The Role of Rural EMS in Addressing Social Determinants of Health

Discussing how rural EMS can participate in addressing social determinants of health without compromising their safety net role. Proposals for systematic changes, financial mechanisms, personnel requirements, and communication needs are evaluated. The content also covers the basic needs of the population for health maintenance, policy engagement, and the current state of EMS services in rural areas.

• Rural EMS
• Social Determinants of Health
• Healthcare Policy
• Public Health
• Financial Mechanisms

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1. Social Determinants for Health Where does Rural EMS Fit? Gregory R. Frailey, DO, FACOEP Medical Director Susquehanna Regional EMS

2. What Discuss the social determinants for health Evaluate where rural EMS can participate Propose systematic changes to make participation effective, and, not undermine the safety net role of EMS Evaluate the mechanisms/finances/personnel needed to allow for EMS participation Evaluate the communication/EMR needs to meet present requirements

3. Social Determinants of Health Institute of Medicine/Kaiser Healthcare/AAFP/HHS Basic needs of the population to maintain health Public Health based

4. The List

6. Social Determinants of Health Policy. Engage directly via community involvement to improve social determinants of health Stay informed and act on local, state, and national policies affecting the social determinants of health of the populations that they serve. The AAFP believes policymaking should be population based and evidence based,... American Academy of Family Physicians www.aafp.org/about/policies/all/social- determinants.html

7. Change in the past Police community policing, neighborhood watch, Fire fire prevention services, codes development, home/business inspections All have undergone change - making value added services to their daily activities Service has become the tool EMS can do the same Public Safety vs. Public Service

8. The Points Present situation EMS is primarily volunteer EMS is typically fire based EMS receives variable support from local government Billing practices are variable Insurers pay for transport only

9. Tends to be volunteer, and associated with FD Tend to be cross trained more training time required Funding mostly through FD Variably bill for services (as a health care agency) foreign to most FD Services outside transport are minimal, but tend to be FD related some do local non emergent transport Some governmental grants available, but tend to be FD supported EMS

10. How does rural EMS compare to rural PD /FD Police services are provided either by the the local government, regionalized services, or contracted from other local/state agencies Funding tends to come under scrutiny of the populous during budget analysis No question that services are required Public will support the search for funding for this necessary service Fire services are provided by volunteer agencies Minimal funding through local government Variable funding through regional/state/federal agencies Need for services generated through emotional support of the public with occasional proactive local governmental planning Dwindling personnel vs. increasing training needs

11. What can we do?

12. Economic Neighborhood/Physical environment Education Food Community Social Context Health Care Systems Some specifics

13. Recommendations What does the Group think?

14. Break-5minutes Please send your suggestions on how we get there via chat

15. How do we get there?

16. Changemaster Establish need EMS calls vs. FD calls Manage change Set up preplan similar to our EM/FD partners Partner with local healthcare system Alternate destination Routine transport Federal and state funding sources Local tax support

17. Local needs vary System augmentation based on the outcome of the local need Health system can help here probably have data already What social determinants are not being met are they opportunities for EMS Needs analysis

18. Lets use COVID-19 as a study example Variable effect on personnel Burnout Volunteering without pay from regular job Definite effect on 911 call volumes Decrease in overall financial income Decrease in education for new students Variable effect on inter facility transport More people sick at home

19. Improve billing practices What do we change to maintain viability and increase visibility? Variable scheduling Alternate methods of transportation Alternate destinations Care at home Revamp the education process

20. Alina Health ambulance service, community based Mixed population urban, suburban, and rural Covered lives supported by the health system = funding Local support State legislation Harris County TX Urban suburban Tax based Health system dedicated support Governmental support Examples

21. Community needs Health system support How did they accomplish this? Change in law 3rdparty payer support

22. Manage our destination or Bing.com/images

23. Respond to the issues presented to us, or That s the way we ve always done it! Unnamed philospher

24. Disaster=response Spend lots of money Stockpile depletion Use of historical data Pre plan based on past disasters Analysis of causes/responses/needs Develop stockpile and human asset needs from the analysis Preposition literal or acutal Reanalysis after the next event Emergency Management example

25. Fire start Response Evaluate needs Request additional assets Recover Fire Service Example Review structures Modify local building codes to assist with suppression Plan response and needs Preplan levels of response Reanalyze the needs after event

26. Federal and State Initiatives Slow change in making EMS a healthcare agency Not just a transportation asset Local population/government wants us to maintain our public safety role Even slower in paying for community involvement Non emergency transport Alternate care receiving site

27. EMS plan Preplan Train Educate Study preposition Multiple use vehicles and personnel Actively manage level of response Priority Dispatch Tiered response

28. Review and reassess Continuous Process Improvement

29. Any Questions

30. References Kaiser Family Foundation: Artiga, S and Hinton, E; Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity; May 2018 American Academy of Family Physicians The Root of the Problem: America s Social Determinants of Health, Alex M. Azar II, November 14, 2018, Washington, D.C. WHO - WHO (World Health Organization). 2012. What are the social determinants of health? http://www.who.int/social_determinants/sdh_definition/ en/ National Academy of Medicine Magnan, S, Social Determinants of Health 101 for Health Care: Five Plus Five, October 2017

31. Thank you for all you do for your communities!