Learn from police experience
   • Outreach to community to get young members into EMS
   • Look at gaps in staging, equipment, training in rural vs. urban agencies
   • Ask volunteer agencies to keep doors open to all
   • State/national health insurance plans paid with taxes to cover everyone
   • Long term engagement rather than trust-building metrics
   • Ethics education in curriculum
   • Equitability in EMS resources in underserved communities
   • Multicultural/language in EMS
   • Improve education on more chronic conditions that affect specific groups
   • Perception vs. reality
   • Surveys and research as what presents on local level to close gaps – problem is larger than EMS
   • Get to know community and know its needs – BP readings, CPR training, etc.
   • Mentoring programs for under-represented groups
   • Social equity should be considered to be added in EMS values and mission
   • Tuition paid back for working areas of need
   • Use reporting to NEMSIS 3 to see community needs
   • Expose EMS community early to young adults in schools
      
9. Sustainable and efficient – How will EMS in 2050 balance preparedness with efficiency and sustainability?
   • Get rid of archaic supplies and equipment lists
   • Better management of funds
   • Make legislative rules and protocol updates more efficient
   • Use EMS data to predict future events
   • Sustainability/retention of employees
   • Create career path for mid-level providers in EMS (like RN or PA) to become industry standard
   • Reduce workload on non-emergency cases
      

For more information on EMS Agenda 2050, click here.