Monthly Archives: March 2013

What is "Performance" in EMS? Part 4

This particular series began with the new year in thinking about the characteristics that make and keep an EMS as an efficient, High Performance system. The previous criteria were all focused on factors including Response TimeEffective Care, and being “Community Connected.” Each of these criteria obviously affects patient care either directly or more indirectly as part of the community, but in order for a high level of performance to be sustainable in an agency, it must take the welfare of the providers themselves into account.

Part 4: Provider Culture

Protocols and Standards of Care are documents that describe what should be done for patients, however these actions must be implemented by the people who work for a service. Since the quality of care (and even patient satisfaction) is exclusively implemented by these individuals, often in extreme conditions, it seems counter-intuitive that the jobs they fill are regularly listed in surveys of The 10 Most Underpaid Jobs. Part of the reason the pay remains so low for a position that is so widely recognized as being critical by the public is that it is still seen as a vocation taught at community colleges and even high schools rather than as a profession. In some cases, EMS is even treated as a certification that simply becomes a gateway to another job.

The demands on Emergency Medical Technicians (EMTs) and Paramedics is strenuous both physically and mentally. Some statistics I have heard suggest that one in four EMS workers will suffer a career ending back injury within the first 4 years of service while others may last only 5 years before the accumulated stress becomes almost intolerable. Those who make it longer often become jaded and cynical due in part to monotony or exposure to patients who seem to routinely abuse the system. It is important that the culture of a highly performing EMS service not view an employee seeking help in dealing with stress as being weak but rather look to support that comrade through their feelings. There are resources readily available to help EMS personnel facing burnout Learn to Cope with Stress. From a very practical perspective, it is typically cheaper to retain a senior employee, even one facing issues, than it is to train a new hire in the organizational way of thinking.

Another real fear that EMS agencies should understand is the problem of complacency. Disengaged employees cost the US economy around $300B year. And worse yet, for EMS agencies, this behavior means lawsuits, bad press, patient dissatisfaction, and employee retention problems. A service culture than promotes performance encourages positive role mentors at all levels. It is important to pay attention to the characteristics of new hires and to personally examine what type of personality you bring to your organization. The chart to the right highlights some important character traits to look for in potential employees as well as yourself.

There are two ways to look at the problem of employee satisfaction: is your service hiring the right sorts of people and are you the type of person that the service you actually want to work for is actively hiring? If you don’t know what the criteria of a good employee are, here are 8 Qualities To Look For When Hiring A Responder. But again, the other consideration is whether your service is a place with whom professional minded individuals are interested in working. Here are 6 Culture Building Principles for Your Response Team that promote professional performance and loyalty within the organization.

Leadership is key to authority in any group. Unfortunately, the only form of authority that can be confirmed on anyone is just “command.” The role of “leader” must be earned. True leadership comes from developing respect, not demanding loyalty. It is developed through an understanding of the job you request others to perform and an appreciation for the way the tasks of that job are carried out. A high performing EMS promotes a “just culture” where positive behavior is rewarded at least as much as poor behavior is reprimanded.

Just as their is no single “correct? model for EMS delivery, there is no single pattern of employee relations. Professionally minded employees must find the right service provider culture for them. Similarly, agencies should demand high performance from those who wear their uniform in order to instill pride both ways.


Filed under Administration & Leadership, Command & Leadership, EMS Health & Safety, EMS Topics, Funding & Staffing, Line of Duty, Training & Development

Quick Thoughts from EMS Today 2013 Conference

Since the EMS Today conference for 2013 started a week ago I know that my thoughts at this point can hardly be considered “quick” any longer. However I wanted to share my experience of the highlights from this event anyway. JEMS has always been known for putting together a great product whether in print or performance and this show was not a disappointment. While I have not heard about attendance figures, it did seem just a little smaller in Washington, DC this year compared with Baltimore last year. I also had a hard time capturing a single shared mood or tone for this year. Perhaps it was the cancellation of my pre-conference course and inability to get registered into any others that may have set me off on the wrong foot. Especially easy to do after a day of work followed by an evening Con Ed class and an all-night drive to beat the forecast “Snowsquester? that was sure to shut down DC. But it didn’t take long to begin catching up with colleagues and realize there were fewer flakes than predicted.

Wednesday: Improvisation is a primary characteristic of both EMS professionals as well as politicians. Fortunately, both implemented plenty of it on Wednesday during a modified “EMS on the Hill Day” event sponsored by NAEMT in conjunction with the conference. While not as many elected representatives were available as hoped due to a weather-related shut down, there was opportunity to explain the impacts of legislation such as PPACA (“ObamaCare”) and the Field EMS bill on our industry to those who knew where it was happening. (An awareness shared by those attendees who participate in social media at conferences.) This is an important annual day of advocacy open to all EMS professionals who register in advance and one that everyone should be involved in supporting. As representatives were found to be available, they were visited by attendees on your behalf.

