Recently, a story broke out of Charlotte, North Carolina, about an emerging protocol that would allow Charlotte firefighters to leave the scene of a medical call if the patient is safe and a Mecklenburg EMS Agency (MEDIC) ambulance is on the way.

This story ignited a fiery response on every EMS-related social media platform with comments ranging from concerns about patient abandonment, to the sentiment of, if patients are OK to be left alone, they are OK to take a taxi!

The details in the news coverage were not crystal clear, so in order to understand exactly what is being proposed, I spoke to the Deputy Director of MEDIC, Jon Studnek, who has been working with MEDIC’s Medical Director, Doug Swanson, MD, on this protocol change proposal. Studnek, a former EMS research fellow with NREMT and later, director of prehospital research at Carolinas Medical Center, is eminently qualified to both comment and conduct the proposed project.

Third-party callers

Studnek related, “we think about the fact that an ALS ambulance is a scarce resource and what is the best way to utilize their response, and in a system like ours where we have first responder, non-transport BLS response with ALS coming next, are all aspects of that system being as efficient with their time as they could be?”

MEDIC’s plan is to conduct an approved, controlled trial where the responding fire crew can identify after a BLS assessment if a patient is of a low-acuity level where they can be left to wait for an ALS crew to arrive, conduct further assessment and determine if transport is necessary.

This enables the fire crew to stand down and prepare for the next response, while also ensuring that responding ambulance crews aren’t racing across town under emergency conditions unnecessarily – a serious issue affecting the safety of our crews, other road users and pedestrians alike.

MEDIC responded to 155,081 calls for service in FY2019 and conducted 117,321 transports. Studnek estimates that only 16% of MEDIC’s responses are life threatening/potentially life threatening. Fire first response is not tasked to lower acuity calls as determined by MPDS but for those calls that begin with a higher priority, that are subsequently downgradable through on scene BLS assessment, the crew can return to duty.

A classic example of this is the “third-party caller,” where the call taker cannot speak to the patient directly as the call is routed through another agency, such as a police department. Those dealing with medical dispatch will know that a third party is assumed to be life-threatening until proven otherwise. These types of call could include anything from a welfare check to a fight in progress, and while the patient condition may not be critical, the lights, sirens and number of assets responding is. Once an on-scene assessment has occurred, crews can stand the responding ambulance down and take a patient refusal or leave the patient in place, return to duty and allow the ambulance to arrive under normal driving conditions.

The project, as described, is only at the proposal stage. It has been vetted by the North Carolina Office of EMS and the State Medical Director to ensure that no regulatory problems could occur. The project hypothesis has also been discussed at the Charlotte quarterly Medical Control Board (MCB) meeting. The MCB consists of eight voting clinicians from the local Novant Health and Atrium Health systems. The clinicians have wide-ranging areas of clinical expertise and are the ultimate approver of any clinical changes to medical protocols proposed by Dr. Swanson.

The MEDIC team is now at the data gathering and clinical pilot-writing stage and will present again on February 18, 2020, to MCB to gain approval to proceed with the control trial. It is their intention to produce outline results in time for the May 19, 2020, MCB meeting. I for one, will be watching with great interest.

Peer-reviewed research in the ET3 era

It is no secret that our current EMS system is unable to keep up with growing call volumes. Creating a safe and well-managed protocol to address low-acuity patient calls is essential. The proposed MEDIC protocol takes an academic approach with the MCB acting in the capacity of an Institutional Review Board (IRB), providing governance, safeguarding and direction.

We are all proponents of conducting small tests of change by planning, doing, studying and acting to achieve positive outcomes, and this process and this program will be an excellent example of this. The resulting proposal, test and, ultimately, results will be interesting to read and provide material for much needed EMS peer-reviewed research. As we enter the ET3 era on the road to 2050, this cohort of low-acuity patients could also be an easy referral for treatment in place or transport to an alternative destination.

In this case, the news got ahead of the actual study, and, thanks to the power of the internet, spread quickly without the benefit of the proposal back story. So rather than dismissing this a risky ploy that will endanger patients, we must pay close attention to the eventual results and outcomes – we may all learn something.

Banners hung from your station, first aid stations at community events and local chili cook-offs have all but lost their flair in today’s recruiting market. Today’s tech-savvy, information-driven, and mission-focused generation of new EMTs and paramedics want more. 

