Emergency medical services (EMS) provide pre-hospital emergency medical services through highly skilled clinicians. The EMS not only offers the first healthcare in emergencies but also is often the first to identify a healthcare crisis (AlShammari et al., 2018). After identifying a crisis that requires emergency medical attention, the EMS system responds through the healthcare personnel and locomotives, such as ambulances and helicopters, that make the services of EMS easily recognizable. The personnel involved in EMS have an inherent risk of acquiring injuries and illnesses while on their job and have high rates of fatal injuries. A call for help activates the EMS, and the response does not just involve transporting victims from an emergency but is a coordinated process that involves numerous professionals and agencies (AlShammari et al., 2018). The system is comprehensive for it to be ready to respond to every kind of emergency, whether or not involving going to the hospital. To achieve this, the EMS does not operate in isolation, but it integrates with other services and systems intended to enhance people’s health and safety. Due to the evolving response goal that has changed towards stabilization, treatment, and timely transport of victims of an emergency to a medical facility that can provide the required medical care, the EMS has strategies that ensure the attainment of the overall goal of enhancing public health and safety and these tactics include:
Data-Driven Quality Improvement
The first tactic employed by EMS is data-driven quality improvement that seeks to collect and analyze data that is critical for the successful operation of the system. The collected data leads to improvement in practices, resource allocation, system design, and support for public policies that involve population health (Lincoln et al., 2019). Quality improvement in EMS is the intentional process of making system-level changes in the system’s processes to improve the delivery of emergency medical services. The improvements are followed by assessments to evaluate the effectiveness of the changes to ensure the continued delivery of high-quality emergency medical services. The assessments are based on the key performance indicators that measure the effectiveness and success of the implemented practices and help identify areas of weaknesses. The EMS system invested in quality improvement of their protocols and practices based on clinical evidence, perceived system needs and an operational need.
The EMS system adopted quality improvement through practices and programs that are effective and transparent to both the administration and the clinical personnel who provide the medical services. These practices are implemented in an environment that embraces change by promoting robust and non-punitive education (Stefanini et al., 2018). The quality improvement practices include improving pre-hospital aspirin administration rates in patients with acute coronary syndromes and improving paramedic identification of ST-Segment Elevation Myocardial Infarction STEMI, which is the most severe type of heart attack. The system has also implemented quality improvement programs that seek to enhance pre-hospital trauma care specifically. The other way through which EMS has promoted quality improvement is through education, which allows enlightening personnel on the need to strictly abide by the established protocols and the need for safe and fast responses to emergencies. Also, there has been the adoption of a team-based approach in the discharge of the services. Therefore, quality improvement efforts have gone a long way in aligning the EMS system toward the delivery of high-quality emergency medical services.
Mobile Integrated Healthcare (Community Paramedicine)
The EMS has implemented mobile integrated healthcare that furthers the EMS’ role from just transporting patients to hospitals to providing high-quality healthcare based on assessments that happen on the emergency scene to avoid unnecessary transportation of victims to hospitals. This calls for the treatment of lower acuity patients on the scene to avoid incurring transport costs.
Following its goal to provide medical care even in non-emergent situations, mobile integrated healthcare encompasses community paramedicine, which is a patient-centered healthcare model in which EMS healthcare professionals provide medical services outside the emergency response system. This type of medical care is provided through scheduled visits to the patient’s home (Tian et al., 2019). These patients are often from underserved populations who do not have ready access to healthcare. Community paramedicine is implemented by paramedics who work closely with primary care physicians, social workers, and other preventive healthcare professionals. The result of community paramedicine is causing positive outcomes among these underserved populations, thus reducing the number of emergency calls for help. Emergency calls are reduced by lowering the super-utilizers.
For example, before the implementation of mobile-integrated healthcare, 7% of the total 60,000 calls annually 911 calls came from the same 100 people in Wisconsin. This accounts for approximately 4300 calls (Julota, 2024). A county such as Alameda in California has a list of the top 25 frequent callers, who, in two years, had collectively called 4291 times. In Texas, 21 patients had been transported to the hospital a total of 800 times, amounting to close to a million dollars in ambulance charges in a year. There is a further waste of resources because these callers did not have health insurance and thus depended on the EMS system for health services. Also, the Tucson Fire Department had identified 50 callers who accounted for over 300 non-emergency 911 calls over a year (Julota, 2024). This was a waste of resources, effort, and time. However, the solution was not to limit people’s access to emergency services but to ensure the frequent caller received high-quality care that resulted in positive outcomes, thus reducing the need for frequent emergency hospital visits.
