IAEMSC Holds Inaugural Leadership Summit in D.C.

A special report by A.J. Heightman, Editor-in-Chief, JEMS

• A.J. Heightman, MPA, EMT-P
• 2009 Sept 28

The International Association of Emergency Medical Services Chiefs (IAEMSC) held its Inaugural Leadership Summit in Washington, D.C., Sept 26–28, 2009. IAEMSC's mission is advocate for improved EMS and offer a forum for EMS operational leaders.

Harvard Fellowship
William H. Sugiyama, MA, NREMT-P, Oakland chief EMS fire division manager, is the Intermedix IAEMSC Harvard Fellow of 2009. Sugiyama described the importance and impact of the Harvard leadership program. The fellowship program helps develop leaders in EMS by assisting participants in understand their strengths and weaknesses, and how government really works.

The 21-day program immerses the participants and, according to Sugiyama, takes the participants "off the dance floor and places them into the balcony," where they learn to see the bigger management picture. The program links professionals from public safety agencies and other businesses. 

The scholarship, sponsored for International Association of Emergency Medical Services Chiefs (IAEMSC) by ADPI/Intermedix, covers tuition, meals and travel expenses, as well as living quarters in an apartment facility affiliated with Harvard University's John F. Kennedy School of Government. Click here to learn more and apply.

At the completion of the program, graduates are enrolled and mentored. They participate in research and represent the IAEMSC at national events to educate other EMS leaders.

Sugiyama says the program provided an outstanding opportunity for him "to understand other people's perspectives and 'give back' to the EMS community."

Political Engagement 101
Andrew Weis, JD, Republican general counsel for the Senate Committee on Homeland Security and Governmental Affairs Committee, discussed the inner workings of the Department of Homeland Security and the political interactions public safety agencies can and should have with government officials.

Lobbying efforts and the disagreement between groups was discussed. He cited disagreement between career and volunteer fire agencies on the components and funding opportunities has slowed the reauthorization process for the Fire Act. He noted that all public safety agencies need to meet and come to some level of consensus to improve this process.

Online EMS Communties
Kris Kaull, manager of Praetorian Group's online EMS initiatives discussed the role of social media in EMS and trends underway. He updated attendees on:

Social Media: Kaull discussed the popularity of social media sites and referenced two Internet sites (del.icio.us and StumbleUpon) that are considered social bookmark sites and allow users to save their favorite Internet sites and access them on computers other than their own.

Collaboration of news sites: Kaull discussed the merits of using sites, such as "Reddit" and "digg," that rank news stories based on reader interests.

Cross-Media sites: Sites, such as "flickr" and "Zooomr," were discussed. These sites allow you to easily upload, store and download photos. 

Video: Video uploads and display are becoming more popular. The exceptional rap video produced and placed on YouTube by two FDNY EMS personnel ("Call 911" FDNY) was discussed. This is an example of cooperation between FDNY EMS and the personnel that created the rap video about what it's like to be an FDNY EMS crew. It had been viewed 35,000 times as of Sept. 28. Click here to read a JEMS.com article on the video.

Podcasts: Kaull noted that iTunes now offers multiple EMS educational opportunities.

Blogging: Kaull pointed out that blogging can be extremely beneficial because blogs offer participants the opportunity to share their activities and experiences via an online diary. He noted that the average age of Facebook users is 35–55 and that Facebook features "fan" pages that help agencies "tell their organization's 'story.'"

LinkedIn: Kaul noted to be a good professional networking and discussion area.

Twitter: Kaull pointed out that Twitter is a good spot for agencies, organizations and individuals to present mini-blogs and limited blocks of information.

Five Roles Social Networks Can Play for EMS Agencies:

1. Provide rapid information about events. The information can be updated second-by-second.
2. Good way to "Tell your Story." A new site by Greg Friese -- PIOSocialMediatraining.com -- was referenced.
3. Good way to distribute information. An example is sharing of emergency plans.
4. Recruit and retain people. An example is an Austin-Travis County (Texas) EMS Recruitment video that has been viewed 8,300 times on YouTube.
5. Share and collaborate.            

Some rules Kaull recommends agencies consider:

• The Internet does not make stupid people intelligent.
• Posting content online is a "forever" action.
• The generation gap is a real issue, and both sides are to blame.
• Sometimes you can't do anything about a posting, even when it's wrong.            

Not having an organizational plan that addresses how your organization handles social media is negligent.

Kaull said an article by Greg Friese in the October 2009 issue of EMS Magazine that addresses social media is exceptional.

