June 6, 2019 | View as webpage


Benchmarking is a universal tool in healthcare to gauge industry standards and trends, and helps organizations adopt innovative strategies from those achieving success.

In this briefing, Fitch & Associates Partner Roxanne Shanks previews the 2019 EMS Trend Report, and how it compares to previous years’ surveys. Findings include perceptions from every level of EMS professional about industry challenges, retention pitfalls and technology adoption. Results will debut before and be discussed in depth at the Pinnacle leadership conference.

Then, learn about the award-winning success St. Charles County Ambulance District experienced with implementing a medication administration cross check to create barriers between medical errors and patients. Share your organization’s success stories by emailing editor@ems1.com, so we can all learn from each other.


Greg Friese, MS, NRP
Editor-in-Chief, EMS1

P.S. Please forward this leadership brief to at an EMS leader at a neighboring agency and let that leader know to sign up here for the Paramedic Chief Leadership Briefing.

In this issue:

By Roxanne Shanks

Ever wonder how your agency stacks up against others across the country? Or whether EMS clinicians and leaders in other organizations feel the same way you do about the future of the profession?

Most of us have at least a few colleagues who help us keep things in perspective; people we can bounce ideas off of to make sure we're not crazy. Thanks to the Fitch/EMS1 EMS Trend Report and the Pinnacle EMS Leadership Forum, we can now see how our ideas compare to those of thousands of fellow EMS professionals.

This year, nearly 3,000 people completed the survey. While we're still going through the answers to more than 30 questions, here's a sneak peek at what we're finding so far.

Recruitment and retention remain the top concerns of field providers and chiefs. As in the 2018 EMS Trend Report, these two answers blew away the other choices, regardless of what type of agency respondents work for or role they hold in the organization. We also asked whether people planned to leave their current employers and found that nearly a quarter of those in the first five years of their careers had no intention of staying in their jobs for very long.

A divide remains between EMS clinicians in the field and the leaders of their organizations over how they're addressing safety and health issues. In the 2018 EMS Trend Report, field providers were much less confident than their chiefs and directors that their agencies were appropriately addressing patient safety, caregiver mental health and related issues. In 2019, that divide continues.

The role of the medical director is one of the most critical for an EMS agency that hopes to integrate with the healthcare system, provide evidence-based care and move the profession forward clinically. This year's EMS Trend Report survey included responses from more medical directors than ever, giving us new insight into their views of where EMS is headed. Most strikingly, four out of five medical directors who responded said they were hopeful about the future of EMS, a significantly higher percentage than field providers or agency leaders.

The adoption of certain clinical innovations appears to have plateaued, a sign that not all agencies are rushing to use the latest technology or tools if they haven't been proven to make a difference. This year, 4.7% reported using ultrasound in the field, for example, only a slight bump over last year's 4% and the 3.2% who reported using it in the inaugural EMS Trend Report in 2016. Mechanical CPR use held steady at 51%, the same as last year. One trend that has continued is the decrease in the use of induced hypothermia during resuscitation of cardiac arrest patients, from 38% in 2016 to only 15% in 2019.

These are just some of the insights about the profession uncovered in the EMS Trend Report. You can hear more when I join Greg Friese, EMS1 editor-in-chief, for a special session at the Pinnacle EMS Leadership Forum in Orlando, on July 25, "Taking the Nation's Pulse: The 2019 Fitch/EMS1 Trend Report." We will discuss more in depth what we found and what it means for the future of EMS. Join us to learn more about what your colleagues said are the profession's biggest challenges; then enjoy fabulous programming and networking opportunities with EMS leaders who are finding solutions (Learn more about Pinnacle and register here by June 10 to save).

About the author

Roxanne Shanks, MBA, is a partner at Fitch & Associates. She serves as the CEO for LifeFlight Eagle Air Medical Program in Kansas City, Mo., and also as the executive director for the Association of Critical Care Transport in Platte City, Mo. She has an extensive background in healthcare and EMS leadership with more than 26 years of experience in progressively responsible clinical and leadership roles. She can be reached at rshanks@emprize.net.

