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Questions for EMS chiefs about safety, careers and active-shooter incidents

The best change in EMS comes from agencies that identify problems, test solutions, and diffuse their best practices

EMS leaders regularly gather to discuss challenges, share solutions and exchange best practices. Part of my preparation for events like Pinnacle EMS Leadership Forum, EMS World Expo, and EMS Today includes thinking of questions to pose to EMS leaders. At past conferences I have sought out chiefs and managers to ask about the development of community paramedicine programs, how to improve cardiac arrest survival, innovations in ambulance design, and adoption of online training.

Though some change in EMS is driven by regulatory changes or evolving recertification standards, much of the change comes from individual agencies identifying a problem, prototyping and testing solutions, implementing the best results, and then diffusing their innovations. These are some of the current challenges facing EMS that I want to ask chiefs to find out which solutions are working (or not working) and how they are spreading their best practices to other departments.

Question 1: In-vehicle safety
“Chief, What is the rate of seatbelt use in your ambulances? How do you monitor seatbelt use in the driver and patient care compartments?”

When I read a news report about an ambulance collision with injuries, I look for specific details about:

  • Seatbelt use in the driver compartment and patient care compartment
  • Driver distraction in the ambulance, as well as any other involved vehicles
  • Driver fatigue and clues about shift length

Most EMS providers are knowledgeable of the importance of seatbelt use, but I am increasingly suspicious that compliance with the actual behavior is low. Clips of the New Orleans cast of Nightwatch and Boston EMS showed medics not wearing seatbelts.

Other ambulance safety questions that warrant discussion include:

  • What changes are you making to shift length and staffing to minimize risks from fatigue-related collisions?
  • What are you doing to protect the driver from distractions caused by electronics, passengers, and patients?
  • What are the best practices for maintaining and replacing ambulances?

Question 2: Career growth and training
“Chief, what are the career opportunities for paramedics and non-clinical pathways for growth in your system?”

For much of the short history of EMS, there have only been two career pathways. The first path is EMT or paramedic to entry-level supervisor (FTO, field supervisor) to middle-management to chief. The other pathway has been EMT or paramedic to a new career, possibly, but not often in health care.

Community paramedic is the most obvious new career pathway, especially for medics to further their clinical skills, but more pathways are necessary. EMS has a need for paramedics to become experts in data analysis and interpretation, computer and information science, digital storytelling and marketing and finance.

Question 3: Active-shooter incident response
“Chief, what actions has your department taken to train and practice active-shooter incident response with your law enforcement partners?”

Active-shooter response, like improving cardiac arrest survival, requires a mindset shift from past practices. An important first step is identifying situations for a tactical medic versus situations where a rescue task force is indicated. More and more communities are creating protocols for and equipping EMS to respond with police support as a rescue task force, which rapidly responds to patients in the warm zone of an active-shooter incident.

An important, and possibly overlooked component of active-shooter incident preparedness, is EMS representatives taking the lead on communicating with the media. In the minutes and hours after the La. theater shooting numerous representatives from Acadian Ambulance did live stand-ups with national television.

The next day, less than 24 hours after the incident, the CEO and chairman of Acadian recorded a video which gave an unprecedented level of detail about the EMS response to an active-shooter incident. The detailed, personal, and authentic video was posted and widely shared on social media. The mix of compassion, empathy, and factual information is a great model for other EMS leaders to follow.

Every agency, as it plans for major incidents, needs to be thinking about how it can leverage internal assets for media production, like the Acadian video, and then use social channels, like a department Facebook page, to widely distribute the information to employees, stakeholders, policy makers, civilians and the media.

What are your top questions for the leaders of the EMS profession?

Greg Friese, MS, NRP, is the Lexipol Editorial Director, leading the efforts of the editorial team on Police1, FireRescue1, Corrections1 and EMS1. Greg served as the EMS1 editor-in-chief for five years. He has a bachelor’s degree from the University of Wisconsin-Madison and a master’s degree from the University of Idaho. He is an educator, author, national registry paramedic since 2005, and a long-distance runner. Greg was a 2010 recipient of the EMS 10 Award for innovation. He is also a three-time Jesse H. Neal award winner, the most prestigious award in specialized journalism, and the 2018 and 2020 Eddie Award winner for best Column/Blog. Connect with Greg on LinkedIn.