Tuesday, December 2, 2014

Is diversity a good thing?

Is diversity a good thing in public safety?

Alan Perry

December 2, 2014

Diversity is defined as “The fact or quality of being diverse; difference; a point or respect in which things differ; variety or multiformity”, according to The American Heritage Dictionary. Having a diverse workforce has clear advantages, but what purpose does diversity serve in determining how to best treat a patient or mitigate an emergent situation? Is it just the way it has always been done, do “best practices” really matter, or is it that we just think our way is the best and that’s that? Why does every station, agency, municipality, region and state have a different set of policies, procedures and structure? I would argue that some degree of diversity is necessary to accommodate variations in resources and the needs of the public, but that only goes so far. We have gone to great lengths to establish national standards for EMS & Fire training, certification and best practices for activities in these realms, yet we are slow to adopt and implement them uniformly. We work in positions of public trust, as such we should move aggressively toward earning and retaining that trust by providing services that are prudent, proven and effective.

You may recall a story of an ancient city called Bable, its tale is told in the Hebrew Bible in the book of Genesis, chapter 11, verses 4-9. In this story a great civilization arose (public safety) and sought to meet their god in person (a perfect world). To accomplish this they all collaborated to construct a great tower (policies, procedures, etc.). As it were, the Lord had reservations about this and sought to thwart their efforts and thus confused their communications via creating many languages (diversity) where there was once one, thus preventing them from obtaining their goal. While our goal is somewhat less lofty, I find it perplexing that we ourselves have imposed this confounding practice of diversity on our organizations willingly. To be fair, we did have to develop our own systems before any of the best practices were yet discovered (with the exception of our stubborn indifference to the EMS Agenda for the Future and its subsequent reiterations.). This does not absolve us from the responsibility of setting things right. We must now deconstruct our defective structures and rebuild using sound and proven practices.

I understand the pessimism some of you have about the ability of these leaders to put aside business as usual and turf battles to create a true regional system. Doing so could transform public safety into a much better integrated and responsive framework that can serve the citizens, and the professionals that have chosen to serve, in a much more efficient and effective manner. These leaders may be justifiably concerned with control of resources and allocation of those resources to the communities they are charged with protecting. Some, if not all, of these localities are already stretched thin on some key assets such as ambulances and paramedics. Will the region take the next step and begin reallocating resources across boundaries to solve response issues?Regionalization is an attainable goal but should not be used to solve individual department’s shortcomings with staffing and resource allocation.

The cost of change is significant, but if done collectively could produce significant improvements in efficiency and effectiveness that will outweigh and justify the cost. We are a long way from national EMS protocols or standard staffing models, but state and regional models are already in place that should serve as examples for Fire and EMS systems as they move toward a more integrated and uniform approach to providing services. Imagine if every firefighter and EMS provider was trained to employ tools and methods that were proven to work and adopted as a best practice by NFPA and/or NREMT (or for that matter VDFP and VAOEMS). The need for agency specific operational policy and protocols would be minimized instantly. Training, logistics and administration could be streamlined and regionalized with little difficulty. It might even be possible to fill those staffing holes with some of the administrative staff that would be out of work.

Happy days indeed,

Alan

Tuesday, October 14, 2014

Add PEP to your EMS public education

Prevention, Education and Participation (PEP)

An EMS Public Education Proposal

By Alan Perry

October 14, 2014

Abstract

This proposal reviews new practices for public education in EMS, elaborates on the benefits of these practices to the public and the organization, and contrasts these with current Fire prevention activities. Consideration is given to public awareness, and public education in first aid, CPR and AED use as a starting point for improving community reaction and knowledge of these events. It also suggests topics for internal training and action that affect perception of our activities by the public relevant to patient family advocacy, and relationships with patient care partners. The goal desired is a more efficient, and effective system, that seeks community involvement and support for the mission of the Fire Department.

Introduction

The power of public education has been demonstrated by the results of Fire Safety and Prevention programs nationally. It seems reasonable to conclude that the same methods and tactics can be applied to Emergency Medical Services (EMS), with similar results. Advocacy and collaboration in the field of EMS are a stated goal of the National EMS Management Association's Strategic Plan (NEMSMA, 2010, p. 4) , and others (IAEMSC) (NAEMT) (NHTSA, 2006, p. 8) (VAOEMS, p. 5) who have conducted recent research toward improving EMS system performance. Many systems have already documented the effectiveness of such programs in improving patient outcomes (Neumar, 2011), reducing nuisance calls (Johnson, 2011), improving public reaction to medical emergencies, improving employee morale, and reducing costs. Any one of these benefits is desirable and seems to justify exploring the concept. No national standard currently exists for EMS public education although it is clear the field of EMS is headed in that direction. A proactive approach to EMS system management will place the organization in a positive light with all stakeholders, and demonstrate to the public and employees, that the Department is best capable of providing this service.

