Robert Vroman, M.Ed., BS NREMT-P

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EMS1 Daily News

Police: Woman backs car into 2-year-old nephew, killing him

The woman was preparing to leave her home Thursday and was moving her car to a closer parking spot to load some packages

Wash. firefighter-EMT dies unexpectedly at home

A GoFundMe page has been created to help Doug Archer’s family pay for funeral expenses

Md. fire dept. receives grant to develop community paramedicine program

The grant will help reduce operational strain on EMS resources and improve care for patients with complex medical conditions

Fundraiser to build new home scheduled for injured SC paramedic

Tessie Smith was responding to a call in March when her ambulance was struck head-on by an impaired driver

Calif. off-duty paramedic, nurse aid man hit by car

A nurse and his wife, a paramedic, pulled over to the side of a highway after they saw a body in the road

1 hurt in San Diego ambulance, trolley collision

The ambulance was responding to a call and had its lights and sirens activated when the crash occurred

EMT severely burned by exploding e-cigarette

Ricardo Jimenez, 24, said he immediately parked his car and took off his pants when they began to smoke

Ky. 911 center criticized by fire union president

When Capt. Christopher Bartley filed a formal request for 911 data relating to calls placed on hold, officials told him they didn't have the data

Report: More than 50K overdose deaths in U.S.

Heroin deaths rose 23 percent in one year, and deaths from synthetic opioids rose 73 percent

Pa. college develops potential carbon monoxide antidote

The antidote cut CO blood levels by half in only 25 seconds in mice and in laboratory testing

EMS1 Topic Articles

Police: Woman backs car into 2-year-old nephew, killing him

The woman was preparing to leave her home Thursday and was moving her car to a closer parking spot to load some packages

Wash. firefighter-EMT dies unexpectedly at home

A GoFundMe page has been created to help Doug Archer’s family pay for funeral expenses

Md. fire dept. receives grant to develop community paramedicine program

The grant will help reduce operational strain on EMS resources and improve care for patients with complex medical conditions

Fundraiser to build new home scheduled for injured SC paramedic

Tessie Smith was responding to a call in March when her ambulance was struck head-on by an impaired driver

Calif. off-duty paramedic, nurse aid man hit by car

A nurse and his wife, a paramedic, pulled over to the side of a highway after they saw a body in the road

1 hurt in San Diego ambulance, trolley collision

The ambulance was responding to a call and had its lights and sirens activated when the crash occurred

EMT severely burned by exploding e-cigarette

Ricardo Jimenez, 24, said he immediately parked his car and took off his pants when they began to smoke

Ky. 911 center criticized by fire union president

When Capt. Christopher Bartley filed a formal request for 911 data relating to calls placed on hold, officials told him they didn't have the data

Report: More than 50K overdose deaths in U.S.

Heroin deaths rose 23 percent in one year, and deaths from synthetic opioids rose 73 percent

Pa. college develops potential carbon monoxide antidote

The antidote cut CO blood levels by half in only 25 seconds in mice and in laboratory testing

EMS1 Columnist Articles

Inside EMS Podcast: Why scene safety needs to be more than an EMS mantra

Download this podcast on iTunes, SoundCloud or via RSS feed

​​In this Inside EMS Podcast episode, co-hosts Chris Cebollero and Kelly Grayson discuss the top EMS news articles from the week, including how an IV infiltration led to a $700,000 negligence award, what EMS leaders need to know about public health and how a 17-year-old EMT student, who was shot while aiding a shooting victim, was able to meet the doctor who treated him on scene.

Kelly also talks about his new book, " En Route: A Paramedic's Stories of Life, Death, and Everything in Between."

EMS Artwork: Emotional toll on dispatchers

Dan Sun Photos Routine

5 things EMS providers should know about seeking mental health treatment

By Bob Sullivan and Shauna Sullivan

EMS providers face a number of challenges that compromise mental health and well-being. These include both acute stress after critical incidents, and chronic stress associated with day-to-day EMS work. Mental health treatment, in the form of therapy and/or medication, can help improve wellness on and off the job.

Here are five things to consider about whether mental health treatment may be helpful for you, how to find the best match with a mental health provider and the options available to pay for mental health care and medications.

1. Receiving mental health treatment does not mean something is wrong with you.
While traumatic stress after critical incidents has gotten a lot of attention recently, there are many other factors that predispose EMS providers to mental health problems and substance abuse. Mood fluctuations associated with sleep deprivation, challenges to healthy eating and fitness, low wages, overtime, conflict with coworkers and unsupportive management over time can lead to symptoms of anxiety and depression.

An NAEMT survey showed that respondents overwhelmingly wanted mental health care to recover from traumatic incidents, to maintain mental health, cope with stress and prevent developing PTSD, anxiety or depression [1]. However, the report also states that the stigma of mental illness and fear of being perceived as weak deters many respondents from seeking treatment. Only about half of respondents reported that they feel comfortable even talking about mental health with colleagues [1].

It does not have to be that way. Mental health treatment can be viewed as an adjunct to diet, exercise, hobbies and other healthy coping strategies to manage the unique challenges associated with EMS work. Seeing a mental health therapist or taking medication for anxiety is really no different from seeing a physical therapist or taking medication for hypertension.

