ANALYZING OUTSIDE FORCES
An analysis of the outside forces affecting volunteer EMS services is important in order for the service to operate effectively. In contrast to the low impact of outside forces in past years, many outside forces now have strong influences and cannot be ignored. The National Rural Health Association's 1995 Rural EMS Task Force concluded that "negative interrelationships between agencies that make up the EMS system interferes with the service's effectiveness and negatively impacts both recruiting and retention of members." The following model depicts the "force field" of organizations that impact today's volunteer services:
1) National Standards/Guidelines:
There is increasing influence placed on volunteer services by existing and increasing national standards. For example, the American Heart Association has very specific response time and patient care guidelines for EMS. Increasingly it seems we are being compared to these national standards.
2) Public Expectations:
Similar to the increasing national standards are the expectations of the public. Every week prime time television shows the public how EMS can and should work, both in a hospital and pre hospital setting (i.e. ER, Chicago Hope, Third Watch, etc). When the public is shown the potential for reducing mortality and morbidity, their expectations of their local providers increase. This is true even if the providers are volunteers. No family wants to have care delayed or not available when their family member is in need, "after all they saved that guy on TV last night."
3) OSHA:
"If you think OSHA is a small town in Wisconsin, you are in big trouble." So says the
bumper sticker in a fire house in western New York State. That is true in EMS as well. Between blood borne pathogen, hazardous materials awareness, hazard communication, and confined space regulations an EMS manager better know what he or she is doing or the service could be in for a big surprise. OSHA can levy fines up to $10,000 a day per violation. Understanding OSHA and assistance in compliance to its regulations is discussed in the health and safety chapter.
4) Local Government:
The relationship between a volunteer EMS service and its local village, town, or county differs widely across America. Many local governments often do not recognize EMS as a funding issue in their communities. In areas where the support of EMS services is high, the interaction is predictably higher. However, many services are independent of local municipalities, and as a result, may have little interaction with them. The trend appears to be toward closer ties as services try to gain or increase funding from local government. The reaction from local government to this is predictable- "there is no new money to provide to EMS". Local government leaders need to realize that the volunteers save their communities significant amounts of money. Local governments need to sharpen their pencils and do some cost/benefit studies between supporting volunteers versus paying personnel to do EMS.
Some local governments are supporting volunteers by providing them with tax credit if they are active. Other local governments are handling the billing for the service. Most volunteer services rely on a county or other form of local government to handle the emergency calls from the public, whether they are 911 or seven digit phone calls. All EMS services need to be strong proponents of enhanced 911 centers that do call prioritization and pre-arrival instructions. If we are not strongly pushing for these centers to provide such services, who will? We are the ones that have to look the family members in the eyes and tell them "everything that could have been done for your loved one was done," yet we know that our 911 service does not provide pre-arrival instructions.
5) Education Source:
The local sponsor of EMS education is an important force for a volunteer service to consider. In many areas these local sponsors are community colleges, hospitals and private contractors. These local sponsors typically have an agreement with the state to conduct education for the local community. Most volunteer services wish they could have the EMT courses in their own headquarters. This is often not possible because these sponsors have limited resources and services have EMTs whose certifications expire at different periods thus making class sizes small. One way services are more likely to get training closer to home is by supporting one of their own medics to become an instructor. However, this will take a long time. Another way to get training held in your town is by befriending an existing good instructor. Instructors love to teach where they are appreciated, taken care of, and the facility is appropriate. For example, do you invite your instructors to your banquet and provide them with a meaningful symbol of your appreciation? Do you thank them by writing
to their employer and to the newspaper? Does the instructor have to clean and lug all the EMS training equipment to and from where it's stored? Can your service enhance the payment that the instructor is receiving from the course sponsor? Can your service provide administrative support to the instructor, i.e. typing, copying, etc. Is the classroom conducive to learning or does the instructor have to compete with diesel engines and radios that "can't be turned down?" Find a good instructor and ask them what it would take for them to teach in your town.
