Amanda Riordan serves as the Vice President of Membership of the American Ambulance Association. She joined AAA as Director of Membership in May of 2015. She has 15+ years of progressive experience in non-profit operations, membership development, marketing, operations, and credentialing.
Join AAA advocacy experts for a fast-paced informal dialogue on Facebook Live! Learn first-hand about EMS advocacy initiatives in the face of COVID-19.
Register to receive a reminder email one hour in advance of the live broadcast on the American Ambulance Association Facebook page!
Panelists
Randy Strozyk, Secretary, AAA
Jamie Pafford-Gresham, Chair, AAA Government Affairs Committee
As the demographics of our nation change, it becomes ever more essential for emergency medical services to foster a diverse and inclusive workplace more representative of the communities that we serve. To support this mission, the American Ambulance Association seeks tips, ideas, and perspectives from our membership on best practices for attracting, recruiting, and retaining the EMS workforce of tomorrow.
For this project, we are using the word “diversity” to refer to characteristics including—but not limited to—race, sex, gender identity, ethnicity, sexual orientation, religion, socioeconomic class, disability, and/or age.
While we are truly appreciative of all responses, AAA especially welcomes the perspectives of those who are themselves members of groups historically less represented in the EMS workforce.
If you would like to contribute your thoughts to this project, please complete our short form below. You do not need to disclose your identity if you do not wish to do so.
A parade of more than 50 ambulances, representing more than 20,000 paramedics, EMTs, and 911 dispatchers, traveled from UMass Medical Center in Worcester, Massachusetts to the warning track inside Fenway Park on Wednesday, May 20. The Boston Red Sox, Mayor Marty Walsh, state officials, and healthcare professionals joined the Massachusetts Ambulance Association, the Professional Fire Fighters of Massachusetts, and municipal ambulance providers in celebrating these front line heroes during National EMS Week.
Once inside the park, the EMS professionals were greeted by video tributes from dignitaries and celebrities and a select number of live speakers following safe social distancing guidelines.
The event takes on even greater significance this year because of the unprecedented response to the COVID-19 crisis from EMS professionals and their colleagues across the state’s medical community.
The Commonwealth’s EMS professionals have been crucial in responding to the current COVID-19 pandemic. Massachusetts has been among the nation’s hardest-hit states, experiencing the third most deaths and fourth-most cases of the novel coronavirus.
During the current public health crisis, EMS professionals have helped manage testing and treatment for homebound patients and provided supplemental support for hospitals and neighborhood health centers, in addition to its duties in responding to daily emergencies.
The American Ambulance Association seeks member organization employees and consultants with grant-writing expertise who may be interested in writing or presenting to ambulance services. Ideally, we would like to develop a one-hour webinar for members that includes tips for finding and winning grants of all kinds ( Assistance to Firefighter Grants, SAMHSA/ SIREN Act, local, non-profit, etc). If you may be interested, please contact ariordan@ambulance.org! Thank you for your support and participation.
Use the American Ambulance Association’s simple form to estimate relief you may receive from the second tranche of HHS COVID-19 funding. Please note that not all providers will receive funds.
For-profit and non-profit non-governmental providers, to determine your Net Patient Revenue for the portal, use the following information from your most recently filed tax return. (2019 if filed, otherwise use 2018 numbers).
Governmental providers, enter your revenue generated for the last audited financial year. When completing the form in the portal, select Tax Exempt Organization. When asked to upload a return at the end, upload your most recent audited financials.
Please do not enter commas or dollar signs. A negative number or zero in the Tranche 2 box indicates that you WILL NOT receive funding in tranche 2.
Thank you to the thousands of EMS and fire professionals who joined our social media campaign to encourage Amazon Business to admit mobile healthcare providers into their new COVID-19 Store. In response to the collective voices of our profession, Amazon has updated their policy! Effective April 6, EMS and Fire will begin to be onboarded into the limited-access marketplace. To participate:
Request access to the COVID-19 Store. When you complete the form, select “OTHER” as organization type until/unless EMS becomes available as an option. When entering your company name, please make it clear that you are an ambulance service or fire department (no abbreviations).
Wait patiently for up to 10 days to receive confirmation of access as each enrollment request is individually reviewed by Amazon staff.
The store is a new venture, and the virtual shelves are in the process of being stocked.However, Amazon has assured us that they have tens of millions of units of PPE and supplies on rush order. We encourage you to set up your agency account and check back frequently for new item availability.
We hope that access to the COVID-19 supplies and Amazon’s legendary logistics and delivery expertise will assist ambulance services in meeting the needs of their communities during this challenging and stressful time.
We are living through challenging and historic times. Please help the American Ambulance Association share YOUR story, the true impact of EMS on the front lines of the global COVID-19 pandemic.
We need your service’s photos and videos! Please send us pictures and videos of your medics in action. (Of course no HIPAA violations, please.) Pictures in the field, in PPE, caring for patients, interacting with the community, taking off a mask after a long shift, etc are all essential for communicating visually with the legislators and regulators who impact our ability to operate effectively. A mix of closeups and broader shots would be great, and candid is typically (although not always) better than posed—use your best judgment!
There are a few ways to share:
Tag the American Ambulance Association on Facebook (@americanambulanceassoc) or Twitter ( @amerambassoc) when you post your own photos that you don’t mind us borrowing for media, PR, etc.