Many people believe that mental health treatment is only necessary for people with significant mental health problems, but this is not true. Talk therapy can provide practical solutions for everyday stress management and work life balance, whether you have a diagnosed mental health issue or only feel symptoms occasionally.

2. Therapists and medication prescribers are the main options for mental health treatment.
Mental health professionals generally fall into two categories — those who provide talk therapy and those who prescribe medications. Some people see only one type of mental health professional and some people see both types; which one to start with depends on your preference. A therapist may refer a client to a prescriber, or vice versa, and the prescriber and therapist can collaborate on how to best meet the patient’s treatment goals.

Mental health therapists have a doctorate or master’s degree, and include psychologists, mental health counselors, clinical social workers and pastoral counselors. While the educational backgrounds are different, all may function in similar roles, and all may specialize in particular populations or conditions.

Medications for symptoms of anxiety and depression are prescribed by psychiatrists, who are physicians trained in mental health disorders. Nurse practitioners and physician assistants may also specialize in prescribing medications for mental health conditions, and some primary care physicians prescribe psychotropic medications as well.

3. Look for a mental health provider who matches your personality and situation.
Several NAEMT survey respondents who received mental health treatment expressed frustration that their provider did not understand the demands of EMS work, and that they would have preferred to see someone with a background working with EMS providers. Consider these resources to find a mental health practitioner who may be a good fit for you.

One referral source is The Code Green Campaign, whose website includes a state-by-state list of mental health providers with experience serving first responders. Other websites with reviews of health care providers include mental health practitioners, and describe areas of specialty.

For people who are comfortable talking to coworkers and friends about mental health, word of mouth can be a good referral source for a therapist or prescriber. Many individual mental health providers also have websites or blogs that describe their treatment philosophy, and populations and conditions that they are comfortable seeing.

Once the search is narrowed, it is a good idea to call the mental health provider before making an appointment. Ask about their experience with people who work in EMS and with people who have your symptoms. See if their initial analysis of your situation gels with your own self-assessment. Also ask if their appointment hours will fit your work schedule.

Many respondents to the NAEMT survey expressed reluctance to seek mental health treatment because of concerns about confidentiality [1]. Information shared during a treatment session is protected by HIPAA, but there are exceptions, such as release because of a court order. A mental health practitioner can describe exactly what information can and cannot be shared before any sensitive issues are discussed.

4. Payment for mental health services may be covered by an employer, health insurance or made directly to a provider.
Many EMS services offer employee assistance programs, which includes confidential, short-term mental health counseling. This may be a good option if you are having difficulty with a particular event or life change, such as a traumatic call or divorce. EAPs are also a way to try therapy before making a financial investment in it. A disadvantage to EAPs is that treatment is usually limited to five or six sessions, and there are few therapists to choose from. Several NAEMT survey respondents stated the short-duration of EAP provided therapy was not enough time and that they had difficulty relating to the therapist they saw through the EAP [1].

You can also look for treatment through your health insurance plan, which has a list of mental health providers who are covered. Out of pocket costs depend on the plan’s copay and deductible. Mental health providers also can be paid directly, which eliminates strings attached to treatment covered by an employer or insurance. This is the most expensive option, but some providers offer a sliding scale or a discount to emergency services personnel.

The cost of mental health treatment deters many people from seeking help. While this is a challenge for many EMS providers, think of the cost as an investment in overall wellness that may help prevent missed days of work, financial setbacks and medical problems in the future.

5. After selecting a mental health provider, feeling a strong connection with them is key to successful treatment.
While many NAEMT survey respondents stated they preferred to see a therapist who specialize in treating first responders, a good therapist can relate to their client even if they do not have a background in the work that they do. Several studies in psychology literature report that the “therapeutic alliance” between a therapist and their client is a strong predictor of success, even more so than the provider’s education background or treatment approach [2]. A good therapist can develop a bond with their client, earn their trust, work with them to achieve goals and understand their factors that impede change.

A personality mismatch with one mental health provider does not mean that any future mental health treatment will be unhelpful. The first few sessions with a mental health practitioner are like a probationary period with an employer; if you do not feel a connection, try meeting with another one.

Seeing a mental health professional can be a valuable way to manage stress and maintain wellness. Think about whether mental health treatment may be right for you, and look for a provider who best meets your personality, situation and budget.

About the authors:
Shauna Sullivan, LCSW, LLC is a licensed clinical social worker providing therapy to individuals and families. She has special interest in eradicating stigma and advocating for those affected by mental illness. Shauna owns a private practice in Wilmington, Delaware, and can be reached at her blog, Take on Mental Health.

Bob Sullivan, MS, NRP, is a paramedic instructor at Delaware Technical Community College. He has been in EMS since 1999, and has worked as a paramedic in private, fire-based, volunteer, and municipal EMS services. Contact Bob at his blog, The EMS Patient Perspective.

1. 2016 NAEMT National Survey on Mental Health Services, retrieved from:"sfvrsn=4

2. Ardito R & Rabellino D. Therapeutic Alliance and Outcome of Psychotherapy: Historical Excursus, Measurements, and Prospects for Research. Frontiers in Psychology. 2011; 2:270. doi: 10.3389/fpsyg.2011.00270

EMS chiefs: Listen for theories

In improvement science, we define "theory" as an idea or concept that’s testable. Theories are different than facts or laws that imply that something is fixed and unchangeable. A theory invites inquiry and experimentation.

