In Our View: An Efficient Response

Local emergency officials seek ways to improve service while managing costs

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In this era of tighter and tighter belt-cinching, kudos are in order for public officials who attack the issues facing their departments rather than relying upon the tried-and-failed "we've always done it that way."Which is what brought local emergency officials before the Vancouver City Council this week. Which is what led Doug Smith-Lee, EMS manager for Clark Regional Emergency Services Agency, to say, "A stubbed toe's no different than a cardiac arrest."

Smith-Lee wasn't referring to the severity of the injuries involved or the risk to the victim. He was referring to the response required by Emergency Medical Services, pointing out one of the dilemmas facing emergency officials as they strive to improve service levels while managing costs.

Along those lines, Clark County EMS District 2, which serves most of the county, is examining ways to alter the manner in which it provides services. At this point, according to an article by Columbian reporter Andrea Damewood, none of the ideas are policy recommendations, which would need to be approved by each agency served by the EMS district. But they do provide some insight into how officials are working to better serve the public.

Among the areas being explored are ways to send low-priority calls through a secondary triage system, in addition to investing in preventative care.

These are areas worth exploring, although they do raise concerns. The idea of using a secondary triage nurse, one who could direct some 911 callers to a primary care physician or to mental health care, leaves open the possibility of patients being underdiagnosed.

Fire Chief Joe Molina stressed that his department would be cautious about making changes in this area, adding that in other locales very few patients have fallen through the cracks. It's an interesting idea, although concrete numbers would have to be explored to better define "very few."

Another proposal suggested that emergency crews during their downtime could work with frequent users of the system on assessment and prevention of their conditions. Smith-Lee said that each dollar spent on such care saves $6 down the road.

These are issues worth exploring, and they are not unique to Clark County. The National EMS Advisory Council recently released a report examining emergency medical response throughout the United States, revealing that 44 percent of ambulance transports are used by Medicare patients.

Among the conclusions provided in the report: Any evaluation of EMS system costs must not be limited to ambulance transport; and officials must work to revise their economic models in a fashion that will allow service to remain at a high standard.

As represented during Monday's presentation to the city council, Clark County's emergency officials are doing just that. They are exploring ways to revamp the care and transport that they provide, and they are taking a proactive approach in meeting the needs of citizens.

As the report says, "The NEMSAC recognizes that EMS functions are a combination of government requirements and services driven by user demand and payer requirements. It is expected that both public funding and user fees will continue to be primary funding mechanisms in the future."

Clark County's EMS redesign committee plans to finish its work by the end of summer and to present local governments with its findings in August and September. It hopes to have policy changes in place by the end of the year, reflecting the fact that having always done it "that way" shouldn't be a blueprint for the future.