Time to evolve our approach

By the Academy of International Mobile Healthcare Integration (AIMHI) In a world where EMS is changing rapidly, it is clear that outdated practices cannot keep up with the evidence-based advances that are reshaping our profession. During the last Academy for International Mobile Health Integration (AIMHI) Webinar – Myth Busters: Providing Emergency Medical Services – Expectation vs. RealityIndustry experts commented on how EMS systems must adapt to overcome inefficiencies and directly address the workforce and economic crises. Their message was clear: It’s time to dispel some long-standing myths about EMS and develop smarter, more effective strategies.

The end result right up front

1. It’s time to move beyond outdated performance metrics and focus on the results that really matter
2. Prioritize resources where they are really needed. Smarter delivery means better care
3. Saving lives doesn’t always mean rushing everywhere – safety comes first
4. Let’s align our expectations with the science
5. Efficiency plus expertise equals better patient care – not every emergency call requires an ALS response

Dispelling the myths

Myth #1: Faster response means better results

For decades we’ve lived by a stopwatch, but Dr. Kevin Mackey, medical director for the Sacramento Fire Department, addressed this myth head-on. He explained that the obsession with rapid response times was due to outdated cardiac arrest protocols – when getting to the target quickly was what mattered.

But today, with public defibrillators available at Costco and gyms, most emergencies don’t require lights and sirens to flash within minutes. Mackey made it clear that modern research shows that the 4- and 8-minute benchmarks have little to do with patient outcomes in most cases.

Dr. Doug Kupas, medical director of Geisinger Health, supported this premise by emphasizing that response times are a narrow measure that ignores the true quality of care. As Kupas put it, “We need to start focusing on outcomes-based metrics that actually tell us something about patient health.”

Myth #2: Lights and sirens should be the default

How many times have we turned on the lights and turned on the sirens because that’s what we’ve always done? Turns out we were doing it wrong. Kupas and Mackey both pointed to studies that show the time savings from using lights and sirens are minimal – just 30 seconds to 2 minutes. But the risks? They are huge.

John (JP) Peterson, executive director of Mecklenburg EMS, shared how his agency flipped the script on crisis response. After reducing the use of lights and sirens from 75% of calls to 25%, a 15% reduction in ambulance accidents was seen – all without impacting patient outcomes. In Peterson’s words, “It’s about safety, both for the crews and for the community.”

|More: Cultural change: Reducing vehicle lights and sirens

Myth #3: Every call needs a paramedic

The belief that a paramedic must be present on every call is another EMS sacred cow that is long overdue for retirement. Kupas challenged that notion, stating that sending ALS on every call is not only unnecessary, but also dilutes paramedics’ skills by spreading them out. “We need to focus paramedics on high-profile cases where their expertise is really needed,” Kupas said.

Dr. Mackey added that EMS can take cues from other parts of the healthcare system, such as trauma centers, where specialized care is concentrated to ensure competency and better outcomes.

Redesign the System: Public Education is Key

Peterson and Chip Decker, CEO of the Richmond Ambulance Authority, both emphasized that changing the system doesn’t just require a small tweak here or there, but requires a complete redesign, especially when it comes to public education. Mecklenburg EMS has implemented a tiered response model, prioritizing advanced resources for the most critical cases while allowing lower priority calls to receive non-urgent responses. Public buy-in was critical, and they spent a lot of time engaging local governments, community groups and the media to ensure everyone understood why these changes were necessary.

Decker echoed these thoughts, emphasizing that balancing community expectations with evidence-based EMS practices is not only smart, but critical. He emphasized that transforming the EMS system often requires political support and stakeholder engagement to bring about lasting change.

Tom Wieczorek, director of the Center for Public Safety Management, put it best: Many of the challenges facing EMS systems stem from outdated perceptions driven by the media and public expectations. “We need to educate the public about what modern EMS really looks like – because it’s not just about getting to your destination quickly,” said Wieczorek. It’s about quality care and safe, efficient service delivery.

Key insights

1. Focus on outcome-based metrics. It’s time to stop chasing time and focus on what matters most – patient outcomes. Performance metrics should reflect the quality of care provided, not just how quickly we show up.
2. Reduce excessive use of lights and sirens. Lights and sirens should be reserved for the most critical cases where every second counts. Otherwise, the risks far outweigh the benefits, both for emergency responders and the public.
3. Implement tiered response systems. Advanced EMS systems adopt tiered models that ensure the right resource is assigned to the right call. This not only improves efficiency, but also increases safety and reduces costs.
4. Reassess the role of ALS. Not every call requires a paramedic. By focusing paramedic expertise where it is needed most, we ensure the right level of care is available when it really matters.
5. Public and political engagement is crucial. The future of EMS will be shaped by public perception. Engaging communities and educating political leaders about the realities of the modern EMS will help pave the way for meaningful, sustainable change.
6. Data-driven decision making. The numbers don’t lie. EMS systems that adopt data-driven approaches will achieve improved resource allocation, efficiency, and patient outcomes. It’s time to let the evidence guide you.

The way forward

The Myth Busters webinar was a rallying cry for EMS leaders and systems across the country. Now is the time to challenge the status quo. By adopting evidence-based practices, reducing reliance on outdated metrics, and educating the public, we can ensure that EMS continues to evolve to meet the needs of patients and providers. The future of EMS lies in smarter, data-driven approaches that prioritize patient outcomes over outdated beliefs.

So let’s shed these sacred cows and usher in a new era of EMS – one where expertise and efficiency drive our success.

The AIMHI webinar is available upon request, as are the links and references used in the webinar via https://aimhi.mobi/ondemand/13420011.