Virginia Emergency Medical Services:
   Rural Health and Policy Agenda

Rural Health Summit
Danville, VA
March 17, 2010
Office of Emergency Medical Services
   Mission: To reduce death and disability resulting
    from sudden or serious inju...
Office of Emergency Medical Services
   Office overall budget - $36.6 Million
    – 1.1% Federal $0.4 Million
    – 94.8%...
Virginia Strategic EMS Plan

Core Strategies

1.   Develop Partnerships
2.   Create Tools and Resources
3.   Develop Infra...
Virginia EMS Strategic Plan (2007 – 2010)
  Vision & Mission                    Core Strategies       Key Strategic Initia...
Virginia Strategic EMS Plan
(2010 – 2013)
Key Objectives
1.   Promote collaborative activities between local
     governme...
Virginia Strategic EMS Plan
(2010 – 2013)
Key Objectives
5.   Develop, implement, and promote a comprehensive
     recruit...
State Rural Health Plan
(SRHP) and EMS
   OEMS participated in Rural Health Strategic
    Planning Summit held in Staunto...
State Rural Health Plan
(SRHP) and EMS
   Emergency medical services (EMS) is
    the umbrella term for a continuum of
  ...
EMS related recommendations
in State Rural Health Plan
(SRHP)
   Hold rural EMS Summit to address rural EMS issues,
    i...
Projected
Impacts/Outcomes
   Results of Rural EMS Summit will lead to
    development of a white paper detailing
    par...
Rural EMS Roundtable and
      Summit
   Identified key rural/frontier issues in Virginia
    at Rural EMS Roundtable hel...
Major Themes
Virginia Rural EMS Roundtable
Priority Issues (03/11/2009)

   EMS Agency Leadership and
    Management
   Local Governm...
Virginia Rural EMS Roundtable
Priority Issues (cont.)

   Quality of EMS Education and Training
   Evidence and outcome ...
Review of EMS in VA by JLARC
(2004)

EMS Agency Survey (278/712
 respondents)

     85% of volunteer EMS agencies and 58%...
Review of EMS in VA (2004)

EMS Personnel Questionnaire (892
 respondents)

     40% of EMS personnel indicated they had
...
Review of EMS in VA by JLARC (2004)

Recommendations
   Amend Code to require local governments
    to ensure EMS provisi...
Distribution of Certified EMS
Personnel
                Affiliation of Certified Personnel by EMS Agency Type




        ...
EMS Personnel Years of
                         Service/Certification
                 4000

                 3500

      ...
Where do we want to be?

   Adequate supply (to meet the
    predicted demand) of volunteer and
    career EMS personnel ...
How do we get there?
   Develop strategies, identify solutions and partners
    to enhance and improve the recruitment an...
Keeping The Best! EMS
Workforce Retention Tool
Kit

   Four workbooks targeted
    at volunteer and career
    EMS agenci...
EMS Retention Principles
         The Life Cycle Model

               0             1            2               3       ...
EMS Retention Principles

   The Belonging Principle - EMS personnel stay
    longer when they feel welcome, needed and
 ...
Survival Guide To
EMS Retention Problems
 “Quick read” guide features 13
 common EMS retention
 problems and solutions.
 S...
Maximizing Your Retention
    Efforts
Designed for the larger and more
complex EMS agencies facing
retention problems driv...
How to Retain ALS Providers
   Most analytical of the
    workbooks
   Employs quantitative and
    qualitative analysis...
Workforce Utilization Model


Define the Current                  Define the Desired
 ALS Workforce                       ...
Recruitment & Retention
(R&R) Initiative -Financial
Assistance to EMS Agencies

 – A total of $432,888 has been awarded to...
R&R Initiatives

EMS Workforce Development Committee
 One of 16 standing committees of the state
  EMS Advisory Board
 F...
R&R Initiative - Technical
Assistance
  Virginia Recruitment and Retention
                 Network
VA EMS R&R Network
R&R Initiatives
EMS Agency Management Series
 EMS Strategic Planning

 Discipline and Due Process for the EMS
  Agency
...
R&R Initiatives
Focused EMS Management Training in Rural Areas
 Cooperative effort with the Office of Minority Health
  a...
R&R Initiatives (other)

   Creating a diverse workforce in Fire and EMS –
    completed in cooperation with the VA Fire ...
R&R Initiatives (other)

