By Brian LaCroix
Updated June 2015
My heart was racing and I was scared.
It hadn’t been long since this very same thing had happened while driving home from a grass fire. That first time, I was driving down a rural highway that led to my home when I began to feel lightheaded. At the time, I was a member of the local volunteer fire department. I had just returned from a rare “working” fire, a grass fire that had burned an acre or two in a nearby state park. With the fire knocked down and the hot spots controlled, we returned to the station, cleaned up our equipment and were released by our chief.
I stopped by Ted’s place, my friend and fellow volunteer, where we drank beer and talked smack about what great firefighters and community members we had been that day. After my third beer, I decided it was time to head home.
It was a late weekday afternoon, and in those days that part of northwestern Wisconsin was mostly populated by weekend cabin-goers from the St. Paul-Minneapolis area 100 miles away. In the middle of the week, it would not have been uncommon for an hour or more to go by before someone drove down that portion of Highway 77. Suddenly, at 60 mph, I had an intense sensation of doom and I went unconscious.
The next thing I knew, I woke up lying directly on the center line of the asphalt. I was confused but remember seeing the driver’s door of my pickup truck hanging agape, hearing music from the radio and the vehicle’s engine running. I have no idea why I didn’t crash, or if it had been hours or minutes since I had passed out. I sat up, slowly got my bearings and climbed back into my truck. I drove home and never mentioned the incident to anyone, not even my wife. I had no idea of exactly what had happened.
Now, just weeks later, it was happening again. This time I was in my living room when I had a sudden awareness that my heart had begun to race and I felt lightheaded. Again, mostly I just felt scared.
A close family friend was my savior. Mary, a local EMT-basic, was about to teach me a lesson that would stay with me for years and shape my perspective of what it means to provide really good EMS.
Knowing what I know now, I am absolutely certain that Mary and her basic EMT partners (who would soon become my partners) were probably every bit as scared as I was, if not more. After all, I was a healthy 22-year-old with no adverse history. Yet I had a pulse of greater than 220 and was having syncopal episodes. They likely had no idea what paroxysmal atrial tachycardia (PAT) was, nor how to manage it in an emergent situation. But what they did know was how to connect with me on a very personal human level. They made me feel that I was in good hands, and they told me they would do their very best to try to help. That experience has never left me—even after three decades.
A profound responsibility
Let’s fast-forward this tape.
Today, I lead the team of a large EMS operation in the Midwest. Allina Health EMS serves 1 million people with emergent 911 service and other medical transportation services. We respond to more than 80,000 calls each year; 220 times each day, someone, potentially having a similar experience as I had years ago, calls on my service and asks us to help. I find this to be a profound responsibility.
We work hard to be sure the technical competency of our staff is up to par. In fact, like many EMS operations, that is the primary measure by which we have historically judged our value. However, I know at a visceral level that there is more to being a great EMS service. I have come to embrace the idea that the very best providers are not only technically competent, but they are good critical thinkers and also have superior interpersonal skills. This idea, which I originally heard from RN leader and educator Dorothy Del Bueno, is what we call the “Intersection of Excellence.” It’s something that separates the mediocre providers from the truly exceptional.
I tell my crews that I can prove this concept is true. I ask them to think of someone they have worked with who is really good at clinically technical skills. Maybe that person can put an IV in an eyelash and intubate blindfolded, but they are a jerk. When I pose this question, people often smile knowingly, thinking about someone they’ve come into contact with during their career. That sort of EMT, paramedic or dispatcher has been seen in EMS operations far and wide across our country. In my view, our industry has been far too tolerant of behaviors that have not always put the patient first.
So I ask you, Mr. and Ms. EMS leader: What are you doing to be sure your patients are having the very best experience they can have when they call your service for help? No matter the size of your organization, if you’re not bringing the voice of the patient to your staff in a very real and meaningful way, you are not a patient- centered organization.
Why you need to hard-wire the ‘soft’ stuff
As a leader, you are responsible for incorporating the patient’s perspective into the work you and your staff do. Your values, policies, management practices and, yes, even your budget must be aligned to be sure that you are serving the needs of your patients.
Why does it matter if you are a patient-centered organization? I hope the answer is clear. It is central to the mission of each and every one of us, regardless of the tax status of our operation. It’s what we do: serve patients! Plus, it’s becoming more closely linked to how we are paid. However, when I talk to EMS colleagues, it always amazes me how infrequently we actually talk directly to our patients to ask for their point of view.
I recognize that leaders face dozens of issues and decisions each and every day just to keep our operations afloat. Schedules, supplies, drug shortages and staffing issues can quickly fill a 24-hour day and cause us to feel like we’re stuck in a revolving door. Who has time to reach out to patients? Truth be told, even when we do reflect on our patients’ experience, it can feel like the “soft” stuff compared to the challenging task of making sure there is a crew in the rig, with the right training and the right tools to respond to the next call. It simply isn’t easy … and it often falls off the list.
I believe you need to hard-wire patient-centric thinking into the routine of your service. Until you do so, you run the risk that your patients might take a back seat to the other work of running an EMS operation.
The American poet Maya Angelou summed it up this way: “I’ve learned that people will forget what you said, people will forget what you did, but people will always remember how you made them feel.” Being a patient-centric operation makes good business sense, can improve the care and service you provide, and feeds your soul.
Brian LaCroix is president of Allina Health–Emergency Medical Services in St. Paul, Minn. During his career in EMS, he has worked as an EMT, paramedic, educator, author, peer counselor and manager. He has been involved with state EMS development in both Wisconsin and Minnesota and has worked on extended international projects in both Nicaragua and France. LaCroix currently serves on the boards of the North Central EMS Institute and the National EMS Management Association.