This document represents the first installment of a plan for comprehensive EMS system improvement which will bring the organization in line with the best practices in EMS across the country. As with any major change, it is best managed incrementally, it must be supported by the administration, line officers and individual providers. All stakeholders will benefit from the effort. Additional programs will need to be developed to address other related system issues (appendix), improve employee morale and improve system efficiency. Some related areas of concern are; efficient and effective use of technology, improving EMS v. Fire cultural differences, staffing and system management issues, healthcare system integration, quality control and quality improvement, and employee retention and training.

What is EMS public education?

EMS public education is a tool; a tool which will accomplish the goals of improving patient outcomes, system performance, system efficiency, provider morale and public awareness. Through education the organization's goals can be communicated clearly and consistently to the public. The key components of EMS public education are awareness of the function, capabilities and needs of the EMS system, proper reaction to EMS events, and how to participate in and facilitate the operation of the EMS system. Through such programs the community may become involved to whatever extent each individual is comfortable doing so, while building trust in, and understanding of the organization. Such education is preferable to the speculation, rumor and disinformation that may fill the void in the absence of a solid public education program. Fire and Life Safety programs do not fully accomplish the goals of EMS public education.

How will EMS public education benefit the patient?

Patient outcomes are directly linked to treatment throughout the continuum of care, from the initial public recognition and reaction to the event, through discharge from the hospital and beyond. EMS public education should seek to add the general public or layperson to that healthcare team, and thereby improve the quality, and efficiency, of the delivery of care. By doing so, recognition and appropriate reactions are achieved, and initial care is provided within the critical window required for survival from the most serious medical events. Even in less serious medical emergencies, the time to an initial intervention has an effect on morbidity and mortality (National Highway Traffic Safety Administration, 1996, p. 37).

How will EMS public education benefit the public?

The public has a vested interest in the performance of the municipal EMS system. This system affects the quality of life in the city, intermittently touching the lives of nearly every citizen. A system that can operate efficiently and produce superior outcomes is an asset to the taxpayer, both as a resource and an investment. EMS public education programs provide a benefit to the public, and simultaneously improve the performance of the system. The significant potential monetary and human cost savings that can be realized should be considered when calculating the cost of providing public education programs and determining the level of support they receive.

How will EMS public education benefit the Department?

Encouraging citizen participation in the system, gives the public a shared stake in its performance. The benefits of greater community involvement extend beyond the effect on outcomes and efficiency. Greater understanding of the EMS system, its challenges, needs, and goals, by the public, will lead to greater support on a wide range of issues. An effective EMS education program will inform the public, and garner their support for the goals of improving patient outcomes and overall system efficiency. With this knowledge, they will be able to exert influence and take ownership of their EMS system when decisions are being made by local government, or when legislation at the state or federal level is presented that affects delivery of EMS services. A positive public image and informed public will improve provider morale and lead to more responsible and appropriate use of the system.

How will EMS public education be paid for?

Cost is understandably an obstacle in the current economic climate. These programs may not require any additional funding. As written, they will require some collateral duty assignments which could be voluntary, or assigned to specific positions suited for that role. A no, or low cost method of putting these into play, without taking away from existing fire and life safety programs, could be achieved by assigning these duties to individuals, engine companies, and EMS supervisors willing to perform the task on-duty. Positive results may support funded positions when fully implemented, these costs may be completely or partially offset by system efficiencies, and a measurable improvement in patient outcomes. As a temporary solution some funding may be available through VAOEMS, DHS, and other federal legislation such as H.R.3144 (GovTrack.US) if passed. A less attractive method would involve using volunteers from CERT or FireCorps programs, or even volunteer career staff. The choice will be dependent on the level of commitment the Department is willing to make.

What EMS public education is appropriate for your department?

Public education in EMS comes in many forms; some are directed solely at the public, others involve educating our healthcare partners. The two areas of focus that may be most beneficial, easiest to implement and least expensive are directed at the general public and are the primary subject of this proposal:

Awareness programs for communities, civic organizations, and businesses

There are many communities and civic organizations that would welcome any form of EMS education we are willing to provide. Assisted living facilities, Girl/Boy Scout troops, Churches, businesses and other City departments are likely target groups. The information we can share could include injury prevention, simple operational information, and how to receive basic first aid and CPR training for their members or staff. A successful program would bring these groups to bear in the community as our allies. Through this type of outreach and public relations effort, the goals and practices of the Department will be better understood by the public. This improved understanding and knowledge should induce a better reaction and cooperation during actual EMS events in the community. CERT and Citizen CORPS (FEMA) programs could be an extension of this type of program.

