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I Am Not Paid Enough To Do That!
Nick Nudell, MS, NRP, FACPE
Wyoming’s 47th Annual Trauma & EMS Conference
August 2017
Cheyenne, WY
W h o a m I ?
Not a Magic School Bus!
Life is about the journey49 States4 Provinces11 months54,250 mi truck33,000 mi trailer9.3mpg5,840 gallons diesel1,540 hours10 fish
The Journey
W h o a r e y o u ?
Objectives
How to 'hack' the data world without having a computer expert on standby
Why the professionalization of paramedicine is important?
When will we be professionals?
How will professionalization affect the future of EMS?
What do you want?
W h a t d o y o u w a n t ?
How do you?
EMS systems are complex
Managing without information is crazy!
Supply Management
Vehicle Purchase & Repair
Medications
Dispatch
CPR Classes
Human Resources
Professional Development
Narcotic Tracking
Defibrillator Upkeep
Community Involvement
Scheduling
State Licensing
Good Data Is Important!
Every EMS agency needs a PIMP!
Paramedic Information - Management Practitioner
• Paramedic Data Analyst (PDA)• Paramedic Data Forensics (PDF)• Paramedic Data Governance (PDG)• Paramedic Data Integration (PDI)• Paramedic Data Manager (PDM)• Paramedic Data Protection (PDP)• Paramedic Decision Support (PDS)
Expert Level Support
Differing Perspectives – Context Matters
Tok Area, Alaska: 41st Largest State
• Pop est: 7,023 or 0.25 per sq/mi (0.01/km²)
• 25,059 sq/mi (64,900 km²)
• AlCan Border Crossing into USA:• 114,996 private passengers
• 1,307 pedestrians
• 3,762 bus passengers
• 6,219 trucks
• 62,277 crossed in to Canada
• 2 physicians, 3 clinic rooms, 60 EMS
Source: https://transborder.bts.govhttp://www.tc.gov.yk.ca/
Tok Area, Alaska: 41st Largest State
Source: https://transborder.bts.govhttp://www.tc.gov.yk.ca/
• Pop est: 7,023 or 0.25 per sq/mi (0.01/km²)
• 25,059 sq/mi (64,900 km²)
• AlCan Border Crossing into USA:• 114,996 private passengers
• 1,307 pedestrians
• 3,762 bus passengers
• 6,219 trucks
• 62,277 crossed in to Canada
• 2 physicians, 3 clinic rooms, 60 EMS
Adapt, Overcome, & Advance!
Nearest hospital is 203mi =4hrs ground or 90 minutes by air
Furthest road point is border @322mi = 6 hours to hospital
Trauma center is 3.5 hr flight after getting to Fairbanks
Environment Dictates Conditions!
Start with where you wanna go!
The Patient
Smar
ter
Spen
din
g
Triple Aim
W h a t i s p a t i e n t c e n t r i c p a r a m e d i c i n e ?
Paramedicine Vision - Of The Future
Previvors
• Prophylactic mastectomy = 90-95% reduction in breast cancer
• Prophylactic salpingo-oophorectomy = 90% reduction in ovarian and 50% in breast cancer
W h a t i s t h e k e y t o p a r a m e d i c i n e ?
H I N T : I t i s t e a m - b a s e d H e a l t h C a r e D e l i v e r y
Teamwork does not meana str ict div is ion of labor,
i t means using the combinedski l ls and judgment of the team
to potentiate one another ’s ski l ls .
- H o w a rd B a c ke r, M D, M P H , FA C E P
How do we get there?
149 million records since 2006 in National EMS Information System national database (as of August 2017)
Making better decisions!
The Future of 1966
L e a v e t h e p a s t b e h i n d !
• 30 minutes per ePCR x 40 million calls = 20 million hours• 20M x $100 = $2,000,000,000 spent on writing ePCRs
• $50 per call!
• What can be improved? Let’s:• Better use the data to show our value to our communities
• Ask data vendors to show us the value of their services
Data entry is expensive
It’s not complicated
Simple Decision Aids
Real time monitoring for trends & outliers
0
5
10
15
20
25
30
5/1
4
6/1
4
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4
8/1
4
9/1
4
10
/14
11
/14
12
/14
1/1
5
2/1
5
3/1
5
4/1
5
5/1
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6/1
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9/1
5
10
/15
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/15
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/15
1/1
6
2/1
6
3/1
6
4/1
6
5/1
6
Tota
l In
cid
en
ts
Month
Number of Cardiac Arrests Per Month
Total Incidents
Median
Reduce variability!