One powerful leadership tool is to listen for theories when people say things as if they were facts. Here are a few that I’ve heard recently:

  • Response times are a lousy measure of EMS system performance.
  • Too much focus on pain management by EMS providers is contributing to the opiate overdose epidemic.
  • There has to be a consequence for poor EMS provider patient care.
  • Patients die every day in our system who could be saved with rapid sequence induction facilitated intubation.

Those of us who are deeply immersed in the science of improvement have a few annoying habits. One of these is responding to pronouncements of fact with something like, "That’s an interesting theory, tell me more about that. Where did it originate" I’d love to see the evidence behind it."

Several years ago, I worked with a Chief Financial Officer (long since retired) that would call those of us running EMS ambulance operations whenever one of our key performance numbers went down for the second month in a row.

The first time I got one of these phone calls he said, "Your transport volume is down for the second month in a row. What’s going on and what are you going to do about it""

There was a long and dreadful silence after I told him, "Volume is down because less people called 911."

I could not believe it when he responded, "Well what are you going to do about that""

It took all of my resistance not to say something career-endingly sarcastic.

Testing the CFO's theory
A month or so after this phone call, I had the opportunity to ask him why he made these phone calls. He said, "A one month drop in performance can happen to anyone. If it happens a second time, then that means there is a trend and a real problem. When I call, things get better. And, quite frankly, a little fear is necessary to lead effectively."

The way he said it indicated that this was factual, the way it is. He left no room for question or debate. Of course I said, "That’s an interesting theory."

Let’s break his declaration into testable chunks:

"When I call things get better."
Since our organization (long since amalgamated) had several 911 operations in various locations, this theory would be easy to test. We could do a prospective controlled experiment. Half of the operations would be on the call list and the other half would be left alone. We could track their respective performance over time and compare the two groups. This method would not get us published in the New England Journal of Medicine, but we are doing improvement not peer reviewed research. The methodology does not have to be perfect, just good enough to reliably answer a performance question for our organization.

"A little fear is necessary to lead effectively."
Just like spanking a toddler, this topic tends to produce hot-blooded opinions for and against. W. Edwards Deming, Ph.D., one of the originators of improvement science, is solidly in the "drive fear out of the workplace" camp. Fans of Machiavelli tend to believe that fear of punishment is helpful.

This is a good spot for reader participation. How would you test the impact of a fear-based leadership style" It would also be great to hear your stories about leading or being led with or without fear. Please respond in the comments or send me an e-mail . We will gather your perspectives and share them in a future article.

"A one month drop in performance can happen to anyone. If it happens a second time, then that means there is a trend and a real problem."
This is a theory that’s been extensively tested by expert statisticians again and again since the 1930s. It highlights one of the cornerstones of improvement science, understanding variation.

All processes have variation. The process that produces response time performance, your blood pressure and your team’s happiness level all yield different results at different times. Your blood pressure at this moment is not exactly the same as it was when you fell asleep last night.

These normal up and down alterations are known as "common cause variation." So the first part of our CFO’s theory, "a one month drop in performance can happen to anyone" is supported by decades of statistical evidence. With common cause variation, a smart leader will not ask about specific data points, but will ask if the overall performance is good enough or not. That’s because with common cause variation, the individual ups and downs don’t mean anything.

If you’re allergic to bees and get stung on the inside of your mouth by a bee that’s landed in your soda can, chances are your blood pressure will drop so low that a limbo dancer would not be able to get under it. This level of change in performance is known as "special cause variation" or as Walter Shewhart, the father of improvement statistics, called it "assignable variation."

When you have special cause variation, smart leaders will ask, "What happened here"" That’s because special cause variation signals that something has changed for better or worse.

In a future article, we will teach you several ways to differentiate common cause variation from special cause variation. For now, let’s just focus on one. If you have six or more data points in a row that are going up or down, it’s a sign of a special cause. Five or fewer data points — going up or down — is common cause variation.

So our CFO was asking a special cause question based on only two data points, common cause variation. When someone higher on the pecking order asks special cause questions of common cause variation, people will come up with answers that are logical, compelling, rational and completely fabricated.

Acting on those fabricated answers often makes things worse. Of course that’s just my theory.

What EMS leaders need to know about public health

By Sean Caffrey, NEMSMA

It has been said that EMS is at the intersection of public safety, health care and public health.

The public safety component of EMS is the most clear. EMS systems are prepared to respond to medical emergencies and traumatic injuries in their communities 24/7 with staff, vehicles and equipment. Much like police departments, fire departments and emergency management, this availability to the community constitutes an essential safety net that can respond immediately. It is this availability to respond that often justifies the public funding of EMS through tax collections or other assessments on the community as a whole.

The health care role for EMS is also pretty clear and begins as soon as we encounter a patient in the field. From that point forward, we are providing individual health care services much like any other part of the health care system. This aspect of EMS requires medical knowledge, care protocols, physician oversight and a level of integration with other health care components. It is the provision of these individual health care services that is the justification for EMS to bill patients directly, a practice uncommon to other public safety functions.

