I recently spoke to a group of young EMS managers and asked them what was emphasized in their degree and management classes to prepare them to take on organizational and operational challenges. They quickly rattled off a list of courses and topics, such as budget development and management principles, strategic planning and development, deployment strategies, statistics and personnel administration.
But many got pale and diaphoretic when I asked if they had been taught guerrilla warfare tactics, the legal ramifications of inappropriate management actions, the proper way to document disciplinary actions and how to navigate political minefields—also known as, Watch Your Back 101.
After resuscitating a few of them, we sat down and discussed key areas. I thought I'd share them with you, because times are changing in EMS and so are the requirements for people who manage and oversee EMS agencies and personnel. And it's clear that politics, proper documentation and people skills are more important than ever for EMS managers to master.
Thirty years ago, when EMS was in its infancy, there were few fights over who would offer or administer it. Many municipal and volunteer agencies failed to, or refused to, bill for their services, relying on budget allocations and other revenue sources. BLS was less expensive to operate than ALS, and staffing and response time requirements weren't written into most service contracts. That's not the case today.
EMS reimbursement also became a cash cow for many agencies in the '80s and '90s, with some billing (and getting) the same ALS fee for everything from cut fingers to codes. I knew a service that billed for, and got away with, an extra extrication fee of $400 when they removed a collapsed patient from the space between a toilet and a sink. But, over time, insurance companies and Medicare got wise to inconsistent billing and changed reimbursement practices.
The problem for today's managers is that reimbursement isn't keeping up with expenses, and it costs many agencies more to answer calls than they're obtaining in reimbursement. So EMS managers, particularly those who don't have municipal funds available to them, have to be especially budget savvy.
EMS also represented a small percentage of fire response in the late '70sƒless than 20% in many areas. Some fire agencies saw EMS as a lower priority than fire response, and they assigned EMS operational and administrative responsibilities to just one captain.
Today, EMS is a primary function and can exceed 80% of the calls in major metropolitan areas. Recognizing this fact, many fire departments have EMS divisions operated by chief positions and a host of other administrative, operational, training, quality management and medical oversight positions.
Sadly, due to budget reductions, some fire agencies have reduced their EMS oversight, medical direction, training and quality control staff, leaving their system highly exposed to errors and liability. These systems can cause their over-burdened EMS managers to burn out and transfer to less stressful positions, resulting in the loss of veteran managers and setting their EMS system back years. You can often identify these agencies by their lack of 12-lead ECG and CPAP capabilities, a medical director nobody knows and resuscitation rates below 10%.
In the current economy, the same situations can also occur in for-profit, hospital-based, third-service and volunteer departments. The sad part is that some CEOs, fire chiefs, hospital administrators and elected officials let it happen (or can cause it to happen) by appointing the wrong people to key EMS administrative positions. An inept, unprepared or poorly respected EMS manager can quickly change the personality and culture of a good system and run an agency into the ground financially.
I recently sat on the sidelines and watched a quality EMS manager get sniped at by his city manager because he fired an EMS supervisor, a political friend of the city manager, for just cause. I also know of a seasoned fire service EMS chief who was forced to meticulously document every wrong move made by an unqualified captain who had been transferred to the EMS section by the fire chief.
Get my message? Training, preparing and keeping good EMS managers is more important now than ever before. If you don't have the right people in place to steer your agency over the rough seas ahead, you need to find, train and polish them, pay them appropriately and do all you can to keep them.
And if you're an EMS manager, become internally and externally politically aware, be fiscally responsible, treat your personnel well and document all key actions and inactions. Also, always watch your back, because sharks are always lurking in any organization, waiting to attack when they smell blood or sense weakness.JEMS