An Interview With Bob Davis on EMS in the Media

Often, the only time we see EMS mentioned to any extent in the media is after a horrific incident, a daring rescue or a scandalous event. It was a great surprise, then, to many in our industry when USA Today featured articles showing a perspective of the EMS system not usually seen in the print media.

In July 2003, USA Today ran Six Minutes to Live or Die, a multi-article report on the state of EMS in the United States, based on an exhaustive 18-month investigation of various performance measures, including emergency response times, prearrival bystander CPR, number of residents trained in CPR and cardiac arrest survival rates (it is still available at www.ems.usatoday.com). Although admittedly less than scientific, the analysis revealed that few cities know exactly how long their EMS crews take to reach cardiac arrest victims, and most are selective about how they portray their overall EMS system performance. A subsequent article, published in March 2005, begged the question of whether limiting the overall number of paramedics in a busy system would be the best operational decision, especially when combined with appropriately placed AEDs and citizens trained in CPR. As the uproar of the EMS community over the public slaying of these sacred cows continues, it cannot be denied that these articles have also engendered significant discussion and debate of EMS-specific issues in places where we often have no voice—local, state and federal government.

For this month’s column, I spoke with Bob Davis, the journalist who penned the above-mentioned articles. Davis is a former paramedic who has been a journalist for over two decades. In 2001, he was a recipient of the prestigious Kaiser Media Fellowship. Davis brings to his EMS articles a perspective that has been molded by both his field experience as a prehospital provider and his inquisitive reporter instincts.

What was the genesis for the Six Minutes… series?

I had seen the disparity in emergency medical care across the nation, first as a Colorado paramedic and later as a national medical reporter at USA Today. On the streets, we knew that the side of the city boundary on which somebody fell could make a life-and-death difference in terms of the care they received. Then, the survival studies in the medical journals made those disparities more clearly visible. I wanted to show this gap to the public, and I wanted to get to the root causes of the differences. I wanted the public to be informed so leaders would get involved and take action to save more lives.

Was it difficult to convince USA Today to approve such an in-depth and lengthy examination of EMS system issues?

My editor loved the idea, but it was so ambitious and time-consuming, I had to chip away at it here and there for months. Then I got an application for the Kaiser Media Fellowship, which supports health reporting by giving journalists funding for a year to work on a project that has significant public health impact. I pitched the EMS project and was named a 2001 fellow. Without the fellowship, the project would have never happened. When I came back to the paper full time at the end of the year, I had a ton of good stuff. But the newspaper editors wanted it to be even better, so they let me spend another six months doing more digging, reporting and writing. The three-day series was one of the biggest projects the paper had published.

How has the EMS community responded to your articles?

The response has been incredible. The vast majority of people who read the entire report have praised the level of detail and the work that went into the findings. Several cities across the nation have applied our measures to their own systems to look for holes to fix. And many EMS leaders are looking at what the top cities do that works so well and are trying to apply the same practices in their towns. There is a healthy competition between some of these cities, and they are using true performance measures instead of thinly sliced response times. Whether it’s getting more people trained in CPR or shaving seconds off their call-to-shock times, they’re pushing themselves to do better and measure their results. There is a lot more accountability and a lot more sharing of information.

Have you heard of any changes/improvements to EMS systems that have occurred subsequent to publication of the articles?

We’ve heard from many cities that are making big changes to try to save more lives. New York City is paying more attention to cardiac arrest outcomes and working harder to improve survival rates. The city is asking firefighters to teach citizen CPR, and they are talking about putting a doctor in charge of EMS, as other systems have done in Louisville, KY, and New Orleans, LA. Many cities are measuring their performances more closely. And politicians and the public are beginning to ask questions about response times and patient outcomes.

What’s next in your article series?

I’m currently working on an article regarding air ambulance issues. I’m not really sure what EMS story I will focus on after that. There are so many ways in which EMS can benefit from becoming more transparent and accountable to the public, and I hope other reporters will pay more attention to this critical service. While more scrutiny has the potential to create some level of initial discomfort, it also helps EMS get more of the resources that it needs and more of the support that every medic deserves.