Text or email photos to Amanda Riordan at ariordan@ambulance.org or 703-615-4492
Thank you for taking time away to help with this project when your services are so very busy. We are here to support you as you care for your communities! #SupportEMS
Demonstrate the value of EMS in the COVID-19 crisis! #EMS is on the very front lines of the #COVID19 epidemic. We provide on-demand #mobilehealthcare for the most vulnerable patient populations, 24/7. Help AAA showcase the incredible importance of #Paramedics, #EMTs, and #Dispatchers in the response to this pandemic. Would you please capture a photo of yourselves in action, holding a simple sign? It is essential that we communicate visually with legislators, regulators, and the general public to help them understand the critically important role we play in saving and sustaining lives. #AlwaysOpen#StayHomeForUs
If practical, please consider showing your medics standing apart from one another (social distancing) if they are not in PPE.
The transcript below was lightly edited for clarity.
Amanda Riordan: Thank you for joining us today. My name is Amanda Riordan, and I am the vice president of member services for the American Ambulance Association. I’m also the administrator for the Professional Ambulance Association of Wisconsin. I’m so happy to have the opportunity to interview John Eich, the director of the Wisconsin Office of Rural Health. John is an exceptional contributor to rural health in Wisconsin. He’s also a sterling advocate for the power of EMS to assist with public health in the least accessible areas of Wisconsin. I’ll ask John a couple of questions today about the recent Rural EMS Listening Sessions that he conducted in a number of areas across the state. John, thanks again for joining us. Would you mind telling me a little bit about your background and how you became the director of the Wisconsin Office of Rural Health?
John Eich: I appreciate your inviting me to talk about some of our programs, so thank you. I took a bit of a wandering path: I’ve done everything from carpentry and marketing to social work with homeless teens. I found my way to community [service] down in southern New Mexico. I caught the bug there working on behalf of the community and society at large. When I moved back home up to Wisconsin—I grew up in a rural area here in southern Wisconsin—I saw an opening and at the Office of Rural Health. I’ve been on board ever since, and it’s a lot of fun.
Amanda Riordan: Thanks so much. And we’re so glad you took the position. Would you mind sharing a little bit about why EMS is so important to rural health?
John Eich: If you’re not familiar with an office of rural health, we receive mostly federal funding to work on the state level. There’s an office in every state in the nation. Here in Wisconsin, we are funded mostly, I would say, to work with rural hospitals and EMS, and we find that EMS is one of the areas of greatest need. Every piece of the healthcare delivery system has its challenges and its strengths. EMS, I think by the nature of having formed itself—at least rural EMS formed itself—around the model of volunteer services. In my estimation, it has sort of painted itself into a corner. It started when medicine was not as complicated, and when populations, were not expecting as much. You were helping out your neighbors by getting somebody to a hospital. It has since evolved in a good way.
[EMS has] evolved into a healthcare profession. And so there are a lot more demands. There’s a lot more education; continuing education, learning new techniques that are lifesaving. Society depends on it. But that means that these volunteer services that started off small are under increasing pressure. That’s why we are trying to dedicate as many of our resources as we can to helping out that system within Wisconsin, and it’s paying great dividends. We’ve always really enjoyed our interactions with EMS. I think it takes a particular kind of person to do it. We just really enjoy our time with those who do the work. That led us to doing what we’re calling a “Rural EMS Listening Session.” So we did five of these sessions around the state in rural areas, and we intend to do a few more.
Part of the idea was that so often policy in general happens in urban centers. In EMS policy, because the state capital is down in the very southern part of the state and Milwaukee, the largest city is also down in the southern part of the state, the rural areas of the state (which most of the rest of it) tend to feel ignored or unheard. It’s much harder for them to participate. So if somebody has to drive five hours to go to a meeting that would take [a city resident] 15 minutes to drive to, that’s a disparity in access and it’s a disparity in having your voice heard. So we decided that it was important to go listening where rural EMS is practicing. So we did that, and are continuing to do so.
It’s been very eye opening. Obviously there was a lot that we expected to hear that we did hear. I mean, there’s, there’s not a lot new here. People in EMS know what the issue is as someone said these are the same ideas we’ve been talking about for the last 20 years or more. And that’s very true. We like to believe that it’s time for things to change. We’ve been talking about this long enough. Maybe we should do our best to push the issues forward. And that’s phase two of these listening sessions: take what we heard and get it into the hands of advocates, like the EMS associations, fire associations, et cetera, and other advocates like the Office of Rural Health that try to speak on behalf of the needs of EMS. I do think I’m optimistic that legislators want to help. When they’ve been presented with bills, they’re interested. Money is always an issue, but I would say that they definitely want to be part of a solution. So, it’s all of our jobs to make sure that they have the right solutions and presented to them.
Amanda Riordan: I think that’s a great segue to one of your other very popular innovative programs in Wisconsin. The Office of Rural Health actually helped put together the EMS at the Capital Day event in 2017. Would you mind telling us a little bit more about what that entailed and the groups that participated?
John Eich: Absolutely. So again, as we work with all parts of the healthcare delivery system, we work with hospitals and clinics and providers; physicians, PAs/physician assistants, nurse practitioners, the nurses that staff the hospitals and clinics and home health services. When we look at EMS, it always strikes me how it has a level of splintering that I don’t see in other professions. In other professions, they’ve managed to sort of circle the wagons and get on the same page and present a united face to push forward their vision and their legislative goals. EMS, for whatever reason. I’m not sure why it seems to have done the work but also, identified a number of differences. You can be a paid or career staffer versus a volunteer. You can work in a rural service versus an urban. You can be in fire versus EMS. You could be a Paramedic or you could be a Basic EMT or an Emergency Medical Responder. Each of those areas, each of those groups, sort of huddle and identify amongst themselves. I would like to see them working more cohesively together and I’m sure they would as well.
