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:
- 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.
- 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.
- 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.
- 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.
- 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