Community first aid, CPR and AED training

The public is not integrated into our current EMS system. Most see an ambulance for the first time when they call 911, or are on the receiving end of our services. Very few know CPR or basic first aid, which makes them less likely to react properly, or be willing to follow CPR instructions effectively, if at all. Training in these skills will instill proper reaction to these events, and effective intervention by the lay-public prior to our arrival. An involved and educated public can improve patient outcomes and reduce unnecessary calls. Many agencies, including King County, Washington (Seattle & King County EMS, 2011), Boston EMS, and FDNY (New York City Fire Department), have already demonstrated the effectiveness of this training. Several organizations; Medtronic, Leardal, and the American Heart Association (AHA), offer programs and resources to accomplish basic first aid, hands-only CPR and AED training.

EMS family advocate

In addition to public education there is a demonstrated need for provider education within the department. The easiest and most beneficial programs are EMS family advocacy and EMS liaison training. Our providers and Officers should be trained to act as family advocate on critical calls where family need emotional support, explaining the care being given, the necessity for treatment, and the need for cooperation during a significant event involving a loved one. By providing kind and compassionate care for the family as well as the patient, the department will enhance its public image and avoid causing undue distress to friends and family of the patient. Other agencies, such as King County, Washington (Neumar, 2011, p. 2900), have demonstrated the effectiveness of treating significant EMS incidents much like a fire incident, with assigned roles, and a command structure which would include a family advocate position, and tracking of benchmarks.

EMS Liaison for health care facilities

Many facilities we deal with on a daily basis are not aware of the capabilities of our system or the needs of our providers when they request patient transports. This leads to misunderstanding, frustration, and inappropriate use of resources. For a relatively small investment in time, our patient care partners could be educated to understand our needs when receiving a patient for transport, and the available non-emergency transport resources. This type of interaction with our counterparts will establish a good starting point for bringing greater healthcare system integration as suggested by the IAFF (IAFF-Department of Emergency Medical services, 1997, p. 18). Such a program also compliments suggested changes proposed by The EMS agenda for the Future (National Highway Traffic Safety Administration, 1996, p. 10).

How will EMS public education be implemented?

The implementation of these initiatives should involve personnel that embrace the EMS mission and the goals of this education program. Making duty assignments for personnel otherwise inclined will inhibit, if not prevent, the success of the programs. The message should be pushed out, promoted, and implemented as quickly as possible to maintain momentum and achieve measurable results in a reasonable time. The entire process needs to be open, keeping in mind that the cooperation, and involvement of the members of the department, is as important as that of the public. EMS public education may need to be completely separated from existing fire prevention programs, including fire truck demonstrations and station tours, to avoid being marginalized or lost in the more dramatic and colorful fire prevention and life safety messages. Perhaps with time this perception and promotion issue will abate. NHTSA (NHTSA, 2006) has published an implementation guide for the EMS Agenda for the Future, which contains specific recommendations directly related to this issue. Other resources include the Public Information, Education and Relations in EMS (PIER) manual, also published by NHTSA. This proposal incorporates many of these recommendations and suggests this outline for the programs proposed:

Web-Based Prevention, Education and Participation (PEP) program

Develop and publish online resource for PEP.
Link to developed local, state, federal and private resources that are already developed.
Provide locale and service specific information and contact points.
Solicit feedback, Monitor and update frequently.
Use as contact tool for direct programs & volunteer opportunities.

Awareness program

Identify qualified and committed personnel.
Develop a general information program about our mission and validate it.
Create list of potential organizations without prejudice (include all).
Make contact with community, provide information, and offer services.
Schedule presentations and dedicate time to complete program.
Give presentation, encourage feedback and record comments.
Provide report, need for re-contact for training.

Community first aid, CPR and AED programs

Identify qualified and committed personnel.
Adopt or develop curriculum and validate it.
Promote the program within the community.
Create target group list, use contacts from awareness program.
Make contact with organization, explain and schedule the program.
Conduct class on schedule without interruption.
Issue certificates, publish roster in local paper.
Create database of attendees for follow-up.

EMS family advocate

Create curriculum for EMS PIO course, validate.
Consider making the curriculum part of regular recertification requirement for all providers.
Identify who must assume this responsibility during calls.
Require this course for all EMS supervisors and company officers.
Create SOP or directive to address responsibility and performance expectations.
Follow up on any questions not answered during presentation.