The effort that that led to an EMS Day at the Capital was to try and get all of the disparate groups together and on the same page. All of them had been working very diligently on the issues that were important to them, and I think there is a lot of overlap. As one of the participants said, “We can agree on a 80 percent of the issues, we may disagree about the 20 percent, but let’s work on the 80 percent and when we get that done, then we can disagree about the rest of them.”
So that was the goal that brought the groups together. So we were lucky to be able to get the two EMS associations in the state, the state fire chiefs, and the professional firefighters. The state EMS board joined in with us as well as they could, in more of a listening capacity. We created a wish list of legislative issues and a lot of it was centered around education: who we are and what we do. And we took that to the state capital. We had tremendous turnout and we had uniforms marching through the, through the offices of the legislature both in the Assembly and the Senate. I like to think we got their attention and we plan to, as I said, take what we’re learning from this rural EMS tour, connect with our urban allies as well, and get EMS advocacy on the same page so that they can do tremendous work together.
Amanda Riordan: It was truly exciting and a privilege to witness everything that happened in November 2017 when the Professional Ambulance Association of Wisconsin, Wisconsin State Fire Chiefs Association, the Professional Firefighters of Wisconsin, and the Wisconsin EMS Association, all came together with the help of your office, the Office of Rural Health, to speak with one voice when meeting with state legislators. I think that by working together they were able to present such an incredibly compelling message to legislators and to key staff that worked with legislators. I think a lot of times people are somewhat unaware that winning over the hearts and minds of critical legislative staff is almost as important as running to over the hearts and minds of legislators themselves.
With that in mind, and with all of the successes you’ve had helping execute your vision of moving EMS and rural health forward in Wisconsin, would you mind telling us a little bit about where you see the future of rural health going in your state, Wisconsin, as well as the country in general?
John Eich: I take it you mean in EMS terms. Because there’s a lot going on in healthcare, as you know! As far as EMS goes, I think the future of EMS care is not a wholly volunteer model. I think it is at least a hybrid model, and I think the industry needs to figure out how to make that transition. I think that’s going to be a difficult and painful transition. I think it’s going to take a lot of education to the local politicians who are used to having their services and frankly to be getting a pretty good deal.
We talked recently to a small community. It was a countywide meeting, but it was held in a small community that had been [served by] a volunteer service. They said they had a core group of about five people. The chief of the service had had volunteered 4,280 hours last year. The rest of his staff [had volunteered] around the 3000-hour level. They were proud of that, understandably. They were also somewhat reluctant to consider another model in their mind. They felt that they were just fine. When I look at that from the outside, I think, “What if one of you tears an ACL as you’re getting off the ambulance rig, what if two of you get the flu really bad? Which happens!” [What happens if] then there are two calls for EMS, at the same time, while two of your staff are bedridden. That’s three people to make all those calls. I struggle with the vision of that is as sustainable.
But when the local community looked at the numbers, they said, well, it looks like as far as the taxes go, that’s about $12 per capita. I was a little horrified, and asked “is that per year?” And they said, “Oh yeah, yeah, that’s per year.” I was struck by the fact that I pay more for Netflix per month than these folks pay per year to have two highly trained individuals show up with the latest technology to save the lives of their loved ones. I’m not criticizing that, but I do think there’s an opportunity there to really examine that in the daylight. And certainly when the board realized that and looked at it, there was a lot of sort of a flurry of questions back and forth. And is this true? On and on.
I think the nature [of the matter is that] if you can possibly put the question to a citizen in a grocery store as they’re walking out with their groceries, “How much would you pay per year in your taxes to have this kind of lifesaving service?” I don’t think the answer would be $12 a year. I think it would be more, but I don’t think most citizens or politicians have been given the opportunity to really look at. I think they assume it’s already paid for. It’s part of their taxes. I think they assume that Paramedics just show up at their door. They don’t necessarily know the difference between a Paramedic and a Basic EMT or EMR. They have a great deal of faith and trust in these people, as they should. I think they’re just not aware—they’re not aware of the challenges and the lack of funding and the way the system is sort of precariously balanced on top of volunteer hours to an incredible amount. I think the future in my mind, if you look at the data and volunteerism trending down, it’s trending down across all sectors, but that is hitting EMS very hard.
If you look at staffing, we’re seeing with low unemployment that means that it’s harder and harder to fill positions. That especially happens in rural areas. People are moving to urban areas for jobs. There’s not as many people there. If they do still live in the rural area, they tend to work in a neighboring larger town or other towns, so it’s harder for them to volunteer. So I just think the data is pretty clear where we’re headed. We just culturally have to try and do some heavy lifting and change the perceptions of what a society should pay for. As Dana Sechler from the Professional Ambulance Association of Wisconsin often says, we pay for garbage collection at $138, the median per capita cost per year. Like I said, some [areas are paying just] $12 per year for EMS. Garbage is very important. I don’t mean to dismiss it, but I think we can do better for lifesavers. I see that as the primary issue.
Garbage is very important. I don’t mean to dismiss it, but I think we can do better for lifesavers. I see that as kind of the primary issue. I think another issue is certainly something we’re hearing that is in rural areas, you have a lot of Emergency Medical Responders (EMRs). They’re taking a class that is 80 hours [in duration] because they want to help their neighbors. They’re not transporting— they are showing up to be of help. But they’re taking the National Registry tests in Wisconsin, and the National Registry tests, for a lot of good reasons, is lifting the industry into a level of professionalism and knowledge that is important and necessary. But I think that certainly what we heard is that an EMR is sort of an entry level to this.
