Heart disease is America’s number one cause of death. In 2016, 12% of people who suffered a cardiac arrest survived. The survival rate for in-hospital cardiac arrest is about twice that.1 Cardiac arrest survival is one of many areas that could be improved by easily identifiable but significant logistical changes – more accessible automated external defibrillators, broader cardiopulmonary resuscitation education, and the establishment of more trauma centers. Other areas for improvement are sometimes less obvious or require new knowledge, such as more advanced medical technology, or updated first responder rescue procedures. Whatever the level of the changes, the basic approach is similar: use the data available to diagnose problems, then investigate solutions. By thinking critically, interpreting data, and communicating findings, the Emergency Medical Service system can make a variety of changes to become more effective. Prehospital care research faces many obstacles, but it has the potential to make large a positive difference, saving many lives.
Some impediments to progress in the field of prehospital medicine are insufficient funding for research, lack of standardized records, and a fragmented EMS system. The EMS system in general is underfunded, and this pattern holds for the funding of research in this field. According to the Institute of Medicine’s report, Emergency Medicine: At the Crossroads, “a range of federal government agencies each contribute relatively small amounts of funding to prehospital EMS research” and “a tiny percentage of [federal health-related] funding is directed to emergency care research in general and prehospital emergency care in particular.”2 Due to the nature of pre-hospital care – brief contact with the patient, no access to medical records, no follow-up, data collection and analysis is difficult in EMS. This means paramedics do not get the same feedback doctors do. Similarly, discrete EMS units do not communicate in the way hospitals do, meaning there is a much smaller dataset to work with. It is troubling that, as the Office of Emergency Medical Services notes, “there is frequently a lack of evidence on the impact of current practices on patient outcomes.”3 With more complete records and a more unified national EMS system, first responders would be better able to see the big picture – what works, what doesn’t, and any common patterns.
Despite these obstacles, there are promising EMS initiatives on the horizon. One example is preventative care teams.4 These teams would visit at-risk individuals at their homes before there is a full-blown emergency. By helping a citizen manage his heart condition and checking in on him periodically, paramedics could prevent rather than treat cardiac arrest. It is heartening to see that the EMS system is working towards better communication and better integration with the rest of the healthcare system.
Luckily, those within EMS organizations are starting to place a greater emphasis on innovation. In a draft report, Mount Sinai Health System’s Kevin G. Munjal MD, MPH and James Dunford, MD, San Diego EMS Medical Director and Professor Emeritus, concede “If one set out to design a prehospital care system for the United States from the ground up it would look very different from the EMS system that we have today.”5 Indeed, in every field, it is important to remember that the systems and beliefs we have today were shaped by a long history and are not necessarily ideal or natural, and even longstanding practices must be examined with a critical eye.
1. American Heart Association. 2017. “CPR & First Aid.” Accessed February 24, 2017. http://cpr.heart.org/AHAECC/CPRAndECC/General/UCM_477263_Cardiac-Arrest-Statistics.jsp.
2. Institute of Medicine. 2007. Emergency Medicine: At the Crossroads. Accessed February 24, 2017. https://www.nap.edu/catalog/11629/emergency-medical-services-at-the-crossroads.
3. Office of Emergency Medical Services, National Highway Traffic Safety Administration. 2011. Progress of Evidence-Based Guidelines for Prehospital Emergency Care. Accessed February 24, 2017. https://www.ems.gov/pdf/2012/EBG_Project_Overview_Dec2011.pdf.
4. Landro, Laura. 2016. “The Revolution in EMS Care.” Wall Street Journal, September 25. Accessed February 24, 2017. https://www.wsj.com/articles/the-revolution-in-ems-care-1474855802.
5. Munjal, Kevin G. and James Dunford. 2016. Promoting Innovation in Emergency Medical Services. National Highway Traffic Safety Administration, Mount Sinai Health System, and University of California, San Diego. Accessed February 24, 2017. http://www.nvfc.org/wp-content/uploads/2016/08/16Aug-PIE-Draft.pdf.
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