EMS liaison for healthcare facilities

Identify qualified and committed personnel.
Identify issues and create talking point list, validate.
Create list of facilities to contact.
Include hospitals.
Schedule visits and dedicate time for meeting.
Listen to their needs and present our concerns.
Develop plan jointly to improve performance.
Create facility point of contact list.
Follow-up on issues, work toward resolution.

Conclusion

These proposals are ambitious; there will undoubtedly be some push-back until everyone understands the full scope, goals and benefits of these programs. With time a perceptible change in attitudes toward EMS, and EMS education within the department, and among the public should be observable. This can be enhanced and reinforced by making the other necessary system changes as well. The Department's position as EMS provider for your city may already under scrutiny; many systems across the nation have been dismantled, or reorganized, because of failure to adapt to changes in the field of EMS system deployment, resource management, and patient care standards. Your department should consider the merits of these programs and develop them for the good of the public, the providers, and the organization.

References

AHA. (n.d.). Hands only CPR. Retrieved March 18, 2012, from American Heart Association: http://www.handsonlycpr.org/

FEMA. (n.d.). Citzen CORPS. Retrieved April 4, 2012, from http://www.citizencorps.gov/index.shtm

GovTrack.US. (n.d.). H.R. 3144: Field EMS Quality, Innovation, and Cost Effectiveness Improvements Act of 2011. Retrieved April 8, 2012, from Govtrack.us: http://www.govtrack.us/congress/bills/112/hr3144/text

IAEMSC. (n.d.). IAEMSC-homepage. Retrieved April 8, 2012, from International Association of Emergency Medical Services Chiefs: http://www.iaemsc.org/

IAFF-Department of Emergency Medical services. (1997). Emergency Medical Services-Adding Value to a Fire-based EMS system. International Association of Fire Fighters.

Institute of Medicine of the National Academies. (2007). Emergency Medical services at the Crossroads. Washington D.C.: National Academies Press.

Johnson, K. (2011, September 18). Responding Before a Call is Needed. Retrieved April 4, 2012, from New York Times: http://www.nytimes.com/2011/09/19/us/community-paramedics-seek-to-prevent-emergencies-too.html?_r=3

NAEMT. (n.d.). NAEMT-Mission Statement. Retrieved April 8, 2012, from National Association of Emergency Medical Technicians: http://www.naemt.org/about_us/our_mission.aspx

National Highway Traffic Safety Administration. (1996). Emergency Medical Services Agenda for The Future.

NEMSMA. (2010). National EMS Management Association Strategic Plan 2010. Retrieved April 8, 2012, from National Emergency Medical Services Management Association: http://www.nemsma.org/AboutNEMSMA/StrategicPlan/tabid/420/Default.aspx

Neumar, R. e. (2011). Implementation Strategies for Improving out-of-hospital Cardiac Arrest in the United States: Concensus recommendations From the 2009 American Heart Association Cardiac Arrest Survival Summit. Circulation: Journal of the American Heart association, 2900.

New York City Fire Department. (n.d.). CPR to Go program website: http://www.nyc.gov/html/fdny/html/general/registrations/cprtogo/index.shtml. New York, New York.

NHTSA. (2006). National Highway Transportation Safety Administration; Implementation Guide- EMS Agenda for the future. United States Department of Transportation.

Seattle & King County EMS. (2011). 2011 Annual Report to the King County Council, p32. Seattle & King County, Washington.

VAOEMS. (n.d.). Virginia Office Of Emergency Medical Services State Strategic and Operational Plan 2010-2013. Virginia Department of Health.

Appendix I

Prevention, Education and Participation (PEP) program website

Vision

A universally useful and effective website for all individuals, groups and organizations needing information, materials and resources related to EMS services, improving outcomes, injury prevention and reaction to emergencies. A resource so compelling and engaging that it affects public perception, reaction and health behaviors. A continually evolving and dynamic resource that is recognized by the community and the broader health professions as a model for public education.

Purpose

This website will convey information via web links, video links and text on a variety of topics affecting public knowledge, perception and reaction to medical emergencies and injury prevention. It will integrate with online resources of the Fire Department, the Virginia Department of Health, The National Highway Transportation Safety Administration, and other resources that provide useful information supporting this message.

Organization

Ideally the webpage will located through the Fire Department website-Public Education, being a distinct and separate from Fire & Life Safety. It needs to depart from the usual and traditional to be effective. The site will be very interactive and engaging, provoking reaction and engagement by the user. The webpage should be easily searchable and discoverable by both internal and external users searching relevant terms.