So how can we figure out a way to lower the barriers to participation, without lowering the standards of care? That’s something we need to look at. And I think frankly, as a nation, we need to look at that and have that conversation with the National Registry. I think they’re doing the work that they do, and, and in a lot of ways it’s good work, but I think they need to have feedback from their customers and all of us states are their customers. All of us need to maintain a dialogue with them and say, this is what we need. We may need critical thinking in our clinicians, but do we need it in our technicians? Do we need it in our EMRs? [For EMRs] do we need sort of tricky questions that two of them are correct and you have to sort of guess which correct answer you wanted to give? I think it’s that sort of stuff that demoralizes local people who may not be eager to take a test in the first place and are a little put off by a computerized test in the second place. Then if they don’t pass, they go right back home to their church, their gas station, and their bar and tell everybody how this impossible test is not worth their time. I’m not against the National Registry tests, but I do think that we need to have more conversation about it and we need to find ways to lower the barriers and maybe that’s preparing EMRs in a different way.
I’ve got a daughter who is preparing for the ACT [college entrance test], and she’s learning the tips and tricks. She’s in a class just to help her take that test, and a lot of it’s not even about the content. Maybe since the National Registry is modeled on these other types of tests we need to train more on not necessarily the skill levels of how to save someone’s life, but how to take a test, which seems a little weird. But if that is our standard, then we need to make sure that our people are prepared when they walk into that room.
Amanda Riordan: That makes a lot of sense. Certainly we hear feedback in both directions from a variety of different stakeholders regarding the increasing professionalization of EMS. On one end, of course, we want to honor and maintain the contributions of those mission critical volunteer providers, particularly in rural areas, and on the other hand we have the push-pull of a Paramedic, in particular, looking for additional certifications and additional recognition of mobile health care as a profession. All of that mixed together with a flat or diminishing reimbursement makes sustaining a mobile healthcare/EMS in all areas really challenging. But of course as you so aptly pointed out, it especially impactful areas of our country and in a state like Wisconsin where you have so much land mass that is in rural areas. [These issues] particularly impact states of that nature is as they look forward to an aging population and the movement of younger people into urban areas. So truly appreciate those insights and those suggestions. And it’s certainly something that I’m sure there will be continued dialogue about for years to come.
John Eich: And I would like to say that I see a real difference between a Paramedic—or in Wisconsin, we also have the Advanced EMT classification—where we are expecting them to have a body of knowledge and to be healthcare clinicians, to be making life or death decisions in the field. Absolutely. Everyone in society wants those people to be the best-trained, the most knowledgeable, at the top of their game. And the tests should reflect that. I do think that if we have someone who is a firefighter who’s driving out to a site to assist, that’s not the same as a Paramedic and I’m not saying that they shouldn’t be trained and there shouldn’t be a gates for them to go through. We need to be sure that they are trained to the best of their scope and to the best of their ability. But I think it’s a different level of care is a different kind of professionalism. So I think we just need to really make sure that we’re doing a service to the rural areas where they are scraping together five people to cover a very large area and they just don’t have time for the level of nuance that you will often see in an urban, metro area where you’ve got, um, you’ve got enough staff to cover these sort of things,
Amanda Riordan: Makes complete sense and certainly something that we know so many communities are wrestling with right now. I thank you for bringing it to everyone’s attention. I think that we will get some lively dialogue in the comments when we get this posted about, as you pointed out, the diminishing volunteerism as well as the other pressures facing most mobile healthcare these days. Before we wrap up here, would you mind giving us some tips or thoughts about how EMS providers, mobile healthcare providers, in Wisconsin can work best with your office? Or if you have any generalized tips about how ambulance services and fire departments across the country can best work with the Offices of Rural Health in their state, we would be very grateful. Clearly you are moving and shaking in Wisconsin and we’d love to see that ripple out to other states.
John Eich: Absolutely. So, I have counterparts in every state and they’re all doing great work when it comes to rural health and rural EMS. If someone in any state simply goes to Google and, enters their state name and “office of rural health,” they’ll get right to them. I think there is a difference between Offices of Rural Health. Many of us are in state government, and so what you experienced there is common of state government—It’s a more bureaucratic system. The websites tend to be a little bit trickier to find the information because there’s obviously a lot going on there and some political considerations. We [here in Wisconsin] are university-based. There’s about 12 of those around the nation, and three that are nonprofit, so, even leaner and more flexible. So every [office] will look differently.
I do think that EMS should reach out to their Offices of Rural Health to let them know about their needs, because when we look at metrics for healthcare and for population health, we see the metrics getting worse. It’s almost like a horseshoe in that they get worse the more rural and remote you are. Suburban areas have the lowest need, and then the inner city tends to be equally challenging. We share a lot of population health issues with inner cities. The difference I think is really transportation. We’re farther away. And if you don’t have a car, you’re really isolated and stuck, so EMS is mission critical.
If you think about that first hour of care being so important to outcomes, [if sick or injured in a rural area] your first half hour could be without care as people are getting to you and you’re trying to find a cell signal to actually call 911. Once they arrive, your rural EMS providers are the people that are giving you that care. So it is vitally important that those people have the resources to do their job the best that they can.
Please reach out to express your needs. One of the things we’ve been talking about based on this Rural Listening Tour and talking with our state EMS office and the associations just yesterday is the idea of some kind of helpline; Somebody to answer the call when a service is identifying that they are really struggling, because [rural services] are a little nervous about calling the state and saying, “Hey, guess what? Things are really rough here. You might want to shut us down.” Nobody wants that. The state EMS office is very clear that it’s not in anybody’s best interest to remove care and burden neighboring services. So getting a helpline with a number of resources and even someone that can drive out and sit across the table and talk through some issues and get some advice would be very helpful for some of these services that are really struggling. Those are some ways that I think folks can get involved, and I’m always interested in hearing more.
