November 16, 2025 • 40 mins
Episode 310: Dr. Remle Crowe, Senior Director of Research and Data Enablement at ESO. Remle began her EMS journey as a volunteer EMT and instructor with the Mexican Red Cross in Mexico City, completed the EMS Research Fellowship at the National Registry of EMTs, and earned her Ph.D. in Public Health from The Ohio State University.We dive into how data drives better patient outcomes, operational efficiency, and provider wellness across EMS and hospital systems. She also shares her experience and advise about my passion projects and as an author of the newly released 2025 AHA Guidelines for CPR and ECC: Part 4: Systems of Care.
Medic2Medic is back, bringing authentic voices, untold stories, and the human side of Emergency Medical Services and beyond.
Medic2Medic is back, bringing authentic voices, untold stories, and the human side of Emergency Medical Services and beyond.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Come up.
Speaker 2 (00:07):
Attention all listeners on this frequency stand by for.
Speaker 1 (00:11):
An important announcement.
Speaker 2 (00:14):
Welcome to Medic to Medic podcast, the weekly podcast for
EMS providers, EMS leaders, EMS, medical directors and others involved
in or those who have an interest in emergency medical services.
Ladies and gentlemen, here's your host, Steve.
Speaker 3 (00:30):
Cohen, coming from the fern Dew Medical Medic Podcast Studios.
It's another fine podcast of medical medic. I'm your host,
Steve Cohen. You can reach me at Medical Medic Podcasts
at gmail dot com. You can find me on Facebook, Instagram,
and of course on any podcast platform like Apple, Spotify, Podbean,
(00:56):
you name it. Medical Medic is there. Yes, the reboot
is going really well well. I am so happy to
be back talking about public safety, especially EMS as well.
Each week we sit down with people who shape EMS
profession and those who challenge turn challenges into data better
outcomes for our patients. Today, I am joined by someone
(01:19):
who was on the podcast way way back when and
has done so much for our EMS community. Doctor Remley
Crowe is the Senior Director in Research and Data at ESO,
where she leads an innovative work that uses analytics to
improve patient care. And outcomes and operation and performances in
(01:40):
EMS world. Remily. I am so happy to have you
back on the podcast. So welcome back to Medical medic.
Speaker 1 (01:48):
Well, thank you for having me back. I'm excited to
be here.
Speaker 3 (01:50):
I know your journey starts were in Mexico City, if
I remember right, you started out a good memory.
Speaker 1 (01:56):
Yeah.
Speaker 4 (01:57):
I got into a car crash in Mexico and just
I should be an EMS.
Speaker 3 (02:01):
Yeah, you became a volunteer EMT. You did some things
with Red Cross, you did some things in EMIS research
and all this. I know something about you did. Didn't
you do a fellowship with n R E m T.
Speaker 1 (02:14):
Right?
Speaker 4 (02:15):
I did.
Speaker 1 (02:15):
I was a research fellow with the n R E
M T.
Speaker 4 (02:18):
Wow.
Speaker 3 (02:18):
Yeah yeah. And where did you go to school?
Speaker 1 (02:21):
The Ohio State?
Speaker 3 (02:22):
Yeah, the Ohio State. Yeah. Well that's a different topic
for another podcast.
Speaker 1 (02:29):
Actually today. Yeah.
Speaker 3 (02:30):
Well, I know. And the other thing about it, I
visited that campus. I have two best friends. One went
to Maryland and one went to the Ohio State. So
their freshman year, I went to visit him and I think,
I don't know, we woke up after Friday night. I
don't remember much, but I think MTV was on. I
(02:51):
think it just started or something like that, and the
Rolling Stones was doing something on video. That's what I remember.
Speaker 1 (02:57):
I don't know, it was like a college experience.
Speaker 3 (03:00):
There are things we're going to talk about it. We're
going to catch up with you. But you've been involved
in the Heart Association, the American Heart Association and the
guidelines that just come out and part four we'll get
to that and talk about systems of care. So what's
going on with you?
Speaker 4 (03:15):
And HI?
Speaker 3 (03:15):
Are things with you? And what you've been doing this
last time we spoke.
Speaker 1 (03:20):
Yeah, it's been a while.
Speaker 4 (03:21):
So lots of great exciting things going on on the
ESO side. We are seeing a lot of great collaborations
in the research space. We recently introduced a longitudinal patient record,
which opens up a whole new world of research to
where we don't just see the patient during one encounter,
we can see repeat visits. I just worked on some
(03:44):
research related to that seventy two hour bounce back.
Speaker 1 (03:47):
So lots of exciting things happening there.
Speaker 4 (03:49):
And we're coming off of the EMS World conference with
so much great learning and so many presentations.
Speaker 1 (03:55):
How to blast there with the.
Speaker 3 (03:56):
Team, we talked a little bit about Mexico, city and everything.
Don't you tell us that story once again?
Speaker 1 (04:02):
Yeah? So I came into.
Speaker 4 (04:04):
EMS a little bit of an non traditional route. I
think a lot of us probably have a weird story
of how we.
Speaker 1 (04:09):
Got to EMS.
Speaker 4 (04:10):
But I was in undergrad I studied business administration, and
I was doing study abroad in Mexico. Got into a
car crash and they put me in an ambulance that
was not injured, but my wheel started turning on.
Speaker 1 (04:21):
Hey this is really cool. How do you get to
do this? And I spoke with the medic and you
told me, well, if you want to be good, you
go to the Red Cross school. That's what everybody does.
Speaker 4 (04:30):
So I finished up my bachelor's in business, moved back
to Mexico and became a volunteer with the Mexican Red
Cross and did EMT training and became an EMT instructor.
Speaker 1 (04:39):
But that's all volunteer.
Speaker 4 (04:41):
So to support my volunteer EMS have it, I found
a job at Ford Motor Company as a powertrain quality
engineer first and then later a powertrain engineer.
Speaker 3 (04:50):
How do you think that experience shaped your EMS career
and through your love for research as well.
Speaker 4 (04:57):
I always say Ford was the best school I ever
went to that's where I actually fell in love with data.
I learned about quality improvement and six sigma and learned
how to actually change.
Speaker 1 (05:07):
Systems to get different results.
Speaker 4 (05:08):
And so you know, when the opportunity came for the
National Registry Fellowship, I thought, here's the place where I
can blend both of my loves. I love data and
I love ems, and I want to bring those two
things together. And so research seemed like a natural path
for that. And the opportunity through the National Registry is
truly incredible where they take ems clinicians and send them
(05:29):
through masters and PhD while you're working and while you're
able to contribute to the profession. So that's how I
ended up in Columbus. And after the fellowship, they say,
go do great things, and hopefully that's what I'm doing.
Speaker 3 (05:41):
You've won a lot of hat during your career from
being clinicians, instructor, senior leader at ESO and all those
kind of good things. How those different experiences shape your
perspective on the relationship between data and patient care delivery,
that's a great question.
Speaker 4 (06:00):
I think those experiences continue to reinforce the need for data.
A lot of times we make decisions with our guts,
and sometimes we can be right, but it's better to
stay curious, I find and let the data guide us,
and not just also accepting that all data is good data,
because that certainly is not the case, but being able
to parse out when something matches the true experience and
(06:22):
when it doesn't. I've learned a lot over the years
about how to stay curious not furious when we see
something that doesn't make sense to us.
Speaker 1 (06:30):
And often I've been wrong.
Speaker 4 (06:32):
I like to joke I've made a career out of
being wrong. Just yesterday I found an air at line
ten of a four thousand line of code issue. So
I think that keeps us humble, keeps us curious and sticking.
Speaker 1 (06:45):
With the data and letting that guide us.
Speaker 3 (06:47):
Well, I think I kind of jumbled your title ESO.
What is your title at ESO?
Speaker 1 (06:55):
I'm the Senior Director of Research and Data Enablement.
Speaker 3 (06:58):
And what does that mean?
Speaker 1 (07:00):
It means I wear.
Speaker 4 (07:01):
Many hats, so one of them being the clinical research side.
We have THEODATA Collaborative, which is one of the ways
that we give back to folks who have spent all
this time entering data into the checkboxes. So as a EMT,
I would never get to see what happened to that data,
and that's not something we want.
Speaker 1 (07:17):
So we have packaged the data d identified.
Speaker 4 (07:19):
We don't know who the clinicians are, who the facilities are,
anything like that, of course, not the patients, and we
make that available to academic researchers who want to ask
and answer important.
Speaker 1 (07:27):
Questions to contribute to our field.
Speaker 4 (07:29):
So that's one hat, and then the other hat, the
data enablement side, is the world has changed a lot
in the past five years with data. You know, I
come from the land of access databases and some will remember.
Speaker 1 (07:40):
That SQL, databases, all of these things.
Speaker 4 (07:44):
But now we have better tools at our fingertips than
we've ever had, so power, BI, tablet, et cetera.
Speaker 1 (07:50):
But that wasn't part of my AMT training. I don't
know if that was part of yours.
Speaker 4 (07:54):
So we're at a point where the industry has changed
and we need to provide tools.
Speaker 1 (07:59):
And data literacy. So I spend a lot of my
time creating.
Speaker 4 (08:02):
Template its, helping others learn data literacy and how can
we make the data model simpler, Because ultimately, I don't
think anybody wakes.
Speaker 1 (08:10):
Up wanting to spend all day trying to code.
Speaker 4 (08:12):
We want to spend our day improving things and so
that's a huge part of what I get to do.
Speaker 3 (08:17):
Kind of want to stay on that topic if you
could give us an example of something you do from
day to day. Or we both have a mutual friend
and co worker with doctor Brent Myers, I mean, do
you interact with him still on a regular basis.
