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Michael Shabkie - EMS Reform

EMS Healthcare Reform - An Alternate Way of Caring

Friday August 31st, 2012
Michael Shabkie, CEO of Priority One Ventures
Phoenix, AZ

As Emergency Medical Services and Hospitals struggle with an increasing demand for services, many EMS systems work in a constant state of "over load". We regularly see media stories on ED overcrowding and ambulance diverts throughout the United States. As one EMS professional stated, “we are working a multi casualty incident- each and every day". With the introduction of the Patient Protection and Affordable Care Act (PPACA), the way EMS responds to 911 requests is going to change dramatically. Is your organization ready for that change?

All over the U.S., hospitals are working diligently to increase patient capacity by hiring more clinical staff, creating more beds and implementing operational changes. To some effect, these measures have provided temporary relief to an already stressed EMS system. By managing patient volume in the Emergency Department, it allows the EMS Agency to go back in service for the next call, the next patient. Good idea but where does this cycle end?

The current EMS model puts the most expensive equipment, with the most expensive mode of transportation taking a patient to the most expensive treatment option. The state of EMS and the healthcare system can be summed up with one EMS old-timer phrase "you call, we haul".
I would like to introduce two terms that have been used over the years as EMS and Medical Professionals cope with the explosive demand for services.

Afterload and Preload


Afterload is defined as the management and placement of patients after they arrive at the hospital. Many EMS systems are working collaboratively with their hospital systems to ensure that patients who call 911 have a place to go. There is an underlying sentiment that the hospitals need to be able to accommodate these patients as volume demands. By increasing bed capacity and staffing, hospitals are trying to meet demand and provide competent medical care. There is a focus in accommodating the patients after they arrive at the Emergency Department. By managing the "afterload" EMS systems and hospitals will never achieve a system that can handle the patient demand. In my opinion, the efforts to improve capacity are merely a Band-Aid covering the underlying issues.


Preload is the management and appropriate medical decisions made in the interest of the patient on scene. EMS systems need to take a hard look at their current system. As we know, patients calling 911 expect a rapid response by highly trained individuals to treat or cure their ailments. As an industry, we have done a terrific job in promoting the concept of 911 access.

Unfortunately, public education on "appropriate use" of the emergent 911 system has not been our strong point. With the changes in healthcare and the emergence of managed care, patients often have no other choice but to call 911 for their medical needs. As America's safety net, we have proven ourselves but at what cost?

With the changes coming to the overall healthcare system, the time has come to manage the preload. That is, ensuring that when a person calls 911 they will receive the appropriate level of response, treated in the appropriate manner and transported to an appropriate facility, if needed.
Many innovative EMS systems are exploring alternative dispatch protocols and alternate transportation protocols. There is now a need to develop alternate medical treatment and alternate destination protocols. By managing the patients' needs up front, we create an integrated healthcare delivery system. We are truly meeting the needs and demand of our patients by getting them to the right services, in the right manner.

The concept of delivering any alternative to what is considered a "standard of care" can make EMS l professionals a little nervous. Many ask, "Why implement change to an already proven system"? My question is "What is in the best interest of the patient and their community"? The current model of "you call, we haul" is not efficient and does not provide the services that the patient may really need.

We have a strong history of providing selfless dedicated service to our communities. Now more than ever, we should become reflective and evaluate how we deliver that service. There is no short-term solution to our current state, but with innovative strategies and responsible changes, our communities and the patients we serve will benefit.

About the Author

Michael Shabkie has extensive EMS and Healthcare management experience in Arizona, Texas and Colorado, with both the public and private sector.  He is currently the CEO of Priority One Ventures, an Arizona based Health and Safety Solutions Company.  He has served as a key collaborator for EMS system design, developed business development strategies, managed political and public affairs, and acted as an executive advisor on operational processes for both public and private ambulance organizations.



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