Mobile Integrated sport utility vehicle If there’s one thing we know, it’s not all EMS calls require a fully stocked ambulance and fire truck. Sometimes we merely provide transportation or on-the-scene care. Four years later and there hasn’t been any job transfers or restrictions, and lost time is a thing of the past. The journey has strengthened and bettered the agency, which has 52 employees and responds to about 10,000 calls annually. We give a thumbs up to McDowell County EMS for making such a positive change by creating necessary programs. We know this agency will inspire others to examine their own practices and develop innovative solutions and partnerships in their community. Those working in the unit can do a lot of what’s performed in the ED, including testing for strep throat, suturing patient wounds and even checking the patient’s blood chemistry. The vehicle always travels with a nurse practitioner who can administer prescription medications as well. The unit is used for on-scene care only, and given the agency only transports patients on 7,000 of its 12,000 annual calls, this could save a significant amount in transportation costs. We give a thumbs up to South Metro for engineering a vehicle that not only cuts down on patient costs, but also saves the time and resources of EMS personnel throughout the city. The rural agency wanted to update and reinforce its culture of safety to guarantee it provided the best service to its patients. In 2010, the agency made a conscious effort to better its culture. So far the program isn’t covered by any insurance providers, meaning South Metro is doing it all out of pocket. Safety Restructuring To initiate change you must first acknowledge there’s a problem, which is exactly what McDowell County (N.C.) EMS did. One investigator claimed the company was more interested in turning a profit than providing the right care to its patients. The lacking quality spanned across 33 nursing homes for six years, and it’s the biggest lawsuit over quality of care in nursing homes in the United States. We give a thumbs down to Extendicare Health Services for putting patient lives on the line in the name of a few extra bucks. We hope this federal fine sends the message that substandard care is unacceptable in our profession. Substandard Care Sorrows One of the largest nursing home chains has been practicing poor care, and now they’re paying for it. In July 2013, McDowell County EMS also became the first agency in western North Carolina to create and implement a mobile integrated healthcare program. The agency partners with local hospitals in an effort to lower readmission rates and the amount of high utilizers of EMS. A paramedic is sent out 48 hours after a hospital discharges a patient who received care for diabetes, heart failure, sepsis or pulmonary disease. The wellness check by the paramedic serves as a good transition from hospital to home. South Metro Fire Rescue Authority in Denver has come up with its own solution to this issue–a mobile integrated healthcare unit located inside an SUV. The vehicle is essentially a hybrid between an ED and an ambulance, allowing EMS personnel to work with more advanced tools in less advanced settings. Extendicare Health Services paid the federal government $38 million in a settlement in October. The chain had been accused of understaffing its hospitals, leading to patients with bed sores and dehydration. Patients also suffered from malnutrition and unnoticed fractures. Short-term patients were admitted even when the staff knew they couldn’t properly treat them. This was due to the hospital administration refusing to take the time to properly train or supervise its staff. In addition to substandard care, the nursing home chain is also accused of filing incorrect Medicare and Medicaid claims, including billing for unnecessary treatments.