I hope everyone’s holiday season was relaxing and enjoyable. Last month, we took a look back at 2017 from an EMS and healthcare perspective. The new Trump administration, natural disasters, mass shootings, access to EMS medications, the opioid epidemic and a new EMS Agenda 2050 were highlighted. This month let’s tilt the lens 180 degrees and look forward into 2018.

 

Partnerships, Mergers & Acquisitions

Healthcare reform using value-based reimbursement and population health models is altering the healthcare landscape. At the healthcare system level, there is a movement toward mergers or partnerships (i.e. UNC & Carolinas Healthcare). Through this consolidation, healthcare systems feel they can improve access to care, improve quality and better negotiate with payers.

CVS recently acquired Aetna, which could be transformational in that care is managed and provided outside the traditional physician's office, hospital or clinic.In December, CVS, a pharmacy and retail clinic giant, announced that it was acquiring Aetna, one of the nation’s largest health insurers. This creates a unique environment where the payer is also the healthcare provider and pharmacy. This could be transformational in that care is managed and provided outside the traditional physician’s office, hospital or clinic.

Another national health insurer, Anthem recently announced that visits to the Emergency Department would be reviewed. If the visit wasn’t an emergency, the patient would be responsible for the cost. Also, in an attempt to decrease Emergency Department use, Anthem announced that they would pay EMS for treatment without transport of patients. The idea is to encourage their members to seek care with their physician or at a less costly urgent care center.

The success of these new partnerships, mergers and hybrid healthcare delivery models will be dependent of data, analytics and the interoperability of healthcare records. In 2018, interoperability and bidirectional health information exchange (HIE) will be expected. Clinical Decision Support will become more prominent within EMS, focusing on patient navigation, standardizing care through clinical guidelines and reducing errors.

EMS is perfectly positioned for success in 2018 with a focus on patient navigation. Getting the patient to the right place in the right time is the goal. Through the use of emergency medical dispatch, triage hotlines and mobile integrative health programs, EMS will have some exciting opportunities. These are also opportunities where EMS can now be compensated without transport.

 

A New Link in the Chain of Survival

Here are a few thoughts for 2018 with respect to out of hospital cardiac arrest and improved survival. It’s exciting to see resuscitation science and technology evolve each year. The term “Chain of Survival” was first used in 1981. The metaphor was effective in describing the components of a cardiac arrest system of care. The five links are recognition of cardiac arrest, early CPR, defibrillation, advanced life support and integrated post-cardiac arrest care. Successfully executing all five links provides the best opportunity for survival.

With the improved performance of manual CPR and the increased availability of mechanical CPR, more out of hospital cardiac arrest victims could potentially be saved using ECMO.

Over the past several years, there has been an increased focus on the quality of CPR. The focus has shifted from “what” we do to “how” it is performed. With a focus on high-quality CPR, outcomes can be significantly improved.

European models of cardiac arrest systems of care have shown an increased level of success and improved outcomes with the use of Extracorporeal Membrane Oxygenation (ECMO). ECMO devices function as a heart and lung machine, providing both perfusion and oxygenation to a patient in cardiac arrest. Patients who suffer a cardiac arrest and don’t respond to resuscitation using the standard chain of survival components are potential candidates for ECMO. ECMO is used in many European countries by physicians who respond to the scene of the cardiac arrest as a component of the EMS system.

In the United States, we now have board-certified EMS physicians. A requirement to become a board-certified EMS physician is to complete an EMS fellowship. There are 62 EMS fellowship programs within the United States, with most located in our urban areas. EMS fellows spend much of their time responding with EMS to the scene of emergencies, and could successfully implement ECMO to patients in cardiac arrest.

Currently in the United States, ECMO is only an option for patients who survive to emergency department arrival. With the improved performance of manual CPR and the increased availability of mechanical CPR, more out of hospital cardiac arrest victims could potentially be saved using ECMO.

In 2018, or the near future, will ECMO become the newest “Chain” in the “Chain of Survival”?

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