Administration and Leadership, Documentation & Patient Care Reporting, Training

EMS Agencies Share their Respected Practices

Issue 1 and Volume 37.

A respected practice is a method or technique that has consistently shown positive results compared with other practices, and thus, has been used as a benchmark. A “respected” practice can evolve to become even more effective as improvements are discovered. EMS systems often develop their own respected—or best practices—over time. These may include clinical interventions that have been made into protocols by forward-thinking medical advisory groups or medical directors, operationally sound strategies for making the most of scant resources or even training on a unique piece of equipment a system uses.

EMS systems come in many sizes and shapes (e.g., fire-based, hospital-based, for-profit and non-for-profit) and generally have a lack of commonly accepted operational standards. They also may have evolved under different circumstances.
Because of this, it’s important to highlight what some systems are doing well.

This article discusses some of the respected practices that a handful of EMS agencies across the U.S. are currently implementing. Perhaps some of the initiatives will assist you and your EMS agency in moving forward with an innovative respected practice of your own.

Austin-Travis (Texas) County EMS
How does an EMS agency ensure that its workforce is appropriately trained for the myriad challenges a unique setting will throw its way? And how do you develop a clear professional development curriculum for your field training staff? These were some of the questions that Austin-Travis County EMS (ATCEMS) has been faced with in the past. To answer these questions, the agency, one of the premier EMS agencies in the U.S., made the decision to develop structured EMS academy settings to appropriately acclimate its new hires: one academy for communicators and one for EMS providers.

The EMS academy is a seven-week process; and, based on direction from the agency’s medical director, Paul Hinchey, the curriculum is being modified based on practical operating guidelines and a reemphasis on clinical performance due to the increase of newer paramedics into the system.

Teresa Gardner, ATCEMS assistant director for the professional practices and standards division, says, “On the front end, this process is an excellent tool for matching providers with our system—we rarely lose providers once they enter the academy.” The major subjects covered at the academy include important administrative aspects (i.e., human resources), driver training, overall operations (including the agency’s electronic patient care report tablets), clinical aspects/guidelines and scenario-based training.

Another unique element of the academy is its focus on physical fitness. ATCEMS recognizes that EMS is a physically demanding and stressful job that puts providers in contact with many harmful pathogens. This, along with the sleep deprivation that is inherent in the profession, is a recipe for injury, illness and such chronic health problems as lower-back pain. The program emphasizes proper diet and exercise to encourage providers to stay fit and healthy.

However, completing the academy is only one element of the entire process of becoming a credentialed ATCEMS paramedic. Once each paramedic candidate graduates from the academy, they’re assigned a dedicated mentor who shepherds them through the remainder of the process.

And ATCEMS’s professional development doesn’t end when providers become credentialed, but rather, it’s a continuing education program based on a 48-hour a year per employee cycle. A key initiative in the ATCEMS professional development lexicon is the education of staff and the rank of the paramedic captain (i.e., a clinical specialist), which focuses on many supervisory elements. These elements include mentoring in the high-acuity environment, delivering appropriate feedback and leadership training. This person is based on the federally developed Field Training Evaluation Program (FTEP) and by various resources from the local junior college. This training involves a 40-hour initial class reinforced with a two-hour quarterly session that focuses on specific supervisory issues.

“This program has helped establish consistency and goals within our training program and involves our captains in the employee development process,” Gardner says. Although this level of initial training and subsequent supervisor development may not be viable for all EMS agencies, the ATCEMS approach can definitely teach lessons on workforce development to other agencies.

Western Eagle County (Colo.) EMS
How do you service a population that’s geographically isolated and, at the same time, ensure that the 9-1-1 calls your service receives are for true medical or traumatic emergencies?

This was the question the Western Eagle County (Colo.) Ambulance District (WECAD) pondered, and this is also where the community paramedicine program comes in—through a collaborative effort between Eagle County’s Public Health Department, Vail Valley Medical Center, Eagle Valley Medical Center, Colorado Mountain Medical and the WECAD.

In 2010, WECAD, based in Eagle, Colo., launched its community paramedic pilot program. The major impetus for the program was the unique rural geography, putting patients served by the EMS agency miles away from the hospital. This made it difficult or costly for them to find transportation for regular medical visits or routine checkups. In addition, the service was experiencing an increase in non-emergent calls.

