What “business” are you really in? Before we provide the structure and training for our Starving EMS Supervisors, leaders should review the current mission of the organization as reflected by the expectations of those that control resources and regulations as well as caregiver day-to-day activities. Here are 3 recent organizational issues.
Transport Destination
The establishment of STEMI Centers, Primary Stroke Centers, Behavioral Health facilities, Sobering Services, Trauma Centers, Pediatric, Burns and other specialties means that the patient may not be transported to the nearest emergency department. In many EMS systems, this dramatically increases the time-on-task for the ambulance crew to deliver the patient to a specialty center and return to the jurisdiction or district.
The Emergency Triage, Treat and Transport (ET3) initiative rolled out by the Centers for Medicare and Medicaid on February 14, 2019, will pay participating ambulance providers to:
- transport an individual to a hospital emergency department (ED) or other destination covered under the regulations
- transport to an alternative destination (such as a primary care doctor’s office or an urgent care clinic)
- provide treatment in place with a qualified health care practitioner, either on the scene or connected using telehealth.
9-1-1 response workload increases: Opioid, Behavioral Health, and Lift Assists
Administration rate of naloxone by EMS providers increased by 75% from 2012 to 2016. The number of additional EMS calls for overdoses is overwhelming in some communities, in Massachusetts EMS response to opioid calls went from 8,389 in 2013 to 20,978 in 2016.
A CDC analysis of state-level data from July 2016 through September 2017 indicates tremendous variability in the impact of opioid overdoses on Emergency Department visits, from 109% to 14%, with a national average of 30%.
Suicide rates in the general population have increased by 31% from 2001 to 2017. 9-1-1 responses to suicide ideation and suicide attempts have also increased. Using the 25:1 attempt versus success guideline, there is 1.18 million suicide ideation/attempts a year. These incidents take significantly longer time-on-task to resolve than an assessment of a person with trouble breathing. Most of these calls do not generate billable services.
Aging Baby-Boomers (25% of the 65+ population falls every year), widowers living alone (50.1% of those 65 or older), an increase in those that are extreme obesity (7.7% of the population), and a decrease in nursing home/assisted living staffing (360 lift assist requests to Tulsa Fire Department in a year) fuels the increased number of lift-assist service calls.
Last year, the Chattanooga Fire Department received 1,320 calls for non-emergency citizen assists, which include lift assists. That’s a more than 300% increase from 435 calls in 2013, according to department data. The number of calls in fiscal year 2019, which runs from July 2018 through June 2019, already has surpassed last year with nearly 1,400 as of Friday.
Angry, Frustrated and Suicidal Caregivers
Maybe you are one of the effective, compassionate, and effective leaders that knows what is going on “on the street” and with your EMS caregivers. Unfortunately, we have some high profile examples of leader disconnect.
New York Mayor De Blasio, responding to a reporter’s question about the up to $40,000 pay disparity for FDNY EMS caregivers said that “… the work is different.” This seemed to be a tone-deaf response that has generated many responses, including this video.
https://youtu.be/RrCCO1tA7k8
A six-year effort to obtain PTSD coverage for Connecticut public safety personnel stumbled as the 2019 legislative session was wrapping up. EMS providers petitioned to be included in the coverage that will serve law enforcement and fire department members. Allegedly, the leaders of commercial ambulance services were concerned about the cost of PTSD coverage.
We are starting to understand a few of the issues leading to EMS caregiver suicide. MedStar’s peer-based HOPE Squad may be an approach to reducing the rate of EMS caregiver suicides. EMS Supervisors could play an important role.
Set your priorities
The EMS Supervisor is the eyes, ears, witness, and brawn of the leader. What do you need the supervisor to do? What is the expectation of your boss?
Based on your assessment, describe the activities that the EMS Supervisor should perform each month. This will start our structure with your organization’s supervisors.
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Featured Image “CM Guerrero/Getty Images” from the Times UK: Review: American Overdose: The Opioid Tragedy in Three Acts by Chris McGreal — a nation’s deadly addiction