Welcome to Module 4 on Supporting EMS Administration and Medical Direction. In Module 1, we introduced the topic with some discussion on why these relationships between hospitals and EMS agencies matter, and we also covered the core subjectives. In Module 2, we explored the different organizations within an EMS system and the different impacts they have on patient care in your hospital. In Module 3, we talked about some ideas on how hospitals can improve their support of EMS field crews. And here in Module 4, we're going to discuss the needs and wants of EMS administration and EMS medical directors from the hospitals. Now, it's important to realize that there's some overlap between what the field crews want and desire, and the wants and desires of EMS administration and medical direction. But there's some important differences as well. Hospitals and EMS leadership share an interest in keeping field crews happy, well-educated, minimizing wait times to transfer patients to emergency department staff, and otherwise, able to get themselves and their units ready for the next call as soon as possible. EMS administration and medical direction are going to be very interested in technology integrations. This may involve the electronic transfer of information from the Electronic Patient Care Report or EPCR that the EMS crews use for field charting and porting that into the hospital charting system. This makes things more efficient for everyone involved. The EMS administration is also going to be very interested in the sharing of billing information, and this can be a bilateral relationship. The EMS crews may be missing a few fields that the hospitals have captured, and vice versa. So that's something that should be explored and exploited as much as possible. Now, with that technology integration, it may make it even easier to do clinical information sharing. This speaks to issues about giving feedback to crews on their individual cases, what happened to those patients, what their dispositions were. But for EMS administration and medical direction, they're going to be particularly interested in getting aggregate feedback, so they have a better idea of how well their agency overall was doing on certain types of calls. For example, getting aggregate feedback on STEMI patients would allow for things like seeing how well overall the EMS system is doing in advanced notification for hospitals, how that's impacting door-to-intervention times. Like on a STEMI case, it might be door-to-needle times or door-to-CT times for stroke patients, door-to-OR times on trauma patients, those sorts of things. So EMS administration and medical direction are going to be very interested in that aggregate feedback, again, so they can have an idea of how the overall agency is doing, not just feedback on the individual cases. Now it's important to note, on the STEMI cases in particular, that the American College of Cardiology has a new tool, NCDRE Reports EMS, that will really help simplify a lot of that feedback to EMS agencies. And what it does is provides the EMS agencies with their own login to the NCDRE system, and they'll be able to access certain types of information from the chest pain MI registry and get that sort of aggregate-level feedback, not only from your hospital if you're participating in the chest pain MI registry, but all the other hospitals as well, and aggregate that all together, again, to provide that more global view of how their EMS agency is performing, not just with your hospitals, but with all of the hospitals in your particular region. You can get more information on NCDRE Reports EMS at acc.org forward slash eReportsEMS. Another opportunity for hospitals to support EMS administration and medical direction is making their physicians, in particular, available for online medical control consults. Now the nature of that is going to vary quite a bit from system to system. Some systems operate almost entirely on protocols without real-time communications with physicians at the receiving hospitals, but that's beginning to shift with newer technologies become available, particularly through smartphone technologies. With those technologies, we're seeing more and more opportunities for direct video consults between the field crews and attending physicians at the hospital or on call from the hospital to directly observe a stroke patient or a trauma patient, see the 12 lead EKG tracings, and have a conversation about whether or not they're going to activate the cath lab, whether or not they should bypass the emergency department and go straight up to the cath lab or straight to the CT scanner and all those sorts of things. And that's also going to be neutrally beneficial because one of the objectives of those consults is to make an appropriate decision about which hospital the patient should be taken to and to give plenty of pre-notification time so that the destination hospital has as much time as possible to prepare for that patient on those time-sensitive emergency cases with activation of the cath lab team, the stroke team, the trauma team, whatever the case may be. So that wraps it up for Module 4, and I'll see you on the next one.

EMS administration

medical direction

hospital-EMS agency relationships

technology integration

NCDRE Reports EMS