Redesigning EMS Handout - ND EMS A

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Redesigning Volunteer EMS

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RedesigningVolunteer EMS

RedesigningVolunteer EMS

Nancy Magee, AEMTConsultant, Managing Partner

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“The most dangerous phrase in the language is‘ We’ve always done it that way’ “ ~ Rear Admiral Grace Holder


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History of Volunteer EMSHistory of Volunteer EMSWhere we started

Where we are now

What will the future look like?

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Volunteers in EMSVolunteers in EMS

ROANOKE Virginia, circa 1928First Organized Volunteer Rescue Squad


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“This was like all fineadventures. All we need todo is reach out - and thereare people to respond.”

~ Julian Wise, FounderRoanoke Virginia First Aid

and Lifesaving SquadEst 1928


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The headlines are everywhere.Volunteer EMS is in “crisis.”

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Don’t Believe The Headlines!Don’t Believe The Headlines!

Every day, EMS volunteersanswer up to two thirds of thenation’s 911 calls.

Up to 90% in most rural states.

Over 60% of EMS providersvolunteer, including more than40% of career providers.

Without volunteers, most of ruralAmerica would be without EMS.


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“Awareness is a key to reducing the influence ofcognitive biases on decision making. Simplyknowing that cognitive biases exist and can distortyour thinking will help lessen their impact.”

~ Psychology Today

Cognitive BiasCognitive Bias


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History and Evolution of EMS, and the Birth ofVolunteer Ambulance and Rescue Squads

History and Evolution of EMS, and the Birth ofVolunteer Ambulance and Rescue Squads

EMS began in France around 1700, on Napolean’s battlefields.

In 1865, the first EMS was established in the US in Cincinnati, Ohio.

First Volunteer Rescue squads formed, separate from VolunteerFire Departments

Roanoke, Virginia 1927

Sommerset, NJ 1928

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History of Volunteer EMS:The Beginning


1930’s-40’s

American Red Cross provides basicmedical training to rescue squadmembers, including CPR & mouth-to-mouth resuscitation.

Hearses were used to transport patients.Medical staff consisted of largelyuntrained funeral home workers.


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Medical and community leaders however,had an alternate view and began theadvancement of innovative EMS programsthat provided medical services, not justtransport.

Stand alone first aid, rescue and lifesavingsquads are being organized in most states.

Rescue squads begin carrying medicalsupplies to assist physicians attendingpatients in the field.


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Evolution of EMS: 1960-early 70’sEvolution of EMS: 1960-early 70’s

In 1960, only 6 states had a standard “rescuer”course.

In most of the country, EMS was unregulated,disorganized and sometimes had very poor care.

1965-The ‘White Paper’-Accidental Death andDisability-The Neglected Disease of ModernSociety” released.

It documented the absence of quality emergencycare in the US and revealed that more than 36,000people were dying in MVC’s annually.

More people were dying on US highways everyyear than during the entire 8 years of the VietnamWar.

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The assignment of EMS to theDepartment of Transportation ratherthan the Department of Health reflectsthe federal governments view thatEMS was to be primarily a transportservice.

Medical and community leaderscontinued to focus on the advancementof innovative EMS programs providingfield care of medical emergencies, notjust trauma and transport.

Military Medics returning fromVietnam became available to applytheir training in prehospital care tocivilians.


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1973 - Star of Life adopted as national

EMS symbol

Six points: integrated components of EMS

Central staff symbolic of medicine and

healing

1973-EMS Services Development Act

Authorized federal grants to develop a comprehensive EMSSystem nationwide

NAEMT is formed

1980-NREMT publishes first national standard exam (EMT-A))

1981-The Omnibus Budget Reconciliation Act decreased fundingfrom the Federal Government and decentralized EMS activitiesand direction to individual states.


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Volunteers in EMS:The Early CultureVolunteers in EMS:The Early Culture

Rescue groups consisted of friends and neighbors, usingphone trees for communication, babysitting each other’skids, developed a tight social circle.