Amanda Riordan: John, thank you so very much for your time and insights today. It has been an absolute pleasure talking to you and I’m sure that we’ll be hearing a lot more from the Office of Rural Health, you, and your staff in the years to come. So again, we truly appreciate it and wish you a very happy National Rural Health Day tomorrow, November 15th.
John Eich: Thank you very much, and I look forward to celebrations around the nation.
La Crosse, WI– The American Ambulance Association (AAA), Minnesota Ambulance Association (MAA), and Professional Ambulance Association of Wisconsin (PAAW) today officially announced the launch of the Midwest EMS Expo conference and trade show. This event will take place annually in La Crosse, Wisconsin beginning in May 2018, and will feature content from national- and state-level ambulance experts.
“AAA is proud to partner with PAAW and MAA in the development of the Midwest EMS Expo. We look forward to bringing together the best in ambulance expertise to deliver a powerful educational experience for EMS leaders,” said American Ambulance Association President Mark Postma.
The program will open on Wednesday, May 2, with key updates from the American Ambulance Association’s renowned experts on EMS reimbursement and advocacy. Highlights include a federal legislative overview by AAA President Mark Postma, as well as strategies for maximizing revenue from reimbursement gurus Asbel Montes, Brian Werfel, Brian Choate, and Scott Moore.
Thursday, May 3rd’s programming was developed collaboratively by the Minnesota Ambulance Association and Professional Ambulance Association of Wisconsin. The day will begin with speaker Captain Ray Dupuis of the Watertown Police Department. In this riveting keynote, he will share what happened in first minutes after the explosions at the marathon finish line, then explain police and EMS action plans that day. Don’t miss this opportunity to learn from a seasoned public servant who helped to lead his city in its darkest hour.
Additional conference topics include employee recruitment and retention, billing and compliance, executive leadership, community paramedicine, employment law, managing across generations, EMS resilience, and many more. For a complete conference agenda, visit www.midwestemsexpo.com/schedule.
According to PAAW President Dana Sechler, “The Midwest EMS Expo will offer a platform for the exchange of ideas and information among ambulance leaders of all levels. Given the constantly changing nature of EMS, it is critical to bring this educational and networking opportunity to our region.”
In addition to powerful educational content, the Midwest EMS Expo will offer attendees the opportunity to experience the best in products, services, and vehicles for EMS providers. Gold Sponsor Savvik Buying Group will be joined by Silver Sponsor Cindy Elbert Insurance Services, Bronze Sponsor eCore, and dozens more exhibitors on the show floor. For a complete list of current vendors, please visit www.midwestemsexpo.com/exhibitors.
Conference registration is now open, with member early-bird rates as low as $200 per attendee. Sponsorship, booths, and vehicle spaces are also available online at low introductory rates. To register for the Midwest EMS Expo or view the complete schedule of events, please visit www.midwestemsexpo.com.
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About the American Ambulance Association
Founded in 1979, the AAA represents hundreds of ambulance services across the United States that participate in emergency and nonemergency care and medical transportation. The Association serves as a voice and clearinghouse for ambulance services, and views prehospital care not only as a public service, but also as an essential part of the total public health care system. www.ambulance.org
About the Minnesota Ambulance Association
The Minnesota Ambulance Association represents Minnesota’s EMS providers by working with and monitoring legislation that impacts EMS, recruitment & retention, financial issues, education & leadership. We work closely with our peers in the hospitals, fire service, police, emergency managers, sheriffs & other associations. www.mnems.org
About the Professional Ambulance Association of Wisconsin
The Professional Ambulance Association of Wisconsin (PAAW) was founded in 2005 to represent the interests of ambulance services in the state of Wisconsin. In addition, PAAW works to create and promote opportunities for collaboration and networking between ambulance service executives, directors, and managers. PAAW serves as an EMS stakeholder group to promote excellence and quality in the ambulance industry in Wisconsin. www.paaw.us
No one knows better than an AAA members the incredible value of membership. Consider sharing your AAA membership experience, and get rewarded for doing so!
Through our new Membership Referral Program, receive a free webinar registration for each new member organization you refer that successfully joins the association. Successfully sign up 6 new member organizations, and you’ll receive a free registration to the AAA Annual Conference & Trade Show! To participate, simply copy ariordan@ambulance.org on emails you send to colleagues inviting them to join. AAA staff will answer questions and help with follow up.
Not quite sure what to write? Here’s a sample email to get you started!
Dear Colleague’s Name,
I hope your year is off to a great start. I wanted to send a quick note to ask if Colleague’s Ambulance Servicemight be interested in membership to the American Ambulance Association?
My service is a proud member of AAA, and the advocacy work they do on behalf of our industry is more important now than ever. In addition to working toward fair reimbursement, AAA now offers free counseling and CISM for your staff, access to experts on operations and Medicare, and much more. I especially enjoy the sessions and networking at Annual Conference, as well as the ability to recognize my top field staff at Stars of Life. I have copied AAA’s membership staff on this message in case you have any questions about benefits or dues.
I hope that you’ll consider supporting the American Ambulance Association. Thanks for considering, and have a great one.
Each year, the American Ambulance Association honors best practices, ingenuity, and innovation from EMS providers across the country with our AMBY Awards.