What is the public health connection to EMS"
Public health is an amazingly broad discipline which includes injury prevention, disease surveillance, meeting the needs of underserved populations, and much more. The American Public Health Association has no less than 31 interest areas and or sections for its members, spanning from HIV/AIDs to school-based health to health information systems to behavioral health. There is even an emergency health services section concerned with EMS and emergency care systems.

As a general rule, public health is a catch-all discipline that is concerned with the health of communities in general. As a result, it is essentially anything health-related that is not an individual health care service. Despite its broad mission, public health is only a fraction of the health care system, especially in the U.S. where we have a substantial focus on acute care services.

The history of public health is extensive, and includes many great successes regarding environmental health, the control of infectious diseases, occupational health and reductions in smoking amongst the general public. Public health is often a governmental responsibility and is accomplished to varying degrees at all levels of local, state and federal government. At the federal level, multiple agencies, including the U.S. Public Health Service and the Centers for Disease Control and Prevention, have public health responsibilities. Every state has a health department, as do almost all counties and many larger municipalities.

Many public health professionals are very concerned with vulnerable populations and health equity issues. Individuals at the lower end of the socio-economic spectrum are more likely to suffer from many diseases, particularly those linked to the environment like asthma or lead paint exposure. Many of these populations also suffer from a lack of access to medical care. The poor and vulnerable, however, often benefit the most from public health accomplishments over time including advances key areas such as clean air and clean water.

Why does public health matter to EMS"
Perhaps the most visible area where public health crosses over into EMS are regarding access to care and regulatory oversight issues, a key role of state health departments. Odds are good that your state EMS office is part of the state health department.

State EMS offices are concerned with ensuring that ambulance and EMS systems meet minimum standards and are accessible to all citizens. Many of these offices also investigate complaints to ensure the public is protected from substandard care.

You may also note that there is somewhat of an inherent contradiction in that state EMS offices are often charged with both regulating and building EMS capacity simultaneously in their enabling state legislation. This relates to the public health aspects of EMS where both access to care and effective regulation are essential.

What are the types of public health prevention"
Public health practitioners view their work through three types of prevention.

  • Primary prevention that involves eliminating disease before it occurs.
  • Secondary prevention that involves identifying disease early through screening and other methods and limiting its progression.
  • Tertiary prevention that occurs in concert with acute treatment and involves minimizing the impact of disease on individuals and populations.

What are the types of diseases"
Public health views disease as infectious or non-infectious. Infectious diseases are exactly as they sound and are the historic bread and butter of public health work. Diseases such as cholera, malaria, measles, Ebola and Zika virus qualify in this category.

Non-infectious diseases, however, represent what EMS is most involved with including such diseases as asthma, diabetes, heart disease and trauma. Due to the success of previous efforts to eradicate infectious diseases, non-infectious diseases have become the population health challenge of our time, and EMS is on the front lines of combating them. Health departments also spend a large amount of time developing and deploying programs to prevent and mitigate these non-infectious diseases.

How is public health engaged in emergency preparedness and response"
Another important aspect of public health activities is emergency preparedness and response to public health emergencies. This begins with surveillance activity for a variety of reportable diseases and also involves epidemiology, the investigative aspect of health.

As emerging diseases are identified, public health officials are charged with monitoring outbreaks and mitigating the consequences. This also involves multi-disciplinary planning activities, such as those to address SARS, pandemic influenza and Ebola that likely involved your EMS service at some level in the past. If you are in an area prone to large scale natural disasters, such as hurricanes or floods, you have also likely participated in public health emergency planning activities.

What is a public health assessment"
A final aspect, particularly of local public health agencies, is community health assessments. These assessments are usually taken on as part of the routine planning activities of local health agencies and are updated on a regular basis. These assessments identify the key health risks in the community and programs in place to address them. In many cases, they have become the basis for community paramedicine and similar programs in the community. If you haven’t seen one for your community, you can probably find it on your local agency’s website. You may be surprised at how much it could inform the activities of your EMS system.

What is the future of EMS and public health collaboration"
EMS will continue to be regulated and influenced by public health at multiple levels. We are fortunate, however, that public health professionals will also remain very interested in the availability and viability of our EMS systems. State rural health offices, the National EMS Information System and the federal EMS for Children program are examples of this type of involvement.

EMS systems should also be willing to partner with their local public health agencies as they often face many of the same population health concerns as EMS. They receive funding from a variety of sources that may help your service provide injury prevention and other programs. At the very least, knowing your local health officials can come in very handy if you find yourself in the middle of a disease outbreak or similar emergency.

Make sure to befriend and connect with public health practitioners in your state and community. Many of them hold a Masters in Public Health or a similar advanced degree. As EMS leaders, we can both benefit from, and provide benefits to, the overall health of our community through public health partnerships.

7 steps to improving your approachability as a paramedic chief

Approachability: a word often used in leadership and management circles, but rarely defined, at least to any degree of clarity in my mind. It means to be "capable of being approached; accessible: specifically, easy to meet or deal with [1]." In my experiences, people will approach me as a leader with their thoughts, ideas, opinions, likes and dislikes only after they:

  • Trust me with their thoughts, ideas, opinions.
  • Believe I will take care of their thoughts, ideas, opinions.
  • Believe that I'll do what I say by keeping my promises.

