Why are the fire service and law enforcement considered essential public services and EMS is rarely considered, if at all. Why do politicians and opinion leaders buy the “snake oil” from some private EMS operations about operating for little or no subsidy and not understand what they’re getting for that little money?
The answer is quite simple. It’s because no one knows what EMS does. And we have ourselves to blame. We’ve done a great job of handing out “Call 911” stickers. People have gotten the message to call 911 for EMS. The problem is that they don’t know who EMS is, much less what we do. With such a lack of public education, can we blame people when they call 911 for a prescription refill, but don’t call EMS when they’re having crushing substernal chest pain radiating to the jaw and down the left arm?
I have a variety of friends in a variety of professions. I’ve had to correct attorneys as to the difference between an EMT and a paramedic. I’ve had an ICU nurse ask me what IV antibiotics I stock on my ambulance. And tonight, a police lieutenant told me he had no idea what EMS did, but that he appreciated them dealing with intoxicated college students.
And how does EMS respond to this lack of knowledge? In most cases, the same ways we’ve always dealt with it. “Call 911” stickers, blood pressure checks during EMS Week, and then complain about the lack of respect that EMS gets even during EMS Week.
Folks, people still see us as barely educated ambulance drivers. It’s because we haven’t taught them anything. The fire service and law enforcement embrace the public education mission. EMS doesn’t. Plain and simple. The cops and the firefighters have “citizens’ academies” where they show off their organizations and answer questions. EMS claims we can’t because of HIPAA, lack of funding, or vague concerns about liability. We need to be showing off — opening the ambulance doors up for real tours — where we show what we can do, allowing ride-alongs, and reaching out to the media.
The people who we don’t educate about what EMS does and why a well-funded, clinically progressive EMS system makes a difference are the same people who are going to call 911 at 3 AM because they ran out of their Xanax. Perhaps even worse, the same people that we don’t educate about EMS are the volunteers that never joined or the community leaders that don’t support the next tax election or fundraising drive.
I worked for a service that practiced public outreach on a variety of levels: general information articles monthly in the local paper, providing standbys for large events at the schools, attending town events, speaking at various civic groups and holding a free summer camp for town children exposing them to various fields in emergency services. The citizens of the town all knew and respects us and the organization. Unfortunately, we missed the most important citizens in our community: the politicians. Despite ALL the outreach and public outcry our service had to close when the 911 contract was awarded to the fire service. This is an important part of running a “public” agency, excellent food for thought.
We need to be teaching CPR and First Aid, be involved in CERT programs, be in the schools. Every cardiac arrest save should be a PR event. Since EMS is a blend of public safety and public health, it needs to be active in the community, visiting with the residents, rather than wanting to post in a parking lot and toss our unzipped boots on the dash while we watch Youtube, waiting for the next emergency call so we can yell at all the “idiot” drivers. Alongside our non-existent positive PR movements, we sink our ships with slogans such as “You call, we haul” and “Call the waaambulance” and spill through Facebook with myriad pages that do nothing other than demonstrate why it is ok to make $11/hr as a Paramedic.
What’s that famous saying by Pogo???
EMS Public Education Proposal
Alan E. Perry
City of Chesapeake Fire Department
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 Chesapeake Fire Department.
Acknowledgments
This proposal was developed through the collaboration of multiple individuals within the Chesapeake Fire Department that contributed ideas, provided comment and support. I would like to recognize them for their foresight, diligence and support in helping to bring these ideas forward especially FF/PM Shean McCoy, Lt. David King and Lt. Brian McIntosh. Lieutenant Shean Emmons and Captain John Gibson also provided their support for this effort. This proposal is put forth with the goal of improving patient outcomes, employee satisfaction, and the overall performance of the Chesapeake Fire Department.
EMS Public Education Proposal, City of Chesapeake 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 Chesapeake 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. The Department’s position as EMS provider for the City of Chesapeake 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. The Chesapeake Fire 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
Chesapeake fire Department
Opportunities for Improvement
Staffing- Create a staffing model that is flexible and reliable
· Role of EMS Supervisors- oversight, training, administrative, caregivers, coach.
· Create clear career path for battalion level EMS officer, examine rank structure.
· Create equity among various classifications- no divisions in workload based on level of EMS training; everyone should be involved in providing EMS service and transport.
· Examine and identify ways to increase numbers of paramedics to facilitate move to all/more ALS apparatus.
Deployment- Create a more equitable and responsive deployment model
· Seek to distribute call volume among all units more equally.
· Cover areas with high call volume with multiple units.
· Create flexible company structure that permits deploying assets based on nature of call.
· Consider options to sending entire engine companies to EMS calls, public assists and courtesy calls.
Training- Create EMS training that is innovative and supportive
· Move to competency based system.
· Role of training division- more emphasis on EMS topics.
· Use of training medic for monthly skill drills.
· Use of some sick leave for elective training.
· Annual MCI training & drills.
· Quarterly BLS/ALS protocol and medication test (exambuilder).
· Integrate new education standards to lessen hardship of transition.
· Include training/obstacle course for patient lifting and moving.
Providers- Enhance the competency, consistency and confidence of EMS providers
· Monthly skills drill based on EMT practical tests.
· Encourage outside and elective EMS training.
· Encourage/train in injury reduction practices related to lifting/moving.
· Scenario based team management training.
Apparatus- Assure apparatus functionality and reliability
· Better oversight of repair & maintenance.
· Reduce cost through preventive services, reduced down time & repeat services.
Administration- Be part of an enabling and responsive administration
· More involvement with front line staff.
· More involvement regionally, i.e. TEMS, other localities, VAOEMS.
· Open communication policy.
· Transparency in decision making process.
· Create a Citizen advisory board.
Communications- Improve communications practicality and efficiency
· Implement true EMD system- priority dispatch single unit based on nature of call.
· Correct shortcomings of HealthEMS- system speed, web filtering, spell check, terminology, use of station computers, additional fixed data entry stations at hospital.
· Integrate/eliminate redundant systems that increase workload with no benefit.
· Examine alternative platforms i.e tablets, ipads, iphones
· Install appropriate mounts in patient care area on medics for laptops.
· Perform hearing protection study, and install headsets on all medics if warranted.
Public Education- Develop or enhance education programs that will benefit citizens.
· Build a pro-active public education program to dovetail with fire prevention programs.
· Investigate and implement program to facilitate proper medical emergency reaction from public.
· Provide more EMS education opportunities for the public.
Volunteers- Improve volunteer recruitment and retention
· Investigate attitudes and barriers to EMS volunteerism.
· Develop pool of potential career providers.
New Opportunities- Look for new opportunities to improve efficiency and value
· Develop new delivery methods- community paramedicine, well checks.
· Create liaison for nursing facilities & assisted living facilities.
· Investigate provision of transport services for non-emergency patients.
· Integrate with public health, community services, social services and hospitals.