   On-line EMS Recruitment Directory
   Provide grading assistance to the Financial
    Assista...
Rural EMS Systems:
An Evaluation
CAH Facilities
   Bath Community Hospital – Hot Springs
   Dickenson Community Hospital – Clintwood
   Giles Memorial H...
CAH Hospitals in Virginia
Scope of Evaluation
1. Examination of Network Agreements for CAH Certification
2. Study Survey
   2a. Questions for EMS Pe...
Site Visits

   Site visits were made to CAH
facilities and EMS agencies during the
evaluations, to get a feel for the
env...
Where can I find copies of the
report recommendations?
    http://www.vdh.virginia.gov/oems/

   Click on “Localities and ...
Resources and New
Information Outlets
   Virginia Office of EMS
    (www.vdh.virginia.gov/oems)
   Online Recruitment Di...
Resources and New
Information Outlets
   Rural EMS Blog
    (http://ruralvaems.wordpress.com)
   MySpace (www.myspace.co...
Office of Emergency Medical
Services

   Goals reached in 2009:


    – Training & Certification of over 35,000 EMS
     ...
Office of Emergency Medical
Services

   Goals reached in 2009 (cont.):

    – Implementation of the EMS Registry, a majo...
Office of Emergency Medical
Services

   2-3 major challenges:

    – Demand for EMS providers will continue to grow
    ...
Office of Emergency Medical
Services

   2-3 major challenges (cont.):

    – Health care delivery issues such as declini...
Questions?

