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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EMSWORLD.com | AUGUST 2018 21 "You're trying to align a bunch of things in which organizations may not have a lot of expertise," says Jim Dunford, MD, who stepped down in December after 20-plus years as medical director for the city of San Diego and its fire and EMS. "When it comes to billing and collections and innovative care models and bundled payments and value-based care and what's coming, that's not traditionally the strength of the fire department, and you can't even assume it's going to be found in an ambulance busi- ness. But that's the kind of expertise you need to have checks and balances. So it's a complicated ecosystem right now, where cities are trying to engage but don't really have people who have ever done that." Similar factors weigh on the operational sides of EMS houses. All that innovative care docs covet must be delivered, expe- diently but not expensively, and compatibly with existing mechanisms and ever-rising call volumes, by systems that may not be designed or constructed for it. On the ops side, chiefs and managers have the same ultimate goals as their docs, but approach their execution from the practical, real- world, wheels-on-the-road view. Medicine is half the battle; delivering it is the other. "I feel like I have a high level of expertise to lead my system, and I don't really need an EMS physician to teach me what modern EMS looks like," says Tom Bouthillet, bat- talion chief over EMS for Hilton Head Island Fire Rescue in South Carolina, whose town is currently hiring a medical control physi- cian. "What I need is somebody who shares that vision and can come in and help with the training and things like that, so when we introduce video laryngoscopy, they don't tell me, 'Oh, all patients should be intubated!' The field is not the ED, and the way they may approach airway manage- ment is not the way EMS should approach airway management in 2018." It's not surprising, then, that the clini- cal and operational priorities of modern EMS systems sometimes conflict. (Folks on the ops side change jobs over this too, but generally with fewer headlines.) Docs are worried about quality of care, medical efficacy, CE and remediating poor perform- ers, and maintaining strong protocols and review. Operations leaders are concerned with staffing, response volume, compli- ance issues, and ensuring their systems function. The challenge lies in reconciling those competing interests (and attending alpha personalities) by some method short of replacing top personnel. What Docs Want The highest-profile breakup of doctor and department in recent American EMS occurred in 2016, when medical director Jul- lette Saussy, MD, FACEP, left the capital's oft-troubled D.C. Fire and EMS. Reflecting a brief tenure marked by squabbles over operational issues, her public resignation letter was four pages of fire-breathing frus- tration, citing a culture "highly toxic" to the delivery of quality medical care. Among Saussy's specific complaints: a lack of performance measurement from response times on; a lack of accountability at all levels, resulting in an undisciplined workforce; and an org chart unreflective of the department's EMS-heavy call volume. We appreciate your service to our communities and country! That is why NAEMT provides information and education to help you provide the best care to your patients. It is also the reason we offer a great benefits package and leadership opportunities to help you achieve your professional goals. JOIN NAEMT. LET US WELCOME YOU HOME! NAEMT.ORG /NAEMTFriends /NAEMT_ 1-800-34-NAEMT NAEMT MEMBERS SAVE $125 on EMS World Expo registration MAKE NAEMT YOUR PROFESSIONAL HOME For More Information Circle 22 on Reader Service Card

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