It's up to me as a coach, champion, mentor and leader to make the first move in creating and nurturing those sentiments among my personnel.

Suggestions for improving your approachability
If you are frustrated with not getting important information on a timely basis from your EMS personnel, it helps to suspect your own level of approachability. This may be in your blind spot. Ask someone you trust if they think you might put people off more than you know. Give them permission to be frank with you about it.

Try this online quiz: Are you a good boss" If your self-assessment leads you to believe you may have an approachability issue, try these seven steps. Like anything, practice makes perfect.

1. Invest time in getting to know your people.
One-on-one time with the boss, above and beyond the communication necessary for the job, helps build the feeling in the individual that you care about them as a person. And who among us couldn’t use some of that on a regular basis"

For starters, learn the names of their spouse or significant other and their children. Learn their birthdays and make it a point to give them a card when it rolls around. Learn why they got into EMS and if their reason for being in EMS has changed through their career.

2. People want to know you.
Getting to know each other is a two-way street. Share a story or two about yourself, especially those that show something about your character and integrity.

3. Display loyalty to the absent.
When you hear members of your team talking about one of their fellow team members "behind their back," put a stop to it immediately. If you let them talk about others who are not present, you’re fostering the idea that you’ll allow others to talk about them when they are not around. Extend this loyalty to personnel who might be out on injury leave, opted for early retirement or changed employers or careers.

4. Listen to understand, not to be understood.
Too often we can find ourselves listening while at the same time formulating our opinion about what we’re hearing or what our response will be. As good as our brain is, it doesn’t do those two things — listening and processing/responding — well simultaneously.

Also, be aware of distractions, like doing other things while people are talking to you. Nothing says, "I’m really not paying attention to what you’re saying," like answering a phone call or reading a text message while one of your team members is talking to you. In the words of my late mom, "That’s just plain rude."

5. Acknowledge ideas and suggestions.
Approachable leaders regularly receive and solicit ideas and suggestions from their colleagues and teams. It doesn’t take much, usually 10 words or less, such as, "I appreciate the heads up" or "Thank you, that update helped me" to show your appreciation.

Acknowledgement encourages further information and idea sharing. When you don’t respond to ideas, people are likely to consider you to be apathetic.After a while, they’ll stop talking to you.

6. Explain decisions to ignore input or recommendations.
Any time you ignore or don't implement an idea, especially the ones you solicited, explain your reasons to forgo the input or recommendations. Without that feedback, people develop their own narrative and it goes something like this, "The chief doesn’t want my input, so why did the chief ask""

7. Understand communication styles and preferences.
Each of us has a different communication style and preference for how we communicate with co-workers and managers. As the leader, improve your approachability by making the extra effort to be gentle with team members and others who are easily intimidated. If you have some personnel that thrive on confrontation and are more likely to go toe-to-toe in their communication, then create those opportunities, but heated debates need to work toward a conclusion.

A case study
A real turning point in my career — in terms of my personal approachability — came when I read " It’s Your Ship" by U.S. Navy Captain (Ret.) David Abrashoff’s. It helped me understand the adage, "People don’t care how much you know until they know how much you care."

I implemented one of the Abrashoff's tools whenever I took over a new unit. It involved asking everyone in the unit — firefighters, officers, civilian employees alike — the following three questions during one-on-one interviews.

  1. What do you like about working in this unit"
  2. What don’t you like about working in this unit"
  3. If you had my job, what one thing would you change tomorrow"

Think that’s too big of a task to take on in your world" Abrashoff interviewed every one of the 300+ sailors and officers in his world, aboard the U.S. Navy destroyer Benfold. In doing so, he and his people took the Benfold from worst to first in the entire U.S. Navy fleet (based on the Navy’s evaluations of performance and combat readiness).

After I completed the one-on-one interviews, I typed up all the responses without names and shared the responses with everyone in the unit. Then I made it my mission to do things daily as a leader that:

  • Would reinforce their responses to question #1 (likes).
  • Sought solutions for their responses to question #2 (dislikes).
  • Sought ways to make their responses to question #3 (changes) a reality.

Was it a lot of work" You bet. Was it worth it" You bet.

So, what are you doing to improve your approachability today"

Further reading
4 reasons why leaders should listen more.

Forensic Magazine. The Importance of Being an Approachable Manager.

Good Reads. It's Your Ship: Management Techniques from the Best Damn Ship in the Navy.

Unique Training & Development. Being an approachable leader.

1. Merriam-Webster Dictionary On-line

5 steps to improve EMS provider engagement

By Steve Wirth

An ongoing Gallup study, State of the American Workplace, covering over 30 years and 17 million workers found that there are essentially three types of staff members in every workplace. You will find these three types, based on their level of commitment and engagement with the work and the workplace, in your EMS agency.

Yes, it just comes down to three key types and understanding these types and how they affect others will go a long way in helping your leadership be more effective in motivating your staff to become better communicators, to do good work and to better serve the patient. This also helps to reduce risk and avoid unnecessary litigation, as most lawsuits in EMS are based on dissatisfaction with the patient experience and not actual negligence.

Here are the three engagement types and five steps for improving staff member engagement that can lead to improved morale and an enhanced patient experience.