     Scott Winston, Assistant Director
         VA Department of Health
   Office of Emergency Medical Service...
Winston
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  1. 1. Virginia Emergency Medical Services: Rural Health and Policy Agenda Rural Health Summit Danville, VA March 17, 2010
  2. 2. Office of Emergency Medical Services  Mission: To reduce death and disability resulting from sudden or serious injury and illness in the Commonwealth through planning and development of a comprehensive, coordinated statewide emergency medical services (EMS) system; and provision of other technical assistance and support to enable the EMS community to provide the highest quality emergency medical care possible to those in need.  Gary R. Brown, Director  P. Scott Winston, Assistant Director  47 FTEs
  3. 3. Office of Emergency Medical Services  Office overall budget - $36.6 Million – 1.1% Federal $0.4 Million – 94.8% Special $34.7 Million  Trauma Fund $9.7 Million (Special Dedicated)  RSAF $8.0 Million (Special Dedicated)  Return to Localities $6.5 Million  VAVRS $502,852  EMS System Development $7.5 Million  State Office of EMS $2.5 Million – 4.1% General Fund $1.5 Million (Poison Control Centers)
  4. 4. Virginia Strategic EMS Plan Core Strategies 1. Develop Partnerships 2. Create Tools and Resources 3. Develop Infrastructure 4. Assure Quality and Evaluation
  5. 5. Virginia EMS Strategic Plan (2007 – 2010) Vision & Mission Core Strategies Key Strategic Initiatives To establish a unified 1.1 Promote collaborative approaches comprehensive and effective 1.2 Attract and support outstanding health 1. Develop care providers EMS system for the Partnerships 1.3 Further community based prevention Commonwealth of Virginia 1.4 Coordinate responses to emergencies both that provides for the health natural and man-made and safety of its citizens and 1.5 Elevate EMS care for special needs patients visitors. 2.1 Facilitate EMS related research and education 2.2 Supply quality education and certification of 2. Create Tools and EMS personnel To reduce death and dis- Resources 2.3 Endorse risk and liability protection for ability resulting from EMS physicians and providers sudden or serious 2.4 Foster appropriate use of EMS resources injury and illness in the Commonwealth through 3.1 Adequately staff OEMS & Regional EMS Councils planning and development of 3.2 Focus recruitment and retention efforts a comprehensive, 3. Develop 3.3 Upgrade technology and communication systems coordinated statewide Infrastructure 3.4 EMS funding EMS system; and pro- 3.5 Enhance regional and local EMS efficiencies vision of other technical assistance and support 4.1 Access compliance with EMS performance to enable the EMS com- 4. Assure Quality and standards munity to provide the Evaluation 4.2 Assess and enhance quality of education for EMS providers highest quality emergency 4.3 Pursue new initiatives that support EMS medical care possible to those in need.
  6. 6. Virginia Strategic EMS Plan (2010 – 2013) Key Objectives 1. Promote collaborative activities between local government, EMS agencies, hospitals, and community colleges to support more community based EMS programs which lead to increased recruitment and retention of certified EMS providers. 2. Evaluate the impact of an aging workforce on the EMS system. 3. Develop, implement and promote leadership and management standards for EMS agency leaders 4. Align all initial EMS education programs to that of other allied health professions to promote professionalization of EMS
  7. 7. Virginia Strategic EMS Plan (2010 – 2013) Key Objectives 5. Develop, implement, and promote a comprehensive recruitment and retention campaign for EMS personnel and physicians, supporting the needs of the EMS system. 6. Support and expand Virginia Recruitment and Retention Network 7. Develop guidance documents to assist EMS agencies going through audit processes and accountability for the use of grant funds. 8. Meet with, and educate local government officials and the public about assuming a greater responsibility in the planning, development, implementation, and evaluation of its emergency medical services system.
  8. 8. State Rural Health Plan (SRHP) and EMS  OEMS participated in Rural Health Strategic Planning Summit held in Staunton, VA in July 2007.  Recommendations for updated SRHP released in 2008 were developed by four workgroup: access, quality, workforce and data/rural definitions.  OEMS staff participated on Workforce and Data/Rural Definitions workgroups.  EMS is a sub-committee of Access Council (access to quality, affordable and accessible health care services)
  9. 9. State Rural Health Plan (SRHP) and EMS  Emergency medical services (EMS) is the umbrella term for a continuum of health services including pre-hospital medical services, emergency services provided at the hospital or health center, and the trauma system.
  10. 10. EMS related recommendations in State Rural Health Plan (SRHP)  Hold rural EMS Summit to address rural EMS issues, including – Availability of EMS and who is responsible – EMS leadership and management (Budget Model Workshop, Rural EMS Managers Awareness Program, etc.) – EMS integration into rural health care infrastructure.  Begin discussions on how to identify areas where EMS is a major issue/trouble spot  Present and disseminate findings from 2007/2008 CAH EMS assessments.
  11. 11. Projected Impacts/Outcomes  Results of Rural EMS Summit will lead to development of a white paper detailing parameters of rural EMS in VA.  Results of Rural EMS Summit will lead to development of EMS legislative package for VA General Assembly.  Recommendations from CAH EMS assessments will assist in strengthening existing EMS structures.
