Administration and Leadership, EMS Insider

AAA Annual Conference: Report from Day One

American Ambulance Association (AAA) President Mark Postma opened the 2018 AAA Conference and Trade Show on Thursday, Sept 6, at the MGM Grand Hotel Conference Center in Las Vegas. AAA’s conference is a place for key leaders in the private ambulance industry to connect, discuss challenges and learn from others’ experiences.

‘Re-Imagining Your Organization’

Postma introduced Keynote Speaker Rob Lawrence, California Chief Operating Officer for Patient Care Logistics Solutions, previously known as Paramedics Plus. Lawrence started his presentation, “Re-Imagining Your Organization”, noting that today social media isn’t always sociable, and email can be a weapons-grade communication device. He also told the attendees that everyone with a phone camera is a videographer for the evening news.

He told managers that the media will reference current and “former” EMTs and paramedics in their reporting, so agencies must be ready to defend themselves and get ahead of it in the media – often going out in the field or to the home of involved patients with the media to clarify issues.

He showed several slides that exhibited his point, poking fun at himself with an image where he was caught checking his cell phone during a public event and showing another EMS officer nodding off during the same event. The message: the media and the community are now watching us 24/7.

With an extensive background of media management, story development and getting in front of a story before it runs away, Rob highlighted the proactive and preventive steps any organization can take to ensure that it survives and thrives in the public eye, twitter-sphere and news at 11.

Lawrence emphasized that we will always be in the news and are “billboard organizations” – like EMS is driving around in a massive billboard. Anything you do, whenever an event happens, wherever your crews go, or whatever happens to your units (whether your ambulance is at fault or not!) it will be broadcast or reported on.

He told EMS managers that we “now have to become publicists and not just PR agents” to keep our agencies viewed in a positive light and seen as innovative health care delivery services. He used his popular KAPE acronym (Keep your Agency in the Public Eye) to drive home several points and offer key tips to the AAA audience of 600 people:

  • Know the names and faces of ALL your employees;
  • Don’t have employees get caught posing in front of their ambulance when it is involved in a collision or incident;
  • Promote your people to the media when they do great things; it is great for them and great for your service’s image;
  • Be the perfect host to visitors to your service, particularly dignitaries, community leaders, members of the news media and visitors from other ambulance agencies from the USA and other countries.

Rob concluded his remarks noting that “it takes 10 good stories in the media to make up for one bad story!”

Management, I Never …

Scott A. Moore, Esq., a licensed attorney, specializing in human resource, employment and labor law, employee benefits, and corporate compliance matters, and Brian S. Werfel, Esq., a partner in Werfel & Werfel PLLC, a New York-based law firm specializing in Medicare issues related to the ambulance industry, presented a fast-paced, light-hearted but highly educational session that pointed out management moments that we are not (or should not be) proud of.

Utilizing an anonymous mobile polling platform (Slido), attendees were asked to respond to common management mistakes or situations they had encountered in their leadership roles. They then discussed how leaders often unknowingly (or knowingly) deviate from management best practices – exposing their organizations to substantial embarrassment or legal liability.

Scott and Brian presented statistics on how regularly these missteps occur in everyday business and provide advice and practical steps for mitigating organizational and personal liability.

Some of the jewels (tips) discussed:

  • Know the names and faces of all your employees so they know that you care;
  • Managers and supervisors should not have too many drinks in the presence of subordinates and co-workers – It will reflect negative on you and come back to haunt you;
  • Be careful not to “reply all” when you do not need to do so;
  • Be careful (spell check) your emails and text messages when you use “auto-spell” because your words may go across the Web incorrectly. Example: “Tell her I have her pies – was auto-spelled as “Tell her I have herpes”;
  • Explore having a “love contract” with your employees, a contract that allows you to transfer or reassign partners who were once in a relationship – that has gone sour – affecting their attitudes or performance. (They noted that they had examples of these contracts available of attendees or other agencies would like to obtain copies.

Rural EMS in America – A Private Provider Model

Mike Williams, vicepresident and CEO of the non-profit Sierra Medical Services Alliance (SEMSA), presented how he and his team have successfully navigated the pitfalls most rural EMS agencies and providers face in the Northern California (Merced County – National Forrest and agricultural areas) and rural Reno Nevada regions.

Mike’s career has spanned nearly five decades and taken him from the basic levels of EMS, 20 years as an Air Force as a medic and commissioned pilot and to a regional CEO for the nation’s largest ambulance provider and EMS Director for the State of Florida.

The SEMSA service area is so spread out that it necessitated the establishment of an integrated ground/air approach in concert with Air Methods/Mercy Helicopter systems.

Williams noted that, “unlike large urban systems where you can say ‘If you see one EMS System, you’ve seen one EMS System’ – in rural regions, there is no such thing as “typical”.

He reviewed similar challenges that rural and remote system have:

  • Recruitment and retention of personnel;
  • Primary and continuing education is difficult to get;
  • Skill retention;
  • Limited mass casualty resources;
  • Limited availability of police officers (“the Cavalry”); So, when crews go out, “they are on their own”;
  • Difficulty maintaining coverage when ambulance are out of the service area on prolonged call with long transfer distances and long return times;
  • Limited technology (No GPS in units; poor radio and cell coverage/communications; no AED trained dispatcher);    
  • Plenty of “miscellaneous” calls because EMS is the only medical “service” available;
  • No interfacility critical care and transportation resources;
  • Difficulty convincing crews that every patient does not need (nor will they accept) transport. Williams said that “Farmer Brown is so dedicated to his farming mission that he will stay on his tractor to finish plowing that needs to be done – even though he just chopped off four toes.”;
  • Inadequate medical services coverage because the areas hospitals, physicians and nurses are (no fault of their own) lacking what a big city has;
  • The need for expanded scope of practices for crews because they are the only car available to the resident;
  • Rural residents that tend to be older;
  • Pediatric trauma deaths tend to be twice that of urban areas;
  • Ambulance calls (particularly from Farmer Brown and other residents tied to the land or their business/job) that tend to be urgent or critical because they wait until they cannot stand pain or condition symptoms before they “give in” and call;
  • High admission rates (perhaps because of the previous delay in requesting care/transport);
  • The need for unique Community Paramedic approaches (His system mirrored Nova Scotia’s program); and
  • The need for low-acuity “cars” to free up transport ambulances from cases that do not need them.

He recommended that attendees review the government’s Rural and Frontier EMS Agenda for the Future document if they want more vision and recommendations for their services.

The Rural and Frontier EMS Agenda for the Future, published in 2004, was a landmark document that focused attention on the issues specific to the survival and improvement of EMS in rural America.

Much of what is included in the document is aimed at policy makers at various levels of government. However, it also contains many practical ideas and concepts that can, and should, be implemented at the local EMS agency level.

Some of the key sections that rural services can benefit from reading:

  • What is the Rural and Frontier EMS Agenda for the Future?
  • Assessment and Planning
  • Key Recommendations from the Rural & Frontier EMS Agenda for the Future
  • Integration and Regionalization
  • Key Recommendations from the Rural & Frontier EMS Agenda for the Future
  • Resources for Quality Improvement Project Development

Note: SEMSA, based out of Reno, Nevada, also provides management services to several rural services and their International Center for Prehospital & Disaster Medicine (ICPDM) is a SEMSA service established to provide education and training experiences to the widest rural, frontier and international audiences possible. The ICPDM programs are offered in a traditional classroom environment and through modes of distance learning that allow students in rural, frontier, and international areas equal access whenever possible.