Gold Cross Ambulance’s Documentation Project Project Awarded a 2016 AMBY for Best Quality Improvement Program
The documentation review process at Gold Cross Ambulance had not changed much since the day of paper trip tickets. Retrospective documentation feedback was being given to crews, but they were not fully utilizing the capabilities of their technology to analyze the feedback and make significant improvements. Gold Cross Ambulance hypothesized that improved documentation goals would lead to better patient care and increased reimbursements. They knew they needed to make improvements in the review process and to better utilize the technology that was already in place. In addition to the documentation goals, they identified the opportunity to work some small, but significant, clinical improvements into a documentation project. One initial focus of clinical improvement was making sure the field crews were obtaining at least two sets of vital signs on every patient, and properly documenting these vital signs in the electronic patient care report (ePCR). Of all the performance indicators we measure, trending of vital signs touches every patient contacted. Educators from Utah EMS for Children shared research citing “inadequate recognition of and response to hypotension and hypoxia was associated with higher odds of disability and death” (Hewes H., 2016). This was such a basic thing to measure, but it had potential to impact every contacted patient. Gold Cross know that vital signs were an area in which they could improve, while also meeting their documentation goals. To do so, they implemented the following:
Create a way to measure overall documentation quality.
Establish a formal standard for documentation and educate crews about the documentation expectations.
Improve the overall documentation of the ePCR.
Improve the number of patients with properly collected and documented vital signs.
Improve amount of reimbursement and decrease collection cycle time.
Gold Cross formed a work group to tackle these issues, which consisted of members of the Quality Department, Training Department, Billing Department, and Operations Department. The group meets every other week to evaluate progress and assess the need for adjustments to the system. Mid-year of 2014, the group worked to revise the program for documentation evaluation. A new standard was created based on the ePCR fields. A point system was established for documentation which gave each ePCR field a weighted number of points, equaling 100%. Incomplete or missing fields result in a loss of points for that field, which provided a way to measure documentation performance. The scoring data is tracked in our ePCR quality module, allowing us to analyze and report on the data easily. The feedback on any areas of missed points is sent to the crew via the ePCR messaging system, so it is easily accessible to the crews during regular daily tasks. Feedback is focused on improvement comments instead of punitive comments. Positive feedback is included in each evaluation. The group released an initial version of the General Instructions for the ePCR, which was an internal manual detailing expectations for every field in our ePCR. The focus was to provide clear expectations to all field crews regarding how to properly fill out the ePCR and what content should be included. The training department created an educational program on the online educational software program, detailing the documentation guidelines and testing the crews on the material. The General Instructions for the ePCR were also posted on the company training site, so crews would have easy access at any time. The Quality Department developed a class for the newly hired providers. The class emphasizes the need for quality documentation, outlines the program, and includes actual documentation examples for evaluation and discussion. Patient advocacy through documentation is instilled in the participants of this class. The Billing Department developed a class which is taught at six months after hire. In the class, documentation is reviewed from class participants. The billing department shows how the bill is processed from the documentation, and they discuss common challenges to the billing process. The program has been monitored with continuous PDSA cycles and has been adjusted as needed for continued improvement.
An initial company goal for documentation was set at 90%. From project start to current date, the company-wide documentation averages have increase from 74% at the beginning of the project to 96% currently. Field crews have expressed greater clarity in the company expectations for documentation. The overall average documentation scores by division are posted regularly for the company to view, and this has had the additional benefit of sparking a competitive streak between some of our divisions, further improving the scores. The improvement in collection of vital signs not only improved overall patient care, but resulted in a Performance Improvement Award from the Utah State Bureau of EMS in 2016. The bureau looked at pediatric vital signs and recognized two rural and two urban EMS agencies in the state for their improvements. Gold Cross Eastern Division won the award for a rural agency, and Gold Cross Salt Lake Division won for the urban agency. Their study found our agency improved the collection of pediatric vital signs by 53% in our urban area and 66% in our rural area.
The most important impact of this project is improvement in patient care, which is our primary mission. The goals for complete documentation have encouraged field crews to make sure they complete proper assessments, since they know those areas of the ePCR are evaluated and must be complete. Improvements in assessment result in better differential diagnoses and improved treatment plans and outcomes. The documentation project has positively impacted Gold Cross financially as expected. Reimbursement rates have increased and the time to complete the collection cycle has improved. Due to the documentation improvements, the billing staff spends less time researching information, following up on incomplete documentation, and fighting in appeals.
Congratulations to Gold Cross Ambulance for the Reduced Readmissions Project’s selection as a 2016 AMBY Winner for Best Community Impact Program.
If you were asked to name the top 10 most popular websites in the United States today, I’m willing to bet that you could guess most of them: they are, in descending order of Alexa page view rankings, Google, YouTube, Facebook, Amazon, Yahoo, Wikipedia, Twitter, Reddit, Ebay, and LinkedIn.
“Wait,” you may be asking, “what is ‘Reddit,’ and how can it be in the top 10 most popular American websites if I’ve never even heard of it?”
As a self-appointed cultural ambassador for the millennial-heavy EMS workforce, I’d love to give you a basic introduction. Seasoned Redditors, feel free to skip this post. But those new to Reddit, or even social media in general, please hang in there—it is increasingly important for ambulance executives of all age groups and technology skill levels to “get” what is going on in influential online communities.
What is Reddit?
Reddit describes itself as “the front page of the internet.” What does that mean?
Reddit (usually styled lowercase as “reddit,” but I’m capping for clarity) is an online community platform allowing users to anonymously share, comment, and vote on links, images, personal stories and more in topic-specific “subreddits.” A user’s self-selected subreddits are merged into a personalized feed, which is often very different than the generic Reddit Front Page generated from the posts voted best across the whole site.
Wildly popular with millennials, Reddit is one of the most engaged and active digital communities in history. Reddit communities’ collective taste-making influence drives modern pop culture and politics in unprecedented ways, and the popularity and sway of the site is only growing.