Visual analysis & reporting
Paramedic benchmarking
Paramedic self-improvement!
Performance monitoring
Adaptable for any
audience & purpose
0
20
40
60
80
100
Pro
toco
l Co
mp
lian
ce P
erc
en
tage
Month
Compliance with Cardiac Arrest Bundle
Protocol Compliance % Median
CL 0.4120.5273
UCL0.946
1.1315
0.0000.000
0.200
0.400
0.600
0.800
1.000
1.200
1.400
1.600
5/1
46
/14
7/1
48
/14
9/1
41
0/1
41
1/1
41
2/1
41
/15
2/1
53
/15
4/1
55
/15
6/1
57
/15
8/1
59
/15
10
/15
11
/15
12
/15
1/1
62
/16
3/1
64
/16
5/1
6
Pe
rce
nta
ge -
RO
SC a
t A
ny
Tim
e
Month
ROSC at Any Time During Cardiac Arrest
CL 0.6125
UCL1.2636
0.000
0.500
1.000
1.500
2.000
5/1
46
/14
7/1
48
/14
9/1
41
0/1
41
1/1
41
2/1
41
/15
2/1
53
/15
4/1
55
/15
6/1
57
/15
8/1
59
/15
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/15
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/15
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/15
1/1
62
/16
3/1
64
/16
5/1
6
Pe
rce
nta
ge -
Cap
no
grap
hy
Aft
er
Air
way
Month
Capnography Used After Airway Placed
CL 0.8380.838 0.9939
UCL1.5251.600
1.8235
LCL 0.1520.076 0.16440.000
0.500
1.000
1.500
2.000
2.500
5/1
46
/14
7/1
48
/14
9/1
41
0/1
41
1/1
41
2/1
41
/15
2/1
53
/15
4/1
55
/15
6/1
57
/15
8/1
59
/15
10
/15
11
/15
12
/15
1/1
62
/16
3/1
64
/16
5/1
6
Pe
rce
nta
ge -
Mo
nit
or
dat
a u
plo
ade
d
Month
Percentage of Cardiac Arrests Where Monitor Data Was Uploaded
Performance Measures!
• EMS Compass 1.0 got us started in defining what should be measured• Also developed a process to develop evidence based performance measures
in the future
• EMS Compass 2.0 is now getting started as the EMS Quality Alliance with broad based participation. More to come!
What is a performance measure?
Measurement Domain
Clinical Area
Topic
Family of Measures
Structure
Process
Outcome
Balancing
Measure Formula
Denominator Numerator =Score
Structure
Process
Outcome Stroke Bundle of Care
For positive stroke assessment,
average time from LKW to arrival at
stroke center
Documentation of LKW
Positive stroke Assessments
transported to Stroke Center
Blood Glucose for Positive
Prehospital Stroke Assessment
Notification of stroke team
Suspected Stroke Receiving
Prehospital Stroke Assessment
Performance Measure Example: Stroke-7 Bundle of Care*
Stroke-1 Stroke-2 Stroke-3 Stroke-4
Stroke-7
Stroke-5
Stroke-6
*For illustration only. This does not represent a final measure and may change significantly before it becomes finalized.
Complementary Perspectives!
Information Systems
Evidence / Operational Knowledge
Performance Improvement
National EMS Management Association (NEMSMA) Information and Technology Committee seeks broad participation to
Develop standard competencies and credential for Paramedic Information Practitioners
To manage the data collection, sensemaking, knowledge building, decision support of paramedic agencies of the future!
What Is needed? Paramedic Information Specialists!
What else is needed? Evidence!
Prehospital Guidelines Consortium identifying evidence for new evidence based guidelines
Medical Director Council publishing new guidelines
BUT:Need to understand implications of evidence in rural vs urban areas and ensure the perspectives are incorporated
Rapidly disseminating new guidelines for rapid widespread adoption is critical
“Previvors” will become common in rural and remote areas as a direct result of strong EMS and healthcare systems supported by
information AND technology!
Paramedicine Vision - Of The Future
ContactNick Nudell, MS, NRP, FACPE
UCHealth EMS
Chief Data Officer & Board Member of The Paramedic Foundation
Board Member of the National EMS Management Association
(760) 405-6869
emsnerd.com
twitter.com/runmedic
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