Website Outline

Public Education Resources-linked externally via keywords

EMS System

How our system works-video

Reaction to emergencies

Chest pain recognition and reaction

Stroke recognition and reaction

Mental Illness

Other emergencies

In the home

In Public

On the road

Additional training resources

Hands only CPR

First aid

Babysitting programs

Injury Prevention

Fall Prevention

Severity of the fall problem

Self-assessment

Home survey

Other resource links

Bike Safety

Rules of the road

Helmets and helmet laws

Other resource links

Boater Safety

Water safety

Safety equipment

Water sports

Hunting & Firearm Safety

Hunter Safety programs

Firearm safety programs

Motor vehicle safety

Motorcycle safety & awareness

Seat belts & car seats

Towing and hauling

Pool & water Safety

Pool safety

Learning to swim

Other resource links

Poisons and chemicals

Poison Control

Safe handling

Disposal

Powered equipment

Tractors and mowers

Power tools

Head injury & concussion

Consequences of repeated head injury

Recognition and grading tools

Avoiding head injuries

Other resource links

Request a home survey

Request a presentation for your group

Sponsor a community event or prevention program

Sunday, August 3, 2014

Organization Survival Management

Organization Survival Management

By Alan Perry

August 3, 2014

I think that many public safety administrators and their organizations struggle with attitudes and traditional beliefs supporting the notion that they are somehow insulated from change by the slow moving wheels of government. The recent history of public safety organization survival challenges can be easily related to the organization’s ability to manage change. Redirecting this traditionalist mindset that believes rapidly changing best practices, regulations, and political pressure do not affect them is truly challenging. There are several constructive pathways out of this situation if the leadership and each of its members are truly committed to improving the organization. There is no silver bullet, every organization is different and must work within certain parameters defined by local government, a budget, human resource limitations or a myriad of other possible roadblocks. The obstacles to improving your organization’s agility, effectiveness and value can be stubborn and will persistently test your resolve.

Our Duty

Our duty, as public resources who exist because of public need and financial support, is to provide the highest quality and most cost-effective service we can with the resources we are provided. We do not have the power or authority to go beyond that; or do we?* we can analyze the attitude of our organization toward change and look in the mirror ourselves asking the questions that need to be asked. Change is a two edged sword, it is rarely a clearly defined or single item that is involved. If not carefully made, changes get bad reputations, leading to skepticism and push-back when implemented. If not made in a timely manner, other less desirable organic solutions may take root or we may miss the opportunity altogether appearing inept and unable to catch up. We cannot prevent change from occurring, it is desirable to recognize and implement timely, appropriate and responsible change in an efficient and predictable way.

Promotion

The attitude of the organization will mirror the collective attitudes of the members of the organization, with those placed in leadership roles exerting greater influence in most cases than the front line professionals. We have after all; given those we promote the ideological nod, reaffirming their personal characteristics and management style. These ranking members are frequently the source of information, and direction for the organization even though they may not be functioning on the front line and may not have done so for a considerable length of time. An organization can easily fall into the trap of hiring and promoting those who do not challenge the status quo and fit a narrow ideological and personality profile. The survival and vitality of the organization will depend on creating diversity in this process, providing a more balanced resource for managing change and avoiding groupthink. We should look for those who respectfully challenge the status quo and explore new and better ways of delivering service in the promotional process and abandon the search for dinosaur eggs.

Hiring

Those entering public service are frequently termed “type A” personalities which loosely describes people who are self-motivated, enjoy challenges and are assertive; all desirable qualities in public safety. Those we hire tend to fall into even more narrow categories depending on the evaluation criteria. The lack of diversity in public safety is widely known. Any selection process can allow personal and organizational bias to affect an objective outcome. Much like a promotional process, the individuals selected to review the applications, do back ground checks, and conduct interviews are selected by the administration because of some characteristic that is valued. These individuals in turn will seek out individuals that have characteristics they prefer, likely similar to their own, perpetuating the organizational culture. Does your process intentionally exclude those who challenge authority, are too analytical, or confrontational? The body is made up of many different tissues, each one essential to our existence, an effective and responsive organization must have variety in its membership, each working cooperatively to help it meet its mission and survive.

Communication

The dissemination of information throughout an organizations structure is essential to effective management, including managing change. Clear communication of new ideas, better ways of doing things, discovery of new challenges, and solicitation for feedback, must occur unimpeded by artificial barriers and tradition. Every organ system in the human body works together to assure the survival of the body, every member of your organization should be given the opportunity to do the same for your organization. An open communication system that permits sharing of ideas and providing bi-directional feedback laterally and vertically within the organization will remove obstacles and improve the speed of communication of ideas and needs. When you burn your finger two things happen; a message goes to your brain informing you that it’s hot, and a message goes directly to the muscle resulting it the reflex removing your finger at nearly the same time your brain feels it. Wouldn’t it be great if your organization could perform that efficiently? How do you think a homogenous workforce reacts to detecting and managing change?