He concluded by making several recommendations on what agencies should do relative to working with, and around, social media:

1. Develop a policy that includes guidance on what is acceptable and not acceptable to post regarding your service or agency;
2. Join, and participate on, at least one social network;
3. Monitor social networks for mentions -- good and bad -- about your organization; and
4. Set up Google news and blog alerts and a Twitter search of RSS feeds.            

Legal Currents in EMS
Lawrence Tan, JD, NREMT-P, chief of EMS for New Castle County (Del.), and a past recipient of a Harvard EMS Leadership Scholarship, presented an informative lecture on current trends in EMS litigation.

Sleep Deprivation Cases Discussed:

1. People who are subjected to 24 hours of "sustained wakefulness" are shown in a recent New England Journal of Medicine to perform below acceptable levels.
2. In most states, you cannot drive a motor vehicle with a blood-alcohol level (BAL) of 0.08 or greater; yet, studies have now shown that sleep-deprived emergency personnel are operating at the same level.
3. In New Jersey, Maggie's Law specifically identifies sleep deprivation as qualifying a driver as a "reckless" driver who can be convicted of vehicular homicide. It's a second-degree crime that could result in a five- to 10-year jail sentence, a fine of up to $150,000, or both.
4. A 1995 case in Oregon (Faverty vs. McDonald's Restaurants of Oregon Inc.) involved a young employee who worked multiple shifts without much of a break between them. He was involved in a major collision on his way home. The employer was found to be responsible for contributing to the cause of injury sustained in the crash after a negligence claim was filed because the employer knew that the worker was working too much time without proper rest periods factored in between shifts.            

The IAFC report, "The Effects of Sleep Deprivation on Fire Fighters and EMS Responders," was discussed and noted to be a signal that the world of public safety leaders realizes that there is a significant problem that can be caused by sleep deprivation and inadequate rest in between employee work periods.

An important and insightful survey conducted by Austin-Travis County EMS was discussed and shown to be a positive force in the resultant change in the EMS work schedules:

1. 64% of the personnel surveyed found it "difficult" or "very difficult" to stay awake when working 24-hour shifts;
2. 29% said they felt they felt they provided less than optimal care at the end of a 24-hour shift; and
3. 5% acknowledged reported that they had fallen asleep at least once while driving during a 24-hour shift.            

As a result of this survey, Austin-Travis County EMS redesigned their shift schedules and deployment strategies:

1. Shortened shifts to 12 hours;
2. Reduced the work week to 48 hours, and
3. Established that personnel had to have at least 10 hours off between shifts.            

Because of the residual effects of alcohol on individuals, Tan recommended that agencies consider adopting a defined policy about the number of hours that must occur between their last consumption of an alcoholic beverage and the start of a shift. 

Tan noted that the courts in many areas view EMS as a safety-sensitive position and reference the trucking and airline industry. The trucking industry only allows a maximum shift of 11 hours after a 10 consecutive hours off duty. The Federal Aviation Administration (FAA) has limitations on pilot activity. Pilots cannot work more than eight hours in a day; no more than 30 hours in a week; and no more than 100 hours in a month.

Wrongful Hiring
Tan told the attendees that employers have a direct liability if they negligently hire or retain an employee who harms a third party and reviewed what the "exercise of ordinary care" was. He discussed background investigations, which should include:

• Employment history;
• Check character references;
• Criminal history and fingerprint record checks, and
• Any actions taken against a person’s certification.            

He recommended that services carefully validation employee credentials via:

• Submission of copies of certifications;
• Online validation, and
• Written verification with certifying agencies -- to include any sanctions against the individual. (He suggested wording such as, "Have you ever had a certification and had it suspended or had any action against it.")            

Cell phones present a "triple threat' to EMS agencies. Tan listed the following reasons:

1. Distractions while operating vehicles;
2. Potential source of privacy or HIPAA violations from cameras and recording capabilities;
3. Negative postings about your agency on social networks, and     

Tan referenced an epic case (Catsouras vs. California Highway Patrol) that involved the display and distribution of graphic photos of a decapitated female killed when her vehicle struck a toll booth. The photos were obtained and distributed by two CHP dispatchers.        

Mandatory Immunization of Staff Members
The mandatory requirement for personnel to be immunized was discussed. The New York State Department of Public Health has enacted emergency regulations that will require healthcare workers to be immunized. 

Tan noted that in Jacobson vs. Massachusetts (197 U.S. 11) in 1905, the courts upheld states' authority to require immunizations "to protect the public."

