By: Adam Heinz – Executive Director, Integrated Healthcare
For years the public has been told to pick up the phone and dial 9-1-1 for emergency medical help, fueling the perception that every call requires a crew to respond with lights and sirens and provide immediate care in the back of an ambulance with transportation to an emergency room. Today, industry professionals across the nation, including those of us at REMSA Health, are revisiting the medical 9-1-1 model and how Emergency Medical Services can and must evolve to ensure we are safely helping patients navigate to the best care, which may not involve an ambulance.
This evolution of the medical 9-1-1 model not only serves our patients; it serves our providers, political partners, and payers too. This shift in perception must become an industry-wide movement to advance the delivery of emergency care.
Providers: Realigning the idea of “Hero”
In a recent article from Matt Zavadskey, Chief Transformation Officer at MedStar Mobile Healthcare, he explains, “Yes, there is an EMS worker shortage in our profession, but that is no excuse to simply hire people because they have a patch and a pulse. Your interview and selection processes should include the applicant’s heart for caring.”
Care and compassion are integral for the continued success of out-of-hospital healthcare.
We must prioritize and work to ensure that the next generation of paramedics and EMTs know that not every call is going to be an emergency. Not all care has to be provided in the back of an ambulance or involve a transport to the ER. Critical, life-saving interventions occur infrequently during a typical shift. Instead, providers should focus on further expanding skills such as compassionately assessing and recommending safe, alternative medical solutions and care pathways.
Just like we’ve taught the public to call 9-1-1 for emergencies big and small, EMS providers have been prepared to respond as if every call is an emergency, and that’s just not the case. There’s an urgent need to align perceptions between the stereotypical EMS hero seen on TV and in the movies and the reality of the day-to-day work. The gap is creating burnout along with recruitment and retention difficulties industry-wide. At REMSA Health we are working to address this by giving providers information and tools to appropriately care for patients.
Politicians and Payers: Forming partnerships
A successful EMS system that evolves to meet the needs of its patients, is one that realigns EMS’ role in the minds of its community partners, politicians, and payers. It’s imperative that we rely on evidence-based medicine and health data trends to shift how EMS is perceived on a legislative level and how it provides effective out-of-hospital healthcare within our community.
Over the years, REMSA Health leaders have continually worked with its medical directors, community hospital partners, legislators, and the Washoe County District Board of Health to develop and implement appropriate protocols to ensure safe, quality care for our patient navigation model.
Patients: Navigating them to the right care
In our Washoe County community, it’s conservatively estimated that nearly 30% of the medical 9-1-1 calls received at our Regional Emergency Communications Center are for first aid level care – things like toothaches, rashes, and sprained ankles. We know that sending the highest level of emergency medical provider as a lights and siren response to a first-aid level call is a malalignment of resources and places our team and the community at unnecessary risk. It keeps services from being available for true emergencies like cardiac arrests and pediatric drownings. In addition, it’s not the care pathway that will be most helpful to the patient with the lower-level need and it sets up a false perception that paramedics and EMS professionals provide critical-level care and transportation to the ER 100% of the time.
Now, in an innovative model that EMS agencies nationwide are adopting, REMSA Health has evolved to situation-based patient navigation operations and services. In addition to providing emergency medical response care and transport, our ground ambulance and medical dispatch teams direct people to the right level of care, both over the phone or when paramedics arrive on-site. Some people may need an emergency response and transportation, while others can be directed to telehealth, urgent care, or transferred to a registered nurse over the phone for care guidance.
Patient navigation has been gradually incorporated into our system since 2012, when REMSA Health was awarded a Health Care Innovation Grant from the Center for Medicare and Medicaid Innovation, a part of the U.S. Department of Health and Human Services. The program REMSA Health developed included three interventions including the Nurse Health Line, Alternative Destination Transport, and Community Paramedicine.
These three programs later served as the baseline for a special program that the federal government launched in 2019, called ET3 (Emergency Triage Treat and Transport). REMSA Health was among 205 agencies chosen to participate in this program intended to provide paramedics and EMTs with greater patient care flexibility.
REMSA Health, with the support of the District Board of Health, has also developed a public-facing communications strategy to help people understand the appropriate use of medical 9-1-1 resources and what’s available to them. The effort to develop and implement this effective public information campaign earned the AIMHI EMS Integration Award in the category of Excellence in Public Information or Education for their work on the Choose The Right Care campaign.
In addition, the Reno-Tahoe American Marketing Association awarded the interactive website component of the campaign with its ACE Award. The site (available in English and Spanish) helps visitors navigate different levels of care based on a few scenarios. An easy-to-understand video was also developed to share across REMSA Health’s channels and for our community partners and influencers to share. Ongoing communication efforts continue with local outreach to northern Nevada news media, public service announcements, bus interior signage, presentations to community groups and more.
Continued communication with employees, providers, elected officials, payers, and community partners will be key to ensuring the success of the patient navigation model and advancing the next generation of out-of-hospital healthcare.
A sustainable EMS model for the future
In 2021, REMSA Health’s Regional Emergency Communications Center managed 276,281 calls. In the same year, our Ground Operations EMTs and paramedics responded to 67,730 calls for 9-1-1 service – of that, 47,705 patients were transported to the ER. The number of calls and responses we service in our community is impressive and in order to preserve medical emergency response resources for true emergencies, it was important we started with educating our teams and community on the right levels of care.
Providing our ground ambulance providers and medical dispatchers with the right tools has empowered them to provide quality care within this innovative model. From patient education materials to detailed protocols that help determine alternate care pathways , crews are equipped to support the patient’s needs on a more individualized basis.
As a private, nonprofit healthcare provider funded by user fees without local tax subsidies, REMSA Health keeps an eye on the future by continuously developing innovative ways to meet the changing needs of our growing community. We reinvest all funds, including more than 64% directly to employees through wages and benefits, into the community through programs, equipment, services and personnel.
We expertly serve our community by understanding how critical it is to rethink, inform and set clear expectations of service for clinically excellent, innovative, compassionate, and reliable care. It’s been our honor and responsibility for more than 35 years to ensure our community feels healthier and cared for. Safe patient navigation to the right care, sustainable financial models, and strong community partnerships, will contribute to our continued success in providing value and out-of-hospital care for those who need it, whenever they need it.