The mobile integrated healthcare was then established to attack the causes of the many emergency calls. This was to mitigate the load and provide quality and effective care to these patients. Mobile integrated healthcare has helped EMS provide healthcare services to patients with chronic conditions, especially from the underserved population (Tian et al., 2019). This has relieved the EMS of the many calls, and thus, the medical staff can provide adequate care to the patients who need it. This mobile-integrated healthcare also reduces the costs incurred by the EMS due to the reduction of the number of emergency visits, thus lowering medical fees and ambulance charges.
The drop in the number of calls corresponds to a decline in the wasted resources while effectiveness is enhanced. Effectiveness is enhanced because the callers also receive proper care through mobile integrated healthcare since the point of community paramedicine was to outgrow the outdated system. Many of the callers did not receive proper healthcare since most had conditions best treated in a primary care setting. Community paramedicine allows patients to receive high-quality and comprehensive care that they would have received in an emergency treatment room in which the physician and nurses are busy and do not have time to explain patients’ conditions to them adequately (Tian et al., 2019). Therefore, treatment via mobile integrated healthcare enables the patients to get knowledge about how to take care of themselves properly and the best practices to engage in during the recovery process. This fosters faster recovery and thus reduces the need for emergency medical services and hospital readmissions.
Education And Training of Medical Providers and the Underserved Populations
The other strategy employed by the EMS is education to personnel and the general public, especially the underserved population. The EMS system has invested in training its healthcare professionals to ensure not only the delivery of high-quality emergency medical services but also ensure that the staff operate in compliance with the set protocols (Riva et al., 2019). Compliance with the established procedures and practices ensures that all personnel operate towards enhancing population health and safety without compromising the safety of the providers. It ensures efforts are geared towards the attainment of the same goals. The EMS has trained the medical professionals on the importance of the priority of the responses based on severity. This means that it has targeted response times to ensure responses are made and resources allocated based on the acuity of the crisis. This tiered approach allows customization of the targeted responses.
Educating the public, especially the underserved population, enlightens them, and this awareness encourages them to seek medical care and not wait for their health to deteriorate to chronic levels that require emergency medical services. The people are educated on the need to seek primary healthcare, and this causes increased access to care, which allows the public to prevent the occurrence of diseases and thus reduce the risk and need for emergency medical services (Riva et al., 2019). Also, EMS assesses the lifestyles of the underserved populations and advises them on what to change. Therefore, through training and education, the EMS enlightens the public on how chronic conditions can be avoided through proper disease management. They are taught why they should use their medication and the benefits of compliance with medication. Also, the knowledge and data of the underserved populations enable the EMS to prioritize their efforts and resources for these populations. Identification of the underserved and high-risk populations guides the development and implementation of programs, influences resource allocation, and tracks the performance of the EMS by evaluating its impact on these populations.
Specialization and Coordination of Units
The EMS system does not operate as a whole wholesomely but is categorized into units that offer specialized services to patients in need of emergency medical services. These units focus on specific areas such as community health, tactical medicine, casualty incident response, and providing care for chronically ill patients (AlShammari et al., 2018). This allows for effectiveness in the delivery of services because the parallel units focus on the same goals, and thus, this is a guarantee of the overall success of the EMS system. Dividing the EMS helps create clearer goals because when an organization is divided into smaller units, each unit can have its specific goals. There is also easy evaluation of quality and compliance with the set standards and protocols (Rudman et al., 2023). This way, each unit can focus on attaining its specific goals, which results in better performance and overall success. It also encourages efficiency in the delivery of the services because when the medical providers focus on one area of specialization, they master it and improve the completion times. Shifting to different areas reduces efficiency and thus lowers the outcomes. Therefore, the specialization allows the units to respond to emergencies with speed because each unit comprises healthcare professionals who are competent in that particular area.
