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Company Officer Leadership: Defining the Cutting-Edge of EMS

Since the release of the 1966 white paper Accidental Death and Disability: The Neglected Disease of Modern Society (PDF, 2 mb), the fire service has taken a leadership role in the delivery of EMS.

When fire departments began to take on EMS, it was to provide care to critically injured or ill patients who needed initial life-saving care and transport to a hospital emergency room. It was this need that produced our first generation of firefighter/paramedics in Los Angeles County, Columbus, Miami-Dade County and Seattle in the early 1970s. Focused on cardiac problems and trauma, these departments and the physicians associated with them, created programs that are the roots of today's modern EMS systems.

These visionaries were definitely on the cutting edge of EMS; most of the states where these programs started didn't have a definition, scope of practice or enabling legislation for paramedics at the time.

Today, most of us likely consider cutting-edge EMS to be associated with technology, new treatments or providers with advanced training. There's no doubt that medications, technology and training have all contributed to the current state of EMS care.

With the exception of automated external defibrillators, it's difficult to tie clear results, increased survival or improved outcomes to any drug, technology or level of EMS training. Much of what we do as EMS providers is still based on experience, expert opinion and anecdote, yet many departments are recognized for their excellent EMS programs and are often credited as being on the cutting edge. What does that mean?

Perhaps cutting-edge EMS isn't so much about specific interventions, technologies or delivery models as it is about monitoring, measuring and improving the different elements of our own systems. Essentially, being the best we can be with the response model, tools and training we have.

In Seattle, being on the cutting edge is constantly measuring and evaluating therapies and performance against patient outcome. Our medical leadership's focus is on cardiac arrest—an event that uses a majority of our ALS and BLS skills and can be measured using survival statistics. Seattle's mantra is "measure and improve."

The idea is that by optimizing the complex response to cardiac arrest, our response to other medical emergencies will improve as well. By constantly measuring, evaluating and tweaking our cardiac arrest protocols for the last 40 years, Seattle has attained an overall cardiac-arrest survival rate over 20% and survival for witnessed ventricular fibrillation is at 60% (Seattle Fire Department, Cardiac Arrest Survival Statistics, 2012).

Most surprising about Seattle's measure-and-improve approach is that improved outcomes often come from the simple tweaks, such as ensuring high-quality CPR compressions, minimizing CPR pauses and reducing turnout time.

It's not happening just in Seattle. Other departments—such as Howard County, Md.; Thurston County, Wash.; and Durham, N.C.—have all significantly improved their cardiac arrest survival rates by implementing a similar measure-and-improve methodology after attending the Resuscitation Academy sponsored by Seattle Fire and King County EMS.

So how does all this apply to company officers?

As the future leaders of the fire service and fire-based EMS, company officers should support measure-and-improve approaches in their own departments. Additionally, there are many opportunities to measure and improve our own crews on EMS responses. How well does your crew follow established protocols? What's their CPR performance like? How long does it take your crew to leave quarters after receiving an EMS alarm? Is there opportunity to improve in your house?

Researchers will continue to study new drugs, therapies, technologies and even the appropriate training and skill level of EMS providers in search of the silver bullet for patient outcome. Until that day comes, we as company officers have the opportunity to be on the cutting edge of EMS by constantly measuring and improving the elements of our own EMS response.

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