Have You Had “The Conversation”?

My plan was to watch some “mindless” television and lay on the bed and more than likely take a little nap to enjoy the afternoon during my mini vacation. The last channel watched was HLN and Dr. Drew was on with a panel discussing Bobbi Christina starting hospice care. Dr. Drew did not mince words when he described how the human body reacts to existing in a comatose state for any length of time. Many of the other panelists were very upset by the description he gave, yet medically it was accurate. How many of our patients have we seen well past the ability to make health care choices for themselves either without family members or with family members that don’t know the reality of the end of life trying to do the best they can?


It is difficult to have influence over a total plan of care that true end of life care should be as prehospital providers with limited interaction time with the patient and their family, often in high stress situations that are not ideal for such a conversation. Yet, there are things we CAN do:

  • We CAN be aware of what services are offered in our response areas either for in patient or out patient and mention them to the patient and or family to follow up on later during an appropriately timed conversation.

  • We CAN also be aware of these services so we can be a part of the end of life health care team when patients have a plan in place

  • We CAN communicate our concerns with Emergency Department staff so they can discuss options with patient and family at a later time.

  • We CAN be aware of our state statutes regarding advance directives and our role in honoring them.

  • We CAN consider end of life care as important as other clinical issues when pursuing continuing education opportunities.

  • We CAN treat (ALL) patients and their families with dignity and care at all times.


We also need to have this conversation with our families and loved ones and have end of life plans in place for both financial and health care concerns. In our line of work we are always aware that we could possibly be gravely injured or killed in the field, yet many of us don’t have a contingency plan to provide for our families’ well being and peace of mind in the horrible event that something should happen to us. This conversation is not just about what we would like to happen in the event we are unable to make medical or other decisions, but what kind of quality of life we expect and how that should happen. Will you expect your family to be your caregiver? Are they able to play that role? What do they expect if such an incident was to occur? Some things to consider:

  • Preparing a Living Will. This communicates to healthcare providers what kind of treatment you would like and in what situations.

  • Preparing a Healthcare Power of Attorney or appointing a Healthcare Proxy. This person is should be aware of what your preferences are for your healthcare and acts on your behalf in healthcare matter when you are unable to communicate.

  • Would you like to donate your organs? Some states require a registry, others allow you to note it on your drivers license, but you should prepare your family before an incident so they are aware of your choice.

  • Obtain Life Insurance. Health insurance is a hot topic in the United States today, but not much mention is made of life insurance which provides for our families financial well being after we are gone and unable to provide for them anymore.

    To be sure, no one wants to die, much less think and talk about it. We are hardwired as humans to love life and do whatever it takes to keep it. Yet, as unfortunate as it is, death will come for all of us and is an important event in our loved ones lives as well. Our demeanor will decide if it is a destructive event or one filled with the love and care of our loved ones celebrating a life well lived. Part of preparing for that celebration is being open to the conversation of end of life planning and bringing our loved ones into the fold with care and compassion.

EOL Cartoon


EMS Compass: The Missing Link in EMS

Hardly a week goes by without hearing about providers feeling left out in the planning of the futures of their agencies and the future of EMS in general. It’s true, some providers will never be happy, that is the nature of humans at large and it is present in any profession. Yet, not everyone is jaded, and many do have a point of not having had a voice in the coming change and development of EMS as we grow up. That is, until now.

The EMS Compass initiative is being led by The National Association of EMS Officials (NASEMSO) and financed by The National Highway Traffic Safety Administration (NHTSA) to develop EMS performance measures over the next few years. Part of their plan is to invite all stakeholders (providers, managers, agencies, government) to participate via direct suggestion during the Call for Measures this month, informational and public meetings, and transparent communication via direct access to key players.

Leaders don't necessarily need a title.
Leaders don’t necessarily need a title.

What is a performance measure?

Performance measures are common in other industries and have been used in medical practice, but not traditionally in EMS. Performance measures enable providers, management, and government agencies to track and improve performance to benefit patients and communities. Some of these measures will be clinical in nature, but operations, safety, and business/ financial aspects are also included as all of these are needed for well rounded agencies and further development of a well rounded industry.

Performance measures don’t have to be complex or convoluted. In actuality they are quite succinct. For example it is widely accepted that patients with cardiac chest pain should take an aspirin. The performance measure for that event would read: All patients who have chest pain of a cardiac nature should receive aspirin. This would then be documented via charting we already complete and reviewed later for quantification. Many things we already do such as standards for STEMI, TXA for Stroke patients, or even trauma protocols were founded in related medical professions performance measures.


Why bother?

-We will be contributing to the development of these standards for our profession, who better to do so? Historically, government at large has not been the best at recognizing what we do and our level of importance (please see “Ambulance Extenders”)

-We already contribute data via NEMSIS for data collection in the EMS industry, this process contributes to data collection and provides information for where we currently stand so we can continue to improve and move forward

-The measures are evidence based. We are Emergency MEDICAL Services and should be practicing medicine in the way that other medical professions do, with evidence not today’s whimsical idea on how to get “cool toys”.

-Provides means of measuring long term performance in our industry so when the next generation of providers arrive, they can build on the foundation we have laid.

-Currently, if your agency bills, you are paid for service whether the patient is treated well clinically and will have an improved outcome or pleased with how they were treated, Medicare will pay for the transport. In the future, in conjunction with The Affordable Care Act (ACA or Obamacare) we will be paid for the outcome: clinically accurate care, patient satisfaction, etc. Hospitals have been preparing for this for the past few years, we should not be naive to think the government will not try to limit our payments.

-Medicare is encouraging other insurance companies to follow suit on requiring a higher standard of care for payment for EMS services.

-Can lead to better provider compensation, improved provider safety and health, and better recognition of the job we do and love.

Obviously, the above is a very simplified over view of what EMS Compass is and will achieve. I have included links below for your information. There is a great webinar you can access on demand that explains how the process works and the history of data collection in EMS. I also included links to the Call for Measures that is live until the end of May, so get your measures in. I also included links to some other blogs and podcasts that have been talking about EMS Compass recently.

Until a standard is set industry wide, EMS as an profession will flounder. EMS needs to define acceptable standards of care on an industry wide level, the lowest common denominator can no longer be our standard if we are to grow into the industry we desire. Much of what is described above are things we already do, we are just organizing and tracking it now. We must to take ownership of our profession before someone else, who has no idea what we really do, tells us how to do it. You can be a part of the future of EMS on a larger level than you ever imagined by contributing to the call for measures by May 31, 2015.

The EMS Compass Site (you can access the Call for Measures and informational webinar here)

The EMS Garage – The EMS Compass

Inside EMS Podcast – How the EMS Compass Initiative will create industry standards

Medic SBK- EMS In The New Decade – The EMS Compass