For those of us attending the impromptu hotel meeting, we heard several good speakers on topics passionate to them. Matt Zavadsky of “MedStar Mobile Healthcare” (formerly ‘MedStar EMS’) discussed his agencies view of changes to the industry saying “we are not Emergency Medical Services (any longer), we are Unscheduled Medical Services.” Others, like Chris Montero, spoke on our increasing role in public health and promoting community paramedics. One easy example was assisting with “mobile immunizations” for the community (or what was jokingly termed “drive-by shootings”). Later in the evening JEMS announced the “EMS 10” Award Recipients for 2012 at a special gala event recognizing those who drove the EMS profession forward. It is definitely worth reading through the accomplishments of these individuals and agencies and commit to continue their work nationally. LeFlore County EMS located in “super rural” Oklahoma, just as an example, improved their save rate from 6% to 40% and has not failed an intubation in 3 years.

Thursday: By far the busiest day with endless concurrent sessions. I tweeted as many of the pearls of wisdom that I heard live as fast as I could. Whether you are attending a conference or not, the ability to share knowledge through social media at an event like this is incredibly valuable. For those at home or on the job, it was their first opportunity to hear even pieces of great lectures and those in the same room get to hear what resonates with others immediately. One of the key points I took away from this day of courses was that as an industry, we need to communicate that EMS response is more than a measure between receiving a call in the dispatch center and the wheels of an ambulance hitting the curb at the scene. It is also important that we “take stock of our dysfunctions in order to embrace the change that means improvement for the benefit of our patients.”

Representatives from the “Gathering of Eagles” presented in a forum session where several “sacred cows” of pre-hospital care were lined up for the slaughter. Such controversial ideas as: “IVs being the only method to administer drugs is becoming an antiquated idea”; “to save patients as well as money, focus on driving safety and alternate endpoints for treatment?; or “where are the papers that support the benefits of the backboard?” Cervical collars, it was argued to the delight of the crowd, properly strapped with patient on a stretcher can be safer than a “slip-n-slide” (i.e. “backboard” which can add to compression/decompression injuries during transport.) I know many of us are watching intently for the paper coming soon on new ideas for spinal immobilization. In short, the best summary of the “Eagles? session was “everything is changing.”

Another informative and challenging session was “What EMS has Learned from the Iraq and Afghanistan Battlefield” with Peter Taillac. Much of this presentation focused on the return of the tourniquet. This device, according to Tallic, got a bad rap because there was historically no evacuation plan once applied, but more recent research shows that survival rates for patients are 96% if a proper tourniquet is applied before signs of shock are present while rates decrease rapidly to only 4% when it is used only as a “last ditch effort.” The other challenge to traditional thinking was stated clearly in the thought that “only a doctor can remove a tourniquet is bullshit.? Medics should apply tourniquets early, as indicated, but reassess the need for a tourniquet during transport and remove if possible. One warning, however, is that if blood pressure increases after removal, the likelihood of “popping a clot? increases too. However, he contends that the goal of an IV is to prevent shock by maintaining perfusion not returning normal blood pressure in the field. Tallic also praised topical hemostatic agents when used properly but chastised the industry in general saying that typically “EMS sucks at pain control.”

The opening ceremonies on Thursday night had all of the requisite pomp and ceremony to make any fire-based EMS service feel comfortable. But it was all pure EMS history as Dan Swayze of the Center for Emergency Medicine in Pittsburgh (CEM) led the audience through a dramatic trip of historic “pre-hospital medicine firsts.” I know I had personally wondered where some practices came from, but it was definitely thought-provoking when Dan asked, “so, you are the first person to ever attempt increasing blood flow with direct intravenous fluids, how do you do it?” Following this presentation, the exhibit hall was officially opened and I got to attend the premier of the latest Code STEMI video in the inspiring FRN series taped this time at the world’s busiest EMS service. Take a look and share it as part of the “Community Connected” initiative I mentioned in my last post.

Friday and Saturday: Continued more sessions and time in the exhibit hall as well as annual favorites like the JEMS Games and the Cook-Off Challenge. Unfortunately, I had to leave before the closing ceremonies and last session, “Gaining and Keeping the Public’s Trust” by a popular and entertaining speaker, Gordon Graham. I do look forward to next year though and hope to see you there.

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Filed under Administration & Leadership, EMS Topics, News