National EMS Health & Safety Surveillance Database
Geoffrey T. Miller, an IAEMSC board member and associate director of research and curriculum development for the Division of Prehospital and Emergency Healthcare at the Michael S. Gordon Center for Research in Medical Education at the University of Miami's Miller School of Medicine, presented a report on the National EMS Health and Safety Surveillance Database that will launch in early 2010.

This important IAEMSC project was developed with support from ADPI/Intermedix to ensure comprehensive and standardized EMS data elements are gathered and available for use by individual agencies and administrators in a manner similar to the NFIRS, UCR/LEOKA and NEMSIS. 

ADPI/Intermedix developed the web interface and data management system, which is currently in its ALPHA phase.

EMS agencies will be able to sign up in 2010 to participate in this new nationwide data system. The process will include: 

• A one-time agency application process for access. This will include completion of a short agency profile;
• Designation of an authorized system user. This will be your agency's primary contact person and the person authorized to access protected agency data reports. That person will be provided free orientation and training on use of the system.
• The requirement to provide annual agency demographic data and agency profile updates.            

A fact sheet will be made available soon on the IAEMSC Web site.

The group will look into ways to share/ transferred data to other State and national forms and platforms.

Emerging Technologies for Operations
Tom Berger, from TeraHop Networks, presented a report on Emerging Technologies for Operations. Berger, a former Motorola employee, is now involved in the development and implementation of Movable Wireless Sensor Networks (MWSN) systems that offer practical applications for the tracking of people and resources.

He noted that there is a gradual, but relentless, shift on what is being demanded of emergency services. He also pointed out that blue collar workers use tools and need info, while white collar workers need information to serve as tools to assist them in doing their jobs.

The TeraHop vehicle gateway establishes an on scene network and "communicate" with Remote Sensor Nodes (RSNs), small, hockey puck-size devices ($300 each) that have multiple radio transmitters (at batteries that will power a unit for at least two years) built in and communicate any movement (or loss of continuous movement) to a computer, similar to a firefighter's PASS alarm. Most important is the fact that these RSNs communicate with, and repeat through, each other so the system's signal strength actually improves and becomes more efficient as additional RSNs arrive on scene or are deployed. Attendees discussed future uses for this technology to track people, equipment and patients, particularly patients at MCIs.

Narcotic Tampering in EMS
Aimin Alton, BA, MICP, a firefighter with the Ventura County (Calif.) Fire Department, member of the California State Firefighters' Association, and team leader of the Emergency Responder Substance Abuse Task Force, discussed methods to detect and stop narcotic tampering and diversion in EMS in his workshop, "Narcotic Tampering Awareness & Detection."

Four of his goals are to:

1. Create and promote model protocols
2. Increase vigilance through the creation of a strong industry diversion awareness program
3. Scientifically validate the use of portable technologies to aid in the identification of tampered with narcotics in prehospital care, and
4. Assist in strengthening health programs for prehospital professionals specific to the recovery from chemical dependency.            

To assist in that regard, Alton has developed an information and advocacy website:  www.stopnarcotictampering.org.

Alton provided multiple examples of EMS personnel who have stolen or tampered with medications.

• A paramedic who misappropriated Fentanyl at least 237 times.
• A flight medic who stole narcotics and became addicted after responding to an aeromedical crash and witnessing the deaths of his friends.
• A paramedic who stole money from a patient. (In this case, there were obvious signs before he was caught that he had significant financial and chemical dependency problems.)
• An EMS division chief who diverted morphine at least 350 times. (He even wore long-sleeve shirts in warm weather to hide is needle tracks.)            

During the investigation of a call where rescuers prematurely "called" a code on a patient who was actually able to be resuscitated, it was alleged by one rescuer, that the two of them had taken heroin earlier that day. While denied by one and the statement later retracted by the other, both showed a history of chemical dependency;

Alton's last case study involved a paramedic that stole a large volume of morphine and Versed and replaced their contents with saline going back at least a year before his arrest, a case whose scope may be the largest of its kind in California's history, if not the nation. 

Alton reviewed some of the reasons EMS personnel steal or divert drugs:

1. Self -- for their addiction or to ease their pain;
2. Another -- for a friend or family member;
3. For profit or exchange;
4. Kleptomania or impulse control disorder; and
5. Anger or spite toward authority.            

The most beneficial part of the workshop was a 60-minute "hands-on" session during which Alton provided groups of attendees with trays of carefully altered vials that they had to inspect for tampering. Alton walked attendees through the methods used to tamper with these containers and then showed them an innovative approach to detect these types of tampering. (For security reasons, Alton did not reveal how these vials had been modified, only how to detect the tampering) 

Inquiries regarding this program can be directed to: info@alton-associates.com.

