Statewide Assessments Help Improve EMS Systems

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Justin Romanello was a newly appointed State EMS official when New Hampshire’s EMS system was the subject of a statewide EMS reassessment. It was the fall of 2018, just five months after he had started as the Bureau Chief of EMS in the State’s Department of Safety.

According to Romanello, New Hampshire was overdue for an EMS reassessment since its initial assessment occurred in 1990, just a few years after NHTSA started sponsoring statewide EMS assessments. For the last three decades, the NHTSA Office of EMS has convened groups of experts to help states evaluate their EMS systems and seek ways to improve prehospital care.

The assessment team that came into New Hampshire observed a few aspects of New Hampshire’s EMS system that needed evolutionary changes such as hiring two additional staff members to manage the state’s trauma program. For Romanello, it was especially helpful to get an outside perspective.

“That reassessment, as well as a recent assessment by the American College of Surgeons, has driven us to post two of those [trauma system] positions last week for that matter,” Romanello says. “That was a direct correlation to the report, getting something done here in the state.”

The Statewide EMS Assessment Program

Since the program’s inception, NHTSA has brought together teams to conduct initial assessments of EMS systems in forty-eight states and two territories, as well as the Indian Health Services and National Park Service. In addition, several states have undergone one or more reassessments. The assessments happen at the request of the state, with some periodically occurring due to requirements in state laws.

Once an assessment is confirmed, NHTSA convenes a technical assistance team of five experts, typically including at least one emergency physician, one trauma surgeon, two state EMS directors and one state official with legal expertise. State officials prepare for the assessment by gathering data and other information to present to the assessment team. When the team arrives on the ground, they immediately get to work, meeting with numerous state officials and receiving presentations on all aspects of the system.

After several days of briefings, the team members then spend a day or two writing up the assessment, delivering a document with the results of their findings as well as recommendations and then presenting them to the state officials.

Andy Gienapp, who has been on both ends of the process as manager of the Wyoming Office of EMS and Trauma and a member of recent assessment teams, says these self-evaluations give states a chance to review aspects of their systems they might not always have the time or resources to examine.

“It really boils down to whether or not the state is ready to roll up its sleeves,” Gienapp says. “That's where the rubber really hits the road. We just try to help give a roadmap and bring some clarity to what their way forward looks like, but they're the ones who have to make it happen.”

Having only been in his role for a few months, Romanello found the process daunting at first. By the end, he was impressed with how comprehensive the final evaluation was. It provided feedback on a number of components of New Hampshire’s EMS system, ranging from communications to systems of care to emergency preparedness. More important, it identified what was working well, and where opportunities for improvement existed.

“It was a tremendous help to really show what my immediate outlook was going to be for the year and plan for the next five to ten,” Romanello says. “It has definitely helped us out.”

Lessons Learned from State Assessments

Veterans of state assessments say they’ve gained value not only from assessments of their own systems, but also the ones they’ve participated in as members of the assessment team or even assessments they were not involved in. The assessments focus not just on areas of improvement, but also highlight areas of innovation and success that other states can emulate.

“That's the real advantage being present for these assessments—to help bring ideas to other state offices that haven't considered them yet,” says Dr. Peter Taillac, Utah’s State EMS medical director and a member of several assessment teams.

Dr. Taillac recalled a recent assessment he participated in for the State of Michigan.

“They did a statewide lights and siren analysis looking to see who's using lights and sirens for their EMS runs and who isn't, evaluating what the benefits and downsides look like,” he says. “It's the only state I know that has done that on a statewide level.”

Similarly, Gienapp explains, “Every time I do one, I see something new and I say, ‘I wish that I could do that in my state.’ You get the benefit of being able to see different approaches to different things, so you always see both sides of that coin.”

Turning an Assessment into Action

In New Hampshire, Romanello and his colleagues are continuing to use the 2018 State Assessment to guide many of their activities. In addition to the new positions to help manage the trauma system, the state is working on several other projects that stem from recommendations from the assessment, including:

  • Establishing a line-of-duty death benefit for EMS personnel
  • Conducting a job survey of 5,500 rural EMS clinicians
  • Instituting a critical care paramedic program

Officials who’ve been both assessors and on the receiving end of assessments point out that the key is approaching the process with an open mind and an understanding that the goal of NHTSA and the subject matter experts is to focus on improvement.

“You have a group of subject matter experts that are in this technical assistance team coming out, looking at the system in a manner that is non-confrontational, and it's never going to come back to hurt you,” Romanello says. “It's only there to assist you.”