The Whole World Watching

   When Ed Racht took over in September as chief medical officer for American Medical Response (AMR), he brought more than 20 years of experience working in healthcare and EMS. He began in the late '80s as medical director for the Henrico Volunteer Rescue Squad in Virginia, and went on to serve in that position for departments including the Richmond Ambulance Authority and Austin-Travis County EMS in Texas, where he was named that state's medical director of the year.

   About two years ago, Racht left EMS to work as vice president of medical affairs and chief medical officer for Piedmont Hospital in Atlanta. The experience, Racht says, taught him valuable lessons about how many hospitals view EMS--perceptions that leaders in EMS are going to need to work to change if they want to expand EMS' role in healthcare.

   You weren't initially thrilled about taking on the role of medical director for the volunteer squad in the '80s. Has EMS changed since then?

   It has evolved tremendously. EMS is a practice of medicine. Medical directors are partners in the system. What happens and how that happens in the out-of-hospital environment can have a dramatic impact on patient morbidity and mortality.

   You got to see EMS from a different perspective when you moved from Austin-Travis County to healthcare administration. What lessons did you take away from that?

   One of the things I learned is that healthcare systems don't understand the role of EMS, and they really don't understand the potential EMS has in terms of partnerships with and impact on patients. They still see EMS as an ambulance service that brings patients to their emergency rooms. There is significant potential for EMS to partner and help manage the entire patient encounter in innovative ways, but we have to integrate more with the hospital and healthcare system.

What attracted you to AMR?

   While working at Piedmont, I fortuitously ran into some of the folks at AMR at various venues. The more I learned about AMR, the more I was fascinated by the breadth and the depth of the organization. They have close to 18,000 care providers and 280 operations transporting almost 8,500 patients a day, with rural, urban, frontier and interfacility operations. There are differences in the way things are done regionally, differences in state regulations, differences in medical directors, and differences in receiving centers' medical practices and approaches to problems such as STEMI, trauma and stroke.

   The amount of data AMR gathers daily is gigantic. Right now I'm in St. Louis with the medical director leadership group, and we're talking about AMR data regarding national airway success percentages based on the number of intubation encounters per medic per year. We're discussing what may be a good predictor of success and how to better support providers with the training or equipment they need to accomplish that.

What will be your primary responsibility as CMO?

   I'll be working with my colleagues at the national and local levels to explore their needs, what the clinical trends are and what we can do better in our interactions with the healthcare system, public safety partners and hospitals.

   Each AMR site has its own medical director. My role is to be their colleague at the national level, to help facilitate and coordinate dissemination of the information when something new comes out in the literature.

What do you think healthcare reform will mean for EMS?

   In EMS, we have historically not done a great job at measuring our performance, although we have gotten a lot better at it. Usually, when we measure performance, we tend to keep it secret. Many in the industry believe the requirement for transparency in EMS performance is coming, and I'm one of them.

   At Piedmont, we reported our mortality rate. As you can imagine, that encouraged us to look at every death in great detail, determine why it happened and see if there were things we could prevent. Transparency is a powerful motivator. For EMS, it's going to be hard love. But it's absolutely the right thing to do. We need to be accountable for the care we are delivering.

   Jenifer Goodwin is associate editor of the monthly newsletter Best Practices in Emergency Services.