EMS
Public Education Proposal
Alan
E. Perry
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 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 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.
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 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?
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
the The Fire 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.
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.
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.
