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EMS advocacy and adaptability with Shawn Baird

The incoming AAA president advises leaders on how to leverage resources, reports on discussion with Biden/Harris transition team


“2020 was a year like no other that I’ve experienced in my 30 years in EMS and I believe that we rose to the occasion at services all over the country,” said Shawn Baird, incoming president of the American Ambulance Association.

Irfan Khan/Los Angeles Times/TNS

As we enter, hopefully, a happier new year, several of our national associations that have been at the forefront of collaborative advocacy efforts and the voices of the EMS profession have undergone planned changes in their leadership.

To welcome in 2021, I sat down, via Zoom, with Shawn Baird, incoming president of the American Ambulance Association and asked him about 2020 and his thoughts on the future of our industry. Shawn is the vice president for rural services with MetroWest Ambulance Family of Companies in Oregon. Shawn spent the last two years serving the AAA as president elect and has been at the center of AAA activity and advocacy.

EMS1: You spent the last two years as the President Elect of AAA. How would you describe how 2020 went for us as an industry?

Baird: I think the first thing I would say is how incredibly proud I am to work with EMS in this year that we’ve just been through. The challenges that we’ve faced, which obviously include the public health emergency and, in many communities, civil unrest, serious rioting, race and equality issues, inclusion issues and wildfires that took many lives as well. 2020 was a year like no other that I’ve experienced in my 30 years in EMS and I believe that we rose to the occasion at services all over the country.

EMS saw an expansion of their role, while, at the same time, enduring the most harrowing financial hardship, changes to their operations, reductions in their call volume and service, sometimes furloughing staff only to suddenly try to recall them all in an instant, because the situation on the ground changed. When I look back at the last 9-12 months, all I can say is kudos to the EMS community for rising to the occasion.

I think it’s fair to say we have been everything to everyone and the adaptability of the workforce has been amazing

On an individual level, I’ve seen EMTs and paramedics expand their role, moving from emergency response or a non-emergency medical transport role to COVID-19 testing, COVID-19 vaccinations, to staffing wildfire camps with advanced medical care clinic type settings for days and days. It goes beyond the clinical because a lot of them took on logistical roles trying to secure PPE, sometimes in an open and dare we say a gray market or, or even a black market in dire straits. The amount of creativity that people have undertaken has been really astounding.

All of this must have shaped your thoughts for the opening weeks of your presidency. What are the top things that you want to get into straight away?

Over the next year or two, I think that my role as president is going to be to create an environment where ambulance services thrive in providing the care to patients despite the really crazy world that we’re working in. So how do we create an environment where ambulance services are going to thrive? And by thrive, I mean, take on all those new roles, fill all the expectations and leave their communities more resilient, healthier and certainly more appreciative of the EMS service they get.

To do that, I think we need to accomplish a couple of things. I see a couple of legislative hurdles ahead of us. First and foremost is the pressing task of responding to what Congress has asked for when they passed the end of the year funding bill. It included the action on surprise medical bills, and we have just about 180 days before a report will go back to Congress on how that should be addressed for ground ambulances. Our association is going to be investing a lot of time, talent, energy and resources to make sure that Congress gets the best possible information so they ultimately understand to a larger degree why we weren’t swept up in “just ban all the patient billing” and that we may need a more nuanced solution for our industry.

Key to this is that EMS is locally regulated, and no other healthcare provider has city councils and county commissioners tell you what level of certification and which cardiac monitor you’re going to carry and how often you’re going to use it by whom and, and you’ll be able to charge X amount of dollars for it because we know that’s what it costs to provide the service emergency. Departments, clinics, hospitals – in fact nobody else has that oversight and that’s going to be a big thing for our industry to make sure that’s understood in that committee process.

In the last 9 months, I’ve noticed that before COVID-19, not many in our industry cared for the financial pressures on EMS, but suddenly, when money has become tight, everyone is business-minded.

If you look at what’s happening in LA County right now, with the direction to not transport, and at the same time, we heard from Congress and from CMS that they weren’t yet ready to find a way to pay for the care we give. When we don’t transport, we’ve really set ourselves up for quite a challenge for systems to be sustainable, much less to thrive. And my goal is to get them to thrive.

Other priorities include our extenders, the Medicare extended payments. We’re about two years out from those expiring and knowing how Congress works, that means we’re at go time for doing the grassroots work to get those renewed and made permanent. Congress has just been sworn in this last week and they need to pass legislation, making those Medicare ad-ons permanent, and that will help establish a baseline for funding.

Also, the cost data collection by CMS which has been postponed by a couple of years. We need to be able to show the true cost of providing care. And so, even though CMS has delayed it, we as an industry need to be working on, internally, collecting that data and vetting it out and making sure that we have an accurate picture of what it costs for us to do this vital work, It’s really a three-legged stool – you’ve got the balanced billing piece, you’ve got the ad-ons and then you’ve got the cost data collection. And if we fumble with any one of those three legs, it’s going to cause tremendous disruption to the emergency medical services around the country. It’s incumbent on us to really rally behind those three things.

