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EMS MANAGEMENT When Skip Kirkwood, MS, JD, NREMT-P, EFO, CEMSO, and EMS director for Durham County, N.C., frst started in EMS in 1973, there was no technology to support ambulance operations. "The way it worked was you sat at a station, a call came in on the telephone and the dispatcher handed you a piece of paper that told you where your call was. You got in the ambulance and you either knew where the call was or you had a map book and you navigated using a paper map. When you were done with the call you wrote a report on a piece of paper. There really was no technology except for the two-way radio in the ambulance." Now, Kirkwood notes, every step of an EMS event involves technology of some sort. "A call comes into a 9-1-1 center, they pick the closest ambulance based on GPS data that shows where all the ambulances are, they use a computer, including some- times a computerized voice, to dispatch the ambulance. You get in the ambulance and push a button to tell dispatch you're on the way, then you push a button to tell them when you've arrived at the scene. Of course you take your ECG, blood pressure and all of that stuf using another tech- nological device. You put the patient in the ambulance and in some cases you'll use another wireless communication device or computer to send information about the patient to the hospital. You'll get to the hospital and use a computer to write your report. And in some of the more sophis- ticated systems that report will never be turned into a piece of paper. The medic will push a button and their report will move electronically into the patient's electronic medical record at the hospital and back to the EMS organization for quality assurance. And then you do it all over again." Kirkwood says operationally tech- nology has improved accuracy, if nothing else. Clinically, there are aspects where it's easy to see where technology has improved patient care. "For instance, if someone is having a heart attack, right now instead of taking the patient to the ED and having them do another ECG there and spend a bunch of time trying to confrm what the paramedic is saying about the patient is correct, you can send that ECG right to the cardiologist and the patient can go directly to the cardiac cath lab to get their treat- ment, reducing the time from the event to treatment substantially." While Kirkwood says every EMS agency is diferent, and have diferent technology requirements that need to be met, the one thing he would encourage every EMS manager to consider purchasing is a driver monitoring and feedback system. These are systems that monitor driver perfor- mance and provide both feedback to the driver and data for management to use for either training their drivers to drive more safely or take action when they don't. He acknowledges some EMS providers might push back against this kind of "Big Brother" technology, but they'll be thankful for it in the long run. "In the beginning they may be scared to death of the systems because 'manage- ment's going to catch us doing something bad.' But I know of a couple cases where that data has saved some careers. I heard of a case where some medics were accused of stopping the ambulance alongside the highway and sexually assaulting a patient in the back of the ambulance. And when the data was reviewed from the cameras and the driving system, it was pretty clear the ambulance never stopped anywhere. It carried the patient right to the hospital and what the patient was complaining of never could have happened. That was a career saver for those medics." Kirkwood is also an advocate for letting staf provide input on new technology and equipment whenever it's possible. "Most of the time I think it's pretty important, if for no other reason than if the staf later have a complaint about it, it was their choice," he says wryly. "Sometimes that's not possible. If your dispatch center has this CAD system, you have to have this mobile data system—you don't get a choice. But if you're going down a new path, if you've never had in-vehicle data or computerized patient care reporting before, then absolutely you need to let the employees play with it, try it out and see which one they like better. If all of the systems being considered meet manage- ment's needs, and as long as they're within budget and do what the company needs to do, why not let the medics have one that's what they want?" Kirkwood's fnal takeaway lesson from his chapter could easily be applied to the entire textbook, which he helped edit. "What the chapter was trying to do was make folks aware of some of the techno- logical options out there. One of the bad things about a book, of course, is it's just a snapshot, so whatever's in there is old the minute after the snapshot is taken. But while the textbook may not mention every driver feedback and monitoring system available, it does talk about them. So then the manager can take what they learn from the book and go out to look at the marketplace to see what's available today and what's the best choice for their organization." Technology in Support of Ambulance Operations Incorporating driver monitoring and feedback systems can save the careers of your providers Every step of an EMS event now involves technology of some sort. EMSWORLD.com | AUGUST 2014 41