S2:E15 - "If you’ve seen one EMS system, you’ve seen one EMS system - A discussion with Emily Bergquist about Michigan’s unique EMS system." Recorded December 11, 2020

In this episode, we welcome Emily Bergquist, MSA, Paramedic I/C (BergquistE@michigan.gov) to compare and contrast Michigan to other US state EMS systems.  Emily is the Medical Control Authority Coordinator for the State of Michigan Bureau of EMS, Trauma and Preparedness.  She is the one at the State EMS office that works on all of the protocols and supports the MCAs to assure that the multitude of Michigan’s EMS systems function the way that they’re supposed to. 

The spectrum of EMS system styles, organizational structures, and response methods in this country is vast.  In addition, each system faces a unique set of conditions, such as the specific geographic area, the citizen demographics, the number and level of EMS personnel, the number of hospitals, and the distance between citizens and the hospitals.  This is why there’s so much truth behind the old saying, “If you’ve seen one EMS system, you’ve seen one EMS system.”  This sentiment couldn’t be truer in the State of Michigan. 

In Michigan, our State EMS office communicates with the various constituent EMS systems, agencies and providers by way of a Medical Control Authority, or an MCA.  An MCA is a quasi-governmental body that maintains EMS standards, regulations and protocols within a defined geographic area.  Per the state law, an MCA is funded by all of the hospitals within that geographic area that receive EMS patients.  In a bit of an oversimplification, an MCAs job is to coordinate the EMS system and establish written protocols for its EMS agencies as well as ensure physicians, hospital staff, and providers are educated on the protocols.  This is a very unique structure with its own set of strengths and weaknesses. 

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Transcript

Geoff Lassers: 0:08

Hello, and welcome to the EMS on AIR podcast. The mission of this podcast is to keep healthcare provider safe, informed and prepared. Today is January 11 2021. I'm Geoff Lassers, and I'll be your host. This episode was recorded on December 11 2020. In general, the average US citizen likely doesn't spend much time thinking about what an EMR system is, what it does, or the related governing entities laws and rules, it's easy to assume that you can just call 911 from pretty much anywhere in this country and receive medical attention from an EMS system. For the most part, that statement is generally true, but that's where the similarities amongst EMS systems ends. The spectrum of EMS system styles, organizational structures and response methods in this country alone is vast. In addition, each EMS system faces a unique set of conditions, such as the specific geographic area, the citizen demographics, the number and level of EMS personnel, the number of hospitals and the distance between citizens and to the hospitals. This is why there's so much truth behind the old saying, if you've seen one EMS system, you've seen one EMS system, this sentiment couldn't be truer in the state of Michigan. In Michigan, our state EMS Office communicates with the various constituent EMS systems, agencies and providers by way of a medical control authority or MCA. An MCA is a quasi governmental body that maintains EMS standards, regulations and protocols within a defined geographic area per the state law and MCA is funded by all of the hospitals within that geographic area that receive EMS patients. In a bit of an oversimplification an MCA's job is to coordinate the EMS system and establish written care protocols for its EMS agencies, as well as ensure that the physicians hospital staff and providers are educated on those protocols. This is a very unique structure with its own set of strengths and weaknesses. I've spent my entire career in Michigan, so I don't know any different. I thought every state EMS system was pretty much the same. But after about a decade in EMS, someone told me and I learned that I couldn't be more wrong. In this episode, I sit down with Emily Bergquist to compare and contrast Michigan to other US state EMS systems. Emily is the medical control authority coordinator for the state of Michigan bureau of EMS Trauma and Preparedness. She is the one at the state EMS Office that works on all the protocols and supports the MCA's to assure that the multitude of Michigan's EMS systems function the way that they're supposed to. If you want to contact Emily, you can find her email in the episode description. Please keep emailing your questions, comments, feedback and episode ideas to the EMS on AIR podcast team by email at QI@ocmca.org. Also, check out our new website emsonair.com. For the latest information, podcast episodes and other details follow us on Instagram @ems_on_air. And please whatever podcast platform you use, subscribe to our podcast and leave us a rating and a review because it really does help us to grow this project. I really can't say this enough, please leave us a rating and a review and help us get noticed on a much larger scale. Remember, the mission of the EMS on AIR podcast is to keep healthcare providers safe, informed and prepared. increasing our ratings and reviews gets us noticed by more listeners and more sponsors. And that will lead to increasing our reach resources, experts abilities and your entertainment value. Bottom line ratings and reviews are vital to our growth and your contribution will give us what we need to serve those that serve our communities. The only cost to you is a few minutes giving us a rating and a review on whatever podcast platform you use. Thank you and enjoy the podcast. Good morning, Emily Bergquist How are you?