The "Engaged"
The "engaged" staff members are the ideal role model individuals for your organization. They have passion for their work, a positive attitude toward EMS and your agency, and in positively interacting with others — particularly the patients.

They are the top-level performers who never cause you angst. They drive the innovation and ideas that fuel the organization’s future. The engaged staff are individuals you want to see in leadership positions and to mentor each new generation of EMS providers.

Their positive energy can affect others in a significant way that will encourage them to want to do their best work. Unfortunately, only about 30 percent of your staff fit into this category, according to the Gallup study.

The "Not Engaged"
The "not engaged" staff members are the ones who do just enough to get by — and not much else. They lack the drive and commitment to improve the organization.

Unfortunately, about half of your staff members may be in this category, according to the Gallup study. The staff members who are not engaged don’t have nearly the level of energy and passion as the engaged staff member, and border on being simply lazy.

The not-so-engaged staff requires considerable attention to keep them headed in the right direction. Staff members in this category can be influenced both positively and negatively.

The EMS agency’s goal should be to surround the not engaged staff with engaged staff members that will serve as positive role models. That will help move these not engaged employees to become engaged.

The "Actively Disengaged"
The "actively disengaged" staff members are your problem personnel. They are the bad apples that can negatively affect those around them.

The problem is that they can often cause the not engaged to join their type, adding to your management nightmares and further bringing down morale. These staff members are too busy blaming others for their problems and lack an objective view of themselves.

The actively disengaged are particularly dangerous, because in acting out their unhappiness, they undermine what the engaged employees are trying to accomplish to advance your agency and its reputation in the community. Their actively negative behaviors lead to problems in communicating and getting along with others, including their co-workers and your patients.

Nearly 20 percent of your staff members are likely to be actively disengaged, according to the Gallup study. With this type of staff member, corrective counseling will not always result in a positive change. Unfortunately, in that case, termination from the organization may be the most effective action you can take to avoid the organizational infection of negativity that the actively disengaged can spread to others.

5 steps to improve staff member engagement
Actively engaged staff members are significantly more productive than their not engaged or disengaged colleagues — some studies say as much as 50 percent more productive. So, the goal should be to improve staff member engagement across the board. Here are five simple steps to help do just that.

1. Set expectations up front and remind often.
It is essential to set the stage for the workplace experience upfront by emphasizing the key personal qualities that are essential to success in your agency. Good communication skills, listening skills and a compassionate and sensitive approach to communicating with others should be emphasized in recruitment, job descriptions, orientation and throughout the EMS staff member’s experience with your agency.

To measure whether the expectations are being met requires feedback. Fundamentally, everyone wants to perform well, yet leadership will often not let the individual know how they are doing in meeting the expectations and what they need to do to improve.

2. Assign a positive mentor.
New staff members should be assigned to one of the engaged staff members who can serve as a positive role model. This will also show the less engaged staff members the core qualities needed for success in your agency.

Never let two disengaged staff members work together. That is a recipe for disaster, including harm to the patient.

Try to keep a more engaged staff member partnered with a less engaged staff member to provide the positive influence necessary for improved engagement. Mentoring provides so many benefits, not just to the person being mentored, but also the mentor and the organization as well.

3. Open channels of communication.
EMS agencies should have multiple methods of upward and downward communications. Transparency in the EMS workplace with everyone practicing active listening should be the goal.

Staff members should be encouraged to ask questions, provide input and contribute to the success of the organization. Leadership must be non-defensive in response to staff member questions, concerns and suggestions. This helps encourage the positive behaviors that contribute to engagement with EMS work and in the organization.

4. Tolerate nothing less than respect and dignity in all interactions.
A healthy EMS agency is one that has healthy relationships between staff members that are respectful, caring and compassionate. When staff members respect each other, they respect their patients. And that is the ultimate goal as mutual respect leads to good communication, good patient care and a positive patient experience with fewer complaints and lawsuits.

Staff members in leadership roles must demonstrate respect in all that they do, and call out those who do not respect their colleagues or their patients. Far too often, leadership members will look the other way rather than confront disrespectful or actively disengaged behaviors because it can be difficult and challenging to do so. But that is a critical responsibility of the EMS leader.

5. Provide regular communications skills training.
EMS continuing education programs are great when it comes to the clinical aspects of our work. But we often fall short on addressing the key human attributes that are most likely to lead to success in EMS and a high-quality experience for the patient — positive interpersonal communications. We need to incorporate interpersonal skills training for all members of the organization so that the proper climate can be set to enhance staff member engagement, which leads to improving the patient’s experience.

Most importantly, improving staff member engagement must start at the top of the organization.

Leadership at all levels must not only "talk the talk," but they must "walk the talk" in a visible and meaningful way. Leaders who are effective at improving staff member engagement model the positive engagement attributes that lead to improved morale and increased staff member commitment to EMS work, your agency and, most importantly, to the patients and communities that you serve.

5 things to know about naloxone

It's no secret that the U.S. is suffering from an opioid overdose epidemic.

In fact, an average of 78 Americans die every day from an opioid overdose, according to the CDC. Since 1999, the amount of prescription opioids sold in the U.S. nearly quadrupled; deaths from prescription opioids have also quadrupled.

These troubling numbers have first responders scrambling to respond to an alarming amount of calls per day. One Wisconsin fire department is working to implement a regional approach between law enforcement and EMS to monitor overdoses.