Large swaths of your staff are routinely participating in Reddit communities, likely many times per week. For all that we hear about generational conflict in EMS organizations, wouldn’t it be great to gain some firsthand insight into the candid thoughts of EMTs and Paramedics across the country? Of course this only works if leaders approach Reddit (and the subs and threads of varying merit within) with an open mind—because of its inherently populist and anonymous nature, there is an ever-changing mix of valuable and abhorrent content that sometimes takes a little time to sort through.
Additionally, more and more people are electing to get their news, pop culture, and entertainment first through Reddit or other social media, instead of mainstream news sources. EMS leaders relying solely on information from TV newscasts or even the websites of traditional print journalism outlets are missing the backchannel dialogue and meta commentary that is shaping the way our industry is perceived.
Can Reddit participation help with EMS advocacy?
Many ambulance execs are unfamiliar with the fact that top politicians as diverse as President Obama and Gary Johnson choose to interact directly with Redditors, personally fielding user questions in the r/IamA sub. Reddit’s political commentary subs are also famed for the sometimes prescient, sometimes wacky user analysis of current affairs and election hoopla. Start with r/politics, the largest sub, to get a feel for the Reddit politosphere, then find your niche in some of the more targeted subs below. Not seeing your interest? Search the site for hundreds of other options ranging from radical to reactionary—or start your own.
We all have that kooky relative who doesn’t “get” Facebook, and so posts inappropriate rants or the equivalent of text voice mails on our walls. Don’t be “that guy” (or gal) on Reddit—although most people are nice, not everyone is patient, and some users may report your post to moderators for removal. Also, it is just good manners to follow the norms of any community in which you participate, be it face-to-face or online. Here are some easy steps to ensure that you become a valued contributor to the Reddit community.
Login to reddit, then visit your subscription page to remove yourself from any default subs that don’t interest you. For me, this meant immediately axing everything related to sports (sorry, I mean, “Go Sox!“).
Next, find and subscribe to many subs that interest you. There are thousands of subreddits for everything from r/cooking to r/gardening to r/motorcyles to r/parenting to r/books, and that is just scratching the surface. Typically large, general-interest subs will list more niche subs in their sidebars to make them easy to find.
Lurk and get used to voting. Read your feed, or peruse a specific sub in-depth, upvoting posts and comments based on quality, not your level of agreement with the poster’s opinion. Typically, it is best to lurk (read without posting) for a month or two before you leap into the fray to get a sense for how each community interacts.
Start posting and commenting. Now that you have some context for the types of conversations going on in your favorite subs, you’re ready to start submitting new posts and commenting on the posts of others, in addition to voting. It is really important to read Reddit’s content rules and Reddiquette guidelines, as well as the sidebar rules for your particular sub, before posting. Also, it is pretty much universally forbidden to share with the group any personally identifying information, even about yourself. Don’t get overwhelmed—most of the rules are common sense, and the time investment will pay off when you experience the thrill of sharing ideas and news with like-minded people from around the world.
Are there EMS-specific subs?
There are many EMS-focused subreddits, ranging from the (mostly) serious to the ridiculous. Here are just a few:
r/EMS – by far the largest, with 21k subscribers as of today. Diverse mix of jokes, personal stories, protocol questions, opinions on employers, and more.
r/911Dispatchers – (2k subscribers) – Sub targeting dispatch professionals.
r/EMScringepics, r/LookImAFireFighter, etc – smaller subreddits where some popular EMS sartorial choices are mocked. Very definitely Not Nice, but may strike your funny bone if you have a certain sense of humor.
r/firefighting (11k subscribers) – sub serving firefighters, but often touches on EMS topics
Hint: Sort by “TOP” then choose a timeframe to catch up on the best (or at least most popular) posts in a particular sub.
My service is mentioned on Reddit in a negative manner. Should I respond?
If someone posts something negative on Reddit (or Facebook, or Twitter, etc, etc) about the organization to which you’ve dedicated so much time and love, it can be very tempting to fire off your side of the story in response. However, it is almost always inadvisable to go in “guns blazing” on an anonymous message board, particularly if you aren’t very familiar with the norms for the specific sub in which you would respond.
If you really feel you must set the record straight, I suggest asking three other sensible Redditors and your attorney to review before posting, to make sure that you don’t accidentally open your organization up to a lawsuit or media nightmare. You may also want to create a separate “throwaway” username before replying, as anything you’ve previously commented or posted under your usual username is publicly visible. No matter how innocuous your past activity may be, it can and will be used against you in the court of public opinion (see: Ken Bone Reddit controversy).
My service is mentioned on Reddit in a positive manner. Should I respond?
In this case, it is a hard maybe. The tricky thing is that you want your organization to avoid being perceived as “Big Brother,” particularly in response to anything (good or bad) that might have been posted by one of your own employees. Given Reddit’s higher level focus on anonymity than, say, Facebook, even a “thanks so much, so glad to be your favorite employer!” reply can seem creepy or intrusive, depending on context. It may be best to just privately enjoy the knowledge that thousands are reading your unsolicited praises (and likely looking for job openings at your service).
If there are no HIPAA or human resources concerns involved, you can enlist the help of seasoned Redditors in crafting a response that is right in tone for your service.
Can I market my ambulance service on Reddit?
Commercial self-promotion of any kind is very much frowned upon by the Reddit community. Viral marketing, or any post planting or vote manipulation that can be perceived as viral marketing, even more so. For a glimpse at the level of energy around this issue, please see r/HailCorporate, or consider the vitriol directed at users who create alternate “sockpuppet” accounts to upvote their own posts. Any kind of advertising outside of appropriate subs that specifically allow it (or actual Reddit ads) is risky at best, and may completely backfire.