Additionally, specialization has encouraged better communication collaboration between different EMS units. Division of the EMS into specialized units makes communication easier and more efficient to address specific issues (Rudman et al., 2023). Collaboration involves combining expertise and efforts in pursuit of a common goal. Having different people contribute their skills and expertise in the response to an emergency saves time and ensures the victims receive the highest-quality care.
Moreover, unit specialization promotes better management and enhances the effectiveness of training and education of the medical providers. Dividing the MS system into specialized units has made the management of each unit better. This allows management to be based on the specific needs of each unit. Also, when these healthcare providers in a unit have fewer responsibilities to master, they can be easily trained, and they master the skills faster than when they are required to learn about providing a range of emergency medical services. The quicker training saves on resources.
Provision of Emergency Mental and Behavioral Health Services
Following the upsurge in mental and behavioral health conditions and problems, the EMS has evolved to provide mental health services to people in crises. The system seeks to provide high-quality support to individuals experiencing a mental health crisis. The goal is to increase access to quality mental and behavioral healthcare for people in need.
According to Ye (2020), the provision of these mental health services sometimes requires collaboration between the EMS medical providers and law enforcement officers because it may sometimes involve forced transportation of the patients and consequent hospitalizations. The preferred way is to have the patient agree to be transported to an emergency department for psychological evaluation and treatment. However, when the patient does not agree to go, the medical providers are forced to collaborate with police and online medical control to determine the best strategy for the emergency.
The EMS has established its protocols and the criteria for forced hospitalizations. The criteria include the patient having a mental illness or a serious mental disturbance that disables or impairs the patient’s logical reasoning (Ye, 2020). Additionally, this mental condition must present the patient as a real threat of harm to self or others. If this criterion is met, the patient may be detained by a law enforcement officer in collaboration with a physician or a qualified mental psychologist.
This type of response aims to reduce the harm caused by these mental disturbances. This goes a long to combating suicidal ideations among patients with mental health problems and thus reducing the number of deaths resulting from suicide. EMS medical providers understand suicidal patient care and the legal requirements guiding the provision of care to patients with mental disturbances. For suicidal care, the psychological care providers approach the patients with a degree of understanding and deal with them in a supportive manner. The patient and their wishes should be respected to the greatest degree possible.
References
AlShammari, T., Jennings, P. A., & Williams, B. (2018). Emergency medical services core competencies: a scoping review. Health Professions Education, 4(4), 245-258. https://doi.org/10.1016/j.hpe.2018.03.009
Julota. (2024). A new model of healthcare has arrived in the form of mobile integrated healthcare community paramedicine (MIH-CP). https://www.julota.com/news/top-7-reasons-that-mobile-integrated-healthcare-community-paramedicine-programs-benefit-everyone/
Lincoln, E. W., Reed-Schrader, E., & Jarvis, J. L. (2019). EMS quality improvement programs. https://europepmc.org/article/NBK/nbk536982
Riva, G., Ringh, M., Jonsson, M., Svensson, L., Herlitz, J., Claesson, A., … & Hollenberg, J. (2019). Survival in out-of-hospital cardiac arrest after standard cardiopulmonary resuscitation or chest compressions only before arrival of emergency medical services: nationwide study during three guideline periods. Circulation, 139(23), 2600-2609. https://doi.org/10.1161/CIRCULATIONAHA.118.038179
Rudman, J. S., Farcas, A., Salazar, G. A., Hoff, J. J., Crowe, R. P., Whitten-Chung, K., … & Joiner, A. P. (2023). Diversity, equity, and inclusion in the United States emergency medical services workforce: a scoping review. Pre-hospital emergency care, 27(4), 385–397.
Stefanini, A., Aloini, D., Benevento, E., Dulmin, R., & Mininno, V. (2018). Performance analysis in emergency departments: a data-driven approach. Measuring Business Excellence, 22(2), 130-145. https://doi.org/10.1108/MBE-07-2017-0040
Tian, S., Yang, W., Le Grange, J. M., Wang, P., Huang, W., & Ye, Z. (2019). Smart healthcare: making medical care more intelligent. Global Health Journal, 3(3), 62-65. https://doi.org/10.1016/j.glohj.2019.07.001
Ye, J. (2020). Pediatric mental and behavioral health in the period of quarantine and social distancing with COVID-19. JMIR pediatrics and parenting, 3(2), e19867. https://pediatrics.jmir.org/2020/2/e19867
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