How EMS is changing

How EMS is changing

In its second year, the EMS Trend Report describes revealing changes in clinical care, finance and the use of technology in EMS

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This feature is part of the 2017 EMS Trend Report, which takes an in-depth look at EMS trends in the United States and sets a foundation for assessing how the EMS profession is changing. Be sure to share this trend report with other EMS leaders and discuss your thoughts on how EMS is changing in the comments.To read all of the articles included in the report, click here.

To an outsider, EMS probably looks pretty similar today to how it did decades ago. Call 911, and an ambulance arrives and takes you to the hospital – simple. Yet we know that  while progress can sometimes feel slow, in other ways the profession might be going through its most transformative era.

Whether it’s a call to change “EMS” to “paramedicine,” a push to reform reimbursement models or the increasing use of data and information technology, the industry will be making decisions in the next few years that might significantly impact how patients are treated and what it’s like to be an EMS provider in the future.

The 2017 EMS Trend Report reveals the current state of the profession and where we are headed. Now in its second year, the report is based on an extensive survey of the EMS Trend Report Cohort – nearly 100 EMS agencies of different sizes and service models across the United States.

The long-term goal of the EMS Trend Report is to monitor movement on key clinical, operational and administrative dimensions among a select group of representative EMS agencies over a multi-year period. In future years, the EMS Trend Report will have even more value in describing how the profession is evolving over time. But now, in its second year, the 2017 EMS Trend Report can for the first time describe some revealing changes in areas such as clinical care, finance and the use of technology.

Clinical care

At the core of every EMS service is clinical care – the protocols, medications and equipment that support patient assessment, treatment and transport. Despite efforts at the national level to create evidence-based guidelines and model protocols, there are still a wide range of procedures being used and devices being carried.

Certain trends predicted in last year’s report have continued. In 2016, we saw that fewer than half the agencies in the EMS Trend Report Cohort were including therapeutic hypothermia as part of their cardiac arrest resuscitation protocols. While it was the first year of the report and previous data were not available, we concluded that the percentage had probably been higher until recent studies and American Heart Association guidelines questioned the evidence supporting prehospital cooling.

In this year’s report, we see a compelling decrease, as only 29 percent of agencies report using hypothermia in cardiac arrest patient care; of the subset of agencies that fully responded in both 2016 and 2017, there was a 32 percent decrease. One responding agency, however, did report the use of hypothermia for patients with potential spinal cord injuries.

The use of mechanical compression devices and impedance threshold devices remains relatively constant, with just over half the responding agencies using a mechanical chest compression device. Less than one in four use an ITD. As more evidence is reported about the impact of these devices on patient survival-to-discharge, we can expect utilization to change.

Certain treatments and diagnostic tests continue to be rare. Prehospital ultrasound remains uncommon among cohort agencies, with only 3 percent reporting its use. A small number of agencies now report allowing administration of thrombolytics in the field for myocardial infarction, with one also administering a clot-busting medication for possible stroke patients.

This year, the EMS Trend Survey included the addition of some relatively new procedures in an effort to start tracking their adoption. One of those is lactate testing, which has gained favor in recent years as a method of confirming sepsis – 12 percent of respondents have lactate testing capability. At the same time, it is possible that many agencies are hesitant to purchase lactate monitors due to cost or other factors.

Performance measurement

Regularly examining data is considered critically important to evaluating an organization’s performance and improving operations, efficiency and clinical care. Most agencies report reviewing information on response time, call volume, compliance with clinical protocols, collection rates and overtime hours on a monthly basis. Some agencies report this information daily.

The vast majority of respondents (81 percent) still do not regularly review hospital discharge information, reflecting a continued struggle in EMS agencies’ ability to access the data they need.

Clinical measures of time-sensitive conditions

In almost all cases, the reported use of clinical data to measure performance is increasing. Among agencies that participated in both years of the survey, twice as many are now measuring their providers’ ability to recognize sepsis. With sepsis now often included alongside trauma, STEMI and stroke as a time-sensitive condition, this trend is not a surprise. Overall, however, sepsis recognition remains a much less used measure than STEMI and stroke recognition, which nearly 80 percent of agencies report tracking.

At the same time, it is clear that some changes are slow to take hold. Only two-thirds (63 percent) of respondents are measuring survival-to-discharge for cardiac arrest.

Agencies are measuring skills, like IV success rates (74 percent), as well as completion of a package of assessment, such as time-to-EKG (71 percent) or door-to-balloon times (66 percent). Although all measurement can have value, focusing on the easy-to-measure completion of tasks might not be as closely linked to patient outcomes as a bundle of condition-specific assessments and treatments.

Measuring skill success rates or assessments performed, though, is often easier because of access to the data and ease of interpretation. For example, a little more than half of agencies (53 percent) measure administration of pain medication, a 33 percent increase from 2016 by the agencies that fully responded to both surveys. Whether or not the use of those measures changes in the future will be something to look for in future editions of the EMS Trend Report.