Emily Bergquist: 3:49

I am good Geoff Lassers, How are you?

Geoff Lassers: 3:52

Fantastic. Thanks for joining us today. Can you give our audience background on who you are, what you do and where you do it.

Emily Bergquist: 4:00

My name is Emily Bergquist and I am the medical control authority coordinator for the Bureau of EMS Trauma and Preparedness. And that is a really long way of saying that I am the person in the state EMS office that works on all of the protocols and supports your MCA's in making sure that your systems continue to function the way that they're supposed to.

Geoff Lassers: 4:20

Well, thank you for that. So you're doing that from home right now. But typically, you're doing that from our state capitol in Lansing?

Emily Bergquist: 4:25

No, we don't have a cool fancy office in the Capitol. We actually have a very nondescript office on the north side of Lansing towards the airport right next to the lab. And it's actually a pretty cool place. And if there's ever a zombie apocalypse, I highly recommend it because it has generators and supplies and things like that because that's where our community health emergency Coordination Center is located. So anytime there's any disasters or emergency responses that are statewide is happening there.

Geoff Lassers: 4:55

Fantastic. So what you're here to do today is to talk about our EMS system here in Michigan. And the real big context here is, in all honesty, if you've seen one EMS system, one EMS agency or one EMS provider, you've seen one of them. There are so many variations of EMS systems. On the specific scales, when you go through this nation in the state of Michigan alone, you know, you go county to county region to region, you can vary a lot, because everybody's conditions are a little bit different. What we face here in Michigan is going to be different than what people face in, let's say, Arizona, we don't get as many heat strokes and poisonous rattlesnake bites out here in Michigan. So we're going to have slightly different things. We have a lot of cold emergencies, we have a lot of other issues. We have a lot of people that hit deer with cars, and they get hurt, too. So can you kind of give us an introduction as to the nation as a whole macroscopically? What is the expectation in the United States when it comes to EMS system? And I guess what I'm asking here is, can you describe any applicable national or federal requirements regarding the establishment or regulation of EMS systems?

Emily Bergquist: 6:02

So that's what's really interesting, and I think it's a common misconception with I think citizens as a whole is that there is no federal requirement for EMS to exist. So there is a federal EMS Office, it's a subdivision of the National Highway Transportation Safety. So NHTSA, which is if you think about that, as an EMS person, kind of a little bit interesting, because most of what we do isn't really about traffic, or traffic safety. And maybe, you know, in the beginnings of ems, that's probably where we were. But now that we do so many different things, it's not really like that anymore. But there is no requirement for EMS to exist. So there's no federal law that says states established an EMS system, it has just organically happened across the country, which is, I think, why they're so different from one state to another state, because there's no minimum, and there's no requirement for it.

Geoff Lassers: 7:02

One of the big things we always learn in EMS school very early on, and even IC school gets reinforced is that the NHTSA, the National Highway Traffic Safety Administration seems to identify scope of practice for ems. In the United States, is that correct?

