Paramedics and EMS Leaders are gathering January 17th in Los Angeles, California as they lay out a vision for the future of EMS.  The project, called EMS Agenda 2050, is being funded and coordinated by the National Highway Transportation Safety Administration, with support from Reflash Group and Redhorse Corporation.

Over 20 years ago, the NHTSA commissioned EMS Agenda for the Future to define the path of paramedicine across the country.  At the time, paramedicine had taken hold and prehospital systems had been in active development for thirty years.  The NHTSA and EMS leaders wanted to look at where they had been in those thirty years and where they were going in the next thirty.  The Agenda for the Future strongly pushed data and evidence-based practice as the upcoming opportunities for improvement in the industry.  Fast forward to now, and both foci have become pillars of modern EMS.

Leaders are now assembled yet again under Agenda 2050 with the same mission.  Comprised of paramedics, entrepreneurs, physicians, administrators, and others, the technical panel of Agenda 2050 is aiming to find consensus on the future of EMS.  The panel is currently in a two year long process of gathering input from community members, stakeholder agencies and the public.

The timing of the Agenda 2050 comes at a crucial time as EMS sits on a precipice of change.  EMS systems are finding new ways to utilize the unique training and expertise of Paramedics.  Expertise vital to healthcare’s continued adoption of new technology and the battle against rising costs and disease epidemics.

States, such as California, have implemented community paramedic programs to bring coordinated-care into the homes and streets of their communities.  These paramedics are addressing a critical need in patient populations.  Diseases, such as diabetes, heart failure, and psychiatric illness, place a large cost burden on the healthcare system and have high likelihood of hospital admission or readmission.  The programs have shown great success, but have not been widely adopted yet.

The recent vaccination of 109,000 individuals in San Diego, California amid a Hepatitis A outbreak further demonstrates the value of paramedicine in public health campaigns.  Paramedics were used in the campaign to vaccinate individuals out in the community.  The program required legal maneuvering but was easily implemented given the paramedics pre-existing training.  Realizing this potential, insurers are rapidly moving to implement reimbursement models to support non-transportation EMS programs in 2018.

California leadership is actively discussing the creation of a critical care paramedic scope with increased educational requirements.  A rise in the minimum requirement of paramedics is viewed as crucial by many in the EMS community.  States, such as Oregon, already require a minimum of an associate’s degree to get a paramedics license.  Community and critical care programs could be a segway for California paramedics to find parity with nurse training and the international EMS standards.

The continued adoption of informatics and data will remain an important focus. Information previously siloed in separate healthcare networks and EMS agencies is now being shared more freely to the advantage of the paramedics, physicians and patients.  Vital signs, electrocardiograms, care reports, and more are being communicated instantaneously between ambulance and in the emergency departments in some systems.  New technology such as autonomous vehicles and drones offer exciting opportunity in a multitude of ways, previously unimaginable.  And biometric advancements offer the ability for event interrogation by responding crews and distributed monitoring of at-risk populations.

The future for EMS in California and across the United States is changing rapidly, but it is bright. Needless to say, there is a great deal to discuss at EMS Agenda 2050.   The technical panel is requesting input from all stakeholders and your attendance is highly encouraged at the upcoming meeting.  Please visit emsagenda2050.org for registration and details.

In San Francisco this past Tuesday, the California EMS advisory groups EMDAC and EMSAAC gathered for their final quarterly meeting of 2017. EMDAC is comprised of Medical Directors and oversees the clinical aspects of California EMS, while their counterpart administrators work through EMSAAC on operations, quality assurance and support. The meetings this week focused on the development of a provision to maintain critical Flight Paramedic skills.

The day started off with a rare, closed door meeting between the EMDAC and EMSAAC bodies, as state leadership looks to address the Flight Paramedic scope of practice in the wake of EMDAC’s decision to revoke pediatric intubation from paramedics last September. At that meeting, a presentation by San Diego Fire-Rescue Associate Medical Director Joelle Donofrio prompted the group to red line pediatric endotracheal intubation from the optional scope of practice for California Paramedics after voicing serious concerns in that Paramedics were not safely using the skill.