Speaker 4 (08:32):
Well, I get to work with an amazing team and
we are led by doctor Brent Myers, who is best
leader I've ever worked with. A lot of our work
centers around trying to help MS agencies be able to
use their data to improve community health and safety. And
so a typical day for me can be a lot
of different things. Some of it is the right here
(08:52):
right now. If there are support tickets that have a
little complexity to the data, oftentimes we chip in and
help our colleagues there. But also we're thinking forward, so
we're thinking five or ten years into the future about well,
what should data entry look like, what should data reporting
look like? And what we do today is not going
(09:13):
to be how we're doing things down the line. So
I spend a lot of time with a group that
we call EESO Labs, which is our innovation branch, and
so myself and Alyssa Green who works with me, she's
a paramedic. We spend a lot of time testing things,
breaking things, and we do love to break things as
EMS clinicians. So that's another giant chunk of our days.
And then some other things are when new guidelines come out,
(09:37):
or when new metrics come out like NIMSQUA, I know
that you've talked about the National EMS Quality Alliance, or
when Mission Lifeline puts out new measures. Our job is
to create ten footed reports that an EMS system can
just log in the morning and click on them and
see how they compare, rather than having to sit there
and spend a ton of time coding or I always
(09:57):
make the reference of apples to apples really isn't good enough.
We want a granny smith to a Granny smith. And
so the way that we do that is by creating
these can reports. And so my team and I get
to spend a lot of time honing and refining and
making those useful for our agencies.
Speaker 3 (10:11):
You've been with the SOO for quite a bit quite
a long time. Now time flives, right, doesn't it? Can
you give us and our listeners an example of a project.
Can you give us an example of a project that
turned analytics into actual measurable change, maybe something that directly
improved patient care.
Speaker 4 (10:30):
Yeah, so there's lots of great examples. I'll get on
my soapbox because you're giving me an opportunity. One project
that I got to work with was I call it
the Data MythBusters.
Speaker 1 (10:42):
So we know that there were disparities in paint management.
Speaker 4 (10:45):
This has been published in tons and tons of research papers.
But that makes us uncomfortable because none of us woke
up for the fame and the fortune and EMS, and
we surely don't like to hear that we might not
treat our patients equally.
Speaker 1 (10:56):
So I worked.
Speaker 4 (10:58):
With our hospital outcomet that's linked to EMS data to see, well,
maybe there's a reasonable explanation for why we see some
patients less likely to get at pay medication.
Speaker 1 (11:07):
And so we limited to patients who have long been
of fractures.
Speaker 4 (11:10):
And then we looked at who was likely to get analgesics,
any analgusic by any route at.
Speaker 1 (11:16):
Any time right, and we found.
Speaker 4 (11:18):
Oh, there is a disparity the black patients being less
likely to receive pay medication. We read the eight hundred
and forty four narratives. We looked at all the different variables.
I did some really complicated statistics around this, and we
see that the disparity persistent. But what that lets us
do is to stop focusing on the measurement and now
we can turn it into action. And I've seen some
(11:38):
systems if the agencies I've worked with have taken that
to heart and said, all right, let's suspend our disbelief
for a minute, and let's change the system so that
we can make sure that we are doing what we intend,
which is to deliver equitable care. And I've seen several
agencies take this project on and it not only made
care better when they focus on that disparity, it made
pay management better overall. One of the things we saw
(12:00):
long bone fracture pain score greater than six, and only
about seventy four percent of those patients were being treated.
So that means there's a one in four chance if
I broke my femur that I'm not.
Speaker 1 (12:10):
Going to get pain medication.
Speaker 4 (12:12):
So it's definitely an area where we've seen increased focus,
and it's.
Speaker 1 (12:15):
An area where an ems we see.
Speaker 4 (12:17):
A ton of patients who experience acute pain, so huge opportunity,
and I have seen a lot of great uptake in
people moving it from research into the quality improvement space.
Speaker 3 (12:27):
A lot of EMS systems struggle with building culture that
values data. It's one of the things. It's one thing
to collect it, but another to trust and act on it.
What's your advice for agencies trying to make that giant leap.
Speaker 4 (12:41):
Yeah, it can be challenging, for sure, and I think
I don't want to hone it on something you said
around Oh, well, maybe people don't.
Speaker 1 (12:48):
Always believe the data.
Speaker 4 (12:50):
One of the barriers that I encounter a lot is well,
they don't document that correctly, or those timestamps aren't real.
Speaker 1 (12:57):
Well, it would be tempting just to out the window
and say it. Then we can't do anything. But my
advice is to just start small and to just get started.
Even with imperfect data.
Speaker 4 (13:08):
Is better than none, so we should look at it
and question it for sure. But if we're not measuring
and we're not attempting to improve, then we're never going
to get better. So I see a lot of people
get stuck in the analysis paralysis.
Speaker 1 (13:21):
But my advice is to just get started and to
just keep moving.
Speaker 3 (13:24):
How do you convince the leaders of those systems that
this is important information, important data. You can always go
back and say it's patient care, right, we improve patient care.
But what advice do you give those people in the
quality improvement divisions departments to go to their leaders and say, hey,
(13:46):
I'm looking at this, we need to make this change whatever.
Maybe here's the proof. How do we talk to our
leaders about this?
Speaker 1 (13:53):
Yeah, and it's a great question there as well.
Speaker 4 (13:55):
So when we teach for the INAMSP Quality and Safety course,
we spend a great deal time not even looking at
the data, but talking about the psychology of change.
Speaker 1 (14:05):
Change can be hard for a lot of people. Thinking
about a change is easy. Doing it is not. Is
one of the quotes from the Improvement Guide that we use.
But one of the things to think.
Speaker 4 (14:14):
About is resistance is most often a response to a
lack of clarity or being overwhelmed. And so when we
get resistance again get curious not furious mantra pops into
my head, we should think about, well, have we articulated
once in it for them? Have we clearly stated why
it's important? A lot of times we have the curse
(14:35):
of knowledge, like we're very clear on why this project matters.
It's very obvious to me why we should make sure
that patients with chest pain and get.
Speaker 1 (14:43):
An asprid, but is that clear to everybody else?
Speaker 4 (14:46):
And making sure that we're taking the time to get commitment.
A lot of people talk about buy in, but one
of the things we teach is Peter Seay's pyramid, and
buy in is just compliance.
Speaker 1 (14:58):
That's not good enough.
Speaker 4 (15:00):
People who are committed, who are going to go out
of their way to make sure that a quality improvement
project is successful. And the way that we do that
is by starting to understand the other person's side and
getting curious when we see resistance.
Speaker 1 (15:11):
Rather than just pushing back.
Speaker 3 (15:12):
If you could name your top three project that you
worked on through your whole career, or maybe just as
one of two, or what is it? Or is it
still to be found?
Speaker 4 (15:22):
Oh? I hope it's still to be found. But I've
had the privilege of working on so many amazing projects
it would be hard to name three. I do think
that the analgesics paper I mentioned earlier is one of
the landmarks for me because it was with a data
set that was never possible when I was in the
field we never had outcome data like that, and to
(15:43):
be able to take a misbuster's approach to a topic
that can be really controversial and really uncomfortable and none
of us want that, but being able to put some
data behind that. Another project that I'll say is one
that has shaped me and changed how I think about
things is when house Field twelve fifty one was introduced
(16:04):
in Colorado. So this was during the time of the
Elijah McClain case, and none of this conversation is to
take away from that tragedy, but what I learned from
that experience is what happens when EMS doesn't have a
seat at the table and if EMS does not get involved.
Speaker 1 (16:18):
In policy and legislature.
Speaker 4 (16:20):
Typically I tried to stay away from politics, and I
wanted I had no interest in anything like that.
Speaker 1 (16:25):
But they called me in and said, remily, this is
really important.
Speaker 4 (16:27):
This piece of legislation has potential to really shape patient care.
Speaker 1 (16:31):
Not just in Colorado but across the entire United States.
Speaker 4 (16:34):
So we need somebody to bring in some data and
have a conversation on is what happened to sentinel event
or is there a system problem.
Speaker 1 (16:41):
That needs to be addressed?
Speaker 4 (16:42):
And so I brought in our data set of fourteen
thousand patients, and I laid out the case and we
ended up making changes to that piece of legislation that
favored EMS. And I think had we not had a
seat at the table, the outcome of that would have
been very different.
Speaker 1 (16:56):
So this has gotten me to understand how important.
Speaker 4 (16:59):
It is that we get involved with legislation and that
we pay attention to what's going on. And I have
since participated in the ANAMSP government relations a haad to
me now three years going to DC and actually talking
with our congress people, educating them about EMS and explaining
why some of the things that we deal with are
really important to them in their community as well.
Speaker 3 (17:20):
My personal opinion is that I don't think EMS does
a really good job of promoting what we do. We
don't promote, We do not promote all the success we have.
We don't talk to the politicians, so they don't know
what's really going on. They might hear it, can hear
three different versions from the public, maybe from another EMS
service or fire service, whatever may be. But I don't
(17:43):
think MS leaders in general do a really good job
of promoting what their service does and what the patient
care that they do provide, and I think that's something
that it gets addressed, but I don't know if anybody
actually acts on that. I don't know what are your
thoughts about that.
Speaker 4 (18:00):
I think we don't do a great job at showing
our value on outside of our realm, and that's an
area where there's great benefit for us going outside of
EMS and talking about what it is we do in
the services we provide. I don't think that most people
understand what EMS is and isn't and maybe they associate
(18:22):
it with just fire, but you know, there's a lot
of other aspects, and especially now with growing interest in
programs like community para medicine and mobile integrated health treatment
in place understanding that the emergency department is not the
right resource for every single patient, or what about patients
who we classify as high utilizers? What is the missing resource?
(18:44):
And we can be a huge link in helping there
because we get to see people where they live and work.
Speaker 1 (18:51):
What better place to do that.
Speaker 4 (18:52):
So I do think that even incorporating this earlier into
EMS education will be highly beneficial on well, what is
us policy, what should we be involved in and how
do we get involved? How do you write to your
congress person, how do you know what bills are introduced
that relate to us and that will because there's a couple.
Speaker 1 (19:09):
Of bills right now.
Speaker 4 (19:10):
There's the Medications Minutes Matter Act, and we need to
make sure that we have access to critical medications that
sometimes it's a challenge getting those manufactured right. But how
often are we communicating this with our front line and
making sure that we're getting involved at all levels.