Justifying Change

Not all change is good or necessary and change occurs for many reasons. Legitimate change improves performance, efficiency and effectiveness, positively affecting the value of the services provided by the organization. Other changes occur due to regulatory or legislative mandates, budget priorities, politics, special interest, personal preferences, changes in administration, because everyone else is, and because it is the path of least resistance. In these cases there is frequently an unsubstantiated need for the change with no tangible benefit. True change will have a defined goal, represent an evolution rather than change alone, and have a purpose with measurable results. In public safety change should have the added objective of improving the value to the public.

*Or do we?

Insert can of worms here. We affect the attitudes and perception of the public on a daily basis. We engage in public safety education and are routinely in the public eye. Our organizations are held in the public trust and administered by Federal, State & Local Government bodies that control the environment we must operate in including our administrations and budgets. Many of us are prohibited from inducing the public to intervene in governmental affairs affecting the organization we are affiliated with, others are not-but the activity is still frowned upon. If public policy or legislation is affecting your ability to make a meaningful change, then confronting that limitation, and compelling its justification, or requesting that it be modified, should not be construed as a hostile act. Any public safety worker, or administrator working for the public good could, and should, seek to educate the public of the particulars and seek their support, if not their active participation, in removing the obstacles.

Get out of the office

As soon as a public safety worker comes off the front line their perception of the organization (and reality) changes, yet they are now tasked with guiding the path for the organization. The only way to overcome this is to get up and get out on the street with some frequency and understand how your staff are interacting with and serving the public today. It is a very dynamic environment we work in today, things change almost daily, a sabbatical from the street of 3 months may as well be 3 years. It will be impossible to relate with the needs of the public and your personnel from a desk, an open communication policy will help, but it is no substitute for the raw nuances of the personal interactions and the spontaneity of the feedback you can appreciate in those encounters. You can more genuinely understand you organization and its needs through close personal interaction and more effectively recognize the state of your organization.

Thriving is preferable

Change is required for survival in public safety management. If you put this article down thinking you are safe with surviving and managing change, you have missed my message. Change is inevitable, learn to master it, embrace and love it. Loose the negative attributed to change, it’s not a negative, the changes you make and instill in your organization will be grounded in need and produce value for the public and your people. You and your whole organization can come out of the bunkers and silos, skip through the fields of success, and bask in the sunshine of positive public perception. You and your organization will become agents of change, showing others the way to high performance in public safety.

Be Adaptable,

Monday, June 23, 2014

Opportunities for Improvement

Opportunities for Improvement in the Fire Service

Staffing- Create a staffing model that is flexible and reliable

· Role of EMS Supervisors- oversight, training, administrative, caregivers, coach.

· Create clear career path for battalion level EMS officer, examine rank structure.

· Create equity among various classifications- no divisions in workload based on level of EMS training; everyone should be involved in providing EMS service and transport.

· Examine and identify ways to increase numbers of paramedics to facilitate move to all/more ALS apparatus.

Deployment- Create a more equitable and responsive deployment model

· Seek to distribute call volume among all units more equally.

· Cover areas with high call volume with multiple units.

· Create flexible company structure that permits deploying assets based on nature of call.

· Consider options to sending entire engine companies to EMS calls, public assists and courtesy calls.

Training- Create EMS training that is innovative and supportive

· Move to competency based system.

· Role of training division- more emphasis on EMS topics.

· Use of training medic for monthly skill drills.

· Use of some sick leave for elective training.

· Annual MCI training & drills.

· Quarterly BLS/ALS protocol and medication test (exambuilder).

· Integrate new education standards to lessen hardship of transition.

· Include training/obstacle course for patient lifting and moving.

Providers- Enhance the competency, consistency and confidence of EMS providers

· Monthly skills drill based on EMT practical tests.

· Encourage outside and elective EMS training.

· Encourage/train in injury reduction practices related to lifting/moving.

· Scenario based team management training.

Apparatus- Assure apparatus functionality and reliability

· Better oversight of repair & maintenance.

· Reduce cost through preventive services, reduced down time & repeat services.

Administration- Be part of an enabling and responsive administration

· More involvement with front line staff.

· More involvement regionally, i.e. TEMS, other localities, VAOEMS.

· Open communication policy.

· Transparency in decision making process.