  12. 12. Rural EMS Roundtable and Summit  Identified key rural/frontier issues in Virginia at Rural EMS Roundtable held in March 2009  Prioritized issues at Rural EMS Roundtable  Identified strategies (problem, solution, outcome measure) and partnerships for the next steps at Rural EMS Summit in December 2009.
  13. 13. Major Themes
  14. 14. Virginia Rural EMS Roundtable Priority Issues (03/11/2009)  EMS Agency Leadership and Management  Local Government Involvement/Accountability  Recruitment and Retention  EMS Resource Management  EMS Dispatch
  15. 15. Virginia Rural EMS Roundtable Priority Issues (cont.)  Quality of EMS Education and Training  Evidence and outcome based patient care  Initial EMS Education  Fee for Service/Revenue Recovery  EMS Continuing Education  Expanded Scope of Practice
  16. 16. Review of EMS in VA by JLARC (2004) EMS Agency Survey (278/712 respondents)  85% of volunteer EMS agencies and 58% of career EMS agencies reported R&R as one of top three issues.  EMS agency leaders reported top reasons EMS personnel left were: – Personal – Not enough time to volunteer
  17. 17. Review of EMS in VA (2004) EMS Personnel Questionnaire (892 respondents)  40% of EMS personnel indicated they had considered leaving their agency within the last year  Top two reasons for leaving – Poor leadership and management – Low pay
  18. 18. Review of EMS in VA by JLARC (2004) Recommendations  Amend Code to require local governments to ensure EMS provision  Allocate state grant funding for R&R initiatives  Require leadership & mgmt. training  Improve access to ALS training  Better publicize volunteer length of service award program (VOLSAP)
  19. 19. Distribution of Certified EMS Personnel Affiliation of Certified Personnel by EMS Agency Type Non Affliated Federal 26% 2% Volunteer Commercial 33% 4% Non Profit 1% Industrial 2% Government 32%
  20. 20. EMS Personnel Years of Service/Certification 4000 3500 3000 # of Providers 2500 2000 1500 1000 500 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 Years
  21. 21. Where do we want to be?  Adequate supply (to meet the predicted demand) of volunteer and career EMS personnel that is well educated and trained, competent and prepared who are valued and respected  Empower our sales force of influential EMS leaders to show the importance of the “soft skills”
  22. 22. How do we get there?  Develop strategies, identify solutions and partners to enhance and improve the recruitment and retention of volunteer and career EMS personnel in Virginia.  Provide technical assistance and develop resources, materials, guides, educational programs and tools designed to be used by EMS leaders as part of the day-to-day operation of their agency.  Create a “buzz” about the EMS workforce recruitment and retention  Create a cultural shift by getting more EMS agencies to buy into the retention principles and other concepts
  23. 23. Keeping The Best! EMS Workforce Retention Tool Kit  Four workbooks targeted at volunteer and career EMS agencies. EMS leaders use these as self- help guides to evaluate and strengthen their retention efforts.
  24. 24. EMS Retention Principles The Life Cycle Model 0 1 2 3 4 5 Average =Life Cycle Time Line in Years Community Invest/ Active Lead/ Resource Train Involvement Mastery Common Retention Barriers The Life Cycle Principle – EMS personnel stay longer when leaders take specific actions at specific times in the retention life cycle.
  25. 25. EMS Retention Principles  The Belonging Principle - EMS personnel stay longer when they feel welcome, needed and respected.  The Success Principle – EMS personnel stay longer when they achieve success in important personal goals.  The Friends and Family Principle - EMS personnel stay longer when they develop strong personal relationships within their agency.
  26. 26. Survival Guide To EMS Retention Problems “Quick read” guide features 13 common EMS retention problems and solutions. Some of the problems and solutions include:  Slackers and the Generation Gap  Your Attitude Stinks  Inter-squad War Games  How to Burn Out Good People  Are Your Leaders Ready to Lead?
  27. 27. Maximizing Your Retention Efforts Designed for the larger and more complex EMS agencies facing retention problems driven by growth and change. Chapters include:  The Crisis of Change  Making the Marriage Work- Volunteer & Career  The Recruiting Process  The Retention Process  Moving from Good Intentions to Results
  28. 28. How to Retain ALS Providers  Most analytical of the workbooks  Employs quantitative and qualitative analysis of current workforce.  Guided visioning helps the EMS leader define and quantify the desired ALS workforce in the next 2- 5 years.
  29. 29. Workforce Utilization Model Define the Current Define the Desired ALS Workforce Future ALS Workforce Fill the Gap Monitor and Re-evaluate
  30. 30. Recruitment & Retention (R&R) Initiative -Financial Assistance to EMS Agencies – A total of $432,888 has been awarded to non-profit EMS agencies between December 2004 and June 2007 for Recruitment and Retention related grants. – Projects include Leadership & Management training, advertising, recruitment materials, displays and building signs.
  31. 31. R&R Initiatives EMS Workforce Development Committee  One of 16 standing committees of the state EMS Advisory Board  Formed to work through EMS recruitment, retention, leadership and management issues.  Two subcommittees – Standards of Excellence – EMS Leadership and Management Standards (I – IV)
  32. 32. R&R Initiative - Technical Assistance Virginia Recruitment and Retention Network
  33. 33. VA EMS R&R Network