Speaker 3 (19:26):
I'm going to preface this next little monologue of mine
is that I'm not a data analyst. I don't I
understand data. I understand research and all that.
Speaker 1 (19:38):
Well.
Speaker 3 (19:38):
I just started working on a project I get. I
find these little passion projects. In my current job, we
have a data analyst in our office and she's excellent.
So she asked me to join her. Our health department
in our county asks her to start looking at some
data of overdoses between the ages of ten years and
(19:59):
ninete years. She wanted me to take a look at
some things, and so I started looking at just our
twenty twenty five data and then I said, h here's
some interesting things that I've saw. When I'm I've read
posted three hundred epcrs. Now there's a story here, at
least in Walkham County from ten years to nineteen, there's
a lot of overdoses and it's just not all about
(20:21):
the opioid crisis. I just don't know what story I
want to tell. I have all this data, and I
have all this information. I might be missing some things
that I need to have, but I don't know what
story I want to tell. So what I've found, and
I know this is asking some professional advice, what I've
noticed is that opioids has been part of it. But
(20:43):
what I've really seen is over the counter medicines, a
lot of self harm and marijuana and edibles. Those are
the things that have been sticking out for me. And
I can find out the outcomes if they've gone to
the hospital. And actually, one thing is really interesting about
our system is that we've transported close to eighty five
percent of those patients. I thought was really strong. But
(21:05):
I don't know what story I want to tell, and
are we doing enough from the mental health perspective for
this age group? And maybe that's a story I need
to write about. And I threw a lot out, but
since we were talking about research and projects, this is
one of my passion projects.
Speaker 4 (21:22):
I love a passion project and I love a data mountain,
so this is not an uncommon occurrence. I love to
teach about data, and my first slide is always good news,
we've got more data at our fingertips than ever before,
and then bad news, we've got more data aut our
fingertips than ever before. Because it feels like sometimes we're
trying to boil the ocean. So how do I get
(21:44):
a story out of that? And not just a story
with the data. I need one that's actionable. So I
always go back to the first question, the bottle for improvement,
and that is what am I trying to accomplish. If
my goal is just to provide a baseline, that's perfectly
fine to provide a lot of different metrics, because five
years from now, we're going to need that data to
know have we made a difference, have we made a
change in a positive direction. But if my goal is
(22:07):
to say, hey, I'm seeing you know, X percent increase
in self harm, then I need to focus in on
that story and then maybe even bring in outside data, like, hey,
the resources available for this age group are not sufficient.
There's waiting times of X number of weeks and that's
not going to be acceptable. So it really depends on
(22:30):
what your goal is with the research, and there's many
different goals that are all equally valid.
Speaker 1 (22:34):
Sometimes it is just descriptive and provide.
Speaker 4 (22:36):
A baseline that data can be hugely valuable later on.
Speaker 1 (22:41):
Another thing to.
Speaker 4 (22:41):
Do, or what I do when I'm trying to figure
out my data story is look to what's already out there.
Are there other communities experiencing some of these same things?
Is there a precedent that you can build off of?
And I'm glad that you brought up opioids because I
had the recent honor of being the lead editor on
the pre Hospital Pergency Cares Special Issue for Enhancing Care
(23:03):
for Patients with Substance Use Disorders, and that was thirty
different articles from across the country.
Speaker 1 (23:07):
I was totally blown away by.
Speaker 4 (23:09):
The submissions that we got, in the quality of submissions
that we got. But it was really interesting to meet
medication for opioid use disorder. I didn't think was that
common yet, but we had nine submissions on that topic alone,
and every system had their learnings that they shared. If
I was going to go implement one of these programs today,
I'd be in a much better spot and I would
(23:29):
know where to look in the data because somebody took
the time to share and publish their finding good.
Speaker 3 (23:34):
I don't know if we're doing enough from the mental
health component for these age hard and then the self
harm component. It just bothers me one as a person
as also as a provider that I'm seeing all this
self harm. We're doing a really good job of documenting it.
Very happy to see that as well. I'm not happy
to see, but I'm able to determine at that. But
(23:57):
these when I see twelve and thirteen year olds that
are thinking about killing themselves, and I just don't know
if that's the story I want to tell. Are we
doing enough to try to prevent it or find resources
for them?
Speaker 1 (24:11):
You know? I think this is interesting.
Speaker 4 (24:13):
I don't It's hard to get those resources, and I
don't always feel equipped to help a patient who's suffering
like that. It was interesting to me. I was an
adjunct professor of statistics at Columbus State Community College in
between jobs, and one of the trainings they offered me
was mental health first Aid, and I took that course
and I was like, Wow, how incredible is this? And
(24:34):
it was interesting I was like, how did I get
mental health first aid as an instructor?
Speaker 1 (24:38):
But I never had that in my EMS career, and
the tools.
Speaker 4 (24:41):
In there were just so valuable to help a person
who's experiencing crisis and to help prevent. But I agree
there's not enough mental health resources and showing that this
is a systems problem is the way that we can
get more support and showing that to your community. Hey,
here's the resources we have and here's the demand we'd have.
These things don't match. We need to make a change.
Speaker 3 (25:01):
And the other project that came to mind, what's really
important from an EMS system and for a public is
how many people have we saved from cardiac arrest? Every year?
The CARES report how are we doing? Yes, and we
talked to the survivors about it as well, But do
(25:21):
we actually talk to their families or people that are
involved with their aftercare and what are they going through?
What did they go through on doing that incident of
that event? And that's another it's not a passion project,
but it's something that came to mind. Do we do enough?
Is there something there that I can maybe turn into
or look at, do a survey or whatever. Maybe I
(25:42):
don't know, but those are two things that I'm kind
of working on or thinking about working on as well.
Speaker 1 (25:48):
We should we share those passion projects.
Speaker 4 (25:49):
I don't know if you're familiar with doctor Glockhamfleck, and
he's a huge social media presence, but he suffered a
cardiac arrest and his wife revived him. But she speaks
about her as often as the spouse of somebody who
underwent cardiac ress and he had a positive outcome, but
the toll that it's taken on her has been extreme
(26:10):
and something that's not well talked about. And those actions
in the moment by the responders who were communicating.
Speaker 1 (26:16):
With her on scene, what that was like for her.
Speaker 4 (26:18):
And then we think about systems where we're focused on
the patient, focused on the patient, but it would what
a difference it could make to have the five seconds
to talk to the family member and let them know
what's going on. Waite County in North Carolina does a
phenomenal job at having a role dedicated to the family
to communicating no matter what the outcome is, but throughout
the event.
Speaker 1 (26:38):
Right. So I think that's a great passion project, and
I know we're going to talk about the systems of
care here.
Speaker 4 (26:43):
But one of the areas that I felt strongly on
was if we're going to be doing best practice, which
is field termination when it's appropriate, we need to prepare
our clinicians to have that interaction with the family, to
have the very difficult task of a death notification, and
to feel confident in perform owing that difficult task because
the tool that it can have on the clinician of
(27:04):
oh I didn't say the right thing or having those
thoughts can also be dangerous, and so having the whole
system there in place to take care of the patient,
the family and the clinicians is really important.
Speaker 3 (27:16):
Well, you maybe to the Wake County experience because that's
where I came from before moving out here to Washington State.
And yes, I played that role numerous times during my
tenure at Wait County, and that training really was so valuable,
and it's so many differences both with the family and
also for the police officers that were on the scene
(27:36):
as well for everyone.
Speaker 4 (27:38):
Yeah, and I know I mentioned it in the special issue.
My brother passed away two years ago, but I sleep
very well at night knowing that it was Wait County
who responded and that they did all the right things
for my family.
Speaker 3 (27:50):
One of my last kariteak arrests in Wait County where
I was in that position, was a family from India
and we're work looking our cardiac arrest. The patient was
a systolic. I'm back and forth with the family and
I can see how upset they are, and we came
to an agreement as the crews who were talking they
(28:13):
did not want to be in the room during the resuscitation.
So we're back and forth three or four or five times,
and providers all know that we're not going to revive
this person. I go talk to the family, say, this
is where we are get to the point where we're
going to have to make a decision where we're going
to have to stop resuscitation because we're not seeing any change.
And I see this the three family members just looking
(28:36):
at me with these tears. So I go back to
the cruise. I go, let's do one more round. And
because I promise, the family will do one more round
and not a hesitation, not one eye roll from the providers.
Speaker 1 (28:48):
We do this.
Speaker 3 (28:49):
We go to a stop resuscitation. Law enforcement gets there
and what the family member told me, and I had
no idea about the culture, they really need to see
the person and do a prayer so they can get
to the right place and they're heaven. And the law
enforcement officers saying, nope, we can't do it. We can't
(29:10):
let him come in. So and he's saying this in
front of the family. So I take the police officer
out of earshot and I talked to the police officer
and I say, listen, we'll move everybody else. You can
be in there. I will be in there. We bring
the family in. They just need this for thirty seconds.
We need to do this. We're back and forth a
(29:31):
little bit, and he says, well, I need to go
talk to my sergeant, and said, you don't need to
talk to your sergeant. I'll talk to your sergeant after
and you can put then you can put the blame
on me and I'll take I'll take the hit for it.
I have no problem with this, but this is really
important to the family. And he's looking at me now
and saying, yeah, you're right, And so we do. We
do bring the family in and they do their prayer,
(29:53):
and the relief on the family to be able to
do that was just unbelie But the things that we
have to do, we don't spend that time back and
forth the Wake County experience as well being trained and
educated and how to do these kind of talk to
people when they die. But that never happens, and I
(30:15):
was able to convince the police officer to let this happen,
and I'm sure that.
Speaker 4 (30:18):
Made all the difference for that family. But having that
training and that confidence to know that you were doing
the right thing by having the conversation with the police officer,
I think is key. And that's not the case for
everywhere yet, but it's certainly. I think it's as critical
as other parts of resuscitation, is knowing what to do
and how to help those conversations.
