EMS Anxiety

EMS (Supply) Anxiety

By Alan Perry

February 29, 2016

What causes EMS supplies to be stockpiled on your medic or in your station? Is it insecurity or anxiety about a procedure? An unreliable EMS supply system? Lack of communication? A fear of an MCI event? In the ideal EMS supply system all units carry the same equipment and supplies, stocked at pre-defined levels, to assure that units can remain functional without unreasonable delays in restocking them. Unfortunately the practice of EMS supply hoarding, whether on the medic or in the station, confounds this goal. It drives up the cost of consumable items by increasing inventory levels while taking them out of circulation where they frequently become damaged or expire. That creates some of the very problems that the hoarding strategy seems to be trying to avoid, namely unpredictable stock levels or out-of-stock items.

I believe fear can be a factor, although an irrational one, it seems some of the supplies most likely to be overstocked are related to ALS procedures (ET tubes), infection control (masks, gloves, etc.) and trauma supplies (kling, tape, bandages). Could it be that somehow having more of these items allows us to handle those situations more effectively, or are they serving as a security blanket?

Communication is also an important factor; if the apparatus get checked off every shift, supply orders are placed every shift as well. If the supply system is not responsive, and fails to fill the orders as they are received, it can easily lead to duplicate (triplicate, quadrupled…) orders unless providers communicate what orders they have placed to each other. If supplies are not kept in specific locations in specific quantities this will lead to items being kept in multiple locations in variable quantities. The system should define what, where and quantity for items stocked on each piece of equipment. In most Fire-based EMS systems and volunteer systems, there is also a high degree of staff variability on each transport unit, frequently only a single shift assignment a month or pay cycle. In that situation you have little ownership of the apparatus or continuity in its care and restocking, both of which further confound the issue.

Most EMS systems now have dedicated resources they can rely on for MCI events. While a medic may be sacrificed in some instances to manage an MCI incident the majority of units will be used for treatment and transport of single patients. There really is no need to equip each ambulance with enough nasal cannulas, ET tubes and 12x30 trauma dressings to treat a dozen victims –that’s an irrational fear.

The reliability and of an EMS supply system will affect its efficiency. If your providers know the supply system is reliable and responsive to their needs they will be far less likely to set up individual stashes of these precious commodities on the medic or in the station. Providers should be aware of the consequences of these actions, which increase the cost to the organization, have a negative impact on its reliability as well.

Be safe,

Alan

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