Monthly Archives: December 2014

Looking Back to See Ahead: 2014 in Review

The end of the year is a great time to take stock in what has already passed and to make plans for the future. The vision I had when I started this blog four years ago was summarized in my first blog post, Hello World. Welcome to HP_EMS!  I’m glad to say that today, while many other things have changed about the business, that vision hasn’t strayed from the original intention of sharing news and trying to build community around the efficient and effective delivery of emergency medical care outside of the hospital environment.

Now, as I look back over this past year, I find it interesting to review which articles have generated the most interest. Topping that list was Rob Lawrences’ list on “11 of the Top 10 Tips for High Performing EMS.” I was so convinced it would generate some conversation that I “trickled” it out one point each day on the EMS Deployment Community of Practice to allow reader comments to be directed at each point. And I hope those comments continue to build. The second most active post was “Is ‘SSM’ Still a ‘Bad Idea’?” I hope it wasn’t just the way I phrased the title, but it may have been helped by timing it with the recognition of the lifetime accomplishments of Jack Stout at the Pinnacle conference or the release of a book I co-authored with John Brophy on “Dynamic Deployment: A Primer for EMS“. As any previous reader of my blog will know, I have a desire to improve the poor implementations of SSM and promote the successful ones.

We hear a lot lately about “Evidence-Based Medicince” (EBM) or “evidence-based practice” as it applies more directly to EMS. But we must sometimes learn how to interpret and apply these “best practices” as I tried to challenge readers in the next most popular post, “Could Busier be Better?” which showed evidence that “busier” services generally gave “better” care to patients. I also hear many comments about how the public is abusing EMS by not using our services “appropriately”. Just today, I posted the question on the High Performance EMS Facebook pagedo we provide the emergency medical services that the public wants, or are we trying to train the public to use the EMS services that we can provide?” It was gratifying to see so much activity on the corresponding post from October asking “Is our success a sign of our failure?” and an honorable mention to the later post “We Need Some New Stories” on the same theme.

I am also heartened to see that the fifth most popular post was about deeper engagement with peers on other social media outlets, specifically Twitter, from the post “Influencing Paramedics on Twitter.” It has never been my desire to create the most popular blog, have the most “Likes” on Facebook, or even the greatest number of Twitter “Followers”, but to simply spark meaningful conversation. It doesn’t immediately need to ignite significant changes either. I want to help people think differently about their job and gradually see new perspectives. I plan to remain in this field for the long haul. The business of EMS does not change quickly, but still change is coming nonetheless. I want everyone concerned to participate in that change and make intelligent decisions for themselves and their service to help us all deliver the best EMS care – whatever that might eventually mean.

The title I chose for that first post four years ago included the phrase “Hello World” as an acknowledgment that my background was in programming and business optimization consulting prior to becoming an EMT late in life and really starting to focus my work specifically in public safety. As I saw the emergence of social networking and its potential to affect change in industries, my hope was to leverage it to build an effective community around change in EMS. As I look back over the years, I find that while my intentions have remained resolute, the results have been skewed toward sharing news rather than building community. That is the reason I brought the idea of a “Community of Practice” to this page centered around EMS Deployment. I hope you will check it out and become part of the discussions on the future direction of EMS (or whatever it becomes.) My hope is still to build that forum of respectful community where both providers and administrators have a voice. Even though I am a relative newcomer to this field, I am a field provider like many of you. I am not an administrator, but my work also brings me closely into their world as an adviser. I hope this unique perspective not only gives me different insight, but that it inspires others in “mobile healthcare” to see things things differently in the coming year. So, here is to the prospect of a prosperous new year for all of us!

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Filed under Administration & Leadership, EMS Topics, Opinion, Social Media, Technology & Communications

What is CAEMS and Why Should I Care?

Two weeks ago, we started a Community of Practice to discuss EMS Deployment. The larger issue of deploying resources is all about efficiency and effectiveness in care, those are also the aims of any High Performance EMS group. However, that message is too often confused with meaning simply “better, faster, cheaper”, when in practice it must be rooted in “doing what is best for the patient” in order to be anything of lasting value.

In the following episode of ‘Word on the Street’, an EMSWorld podcast hosted by Rob Lawrence, representatives of the Coalition of Advanced Emergency Medical Systems (CAEMS) chat about the professional association and exactly what makes EMS systems “high-performance.” Give it a listen (or even download it) here:


Filed under Administration & Leadership, Dispatch & Communications, EMS Dispatch, EMS Health & Safety, EMS Topics, Technology, Technology & Communications, Training & Development

11 of the Top 10 Tips for High Performing EMS

Rob Lawrence, the Chief Operating Officer of Richmond Ambulance Authority, offered these tips as an article for publication in this blog, but we decided they would make good initial discussion points in an ongoing dialog with our readers and contributors. Consequently, each of these points is made as a separate page under the EMS Deployment Community of Practice link. For ease in reading the entire list, we have presented the original article here. I do ask, however, that any discussion of the specific points not be made in this general comment section, but directed to the comments of the appropriate section within the Community of Practice. Each heading is linked to take you straight there.

