Administration and Leadership, Commentary, News, Training

Where in the World of EMS is A.J.?

At the 2014 Pinnacle Conference, JEMS Editor-in Chief A.J. Heightman presented a half-day workshop on advanced strategies for managing an EMS agency with Skip Kirkwood, EMS chief of the Durham County (N.C.) EMS system and former president of the National EMS Management Association.

The session, attended by more than 100 key fire and EMS managers, addressed the pillars of EMS systems: operations, clinical quality, finance and human resources. It discussed how EMS managers and systems should take full advantage of new opportunities to ensure their organizations excel in the four critical pillars.

The duo noted that if an organization is weak in any one area, the entire organization is vulnerable, and therefore unable to respond to challenges.

They also spoke about the latest issues, trends and advanced strategies facing EMS agencies such as reduced financial support, healthcare demand and employee resistance to change.

Topics included:

·         The value of response times and the need for a paradigm shift;

·         The latest thinking in call demand, resource matching and deployment;

·         The need to balance efficiency and caregiver satisfaction;

·         Crew schedules that best serve customers, employees and the agency;

·         Fundamentals of quality: measuring what matters, learning to integrate the lessons and building new capabilities/attitudes;

·         The effects of sleep deprivation on operational and personal efficiency, and the increasing liability it’s bringing to emergency response agencies and government entities;

·         Tips to develop a functional supervisory team;

·         The need for better training and orientation of new employees, particularly on driving, assessment and inter-personal skills;

·         The need for better financial management in the future; and

·         The true need for governmental subsidies for EMS agencies to survive in a reduced-transport health care system that is rapidly approaching us.

Fire Service Evolution

During “How the fire service needs to evolve: expectations from city & county government,” a stellar panel of experienced EMS, fire and government personnel told attendees that, to local government officials, the fire service represents a budgetary behemoth, one that can’t be ignored in the quest to trim public expenditures.

The panel addressed the relationship between the expectations of local government and the need for the fire service to better define its core mission. They then zeroed in on how fire agencies need to develop and adopt new models.

Some of the key areas discussed were:

·         Critical metrics in an increasingly accountable environment;

·         The risks and options to cover them;

·         Translating demand and workload into workable schedules;

·         Substitution concepts for apparatus and personnel;

·         Who should do what, and why match resources and call type;

·         Strategies for developing leaders who embrace change;

·         Key elements of budgets and creative ways to present fiscal information;

·         How to use data to build support, both internally and with councilmembers—and what should be avoided;

·         How to work collaboratively rather than confronting the political leadership; and

·         Case studies of collaboration, via public/private partnerships.

Panelist Scott Somers, a Mesa, Ariz. councilmember, firefighter and national EMS advisory councilmember, noted that nationwide, there has been a 46% drop in fires responses since 1982 and an increase of over 300% in EMS calls, yet the fire service continues to deploy fire resources and respond in a manner that relates back to 1982. More significantly, Somers pointed to the steady increase in low acuity calls that tax fire and ambulance service resources. At the same time, staffing for the specialized capabilities required of an all-hazard department is increasingly difficult to justify.

Mesa, Ariz. has implemented transitional response units that are staffed by a physician’s assistant or nurse practitioner and a firefighter or paramedic. This system has been able to reduce response times, save money and eliminate using first responder resources on low-acuity calls.

Panelist Bruce Moeller, executive director of public safety in Pinellas County, Fla., noted that city managers have realized that fire service is really not that big—fire calls are down more than 50%, fire fatalities are down more than 70% and only 661 fire departments can currently meet NFPA1710 response standards.

He also spoke about public policy issues:

·         The gap between the current state, and where you want to be;

·         Not everyone will agree that a problem exists;

·         Bring attention to areas of public safety that may embarrass the system; and

·         Bring solutions to the problems.

In a poignant statement, Moeller said that no one can show him how 24- or 48-hour shifts help patients.

Moeller felt there were several areas the fire service needs to focus on:

·         Transport to alternative (non-emergent) facilities;

·         Do post-discharge medicine (integrated mobile healthcare);

·         Needs to be able to compete in a healthcare setting; and

·         Personnel must accept change

Panelist Steve Knight, a third-generation firefighter and a senior associate with Fitch and Associates, spoke to the group about how fire-based systems should react to budget and system changes.

Knight said one of the problems facing the relationship between fire services and EMS is a lack of a solid consensus. Some want EMS as first response and some want them to transport. Some want to embrace change and others don’t. Some want to implement integrated mobile health concepts and others don’t. Knight said this, plus the debate of whether response times affect EMS service and quality, confuses and concerns elected officials.

In a powerful visual that showed a red fire service ambulance and a SunStar ambulance, Knight asked the audience what the public would say if both ambulances were the same color and parked in front of a house where an EMS call was underway. His point—well-taken by the audience—was that it’s not efficient to send two ambulances (one staffed by firefighter paramedics and one staffed by a contracted ambulance agency) to the same call, especially when fire ambulance vehicles rarely transport.

Panelist Guillermo Fuentes, MBA, spoke about how Fitch and Associates used science, such as computer simulation, and analytics to redesign the Pinellas County EMS response system. He noted that 25% of calls are cancelled calls, yet we continue to send dual response agencies to all calls, and few fire service agencies get subsidized for first response.

He showed how the computer simulation, through use of actual CAD data, was able to replicate the actual calls to show what was efficient and inefficient.