Engage and support providers with these resources:

Your work and dedication to high-quality CPR training saves lives.

The Resuscitation Suite program from the American Red Cross introduces new BLS, ALS, & PALS courses, giving you a better solution at a better price.

Learn more redcross.org/healthcare

By John Romeo

In April, the Center for Patient Safety awarded St. Charles County Ambulance District the EMS Patient Safety First Award. The Center for Patient Safety cited SCCAD's establishment of a Peer Review Committee, development of a safety plan involving all staff, and the adoption of a Just Culture as a rationale for the selection. The group also lauded the implementation of the medication administration cross check as a measure to reduce dosing errors.

EMS providers are at increased risk for medication error due to the emergency nature of their work environmental conditions and time pressures. Providers work long hours, and fatigue often plays a role. In 2014 in "Prehospital Emergency Care," Lammers et al. published a simulated study on the treatment of pediatric anaphylaxis. Fifty percent of providers gave incorrect doses of epinephrine. The root causes for these medication dosing errors were identified as:

  • Weight estimation errors
  • Incorrect recall of doses
  • Inaccurate references
  • Calculation errors
  • Dose estimation errors
  • Communication errors

The medication administration cross check was first designed and implemented by the Sedgwick County, Kansas, EMS System in 2012. It was developed by Dr. Sabina Braithwaite (medical director for the Sedgwick County EMS System at the time), Captain Paul Misasi and Major Jon Friesen of the Wichita/Sedgwick EMS System.

Cross-checking the 6 rights of medication administration

Most providers are familiar with the six rights of medication administration. The sixth right of safe medication administration – the right documentation – is frequently used as a guidepost, and provides the basis for the medication administration cross check. It is a simple, two-provider verbal procedure, which requires the providers to confirm the planned:

  • Drug name
  • Dosage
  • Administration route
  • Administration rate
  • Rationale for administering

Contraindications (or lack thereof) are considered as a second step by both providers. Next, providers confirm volume or quantity to be administered. Finally, they concur and provide dual positive visual verification for the drug concentration and volume (or amount) to be given before administering it to the patient.

The medication administration cross check contains error traps and provides a barrier between errors and the patient. This method creates a pause point before the medication is given. It takes a minimal amount of time to complete and is easy to do once practiced.

In a 2013 research project performed on the effectiveness in reducing errors of the medication cross check, Sedgwick County's Misasi, Keebler and Braithwaite reported providers who verified the rights of medication administration verbally reported 50% fewer medication errors when administering a drug.

SCCAD rolled out the medication administration cross check with permission from the Sedgwick County Kansas EMS System in 2014 as a preventative measure and to foster a more Just Culture. Leadership recognized the need to implement system measures to help avoid errors. The intent for implementing this procedure is to protect patients from harm and providers from the stress of making errors.

Since implementation in 2014 in the SCCAD system, the medication administration cross check has become a part of policy and is to be used for every patient, every medication, every time. New providers in the system receive initial training and seasoned paramedics receive continuing education on the cross check. The cross check procedure is included as a component each time training is rolled out on any new protocol.

The cross check has undoubtedly prevented medication errors from making it to patients and helped our district progress in our journey to become the safest system possible.

About the author

John Romeo is deputy chief medical officer, St. Charles County Ambulance District.

Take steps to reduce medical dosing errors in your practice:

3. Simple solutions to complex problems. Corrections Superintendent William Cope shares six strategies to overcome obstacles that are hiding in plain sight that apply to all leaders.

2. The big picture perspective on quality improvement projects. Senior management’s role in the team-based clinical quality model includes triage and removing roadblocks.

1. What to read next. In “Life and Death Matters,” NREMT Paramedics Samuel Adams and Christian Adams delve into the importance of character attributes, interpersonal skills and drive in EMS.

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Paramedic Chiefs want to hear about your successes and learn how you are solving the pressing challenges of EMS leadership. Send your Chief Report to gfriese@lexipol.com for consideration in an upcoming edition of the Paramedic Chief Leadership Briefing.

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