11 of the Top 10 Tips for High Performing EMS

1. Economic Efficiency
From an economic sense, the mission of EMS, or any other healthcare organization for that matter, is to “convert the amount of available budget money into high quality healthcare in order to produce excellent clinical outcomes.” Money is too tight to mention right now and the days of well-padded budgets are a thing of the past. Municipal coffers are shrinking for the public sector, collection rates and reimbursements are down for private EMS, and charitable giving and the donation of free time is fast disappearing in the volunteer sector. In other words, no matter the type or style of your organization, it must be run as a business, with an eye on the bottom line and a realization that EVERYTHING costs something.

2. Data is our Favorite Four Letter Word
In this day and age it’s difficult to believe that some EMS organizations think they have little or no management information. The actual situation is quite the contrary and individual data mines are bottomless. Information is freely available from call volume to patient condition to mean times between failures of vehicle components. When collected, collated and analyzed this information becomes a valuable intelligence product that can be acted upon to improve the next cycle of response, care and administration.

3. System Status Management (SSM)
System Status Management (SSM) is the science of being in the right place with the right resource at the right time to meet the patient’s need. Some say it is the practice of placing ambulances on street corners, but the crucial thing we must remember is that the patient is the one having the emergency so we must be poised to respond with minimal delay and maximum impact. SSM takes the intelligence products of demand analysis for both time and space and matches manpower and availability to deploy a responder as close to the patient as possible. This achieves a minimal response time for the patient and reduces time spent running under emergency conditions for the crew (and distracted pedestrians!).

4. Clinical Excellence
So far all the planning and data crunching has been devoted to the first 10 minutes or approximately 1/6th of the patient response episode. It is ironic that some organizations set their store in, and are judged on, their response times alone. It’s not “high performing” if you are good at racing to the scene only to be incapable of delivering the clinical goods on arrival. A well-trained workforce that has sufficient preception, mentoring and training, and is clinically current is an absolute requisite for success. To achieve this, the involvement and active engagement of the Operational Medical Director (OMD) must occur (often).

5. Lean Systems
EMS is not only response, treatment and transport – the back office and support functions are the “power behind the punch” of service delivery. The creation of lean, efficient and measurable systems is the key to success. An example of this is a high functioning fleet service. If your vehicles fail on the way to calls, then so does the mission. Keeping your organization well serviced and maintained is an arterial function and performance could hemorrhage if you can’t get to where you need to go. The swift conversion of treatment – to bill – to income is also an essential function. Remembering the economic requirement that we turn the amount of available funds into quality healthcare requires the generation of said funds to keep the EMS circle of life turning. While those in support functions are not delivering lifesaving and patient care, they keep the organization alive and healthy.

6. Culture of Safety
The Culture of Safety is perhaps surprisingly a new concept to some quarters of U.S. EMS. This is nationally apparent by a stream of Line of Duty Deaths (LODD) and devastating vehicle accidents that result in well publicized photos of ambulances splayed like bananas after impacts with both moving and static objects. An environment of cultured safety seeks to establish the root cause of these issues then put techniques, practices, procedures and philosophy in place to create a safe environment for all.

7. We Are Public Health As Well
When I go out and speak, I often ask the audience if they know who their Public Health Director is. Many do not, which is shameful. EMS enjoys its role in public safety and recognizes its place in the house of medicine, but fails to realize it is an essential member of the public health camp. Prevention is better than cure every time so understanding the aims and objectives of the public health system is essential. The current Ebola crisis has reinforced the point that we are joined solidly to public health and we must interact often and well.

8. Innovation and Research
To continue to push the boundaries of the EMS world, we require evidence-based practice, outcomes and data to trump industry anecdote and tradition. To progress, we can’t simply hide behind the mantra that “We have always done it that way.” Organizations should consider researching, collaborating, capturing and presenting studies and good practices. It doesn’t have to be major projects or massive patient studies, but perhaps a series of “small cycle testing” that relies on a “Plan, Do, Study, Act” (PDSA) cycle. Large change can occur from small tests. Writing these up, complete with supporting evidence, can effect change not only in the researchers’ organizations, but in the wider industry.

