Reprint from
EMS1.com
Data has long been my professional four-letter word. And in conducting a review of 2021 and a look forward into 2022, I looked to data from the National EMS Information System (NEMSIS) to help tell the EMS story.
As of this writing, NEMSIS data guru, Dr. Clay Mann, informed me that the system had collected 43,327,506 activation records from 12,782 agencies in 52 states and territories in 2021. Dr. Mann reported that in 2020, 43 million records were received and this year he expects to receive north of 46 million – a new record. If the year felt busy with less people – it was! Using the informative NEMSIS TAC weekly “EMS by the Numbers” charts, we can review the year through our own activity levels and draw lessons and conclusions.
A TIME TO RESPOND
TIP and TILT have allowed us to treat the patient in the right place, first time during the pandemic. (image/Pulsara)
EMS volumes have remained high against previous years. The constant that remained is the requirement to respond within a given time – and the frequent use of lights and sirens to get there. The arbitrary requirement to hit a target response time throws up a perverse incentive: arriving under the required time is a success even if the patient dies, and arriving late is a failure even if the patient lives – a case of hitting the target and missing the point. Academic research has clearly demonstrated that not every patient needs a very rapid response, and the associated emergency driving should be preserved for truly life-threatening conditions only. In any case, why get to the patient in under 10 minutes only to then spend an hour to hand them over at the ED?
Looking forward. This discussion will continue into 2022, with several of our national associations already coming together with federal agencies to continue this safety dialogue.
Response volume has run hot in 2021, outpacing previous years … but are there enough people to respond? (NEMSIS)
DRUGS OF ADDICTION
Despite the presence of the pandemic, the real underlying theme to 2021 has been the continued acceleration of the opioid crisis. In November, the CDC announced that there were an estimated 100,306 drug overdose deaths in the United States during a 12-month period ending in April 2021, an increase of 28.5% from the 78,056 deaths during the same period the year before. As we know, this isn’t a criminal issue and it isn’t going to be solved through arrest and detention. Intervention and rehabilitation are the only way out of this epidemic.
Looking forward. On the streets, EMS remain front and center in the epidemic in terms of understanding where and when ODs are occurring via our data systems and are on scene to manage the patient and transport to hospital. We have the continued opportunity to take a lead in this area.
Naloxone may well be the most used EMS treatment in 2021. (NEMSIS)
POLITICIANS ON DRUGS
Response to behavioral health patients also remained a constant. We all became interested in the ruling of Colorado lawmakers that placed restrictions on the use of ketamine by paramedics outside of hospitals. All those in favor of the bill, House Bill 21-1251, signed into law by Governor Polis, hoped it will keep law enforcement officers from influencing paramedics’ decisions on whether to use the drug on people who are experiencing agitated delirium. The view (and stated response) of the house of EMS and medicine has been that we would rather not see lawmakers legislate patient care. Within the tense political landscape, we must be prepared for more of the same.
Looking forward. Issues such as this are always accelerated by the fact that we practice our craft in the full view of the public, whereas everyone else’s medicine mainly occurs behind fully closed and guarded doors. While we are doing the right thing and operating within direction and protocol, everyone is watching – which may make us open to public misinterpretation. Public education before the fact is the answer to many of these issues.
Response to behavioral health patients remains at an all-time high. (NEMSIS)
HIJACKED AMBULANCES
An exceptionally frustrating point of tension in 2021 has been the amount of time spent waiting to hand over the patient at the hospital. The knock-on effect of waiting on the wall for hours at a time means that the ability to respond to the next call has been severely diminished. This has led to EMS systems to the situation where they may have to put more staff on (if they even exist) to react to delays, which is an inflated cost. On the other end, they suffer criticism and contractual penalties for not meeting response time requirements which can run into six figures and add more pain to the operational bottom line – for a problem not of their making.
Looking forward. The recent trilogy series by Page, Wolfberg & Wirth is a must read as well as downloading their fact sheet that highlights the legal requirements around EMTALA. This issue will no doubt roll on and if Omicronpicks up and takes off as other countries are seeing, we will be back on the wall and sitting in the lengthy line again very soon.