PREHOSPITAL CARE
Improving Continuity of Care through EMS Assessment of Social Determinants of Health SAEM PULSE | JANUARY-FEBRUARY 2023
By Mel Ebeling on behalf of the SAEM Global Emergency Medicine Academy
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Seasoned with diesel fumes and CaviCide, my interviewing skills and ability to build quick rapport with my patients were two things I took great pride in when I started medical school. Yet, the transition from emergency medical technician (EMT) to medical student did not come without a great deal of turbulence and discomfort for me. In each of my interactions with standardized patients, something felt…off. I initially chalked this up to nerves, but after some introspection, I discovered that the fluidity and sense of ease of my interview characteristically began to drop off as I started taking the social history, when I became much more awkward. Despite knowing the significant impact of social determinants
of health (SDOH) on health outcomes and the usefulness of that information in the development of a differential diagnosis, I still squirmed as I asked patients about their home life and education status. Why was this so? Why was there such a difference in how I felt interviewing patients now versus out in the field? In the field of emergency medical services (EMS), asking the patient about their SDOH is largely unnecessary, as we have the privilege of observing these factors at almost every call. We see people’s neighborhoods — those with a Trader Joe’s down the street and those with a Dollar General as the only grocery store nearby. We see the degrees on the walls and the hallways
full of pictures of their support systems. We see the excess stairs leading up to the front entrance and the dusty car, indicating that this person may have trouble with mobility. We see the pile of bills on the kitchen table and cockroaches on the floor. We see, hear, and smell it all. To be invited into patients’ homes, in any state, is an honor, a window into their lives, and is a unique aspect of the profession. What if this could be harnessed to improve the health and lives of the people served by the emergency department (ED)? Overutilization of EMS and EDs is an ongoing issue, and combined with an ever-increasing number of bureaucratic tasks, physicians must ultimately spend less time with each