As we begin 2014, we will all experience changes in our health care due to the implementation of the Affordable Care Act. All areas of health care will strive for an increased focus on preventative care as well as outcome based medicine. EMS and pre-hospital care will be experiencing some dramatic changes, too.
Historically, the structure and philosophy of EMS has centered on the idea of rapid response, treatment, stabilization and transport of patients to local emergency departments. There will always be a need for rapid response and treatment for ambulance patients, such as with severe trauma patients and cardiac events. Already EMS providers and hospitals are working together to better treat these patient conditions.
Trauma patients are being directed to trauma centers, while cardiac and stroke patients are being treated with more aggressive protocols — in some cases, by-passing the emergency departments and going directly to a cardiac cath lab, saving valuable minutes and improving patient outcomes.
Several other types of emergency calls are being studied to determine best practices. Often paramedic care at the home can successfully treat patients while avoiding transportation to an emergency department; this is common practice already with repeat diabetic and seizure patients.
In addition, patients with mental health issues may be best treated in mental health facilities rather than in an emergency department.
EMS is quickly evolving into the practice of “community paramedicine,” where the EMS providers will be working in conjunction with doctors, hospitals and several other health care practitioners to better serve the needs of the patient.
We also foresee the community paramedics will be doing preventative care, hoping to intervene with minor medical problems to prevent them from becoming serious which would result in a call to 911. Hopefully, this will decrease the amount of nonemergency patients using the emergency room for all their health care needs.
Technology will aid us in this new approach to avoid hospital care. Smart phones and video conferencing will allow the community paramedic to link the patient to the doctor if the need arises. The doctor can communicate directly to the patient and paramedic in the patient’s home. If tests or interventions are needed, the expanded role of the paramedic will allow the procedures to be done in the home and not require an expensive trip into the hospital.
Also, the paramedics will be able to enter all the information into the patient’s electronic medical records so their primary care physicians will be able to handle follow-up care.
How and when will all this occur? Well, we will need to overcome the obstacles of regulations, reimbursements and outdated ideas. However community paramedicine holds tremendous promise in improving patient experiences. And fortunately here in Northwest Indiana, many of our local hospitals have begun initiatives toward this.
We appreciate opportunities to partner together to provide better health care to all.