Integration of Emergency Medical Services and Public Health

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Integration ofEmergency Medical
ServicesandPublic Health
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Integration of EMS Public Health

• Describe differences and similarities between EMS
  and Public Health
• Describe benefits of collaboration
• Provide examples of EMS activities
• Describe challenges and opportunities

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Integration of EMS Public Health
EMS Agenda For the Future 1996

• EMS must expand its public health role and
  develop ongoing relationships with community
  public health and social service resources.

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Integration of EMS Public Health

• EMS Agenda For the Future 1996
• EMS represents the intersection of public health,
  public safety and health care systems
• A vision that EMS will be fully integrated with
  health care providers, public health, and
  public safety.
• A vision that EMS can contribute to the
  treatment of chronic conditions and community
  health monitoring

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Integration of EMS Public Health
Trauma System Agenda for the Future

• A trauma system is an organized, coordinated
  effort in a defined geographic area that delivers
  the full range of care to all injured patients
  and is integrated with the local public health
  system.

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Integration of EMS Public Health

• Most lead EMS agencies are withinDepartments of
  Health

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Integration of EMS Public Health

• Key differences EMS Public Health
• EMS is typically
• Patient/scene based
• Respond to acute events
• Optimized to respond quickly/maximally
• Reliant on public access communications system to
  detect incidents and target response to incidents
  
• Not well integrated with other health care
  activities
• Expects patients health to improve on the way to
  the hospital

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Integration of EMS Public Health

• Key differences EMS Public Health
• Public Health is typically
• Community or population based
• Proactive
• Utilizes epidemiologic methodsto systematically
  detect threats to community health
• Intervening mainly through changing environmental
  factors or through strengthening community
  immunity to the disease
• Able to recognize that many changes will take time

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Integration of EMS Public Health

• Key Similarities
• Committed to improving patients health
• Workers are passionate about their field
• Immersed in same environment of change -the need
  to do things differently

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Integration of EMS Public Health

• Benefits of Collaboration to EMS
• Increased professionalism
• More analytic approach
• Use of public health data for EMS purposes
• New funding opportunities
• Increased satisfaction
• Strong partnerships
• Broader community perspective

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Integration of EMS Public Health

• Benefits of Collaboration to Public Health
• Prevention
• Visibility
• Increased response capability
• Rapid communication
• Data collection
• Referrals
• Increased cost effectiveness
• Access to populations

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Integration of EMS Public Health

• Benefits to the Community
• Reduced health care costs
• Increased access to health care
• Increased accountability
• Better consumer education
• Improved health

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Integration of EMS Public Health

• State EMS Involvement in Public Health
• Injury prevention and surveillance
• Providing public information and education
• Integrate current programs with public health and
  primary care
• eg. Fall Prevention
• eg. SBIRT Screening, Brief Intervention and
  Referral to Treatment
• eg. Head Injury Surveillance
• Disaster management
• Immunization

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Integration of EMS Public Health

• Local EMS Involvement in Public Health
• Seat belt campaigns
• Screening programs (BP, diabetes)
• "Childproof Home" safety checks
• Immunization programs
• Providing public information and education
• Child safety seat checks
• Bike rodeo
• Campaign for AED placement
• Heart disease prevention efforts

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Integration of EMS Public Health

• Local EMS Involvement in Public Health
• A new SPHERE for EMS
• Supporting Public Health with Emergency
  Responders
• Seattle/King County Medic One
• Goal of SPHERE is to
• Prevent future 9-1-1 calls by identifying
  potentiallylife-threatening conditions whenever
  a patient isseen by responders.

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Integration of EMS Public Health

• A new SPHERE for EMS
• Supporting Public Health with Emergency
  Responders
• EMTs evaluate a 57-year-old with a mild allergic
  reaction.
• Prior to EMS arrival the patient
  self-administered Benadryl and has improved upon
  arrival of EMTs.
• He is stable on exam, with a mild rash on his
  arms and trunk. His blood pressure is 170/105 and
  blood glucose (checked because the patient says
  he has bouts of low blood sugar) is 182 mg.
• He says he will follow up with his doctor. The
  EMTs casually mention to the patient that his
  blood pressure and blood sugar are both high.
• Because of his stable condition and patient
  refusal for transport, EMTs decide that transport
  is not needed. The medical incident report is
  completed and duly filed.

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Integration of EMS Public Health

• A new SPHERE for EMS
• Supporting Public Health with Emergency
  Responders
• Same situation, but this time the EMTs not only
  mention that the blood pressure and sugar are
  high, but also give the patient a personalized
  written "High Blood Pressure Alert" and "High
  Blood Sugar Alert" that strongly advise him to
  have follow-up for possible hypertension and
  diabetes.

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Integration of EMS Public Health

• A new SPHERE for EMS
• Supporting Public Health with Emergency
  Responders
• They indicate on the incident report that the
  alerts were given, and one month later the
  patient receives a call from the EMS office
  asking if he has followed up with a physician.

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Integration of EMS Public Health
Challenges

• Lack of cross training
• Inclusion of private practitioners and agencies
• Legislative support
• Assessing community needs
• Need for collaboration

• Traditional roles and cultures
• Traditional performance measures
• Funding and reimbursement issues
• Regulation/licensing issues

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Integration of EMS Public Health

• The Future of EMS Involvement in PH
• Improve safety and prevent injuries in homes
  visited by participants.
• Educate existing home visiting groups of
  unintentional injuries and related hazards in the
  home.
• Train home visitors to perform home safety
  reviews and provide devices necessary to reduce
  hazards in the home.
• Community Paramedicine

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Integration of EMS Public Health

• Next Steps
• Remain flexible and focused on the health of the
  patient
• Identifying opportunities for improved patient
  care
• Collect and promote best practices
• Invest in the development of EMS and Public
  Health partnerships
• EMS education which betterprepares EMS providers
  as PH team members

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Integration ofEmergency Medical
ServicesandPublic Health
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