Missouri DHSS Gets New State EMS Doc

Last August, the private, non-profit funding corporation Missouri Foundation for Health (MFH) announced that it had awarded $1.2 million to Missouri's Department of Health and Senior Services (DHSS) to coordinate and improve how emergency medical services are delivered across Missouri.

Leslie Reed, the vice president for health policy at MFH, says the foundation is not suggesting Missouri's problems are any different from other states'. But in 2004, it had received numerous applications for similar kinds of EMS funding: ambulances, defibrillators, grants to save emergency departments going out of business and so on. She didn't think throwing money piecemeal would make enough of a difference to what looked like a system-wide problem.

Thus began a year of MFH-sponsored discussions among the various parties in the system regarding the creation of "an even, systematic approach to emergency medical services."

One of those parties was the State Advisory Council on EMS (SAC), which had been set up by the previous governor and was chaired by Bill Jermyn, DO, FACEP, medical director in Moberly, MO, whom the group chose to lead these discussions as well. There was a strong consensus across the state that centralizing EMS would help the system as a whole.

They looked to DHSS's Unit of EMS as the natural home for the effort, and with incoming Governor Matt Blunt's consent, MFH offered to fund a coordinating position for three years to get it done. "We're happy with Julie Eckstein's approach," says Reed, referring to the new administration's DHSS director. "She's businesslike and she sees the value in this." That's a very good thing, considering the fact that budget cuts since 1996 have resulted in her department's Unit of EMS, headed by Paula Kempf, shrinking from a staff of 22 to 12.

Make that 13. Jermyn, an emergency physician for over 25 years, chair of the American College of Emergency Physicians (ACEP) EMS committee and a board member of the Commission on Accreditation of Ambulance Services (CAAS), was subsequently named the unit's new Medical Director of EMS. One of Jermyn's tasks in the current nationwide climate of decreasing tax revenues will be to find a self-sustaining source of revenue to fund the office after the grant expires.

But that's the least of his worries, he says. His aim? "To develop and implement an integrated EMS system in the state." That means, for starters, developing a common vision throughout the entire emergency healthcare system-from dispatch through discharge-that's "all about patient care," he says. And he's confident he can do it.

"In 2004, during ACEP's EMS Week, we put out a scenario, with a car crash, for how the entire emergency system should work, not just EMS," he says. "And there was a circle-what we called the EMS circle-diagrammed there. That's become my circle."

You know it's working when everything comes together, says Jermyn, relating a recent call to a dispatch center 70 miles away from a major medical center. The dispatcher suspected her male caller-age 44-had a serious condition, and sent ground. She also early-activated air, per Missouri protocols, and when ground arrived and confirmed her suspicions, air was in place. Their 12-lead EKG showed an inferior MI, and with a nine-minute scene time, they flew the patient to a regional facility. Treating it as a Level-1 trauma, a cardiologist met the patient in the ED and in less than five minutes had him in surgery.

"So, you've got a 44-year-old male 70 miles out with a symptom-onset to balloon-time of 107 minutes. He had a two-day stay and was back at work. Incredible," says Jermyn.

"When you QI the whole system, think about the trust between all the segments. That's the way it ought to work. Now, we just need to design a system where we can do that 500,000 more times."

Jermyn is beginning that process with a PowerPoint presentation, Communicating the Vision. Next he'll have to marshal the forces to hammer out plans for each individual component, then develop consensus on how they all fit together. "After that we'll have to craft a statutory package mandating these things and get that through the legislature," he says.

In three years.

With his work cut out for him, Jermyn says he is indebted to the support from MFH, Kempf and her hard-working staff. But if Missouri succeeds in creating an integrated model for the EMS circle of care, we'll all be thanking them.