Hiring the Right People
Erik S. Gaull, NREMT-P, CEM, CPP, interim associate vice president for safety and security at George Washington University, spoke on how to hire the right people and offered several suggestions. These included the need to:

• Know the nature of the position to be filled. (He pointed out that sometimes the most technically qualified person is not the right person for the job.
• Be aware that different level positions require different searches and qualifications. He reviewed a well-developed list of essential traits and qualifications for positions used by the Madison (Wis.) Fire Dept.
• Know your organizational values and culture.            

Gaull recommended EMS managers understand the generations they're called on to interact with. These include the following:

Baby boomers are born 1946–1963 and aged 45–62. Their values are open-minded teamwork, long hours, hard work, recognition and respect.

Gen Xers are born 1964–1980 and aged 28–44. Their values are autonomy, informally, competency, ongoing learning, feedback, balance and respect.

Millennia/GenYers are born 1981–1995 and aged 13–27. Their values are achievement, structure, collaboration, mission and respect.

Gaull said agencies should advertise in trade publications, on websites and social networks, and in newspapers. He also offered the following suggestions to the group on how to write a good ad.

• Use a mini position description.
• Link the text to knowledge, skills and abilities (KSAs) and critical success factors (CSFs).
• List any absolute requirements.
• Give specific submission instructions.
• Give your salary range or Dependant on qualification (DOQ) statements.
• Sell yourself as an employer.
• Be specific and careful.
• Have your ad reviewed.            

EMS Billing Issues & Trends
Doug Shamon, chief executive officer of ADPI/Intermedix, the largest EMS billing company in the USA, discussed EMS billing issues and reimbursement issues. He pointed out that 6.5 million patients (50%) enter the hospital through the emergency department (ED) and two million (20%) of hospital admissions enter via EMS.

He also noted that demand for EMS service is increasing with the age of our population and what he termed the "socialization of 9-I-I," where the population relies on EMS for more and more non-emergent needs.

The collection cycle for EMS billing was presented as:

• 60% after 3 months
• 85% after 6 months
• 95% after 9 months            

The average amount collected for transport was reported as $300 today and $195 in 2002.

Shamon encouraged the EMS chiefs to pay close attention to their billing processes and procedures, because False Claims Act fines can be $5,000 per claim. He also reviewed the following major fines for violation of HIPAA HITECH rules:

• Without knowledge, $100 per violation, up to $25,000 per year for violations of the same requirement.
• Due to reasonable cause and not due to willful neglect, $1,000 per violation, up to $100,000 per year for violation of the same requirement.
• Due to willful neglect and corrected within 30 days, $10,000 per violation, up to $250,000 per year for all violations of the same requirement.
• Due to willful neglect and not corrected within 30 days, $50,000 per violation, up to $1.5 million.            

The EMS chiefs spent a significant amount of time reviewing data that Shamon presented regarding chart completeness because 15% of transports exhibit inaccurate demographic data at the time of capture. That can delay submission for reimbursement and receipt of essential reimbursement. 

Completeness Deficiencies
75% have missing ZIP code

25% have missing insurance information

50% have missing patient telephone number

90% have missing patient date of birth

80% have missing patient social security number

Shamon concluded his remarks by updating the EMS chiefs on reimbursement changes anticipated in 2010:

• On Jan. 2, 2010, the Medicare allowable could vary widely from a 2% decrease in reimbursement, up to a 4% increase -- depending on congressional action or inaction.
• The Ambulance Inflation Factor (AIF) is expected to be 0%.
• The Medicare Ambulance Access Prevention Act is requesting a 6% increase base upon the GAO study and permanent extension of 22.6% increase for super rural transports.    

Concluding remarks
The IAEMSC Inaugural Leadership Summit in Washington, D.C. met the association's goal of bringing EMS chiefs and leaders together in a forum that educated and inspired them, and it enabled attendees to discuss common issues and projects. Those who were able to attend benefited from the content of the program and the access they had to key federal officials and their Congressional representatives. This special report by JEMS is an effort to bring you a detailed progress report on the Leadership Summit and the work of the IAEMSC. For more on the association, visit www.IAEMSC.org.

• 

• A.J. Heightman

  Editor-in-chief of JEMS A.J. Heightman is a former EMS director and EMS operations director who has researched and specialized in MCI management training for 30 years. Contact him via e-mail at a.j.heightman@elsevier.com.  

  Learn more from A.J. Heightman at the EMS Today Conference & Expo, March 2–6 in Baltimore.