Emily Bergquist: 7:17

So it's an interesting thing. So they identify the components of a scope of practice. But in order for your scope of practice to be valid, you have to have a whole bunch of different pieces. So one, you have to be educated, right? you have to have a competency, which is your test that you have to take, you have to be the certification of for us, we use national registry, whatever exam that you take, then you have to be licensed by the state in which you work. And then you have to be privileged. So it's like four pieces, you establish competency through school, you're certified by your testing organization, you are licensed by your state by meeting requirements, and then your privilege and in our state, privileging comes from the medical control authorities. So theoretically speaking, actually, in a few instances, there are EMTs, whose scope of practice is just a little bit different in one MCA than it is in a different MCA because their protocols are different.

Geoff Lassers: 8:13

You just gave us an overview where it felt like that's a checklist that every state is using, there was the education, the privileging, the licensing, there was another one, I think I'm missing in there.

Emily Bergquist: 8:23

Yeah, certification.

Geoff Lassers: 8:24

Certification. So in that process, where you're getting those four from did those come from anywhere? Or is that just something every state has adopted as that that's actually from NHTSA. Yeah, it's a pretty picture, they make a little Venn diagram with. So is it safe as NHTSA provides the recommendations to say, here are all of the objectives, actions and scope of practice of the levels of emfs, that should be available across the United States, and then that should be modified to meet those states. And then when a state adopts it, here are the four things that need to occur for somebody to actually go on cause, right, like, be educated on these things are tested on these things, be licensed for these things, and then be privileged for these things, depending on what your different pieces are. Can we know shift more specifically in Michigan? Well, let's go into the details here. So we know the Big Four that NHTSA says we have to do nationally. How has Michigan made that work here?

Emily Bergquist: 9:18

So I always like to talk a little bit about our law because I never read our law until I came into the state office. I didn't say this in the beginning. But I worked as a paramedic full time for 17 years before I came into the office. And I've only been off like I worked part time for a while when I first started and I'm one been off the road for a little bit. And I didn't know as a paramedic that, you know, my law was public act 368 of 1978. And rules promulgated for that law. So I had never read them. And I just, you know, I went to work and my agency educated me and told me what I should be doing and I knew who my medical director was, but what his role was I didn't really know. And I just kind of went about my business taking care of my patients. So our law actually is kind of set up into a few different sections. There are the departments responsibilities, which is my office's responsibilities, there are the responsibilities of the medical control authority, then there are the responsibilities of the agencies. And then there are the responsibilities of the personnel. So in our EMS system, we each have a role. The humans, the personnel, I always say providers, and I know that that's not technically the word, it's licensed EMS personnel, the EMS agencies, and then the MCA is in our office, the goal is for the MCA is to actually do most of the work because they are closer to the system itself. So where are we sit, we can think about the whole state and what we want it to be minimally, that's a hard word for me to say, apparently, what we would like to see for every citizen, but there is also a strong awareness of the fact that our state is pretty diverse, quite honestly. And we have some pretty urban areas, we have some super rural areas, and then every agency and provider inside of it, he did it again. And all the personnel inside of it operate a little bit differently depending on the environment in which they're in. So if you haven't had a chance to actually look at that law, I highly recommend it just to get a perspective of whose job is it to do all of the different pieces whose job is it to make sure that the wheels are kind of going around on your ambulance.

Geoff Lassers: 11:35

So the law that applies to the establishment of an EMS system in Michigan is public act 368 of 1978, as amended. And then it breaks it up into the four main responsibilities. It breaks it up on what the department, the state of Michigan is responsible of doing. And then what are the

