A VISION OF TOMMOROW;
PREDICTIONS FOR EMERGENCY MEDICAL SERVICES SYSTEMS
1992 & BEYOND

By Clark Staten, EMT-P

As we begin another year in the final decade of the 20th Century, an exploration of future possibilities for EMS systems and personnel comes to mind. An endless array of problems and opportunities will undoubtedly arise, and the maturing EMS professional will be faced with many difficult and demanding challenges.

Many new and innovative ideas and products will emerge during the next few years. Technology can be expected to continue to advance, both in the practice of prehospital medical care and in the equipment that is used to perform it. The public's expectation of quality and quantity of emergency medical care is certain to continue to increase.

In light of this emerging "vision", the following "predictions" are submitted for the reader's consideration:

• 1. The "downsizing" that has occured in many businesses and some subdivisions of government is certain to strike some emergency response agencies. Although more productive than almost all other functions of government, Emergency Medical Service systems will need to increase efficiency and effectiveness through better planning and the use of advanced technologies. Regardless of cuts in other city/county agencies, EFFECTIVE EMS agencies are unlikely to suffer lay-offs...the public won't allow it.

• 2. Many fire departments, and some police departments will attempt to regain control of Emergency Medical Service (EMS) functions in their jurisdiction. Shrinking tax bases and ever-vigilant city administrators will force previously "untouchable" emergency agencies into proving that they are productive. Many fire departments find themselves faced with an ever-decreasing number of actual fire suppression responses, while the number of EMS responses continues to increase. This effort will be lead by labor organizations (i.e. Firefighter's Unions), as well as management experts.

• 3. Tremendous advances in technology will decrease the size and weight, and increase the capabilities of much of the equipment that we use. A major leadership effort will be undertaken within the next year, by one of the nation's largest U.S. EMS agencies, that will have a profound affect on the way that emergency service products are designed and developed. Equipment designers and manufacturers will begin to participate in "cooperative partnerships" that will enhance the capability and integration of EMS equipment. At least one major EMS publication will undertake an OBJECTIVE and concise product review system, that will report on the viability of new technology.

• 4. National equipment standards will be be promulgated and proposed that would allow "interoperability" of different brands and types of radios, cardiac & respiratory monitors, defibrillators, and other diagnostic and communication equipment. As an example, these standards will allow system administrators and purchasing agents to insure that "X" defibrillator will connect to "Y" monitor, and that ECG can be transmitted with "Z" radio by means of standardized connectors, cables, and electronic interfaces. Various manufacturers will attempt to resist the "standard approach", but will be losers at "contract time".

• 5. Conversion of voice, data, video and other communications signals will be changed to an "all digital" standard. Digital signals will allow "interoperability" between the various system components and the transfer of various kinds of data through a computer controlled ambulance environment. This will also allow the computerization and effective processing of information and communications, eventually leading to "paperless" communication and recordkeeping.

• 6. Thrombolytic agents will begin to be used in the field by paramedics to treat Myocardial Infarction patients. 12- Lead ECGs will be routinely taken to verify the need for such intervention. Early studies will show that the earlier the "clot dissolving" drugs are given in the course of a heart attack, the better the resulting outcome. Some emergency physicians will resist the provision of this treatment, but will be proven wrong as the studies of efficiency are provided.

• 7. If economic circumstances continue to worsen, less- scrupulous EMS systems may attempt to decrease the advanced treatment that is provided "in the field", and will order EMT/Paramedic crews to "scoop and run"...even when faced with medical emergencies and cardiac events, that could well be treated in the prehospital phase of care. This will be done, not due to the ineffectiveness of prehospital care, but because hospitals can not charge for services that are provided by prehospital personnel. Those systems that participate in such an obvious degradation of care will be "soundly criticized" by their peers and eventually action will be taken to prevent it... by health care regulators.

• 8. One of the EMS management "buzzwords" for the 90's will be...INTEGRATION. It will refer to various systems within the administrative office environment, within the EMS vehicle, and with the equipment used by EMTs and Paramedics. More consideration will be given to issues like ergonomics, ease of use, value-added cost, interoperability, and potential benefit to the patient. Computerization of many operations and procedures will lead the other associated fields and industries into integration of design and implementation.

