The NHTSA Office of EMS forward-looking document, EMS Agenda 2050, begins by offering that, “the world in 2050 will be dramatically different, with new challenges and opportunities,” and suggests that “the best way to predict the future is to create it.” Released in 2019, the title implies that to get to where we need to go will take 30 years, but the events of the last few months could well have given this a boost as a combination of necessity and survival have forced us to overcome through improvisation and adaption.
The EMS Agenda 2050 identified that for change to occur, the systemic and cultural shifts required will take a generation. COVID-19, with its infection and mortality rates, has generated a new culture and system virtually overnight with EMS at the forefront, witnessing the effect on the population. We have had to adjust our playbook rapidly, adhering in some cases to the Darwinian principle that it is not the strongest that survive but those most adaptable to change.
Breaking telemedicine out of its silo
According to the Agenda, looking 30 years ahead, we envision call center based telemedics working with community volunteers and artificial intelligence medics, all enjoying the benefits of an immediate assessment via the patient’s wearable monitoring devices and a rapid history via the connected healthcare information systems. Immediate medication delivery will be achieved via drone and transport to the most appropriate treatment node in autonomous vehicles, all without lights and sirens (which ultimately solves the “don’t call me an ambulance driver” debate for good). The only thing missing was the requirement to pave paradise and put up a parking lot.
If we break future prehospital medicine down into its constituent parts, we can see most of what we aspire to already exists, albeit sitting in silos that their process owners are reluctant to launch. The EMS Agenda 2050’s view that we need to achieve a people-centered EMS system that includes processes, protocols, technology, policies and practices designed to provide the best possible outcome for individuals and communities – every day and during major disasters – is here with us now.
The futuristic vision that we remove the perverse incentive that says we only gain income from taking the patient to the ED (possibly outside their wishes and our best interest) is now playing out. As we conduct the sensible practice of treating the patient in place, where the acuity warrants it, we conduct not only admission avoidance, but actual arrival avoidance and potentially save a bed for those who truly need it. Reimbursement legislation has not yet caught up with this innovation, and we continue, collectively, to lobby for the money to allow this forward-thinking procedure to continue.
Telemedicine, thanks to COVID-19 CMS waver, is becoming a standard of care, and importantly, patients like it. This, along with treat in place, is a pillar of the ET3 demonstration – except we have now demonstrated it works, and it is happening. So let us fund it and move forward – not so easy, however, as we in EMS are in one silo and the cash register in this case is in another.
A glimmer of funding hope has emerged this week as Rep. Cindy Axne (IA-03), Rep. French Hill (AR-02), and Rep. John Larson (CT-01) led a bipartisan letter addressed to HHS Secretary Azar and CMS Administrator Verma seeking fair reimbursements, including treat in place, for firefighters, EMS and other medical first responders.
Degree requirements and the EMS Compact
The EMS Agenda 2050 describes a highly educated EMS workforce with educated, highly capable and appropriately compensated EMS clinicians, managers and EMS physicians. In the Agenda, those licensed EMS clinicians will be granted the privilege to practice across the country, with all EMS professionals able to practice at the level that their education prepares them for. Perhaps this is a rate-determining step that COVID-19 cannot accelerate for us, but finally answering the degree requirement question and a nationwide spread of the Recognition of EMS Personnel Licensure Interstate CompAct (REPLICA) may assist. On a positive education note, the proliferation of immersive, virtual online education is increasing as online learning management systems are offering fresh, vibrant education for all.
As with all things EMS, we must make sure we continue to evolve and resist the temptation to revolve. In the final analysis, we should still hold by the vision of the EMS Agenda 2050, although COVID-19 has helped release and advance some of the procedures, policy and politics have not totally cooperated. But I do believe we are beginning to drag the envisioned future to us, as opposed to moving slowly towards it.
EMS 2050: EMS One-Stop With Rob Lawrence
For an audio version of this article, listen below.