Emily Bergquist: 13:21

The MCA is operate with a delegated medical control authorities responsible for doing and then authority from the department so they are quasi governmental, the we'll get into what an MCA i here in a minute. But the MCA i MCA is most of them are not actual government entities. in general are made up of al the agencies in a define geographic area. And then i breaks up what each agency i They're not like actual county departments or anything like responsible for at a state la level. And then down to th that. But they act with authority that our department licensee, the EMS provider wh goes on calls. So Emily, you'r gives them. So they are designated by our department to saying that you utilize me ical control authorities be a county or a part of the county or multiple counties. So as a tangible arm to ge the information to and from it can be really any geographic area. And they are tasked with your localities because in very different let's call it Co the responsibility of establishing a functioning EMS nty, in Michigan, in Oakland Co nty, Michigan, we go from 15 system inside that geographic area. And there are certain 20-30 story buildings in Southf eld, Michigan, all the way o mandatory components that an MCA has and I'm going to go through t to farmland in North Oa land County. So we have a them real fast, because I have an entire training that's an very diverse depiction, I thi k of Michigan, because we h hour long, just about how an MC is structured, but they have to ve a little bit of everything that all of Michigan has to have a medical director, they have to have an MCA board, they deal with. But if you go to the p of Michigan, if you o to Sheboygan, Michigan, yo get real far up north have to have an advisory committee, and they have to have the conditions change a lot the number one less hospi professional standards review organization that does quality als, number two less EMS provi ers. So you're going to improvement work. So those are the four pieces that we make have different situations that require different s stem protocols for that ar a or modification. Because we'r every MCA have, but their role is to make sure that what is happening in ems in your geographic area is happening at not talking apples to apples, e're talking oranges, to banan the best possible way it can. And so in some areas, that means s to grapefruit, when you're ta king about the different are there's two agencies in a giant vicinity and they continue. So s of Michigan. So can you now gi e us a little background now on I'm trying to think of Montcalm County has one of them that they what a medical control authorit is, it's really important ever have a county based agency that does all of the first response body listening understands y u're gonna hear medical co trol authority that's only spe ific to Michigan, you're not and all of the transporting and there's nobody else. It's just onna find one in the 49 oth r US states. We're very, them versus some of the more diverse counties. Wayne has two very different that regard. So et's start with there Emily. MCA inside of it.

Geoff Lassers: 14:51

We have 54 agencies now in Oakland County. Wayne County, like you mentioned for those of you not familiar with Michigan, Detroit is in Wayne County in Detroit is such a Big agency with so many runs, that they're their own medical control authority along with some of the very small agencies that are down there in some public safety agencies that are small.

Emily Bergquist: 15:10

So they have their own whole system established kind of around the city of Detroit. So the MCA's themselves are designated by law to be operated by the hospitals inside that geographic area. Some people will say like, what why is it that way? And I guess I don't know I was born the year This law was written. So I don't know why they made it the way that it is. But it is an interesting system, and it functions pretty well. So those hospitals have a vested interest in making sure that their patients are taken care of well, right you think about what a hospital's goal is a hospital's goal is to have their sick patients brought to them better than they were when they first you know, whenever the first incident happened. So they're invested in good EMS, because good EMS equals better patients for the hospital themselves. So that's the idea is because these emergency departments inside hospitals are invested, then everyone can work together. That's kind of how they're set up. The hospitals are the ones who control the MCA's, the agencies must actually participate with the MCA's and everybody is responsible for the protocols that come out of the MCA. So it's like a symbiotic relationship, I'll say.

