Within healthcare, I’ve found that prehospital emergency medical services (EMS) is perhaps the most overlooked link in the chain of healthcare. This is evidenced by EMS systems’ generally inadequate funding and reimbursement in comparison to other healthcare fields. While it’s still uncertain how healthcare reform is going to impact EMS agencies’ revenue, I suggest agencies faced with unfavorable financial outlooks (as well as those with favorable outlooks) consider taking the opportunity to focus their resources on training and continuing education. The importance of continuing education in healthcare can never be overstated, but it plays a uniquely imperative role in the prehospital setting. This is due to the diversity of scenarios prehospital providers address. When engaged in a business that exposes its personnel to anything, they should be trained for everything. I encourage EMS managers to focus on training initiatives comprised of prehospital providers at various levels of certification/licensure, as well as taking an interdisciplinary approach to continuing education; managers should strive to involve their medical director, emergency department physicians, other health care providers, police departments, fire departments, and specialized incident response teams. It’s important to go further than simply meeting the region’s continuing education unit requirements; employees should be exposed to challenging scenarios and drills. Finally, agencies should also address potential scenarios not routinely encountered. As a broad example, urban-based providers should be able to competently perform long-distance advanced life support transports to which they’re unaccustomed, and their rural counterparts should be prepared to respond to mass casualty incidents.
At this point of the article, you may very well be thinking that prehospital healthcare deals with a “captive audience,” and that disproportionately budgeting for training is therefore not applicable to the revenue cycle. You could not be more wrong. Available research concerning patient outcomes and rationale for calling or not calling 911 in medical emergencies consistently points to fear and ignorance on the part of patients and their families. Thoroughly trained professionals inspire patient confidence, whereas patient experiences with less competent providers leave them, their family, friends, and associates reluctant to call 911 in the future. Consider the power of word of mouth following an emergency: “The ambulance kept getting lost and passing my house. They carried me down the stairs on a chair, and they were more nervous than me. I would have gotten to the hospital faster if I just drove, and no one would have tried to start an IV on me five times.” Also consider, “The ambulance saved my husband’s life.” True, with rare exception, EMS agencies do have a captive audience, but ensuring that audience is comfortable will increase its size and attendance frequency. Additionally, high-quality continuing education will positively impact an agency’s recruitment and retention strategy. Finally, in the case of nonprofit systems and agencies, the quality of a continuing education program will be clearly demonstrated by its fundraising proceeds.
In summary, EMS managers should consider placing training and continuing education as a budgetary priority. Of all possible initiatives, this is the most cost effective strategy. As an additional bonus, let’s not forget that it’s the most effective strategy for good patient care.
Jonathan A. Mase, MS, MBA
Jonathan Mase has been an Emergency Medical Technician and Paramedic for over fifteen years. He’s held various positions in the professional and volunteer EMS sectors, including chief operating officer, chief executive officer, administrative captain, company president, and chairman of the board of directors. He has expertise within several fields across the healthcare spectrum.
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