Speaker 3 (30:39):
That was a doctor Myers and doctor Williams pathway for
us and started that way back when we were doing
that way way back when. I mean, and that's something
they recognize, especially doctor Myers recognize that. And the training
and education the providers about how to talk to people,
that's something really important. It's so important. All Right, I
(31:00):
know that kind of went off the rails and everything,
but thank you very much for going off the rails
with me on that.
Speaker 1 (31:05):
So let's talk about it.
Speaker 3 (31:07):
Let's talk about the twenty twenty five American Heart Association
Guidelines for CPR and ECC or Emergency Card to Care.
You're one of the authors on part four, Systems of Care.
What was that experience? Like, how'd you get involved? And
let's talk about that.
Speaker 4 (31:20):
Yeah, it was a really big privilege to get to
participate in this experience.
Speaker 1 (31:25):
I've obviously been a consumer of the guidelines.
Speaker 4 (31:27):
Throughout my EMS career, but this opportunity came by way
of doctor jose Kabinez actually, who said, you know, AHA
cares a lot about having both in hospital and out
of hospital clinicians involved in these and my expertise and
quality improvement aligned with the Systems of Care.
Speaker 1 (31:45):
Writing group, and they invited me to take part.
Speaker 4 (31:47):
And it was over a two year endeavor actually to
go through the existing guidelines, update the searches and the
systematic reviews that are associated with each of the recommendations,
to see what new research has come out, and then.
Speaker 1 (32:02):
To determine whether or not we need any new areas.
Speaker 4 (32:05):
And so in the systems of Care you'll see there
actually are some new areas that we're not included in
previous guidelines, things like public access and oxidant or resuscitation
on scene that were added because of how this group
came together, and so this was a really wonderful group
that consisted of both in hospital professionals.
Speaker 1 (32:22):
And out of hospital.
Speaker 3 (32:24):
Well, let's talk about your part four. I mean system
care is huge.
Speaker 4 (32:29):
Yeah, systems of care is really important because this it
does take a system to save a life.
Speaker 1 (32:33):
I know that's a refrain that we talk about.
Speaker 4 (32:35):
Often, but in this case it's never more evident than
in cardiac arrest. All of the pieces of the system
have to be in place to have that positive outcome.
And so one of the graphics that you'll see in
that chapter talks about the different components that contribute to
cardiac or as systems of care, including obviously my passion
quality improvement, but having the right equipment and the resources,
(32:56):
the information, policies and procedures, and the environment of where
the care is, and then of course the personnel.
Speaker 1 (33:04):
So we thought long and hard about these.
Speaker 4 (33:06):
Components of the systems of care, and then of course
the cardiac chain of survival.
Speaker 1 (33:11):
There was an update this year.
Speaker 4 (33:13):
So previously there were four separate chains for things like
in hospital, out of hospital, pediatrical adult. Now that's combined
into a single chain and the links are very similar,
and that we start with the recognition and activation of
the emergency system all the way through recovery and survivorship.
A link that was not added, but that was heavily
discussed and remains important, especially in the systems of care,
(33:35):
is prevention. So can we prevent the cardiac arrest from
occurring in the first place? Obviously we can take that
as far upstream as we.
Speaker 1 (33:42):
Want, but in this chapter we also talk.
Speaker 4 (33:44):
About when we have a patient, how do we recognize
decompensation and make sure that we don't progress into cardiac arrest?
And some papers out there on sudden ambulance dead syndrome
and things like that, but for us, obviously the best
case here is to prevent the arrest from occurring.
Speaker 3 (34:00):
I assume you enjoyed the project. How long did it
take you to do it? How many revisions?
Speaker 4 (34:06):
I loved working on the project was It was very
different than projects I've worked on before, and so there
was a lot of learning for me which I greatly appreciated,
even from understanding what the different class of recommendations means.
Speaker 1 (34:18):
Like I've seen you class one, but what does class
one actually mean?
Speaker 4 (34:22):
So breaking that down for us and helping get us
oriented and doctors as Fulian and Kavanya's where the leaders
on this and helped.
Speaker 1 (34:30):
Orient us to the process.
Speaker 4 (34:31):
And then in addition to the class of recommendation, we
have to think about what is the level of evidence,
So not what I want the level of evidence to be,
but what is.
Speaker 1 (34:39):
Actually out there.
Speaker 4 (34:41):
Working with reference librarians to do these searches, and reference librarians.
Speaker 1 (34:45):
I don't think they get enough credit. They are so
important to this process.
Speaker 4 (34:48):
It's such a big deal to be able to pull
the evidence into one spot for us to review, and
they do it so quickly and so well. But we
have to look at well, are there you know, the
highest level of evidence available on this?
Speaker 1 (35:00):
Is it a randomized control trial? Is it?
Speaker 4 (35:03):
There might be limited data, but we have a room
full of experts, and so if this is an important
enough thing that even though there's not, you know, a
randomized control trial, we can put.
Speaker 1 (35:12):
Out expert opinion and with that caution around it.
Speaker 4 (35:16):
So those are things I hadn't really thought of when
I was consuming the guidelines before, but got to be
very acquainted with and I appreciated that education that occurred
with this as far as how long did it take,
it was longer than two years in a project. There
were two in person meetings, but countless meetings outside of that.
Speaker 1 (35:34):
And the way that it.
Speaker 4 (35:34):
Works is we break into smaller groups to work on sections,
and so I was partnered with other pre hospital clinicians
to work on certain sections and complete the evaluation of
the evidence. So that's one of the pieces that takes
the longest in this is getting all of the data.
We load it into a program called covenants, where we
can say this abstract is related to this question or
(35:56):
this one's not. And then once we've rated the abstracts,
we look the full papers and we say, Okay, what
new evidence has been added?
Speaker 1 (36:04):
Does this change the recommendation? Does it change the level
of evidence?
Speaker 4 (36:08):
And move from there, and then we write the synopsis,
the recommendations themselves and that supporting evidence that goes with them,
which is you'll see that pattern over and over again
throughout the guidelines in.
Speaker 1 (36:18):
All of the chapters.
Speaker 3 (36:20):
Lots of discussion. Leaders, Yeah, amazing leaders. Lots of discussion,
which is how we evolve in patient care. I want
to kind of wrap up here a little bit. I
got two other questions for you, one is you've been
a mentor to a lots of people in this profession.
What do you tell those who are thinking about it,
(36:41):
who are maybe thinking about a similar path, What kind
of advice would you give them?
Speaker 4 (36:44):
Yeah, I think there are so many paths in the US.
It's a lot of cheeser and an adventure, and I
encourage that. I say, I don't know what I want
to be when I grow up. I surely don't plan
on growing up. But if research or quality improvement data
calls to you, there are a lot of ways to
test the waters find out where your passion lies. So
for quality improvement, the National Association of EMS Positions hosts
(37:06):
a couple of different courses, one of them being a
pre conference to day in person.
Speaker 1 (37:11):
The next one is in Tampa in January.
Speaker 4 (37:13):
Highly encourage that route if you're interested in using your
agency's data to make a change to improve compliance.
Speaker 1 (37:20):
With guidelines as an example.
Speaker 4 (37:23):
But if you're curious about research, there's a lot of
ways to get involved. You don't have to be a statistician.
I know that the math scares a lot of us away,
and I love to tell people.
Speaker 1 (37:31):
I am not a math person.
Speaker 4 (37:33):
I actually scored thirty third percentile on the gre In math.
Don't ask me how they let me in, but here
I am today. So I learned to start treating statistics.
Speaker 1 (37:42):
More like a language than math. So don't let the
math be the scary part.
Speaker 4 (37:45):
But if you are thinking, I'm super curious about research,
pre Hospital Care Research Form at UCLA hosts three day
workshops throughout the country, and at ESO we co sponsor
two of them. So the next one will be May
twelve through fourteenth, and you can go to Prehospitalcare dot
org to sign up and apply to come to that.
It's a three day event in Austin, Texas in May
(38:08):
is not a bad time to be in Austin, Texas.
Speaker 1 (38:10):
We're not too warm yet.
Speaker 4 (38:11):
But that's a great way just to get involved, make
some network connections, and to decide is this a route
I want to pursue, and then if it is. There's
so many different ways to get involved. There's not just
one path through. The academic route, of course, is available,
but there are other routes. And there's certainly a need
at the national level for people who are focused on
(38:31):
research and data and how do we use that to
inform policy.
Speaker 3 (38:35):
Yeah, Austin and May. Good music, good food, you can't
beat it, good people well and good people in good education.
Oh wow, that's pretty good. And finally, kind of a
more of a personal question for you, what keeps you inspired?
What keeps you pushing the boundaries to keep finding new
ways to make data work for our EMS world?
Speaker 1 (38:53):
Great question.
Speaker 4 (38:55):
The things that inspire me are actually the people that
I know.
Speaker 1 (38:58):
We're in a world where AI.
Speaker 4 (38:59):
Is to take it over, but it's and it's super exciting,
and I love using a I don't get me wrong,
but I find that I am most inspired when I
have these conversations with others. Somebody has an innovative way
of solving a problem, or somebody has a problem that
they haven't figured out.
Speaker 1 (39:16):
I love a good puzzle.
Speaker 4 (39:18):
So for me, coming out of EMS world, I feel
extra energized, perhaps because of the hallway conversations and the
lectures I was able to sit in on. For me,
working with researchers mentoring also keeps me inspired. I think
I do a lot more learning than I do teaching
most of the time, and I love that about it.
Somebody always has a different way of looking at a
(39:38):
data set that I hadn't yet thought of. And you know,
as I stay inspired because of the frontline.
Speaker 1 (39:45):
So I do like to stay connected. I maintain I.
Speaker 4 (39:47):
Am due to recertified national Registry. I've got a few
more months left, and I feel like that maintaining that
connection is really important because that's ultimately the reason why
we do what we do is let's keep the frontline
safe and let's improve patient outcomes.