Geoff Lassers: 16:20

Yeah, it's a balance of responsibility. I don't say balance of power, it's a balance of responsibility, because we're all responsible for the patients in our areas. So one of the things I do for Oakland Couny Medical Control Authority is I help our medical control authority interface with the state. Because we go back and forth, we talk to the state, we take direction from the state, we give information to the state, we collaborate with the state, and then we do the exact same thing to the agency. So we're that intermediary group that helps to facilitate the what's expected, and then what can actually happen and find the best way to do things with them. I do want to address the fact that people are like, well, who pays for this thing? Well, like you just addressed it, the law says that the hospitals are responsible for operating the MCA, that means they are responsible for financing the MCA for putting the subject matter experts in place to ensure that protocols are there and to meet public act 368. And for that defined geographic area, in some areas of Michigan, it's multi-counties. In some, it's one county, for the most part, it's about one county each, there's a lot of multi county systems out there, and then you got a little piece in Wayne County. So they pay for the operation of that the hospitals in that area. So you can imagine the more hospitals you have in a defined geographic area, you're gonna at least have more resources. But then you can also have, let's say, a difference in practicing medicine or ideas. So everywhere in Michigan is going to develop its own personality based on the hospitals, agencies, conditions of their citizens, and what's expected in that area. But they all work in concert back and forth with the state of Michigan to make sure we're all meeting the same standards. So let's talk about more of those medical directors and those experts to help guide us in protocols. One of the big differences here in Michigan is that our medical control authorities have medical directors and even though every agency has an assigned medical director, it's not as intense as most other states, it appears that most other US states, typically each agency has a medical director on staff and paid for by the agency. And in a lot of circumstances, those protocols are specific only to that agency. So can you give us a compare and contrast to the role of a medical director in Michigan VS. a lot of our neighboring states.

Emily Bergquist: 18:31

Sure, so a medical director in Michigan, one has some state minimum standards that they have to be right. So that's also in the law. So they can't be like a primary care physician, for example, they have to be an emergency physician or similar with that level of practice, as well as some different certifications they have to have, so that they're at least aware of what the EMS system is and how it functions. And those medical directors are responsible for the provision of ems inside their geographic area. And anytime I do an orientation for new medical directors, I always say please don't quit. Please don't quit on your first day. Because when you start hearing about the responsibilities that are kind of bestowed on them, there's a lot of gravity to that, where nationally, they're employees of the agency. And so who they're kind of answering to is agency leadership. So those medical directors have usually more or should have some direct interaction with employees, which we don't always have with our MCA medical directors, but they are also responsible and responsive to the same people, whereas our medical directors in our geographic areas are responsive to our advisory bodies that's in the statute, right? So they have to be responsive to our advisory bodies, while our advisory bodies are made up of all of the EMS agencies, and oftentimes other people like dispatchers, etc. And our medical directors look at all of the pieces of the EMS system. So I know there's a lot of these MCA medical directors that review every dispatch card and go over responses, you would never see that in a different state. They really just focus on what their people are doing, which is interesting. Like the deeper you think about it, who do those medical directors answer to? And MCA medical directors answers to the system and to patient outcomes, not to anything else. It's really it's a hard job.

Geoff Lassers: 20:26

Yeah, I could see the benefits of both of them. I wish we could combine that because I see, I'm not saying that we should change the law to require that every agency requires a medical doctor be on staff, but man, I do see the huge benefits of having medical directors for each system to help manage the conditions of that system. And then I also understand man, it would be cool to have somebody who works specifically with our agency, but what you're saying is sort of the answer to now if each one of those positions understood the system as it is and how they can be a tangible asset for that specific agency and being in concert with the system. That'd be amazing. But that's not always the case outside here. Is it?

Emily Bergquist: 21:02

Right? No, it's it's really not. And you're kind of as an agency in another state, when you have to rely on what medical director you can get and what medical director you can afford to get. Right. So I have very strong personal opinions about the almighty dollar in EMS, because it's a really tough thing to think about, because I passionately believe that every single person regardless of how much money they should have or not have, should get the same treatment. And that is something that when you're talking about an agency based system, you're not necessarily going to see that the agencies are purchasing their own medications, they're paying for their own medical director, etc. And all of that is not inexpensive. And ems is not a it's not where you go to make money.

Geoff Lassers: 21:50

No, it's not designed for that people don't really wasn't made for that. So yeah, service emergency medical service.

Emily Bergquist: 21:57

Service. Yes, we are in the service industry. So yeah, it's an interesting thing. And I think that Michigan is laid out very well for that, because we are broken up into these specific geographic areas that are attempting at least to keep things the same or similar for everyone. We want everyone to get treated the same way or similarly.

Geoff Lassers: 22:18

So the big picture takeaway here from Michigan to most other US states is that Michigan has a more systematic approach to the use of their medical directors, whereas a lot of states are very agency based medical director, the way they do it at the agency versus the way they do it in a bigger defined region.