I want to just switch over and talk about advocacy and partnerships. We have enjoyed amazing collaboration and partnerships this year – is that going to continue?

Yes, absolutely. My predecessor, now past president Aaron Reinert, really did a tremendous job of building relationships with the key organizations that represent various constituencies within EMS – the IAFC, NAEMT, NAEMSP and others. I’m certainly committed to building on the foundation that Aaron laid in that regard, because I think there’s an absolute strength when we go to Capitol Hill and have a singular message, such as, finance equals a healthy EMS system, which equals a healthy community.

What can the association do now and what can everybody else do now to advocate for their national, state or local EMS systems?

At home, one thing is let your policymakers know what you’re doing in the community in EMS. This may sound strange as a paramedic saying this, but we’re a little bit quiet sometimes, we may not think so, but we tend to just go in, do the good work and get done and split. We need to make sure though, that policymakers, whether they’re city council members or county commissioners, know what we’re doing with COVID-19 testing, with treating at home, treating in place with either up or down call volume and how that’s affecting us, and at the local level, that’s something that can be accomplished.

That does push forward all the way to D.C. when we do that well, getting media coverage, when people do events around the public health emergency or wall time issues or whatever it is that your local services facing. Reach out to your local media and engage with them, or make use of your state association, the AAA or another association that might represent you to help facilitate it. Getting that media interest in the absence of being able to have advocates on the Hill, knocking on doors and having meetings all day, is the best thing we can do.

You have recently had a discussion with the Biden/Harris transition team – can you tell us what you discussed?

Yes, we discussed priorities for the industry and that finance and sustainability was at the top of the list. We talked about different things that needed to happen – the extenders need to be renewed, we talked a lot about treatment in place and we talked about some of the non-finance issues, which were PPE and supply chain – things still kind of creeping up to be a problem. The conversation took place in the very early days of the vaccine becoming available, so we had the opportunity to reinforce the importance of EMS being at the front of the tier 1a line. We felt like it was a well-received message and that the administration sounded very committed to seeing through and as they start to fill the positions that information would get to the right people.

How are you going to remain visible to members, medics, employees, leaders across the country?

One point of access is via the AAA Board of Directors, which is broken out by geographic region. I will also welcome invitations from state associations to jump on to their Zoom call meetings for a few minutes, so I can hear what they are up to. I recently joined the California Ambulance Association, and spending an hour listening to folks in a state talk about what their most pressing need is gives me a much better sense and feel for gauging the priorities around the country. I’m certainly open to doing that with any of the states or different interest groups that have an EMS voice and would like some AAA participation. Once “normality” returns, I would like to get right back out on the road again, I’ve always enjoyed traveling and seeing EMS operations in different parts of the country. I’m just tremendously excited and anxious for the day when I can just start jumping back on a plane and going to different events around the country and getting to know what’s happening on the ground in different places.

Finally, what is your message to EMS workers right now?

First and foremost, thank you. I’m a paramedic myself, worked in the field and I still go out in the field and do a little bit of work now and then. I have the utmost respect for everybody who is putting themselves out there right now in this very scary time that we’re in. I want them to know that myself and the AAA are fully committed to our mission of caring for people first – we’re the first responders, we’re the first people to administer aid in many cases, to get people to the definitive care they need. Also caring for people first means not just caring for the patient, but it means caring for the workforce, for our employees, for their families and everybody. They need to know how appreciated they are, and this includes not only our EMTs and paramedics in the field, but our dispatchers and office employees and vehicle technicians – it takes every bit of that group to make this work, and I take it to heart how much they put on the line every day.

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Rob Lawrence has been a leader in civilian and military EMS for over a quarter of a century. He is currently the director of strategic implementation for PRO EMS and its educational arm, Prodigy EMS, in Cambridge, Massachusetts, and part-time executive director of the California Ambulance Association.

He previously served as the chief operating officer of the Richmond Ambulance Authority (Virginia), which won both state and national EMS Agency of the Year awards during his 10-year tenure. Additionally, he served as COO for Paramedics Plus in Alameda County, California.

Prior to emigrating to the U.S. in 2008, Rob served as the COO for the East of England Ambulance Service in Suffolk County, England, and as the executive director of operations and service development for the East Anglian Ambulance NHS Trust. Rob is a former Army officer and graduate of the UK’s Royal Military Academy Sandhurst and served worldwide in a 20-year military career encompassing many prehospital and evacuation leadership roles.

Rob is a board member of the Academy of International Mobile Healthcare Integration (AIMHI) as well as chair of the American Ambulance Association’s State Association Forum. He writes and podcasts for EMS1 and is a member of the EMS1 Editorial Advisory Board. Connect with him on Twitter.