Emergency medicine can be helped through public health investment

When I first joined the field of emergency medicine, I did so because I wanted to care for patients at a time when they needed the healthcare system the most. I appreciated the fact that, despite various social factors, everyone is on equal footing in the ambulance or in the emergency room.

While that is mostly true, I realized over time that massive healthcare disparities predict a person’s chances of healing and overcoming health challenges. It would be later in my career when I entered public health that I realized the critical need for interventions at a systemic level and the need to proactively treat conditions to prevent life-threatening illness. For many Hoosiers, the gap in access to public health services has grown wider and wider.

My friend, who we will refer to as Thomas to protect his privacy, like many other Hoosiers, utilized the EMS system as a safety net to treat various ailments. He lived in a rural area and had a low healthcare literacy. He would often arrive to the hospital by EMS to be stabilized and comforted, but the truth is there was little chance he would have long-term improvement. He was stuck in an unfortunate cycle, like many, where prominent gaps in preventive care left no choice but to utilize the EMS and hospital systems. 

Many patients who arrive at the hospital are critically ill and in need of emergent care, but for many, preventative care would resolve the issues before they arrived.

Upfront investment

A strong public health system offers the opportunity to intervene and prevent critical conditions, a chance to educate people about helpful methods to lessen their pain and reduce their exposure to life-threatening illnesses. Thomas never had access to education about healthy eating or diabetes management or support from local public health officials to adequately battle his ailments. This is the critical role of public health, the foundation to a system of preventive care and a stopgap to overtaxing the limited hospital and EMS systems across Indiana.

To look at this example another way, think about the cost savings and efficiencies from eliminating or reducing multiple hospital visits each year. Had Thomas had access to the care he needed, perhaps one of two ambulances available in his county would not have been tied up to transport him.

That ambulance would have been available to respond to high-acuity runs, potentially allowing someone to get to a hospital in 20 minutes rather than an hour. The sole paramedic on shift in his county might have been available to respond to a serious car accident, where every second of access to emergency care makes a difference. Instead, the system is taxed unnecessarily; hospital beds are full; and ambulances are out of service. Investing in adequate resources before Thomas called for an ambulance could have saved the public healthcare system thousands of dollars and improved the quality of life for Hoosiers.

I see this scenario play out every day across Indiana. As an emergency room physician, I see countless patients arrive at the worst point in their lives, but sometimes it is easy to see how their situations could have been avoided. I understand the challenges with capacity and reaching rural Hoosiers who may not be able to drive or have no family support to seek preventive care.

And as chief medical director for Indiana EMS, I hear stories everyday of how EMS personnel are overworked and underpaid. EMS runs have been up by about 30% since the pandemic started, and the service continues to serve as a safety net for many in our communities. 

A path forward

The drive and passion of our public health personnel to help people has never wavered, and the solutions are out there ready for implementation. For decades, EMS and public health have struggled to fulfill growing demands amid declining revenues and recruitment. For the first time in a long time, I’m excited about the future of public health and EMS because of the transformational recommendations posed by the Governor’s Public Health Commission.

This intense study opened the eyes for many across Indiana to how poorly the state ranks in the national average funding per capita for public health. It provides a list of core public health services for local health departments to provide — not a wish list, but a strong foundation upon which our state can grow. The recommendations also include a call to fund them, which Gov. Eric Holcomb has made a prominent feature in his budget recommendations in this legislative session. He has asked for more than $300 million across the next two years to create and sustain vital services, with most of that money going to county-level public health systems. 

While average is never something our state should be satisfied with, I can tell you, without question, not a single EMS or public health professional I have worked with in recent years would be considered “average.” They want to continue to answer the calling in public health, and it is time the state provides the resources they need to serve such a noble cause. The health and livelihood of our state depend on it.