Medical Directors representing state aeromedical providers are now scrambling to create an exemption for their Flight Paramedics. They argue these teams, most often a Registered Nurse and Paramedic, must work dynamically in the treatment of pediatric patients, and that it is vital for paramedics to participate in the induction and intubation care often utilized in aeromedical cases. Interestingly, significant data of current pediatric intubation is being requested of all aeromedical providers as a part of the decision. This contrasts the decision to remove pediatric intubation which utilized historical studies but no current data.

A promising solution appears to be forming around the creation of a unified Critical Care Paramedic scope of practice. This scope would require additional training by providers, but would then give them additional skills such as pediatric ET intubation and potentially RSI.  The scope would be identical in all LEMSAs, which is important for helicopter crews working in multiple jurisdictions. Aeromedical Directors are eager to establish this scope, as it would allow their Paramedics to retain lifesaving protocols. It remains unclear if EMDAC physicians will allow ground providers to utilize this new advanced scope. If allowed, it would afford Medical Directors, and their LEMSA providers, the opportunity to retain vital skills and also alleviate concerns of low training or data monitoring. It would also create a tiered mechanism by which the state could elevate education for Paramedics and better align it with the international community.

Dr. Kevin Mackey, the incoming EMDAC President, presented on perilaryngeal airways which will be introduced across the state in the absence of pediatric endotracheal intubation. LEMSAs will also be able to request the use these devices for adult patients as a rescue airway, the idea being providers would only have to train on one device instead of their current supraglottic device and the new device. A Resuscitation Outcomes Consortium study by Wang, et al., showed decreased survival in adult patients intubated with supraglottic airways compared to those endotracheally intubated. However, that study did not include pediatric patients.

EMDAC and EMSAAC plan to continue working on the new scope prior to their next quarterly session scheduled on March 20th, 2018 in Anaheim, CA. Paramedics and the public are welcome to attend the open meetings. Please contact us or visit emdac.org for more information.

Today, EPIC Medics gathered for their third and final Helmets for Kids event of 2017.  The event took place at the Parkway Plaza in El Cajon, with the previous two events taking place at Fashion Valley Mall and North County Mall.

This community event provides children with a brand new bicycle helmet and a strong and lasting message of safety.  The Helmets for Kids campaign is a unique opportunity for these providers in that they get to deliver a powerful message to children with the hope of preventing future injury instead of responding to an injury after the fact.  “We have fitted and donated about two to three hundred helmets at each event this summer,” says Paul Maxwell, EPIC Medics founder and event organizer.

According to the Centers for Disease Control and Prevention (CDC), in 2013, 238,337 children age 19 and younger sustained injuries associated with bicycles, with children between the ages of 5 and 14 years at the highest risk for bicycle injury.  An estimated 140,000 children are treated each year in emergency departments in the United States for traumatic brain injuries sustained while riding bicycles.

The use of paramedics and EMTs creates a memorable moment for the children, encouraging helmet use which can help reduce the danger of devasting bicycle-related injury.  The California Paramedic Foundation’s EPIC Medics, in partnership with Cox Cares, Kaiser San Diego and Ark Marketing, have been hosting the event for over 7 years.  Paul Maxwell estimates the campaign has seen over 5,000 helmets donated.

Thank you to our generous partners and the providers who graciously donated their time.

Welcome to the new California Paramedic Foundation website!

EPIC Medics and the San Diego County Paramedic Association have joined forces to create this new organization with the hope of spreading their impact across the golden state.  Both organizations have thrived in Southern California for decades, and it is the goal of the CPF to expand this success, helping providers and their communities near and far.

Our new website will help us achieve this mission.  Visitors can sign up for our newsletter — the easiest way to stay current on programming, scholarships and upcoming events.  You can also find the new online store here.  Currently stocked with must-haves for San Diego providers, this marketplace will soon be expanded to include communal and training products for providers across the state and from varying organizations and associations.

Visibility is key to the success of the EMS industry and our organization’s community campaigns.  From finding training sites and continuing education events to key updates from LEMSAs and the EMS Authority, providers have a one-stop-shop.  Practicing providers will also find a plethora of ways to get involved in community campaigns, education, and more.

Thank you for taking a few moments to learn about us.  Sign up for our newsletter today and join us on this journey!