EMS Insider, Expert Advice

Bridging the Gap to Understanding

One of the most challenging aspects of an EMS leader’s job is communicating with stakeholders outside the agency—especially elected and appointed officials. Explaining unit hour utilization or the difference between BLS and ALS to a city council member or county manager can be difficult and even frustrating. Trying to comprehend a municipal budget process and the reason some decisions get made can be maddening.

Bruce Moeller, PhD, Fitch & Associates

Bruce Moeller, PhD, a senior associate consultant with Fitch & Associates, knows the difficulties of explaining fire and EMS to local officials—he has decades of experience in the fire service, including stints as chief in the City of Sunrise and Broward County, Fla. But he also knows what it’s like to be on the other side, leading a municipal government facing many challenges and trying to balance several priorities, things he had to do as city manager in Sunrise and as an assistant county administrator in Pinellas County, Fla.

At the Pinnacle EMS Leadership Forum next month in San Antonio, Moeller will discuss these issues as part of several sessions aimed at building bridges between fire and EMS leaders and the municipal officials in their communities. EMS Insider sat down with Moeller to talk about this topic and his experience as a fire chief and a municipal official.

Q: How much do most city and county officials really understand about EMS?

Moeller: Not much. Elected officials and appointed officials are generally concerned about two things: They’re concerned about budget, and they’re concerned about the politics of an issue. They really have to rely on their EMS chiefs to be the subject matter experts. Chiefs need to understand the constraints of budget and public policy that local officials face.

The EMS chief also has to understand the economic situation that most communities are in right now. Historically the U.S. has had a recession about every eight years. The last major downturn, the “Great Recession,” was in 2008. So really, forward-thinking city and county managers are worried about when the next economic downturn is going to occur, because we’re essentially at that point. A lot of chiefs I talk to think things are better now, property values are coming back. But the economic situation is still tenuous.

I can juxtapose that against the fact that EMS demand is going up at a rapid rate… while fire activity has dropped dramatically. Are you running things today the same way you were two decades ago? Because if you are, maybe you’re not aware of what’s going on in the industry. The economy and the changing demand—that’s what the manager’s going to be thinking about. When you come in looking for resources, he or she will want to know, what’s your justification and what are you doing differently?

Then you need to engage the manager or mayor in a dialogue about the community’s expectations. To me that’s the key question. And defining that is difficult because, while people like to talk about engagement theory, the harsh reality is that communities don’t really know what they want. They rely on their EMS chief to tell them.

Q: So how do you educate local officials about EMS?

You have to have relationships with your elected officials and your appointed officials. You have to. The advantage we have in fire and EMS is that we have neat stuff. It’s that excitement for elected officials that they get to ride in an EMS supervisor or battalion chief’s car, responding to calls. But it’s not just a ride-along to show them a good time. It’s a ride-along to say look, here we have a minor incident and we’ve sent two, sometimes three, resources. If you’re resource constrained, talk about that. Explain the challenges of increased call demand. Before you get them in the vehicle, plant a seed about alternative response models or other options.

Take it slow, develop the relationship with them; it’s a constant education. Once you do that, then continue to feed them information. Maybe there’s a new article that came out that talks about how call prioritization can help manage resources. Or another about how response time isn’t as important as we used to think it was. It is a long process.

Q: How do I talk to local officials about mobile integrated healthcare and community paramedicine?

Actually, those things are exciting to elected officials. When you talk about MIH though, I wouldn’t start with the financial side—we certainly don’t have a portfolio of programs that can be replicated that show they can make money. It’s new, it’s exciting, it adds value to the community. For those communities that do have some resources, the fact that I am an elected official or city manager and I can get behind a program that’s new and cutting edge—you’ve actually got an easier sell with that.

Chiefs who are basing their arguments for MIH solely on the finances are going to struggle, because they’re going to get jammed up when the programs are not bringing in enough revenue. So you have to be careful.

Q: What’s the hardest part of EMS for a local official to understand? What do we need to explain better?

Fractile versus average response time creates a lot of confusion. We need to start using both average time and fractiles, because people understand averages.

Also, what happens is an inevitable comparison of your community to a community next door. But organizations measure things differently, and lie to make themselves look better. Multiple reports from inspectors general of large cities across the nation have looked at fire and EMS systems and found they’re not doing what they claim.

Whatever measures you do use, be clear on what they are. Focus more on internal benchmarks and whether you’re moving in a positive direction rather than external comparisons. Focus more on your community, your system and what value you bring to your residents.