Speaker 3 (40:00):
Remember, the data doesn't just tell you your story or
our story, it helps you write the next chapter. Remiley,
thank you very much for sharing your information and your
journey with me and also giving me some pretty cool advice.
I appreciate that very much, And thank you very much
for coming back on Medical Medical Podcast.
Speaker 1 (40:20):
Thank you for the opportunity to be here and to
share what I'm passionate about.
Speaker 4 (40:23):
It's been a blast, and I hope we get to
connect against you
Come up.
Speaker 2 (00:07):
Attention all listeners on this frequency stand by for.
Speaker 1 (00:11):
An important announcement.
Speaker 2 (00:14):
Welcome to Medic to Medic podcast, the weekly podcast for
EMS providers, EMS leaders, EMS, medical directors and others involved
in or those who have an interest in emergency medical services.
Ladies and gentlemen, here's your host, Steve.
Speaker 3 (00:30):
Cohen, coming from the fern Dew Medical Medic Podcast Studios.
It's another fine podcast of medical medic. I'm your host,
Steve Cohen. You can reach me at Medical Medic Podcasts
at gmail dot com. You can find me on Facebook, Instagram,
and of course on any podcast platform like Apple, Spotify, Podbean,
(00:56):
you name it. Medical Medic is there. Yes, the reboot
is going really well well. I am so happy to
be back talking about public safety, especially EMS as well.
Each week we sit down with people who shape EMS
profession and those who challenge turn challenges into data better
outcomes for our patients. Today, I am joined by someone
(01:19):
who was on the podcast way way back when and
has done so much for our EMS community. Doctor Remley
Crowe is the Senior Director in Research and Data at ESO,
where she leads an innovative work that uses analytics to
improve patient care. And outcomes and operation and performances in
(01:40):
EMS world. Remily. I am so happy to have you
back on the podcast. So welcome back to Medical medic.
Speaker 1 (01:48):
Well, thank you for having me back. I'm excited to
be here.
Speaker 3 (01:50):
I know your journey starts were in Mexico City, if
I remember right, you started out a good memory.
Speaker 1 (01:56):
Yeah.
Speaker 4 (01:57):
I got into a car crash in Mexico and just
I should be an EMS.
Speaker 3 (02:01):
Yeah, you became a volunteer EMT. You did some things
with Red Cross, you did some things in EMIS research
and all this. I know something about you did. Didn't
you do a fellowship with n R E m T.
Speaker 1 (02:14):
Right?
Speaker 4 (02:15):
I did.
Speaker 1 (02:15):
I was a research fellow with the n R E
M T.
Speaker 4 (02:18):
Wow.
Speaker 3 (02:18):
Yeah yeah. And where did you go to school?
Speaker 1 (02:21):
The Ohio State?
Speaker 3 (02:22):
Yeah, the Ohio State. Yeah. Well that's a different topic
for another podcast.
Speaker 1 (02:29):
Actually today. Yeah.
Speaker 3 (02:30):
Well, I know. And the other thing about it, I
visited that campus. I have two best friends. One went
to Maryland and one went to the Ohio State. So
their freshman year, I went to visit him and I think,
I don't know, we woke up after Friday night. I
don't remember much, but I think MTV was on. I
(02:51):
think it just started or something like that, and the
Rolling Stones was doing something on video. That's what I remember.
Speaker 1 (02:57):
I don't know, it was like a college experience.
Speaker 3 (03:00):
There are things we're going to talk about it. We're
going to catch up with you. But you've been involved
in the Heart Association, the American Heart Association and the
guidelines that just come out and part four we'll get
to that and talk about systems of care. So what's
going on with you?
Speaker 4 (03:15):
And HI?
Speaker 3 (03:15):
Are things with you? And what you've been doing this
last time we spoke.
Speaker 1 (03:20):
Yeah, it's been a while.
Speaker 4 (03:21):
So lots of great exciting things going on on the
ESO side. We are seeing a lot of great collaborations
in the research space. We recently introduced a longitudinal patient record,
which opens up a whole new world of research to
where we don't just see the patient during one encounter,
we can see repeat visits. I just worked on some
(03:44):
research related to that seventy two hour bounce back.
Speaker 1 (03:47):
So lots of exciting things happening there.
Speaker 4 (03:49):
And we're coming off of the EMS World conference with
so much great learning and so many presentations.
Speaker 1 (03:55):
How to blast there with the.
Speaker 3 (03:56):
Team, we talked a little bit about Mexico, city and everything.
Don't you tell us that story once again?
Speaker 1 (04:02):
Yeah? So I came into.
Speaker 4 (04:04):
EMS a little bit of an non traditional route. I
think a lot of us probably have a weird story
of how we.
Speaker 1 (04:09):
Got to EMS.
Speaker 4 (04:10):
But I was in undergrad I studied business administration, and
I was doing study abroad in Mexico. Got into a
car crash and they put me in an ambulance that
was not injured, but my wheel started turning on.
Speaker 1 (04:21):
Hey this is really cool. How do you get to
do this? And I spoke with the medic and you
told me, well, if you want to be good, you
go to the Red Cross school. That's what everybody does.
Speaker 4 (04:30):
So I finished up my bachelor's in business, moved back
to Mexico and became a volunteer with the Mexican Red
Cross and did EMT training and became an EMT instructor.
Speaker 1 (04:39):
But that's all volunteer.
Speaker 4 (04:41):
So to support my volunteer EMS have it, I found
a job at Ford Motor Company as a powertrain quality
engineer first and then later a powertrain engineer.
Speaker 3 (04:50):
How do you think that experience shaped your EMS career
and through your love for research as well.
Speaker 4 (04:57):
I always say Ford was the best school I ever
went to that's where I actually fell in love with data.
I learned about quality improvement and six sigma and learned
how to actually change.
Speaker 1 (05:07):
Systems to get different results.
Speaker 4 (05:08):
And so you know, when the opportunity came for the
National Registry Fellowship, I thought, here's the place where I
can blend both of my loves. I love data and
I love ems, and I want to bring those two
things together. And so research seemed like a natural path
for that. And the opportunity through the National Registry is
truly incredible where they take ems clinicians and send them
(05:29):
through masters and PhD while you're working and while you're
able to contribute to the profession. So that's how I
ended up in Columbus. And after the fellowship, they say,
go do great things, and hopefully that's what I'm doing.
Speaker 3 (05:41):
You've won a lot of hat during your career from
being clinicians, instructor, senior leader at ESO and all those
kind of good things. How those different experiences shape your
perspective on the relationship between data and patient care delivery,
that's a great question.
Speaker 4 (06:00):
I think those experiences continue to reinforce the need for data.
A lot of times we make decisions with our guts,
and sometimes we can be right, but it's better to
stay curious, I find and let the data guide us,
and not just also accepting that all data is good data,
because that certainly is not the case, but being able
to parse out when something matches the true experience and
(06:22):
when it doesn't. I've learned a lot over the years
about how to stay curious not furious when we see
something that doesn't make sense to us.
Speaker 1 (06:30):
And often I've been wrong.
Speaker 4 (06:32):
I like to joke I've made a career out of
being wrong. Just yesterday I found an air at line
ten of a four thousand line of code issue. So
I think that keeps us humble, keeps us curious and sticking.
Speaker 1 (06:45):
With the data and letting that guide us.
Speaker 3 (06:47):
Well, I think I kind of jumbled your title ESO.
What is your title at ESO?
Speaker 1 (06:55):
I'm the Senior Director of Research and Data Enablement.
Speaker 3 (06:58):
And what does that mean?
Speaker 1 (07:00):
It means I wear.
Speaker 4 (07:01):
Many hats, so one of them being the clinical research side.
We have THEODATA Collaborative, which is one of the ways
that we give back to folks who have spent all
this time entering data into the checkboxes. So as a EMT,
I would never get to see what happened to that data,
and that's not something we want.
Speaker 1 (07:17):
So we have packaged the data d identified.
Speaker 4 (07:19):
We don't know who the clinicians are, who the facilities are,
anything like that, of course, not the patients, and we
make that available to academic researchers who want to ask
and answer important.
Speaker 1 (07:27):
Questions to contribute to our field.
Speaker 4 (07:29):
So that's one hat, and then the other hat, the
data enablement side, is the world has changed a lot
in the past five years with data. You know, I
come from the land of access databases and some will remember.
Speaker 1 (07:40):
That SQL, databases, all of these things.
Speaker 4 (07:44):
But now we have better tools at our fingertips than
we've ever had, so power, BI, tablet, et cetera.
Speaker 1 (07:50):
But that wasn't part of my AMT training. I don't
know if that was part of yours.
Speaker 4 (07:54):
So we're at a point where the industry has changed
and we need to provide tools.
Speaker 1 (07:59):
And data literacy. So I spend a lot of my
time creating.
Speaker 4 (08:02):
Template its, helping others learn data literacy and how can
we make the data model simpler, Because ultimately, I don't
think anybody wakes.
Speaker 1 (08:10):
Up wanting to spend all day trying to code.
Speaker 4 (08:12):
We want to spend our day improving things and so
that's a huge part of what I get to do.
Speaker 3 (08:17):
Kind of want to stay on that topic if you
could give us an example of something you do from
day to day. Or we both have a mutual friend
and co worker with doctor Brent Myers, I mean, do
you interact with him still on a regular basis.
Speaker 4 (08:32):
Well, I get to work with an amazing team and
we are led by doctor Brent Myers, who is best
leader I've ever worked with. A lot of our work
centers around trying to help MS agencies be able to
use their data to improve community health and safety. And
so a typical day for me can be a lot
of different things. Some of it is the right here
(08:52):
right now. If there are support tickets that have a
little complexity to the data, oftentimes we chip in and
help our colleagues there. But also we're thinking forward, so
we're thinking five or ten years into the future about well,
what should data entry look like, what should data reporting
look like? And what we do today is not going
(09:13):
to be how we're doing things down the line. So
I spend a lot of time with a group that
we call EESO Labs, which is our innovation branch, and
so myself and Alyssa Green who works with me, she's
a paramedic. We spend a lot of time testing things,
breaking things, and we do love to break things as
EMS clinicians. So that's another giant chunk of our days.
And then some other things are when new guidelines come out,
(09:37):
or when new metrics come out like NIMSQUA, I know
that you've talked about the National EMS Quality Alliance, or
when Mission Lifeline puts out new measures. Our job is
to create ten footed reports that an EMS system can
just log in the morning and click on them and
see how they compare, rather than having to sit there
and spend a ton of time coding or I always
(09:57):
make the reference of apples to apples really isn't good enough.
We want a granny smith to a Granny smith. And
so the way that we do that is by creating
these can reports. And so my team and I get
to spend a lot of time honing and refining and
making those useful for our agencies.
Speaker 3 (10:11):
You've been with the SOO for quite a bit quite
a long time. Now time flives, right, doesn't it? Can
you give us and our listeners an example of a project.
Can you give us an example of a project that
turned analytics into actual measurable change, maybe something that directly
improved patient care.
Speaker 4 (10:30):
Yeah, so there's lots of great examples. I'll get on
my soapbox because you're giving me an opportunity. One project
that I got to work with was I call it
the Data MythBusters.
Speaker 1 (10:42):
So we know that there were disparities in paint management.
Speaker 4 (10:45):
This has been published in tons and tons of research papers.
But that makes us uncomfortable because none of us woke
up for the fame and the fortune and EMS, and
we surely don't like to hear that we might not
treat our patients equally.
Speaker 1 (10:56):
So I worked.
Speaker 4 (10:58):
With our hospital outcomet that's linked to EMS data to see, well,
maybe there's a reasonable explanation for why we see some
patients less likely to get at pay medication.
Speaker 1 (11:07):
And so we limited to patients who have long been
of fractures.
Speaker 4 (11:10):
And then we looked at who was likely to get analgesics,
any analgusic by any route at.
Speaker 1 (11:16):
Any time right, and we found.
Speaker 4 (11:18):
Oh, there is a disparity the black patients being less
likely to receive pay medication. We read the eight hundred
and forty four narratives. We looked at all the different variables.
I did some really complicated statistics around this, and we
see that the disparity persistent. But what that lets us
do is to stop focusing on the measurement and now
we can turn it into action. And I've seen some
(11:38):
systems if the agencies I've worked with have taken that
to heart and said, all right, let's suspend our disbelief
for a minute, and let's change the system so that
we can make sure that we are doing what we intend,
which is to deliver equitable care. And I've seen several
agencies take this project on and it not only made
care better when they focus on that disparity, it made
pay management better overall. One of the things we saw
(12:00):
long bone fracture pain score greater than six, and only
about seventy four percent of those patients were being treated.
So that means there's a one in four chance if
I broke my femur that I'm not.
Speaker 1 (12:10):
Going to get pain medication.
Speaker 4 (12:12):
So it's definitely an area where we've seen increased focus,
and it's.
Speaker 1 (12:15):
An area where an ems we see.
Speaker 4 (12:17):
A ton of patients who experience acute pain, so huge opportunity,
and I have seen a lot of great uptake in
people moving it from research into the quality improvement space.
Speaker 3 (12:27):
A lot of EMS systems struggle with building culture that
values data. It's one of the things. It's one thing
to collect it, but another to trust and act on it.
What's your advice for agencies trying to make that giant leap.
Speaker 4 (12:41):
Yeah, it can be challenging, for sure, and I think
I don't want to hone it on something you said
around Oh, well, maybe people don't.
Speaker 1 (12:48):
Always believe the data.
Speaker 4 (12:50):
One of the barriers that I encounter a lot is well,
they don't document that correctly, or those timestamps aren't real.
Speaker 1 (12:57):
Well, it would be tempting just to out the window
and say it. Then we can't do anything. But my
advice is to just start small and to just get started.
Even with imperfect data.
Speaker 4 (13:08):
Is better than none, so we should look at it
and question it for sure. But if we're not measuring
and we're not attempting to improve, then we're never going
to get better. So I see a lot of people
get stuck in the analysis paralysis.
Speaker 1 (13:21):
But my advice is to just get started and to
just keep moving.
Speaker 3 (13:24):
How do you convince the leaders of those systems that
this is important information, important data. You can always go
back and say it's patient care, right, we improve patient care.
But what advice do you give those people in the
quality improvement divisions departments to go to their leaders and say, hey,
(13:46):
I'm looking at this, we need to make this change whatever.
Maybe here's the proof. How do we talk to our
leaders about this?
Speaker 1 (13:53):
Yeah, and it's a great question there as well.
Speaker 4 (13:55):
So when we teach for the INAMSP Quality and Safety course,
we spend a great deal time not even looking at
the data, but talking about the psychology of change.
Speaker 1 (14:05):
Change can be hard for a lot of people. Thinking
about a change is easy. Doing it is not. Is
one of the quotes from the Improvement Guide that we use.
But one of the things to think.
Speaker 4 (14:14):
About is resistance is most often a response to a
lack of clarity or being overwhelmed. And so when we
get resistance again get curious not furious mantra pops into
my head, we should think about, well, have we articulated
once in it for them? Have we clearly stated why
it's important? A lot of times we have the curse
(14:35):
of knowledge, like we're very clear on why this project matters.
It's very obvious to me why we should make sure
that patients with chest pain and get.
Speaker 1 (14:43):
An asprid, but is that clear to everybody else?
Speaker 4 (14:46):
And making sure that we're taking the time to get commitment.
A lot of people talk about buy in, but one
of the things we teach is Peter Seay's pyramid, and
buy in is just compliance.
Speaker 1 (14:58):
That's not good enough.
Speaker 4 (15:00):
People who are committed, who are going to go out
of their way to make sure that a quality improvement
project is successful. And the way that we do that
is by starting to understand the other person's side and
getting curious when we see resistance.
Speaker 1 (15:11):
Rather than just pushing back.
Speaker 3 (15:12):
If you could name your top three project that you
worked on through your whole career, or maybe just as
one of two, or what is it? Or is it
still to be found?
Speaker 4 (15:22):
Oh? I hope it's still to be found. But I've
had the privilege of working on so many amazing projects
it would be hard to name three. I do think
that the analgesics paper I mentioned earlier is one of
the landmarks for me because it was with a data
set that was never possible when I was in the
field we never had outcome data like that, and to
(15:43):
be able to take a misbuster's approach to a topic
that can be really controversial and really uncomfortable and none
of us want that, but being able to put some
data behind that. Another project that I'll say is one
that has shaped me and changed how I think about
things is when house Field twelve fifty one was introduced
(16:04):
in Colorado. So this was during the time of the
Elijah McClain case, and none of this conversation is to
take away from that tragedy, but what I learned from
that experience is what happens when EMS doesn't have a
seat at the table and if EMS does not get involved.
Speaker 1 (16:18):
In policy and legislature.
Speaker 4 (16:20):
Typically I tried to stay away from politics, and I
wanted I had no interest in anything like that.
Speaker 1 (16:25):
But they called me in and said, remily, this is
really important.
Speaker 4 (16:27):
This piece of legislation has potential to really shape patient care.
Speaker 1 (16:31):
Not just in Colorado but across the entire United States.
Speaker 4 (16:34):
So we need somebody to bring in some data and
have a conversation on is what happened to sentinel event
or is there a system problem.
Speaker 1 (16:41):
That needs to be addressed?
Speaker 4 (16:42):
And so I brought in our data set of fourteen
thousand patients, and I laid out the case and we
ended up making changes to that piece of legislation that
favored EMS. And I think had we not had a
seat at the table, the outcome of that would have
been very different.
Speaker 1 (16:56):
So this has gotten me to understand how important.
Speaker 4 (16:59):
It is that we get involved with legislation and that
we pay attention to what's going on. And I have
since participated in the ANAMSP government relations a haad to
me now three years going to DC and actually talking
with our congress people, educating them about EMS and explaining
why some of the things that we deal with are
really important to them in their community as well.
Speaker 3 (17:20):
My personal opinion is that I don't think EMS does
a really good job of promoting what we do. We
don't promote, We do not promote all the success we have.
We don't talk to the politicians, so they don't know
what's really going on. They might hear it, can hear
three different versions from the public, maybe from another EMS
service or fire service, whatever may be. But I don't
(17:43):
think MS leaders in general do a really good job
of promoting what their service does and what the patient
care that they do provide, and I think that's something
that it gets addressed, but I don't know if anybody
actually acts on that. I don't know what are your
thoughts about that.
Speaker 4 (18:00):
I think we don't do a great job at showing
our value on outside of our realm, and that's an
area where there's great benefit for us going outside of
EMS and talking about what it is we do in
the services we provide. I don't think that most people
understand what EMS is and isn't and maybe they associate
(18:22):
it with just fire, but you know, there's a lot
of other aspects, and especially now with growing interest in
programs like community para medicine and mobile integrated health treatment
in place understanding that the emergency department is not the
right resource for every single patient, or what about patients
who we classify as high utilizers? What is the missing resource?
(18:44):
And we can be a huge link in helping there
because we get to see people where they live and work.
Speaker 1 (18:51):
What better place to do that.
Speaker 4 (18:52):
So I do think that even incorporating this earlier into
EMS education will be highly beneficial on well, what is
us policy, what should we be involved in and how
do we get involved? How do you write to your
congress person, how do you know what bills are introduced
that relate to us and that will because there's a couple.
Speaker 1 (19:09):
Of bills right now.
Speaker 4 (19:10):
There's the Medications Minutes Matter Act, and we need to
make sure that we have access to critical medications that
sometimes it's a challenge getting those manufactured right. But how
often are we communicating this with our front line and
making sure that we're getting involved at all levels.
Speaker 3 (19:26):
I'm going to preface this next little monologue of mine
is that I'm not a data analyst. I don't I
understand data. I understand research and all that.
Speaker 1 (19:38):
Well.
Speaker 3 (19:38):
I just started working on a project I get. I
find these little passion projects. In my current job, we
have a data analyst in our office and she's excellent.
So she asked me to join her. Our health department
in our county asks her to start looking at some
data of overdoses between the ages of ten years and
(19:59):
ninete years. She wanted me to take a look at
some things, and so I started looking at just our
twenty twenty five data and then I said, h here's
some interesting things that I've saw. When I'm I've read
posted three hundred epcrs. Now there's a story here, at
least in Walkham County from ten years to nineteen, there's
a lot of overdoses and it's just not all about
(20:21):
the opioid crisis. I just don't know what story I
want to tell. I have all this data, and I
have all this information. I might be missing some things
that I need to have, but I don't know what
story I want to tell. So what I've found, and
I know this is asking some professional advice, what I've
noticed is that opioids has been part of it. But
(20:43):
what I've really seen is over the counter medicines, a
lot of self harm and marijuana and edibles. Those are
the things that have been sticking out for me. And
I can find out the outcomes if they've gone to
the hospital. And actually, one thing is really interesting about
our system is that we've transported close to eighty five
percent of those patients. I thought was really strong. But
(21:05):
I don't know what story I want to tell, and
are we doing enough from the mental health perspective for
this age group? And maybe that's a story I need
to write about. And I threw a lot out, but
since we were talking about research and projects, this is
one of my passion projects.
Speaker 4 (21:22):
I love a passion project and I love a data mountain,
so this is not an uncommon occurrence. I love to
teach about data, and my first slide is always good news,
we've got more data at our fingertips than ever before,
and then bad news, we've got more data aut our
fingertips than ever before. Because it feels like sometimes we're
trying to boil the ocean. So how do I get
(21:44):
a story out of that? And not just a story
with the data. I need one that's actionable. So I
always go back to the first question, the bottle for improvement,
and that is what am I trying to accomplish. If
my goal is just to provide a baseline, that's perfectly
fine to provide a lot of different metrics, because five
years from now, we're going to need that data to
know have we made a difference, have we made a
change in a positive direction. But if my goal is
(22:07):
to say, hey, I'm seeing you know, X percent increase
in self harm, then I need to focus in on
that story and then maybe even bring in outside data, like, hey,
the resources available for this age group are not sufficient.
There's waiting times of X number of weeks and that's
not going to be acceptable. So it really depends on
(22:30):
what your goal is with the research, and there's many
different goals that are all equally valid.
Speaker 1 (22:34):
Sometimes it is just descriptive and provide.
Speaker 4 (22:36):
A baseline that data can be hugely valuable later on.
Speaker 1 (22:41):
Another thing to.
Speaker 4 (22:41):
Do, or what I do when I'm trying to figure
out my data story is look to what's already out there.
Are there other communities experiencing some of these same things?
Is there a precedent that you can build off of?
And I'm glad that you brought up opioids because I
had the recent honor of being the lead editor on
the pre Hospital Pergency Cares Special Issue for Enhancing Care
(23:03):
for Patients with Substance Use Disorders, and that was thirty
different articles from across the country.
Speaker 1 (23:07):
I was totally blown away by.
Speaker 4 (23:09):
The submissions that we got, in the quality of submissions
that we got. But it was really interesting to meet
medication for opioid use disorder. I didn't think was that
common yet, but we had nine submissions on that topic alone,
and every system had their learnings that they shared. If
I was going to go implement one of these programs today,
I'd be in a much better spot and I would
(23:29):
know where to look in the data because somebody took
the time to share and publish their finding good.
Speaker 3 (23:34):
I don't know if we're doing enough from the mental
health component for these age hard and then the self
harm component. It just bothers me one as a person
as also as a provider that I'm seeing all this
self harm. We're doing a really good job of documenting it.
Very happy to see that as well. I'm not happy
to see, but I'm able to determine at that. But
(23:57):
these when I see twelve and thirteen year olds that
are thinking about killing themselves, and I just don't know
if that's the story I want to tell. Are we
doing enough to try to prevent it or find resources
for them?
Speaker 1 (24:11):
You know? I think this is interesting.
Speaker 4 (24:13):
I don't It's hard to get those resources, and I
don't always feel equipped to help a patient who's suffering
like that. It was interesting to me. I was an
adjunct professor of statistics at Columbus State Community College in
between jobs, and one of the trainings they offered me
was mental health first Aid, and I took that course
and I was like, Wow, how incredible is this? And
(24:34):
it was interesting I was like, how did I get
mental health first aid as an instructor?
Speaker 1 (24:38):
But I never had that in my EMS career, and
the tools.
Speaker 4 (24:41):
In there were just so valuable to help a person
who's experiencing crisis and to help prevent. But I agree
there's not enough mental health resources and showing that this
is a systems problem is the way that we can
get more support and showing that to your community. Hey,
here's the resources we have and here's the demand we'd have.
These things don't match. We need to make a change.
Speaker 3 (25:01):
And the other project that came to mind, what's really
important from an EMS system and for a public is
how many people have we saved from cardiac arrest? Every year?
The CARES report how are we doing? Yes, and we
talked to the survivors about it as well, But do
(25:21):
we actually talk to their families or people that are
involved with their aftercare and what are they going through?
What did they go through on doing that incident of
that event? And that's another it's not a passion project,
but it's something that came to mind. Do we do enough?
Is there something there that I can maybe turn into
or look at, do a survey or whatever. Maybe I
(25:42):
don't know, but those are two things that I'm kind
of working on or thinking about working on as well.
Speaker 1 (25:48):
We should we share those passion projects.
Speaker 4 (25:49):
I don't know if you're familiar with doctor Glockhamfleck, and
he's a huge social media presence, but he suffered a
cardiac arrest and his wife revived him. But she speaks
about her as often as the spouse of somebody who
underwent cardiac ress and he had a positive outcome, but
the toll that it's taken on her has been extreme
(26:10):
and something that's not well talked about. And those actions
in the moment by the responders who were communicating.
Speaker 1 (26:16):
With her on scene, what that was like for her.
Speaker 4 (26:18):
And then we think about systems where we're focused on
the patient, focused on the patient, but it would what
a difference it could make to have the five seconds
to talk to the family member and let them know
what's going on. Waite County in North Carolina does a
phenomenal job at having a role dedicated to the family
to communicating no matter what the outcome is, but throughout
the event.
Speaker 1 (26:38):
Right. So I think that's a great passion project, and
I know we're going to talk about the systems of
care here.
Speaker 4 (26:43):
But one of the areas that I felt strongly on
was if we're going to be doing best practice, which
is field termination when it's appropriate, we need to prepare
our clinicians to have that interaction with the family, to
have the very difficult task of a death notification, and
to feel confident in perform owing that difficult task because
the tool that it can have on the clinician of
(27:04):
oh I didn't say the right thing or having those
thoughts can also be dangerous, and so having the whole
system there in place to take care of the patient,
the family and the clinicians is really important.
Speaker 3 (27:16):
Well, you maybe to the Wake County experience because that's
where I came from before moving out here to Washington State.
And yes, I played that role numerous times during my
tenure at Wait County, and that training really was so valuable,
and it's so many differences both with the family and
also for the police officers that were on the scene
(27:36):
as well for everyone.
Speaker 4 (27:38):
Yeah, and I know I mentioned it in the special issue.
My brother passed away two years ago, but I sleep
very well at night knowing that it was Wait County
who responded and that they did all the right things
for my family.
Speaker 3 (27:50):
One of my last kariteak arrests in Wait County where
I was in that position, was a family from India
and we're work looking our cardiac arrest. The patient was
a systolic. I'm back and forth with the family and
I can see how upset they are, and we came
to an agreement as the crews who were talking they
(28:13):
did not want to be in the room during the resuscitation.
So we're back and forth three or four or five times,
and providers all know that we're not going to revive
this person. I go talk to the family, say, this
is where we are get to the point where we're
going to have to make a decision where we're going
to have to stop resuscitation because we're not seeing any change.
And I see this the three family members just looking
(28:36):
at me with these tears. So I go back to
the cruise. I go, let's do one more round. And
because I promise, the family will do one more round
and not a hesitation, not one eye roll from the providers.
Speaker 1 (28:48):
We do this.
Speaker 3 (28:49):
We go to a stop resuscitation. Law enforcement gets there
and what the family member told me, and I had
no idea about the culture, they really need to see
the person and do a prayer so they can get
to the right place and they're heaven. And the law
enforcement officers saying, nope, we can't do it. We can't
(29:10):
let him come in. So and he's saying this in
front of the family. So I take the police officer
out of earshot and I talked to the police officer
and I say, listen, we'll move everybody else. You can
be in there. I will be in there. We bring
the family in. They just need this for thirty seconds.
We need to do this. We're back and forth a
(29:31):
little bit, and he says, well, I need to go
talk to my sergeant, and said, you don't need to
talk to your sergeant. I'll talk to your sergeant after
and you can put then you can put the blame
on me and I'll take I'll take the hit for it.
I have no problem with this, but this is really
important to the family. And he's looking at me now
and saying, yeah, you're right, And so we do. We
do bring the family in and they do their prayer,
(29:53):
and the relief on the family to be able to
do that was just unbelie But the things that we
have to do, we don't spend that time back and
forth the Wake County experience as well being trained and
educated and how to do these kind of talk to
people when they die. But that never happens, and I
(30:15):
was able to convince the police officer to let this happen,
and I'm sure that.
Speaker 4 (30:18):
Made all the difference for that family. But having that
training and that confidence to know that you were doing
the right thing by having the conversation with the police officer,
I think is key. And that's not the case for
everywhere yet, but it's certainly. I think it's as critical
as other parts of resuscitation, is knowing what to do
and how to help those conversations.
Speaker 3 (30:39):
That was a doctor Myers and doctor Williams pathway for
us and started that way back when we were doing
that way way back when. I mean, and that's something
they recognize, especially doctor Myers recognize that. And the training
and education the providers about how to talk to people,
that's something really important. It's so important. All Right, I
(31:00):
know that kind of went off the rails and everything,
but thank you very much for going off the rails
with me on that.