As a result, we need to change our traditional hiring habits and look outside of the box a bit. By all means, some of our traditional practices still work, but whether or not they’re sustainable much longer remains the question. 

Here are seven paradigm-shifting practices for you to consider while revamping your recruitment process. 

1. Start in high school 

Many fire and EMS agencies do, in fact, start recruiting future EMTs in high school. Incorporating explorer programs into your organization can help to build career interest, while introducing hands-on components into an extracurricular program for students that are looking to explore different career opportunities. Taking it one step further, work with your high school and community/technical college to offer an EMT course as a class option for a semester. This is a great way to start prospective EMS professionals early (and hopefully keep them engaged). 

2. Follow students to college 

Whether EMS is the desired end goal or not, it may be a stepping-stone in a recruit’s overall career development path that can gain them valuable insight – and can potentially benefit your organization in the process.  

As students enter college, they may be restricted to dorm life, or have limited off-campus interaction – especially if they’ve moved away from home to gain their schooling. Could you offer them a housing or common-space opportunity? In exchange for covering on-call or scheduled shifts, you might purchase a local residence, offer rent subsidies or supply students with in-station housing for an extended period of time. Combined with a stipend for their attendance, you may find some focused students that are looking to build a resume while they’re finishing their degree program at the same time. You may even find your next full-time hire in the process. 

3. Promote growth opportunities 

Aside from some of the low hanging fruit of recruiting students, you may find achieve of an impact by exploiting your agency’s relationships a bit. When you’re recruiting individuals who may have other jobs outside of EMS, sharing how being involved in your agency can help their overall career goals can go a long way in terms of expanding their opportunities.  

In exchange for working for your organization, introduce a mechanic-turned-EMT to local ambulance manufacturers and set up a direct line of networking communications. Or, involve your accountant-turned-EMT, in some of your agency’s financial practices and make introductions to your billing company. You may just spark an interest to become credentialed as a certified ambulance coder. How about connecting the medical students that volunteer for your agency with your medical director and involving them in some statewide discussions toward medical oversight. You could be meeting your agency’s future medical director in the process. 

4. Focus on your mission 

Providing a paycheck is certainly one aspect of compensating staff, but so is fulfilling them. Yes, our mission is to help people in a time of their need, but hopefully, your agency’s mission extends beyond “just” that.  

Newer generations of EMS providers want to do something that provides them with a sense of accomplishment, validation and completeness. They want to believe in their organization’s mission, not just work for a company that has one posted on the wall. If your agency isn’t in a position to offer much in terms of financial compensation, then you need to make up for it in both opportunities and mission. 

5. Offer fringe benefits 

Student loans and debt are a real thing, so why not offer to help? Offer your employees a tuition reimbursement plan, or a loan payoff plan. On an even more local or individual scale, work with each employee to determine what their wants or needs are, and then develop a plan to help fulfill them. If your employee’s goal is to take a vacation within the next year, then formulate a plan together to save vacation hours, set aside employer-matched money, and coordinate with a local travel agent. If another provider has a goal of paying off a mortgage within the next 10 years, then match a savings plan to help.  

Not everyone is in need of money for tuition assistance. Some of your employees already have paid-off degrees. But, that doesn’t mean they couldn’t use a little extra cash for some of their other ambitions. 

6. Inform them, often 

Starting right from the beginning, having an updated and active website, social media presence or even an internal communications tool can keep your employees in the loop. When communications break down, rumors begin to run rampant, conspiracy theories evolve and employees become disengaged (especially younger generations). Drama, rumors, internal politics, playing favorites and miscommunications break down organizations ... and employees leave. Being proactive and having measures – functions – in place to combat this not only promotes retention, but recruitment as well. 

7. Incentivize recruitment 

Some of our industry’s best headhunters are our own employees. When one employee recommends hiring another individual, there’s a lot at stake. If employees are willing to put their reputations on the line to hire another individual, they should be rewarded for their actions. Yes, online postings can go a long way, but so can word of mouth and personal interactions. By no means does this mean that you need to hire a employee’s entire family. Instead, soliciting feedback about an employee’s interactions with various students in a class that they help to teach can serve as somewhat of a pre-interview phase.