Pinnacle 2020 Quick Take: How to lead through the COVID-19 rollercoaster

The EMS Leadership Round Table tackles community messaging, public health funding and caring for the caregivers at the Virtual Pinnacle Leadership Summit

This week, EMS leaders gathered not at the Desert Ridge Resort in Phoenix, but virtually to launch the first Virtual Pinnacle Leadership Summit hosted by Fitch & Associates.

Some familiar faces welcomed attendees for the EMS Leadership Round Table. Presenters included:

  • Jay Fitch, PhD, Pinnacle program chair and founding partner of Fitch & Associates
  • Mike Taigman, MA, quality improvement expert and the improvement guide at FirstWatch
  • Matt Zavadsky, MS-HSA, president of the National Association of EMTs and chief strategic integration officer for Fort Worth’s MedStar Mobile Healthcare
  • Ray Barishansky, MPH, deputy secretary for Health Preparedness and Community Protection at the Pennsylvania Department of Health and the recipient of the 2019 Pinnacle Leadership Award
Amid recent national events, the panel gathered to discuss how preparedness, response, treatment and transport must be reexamined, challenging EMS like never before.
Amid recent national events, the panel gathered to discuss how preparedness, response, treatment and transport must be reexamined, challenging EMS like never before. (Photo/Getty Images)

As recent national events including COVID-19 and civil unrest have changed the EMS environment, the panel gathered to discuss how preparedness, response, treatment and transport must be reexamined, challenging EMS like never before.

Memorable quotes on the future of EMS

Here are some of the key points from the panel on where EMS goes from here:

“It is a transformed world; W. Edwards Deming said it best, ‘it is not necessary to change, survival is not mandatory.’” — Ray Barishansky, MPH

“Be realistic about what your community is able to support so you don’t overpromise and then underdeliver when they go to evaluate these programs.” — Matt Zavadsky, MS-HSA

“This is a marathon of sprints.” — Ray Barishansky, MPH

Left to right: Matt Zavadsky, MS-HSA; Jay Fitch, PhD; Mike Taigman, MA; and Ray Barishansky, MPH. 
Left to right: Matt Zavadsky, MS-HSA; Jay Fitch, PhD; Mike Taigman, MA; and Ray Barishansky, MPH. 

Top takeaways on how EMS can rise to face COVID-19 challenges

Though the EMS experience during the COVID-19 pandemic has been “a tale of two communities” – the hot spots, and then everywhere else – Zavadsky related what NAEMT is hearing points to three main concerns amongst providers:

  1. The PPE supply chain. Zavadsky noted EMS has moved up the priority list from fifth to third in terms of PPE distribution
  2. Workforce issues. The potential for contracting the virus as well as how to sequester providers and care for them and their families
  3. Economic stability. Zavasky noted this is coming across loud and clear, agencies are taking a hit due to the reduction in volume and the increased expenses, and providers are concerned about potential furloughs

Here are three takeaways on how EMS can weather the COVID-19 storm:

1. Engage local media

Fitch began the Leadership Round Table by asking the panelists if COVID-19 is a bump in the road or the end of EMS as we know it. Barishansky opted for a third option – opportunity. Barishansky noted this is a unique opportunity for EMS to engage with public health as they are on the front lines of the pandemic and are on the front pages of national media.

“I view this as one of the ultimate opportunities for modern-day EMS leaders to really grab the bull by the horns to say, we have capabilities and capacities that many people don’t understand at the same time, we can take those capabilities and capacities, our providers and what they do, and we could fold it into or assist with various public health functions, this could include contact tracing, disease investigation, vaccinators, you name it,” Barishansky said. “Let’s not squander it.” 

Part of that opportunity lies in educating the public about EMS. Fitch added, “If we don’t want it to be the beginning of the end; we only want it to be a bump in the road or a bump that we can take flight from, and encourage folks to understand who we are and what we do, we really have to use that local media in a different way.”

He encouraged all attendees to ensure that they are optimizing and maximizing local coverage. “By and large as I look around the country, leaders in some respects may have been so busy dealing with the mechanics that they have not focused on how important it is to tell our story.”

Another important message to communicate to community members is not to fear utilizing the healthcare system during the pandemic. Zavadsky pointed to data from AIMHI revealing an increase in high acuity calls and cardiac arrests, indicative of people being afraid to seek care for risk of COVID-19. MedStar has engaged in community releases and messaging to encourage citizens to call 911 if they are experiencing a medical emergency, with the tagline, “Don’t be scared to death.”

2. Leverage public health relationships

Zavadsky shared how MedStar Mobile Healthcare has been able to build from a foundation of solid relationship with public health and the rest of the healthcare system to begin performing services outside the “normal” scope of EMS, including:

  • Hosting a drive-by testing site at its headquarters, each weekday, at which 10-30 healthcare workers and first responders are directed by the health department. The mobile healthcare team performs the swabs and sends them out to be tested so people can quickly get back to work.
  • Performing in-home testing for probable cases and healthcare workers
  • Testing patients and staff at skilled nursing facility hotspots, and teaching staff how to use PPE and infection control practices
  • Relocating residents from a skilled nursing facility closed down by the state

Zavadsky encouraged attendees, “use this opportunity to build those relationships with the key stakeholders in your community so that you can use this to do things that continually transform the EMS system and the EMS care that you deliver in your local community.”

He also stressed that it’s important to ensure you can deliver what you promise. As resources are being redistributed, confirm your local partners, like urgent care facilities, can still handle your capacity. Payors want to pay for this expanded scope of practice, but be realistic to ensure when they go to evaluate these programs, you’ve proven the value.  

Barishansky also pointed out that public health is seeing more funding than it’s seen in many, many years, through expanded care grants, Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases, or emergency preparedness grants, and preparedness programs, making this the time for EMS to try to obtain some of that funding by being a good partner to public health.

3. Acknowledge the need for reassurance, rest and recharging

Zavadsky explained, like everyone else, MedStar prepared for a potential tsunami of patients by implementing protocols to help preserve healthcare system capacity, developing surge plans and preparing alternate staffing models. They also worked with their office of the medical director to implement infection control procedures and strategies like treat in place, and referring hemodynamically stable COVID suspected patients.

While prepared for increased COVID-19 volumes, they found that low volume is itself a stressor for personnel. MedStar experienced a 20% decrease in response volume and a 30% decrease in transport volume. For a team of folks used to managing 300-400 calls a day, low volumes led to boredom, stress and fear of furloughs, Zavadsky related.  

The leadership team found it was helpful to implement a regular communication plan and launched a twice-weekly conference call to update staff on operations.

One conference participant posed a question about stress relief techniques in this socially distance-limited environment. Taigman asked attendees to think of the last time they felt no stress – in their mother’s womb. He explained neuroscience research has found that recreating that experience with a warm bath, dimming the lights, and putting on some music with a beat rate between 60-80 beats per minute (mimicking your mother’s heart rate), might sound weird, but can be profoundly transformative for the nervous system and is an excellent strategy to relax and reset.

Taigman noted it is essential to consider the health and wellbeing of personnel during this emotional rollercoaster. He encouraged EMS leaders to focus on coaching employees to take time off, to unplug, rest, recharge and nourish their mental health – and to include this as part of strategic planning for the long haul.

Additional resources for facing COVID-19 challenges

Learn more about how EMS leaders can overcome the challenges wrought by COVID-19 with these resources:

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