Can you hit a moving target?

Can you hit a moving target?

Alan E. Perry

November 17, 2013

Anyone can tell you that in order to hit a moving target you must compensate for the motion of the target and the trajectory of the object you intend to hit in with. It can be tricky enough when you know the values for these variables, compensating for them, leading your target and adjusting for elevation, windage, air density and gravity. It is nearly impossible, except for dumb luck, to accomplish a hit if one or more of these is not known, or worse is constantly changing. This is the circumstance EMS leaders are finding themselves in as they try to grasp concepts like community paramedicine, mobile integrated healthcare and all of their variations being explored throughout this country and elsewhere.

EMS is no stranger to change; it began in 1967 with an article titled Death in a Ditch, our growth as a viable public safety essential service, the 1996 EMS Agenda for the Future, its follow-up implementation guide and the 2007 EMS at the Crossroads describing the future of healthcare. We can’t say we didn’t see the changes coming; many organizations have been quietly and productively working at solving problems, filling service gaps and improving the quality of their services for many years. The rest of us are now staring at the ambulance barreling down on us and trying to decide which way to run.

The Patient Privacy and Affordable Care Act (ACA) is not new, it has been around and its consequences known for several years. This is the latest variable added to the changing world of EMS, many of its objectives are compatible with the needed changes to EMS that were recognized in 1996, yet we have still not acted on the majority of them. These were once stationary goals that EMS alone sought to achieve, we are now so far behind that the change is now being pushed down on us from the Federal Government! What has happened to us? We are so worried about studies, stakeholders, regulations and politics that we can’t even do the simple and easy things we have known we need to do for decades.

So, about that target, what is it? Do you want to just look good, or actually do good? We know that better patient outcomes are at the top of the list closely followed by greater healthcare system integration and lower costs, all identified in 1996 but now also required to obtain the objectives of the ACA. We have now lost the initiative; hospitals are improving readmission rates on their own, hospice and home health care organizations are filling the gaps between primary care and the hospital more fully, both are reducing costs and improving the quality of care for the patient. It may be that EMS will not play much of a role in this new system as we had hoped despite finally coming up with innovative ways of delivering care.

Let’s not forget the taxpayer, citizen’s and city managers out there, will they support increased services and increased expenses for EMS systems to duplicate services they have until now thought to unimportant to develop on their own? Will you be able to convince hospital administrators that you can do a better job than they of reducing readmission rates? Will your regulatory bodies allow you to expand your roles in the face of all the other changes going on in healthcare at the moment? Can all this be done quickly enough to even make a difference, or will you be driven to provide whatever services all these other parties decide you are competent to perform? As you can see we are not just trying to hit a moving target, we are trying to hit multiple moving targets that are rapidly changing direction, as it sits I think we will go home empty handed unless we change our way of thinking and our tactics.

I suggest that we go back to basics, clean up our house, and begin working on developing real and meaningful strategies that will improve the quality and value of our services whether or not we can develop new ways of delivering that service. Work on developing your staff, cultivate your leaders, and train your providers with the best programs available.  Educate your public, policy makers and stakeholders. The true value of public education is severely underappreciated by EMS, look at the outcome, and resources, dedicated to public education in fire prevention, why is EMS any different. This is a target we can hit.

Be Safe,

Alan