The squad members are well known, respected,appreciated for the service provided for the community.

Care initially consisted of basic first aid with the goal ofrapid transport to the local doctor’s office or hospital.

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Transport by Cadillac type ambulance (basically a modifiedhearse) equipped with bandages, oxygen delivery system,radio communication equipment.

Often the patient was alone in the back.


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The Volunteer Culture ChangeThe Volunteer Culture Change

Meanwhile… America changed, too.

Two income families become the norm, creatinga void in members available for daytimecoverage.

Young adults moved out of town either becauseof rising home values, or lack of local jobs.

Young urban professionals who had grown upwith an perception of EMS based on TVdramas, and unfamiliar with volunteeremergency services, moved into suburban andrural areas.


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Evolution of EMS and VolunteerAmbulance and Rescue Squads:

1970-1980’s

Evolution of EMS and VolunteerAmbulance and Rescue Squads:

1970-1980’s

Emergency! & M*A*S*HTV shows bring prehospitalcare into living rooms allover America.

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Widespread adoption of the 911system, combined with TVshows and mediarepresentation, have createdunrealistic expectations aboutspeed of access and availabilityof EMS care.

People have been conditionedto call 911. The unintendedconsequence is that almost halfof all emergency calls do notactually require EMS.


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The Evolution of EMSThe Evolution of EMSThe first nationally recognized EMT-A (ambulance)curriculum was not established until 1969, consisting ofroughly 80 hours of trauma care taught primarily byphysicians.

1994 - revised EMT Class is 110 hours.

2000 – “EMS Education of the Future” released, withthe EMT class now consisting of 150-190 hours classtime, plus varying clinical hours and specialty training (NIMS, HAZMAT, EVOC).


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Although the “new” training requirements are often blamedfor declining volunteer recruitment, the need for theadditional training was recognized and the new curriculumdeveloped over 20 years ago.

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Recognition of the difference that prehospital care canmake in critical medical patients –cardiac, stroke,sepsis, ARDS – and not just trauma, was the impetus forthe additional emphasis on pathophysiology, anatomy,critical thinking and enhanced assessment skills.

Electronic patient care reporting designed to improvepatient care, streamline insurance billing, and collectdata on a national level (NEMSIS) require a level oftechnological skill that has been problematic for manylong term providers whose have had little prior trainingin computer skills.


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Volunteerism TodayVolunteerism Today

Long-established volunteer squadsare closing their doors.

EMS is losing much of its history.

EMS and fire departmentvolunteers save the US taxpayersbillions of dollars annually.

America cannot afford to lose ourlocal volunteer ambulance and fireservices.

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Will Your Agency Survive?Will Your Agency Survive?The average American taxpayer believes that EMS is taxfunded.

Much of it is not.

There is no Federal mandate, and state and localmandates for funding are rare.

The vast majority of citizens have no idea how the EMSsystem actually works, or how or if the local ambulance ispaid.

Taxes are high, and most people believe that EMS isincluded in their property tax.

An aging population and misunderstanding of appropriateuse of the 911 system has dramatically increased callvolume.


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Costs are going up.Reimbursement is going down.THIS IS NOT A SUSTAINABLE MODEL.


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Everywhere you look, media pundits and EMS industryleaders are tolling the death knell of volunteer EMS.

Recruitment and retention, rising costs, and dwindlingreimbursement are challenges shared by all models ofEMS delivery.

In the future, we’re going to have to abandon traditionsand practices that no longer work in today’s healthcareand economic climate.

If we’re going to survive, we have to redesignVolunteer EMS.

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“The greater danger for most ofus lies not in setting our aimtoo high and falling short; butin setting our aim too low, andachieving our mark.”

~ Michelangelo


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How ‘Redesigning Volunteer’ EMSGot Started

How ‘Redesigning Volunteer’ EMSGot Started

Connecticut – 70% mostlyBLS volunteers for 911

Louisiana – volunteer EMSalmost nonexistent.

