Guest Editorial: Partners in Prevention

In my time working on an ambulance, if I thought about public health at all, my mind would automatically go to initiatives such as immunization clinics and smoking-cessation programs. Later, when I went to graduate school, I heard about some public health initiatives that impacted EMS, such as fall-prevention programs, but the true synergy between the two disciplines still wasn’t clear to me. 

It was during graduate school that I began to understand how public health departments are structured and funded. I also learned that healthcare is traditionally individualized and focused on unique patients, while public health looks at community and even population health and is concerned with making communities healthier.

It was also during this time that I began to notice a divide between the two disciplines. Although EMS and public health have many areas of potential overlap, EMS providers don’t always fully understand what public health is and does. At the same time, public health practitioners may not fully grasp the capabilities, capacity, and flexibility of the EMS system. This inhibits synergy between the disciplines, potentially hurting efforts in both fields.

But to be clear, I have seen initiatives in which EMS and public health have been able to evolve past their regulated roles and come together to bridge recognized needs. Some examples include:

• An initiative in Pennsylvania that allows EMS providers to leave naloxone behind at the scenes of treated overdoses where patients do not wish to be transported. This initiative started in early 2018, and thousands of doses of naloxone have now been left by EMS providers across the state. 
• Various community-based programs focusing on safety, including bicycle safety, drowning prevention, and child car seat inspections. These programs save lives by preventing emergencies before they happen. 
• Owing to the unique nature of mental health emergencies and the manner in which they are best handled, many areas have developed mental health response teams to answer 9-1-1 calls for mental health issues. EMS providers with additional mental health-specific training are typically a component of these teams.

There are additional areas in which public health and EMS have come together, such as in response to the COVID-19 pandemic and other public health emergencies. EMS providers have proven expertise in many areas pertinent to public health. They have adapted easily as fit testers for various levels of PPE, contact tracers, and even patient triagers, both in person and telephonically. The incorporation of these strengths into the response framework of public health emergencies can benefit both public health entities and the public we all serve. 

Both EMS and public health have the goal of population health at the center of their organizational missions. As our populations age, initiatives such as fall-prevention programs will become even more important as patients aim to “age in place.” These programs can result in EMS responding to fewer calls for falls and/or lift assists as well as fewer people potentially entering skilled nursing facilities.

This goal is also accomplished through various community paramedicine programs, which enhance access to care. Community paramedicine, regardless of which target objective it is addressing, is an example of a functioning public health initiative. Through changes in the way they access available care, persons requiring minor treatment can be seen outside acute-care settings, decompressing taxed resources and increasing the availability of services. We should not look at our respective goals as competing but rather as an opportunity for synergy.

The time is now to seize the moment and take the relationships that were forged during the COVID-19 pandemic to the next level—we have all proven ourselves in this new paradigm and simply cannot let that opportunity slide. Take a moment to reach out to your public health department to discuss areas where you can work together, whether they concern emergency preparedness or some of the other areas noted above—the websites for the National Association of County and City Health Officials (NACCHO) and the Association of State and Territorial Health Officials (ASTHO) can be invaluable in getting this information. 

Public health authorities need to better understand what your systems look like and what you can realistically do, and there is no one better to educate them than you.  

Raphael M. Barishansky, MPH, MS, CPM, is deputy secretary for health preparedness and community protection at the Pennsylvania Department of Health and a member of the EMS World editorial advisory board.