Emily Bergquist: 22:35

Right. And so there are some states that have regional committees.

Geoff Lassers: 22:40

Yeah, I've talked to a number of people like yourself that work at a state level to do things like this. And there is a lot of great states out there. And I can't quote any right now off the top of my head, but there are a lot that work in concert with a lot of their neighboring communities. Because when you're making protocols, man, is it a lot easier when you got a lot more brains to make a group of protocols that we can all share. Plus, when you get mutual aid, one of the big benefits here is that the protocols are protocols, so when I get called mutual aid to three cities over, they're not going to get anything different, they're gonna get the same high ability of this. And then if I need to work with another agency, we can just talk with our eyes basically, at that point, we know what the next steps gonna be. Yeah. And the other big one is I never thought about this, but your agency would have to pay for your drug box and your drug. There's, like so many other aspects of this that are so foreign to me that seem just so weird. But yeah.

Emily Bergquist: 23:28

yeah, you would make decisions about what medicines you had based on what you could afford.

Geoff Lassers: 23:34

Wow. So you're saying that my drug box may or may not have the same amount of stuff in it, because now we're talking finances at the agency level rather than finances at a very big County, multi county level.

Emily Bergquist: 23:45

Right, like when you're absorbing across the system is different than when one agency is footing that bill.

Geoff Lassers: 23:51

Well, and to expand on that it gets even less expensive when you have multiple in Michigan, multiple medical control authorities.

Emily Bergquist: 23:59

Drug box exchange is a good example of that, right? So like the whole system purchases. So like solumedrol, or prednisone for example, those are medications that not everybody has the same way like you can make a decision as a system. And those medications have a really long shelf life, right. So they go into a box, and they'll circulate around your system pretty much until they get used. And because they're getting you know, circulated around, there's a higher potential that they will get used as opposed to expiring and being wasted. We could talk about medications all day too. But that's another advantage of having a system wide approach as opposed to individual agency approach.

Geoff Lassers: 24:39

And how that's working here in Michigan is that we have nine MCA's in Southeast Michigan we use the same exact drug box that same exact drugs the same exact exchange protocol so that nine MCA is can share one responsibility instead of doing it nine different ways. And then you can imagine like other states, there's crossing over a hospital so if agency A or MCA A only uses these drugs and then the other agencies or medical control authorities use those drugs. What a mess.

Emily Bergquist: 25:03

Yeah. So like, I can tell you I worked in Jackson, right? That's not a secret. We were our own MCA. And if we went north to Sparrow or whatever, in Tri-County, we couldn't exchange our box, we would have to go back to Jackson to exchange our box to get back in service. So we actually carried two boxes, specifically, because we left our county, we didn't have any ability in any direction to exchange a drug box. It's just really interesting how things work like that we at the hospital in Jackson, they carry Tri-County boxes, because so often neighboring agencies like Stockbridge would come down and transport a patient to the Alegion, they could exchange their box, but we couldn't really exchange anywhere else, which is amazing. You know, like, it's just an interesting thing. And it really goes to show that like, there are a lot of different things. And honestly, Jackson is not that far from the southeast Michigan exchange, right? It's one county over from Washtenaw, which does that. So it's just a really fascinating thing to see how things are different.

Geoff Lassers: 26:02

Yeah, I can help my car right now get to Jackson in an hour. That's not that far. So now that we understand how Michigan's EMS system in the general sense work, and big picture macroscopically how these things are kind of moving, I want to talk about two problems. There's a long term problem, and there's a short term problem. Let's start with the short term problem. Can you talk about how the state of Michigan EMS system is addressing this COVID pandemic? Currently, now, we've talked about this in this podcast a lot. We've talked about protocols you've even been on here before. But right now, can you just give us an update? Big Picture EMS and COVID? I call it a short term problem, because I hope it's gone in less than a year.

