University of Southern California & Los Angeles Fire Department
Excellence in Value Demonstration or Research: This award recognizes an EMS or non-EMS organization that created and implemented an analysis of data and/or research project to demonstrate the value impact of the services provided by the organization.
Dr. Stephen Sanko and Dr. Marc Eckstein helped create numerous approaches to mobile integrated healthcare, and have published on the implementation, safety and efficacy, and role during COVID of advanced practice providers and community paramedics in 9-1-1 response. Their peer-reviewed publications in the Journal of Emergency Medical Services, Prehospital Emergency Care, and the New England Journal/Catalyst Innovations in Care Delivery are frequently cited by other medical directors and MIH task forces as justification for exploring and implementing novel MIH approaches.
Dr. Sanko is Assistant Medical Director overseeing strategic development and providing medical oversight for the Los Angeles Fire Department Mobile Integrated Healthcare Unit. Dr. Marc Eckstein is the EMS Bureau Commander and Medical Director of the Los Angeles Fire Department. LAFD is the second largest municipal EMS provider agency in the United States. Since 2015, its mobile integrated healthcare responders have attended over 7000 9-1-1 patients, and worked closely with alternate destinations and patient liaisons to track patient outcomes.
Description of Data & Methodology
In January 2017, the Dr Sanko and Dr Eckstein co-authored a peer-reviewed description of the implementation of the LAFD Nurse Practitioner Response Unit (NPRU) for the Journal of Emergency Medical Services. A precursor to the later Advanced Practice Response Unit (APRU), this NRPU combined the skills of a Nurse Practitioner with emergency experience and a firefighter/paramedic to offer treatment-in-place and alternative destination transport in downtown and South Los Angeles. It also provided the first published narrative reflections on the unique nature of this new model of care delivery from the perspective of the team member.
In 2019, Sanko and Eckstein co-authored a report for Prehospital Emergency Care describing the first year of the Advanced Practice Response Unit Program. This included a description of services provided, provider impressions, patient dispositions/outcomes, and the impact on other non-MIH 9-1-1 resources. Importantly, it provided one of the earliest assessments of safety and efficacy for 9-1-1 mobile integrated healthcare in a large US city.
In February 2021, Sanko and Eckstein published a peer-reviewed report in the New England Journal of Medicine/Catalyist Innovations in Care Delivery on the importance of MIH in confronting the COVID-19 pandemic in Los Angeles. In addition to demonstrating how multiple strategies can interact and complement eachother in 9-1-1 MIH, this paper also provided one of the first descriptions of per-incident cost savings through MIH-care compared to standard EMS care.
The authors have presented numerous other abstracts at national conferences on both NPRU, APRU, community paramedicine and 9-1-1 telemedicine use in EMS.
Advanced Practice Providers in the Field Implementation of the Los Angeles Fire Department Advanced Provider Response Unit.pdf