The specially trained WECAD paramedics, who now respond as “community paramedics,” have taken an additional 300 hours of clinical classes related to primary care, discharge planning, public health, social health and other areas to deliver in-home services that were once traditionally reserved for the hospitals: drawing blood, giving injections not routinely given by prehospital paramedics and changing bandages, as well as keeping tabs on how patients are caring for themselves at home.

According to WECAD Chief and 2010 Innovator in EMS award winner Chris Montera, EMT-P, the two primary goals of the community paramedics program are to reduce hospital readmission rates by 50% and ensure all patients have a primary care physician referred to in the WECAD system as a “medical home.”

The other three “program measures” include calculating cost savings of the community paramedics program. The cost of ongoing care/hospital care, measuring injury prevention, potential costs associated with no prevention, and keeping track of the number of vaccinations given and public health visits. WECAD’s program has attracted national attention, including being the reason Montera was named a 2010 Innovator in EMS. As Montera says, “EMS systems need to understand the niche that these providers are filling. This is about filling healthcare gaps and expanding the role, not the scope.”

Richmond (Va.) Ambulance Authority
How many times have you arrived at the scene of an accident only to find unconscious or semi-conscious patients and wished that the patient’s information was readily available?

As a result of this common occurrence and the preponderance of motorcycle crashes and resultant fatalities in the Commonwealth of Virginia, Richmond Ambulance Authority (RAA) Chief Operating Officer Rob Lawrence, MCMI, went back to his roots in Great Britain and came up with the CRASH card (pneumonic for caution, road, accident, serious, help). A similar card was developed in the U.K. two years ago by the Ambulance Motorcycle Club.

In April, the RAA implemented the Rider Alert ( program. The first of its kind in the U.S., the program provides free, waterproof identification data cards for motorcycle riders that will help first responders provide rapid and accurate medical assistance. The data cards are placed inside riders’ helmets and contain vital, lifesaving medical information, emergency contact information and pertinent medical history.

When first responders arrive on the scene of a motorcycle accident, a one-inch round sticker on the outside of the helmet indicates that the biker has the Rider Alert card. The sticker also warns bystanders not to remove the helmet, which could prevent further injury. With sponsorship from various entities, including Bon Secours Virginia Health System, and the nonprofit organization Motorcycle Virginia, as well as the support of the Virginia Office of Emergency Medical Services, RAA rolled out an initial printing of 5,000 cards at its April launch event.

Since then, the program has gone viral and more than 125,000 cards have now been distributed across five states in a six-month period, a solid indication of the program’s success and usefulness. Additionally, the program now provides a card to everyone who takes the beginner motorcycle training program through the Virginia Department of Motor Vehicles.

“We knew that the program was sound after the success of the U.K. card, but the speed that this snowball turned into a safety avalanche on this side of the pond amazed us all,” Lawrence says. “After only six months, we have already seen examples where the presence of the card has helped us to help riders. One of my own medics attended an accident recently where the presence of the card helped both EMS and the emergency department to identify and treat the unconscious casualty. It makes it all worthwhile.”

He attributes the program’s success to the wholesale support the program has received from all public safety agencies that have become involved in the program as well as the initial sponsors who continue to support it. Additional sponsors include PHI Helicopters, Inc., the American Ambulance Association and Geico Insurance—the latter of which took the card program to South Dakota to the 71st Sturgis Motorcycle Rally, one of the largest motorcycle events in the world.

The next steps for the innovative program include discussions about Rider Alert with other EMS agencies in the U.S., as well as continued outreach to other countries. Just as RAA inherited the program from the U.K., the agency is now working to spread the word to Australia, where some police and fire-based motorcycle groups are looking to start their own program.

The respected practices mentioned above are but a few of what are currently being field-tested by systems across the U.S.

EMS is in a constant state of flux. Various factors—from shrinking public funding mechanisms to uncertain future healthcare dollars and rising unemployment in the face of an aging boomer generation—have the potential to make the practices highlighted all the more important. JEMS

This article originally appeared in January 2012 JEMS as “Striving to Thrive: How to implement the ‘best’ for your agency.”

 For more about WECAD’s program see: