Nick Simpson of Hennepin EMS: Inside the Quest to Break Down Healthcare Silos and Revolutionize Prehospital Emergency Response

As a part of our interview series called “5 Things We Must Do To Improve the US Healthcare System”, I had the pleasure to interview Nick Simpson, MD, Chief Medical Director, Hennepin EMS.

Dr. Simpson trained in Emergency Medicine and then expanded that focus to the prehospital arena with a fellowship in EMS.

Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a story about what brought you to this specific career path?

When I was still in training, I remember one of the first times that arrived at a scene with multiple patients from a motor vehicle accident. In my head, I had an idea of what to do with a single person who has severe injuries and a thought process to follow.

Then I got to the scene and there were six patients, many of them badly injured. Suddenly, I was in over my head. I stood there trying to figure out who to assess first. It wasn’t like in the hospital. I didn’t know anyone’s name. Didn’t know anyone’s vital signs. I briefly froze, not knowing where to start. Then, one of the paramedics who arrived about the same time said, “Hey Doc, go grab the traction splint.” The crew had already worked their way through most of the patients and had an idea where to go. Fire arrived and worked on safely extricating and moving patients. Police ensured scene safety and redirected traffic. It was a well-oiled machine. Not only were these professionals outstanding at their job, each of them also showed incredible humility and grace for a scared new person. To this day, I feel privileged to work with frontline emergency personnel both in and out of the hospital.

Can you share the most interesting story that happened to you since you began your career?

I very vividly remember a young child that I cared for after a drowning incident. When he arrived from EMS, he was getting CPR and hypothermic. With a tremendous amount of teamwork and effort he regained a pulse and he was stabilized. Weeks later, I got to meet the little boy on the hospital floor. He was up playing in the kids’ room and gave me a high five when I stopped in. That high five and knowing that he was getting a second chance was one of my more career-affirming moments.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

While not a mistake, I can share that I had a moment of intense panic when I was just starting as a physician. We’re required to take calls in a number of different areas in the hospital through our training. I remember being asked by a nurse about a pregnant woman getting some Benadryl at 3am. It didn’t feel like enough to wake up the more senior doctor on service, but I remember a series of questions flying through my head about safety, pregnancy classification, lactation, side effects, cross-reactions and a ton of what-if scenarios. Ultimately, I checked a couple references, went to see her, and everything was fine.

This memory reminds me of the weight of even seemingly simple decisions when people are gaining experience. I share this with new physicians all the time and try to ensure to keep it in mind when working with new folks.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

“Make the best use of what is in your power, take the rest as it happens.”

~Epictetus

This concept is one that has only become more important as I’ve gotten older. We can control our choices and what we do, however, we cannot control what happens because of those choices. In healthcare especially, it’s very possible to do everything exactly right — exactly as the textbooks say and right in line with the most cutting-edge science — yet still have a bad outcome. We can’t expect that if we do perfect CPR or instantly know the diagnosis that we can always prevent bad things from happening.

How would you define an “excellent healthcare provider”?

To me, an excellent healthcare provider is first and foremost an excellent human being. They must genuinely care about their patients and families. They also must be able to communicate well with others. This includes patients, families, and others in the profession to ensure the best possible holistic care.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

Some of the books that have really resonated with me are: “Extreme Ownership” and “The Dichotomy of Leadership” by Jocko Willink, as well as “Ego is the Enemy,” “The Obstacle is the Way” and “Stillness is the Key” by Ryan Holiday.

Although none of these books are necessarily about healthcare, they’re about understanding people and being a better human being. The concepts in those books have been helpful to better frame issues that come up and how to approach them.

Are you working on any exciting new projects now? How do you think that will help people?

We’ve had several exciting projects that we’ve recently implemented including adding ultrasounds to every ambulance, improved language access with a new video interpreter service, a prehospital Suboxone initiation program, and other harm reduction efforts to combat the opioid epidemic.

The long-term project that I would love to get off the ground involves improved healthcare access, improved equity, and a more efficiently integrated emergency response and other parts of the healthcare system. There are ways that this is possible using relatively simple technology and existing infrastructure. I see this as helping patients and families by improving access to healthcare. It would help responders and the rest of the system as it would allow for a more accurate triage and needs assessment without requiring that almost all care is centered around the hospitals and clinics.

When there is someone who is critically ill or injured, there is no mistake that our traditional 911 response is among the best in the world. We recently did a pilot program at Hennepin EMS to see if we could better understand the dynamics of a situation and through that offer improved instructions to callers and improve the triage process for our emergency response system. This was done using a platform called GoodSAM. It is a system that’s been used in other parts of the US and around the world. We found it very helpful and that having those resources added a lot of insight into the situations surrounding 911 calls.

Ok, thank you for that. Let’s now jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high-income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?

This one has a lot to unpack. While I could easily spend months going into these, I’ll try to distill my thoughts down to a few main points.

1. There are many silos that have been created in the lives of our patients. The by-product of having silos are significant inefficiencies. This issue is prevalent in nearly every aspect of care. As an example, someone’s notes or imaging results may or may not be accessible by providers in another hospital system. In the emergency department, there are some hospital/clinic systems that I can see any time and others that may only be accessible during business hours requiring phone calls and faxes to attain. In today’s digital world, this roadblock unnecessarily slows down care in a patient’s most critical moments.
2. The article speaks of poor equality in coverage. That’s certainly a real phenomenon. Thankfully, when I’m treating patients prehospital or in the emergency department that is not something that I have to worry about in the same way as my colleagues in the clinics. That said, inequality in coverage is one thing that leads people to utilize emergency services for things that may not be emergencies — if they’re not able to get into an accessible clinic or see other providers.
3. We commonly see patients who have had their health issues progress due to things like inability to get into clinic and inability to afford their medications. It’s always troubling to see someone end up critically ill from something that could have been avoided through routine preventative care. This is a complex problem. When someone is forced to decide between paying for their medicine or putting food on the table for their family, it’s a set-up for failure. When someone can’t get to clinic because they can’t get the time off work, childcare, or transportation those inequities are compounded again.

As a “healthcare insider,” if you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system?

1. Increasing accessibility to care by expanding options in location, type and hours of clinic services. I would propose that clinics offer their patients more options for expanded hours (e.g., evenings/weekends) as well as telehealth to break down barriers to care. It is a common occurrence that people are forced to present to the emergency department for needs that would typically be addressed in a primary care setting but they’re unable to make an appointment at a particular clinic.
2. Increasing portability of healthcare information. Electronic Health Records (EHRs) are nearly ubiquitous now, however, the ability for agencies to share data with other agencies is not always the case. In the age of cyber-attacks, I’ve also encountered agencies that have the ability to share data electronically but are concerned about security and have turned those features off. It’s a real challenge, as being hacked can shut down the entire hospital computer network. If there was a standardized way that all systems could talk with one another and have interoperability it would make a big difference.
3. We would see increasing integration with other disciplines. When we talk about EMS, it’s at the confluence of healthcare, public safety, public health, and emergency management. We would have more inter-disciplinary conversations to bridge the gap between some of our most high-needs patients. As an example, in our system we have encountered people who call 911 sometimes multiple times a day. We’ve been able to work with other responders, social workers, clinical coordinators, and hospital staff to help garner additional services and decrease the number of times they’re in crisis.
4. We would have more support for innovation at all levels. In some ways, we see innovation relatively frequently (e.g., new medications being introduced). However, in some ways it is quite difficult to innovate in healthcare. As an example, in the prehospital area when we add new equipment or medications there is often a cost associated with them, yet the reimbursement from the payors does not change. Thus, we rely on individuals and organizations to push for improved care even though there is often no financial incentive to do so.
5. Better mental health care and support for all those involved in patient care and emergency response. Nearly every organization has some form of mental health support — the challenges seem to arise when those resources/services are significantly removed from the work of those who are seeking help. One of the barriers to having emergency responders seek more counseling is that often the therapist doesn’t understand the environment they’re working in. Having a therapist that “gets it” can make a world of difference.

What concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

1. Individuals need to continue to collaborate with other disciplines and brainstorm ways that we could re-think some systems and occupational cultures to remove traditional barriers to care. A big portion of this is being open-minded to change and the evolution of systems.
2. Corporations could allow more interoperability between devices and equipment made by different companies. In healthcare there are many different types of equipment, and often if one company makes several of them (e.g. heart monitor & mechanical CPR device) the data can be shared and integrated easily. If not, the data is often brought together in a piece-meal fashion adding additional work and possibility of error when analyzing clinical situations. It’s similar to having a standard smart phone charging cord amongst the major brands, it would take a lot of discussion and isn’t something that would happen fast.
3. Communities can continue to acknowledge the challenges faced by emergency responders and healthcare workers. Understanding that this kind of work can take a serious emotional toll and requires a lot of support for the work and the people.
4. Leaders can work to reward innovation and incentivize people to collaborate and break down barriers.

The COVID-19 pandemic has put intense pressure on the American healthcare system, leaving some hospital systems at a complete loss as to how to handle this crisis. Can you share with us examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these issues moving forward?

We have seen and continue to see the U.S. healthcare system struggle with things like staffing. I do not know of any hospital systems that are able to care for the same number of patients today as they could five years ago. The stresses of COVID have caused many in healthcare to retire or change careers. That, plus the shifting demographics of our population have created a supply/demand mismatch for healthcare.

I don’t believe that we can keep doing things the exact same way and expect to get out of this crisis for at least the next 50 years. As a system, we must rethink our care model and how to increase efficiencies. It will take a concerted effort from legislators, payors, healthcare systems, and personnel at every level.

How do you think we can address the problem of physician shortages?

Here again, I think if we continue to do things exactly as we always have — we may never get out of this shortage. However, if we can do things to increase our efficiencies and extend the reach/impact of our physicians we will be much better off. This would include things such as increased telehealth to cut down on commuting of both patients and physicians. Whether in isolation or in combination with other providers like PAs/NPs, Paramedics/EMTs, Community Paramedics, Community EMTs, etc., if we are more creative and make it sustainable from a reimbursement and regulation standpoint — we can augment the impact of our physicians.

How do you think we can address the issue of physician and nurse burnout?

This is a very real and dangerous problem right now. We’re constantly attempting to do more with less. Those that haven’t left the field are being pushed even harder, thus compounding the trauma of a field that is prone to being near (and thereby affected by) tragedy. I’ve had some quite troubling cases personally. We are often present for catastrophic events in people’s lives. One of the things that can be hardest, is that sometimes even with our best efforts we are unable to change someone’s outcome. Those patients who are talking to you and then die in front of you, even if you know what’s happening and you try to stop it — those hurt.

I would suggest that we reinvest in things like counseling and trauma therapy. I can attest that having dealt with some impossible situations, those things were able to help me process and cope. I’ve had more than one case that without the right support system could have easily been career ending. It’s such a critical aspect of self-care that we historically have rarely talked about.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

If people could be more reflective in their daily life and focus on things within their own control, I think the world would be a friendlier place. I’ve personally found a lot of solace in studying the Stoic philosophers. However, this concept is common in essentially every major world religion. In today’s world, it’s too easy to blame someone else or get upset about other’s reactions. Two thousand years ago Marcus Aurelius wrote, “Blame yourself — or blame no one.” I think this would lead to a lot more honest conversations and genuine understanding across all of society.

Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.