Starving Supervisors | Company Commander

EMS Supervisors tend to gravitate to one of these four types: Senior Clinician, Street Boss, Staff Specialist, or Super Paramedic. While a successful supervisor fulfills elements of all four types, please consider which of these types is most needed by your organization right now.

Senior Clinician. This role comes from Dr. Paul Pepe’s model of utilizing EMS Supervisors as his eyes, ears, and hands. He trained them in advanced airway management techniques and expected them to respond to and manage all seriously injured or ill patients.

Just like the role a physician takes in the emergency department trauma bay, the EMS Supervisor is in charge of out-of-hospital patient care and brings advanced techniques to the incident. Shares a deep well of pathophysiological and disease process information when coaching caregivers to deliver excellent clinical care. Participant in hospital Mortality and Mobility Conference meetings. Focuses on patient outcomes.

Street Boss. This person sweats the delivery of EMS services hour-to-hour. Stays on top of staffing, vehicles, supplies, and equipment. Has a list of caregivers that can work overtime on short notice.

Looks after the crews by responding to calls where police are dispatched, accidents with entrapment, structure fires with civilians trapped, hazmat with Level B or A entry, and incidents with 4 or more patients. On first name basis with emergency department charge nurses and ED unit managers.

Has a “Plan B” and “Plan C” to keep units rolling. Got an ambulance tire replaced on a holiday weekend when all of the regular vendors were closed. Does everything possible to avoid a Level Zero status, including liberating ambulance crews stuck in hospital wall time.

Staff Specialist. This is the manager “… that does things right.” For the EMS agency that means that the state required caregiver credentials never “accidentally” expire, requiring a refund of ambulance bill payments.

The annual state inspection of certified vehicles and records do not have any unexpected corrective actions or penalty payments.

Caregivers are paid correctly, including overtime and special assignments. Vacations are handled fairly. All of the personnel office requirements, such as mandatory training, flu shots and annual evaluations, are promptly completed. Maintains oversight of annual budget expenditures.

Super Paramedic. Has the same clinical skills as ambulance-assigned paramedics, responds to many “good” calls to provide a helping hand. Deeply invested in specialty roles, such as Tactical Medic, Technical Rescue, and Hazardous Materials. On first name basis with the police precinct supervisors, 911 center supervisors, and battalion chiefs. Unlike the Street Boss, who oversees specialized or complex situations, the Super Paramedic is an active participant in such incidents.

The Super Paramedic is a very enthusiastic provider of EMS services. Closely monitors EMS activity and often responds as an ALS first responder. May have the highest number of live intubations as a field medic within that organization. Depending on how the Super Paramedic channels enthusiasm for action, is either an asset or a jerk.

THE VALUE OF AN EMS SUPERVISOR

Under the current ambulance service compensation system, the tasks delivered by an EMS Supervision does not create billable work. Some of their actions indirectly impact the agency’s revenue.

The Staff Specialist makes the biggest impact on revenue through two practices:

Verifying that caregivers hold current credentials and ambulances are properly registered as ALS (Paramedic) or BLS (Emergency Medical Technician) vehicles. This means that no transport bills will have to be refunded and the agency’s ability to bill for Medicare will not be endangered.
Making sure that caregivers obtain the appropriate signatures and write narratives that match the Patient Care Report coding. In some services, this resulted in a revenue increase of 12% to 20%.

The Street Boss makes the next biggest impact on revenues by identifying and reducing situations where caregivers are stuck in a non-revenue situation and unable to respond to ambulance transport assignments.

Implementation of the Institute for Healthcare Improvement’s Triple Aim that links reimbursement with improved health outcomes and patient experience is an area where the Senior Clinician can potentially make the biggest impact on agency revenue in the future.

Using revenue as a measurement, the Super Paramedic makes no impact, unless your system is so under-resourced that the EMS Supervisor is spending a good part of the day responding as an ALS first responder to avoid financial penalties or a breach-of-contract termination.

TAKE EMS SUPERVISOR SURVEY

We will be exploring the feeding of Starving EMS Supervisors in later articles. To help me develop those articles, please take 3 minutes to complete a 5 question survey.

We will share the results in a later article.

https://www.surveymonkey.com/r/X97MSG3

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Picture sources:

Jamie N. Deis, Keegan M. Smith, Michael D. Warren, et al. (2019) “Transforming the Morbidity and Mortality Conference into an Instrument for Systemwide Improvement.” Advances In Patient Safety Rockville, MD: Agency for Healthcare Research and Quality.

Loberger, Dale (2017 February 9) “What ‘Level Zero’ Really Means in EMS.” High Performance EMS

Backer H.D., D’Arcy N.T., Davis, A.J., Barton, B., Sporer, K.A.. (2019 May-June) Statewide Method of Measuring Ambulance Patient Offload Times. Prehospital Emergency Care. 23(3):319-326.

Lawrence, Robert (2013 December 31) The Business Side of EMS: Knowing our business means understanding every possible metric, from billing to vehicle maintenance. Journal of Emergency Medical Services.

Boynton, Andy (2016 March 31) Nine Things That Separate The Leaders From The Managers. forbes.com

42 CFR § 410.41: Requirements for ambulance suppliers

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

IHI (2019) Initiatives: The IHI Triple Aim. Boston, MA: Institute for Healthcare Improvement