Emily Bergquist: 26:38

Yeah, I mean, really, we can hope for that.

Geoff Lassers: 26:41

Right.

Emily Bergquist: 26:42

Somebody said to me yesterday, we're putting a lot of faith in this vaccine. And I'm like, I have to.

Geoff Lassers: 26:47

man, that's how I get to tomorrow is thinking about the fact that it's gonna get a little better. So kind of give us an update. How is the state of Michigan currently responding? As of now we know how they did before what's going on what's new, give us an update.

Emily Bergquist: 26:59

So it's really interesting. I think that our system because we have state protocols, and because we work as a system that has been an asset to this particular response, because not all MCA's have the resources to make a response. So as we learn things, we're just constantly adapting, like, we have, I think, three different protocols that are currently being adapted right now one for the antigen testing cards, one for some possible PPE changes to kind of clarify the gown utilization, and one for high flow nasal oxygen, which is kind of a little bit of a weird thing to say for someone who never touched a high flow nasal cannula before they came off the road. But apparently, it's really, really working really well for COVID patients. And so we want to make sure that we're listening to the things that are coming from different areas and trying to respond so that everybody has the resources that they need. So that's like our short term gap. As far as like what we're doing otherwise is right now, we kind of alluded to that. But vaccine planning is like the entire universe right now. We've been watching more what's happening from the CDC right now, just to see what's going to happen. Is the FDA again, what are they going to say? What are the guidance is going to say, and developing about 40,000 It feels like contingency plans for what if we get this many doses? What if we get that many doses? Where are we going to take it? Where is it going to get stored? Who's going to go first? And because the fact of the matter is everybody wants to be first. And if everybody's first then no one is. And so that has been a thing that you know, our job, or my EMS office's job is to make sure that we're advocating because ems honestly, is first, you know, like we ems are the first people to encounter these patients, they have no real capability of knowing in advance, which is very different than a lot of the rest of the healthcare system. And so we've really been advocating that they need to be 1A tier one is what they call it. And fortunately, we've managed to keep emfs there. So I'm going to put my plug in for please, please do your actual research about the vaccine and educate yourself and make your plan for when you're going to get it because it's very important. We need our people to stay safe and healthy. There's my vaccine plug.

Geoff Lassers: 29:22

No problem, we're going to be hitting the vaccine more. We just did an episode recently on an update for vaccines for all of our providers and how we're using an example in Oakland County, Michigan, how it might roll out. So more to follow on that. But yes, do your research on the vaccines that are out there and check out our future and old episodes about it. Let's talk about a long term problem. So in season two of the EMS on AIR podcast, we've been focusing a lot on stroke. And over the last couple of years, you're well aware that stroke has always been a problem and we've been trying to really make a big push in Michigan. We were on the verge of making some really big stuff happen here and then this whole pandemic came up and it's ruined everybody's schedule, but I do want to get your take on how the state of Michigan is addressing the long term of stroke care in Michigan, and the advancement of the use of stroke severity scales where they apply in certain parts of Michigan. So I'd like to get your take on that.

Emily Bergquist: 30:10

So I think that what's really interesting about it is it's the definition of what quality improvement is, our job at the state. And obviously, not everything can be the same, right? Especially when you talk about stroke, because stroke centers are not everywhere, that's a real thing. What we have to do is we have to one establish what the problem is, we have to gather the data around it, then we have to make changes that are measurable so that we can watch the outcomes and you want, well, maybe not you collectively, but I would like and I'm sure Geoff would like for it to be a more instantaneous turnaround, right? So when I was in, you know, high school, they used to call it what they call a guessing check, you know, the scientific method, you you take a stab, and then check it and be like, dang, it didn't work. And then you would try something different. And see, you know, where you can move that needle, like, we know where we're going. We're trying to get people stroke patients specifically to the most appropriate facility in the quickest amount of time. That's where we're trying to get. But the question is, how do we get there. So our job is to keep looking at different metrics and different case definitions and different ideas. And then tweaking a protocol, doing education, checking, again, tweaking your protocol, doing education, and checking again, it's the old on plan, do study act, right? That's the actual quality improvement circle, we go from guessing check to plan, do study act, and we're going in that circle. And that is the actual definition of what we should be doing. And I know that Geoff is right, this pandemic has distracted us from so much. And it's not because it's not important. I just like to say it's because it's not on fire. Like, if you're not on fire right now, you're not getting the kind of attention that you deserve. But that's the fact of the matter is, this is where we're going like we're looking at data quality, we're looking at initiatives to try to make care better across the board one condition at a time, because you can't change everything all at the same time. It's just not possible. So there's my two cents on that.