· Create a Citizen advisory board.

Communications- Improve communications practicality and efficiency

· Implement true EMD system- priority dispatch single unit based on nature of call.

· Correct shortcomings of HealthEMS- system speed, web filtering, spell check, terminology, use of station computers, additional fixed data entry stations at hospital.

· Integrate/eliminate redundant systems that increase workload with no benefit.

· Examine alternative platforms i.e tablets, ipads, iphones

· Install appropriate mounts in patient care area on medics for laptops.

· Perform hearing protection study, and install headsets on all medics if warranted.

Public Education- Develop or enhance education programs that will benefit citizens.

· Build a pro-active public education program to dovetail with fire prevention programs.

· Investigate and implement program to facilitate proper medical emergency reaction from public.

· Provide more EMS education opportunities for the public.

Volunteers- Improve volunteer recruitment and retention

· Investigate attitudes and barriers to EMS volunteerism.

· Develop pool of potential career providers.

New Opportunities- Look for new opportunities to improve efficiency and value

· Develop new delivery methods- community paramedicine, well checks.

· Create liaison for nursing facilities & assisted living facilities.

· Investigate provision of transport services for non-emergency patients.

· Integrate with public health, community services, social services and hospitals.

EMS Public Education Proposal

Alan E. Perry

Abstract

Introduction

The power of public education has been demonstrated by the results of Fire Safety and Prevention programs nationally. It seems reasonable to conclude that the same methods and tactics can be applied to Emergency Medical Services (EMS), with similar results. Advocacy and collaboration in the field of EMS are a stated goal of the National EMS Management Association’s Strategic Plan (NEMSMA, 2010, p. 4) , and others (IAEMSC) (NAEMT) (NHTSA, 2006, p. 8) (VAOEMS, p. 5)who have conducted recent research toward improving EMS system performance. Many systems have already documented the effectiveness of such programs in improving patient outcomes (Neumar, 2011), reducing nuisance calls (Johnson, 2011), improving public reaction to medical emergencies, improving employee morale, and reducing costs. Any one of these benefits is desirable and seems to justify exploring these programs. No national standard currently exists for EMS public education although it is clear the field of EMS is headed in that direction. A proactive approach to EMS system management will place the organization in a positive light with all stakeholders, and demonstrate to the public and employees, that the Department is competent to continue providing this service.

What is EMS public education?

EMS public education is a tool; a tool which will accomplish the goals of improving patient outcomes, system performance, system efficiency, provider morale and public awareness. Through education the organization’s goals can be communicated clearly and consistently to the public. The key components of EMS public education are awareness of the function, capabilities and needs of the EMS system, proper reaction to EMS events, and how to participate in and facilitate the operation of the EMS system. Through such programs the community may become involved to whatever extent each individual is comfortable doing so, while building trust in, and understanding of the organization. Such education is preferable to the speculation, rumor and disinformation that may fill the void in the absence of a solid public education program. Fire and Life Safety programs do not fully accomplish the goals of EMS public education.

How will EMS public education benefit the patient?

Patient outcomes are directly linked to treatment throughout the continuum of care, from the initial public reaction to the event, through discharge from the hospital and beyond. EMS public education should seek to add the general public or layperson to that healthcare team, and thereby improve the quality, and efficiency, of the delivery of care. By doing so, recognition and appropriate reactions are achieved, and initial care is provided within the critical window required for survival from the most serious medical events. Even in less serious medical emergencies, the time to an initial intervention has an effect on morbidity and mortality (National Highway Traffic Safety Administration, 1996, p. 37).

How will EMS public education benefit the public?

The public has a vested interest in the performance of the municipal EMS system. This system affects the quality of life in the city, intermittently touching the lives of nearly every citizen. A system that can operate efficiently and produce superior outcomes is an asset to the taxpayer, both as a resource and an investment. EMS public education programs provide a benefit to the public, and simultaneously improve the performance of the system. The monetary and human cost savings that can be realized should be considered when calculating the cost of providing this service and determining the level of support it receives.

How will EMS public education benefit the Department?

Offering citizens participation in the system, gives the public a shared stake in our performance. The benefits of greater community involvement extend beyond the effect on outcomes and efficiency. Greater understanding of the EMS system, its challenges, needs, and goals, by the public, will lead to greater support on a wide range of issues. An effective EMS education program will inform the public, and garner their support for our goals of improving patient outcomes and overall system efficiency. With this knowledge, they will be able to exert influence for our benefit during emergencies, when decisions are being made by local government, or when legislation at the state or federal level is presented that affects delivery of EMS services. The department may also realize improvements in employee morale and a reduction in unreimbursed nuisance calls as a result of improved communication with the community.