Negative press & volleybashing…

Response to EMS1.com

“Why Volunteers AreCrucial to the Future ofEMS”


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ObjectivesObjectivesUsing a SWOT Analysis format, we will talk about thesethings:

Survival is a Darwinian process. Discuss how to makeyour agency the fittest and most adaptable to change.

Demonstrate that volunteer EMS still provides the“biggest bang for the buck” of all EMS delivery models.

Discuss the importance of focusing on the business ofEMS and ending the “clubhouse” mentality.

Understand that to stop vollie bashing, we have tocommit to transparency, accountability, andprofessionalism in volunteer EMS.

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What is a ‘SWOT’ Analysis?What is a ‘SWOT’ Analysis?

Strengths

Weaknesses

Opportunities

Threats


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SWOT: Strengths ofVolunteer Service Model

SWOT: Strengths ofVolunteer Service Model

Years of service to the community have createdpublic loyalty to the organization.

Your service will always be needed, and the needwill most likely increase.

Majority of EMS providers are volunteers.

Volunteers are passionate and fiercely dedicated totheir mission.

The volunteer/ non profit model can be by far thebest service, and bang for the buck for almost allrural, and most suburban communities


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Community LoyaltyCommunity Loyalty

Respect, appreciation fromcommunity

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SWOT: Opportunities forVolunteer Agencies

SWOT: Opportunities forVolunteer Agencies

Educate the public on the importance and benefitof maintaining a local non-profit EMS system.

Become an organization that people are eager tobelong to.

Shape the future of EMS

Community health improved


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Educate the PublicEducate the Public

Crew makeup 96%volunteers

38 VBEMS SCA patientsreturned to family

Annual report: 117 pagesof compelling info:

Public support


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Community Health = Created ValueCommunity Health = Created Value

LVAD education

Diabetes education

Vaccinations

Autism awareness

Terrorism response

Disaster response

Vial of Life

Pet first aid

CPR programs

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Improved Community RelationsImproved Community Relations

Public education andawareness

School visits

Visit Senior centers

Event standby

Assist with fund raisers

Well-being checks


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Resource Sharingand RegionalizationResource Sharing

and Regionalization


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SWOT: Weakness CommonIssues in Volunteer AgenciesSWOT: Weakness Common

Issues in Volunteer AgenciesResponse Failures:

Failure to meet performance standards

Lack of financial and management expertise

Cultural stagnation

Inability to attract new members

Lack of professional image

Complacency

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Response FailuresResponse Failures


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Leadership IssuesLeadership Issues

Lack ofpersonnelmanagementexperience

Lack offinancialmanagementexperience


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Cultural StagnationCultural Stagnation

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Inability to Attract New MembersInability to Attract New Members


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Clubs respected by thecommunity

Clubs respected by thecommunity

Rotary Club

Lions Club

Kiwanis Club

Hibernians

‘Clubs’ can be great service organizations

Not ‘Pee Wee’s Playhouse’!


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Lack of a Professional ImageLack of a Professional Image

Peers

Other healthcareprofessionals

Public

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Larry the First ResponderLarry the First Responder

Do paid providers whointeract with volunteersrespect them?

Stereotypes arewidespread.

Everybody knows a“Larry.”


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SWOT: Threats to VolunteerEMS Survival

SWOT: Threats to VolunteerEMS Survival

Resistance to change

Failure to evolve

Losing sight of the mission

Inability to demonstrate value and benefit to thecommunity

Failure to implement successful recruitment andretention program

Financial instability

Low expectations become a self-fulfilling prophecy


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“Face reality as it is, not as itwas, or you wish it to be. Changebefore you have to.”

~ Jack Welch


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Resistance to ChangeResistance to Change

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Failure to EvolveFailure to Evolve


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Losing Sight of the MissionLosing Sight of the Mission


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Low Expectations EqualLack of Accountability

Low Expectations EqualLack of Accountability


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Social Media: FAILSocial Media: FAIL

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AccountabilityAccountability

The right thingis not always thepopular thing.


