Welcome back. This is Module 2 on EMS Organizational Roles and Their Impact. To recap, in Module 1, we provided some scenarios to get you thinking about why hospital relationships with EMS matter, and we went through the core subjectives. Here in Module 2, I want you to recognize that EMS is not just the ambulance service, that it's an umbrella term for a group of organizations that work together to deliver out-of-hospital care. One of those organizations is the 911 Communication Center. The 911 Communication Center is responsible for emergency call-taking, not just related to EMS, but also for fire calls and police calls, so it will be up to the 911 Communication Center to make the initial triage for which agency or agencies will be responding on this particular call. Once they've determined which agencies are going to go, then they'll also need to determine which particular units within those agencies will be assigned the call, and that may be on the basis of proximity. It also may be on the basis of load balancing call volume, particularly in non-emergency cases. The 911 Communication Center will also be responsible for some sort of medical triage, identifying what the particular medical problem is, and in many cases, they may also follow up with what are called pre-arrival instructions, where they would advise the caller on how to facilitate an emergency childbirth, stopping bleeding, doing CPR, all of those sorts of things. So the 911 Communication Center is really an integral part of the EMS system in getting the right resources assigned to the call and getting care initiated even before the first EMS units arrive on scene. Now I mentioned that there may be more than one type of unit responding to a call with the non-transport medical first response agencies, and in many communities, this is the fire department, but it doesn't necessarily have to be the fire department. Sometimes it may be law enforcement. Sometimes it may be a volunteer rescue squad. But whatever the case, their primary purpose in responding to these scenes is to try to shorten the response time interval from when the 911 call was received until someone gets on the scene to be with the patient and initiate time-sensitive care whenever possible. The other benefit of having the second agency respond is in scenarios where more personnel may be needed to provide care to the patient, as might be the case with cardiac arrest. With the added emphasis on CPR quality now, we try to have a lot of crew members on scene to rotate responsibilities for chest compressions to keep those at a very high quality. We may have issues with managing other commotion that's taking place at the scene with crowd control, those sorts of things. It may be a traffic accident where we'll need fire crews and police crews to control the surrounding traffic, as well as perform emergency extrication procedures with the jaws of life and other tools of that nature. Another part of the EMS system is obviously the ambulance service itself, and they'll obviously provide the transport services and in-transport care. The ambulance service and the non-transport medical first response crew will work as a team on scene to do everything from initial on-scene triage and making a field diagnosis, initiating care, and notifying the receiving hospital, when appropriate, of an incoming patient. And this will be particularly relevant on time-sensitive emergencies like STEMIs, major trauma, stroke, those sorts of things, so that the hospital can be ready to receive the patient and initiate definitive care as soon as possible after their arrival. The other part of the EMS system you should be aware of are the EMS regulatory agencies. They're going to be responsible for developing the clinical policies and procedures and protocols that the EMTs and paramedics and emergency medical dispatchers will all work under. They'll be oftentimes responsible for certain elements of their quality management program, continuing education, providing an EMS medical director for physician oversight of the clinical activities of the field crews, as well as coordination between the different EMS organizations within the system. Those EMS regulatory agencies may also be the ones to help facilitate smooth working relationships between the different EMS agencies and the 911 communication centers with the receiving hospitals. Now it's important for you to understand the impact that the EMS system can have on patients and your hospital. Consider what happens if the 911 communication center fumbles the ball. They may not appropriately triage the severity of the call. They may not assign the closest, most appropriate units to the call. They may not be providing the most appropriate pre-arrival instructions to guide the bystanders or the patient on self-care before EMS arrives, which is going to be particularly important in many time-sensitive emergencies, particularly with bleeding, CPR needs, emergency childbirth. If the non-transport medical first response units and the ambulance services working together on the scene fumble the ball, that might lead to an inappropriate field diagnosis, inappropriate field interventions with medications and procedures, and maybe miss the opportunity to pre-notify the hospital of an incoming time-sensitive emergency patient. But when they succeed, operationally, the EMS system will make sure that we get the right resources, the right destination, timely notifications, with the right information provided to the receiving hospital to facilitate a timely patient flow. Now, the EMS system can impact hospitals politically as well. EMS organizations, particularly government-operated EMS organizations, have frequent contact and influence on senior appointed and elected officials on emergency health care issues. They also have a lot of influence with the media, and they can also build or diminish hospital reputations with other EMS agencies, municipal officials, and regulatory entities. The EMS system can also impact hospitals financially. At an administrative level, we're talking about destination policies and protocols impacting hospital census. Those sorts of decisions can be influenced by hospital performance and collaborative relationships, things like information sharing, performance feedback to fuel EMS QA and QI activities, and their continuing education programs. And frankly, it's significantly influenced by the demeanor and courtesy that the hospital shows towards the EMS administrative officials and their medical directors. Now, at a field level, the dynamics are a little bit different. As we mentioned before, the field crews do oftentimes have some discretion in destination hospital selection, when no preference is expressed by the patient, and when they have to recommend based on hospital capabilities, particularly when there's similar drive times between two otherwise equally appropriate hospitals. So what you have to understand is that these EMS relationships will influence what types of patients you get and how many patients your hospital gets. So now that we've kind of put some context into the types of organizations that comprise an EMS system and the impact that they can have on your hospital in many different ways, let's wrap up module two with that. I'll meet you in module three, where we'll talk about how hospitals can better support EMS field crews.

EMS system

organizations

911 Communication Center

non-transport medical first response

ambulance service