Describing Your EMS Service and Successes

The photo shows a white ambulance.
File Photo

Community Expectations

I was chatting with an EMS chief who was looking to replace his cardiac monitors. He said that his services current technology platform was going to sunset and he needed to make an upgrade. I asked him how he would describe his service to the board of supervisors to get approval for a mid-year budget adjustment. He told me that they had four basic life support ambulances, four advanced life support ambulances, operating 24-hours a day and that they handled about 38,000 EMS calls per year. He said they covered everything from cardiac arrests to motor vehicle collisions and everything in between.

I think for most of us that is probably the way we would describe our services. It doesn’t make a difference that he is speaking to a member of the legislator, or the press, or even the general public, how we describe ourselves in budget meetings, town halls, and even face-to-face matters.

What if he said we run four basic life support ambulances 24 hours a day, 2 advanced life support ambulances 10 hours a day, and two advanced life support ambulance 24 hours a day and that they handled about 38,000 EMS calls per year, for a population of 317,000 covering an area of 57-square miles. That the response zone covered residential, industrial, along with a community college, an airport and four major interstate highways.

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His service responded for over 30 different classifications of requests, but his top five categories were: asthma/respiratory distress; chest pain; OB/GYN; behavioral health emergencies; and motor vehicle collisions. His payer-mix for re-imbursement were 29% Medicaid; 29% Medicare; 28% were a mixture of private insurance/motor vehicle insurance/workers compensation; and the remaining 14% were self-pay.

What if he spoke about the demographics of the community, how many men and women; how many children under 18 and under 5; how many people were over 65 years of age; how many were Black, White, Asian and Latinx?

You start to get a picture of the community, the challenges of service delivery; you begin to flesh out the dynamics of your service, the complexity of who you care for and what you’re providing.

My Service Is the Best

I worked EMS in a U.S. city for 20 years, one near and dear to my heart, that I would swear in a court of law was the best EMS service in the country. Yet if you asked me why this service was the best my only response would be “because we are good!” I couldn’t quantify it any more than that.

After I had about 15 years in the field, I had the chance to run an EMS service in a neighboring community. It was a challenging situation because it was in financial failure and it needed so much work because of out and out mismanagement it was staggering. When we first took over, I met face to face with every staff member to talk about their concerns.

One young man who was working there was bright, enthusiastic and he provided excellent patient care. He represented the best of our future, not only in EMS and but in healthcare. I asked him what he liked about working here and he said he loved the volume of calls, the complexity, you could go from a STEMI to a shooting to a pediatric asthma all within the span of a single shift. I then asked him what he didn’t like. He said to me quite plainly. “I don’t know what we are doing here,” he said.

I was stunned. When we spoke a little bit more he said he didn’t know if what he was doing was making a difference. Yes, we responded on calls; Yes, we took people to the hospital, but did any of this make matter, were we actually making a difference in patients’ lives.

When I met with members of the community, I heard the same thing: they felt that the ambulance and the emergency department were revolving doors. Did it really make a difference in what was going to happen or was their fate ultimately inevitable? There was a degree of despair in their words. We are talking about members of society who were socially and economically disadvantaged, resigned to fate. We needed to do a better job, not only for our patients, their families, and their neighbors, but also for our workforce.

If we go back to my colleague who was looking to buy cardiac monitors and asked what his Utstein cardiac arrest survival rate to discharge for cardiac arrests were, where someone was performing CPR, and he said that it was 44%, that will help clinicians and others understand what you are doing. If he said that his service completed 3,800 12-leads that were transmitted to their STEMI center that resulted in 27% reduction in deaths due to myocardial infarction since they started their program, they not only help underscore their need for quality equipment, that demonstrate the value their service provides to the community. The outcome of the patient’s interaction with the processes and systems we design and implement are essential to identifying and communicating our success in the clinical environment.

It isn’t only important to collect that information, it needs to be shared far and wide. The late Jonathan Best, past president of the National Association of Emergency Medical Technicians (NAEMT), used to say “where is the sugar for my dime?” He was right on many levels. Every member of the department needs to know that what they do makes a difference, but so do other clinicians, the elected officials, the patients, they all need to know that their efforts in the clinical environment, their tax money, insurance money, fees for service are used to provide a valuable service to the municipality. That what we do matters, we cannot just say we save lives and reduce disability, but we can prove it.

We all send those “atta-boy” letters to men and women who staff our ambulances, but improvement in outcomes show the success of not only of the service but of the system as a whole. Most importantly, it demonstrates the contributions of the people who make it work.

Here’s something funny that I would be remiss if I didn’t mention. The first service I ever ran was a small, urban service on the East Coast. The mean income was below the poverty level, services in the community were inconsistent, and when I met with the people who live there, there was a feeling of despair that was palpable. It kept me up at night.

I needed to get my hands around the issue, what were the publics expectation from EMS? I couldn’t fix the other city services, but at least I could work on my own. There is a formula for quality, where quality equals the value divided by the cost of the provision of the service. While that may seem all well and good it was not applicable in this situation.

The healthcare system I was working for used the Press-Ganey survey, which is sent out via snail mail to anyone who we provided care for, and we adopted it, but with a twist. Since the community was apathetic with government and community services, there was less than a stellar response on the mailed surveys. We decided to hand out surveys at every community meeting, every time we received an inquiry from someone who had used the service, anyone we came into contact with.

The results were pretty straight forward. No one cared if the paramedics got the IV on the first shot or if we recognized a hiatal hernia or a myocardial infarction. What was important to the people who we were entrusted in providing care for were:

  • Was the ambulance clean?
  • Did they have a quick response?
  • Did they cover you with a blanket or sheet when carrying from your home?
  • Were they nice?

They didn’t care if I sent a BLS or ALS unit initially to their home, or the quality of the clinical care that was provided.

A quick response; a clean ambulance; to be covered with a sheet/blanket when we carried you out of the house; and most importantly, were we nice, became the foundational elements of our essentials for patient care philosophy.

Fast forward about 10 years. I arrive in the San Francisco Bay-area. I become the EMS coordinator for a fire department that provides EMS and first responder services to the community. This city is very affluent, they were happy with the services provided by government and community agencies as a whole. The complete opposite from what I experienced previously. Still, I wanted to find out what was important to them. I had graduate students I was working with from the University of San Francisco, one of the first things I did was put them to work on customer service surveys using the same format as Press-Ganey.

What did we find out? The things that were most important to the members of this affluent community were: Did we provide a quick response? Aas the ambulance clean? Did we cover you with a sheet/blanket when we carried you out of the house? And most importantly, were we nice?

Two communities that when speaking about demographics, financial status, education, or whatever measure you decided to pick, could not get any more different if you tried. Yet they had the same “wants” from EMS.

Summary

Describing your service and quantifying success are multifactorial. Modern EMS has never been just a ride to the hospital, but we need to do a better job of communicating what we do and the environment we must provide care under. Everything we do is important, and depending on who we are speaking to, patients, career civil servants, clinicians, elected officials, families, or the body politic, they will embrace one, some, or all of the elements that constitute success.

Their perspectives and focus will be different, but also so is their understanding of what the service is and what we are providing to the community. All of these elements are important regarding how we describe our service and successes because they all demonstrate our value to society.

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