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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

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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

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60

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100

Pro

toco

l Co

mp

lian

ce P

erc

en

tage

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Compliance with Cardiac Arrest Bundle

Protocol Compliance % Median

CL 0.4120.5273

UCL0.946

1.1315

0.0000.000

0.200

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0.600

0.800

1.000

1.200

1.400

1.600

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Pe

rce

nta

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RO

SC a

t A

ny

Tim

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ROSC at Any Time During Cardiac Arrest

CL 0.6125

UCL1.2636

0.000

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2.000

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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

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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

nikiah.nudell@uchealth.org

(760) 405-6869

emsnerd.com

twitter.com/runmedic

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