Here's an overview of what naloxone is and how responders are helping curb this devastating epidemic.

1. What is naloxone"
Naloxone, which can also be sold under the name Narcan, blocks or reverses the effects of an opioid overdose. Naloxone was patented in 1961 and was approved for opioid overdose by the FDA in 1971. It's often included in an emergency overdose response kit and has been shown to reduce rates of deaths due to overdose.

2. How is naloxone administered"
Naloxone is injected into a muscle, which is usually given in the outer thigh, under the skin or into a vein through an IV. When given intravenously, it works within two minutes. When injected into a muscle, it works within five minutes. Naloxone can also be administered via intranasal.

The injection is most likely given by health care or emergency medical providers. However, naloxone is now being given to the public, family members and caregivers, and even addicts to administer. If a patient is not breathing or is unresponsive after a suspected overdose, give naloxone immediately by the administration route available to you.

You may need to give another dose every two to three minutes in some situations. If you are a layperson — a friend or family member — of someone who has overdosed, call 911 after administering naloxone or if naloxone is needed.

3. What are the signs of an opioid overdose"
Signs and symptoms of an opioid overdose may include slowed breathing, or no breathing at all, very small or pinpoint pupils in the eyes, a slow heartbeat or extreme drowsiness.

4. Roughly, how much does naloxone cost"
Boxed syringes cost $40-50 each — add $5 for a nasal adapter and about $15 per bag to make a naloxone administration kit. Prices for auto-injectors start at $250 and can be as much as $825 per unit. Remember to replace sealed naloxone vials every two-to-three years based on the stamped expiration date.

Naloxone, especially as an intranasal spray, may be available as an over-the-counter medication in your state. Naloxone is also sometimes distributed through public health programs.

5. First responders and civilians carrying naloxone
First responders, including some police officers, firefighters and EMS personnel, are being trained on how to administer naloxone.

Many, though not all states, allow the drug to be sold over the counter for lay rescuers. Some school districts and restaurants have also stocked up on the overdose-reversing drug.

Who do you think should be responsible for administering naloxone"

Why EMS personnel need a valid physical abilities test

A valid physical abilities test specific to EMS is an elusive unicorn EMS leaders have been attempting to capture for as long as I can remember. Pre-hire physical abilities testing and a yearly incumbent PAT is something that EMS has long needed. With the cost of worker’s compensation continuing to rise, we can no longer afford to hire the unfit and physically unable.

As a visionary risk manager once said to me, "We have to stop hiring our injuries. EMS will never get the respect it deserves as long as we hire unfit employees." Moving from sage advice from a risk specialist to designing and validating a PAT is a whole different set of hurdles.

As I look across the country at EMS departments, I consistently see injury rates continuing to increase, even as new technologies designed to make patient handling easier and more ergonomically correct. The continuing rise in on-the-job injuries is leading many EMS leaders to ask how an EMS department can design, validate and administer a PAT that is:

  • Affordable to run in house
  • Truly job specific
  • Tests human power generation
  • Assess anaerobic capacity
  • Legally defensible

This is an issue many departments struggle with and there is not a consensus on how to solve. Some departments run a pre-hire PAT that they self-validate, which means there is often candidate and examiner bias in the test. In addition, the results are not compared to a national data set. Other departments borrow tests from other public safety disciplines. Many departments outsource pre-hire physical assessment to an occupational medicine clinic where the candidates are not tested using EMS gear.

Goal of physical abilities testing
Since overexertion injuries account for a large number of all work-related injuries in EMS, it is the goal of EMS departments to reduce the potential for overexertion by hiring physically capable employees. A valid PAT test is intended to reduce injuries for which high levels of strength, mobility and power are required.

For a PAT to be valid, it must be a job task simulation using standardized gear and weights. There must be no bias to candidate's age, gender, height or from the examiner. The PAT must be reviewed for biomechanical accuracy and statistically analyzed for expected completion times.

Don't hire your next injured employee
You can learn a lot from watching someone move. You can learn a lot more about them when you load them up with weight.

I recently completed five days of physical abilities testing for a large, urban fire department's EMS division, testing over 100 candidates. Watching over 100 candidates climb stairs with gear, lift, move, pull, squat to do CPR and lift cot’s is eye-opening. The lack of job specific mobility — squatting, kneeling, stepping — was staggering and it’s often these poor movement patterns that lead to injury.

EMS is a 100 percent physical job that requires a blend of job specific mobility, strength, power and anaerobic conditioning. Without the proper blend of physical ability, first responders are at a very high risk of injury. So it begs me to ask the following questions of EMS leaders and hiring managers:

  • Are you hiring your department's next injured employee"
  • Are you OK with risk and liability exposures because employee fitness is poor"
  • How do you know if your current employees are still physically able to perform the job safely"
  • How do field personnel know what the job has done to their body"

PAT effect on staffing
EMS departments that are using a validated job task simulation that has no bias to age, gender or from the examiner hire higher-caliber employees year after year. The physical ability and attitude of their potential employees has changed for the better, because the people who know they are out of shape or injured go somewhere else for a job. They usually go to a service that does not have a PAT, usually just using a static lift test or, even worse, out-sources testing to an occupational health clinic. Lifting milk crates doesn’t simulate anything expected of EMS personnel.