  34. 34. R&R Initiatives EMS Agency Management Series  EMS Strategic Planning  Discipline and Due Process for the EMS Agency  Funding your Future, Establishing Fee-for- Service Programs in Non-Profit EMS Agencies (EMS Revenue Recovery through Billing for Services: An Introductory Kit )
  35. 35. R&R Initiatives Focused EMS Management Training in Rural Areas  Cooperative effort with the Office of Minority Health and Public Health Policy  Budget and Financial Management Training, on-line EMS Medical Director training and on-line management for new EMS supervisors.  Priority shall be given to EMS agencies serving Critical Access Hospitals and participants in the Virginia Small Rural Hospital Improvement Program.
  36. 36. R&R Initiatives (other)  Creating a diverse workforce in Fire and EMS – completed in cooperation with the VA Fire Chiefs Association and the VA Dept of Fire Programs.  Serve as a clearinghouse and information center for rural EMS agencies starting recruitment, retention, management and leadership projects and programs.  Dual enrollment High School based EMT training program  Rural EMS Blog, MySpace, Facebook, Twitter, YouTube, ListServes, etc.
  37. 37. R&R Initiatives (other)  On-line EMS Recruitment Directory  Provide grading assistance to the Financial Assistance Review Committee for recruitment, retention, management and leadership related grant applications.  State Rural Health Plan  Annual state EMS Symposium – Leadership and Management certificate, $5K Scholarship for HS Senior and Job Fair
  38. 38. Rural EMS Systems: An Evaluation
  39. 39. CAH Facilities  Bath Community Hospital – Hot Springs  Dickenson Community Hospital – Clintwood  Giles Memorial Hospital – Pearisburg  Page Memorial Hospital – Luray  RJ Reynolds Patrick County Memorial Hospital – Stuart  Shenandoah Memorial Hospital – Woodstock  Stonewall Jackson Hospital - Lexington
  40. 40. CAH Hospitals in Virginia
  41. 41. Scope of Evaluation 1. Examination of Network Agreements for CAH Certification 2. Study Survey 2a. Questions for EMS Personnel for assessing EMS capabilities in agencies in areas served by the CAH. 2b. Develop questions for CAH personnel for the purpose of assessing the overall function of the local EMS system 3. Study Components 3a. Demographics of the CAH area 3b. Staffing of the local EMS System 3c. Placement of units on basis of call volume and population density 3d. Training Initiatives 3e. Communications 3f. Resource Management 3g. Fiscal Support 3h. Medical Direction 3i. Quality Assurance 3j. Mass Casualty Preparedness 3k. System Partnerships 3l. Hospital Capabilities 4. Recommendations
  42. 42. Site Visits Site visits were made to CAH facilities and EMS agencies during the evaluations, to get a feel for the environment, and the “on the street” perspective. It was important to see what rural EMS agencies and the CAH faces first hand.
  43. 43. Where can I find copies of the report recommendations? http://www.vdh.virginia.gov/oems/ Click on “Localities and EMS Officials” and look under “Rural EMS” Giles, Patrick, Rockbridge, Dickenson, Page, and Shenandoah reports now online
  44. 44. Resources and New Information Outlets  Virginia Office of EMS (www.vdh.virginia.gov/oems)  Online Recruitment Directory (www.vaemsjobs.com)  EMS Leadership Challenge (www.vavrs.com)  OEMS/VDFP bookstore (www.vafire.com/bookstore)
  45. 45. Resources and New Information Outlets  Rural EMS Blog (http://ruralvaems.wordpress.com)  MySpace (www.myspace.com/virginiaems)  Twitter (http://twitter.com/virginiaems)  Facebook (http://www.facebook.com/profile.php?id=1 332796920&ref=ts)
  46. 46. Office of Emergency Medical Services  Goals reached in 2009: – Training & Certification of over 35,000 EMS providers, licensing of 700 EMS agencies, permitting of 4,132 EMS vehicles, 22 Paramedic and 15 Intermediate Accredited Training Program Sites conducted by 14 of 23 Community Colleges in VA, and over 600 certified EMS Instructors eligible to apply for contracts to teach courses that meet the national educational standards and national scope of practice.
  47. 47. Office of Emergency Medical Services  Goals reached in 2009 (cont.): – Implementation of the EMS Registry, a major IT project under VITA, that replaces an outdated data collection system with web-based, electronic medical record technology that conforms to the new national EMS dataset which will allow collaboration on the local, state, and national level. – 100% of funding distributed per the Code of Virginia to support the Commonwealth’s EMS System through EMS training contracts, Regional EMS Councils, Grants to Rescue Squads, Funding to local governments for EMS support, etc.
  48. 48. Office of Emergency Medical Services  2-3 major challenges: – Demand for EMS providers will continue to grow to meet the estimated 12% population growth through 2010 and the increasing EMS call volumes while the pool of volunteers is decreasing due to competing demands placed on them by family and employers. – As the public’s expectations for EMS services increases, local governments and EMS agencies will seek the assistance of OEMS to increase the level of patient care while finding ways to maximize the impact of public funds.
  49. 49. Office of Emergency Medical Services  2-3 major challenges (cont.): – Health care delivery issues such as declining on- call availability of physician specialists, diversion, hospital overcrowding, difficulty of access to primary care, uninsured patients and increasing EMS call volume will require the state Office of EMS to play a significantly larger role in community health delivery and coordination of services.
  50. 50. Questions? Scott Winston, Assistant Director VA Department of Health Office of Emergency Medical Services scott.winston@vdh.virginia.gov 804-864-7606 www.vdh.virginia.gov/oems

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