Geoff Lassers: 32:13

Thank you very much. Do you have any closing thoughts for personnel here in Michigan or nationally and shout out to Lake Stevens, Washington, they have been our biggest market in the last like 510 episodes, they've had the most download. So I don't know anybody in Lake Stevens, Washington. But you guys rock number two, Columbus, Ohio, home of the National Registry. They've actually had the second most downloads of all episodes on EMS on AIR. So that's just showing a little bit of our reach. So I tip my cap to my friends in Ohio and Lake Stevens, Washington. You guys rock. So do you have anything you want to say in closing to our audience here about Michigan EMS, anything? What do you got?

Emily Bergquist: 32:49

I guess I think my biggest thing for people to understand is that we're not actually a big scary state office, there are only 20 of us total, not counting managers. So there's not a whole lot of us. And we are really trying to help. Like that's actually our goal. So if you're stuck, or you're wondering, or you have a question, just reach out to us, all of our contact information is on our website. Maybe we're not going to answer instantaneously, but we're more than willing to talk to you because we're all busy with COVID. But as I said, just reach out to us because we're more than willing to answer questions or talk to you about what's going on or whatever. And we're transparent, you can find us anyway.

Geoff Lassers: 33:30

You can find anybody the state of Michigan, the EMS office michigan.gov/ems and then click on contact us and you will find the list of the 20 or so people that Emily's referring to. It also lists what they do so that you can dial in and you're looking for licensing questions, continuing education questions, or MCA questions. And if you do have questions about your medical control authority in Michigan, I would contact your medical control in Michigan, if you have questions for Emily, I'm sure she'd be able to get ahold of you. Emily, what's your email?

Emily Bergquist: 34:01

Are you ready? Bergquiste@michigan.gov.

Geoff Lassers: 34:08

Perfect if you want to get ahold Emily or tell her your feelings about the Medical Control get hold of her. I'll even put her personal cell phone on here later. Emily, thank you very much for joining us today. We're gonna have her back to have a discussion about what do I do if I make a mistake? And one of the big things I do at Oakland County Medical control authority is I'm a part of the investigation process when and if a potential mistake was made, and what I've learned throughout the last five years of doing that is not everybody knows the right thing to do after they make a mistake. What are those best practices to kind of get back to the good graces so Emily's gonna come back in the next week and talk to us about things you should do after making a mistake on a call or on duty and things you should do if you made a mistake off duty. e're talking about legal roubles here. So we'll get all hat next time. And Emily, you ave a great day.

Emily Bergquist: 34:57

All right, you too. Thanks, Geoff.

Geoff Lassers: 35:02

That is all for the show today everyone. Thank you for listening. Thank you Emily for coming on the show and spreading your knowledge. If you want to get a hold of Emily you can find her contact info in the episode description. Please keep emailing your questions, comments, feedback and episode ideas to the EMS on AIR podcas team by email at QI@ocmca. rg. Also check out our we site emsonair.com for the latest information podcast episod s and other details. Follow us on Instagram @ems_on_air an please whatever podcast p atform you use, subscribe to our podcast and leave us rating and a review because i really does help us grow this thing. Thank you for listening to the EMS on AIR podcast. S ay safe and have a great day!