Speaker 1 (31:05):
So let's talk about it.
Speaker 3 (31:07):
Let's talk about the twenty twenty five American Heart Association
Guidelines for CPR and ECC or Emergency Card to Care.
You're one of the authors on part four, Systems of Care.
What was that experience? Like, how'd you get involved? And
let's talk about that.
Speaker 4 (31:20):
Yeah, it was a really big privilege to get to
participate in this experience.
Speaker 1 (31:25):
I've obviously been a consumer of the guidelines.
Speaker 4 (31:27):
Throughout my EMS career, but this opportunity came by way
of doctor jose Kabinez actually, who said, you know, AHA
cares a lot about having both in hospital and out
of hospital clinicians involved in these and my expertise and
quality improvement aligned with the Systems of Care.
Speaker 1 (31:45):
Writing group, and they invited me to take part.
Speaker 4 (31:47):
And it was over a two year endeavor actually to
go through the existing guidelines, update the searches and the
systematic reviews that are associated with each of the recommendations,
to see what new research has come out, and then.
Speaker 1 (32:02):
To determine whether or not we need any new areas.
Speaker 4 (32:05):
And so in the systems of Care you'll see there
actually are some new areas that we're not included in
previous guidelines, things like public access and oxidant or resuscitation
on scene that were added because of how this group
came together, and so this was a really wonderful group
that consisted of both in hospital professionals.
Speaker 1 (32:22):
And out of hospital.
Speaker 3 (32:24):
Well, let's talk about your part four. I mean system
care is huge.
Speaker 4 (32:29):
Yeah, systems of care is really important because this it
does take a system to save a life.
Speaker 1 (32:33):
I know that's a refrain that we talk about.
Speaker 4 (32:35):
Often, but in this case it's never more evident than
in cardiac arrest. All of the pieces of the system
have to be in place to have that positive outcome.
And so one of the graphics that you'll see in
that chapter talks about the different components that contribute to
cardiac or as systems of care, including obviously my passion
quality improvement, but having the right equipment and the resources,
(32:56):
the information, policies and procedures, and the environment of where
the care is, and then of course the personnel.
Speaker 1 (33:04):
So we thought long and hard about these.
Speaker 4 (33:06):
Components of the systems of care, and then of course
the cardiac chain of survival.
Speaker 1 (33:11):
There was an update this year.
Speaker 4 (33:13):
So previously there were four separate chains for things like
in hospital, out of hospital, pediatrical adult. Now that's combined
into a single chain and the links are very similar,
and that we start with the recognition and activation of
the emergency system all the way through recovery and survivorship.
A link that was not added, but that was heavily
discussed and remains important, especially in the systems of care,
(33:35):
is prevention. So can we prevent the cardiac arrest from
occurring in the first place? Obviously we can take that
as far upstream as we.
Speaker 1 (33:42):
Want, but in this chapter we also talk.
Speaker 4 (33:44):
About when we have a patient, how do we recognize
decompensation and make sure that we don't progress into cardiac arrest?
And some papers out there on sudden ambulance dead syndrome
and things like that, but for us, obviously the best
case here is to prevent the arrest from occurring.
Speaker 3 (34:00):
I assume you enjoyed the project. How long did it
take you to do it? How many revisions?
Speaker 4 (34:06):
I loved working on the project was It was very
different than projects I've worked on before, and so there
was a lot of learning for me which I greatly appreciated,
even from understanding what the different class of recommendations means.
Speaker 1 (34:18):
Like I've seen you class one, but what does class
one actually mean?
Speaker 4 (34:22):
So breaking that down for us and helping get us
oriented and doctors as Fulian and Kavanya's where the leaders
on this and helped.
Speaker 1 (34:30):
Orient us to the process.
Speaker 4 (34:31):
And then in addition to the class of recommendation, we
have to think about what is the level of evidence,
So not what I want the level of evidence to be,
but what is.
Speaker 1 (34:39):
Actually out there.
Speaker 4 (34:41):
Working with reference librarians to do these searches, and reference librarians.
Speaker 1 (34:45):
I don't think they get enough credit. They are so
important to this process.
Speaker 4 (34:48):
It's such a big deal to be able to pull
the evidence into one spot for us to review, and
they do it so quickly and so well. But we
have to look at well, are there you know, the
highest level of evidence available on this?
Speaker 1 (35:00):
Is it a randomized control trial? Is it?
Speaker 4 (35:03):
There might be limited data, but we have a room
full of experts, and so if this is an important
enough thing that even though there's not, you know, a
randomized control trial, we can put.
Speaker 1 (35:12):
Out expert opinion and with that caution around it.
Speaker 4 (35:16):
So those are things I hadn't really thought of when
I was consuming the guidelines before, but got to be
very acquainted with and I appreciated that education that occurred
with this as far as how long did it take,
it was longer than two years in a project. There
were two in person meetings, but countless meetings outside of that.
Speaker 1 (35:34):
And the way that it.
Speaker 4 (35:34):
Works is we break into smaller groups to work on sections,
and so I was partnered with other pre hospital clinicians
to work on certain sections and complete the evaluation of
the evidence. So that's one of the pieces that takes
the longest in this is getting all of the data.
We load it into a program called covenants, where we
can say this abstract is related to this question or
(35:56):
this one's not. And then once we've rated the abstracts,
we look the full papers and we say, Okay, what
new evidence has been added?
Speaker 1 (36:04):
Does this change the recommendation? Does it change the level
of evidence?
Speaker 4 (36:08):
And move from there, and then we write the synopsis,
the recommendations themselves and that supporting evidence that goes with them,
which is you'll see that pattern over and over again
throughout the guidelines in.
Speaker 1 (36:18):
All of the chapters.
Speaker 3 (36:20):
Lots of discussion. Leaders, Yeah, amazing leaders. Lots of discussion,
which is how we evolve in patient care. I want
to kind of wrap up here a little bit. I
got two other questions for you, one is you've been
a mentor to a lots of people in this profession.
What do you tell those who are thinking about it,
(36:41):
who are maybe thinking about a similar path, What kind
of advice would you give them?
Speaker 4 (36:44):
Yeah, I think there are so many paths in the US.
It's a lot of cheeser and an adventure, and I
encourage that. I say, I don't know what I want
to be when I grow up. I surely don't plan
on growing up. But if research or quality improvement data
calls to you, there are a lot of ways to
test the waters find out where your passion lies. So
for quality improvement, the National Association of EMS Positions hosts
(37:06):
a couple of different courses, one of them being a
pre conference to day in person.
Speaker 1 (37:11):
The next one is in Tampa in January.
Speaker 4 (37:13):
Highly encourage that route if you're interested in using your
agency's data to make a change to improve compliance.
Speaker 1 (37:20):
With guidelines as an example.
Speaker 4 (37:23):
But if you're curious about research, there's a lot of
ways to get involved. You don't have to be a statistician.
I know that the math scares a lot of us away,
and I love to tell people.
Speaker 1 (37:31):
I am not a math person.
Speaker 4 (37:33):
I actually scored thirty third percentile on the gre In math.
Don't ask me how they let me in, but here
I am today. So I learned to start treating statistics.
Speaker 1 (37:42):
More like a language than math. So don't let the
math be the scary part.
Speaker 4 (37:45):
But if you are thinking, I'm super curious about research,
pre Hospital Care Research Form at UCLA hosts three day
workshops throughout the country, and at ESO we co sponsor
two of them. So the next one will be May
twelve through fourteenth, and you can go to Prehospitalcare dot
org to sign up and apply to come to that.
It's a three day event in Austin, Texas in May
(38:08):
is not a bad time to be in Austin, Texas.
Speaker 1 (38:10):
We're not too warm yet.
Speaker 4 (38:11):
But that's a great way just to get involved, make
some network connections, and to decide is this a route
I want to pursue, and then if it is. There's
so many different ways to get involved. There's not just
one path through. The academic route, of course, is available,
but there are other routes. And there's certainly a need
at the national level for people who are focused on
(38:31):
research and data and how do we use that to
inform policy.
Speaker 3 (38:35):
Yeah, Austin and May. Good music, good food, you can't
beat it, good people well and good people in good education.
Oh wow, that's pretty good. And finally, kind of a
more of a personal question for you, what keeps you inspired?
What keeps you pushing the boundaries to keep finding new
ways to make data work for our EMS world?
Speaker 1 (38:53):
Great question.
Speaker 4 (38:55):
The things that inspire me are actually the people that
I know.
Speaker 1 (38:58):
We're in a world where AI.
Speaker 4 (38:59):
Is to take it over, but it's and it's super exciting,
and I love using a I don't get me wrong,
but I find that I am most inspired when I
have these conversations with others. Somebody has an innovative way
of solving a problem, or somebody has a problem that
they haven't figured out.
Speaker 1 (39:16):
I love a good puzzle.
Speaker 4 (39:18):
So for me, coming out of EMS world, I feel
extra energized, perhaps because of the hallway conversations and the
lectures I was able to sit in on. For me,
working with researchers mentoring also keeps me inspired. I think
I do a lot more learning than I do teaching
most of the time, and I love that about it.
Somebody always has a different way of looking at a
(39:38):
data set that I hadn't yet thought of. And you know,
as I stay inspired because of the frontline.
Speaker 1 (39:45):
So I do like to stay connected. I maintain I.
Speaker 4 (39:47):
Am due to recertified national Registry. I've got a few
more months left, and I feel like that maintaining that
connection is really important because that's ultimately the reason why
we do what we do is let's keep the frontline
safe and let's improve patient outcomes.
Speaker 3 (40:00):
Remember, the data doesn't just tell you your story or
our story, it helps you write the next chapter. Remiley,
thank you very much for sharing your information and your
journey with me and also giving me some pretty cool advice.
I appreciate that very much, And thank you very much
for coming back on Medical Medical Podcast.
Speaker 1 (40:20):
Thank you for the opportunity to be here and to
share what I'm passionate about.
Speaker 4 (40:23):
It's been a blast, and I hope we get to
connect against you
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