How will EMS public education be paid for?

What EMS public education is appropriate for the The Fire Department?

· Awareness programs for communities, civic organizations, and businesses

· Community first aid, CPR and AED training

In addition to public education there is a demonstrated need for education within the department. The easiest and most beneficial programs are EMS family advocacy and EMS liaison training.

· EMS family advocate

Our providers and Officers should be trained to act as family advocate on critical calls where family need emotional support, explaining the care being given, the necessity for treatment, and the need for cooperation during a significant event involving a loved one. By providing kind and compassionate care for the family as well as the patient, the department will enhance its public image and avoid causing undue distress to friends and family of the patient. Other agencies, such as King County, Washington (Neumar, 2011, p. 2900), have demonstrated the effectiveness of treating significant EMS incidents much like a fire incident, with assigned roles, a command structure, which would include a family advocate position, and tracking of benchmarks.

· EMS Liaison for health care facilities

Many facilities we deal with on a daily basis are not aware of the capabilities of our system or the needs of our providers when requesting patient transports. This leads to misunderstanding, frustration, and inappropriate use of resources. For a relatively small investment in time, our patient care partners could be educated to understand our needs when transporting a patient, and the available non-emergency capability we possess through our NETCARE program. This type of interaction with our counterparts will establish a good starting point for bringing greater healthcare system integration as suggested by the IAFF (IAFF-Department of Emergency Medical services, 1997, p. 18). Such a program also compliments suggested changes proposed by The EMS agenda for the Future (National Highway Traffic Safety Administration, 1996, p. 10).

How will EMS public education be implemented?

The implementation of these initiatives should involve personnel that embrace the EMS mission of the department, and the goals of this education program. Making duty assignments for personnel otherwise inclined will inhibit the success of the program, allowing a further digression of morale within the department. The programs should be pushed out, promoted, and implemented as quickly as possible to maintain momentum and achieve measurable results in a reasonable time. The entire process needs to be open, keeping in mind that the cooperation, and involvement of the members of the department, is as important as that of the public. EMS public education needs to be completely separated from existing fire prevention programs, including fire truck demonstrations and station tours, to avoid being marginalized or lost in the more dramatic fire prevention and life safety messages. Perhaps with time this perception and promotion issue will abate. As an additional resource, NHTSA (NHTSA, 2006) has published an implementation guide for the EMS Agenda for the Future, which contains specific recommendations directly related to this issue. This proposal incorporates many of these recommendations and suggests this outline for the programs proposed:

Awareness program

1. Identify qualified and committed personnel.

2. Develop a general information program about our mission and validate it.

3. Create list of potential organizations without prejudice (include all).

4. Make contact with community, provide information, and offer services.

5. Schedule presentations and dedicate time to complete program.

6. Give presentation, encourage feedback and record comments.

7. Provide report, need for re-contact for training.

Community first aid, CPR and AED programs

1. Identify qualified and committed personnel.

2. Adopt or develop curriculum and validate it.

3. Promote the program within the community.

4. Create target group list, use contacts from awareness program.

5. Make contact with organization, explain and schedule the program.

6. Conduct class on schedule without interruption.

7. Issue certificates, publish roster in local paper.

8. Create database of attendees for follow-up.

EMS family advocate

1. Create curriculum for EMS PIO course, validate.

2. Consider making the curriculum part of regular recertification requirement for all providers.

3. Identify who must assume this responsibility during calls.

4. Require this course for all EMS supervisors and company officers.

5. Create SOP or directive to address responsibility and performance expectations.

6. Follow up on any questions not answered during presentation.

EMS liaison for healthcare facilities

1. Identify qualified and committed personnel.

2. Identify issues and create talking point list, validate.

3. Create list of facilities to contact.

4. Include hospitals.

5. Schedule visits and dedicate time for meeting.

6. Listen to their needs and present our concerns.

7. Develop plan jointly to improve performance.

8. Create facility point of contact list.

9. Follow-up on issues, work toward resolution.

Conclusion

These proposals are ambitious; there will undoubtedly be some push-back until everyone understands the full scope, goals and benefits of these programs. With time a perceptible change in attitudes toward EMS, and EMS education within the department, and among the public should be observable. This can be enhanced and reinforced by making the other necessary system changes as well. Your Department’s position as EMS provider is already under scrutiny; many systems across the nation have been dismantled, or reorganized, because of failure to adapt to changes in the field of EMS system deployment, resource management, and patient care standards. Your Department should consider the merits of these programs and develop them for the good of the public, the providers, and the organization.