Why EMS tactics must support overall agency objectives

Knowing the fundamentals of ICS can also help you address clinical and operational issues

Many of us have probably sat through Incident Command Structure (ICS) classes and wondered why it was so important to learn the difference between objectives, strategies, and tactics. I know I certainly have.

But recently I realized how useful those distinctions can be in just about any setting in EMS.

During my career, I came to see how those concepts could help when responding to a motor vehicle accident, planning for a marathon, or preparing for a snow storm. Having clear objectives ensures that everyone works in concert to achieve established goals, and also that every action taken is part of that effort.

In our training, our patient care, and certainly our long-term planning and quality management processes, understanding the difference between objectives and tactics is crucial.

Consider the quality management process. For many years, we have focused mostly on tactics. Are we good at starting IVs? Did we arrive on scene within eight minutes?

Consider if the tactics support your objectives

These tactical questions may be good ones to ask, but only after we’ve addressed the larger questions about our objectives. Why do we care if we got the IV? Is it critical to our patient care?

While we need to ensure that we are proficient in patient care tactics, they do not do as much good without considering the overall objectives. I have been in situations where I tried several times to start an IV on a patient, even though I had no plans to administer any IV medications.

I was caught up in the tactics—I had been yelled at by physicians more than once for not having an IV in a critical patient—without remembering the overall objective. In the end, I probably delayed transport to the hospital or neglected other aspects of assessment and treatment in pursuit of a tactic that didn’t directly support my goals.

Strategic planning must address current objectives

At the agency level, this consideration is no less critical. This is certainly the case for departments across the country rushing to launch community paramedic programs. Programs that start with objectives and work toward tactics will succeed, while those that don’t follow those principles may struggle.

Community paramedic programs need to be tailored to the strategic objectives they aim to accomplish. For example, a community with a large number of frequent EMS users with substance abuse problems will require different tactics than a community whose frequent EMS users are elderly and suffer from chronic disease. Trying to implement a program without first determining the strategic objectives will lead to a mismatch between needs and resources.

Similarly, departments that hope to put more ambulances on the street or add paramedics to fire engines should recognize that these are all tactical decisions. They might be good ones, or they might not be.

If an agency gets too caught up in implementing specific tactics without considering the overall objectives, its leaders may neglect to consider other options. Even worse, they may fail to see the negative impacts of those tactical decisions.

What’s important is that the overall objectives are considered first. Is the objective to save more victims of cardiac arrest? Are these tactics the best way to accomplish that goal? Have other tactics been examined or even considered?

“Strategic planning” is a much maligned phrase, and for good reason—I have been involved in strategic planning efforts that were far from productive. But decisions in EMS should all involve some level of strategic planning—from agency-wide policy changes to budgetary decisions, clinical oversight to individual patient care decisions.

Measure success accurately 

After implementing these programs, agencies also need to ensure they are measuring their success based on the strategic outcomes, not tactical ones. If an agency measures the success of its paramedic engine program by examining the percent of incidents that have multiple paramedics on scene, they are likely to find they have succeeded. But that does not mean it achieved any improvement in service or patient care. Instead, the agency should measure whether or not that tactical decision improved patient care or made the system more efficient and effective.

Too often, we focus on tactics in order to promote an agenda or ideal that we believe in without revisiting the strategy. As evidence grows, budgets shrink and standards evolve. We have to start at the beginning with each decision and think about what we are trying to accomplish and what are the best ways to get there in the current environment.

Otherwise, we’re simply making decisions because people before us made similar ones—even though we often have more knowledge and face a different climate than others who used similar tactics to address a problem.

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