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An Absolute TruthAn Absolute Truth

EMS people will find a problem for everysolution.

This is a weakness we must overcome.


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Failure to evolve and a willingness to lowerstandards to the lowest common denominatorout of desperation to fill the roster, are thebeginning of the end.Cultural stagnation and a focus oninterpersonal dissent and drama are thehallmarks of a dying organization.Low expectations become a self- fulfillingprophecy. Negativity, fear mongering, excusesand anger pervade both internal and publicmeetings.These agencies will not garner communitysupport for funding, attract new members, orretain their most dedicated responders.Their days are numbered. “


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The Future of EMSThe Future of EMS

Darien, CT Post 53

All high school students

Tiered system running1500 calls annually

No government funding

Adult advisors, butstudents run the system

It is the only student-runEMS organization in thenation.


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Where We Stand TodayWhere We Stand Today

EMS is still not an essential service.

Despite the recommendations of every studyand white paper written in the last 20 years,and efforts by elected officials in severalstates, EMS is still not defined as an essentialservice by the federal government or moststate governments.

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Where is the moneyappropriated for EMS?

Where is the moneyappropriated for EMS?

Most states appropriate funds for traumasystems and EMS through various meanssuch as add- ons to traffic and criminalviolations and tobacco taxes. Those fundsare often funneled into a general fund orutilized as a slush fund to balance deficits instate budgets, never reaching the EMSinitiatives it was intended for.


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Are citizens resigned toreliance on luck?

Are citizens resigned toreliance on luck?

The Montana report summary warns thatwithout change the state's citizens and visitorsare reliant on luck. The report states, "Wehope government officials and communitymembers in rural Montana are able to identifyand implement sustainable solutions beforetheir luck runs out.“

Hope and luck are two words that have noplace in a discussion regarding the provision ofEMS.


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No VolunteersNo Volunteers

Washington state

Arizona

Hawaii

Michigan

Georgia

Florida

Illinois

Tennessee (the Volunteer State!)

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1 - 10% Volunteer Response1 - 10% Volunteer Response

Utah

New Mexico

Missouri

Louisiana

Mississippi

Alabama

South Carolina

Kentucky


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11 - 50% Volunteer11 - 50% Volunteer

Oregon

Idaho

Oklahoma

Iowa

Arkansas

Wisconsin

North Carolina

Pennsylvania

New York

New Jersey (20k volunteers!)

Massachusetts

New Hampshire

Maine


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> 50% Volunteer Response> 50% Volunteer Response

Alaska

Nevada

Montana

Wyoming

Colorado

Texas

Kansas

Nebraska

South Dakota$31 million savings

North Dakota

Minnesota

$37 million savings

Indiana

Ohio

Virginia

Connecticut

Rhode Island

Vermont

Delaware

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A lack of data inhibits EMS workforce planningfocusing on the challenges of volunteers,particularly in rural EMS systems

There exists little data showing a relationshipbetween EMS workforce factors and patientoutcomes. Much of the workforce planning thatis done is based on perceived communityneeds rather than data

32 States have different criteria for classifyingpaid and volunteer work; a “volunteer” in onestate may be classified as “paid” in another.


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Taxpayer SavingsTaxpayer Savings

Volunteers savetaxpayers $140 billionannually.

Number is likely higherbecause of variances inreporting, and becausewe suck at datacollection.


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Will Your Community Pay for It?Will Your Community Pay for It?

70% of voters would okay taxes to ensureservice.

85% of EMS calls are non-life-threatening.

~ Kevin McGuiness

NASEMSO

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SummarySummary

Volunteer EMS isn’tfailing... unless we let it.

“Those who continuallylook to the past will neversee the future.” ~ JFK

Clinging to old paradigmsis the path to failure.

http://tinyurl.com/vollyems


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Remember Six C’s for SuccessRemember Six C’s for Success

Commitment

Communication

Coordination

Creativity

Culture

Change


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Redesigning Volunteer [email protected]/vollyems

Documents

Redesigning EMS Handout - ND EMS A