Response to the “What does your EMS Supervisor do?” survey was clear: 64% want a Street Boss. Senior Clinician was wanted by 22%. Super Paramedic and Staff Specialist were in single digits.
The Street Boss sweats the delivery of EMS services hour-to-hour. Stays on top of staffing, vehicles, supplies, and equipment. Looks after crews by responding to high hazard or complex incidents. Maintains a “Plan B” and “Plan C” to keep units rolling and avoiding a Level Zero status.
The Chicago Experience
Chicago Field Chief Majorie Bomben described her transition from paramedic to a supervisor, where she oversees 9 paramedic ambulances.
It’s a middle management job that lays somewhere in that gray area between being one of the paramedics, and being their boss. The job is one-third administrative, one-third mandatorily dispatched runs, such as a multi-ambulance response or a fire, and one-third could be for almost anything under the sun. (Bomben 2016)
1. Intimate Knowledge of EMS Operations: Dispatch and Public Safety
There is a big change of perspective when your organizational view goes from the windshield of your ambulance to looking at the needs of a group of caregivers.
Visit your dispatch center and become intimately familiar with how requests for service are processed – the number of steps and the time it takes for each step. For example, this is how a life-threatening 911 call is handled in an urban county with multiple police jurisdictions and a commercial EMS service :
Upwards of 5-7 minutes of that wait time is in the processing at [the town 911 center] before the hand off to County 911 prior to dispatch of fire units. Then add County 911 processing and handoff the call to EMS agency be processed again you are now at 9-15 minutes before the first EMS unit is alerted.
Get on a first name relationship with the police district supervisors and battalion chiefs and understand their resources as well as the issues they have when working with EMS. You are their colleague in the street. For example, a police district with 7 patrol officers on duty in the 3 pm to 11pm shift may only have 2 officers working the 11 pm to 7 am shift.
2. Know how to get resources to the caregivers: Medications, Supplies, Equipment Replacement, and Vehicle Repairs
Many services have procedures that work during normal business hours. The Street Boss needs to develop the contacts, knowledge, authorization, and access to the procedure to get resources to caregivers every hour of every day. Some local governments and commercial EMS organizations do not address this. A local government chief administration official expressed concern that the warehouse will be empty by Monday morning if EMS had after-hours access.
The organization needs to support the Street Boss in getting the appropriate authorizations, budget program tracking number, and identification/access to the individuals capable of resolving the resource issue. In some situations, this may require a change in administrative procedures, an increase in the EMS Boss training or a redesign of that part of the system.
3. Identify when it is required, or appropriate, to interrupt a patient care encounter.
The caregiver may be in a dangerous situation requiring the patient care encounter to stop to make the situation safe for caregiver, patient, fellow public safety/healthcare colleagues, and the public. These situations range from Getting off the X to de-escalating a personality conflict impacting patient outcome. These are often the High Risk/Low Frequency with No Discretionary Time situations Gordon Graham advocates preparing for.
Some of these actions are covered in detail within your organization’s personnel regulations, some – such as initiating an involuntary treatment following a psychiatric crisis may require additional training.
4. Know all of the organization’s human resource programs, options, and procedures when considering a CISM, fit-for-duty, behavioral health or caregiver restriction.
As a hospital Chief Operating Officer explained, these human resource procedures are there to protect the organization and the Street Boss that will be implementing an action. Unlike Item 3, these items have discretionary time. Many demand review and approval from a person above the Street Boss’s level before action is taken.
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Bomben, Marjorie (2016 April 14) EMS Field Chief Says Her Job Is Like a “High-Wire Act”: Majorie Bomben talks about the transition from street paramedic to field chief in the Chicago Fire Department. Firehouse.com
EMS Supply room from Nanuet Community Ambulance
Feature Image from survey results.