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Emergency Medical Service: Not Done Changing Yet

When you’re finished changing, you’re finished.
~Ben Franklin

In Fred McChesney’s Washington Post op-ed (9/4/2015), he advocates that because the fire service today responds to fewer fires, especially those tragic, “almost unheard of” fires where more than 10 people die, we should adopt an all-volunteer fire service.

Many of the responses to that article were spot-on and well-written. The fire service has proven its worth in the all-hazards role over the past two decades.

McChesney’s opinion that the fire service should stand down insinuates that the fire service can’t adapt, overcome and remain a relevant, efficient emergency response resource—career and volunteer—for our communities.

To that, I say the evolution of the fire service as an all-hazards response resource has proven the fire service’s ability to adapt and innovate. Which brings me to my point: the fire service must adapt and innovate again.

The next change and challenge facing the fire service is to respond to the Patient Protection and Affordable Care Act (PPACA) and the implications it has and will have on healthcare, the fire service and fire-based EMS.

This legislation was passed with the intent of improving the quality and cost of health insurance, reducing the uninsured rate and lowering the overall cost of healthcare. Further, PPACA is apt to apply the Institute of Healthcare Improvement’s Triple Aim, which includes initiatives to improve the patient care experience, improve the health of patient populations and reduce the per capita cost of healthcare.

We have seen the effect of these initiatives indirectly in our EMS systems with the implementation of Center for Medicaid Services (CMS) programs in hospitals and for physicians. We will see them directly when the CMS implements similar performance programs for EMS providers as well.

For example, components of PPACA that directly affect hospitals and physicians in part sparked the current mobile integrated health (MIH) programs that relate to CMS’s pay-for-performance efforts in hospitals, hospital-acquired infections and re-admittance initiatives.

These elements of the law have not yet directly affected EMS, but they’ve had a profound effect on many fire departments that have stepped up and implemented MIH programs in an effort to address the CMS and Triple Aim initiatives.

Published in July 2015, the Mobile Integrated Healthcare and Community Paramedicine (MIH-CP): A National Survey, reported more than 100 EMS agencies have taken steps to build similar innovative programs in response to PPACA and the issues facing American healthcare. 

Jokingly, we say that the fire service is “200 years of tradition unimpeded by progress.” Fundamentally, this is true; fire service organizations remain steadfast in their traditions, core purpose and core values. Our steadfast ideology and commitment to the public good allows us to maintain our identity and the public’s trust.

However, if the fire service stands fast in its methods and refuses to adapt to the changing world, we’ll become irrelevant.

As difficult and complicated as the road ahead of us may look, the fire service—career and volunteer—has an infinite capacity to adapt to the changing needs of our world and the communities we serve.

And if we remain steadfast in our dedication to our traditions, core purpose and core values, we’ll continue to thrive and serve our communities as we have for the past 200 years with integrity and honor in whatever capacity our communities dictate. The change is just coming faster these days.

Retired L.A. County Chief Deputy Michael Metro said it best:

Medical care is evolving and if we as EMS leaders don’t change our systems to align them with the Triple Aim, there will be progressive EMS providers that will have embraced change, evolved their systems and will be in the position to replace the outdated EMS providers that failed to see the future.

If we’re finished changing, we are finished.

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