• 9. In the later part of the decade, serious consideration will be given to EMS vehicles that "fly". Traffic congestion and "gridlock" in urban areas will necessitate an alternative method of timely emergency medical response. Long response times in rural areas will prompt a similar conclusion. Various configurations of "STOL" (Short Takeoff & Landing) aircraft will be suggested for use as air ambulances. Upgraded engines and propusion systems will allow the carrying of potentially large payloads, while allowing a wide margin of safety. Computerization of flight control and guidance systems will make these aircraft as easy to operate as current land-based vehicles.

• 10. Earlier in the decade, some EMS system administrators, analysts, and providers will begin to utilize P.C. (Personal Computer) based communication networks for the purposes of sharing news and information, group problem solving, data storage/retrieval, research, planning, and multi-agency disaster responses. As individual ambulances and providers become linked by this technology within local systems, virtual networks can be created that will allow almost "automatic linkages" of multiple agencies in the event of a mutual aid response or disaster.

• 11. By the Mid-1990s, individual EMS providers should be "com-linked" by miniaturized, individual radio/cellular telephone devices that will function as pagers, voice transcievers, data processors, and video display terminals. Public safety employee safety will be greatly enhanced by built-in "panic alarms" and position locater emitters that will enable emergency dispatch centers to immediately send help to any emergency responder that needs it.

• 12. Enhanced "911" communications centers will INTEGRATE Fire/Police/EMS/Medical/Disaster dispatch and system management capabilities under "one roof". This concept will allow data and information sharing within the various departments, as well as forming a part of the nucleus of a potentially global emergency response network. By computer linking of enhanced "911" centers in various locations, throughout the nation or world, an effective response could be configured to respond to almost any kind of natural or man-made emergency.

• 13. By the mid-to late 1990s, a major effort will be instituted to cause all Emergency Medical Technicians (EMTs) to undertake a minimum of an associate's degree in prehospital care education, with paramedics being expected to complete a specialized baccalaureate degree. EMS supervisors and adminstrators will be expected to have completed a Masters degree in a specialized prehospital care management program. This will lead to greatly enhanced pay and benefits for EMS personnel and advanced recognition as health care providers, within the medical community.

• 14. Most Continuing Medical Education (CME) and many entry level training programs could be performed in a "virtual reality" multi-media, computer/video based environment. "Real-life" scenarios and practical applications of skills could then be performed in a realistic way without danger to rescuers or patients. These systems, like the advanced flight simulators of today, could allow emergency personnel to experience sights, sounds, and sensations that might be unlikely during their normal careers, but could be reproduced for training purposes. Artificial intelligence and expert systems could function as "teachers" and "mentors" for new emergency care students and to evaluate and monitor experienced responders.

  15. Lastly, computerization and miniaturization of diagnostic and laboratory equipment should allow it to be brought to the prehospital phase of care. "Cat-Scan", "Magnetic Resonance Imaging" or "Sound-wave" type equipment could be brought to the patient's side and used to better analyze the patient's condition. Automatic cardiac, respiratory, and brain monitors and probes could analyze those functions. Blood gas and other analysis could well be performed by an automated machine, within the ambulance, that could allow definitive treatment of acid/base disorders, metabolic disorders, oxygen usage and other blood-based problems. Upon determination of these tests, an "expert computer diagnostic" system could analyze the data that had been gathered and recommend a course of treatment. Video and audio consultation could take place between the prehospital provider and a physician if that were deemed necessary, and all of the information obtained by the emergency medical personnel would be immediately available on-line for evaluation. No patient records would need be kept by either the prehospital personnel or the receiving hospital; that would be done automatically and simultaneously by the computers.

Much of the technology mentioned in these predictions is available today, or already in the development stages. Many of the predictions are based in wants or needs that are being echoed by EMS providers, system analysts, supervisors, and administrators. Others are the outgrowth of an objective evaluation of the current state of affairs in the emergency community. Some of what is predicted may be wishful thinking. Other parts of the predictions are necessities for the successful evolution of the prehospital care profession.

You may disagree with the conjecture as presented, but, must surely agree with the need to dream... and plan for the future.