For field providers, physical abilities testing is not about taking anyone’s job away. In fact, it’s all about keeping field personnel happy, healthy and uninjured. An annual physical abilities test informs field providers where they are in the physical spectrum. But before testing field providers annually, two things need to be in place.

1. Employees must have access to a fitness facility.

2. Employees should be given a scientifically accurate protocol to follow that is no less than eight weeks long to allow them to build the mobility and strength to pass the test.

Remember, our goal is a fit and injury free workforce. If field providers perceive that their employer is out to get them, then we have missed the point completely.

Risk in EMS is multifaceted
Field personnel are constantly facing risks from driving to assaults to infectious diseases to liability from ePCR documentation. I know fitness reduces risk. A fit employee:

  • Gets hurt less
  • Is more productive
  • Has lower liability exposure, especially as it pertains to patient handling.

I also know a fit company has less turnover and better morale.

All of these are goals of forward leading EMS organizations and the first step for an employer is a physical abilities test. The first step for a field provider is to accept that the job is physical. After that, acceptance, a positive organization culture and individual change is possible. I have seen it happen.

EMS agencies must learn from worsening UK ambulance crisis

The ambulance trust system in England has been in crisis for several years. Not enough providers, too many calls and long waiting lines at hospitals for paramedics waiting to offload patients have combined to create a national EMS system that is unable to respond to emergency calls for assistance in a consistent, timely manner. Moreover, the incredible workloads have resulted in an increasingly burned out workforce, with well-intentioned people unable to handle the stress any longer and leaving.

Of course, it's true that the U.K. and U.S. systems are entirely different from each other. But we are seeing the same pressures being placed on American systems that are gutting the trusts. U.S. hospitals have fewer beds to admit patients, causing emergency department gurneys to fill up and EMS personnel unable to handoff or offload their patients.

Many U.S. providers are unable to maintain response times due to the high volume of low acuity calls. Financial pressures from lower reimbursements that are unable to cover operating costs are causing agencies to reduce the number of ambulances available for calls.

Adding more ambulances is definitely not part of a solution to a complex, multifaceted problem. Changes in how health care is provided — and reimbursed — will prohibit the growth of a traditional 911-only systems.

Taxpayers aren't going to foot the bill either. Given the impending shift of political winds in the federal government, there will be little appetite by government to take on additional financial burden of public safety and health.

Frankly, it's time to re-engineer our thoughts of field care medicine. Traditional 911 system response hasn't been appropriate for the majority of calls for a long time. It's been due to the constraints of reimbursement. We only got paid if we took the patient to an emergency department.

It's what the unsuspecting public felt was "needed" as well. Countless television shows and health care advertising that reinforces the notion that one only got "better" by going to a hospital. The same shows glamorize the flashy lights and blaring sirens and the heart pounding drama of saving countless lives only to attract newcomers to the business that is so not filled with television "reality."

How do we transition the paradigm of field medicine" By embracing what works and changing what doesn't work.

An increasing number of EMS systems are implementing community based systems of care, often in conjunction with hospitals, hospice care, physicians and mental health providers. Other agencies are beginning to reconceptualize "emergency calls" so that response times to true emergencies are met. Beyond the confines of the ambulance service, large health systems are investing in more preventive strategies for the overall health of their member populations, potentially reducing the number of patients that enter the 911 system.

A few years back, it was said that a fast, cheap and high quality EMS system didn't exist. It could be fast and cheap, but not high quality. Or, the system could be of high quality, but it wouldn't be fast or cheap. I would posit that we could have a system that would have all three attributes, as long as we drop the tradition-laden constraints of EMS dogma that will keep us permanently in the dark ages.


EMS1 Tips

7 ways to best use, or avoid, capnography in the field

EMS1 readers shared their suggestions on how to get the most out of the method

Active-shooter response: Are you physically ready?

Normally, I am strong believer that paramedics are at their best when they saunter into a scene, slowly walking and looking for clues and risks. But an active-shooter incident is going to require repetitive bursts of significant physical activity.

3 energy-saving tips for your EMS station

Earth Day, or any day, is a good time to see what you can do at your agency and home to save both resources and money.

How this video can "Keep Yourself Safe"

Consider using this PPE safety video in your EMT course or refresher class

CPR class instruction tips: 5 ways to make it great

My most recent healthcare provider recertification was memorable for all of the things the instructors did well.

Patient assessments: How to avoid free-for-alls

Substantial cajoling and adult guidance from mom in a Santa hat was required to initiate an orderly process of taking turns, appreciating a gift after it was opened, and taking occasional pauses for a meal or to welcome additional relatives.

Patient assessment is a non-linear process

On a skill sheet, patient assessment is presented as a linear process: First size up the scene, then complete the primary assessment followed by the secondary assessment.

Blood pressure reading tips and tricks for EMS

One of the things I'm most often asked by students and rookie EMTs is, "Kelly, how am I supposed to hear a blood pressure in the back of the rig?"

How to use Slideshare for EMS education and training

Slideshare is an online community and tool for sharing presentations.

How to get optimal battery life from your devices

The batteries in your wireless cell phone, tablet or laptop are probably not the same old Duracells you used in your childhood walky-talkies.

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