Editors` Expressions: Spurring Innovation in EMS Through Tragedy

Amid the tragedy and challenges the COVID-19 pandemic has wreaked on our society, we must seek silver linings and leverage the opportunity to make positive changes, particularly within the healthcare system. Since a large part of the delivery of care has been transferred online via telemedicine visits to abate viral spread, EMS is in a ripe position to further integrate itself into the delivery of care at home; namely, through mobile integrated healthcare/community paramedicine (MIH/CP). These changes have been slowly evolving until the pandemic forced them to accelerate into widespread adoption, not unlike the way society rapidly developed public health policies after the 1918 pandemic.

When the 1918 influenza took hold of the world, we hadn’t even officially discovered viruses yet; we only knew how to treat bacterial infections. We couldn’t test for nor monitor the spread of the disease like epidemiologists do now.¹ It was far more lethal and gruesome than the coronavirus ravaging the world today, as people often died within days, if not 24 hours, of exhibiting symptoms. In Philadelphia, which had the highest death toll in the U.S., one hospital reported one-quarter of its patients died every day, only to be replaced by a new swath of the sick the following day. Entire households, neighborhoods and even towns were wiped out, particularly in remote Eskimo villages in Alaska where people had little access to healthcare (similarly, Native Americans and American Indians are now facing an incidence of COVID-19 that is 3.5 times higher than that among non-Hispanic whites).^2,3 

On October 1, 1918, the nation’s first school of public health opened at Johns Hopkins University to encourage the science-based study of disease prevention. Public health was somewhat in its infancy, having only become a practice in the later part of the 1800s, but had made great strides in saving lives through large-scale interventions like vaccinations, filtering water and even killing rats to contain merciless diseases like yellow fever, smallpox, typhoid and cholera.^2,4

If a century ago, society—when we had far less medical and technological advancements than today—could make could such sweeping changes in public health policy to improve outcomes when the next tragedy struck, then EMS can do the same today. 

As a component of both public safety and public health, EMS is in a unique position to establish a better foothold in the community and be considered a critical part of the healthcare continuum. Disparities in care among minority and low-income populations disproportionately affected by the virus have been magnified—can’t we intervene early enough with MIH/CP to prevent the sick from getting sicker, the vulnerable from dying? Let’s face it, this is not the last pandemic we’ll see in our lifetimes. We know community paramedicine works without a pandemic—imagine the impact we could make the next time around in preventing preventable deaths and sickness.

In my master’s program in public health, I’ve been learning a lot about the chain reaction impact of disparities in care. While in medicine, people are usually treated after they’ve developed a chronic health condition, public health works to prevent that from happening in the first place. Disease prevention takes some of the burden off of the healthcare system; offering zero interventions or preventative measures is just negligent. One hundred years ago, the leading causes of death in the U.S. were infectious diseases; now they’re chronic—and often preventable—diseases. EMS providers frequently see patients with cardiovascular disease, diabetes, hypertension, obesity and respiratory illnesses. 

Our patients with comorbidities are the ones likelier to suffer most if infected with COVID-19. What if EMS could change that? In a community paramedicine program proposal that I created with a classmate last year, we discovered that older adults with chronic diseases account for 38%–48% of 9-1-1 calls.⁵ We know MIH/CP helps lower hospital readmission rates by providing preventive and primary care to those who may not have access to it otherwise. As we trudge our way through this pandemic, it’s imperative that we seek innovative ways to mitigate the impact on our patients and ultimately, the healthcare system. Community paramedics can provide patients with education on healthy living and measures to protect themselves against COVID-19; some are even talking about tasking these providers with eventually vaccinating patients in the comfort of their homes once an effective vaccine is developed. 

There’s no quick fix to the pandemic, but EMS is certainly capable of being a part of the solution. But we don’t have to wait for an invitation to a seat at that table—we can plant ourselves there. EMS deserves the recognition for the hard work of its dedicated providers. MIH/CP could allow for a more efficient use of resources and talent in the profession. The battle against COVID-19 has undoubtedly hit our people hard, but not only can we make a comeback, we can get back up even stronger and ready to fight by providing better, more innovative services for our patients. Let’s not waste this opportunity to make a name for ourselves—our patients need us now more than ever.

References 

1. CDC. Partner Key Messages on the 1918 Influenza Pandemic Commemoration, www.cdc.gov.
2. Barry JM. The Great Influenza. New York, NY: Penguin Group, 2005.
3. CDC. CDC Data Show Disproportionate COVID-19 Impact in American Indian/Alaska Native Populations. www.cdc.gov.
4. Scally G. “Public Health Profession.” Culyer AJ, Encyclopedia of Health Economics. Amsterdam, Netherlands: Elsevier, 2014, pp. 204–209.
5. Agarwal G, Angeles R, et al. Reducing 9-1-1 emergency medical services calls by implementing a community paramedicine program for vulnerable older adults in public housing in Canada: A multi-site cluster randomized controlled trial. Prehosp Emerg Care, 2019 Sep; 23(5): 718-729.