9. Community-Based Programs
The evolution of community-based programs here is almost anthropological in nature. Community paramedicine, or mobile integrated healthcare, is evolving and forming according to local environmental and political conditions. No two programs are the same, which is technically good, as they are shaped to meet the needs of the population for which they are intended to serve. The bottom line for many of these programs to be successful and attain longevity is to be actuarially sound and generate income to be self sustaining.

Sadly many programs to date have operated on a loss leading footing and, unless sustainable income is forthcoming via legislative changes, some could fade as quickly as they initially shone. That said, some community-based activity is already part of normal daily EMS practice and could rightly be classed as “paramedic in the community” activity.

Understanding who your “frequent service users” are and managing their whole system use and creating case conferences is a great community activity. Fostering relationships with other local care organizations such as behavioral health, social services, faith-based groups and both the primary and secondary care sectors may lead to the creation of cost-effective and sustainable programs. This level of liaison also assists in the breaking of barriers and removal of care silos.

10. Communicate, Communicate, Communicate
Internally, “If no one is following, then you are not leading.” Externally, if you don’t broadcast your message, then no one will hear it! A key communication strategy should be a major corporate activity. Some say that it takes 10 good news stories to trump the one bad one. Having an active communication plan that involves providing your local media with positive stories (to get your 10 good ones in the bank) is a good investment in time. Good news stories inform the public as to the quality of your agency and instills a sense of pride within the service. In the social media age, it is now relatively easy to place news. A photograph and a descriptive paragraph can quickly be crafted and posted on your organization’s social media sites or sent to the editor of a national trade magazine for both national and international coverage.

11. A Bonus 11th Point: The Four Words That Count Most
EMS organizations are usually only separated by a single degree from the world of politics. Public sector organizations are governed by Councils or Boards of Supervisors, private sector companies have shareholders and executive boards. If those who lead our EMS organizations are not politically aware and astute at navigating the rocky waters of achievement and funding then no matter how good or efficient an organization, they can be overturned by four political words: “All Those In Favor.” If you have an inability to influence those who govern, then be prepared to be out-voted or worse, voted off the island.


Filed under Administration & Leadership, EMS Topics, News, Opinion, Training & Development, Vehicle Operation & Ambulances

Fore Thoughts of EMS Today 2015

For the last few years I have written my initial impressions of conferences in blog posts shortly after, or sometimes even during, a conference. The post “Quick Thoughts from the EMS Today 2012 Conference,” for instance, described my first EMS Today experience and captured the fact that I actually had the opportunity to give ‘two thumbs up‘ to my boyhood idle ‘Johnny Gage’ (aka Randolph Mantooth) among other professional icons. I also had the opportunity to ride along with a BCFD crew and documented that experience in the post “A Country EMS in the Big City” that year. The next year, I got to experience EMS Today in DC along with the much hyped ‘Snowquester‘ that abbreviated the EMS on the Hill advocacy opportunity, but where I did still get to witness a small ‘Gathering of Eagles‘ slaughtering a number of ‘sacred cows.’ A summary of that experience is recorded in the post “Quick Thoughts from EMS Today 2013 Conference.” Last year provided a very different perspective as I got to document EMS Today from the viewpoint of a pre-conference presenter and spent much of my time as an exhibitor on the show floor. One of my favorite learning experiences, however, was the ‘Resuscitation Academy‘. Some of my experience that year was covered in the post “Quick Thoughts from EMS Today 2014.” But this particular post is a unique first, as I am writing this time about a conference that hasn’t even happened yet – EMS Today 2015!

My interest in this coming conference is as a blog reporter. I hope to attend this conference as an official blogger tasked with documenting once again my experience as a participant in all of the fascinating aspects of this powerful and educationally-packed conference. If you are planning to attend the conference, we can help each other. Your registration using the code ‘EMSBDALE’ gets you a discount, even beyond the early bird discount rate, and provides a vote of confidence in me to be selected as the official blogger for this coming event. To make it an even better deal for you, each registration using my code will be entered into a drawing for a mini Apple iPad this month and another for anyone who enters my code during registration for January as well.

I hope that you do get to go to this keystone EMS event and that you will help me get there as well. If we do win, you will hear about it first on this blog page. PennWell and JEMS is working closer with its Fire EMS blog network than ever before in order to bring you a more intimate view of the conference and the larger industry of EMS as well through independent blogs, Facebook pages like High Performance EMS, and Twitter feeds including @hp_ems. So even if you don’t get to the 2015 EMS event of the year, you can still experience some of the excitement and continue to learn all throughout the year.

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Filed under Administration & Leadership, Conferences, EMS Topics, Fire Rescue Topics, Funding & Staffing, News, Technology, Training & Development