Many services need to invest more of their budget in education. Many times I have heard a service leader complain about the cost of an EMT course as he or she is showing off their new ambulance that has all the bells and whistles imaginable and more. Services need to place their money where your mission is -- strobe lights, gold leaf trim, and stereos don't save lives -- well-prepared medics do!
6) Hospitals:
Hospitals vary widely in their support of volunteer EMS services. In some areas EMS is considered an integral part of emergency medicine and the hospitals support EMS accordingly. In other areas the hospitals want nothing to do with EMS (unless something has interfered with how many patients are being brought to them). One of the best arguments we have ever heard for a hospital to support clinical training for paramedics came from an emergency physician trying to convince stubborn physicians to allow EMTs into clinical settings. The emergency Doc said to his colleagues; "these EMTs will learn these skills on your patients with guidance from hospital Docs and nurses or they will learn these skills on your family with another EMT helping them. It's your choice!" Hospitals in some areas provide meaningful and regular quality improvement assistance. Some do the billing. Some even provide the medical coverage for volunteers that have little or none of their own. The Hospitals the EMS services respond to in the Livingston and Steuben Counties vary in available support. EMS services should strive to partner in the following areas to increase success and minimize failures. The types of partnering that should occur are:
7) Local & Regional Councils/Committees:
Local and regional EMS councils and committees have varying responsibilities across the country. Many of these organizations are an advisory body to volunteer services in the areas
of system planning, communications, training, mutual aid, disaster response, etc. As such,
volunteer services can choose to adopt the measures or ignore them. Other councils and
committees have statutory authority over volunteer services and therefore their edict must be
followed. In either situation these agencies should be treated with respect. Do not criticize
their work if you have never been to one of their meetings. The biggest critics of these
councils and committees seem to be people that have never attended one of their meetings.
8) Other Emergency Services:
Volunteer EMS services interact daily with other emergency services. Most of these interfaces are unremarkable, but others can be quite stressful or even damaging. Like
yourself, other emergency service workers in your community are usually highly respected.
As such, when fire and police people mention how much of a "jerk" the EMS manager is,
people will likely believe them. Take time to get to know these people. In some areas there is
great strain between services. The source of this conflict usually dates back to one incident
years ago, probably before you were even a member. (It doesn't matter that every other
incident with this agency over the years has gone well.) Recognizing this good work, perhaps it is time to send a letter to that agency or recognize them publicly. There is simply too much at stake (sometimes a patient's life) for us to be continuing a feud
that no one can remember when or why it started.
9) Medical Director:
Services that practice at the basic life support (BLS) level often do not have medical
directors. However, once a service enters into the advanced life support field, a physician's
license is required. Successful EMS services all have one thing in common, they all have
strong physician involvement. Services that only want a physician to sign off on their
protocols and leave them alone is not a service I would want to volunteer for. Likewise, a
physician that only lends his or her signature to allow the service to practice ALS is not one I
want going to bat for me if I make a mistake in the field. Many well meaning physicians are
not prepared to be EMS medical directors. Regional and/or state EMS councils and
committees need to educate physicians in the area of medical direction.
10) Media:
The media can play an important role in any organization. This is especially true in a high
visibility business like EMS. Volunteer EMS services, however, rarely take advantage of the
power of the media. Many services only react to media accounts rather than direct them.
Virginia's state EMS program has a great media relations guide. This guide can be acquired
by calling Virginia EMS at [(804) 371-3500]. Additionally, the Maryland EMS [(401) 706-5074] office has information with helpful Medic contact suggestions.
11) Suppliers:
A supplier to an agency is considered a powerful force if the following situations exist:
Fortunately, there are dozens of sources of equipment and suppliers to volunteer EMS
services. Likewise, there exist few, if any, unique items used in the volunteer EMS business.
The suppliers to volunteer services are not a threat to the agency. The only exception to this
is if the service is a local commercial EMS service. And finally, the suppliers are rarely, if
ever, a customer of the service.
All these outside agencies can and do have a profound impact on a volunteer EMS service.
Only by better understanding and a closer working relationship with these agencies will the
service benefit from what these agencies have to offer.