Can I post job listings to Reddit?
Read the sidebar rules of the subreddit you’re considering posting in to see if commercial offers are permitted (for example, counter-intuitively, r/jobs forbids job postings). Your may wish to consider posting to one of the subs dedicated to job seekers, including r/jobopenings, r/youngjobs, and r/jobbit, or your closest local job sub.
Another thing to consider is buying an ad on the Reddit site, then running it in EMS-specific subs, particularly if you’re open to paying relocation for medics from other areas, or if you are willing to train individuals coming from other industries.
Note: recruitment is not yet a primary Reddit focus, so you may or may not have much luck at this point. However, as more people join Reddit and rely on it new and different ways, this is likely to change.
Glossary
Default sub—Default subreddits are subs considered to have the right mix of popularity and quality to be automatically included in new users’ subreddit subscriptions. You can remove default subreddits that you are not interested in following on your subscription page after you create a login.
Karma—When a post or comment is submitted, other users can vote it up or down. “Karma,” divided into post karma and comment karma, is a loose indicator of the quality of a thread. You can track your own karma on your profile page, but it has no monetary or other value. In theory, voting is supposed to be based on the quality and relevance of the post or comment, but this doesn’t always play out perfectly. Some users have high overall karma scores because they post very relevant articles or incredibly insightful posts, others because they draw sketches or write poems related to posts, and still others because they are known for submitting posts or comments that the community finds funny.
NSFL—an initialism for “Not Safe for Life.” This is used in the title of a post to indicate offensive content that shows or makes reference to gore, death, serious injury, the abuse of animals or people, etc. I would very strongly suggest that even the most hardened EMS folks stay away from most of these posts and the comments sections about them—NSFL posts do not bring out the best in humanity.
NSFW—an initialism for “Not Safe for Work.” This is used in the title of a post to potentially sensitive content involving any kind of nudity or sex. Depending on context and the subreddit in which it is posted, this flag can be used for posts covering everything from a news photo of the Janet Jackson Super Bowl wardrobe malfunction to actual pornography. Use your best judgment.
OP—like most other internet forums, on Reddit “OP” refers to “original poster,” and is a generic term used in comments to refer to the creator of the thread you’re currently reading.
Meme—Most folks have probably heard of memes (pron. “meems”, not “meh-mehs,” “me-mes,” etc), or may even have shared some around the office or on Facebook. Reddit has a variety of inside jokes and memes specific to the community. If someone replies to a post with something that seems like a total non-sequitur, but others seem to find it funny, you may want to Google for inside jokes or check Know Your Meme for answers. Be forewarned: while some are funny or insightful, many memes and Reddit inside jokes are crass, prejudiced, or just stupid.
Sub / Subreddit—Although originally not officially recognized, “sub” or “subreddit” are now almost universally used terms refers to self-moderated community centered around a particular topic. Here are just a few examples of the tens of thousands of subs you can choose to subscribe to, depending on your interests.
Have questions about Reddiquette or other social media platforms? Please don’t hesitate to reach out at ariordan@ambulance.org. Please feel free to share your own tips in the comments section below. We would love to hear about your ambulance service’s online successes and foibles.
The American Ambulance Association is sad to report that Barry M. Mogil, former CAAS reviewer and director of communications for Pinellas County, Florida EMS, passed away.
Our thoughts are with his family. Barry’s contributions to Florida EMS will not be forgotten.
The American Ambulance Association is saddened to report that f Allan S. (“Al”) Reichle passed away on July 20. In addition to owning Springs Ambulance and other successful business ventures, Al served on AAA’s Government Affairs and AMBUPAC Committees. Our thoughts are with his family.
Use the Savvik Buying Group discount included with your AAA membership to save on the ZOLL products you are already buying. Simply ask your ZOLL sales representative to apply the Savvik contract rates to your next purchase. That’s it!
The American Ambulance Association is pleased to announce that AAA members can now save significantly on Physio-Control products through the Savvik Buying Group.
Through Savvik’s partnership with Vizient (formally Novation), the largest acute care GPO in the United States, AAA members now have access to this discounted contract on AED’s, Monitors, and Lucas devices and accessories.
Last week, American Ambulance Association staff took a road trip south to tour the Richmond Ambulance Authority. Known across the country and around the world for their innovative approach to EMS, RAA certainly did not disappoint.
Thank you to Chip Decker, Rob Lawrence, Dan Fellows, Elizabeth Papelino, Danny Garrison, Dempsey Whit, Jason Roach, and the whole RAA team for the hospitality and generosity with their time!
The documentation review process at Gold Cross Ambulance had not changed much since the day of paper trip tickets. Retrospective documentation feedback was being given to crews, but they were not fully utilizing the capabilities of their technology to analyze the feedback and make significant improvements. Gold Cross Ambulance hypothesized that improved documentation goals would lead to better patient care and increased reimbursements. They knew they needed to make improvements in the review process and to better utilize the technology that was already in place. In addition to the documentation goals, they identified the opportunity to work some small, but significant, clinical improvements into a documentation project. One initial focus of clinical improvement was making sure the field crews were obtaining at least two sets of vital signs on every patient, and properly documenting these vital signs in the electronic patient care report (ePCR). Of all the performance indicators we measure, trending of vital signs touches every patient contacted. Educators from Utah EMS for Children shared research citing “inadequate recognition of and response to hypotension and hypoxia was associated with higher odds of disability and death” (Hewes H., 2016). This was such a basic thing to measure, but it had potential to impact every contacted patient. Gold Cross know that vital signs were an area in which they could improve, while also meeting their documentation goals. To do so, they implemented the following:
