The Evolution of EMS: An Interview with Dr. Ed Racht
This article was originally published by EMS Insider and Medlert Inc.
Dr. Ed Racht, the Chief Medical Officer at American Medical Response (AMR) got pulled into EMS at his first job on the faculty in the emergency department of Medical College of Virginia.
“The department chair needed a physician to be medical director of a volunteer rescue squad,” explained Racht. “No one else in the department would do it. He made it very clear that, because I was the new kid in the department I’d have to do it. So, begrudgingly I became the medical director for Henrico Volunteer Rescue Squad.”
“From then on, the EMS virus rapidly replicated and overtook my entire being,” Racht said. “I spent a fair amount of time learning, not by choice but because I realized I didn’t know anything about EMS,” said Racht. “So, I would go up to the station. The medics in Henrico Volunteer Rescue Squad would go out on calls. They’d teach me about EMS.”
And he loved it.
“I really started to understand the interesting aspects of the field of medicine,” said Racht. “Some of those things are really hard to teach, like the power of persuasion and managing the art of medicine in a different kind of an environment, either in a patient’s car, or their home, or at a long-term care facility.”
EMS: Historically ‘You Call, We Haul.’
“My entire practice of medicine for 13 years was street medicine,” said Racht, but a lot of people didn’t understand why he was working in EMS.
“They said to me, ‘What’s wrong with you, Ed? Why are you doing EMS? Those are ambulance drivers.’” Racht said. “EMS had historically been ‘you call, we haul.’”
Things have radically changed since Racht started in EMS.
“Today, there is a ton of good data on how EMS affects morbidity/mortality and EMS program design can really dramatically change the health of populations,” said Racht.
With all the changes taking place in healthcare and in the EMS industry, I asked Racht what are the biggest changes he has seen in EMS . He pointed to three big changes in EMS over his career.
Racht pointed out that over the course of his career, EMS has honed the industry’s professionalism and professional qualifications. As EMS has become as a key player in the healthcare system, EMTs and paramedics are recognized as more than ‘ambulance drivers.’
A More Evidence-based Approach to Care
Part of the recognition of EMS professionals as healthcare professionals has come out of the push towards more evidence-based approaches to EMS care.
“You can’t be recognized as a player in healthcare today if you’re aren’t based in sound science,” said Racht. “Evidence-based EMS and the accountability to be evidence-based is a dramatic change.”
Better Performance Metrics
A third big change, Racht pointed to, is a shift towards more sophisticated performance metrics for EMS.
“It used to be just get there fast,” said Racht. “But we’ve seen that getting there fast is not as important as getting the right resource there in the right amount of time.” He continued that EMS has evolved in terms of its performance metrics as it has become more evidence-based.
Expertise in Patient Navigation
With the growing burden of non-communicable disease, EMS’s role in healthcare is continuing evolve. According to Racht, one the EMS industry’s greatest strengths is patient navigation logistics. He predicts that if this strength is well utilized EMS could be a huge asset in an integrated healthcare system.
According to Racht, healthcare insurance agencies are increasingly interested in EMS professionals’ patient navigation abilities.
“We’ve seen the evolution of Mobile Integrated Health programs and the utilization of a dispatch center as more of a medical command or triage center for patients. Health insurers are interested in what EMS providers can do,” said Racht. “I think what’s changing is that EMS systems are being recognized as just as valuable for the lower acuity, non-acute, unplanned care as they are on the high acuity, acute, unplanned care in terms of navigation.”
Refocusing on Non-Acute Care
This shift is driven in part by changing patient needs particularly with a growing population of elderly patients and more people living with chronic disease. It’s necessitating changing on the part of EMS professionals and the industry as a whole.
“Most people who get into EMS are attracted to EMS because we can pull people off that big escalator either up or down,” said Racht. “As everyone in EMS knows that’s the minority of patients. The reality is the majority of what we see are non-acute.”
This shift towards EMS taking a central role in non-acute care is part of future of the industry. Racht sees the need for changes in the EMS workforce to respond to this shift.
“Our current workforce is really expert in determining if you are sick or not sick,” said Racht. “But we are but not so expert in prevention or assembling a potential differential diagnosis. We have to develop that skill set.”
More and more said Racht, EMS isn’t going to be about “busting into a car or ripping the roof off” to save someone, it’s going to be about going to the long-term care facility to see patients who were recently hospitalized; to sit and talk with them and to evaluate how they can be—and can stay—healthier.