EMS World

AUG 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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COVER REPORT: MEDICINE AND OPERATIONS 20 AUGUST 2018 | EMSWORLD.com THE UNEASY CHAIR: KEEPING PEACE BETWEEN DOCS AND OPS The clinical and operational imperatives of EMS sometimes confl ict—how can systems minimize the friction? By John Erich (Photo: Doug Mathieson) I n 2012, EMS World and the NAEMT named New Orleans EMS their Dick Ferneau Paid EMS Service of the Year. A little more than five years later, NOEMS' respected director and medical director, Jeff Elder, MD, was abruptly ousted from the system he'd helped rebound from the devastation of Hurricane Katrina. At the time and since, new Mayor LaToya Cantrell and other leaders have been tight- lipped about the reason for Elder's dismiss- al. Elder was replaced by an ER physician with experience treating patients but not running a large, growing, complicated, and sometimes messy modern emergency medical services system. While that suc- cessor may do a wonderful job, the move, absent any explanation, left a lot of observ- ers scratching their heads. But Elder hasn't been the only top doc moving on or feeling uncomfortable in their chair lately. As EMS is in rapid and substan- tial flux, a number of medical directors both prominent and long-serving have experi- enced sudden changes of employment. The official reasons vary, as no two situ- ations are the same, but there's no doubt the role is difficult. For one, the medicine of EMS is advancing and complex, increasingly requiring tight, specific integration and coor- dination with other players across a volatile political landscape. Beyond that, the whole concept of EMS is evolving a more proactive bent, with concepts like mobile integrated healthcare and population health shaping how systems tailor their capabilities. Over- laying all is a looming mandate to provide value to payers, consumers, and those who make law and policy, all while continuing to deliver exceptional care. Those are big challenges, on top of the other big challenges system leaders face, and they can put a lot of pressure on medi- cal control physicians to not only define top- notch care deliverable at a reasonable price, but to innovate and keep their departments on the clinical cutting edge. They also create ample opportunities for conflict.

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