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Jems201210 dl

  1. 1. OCTOber 2012 Always En Route At
  2. 2. Choose 11 at www.jems.com/rs
  3. 3. Choose 12 at www.jems.com/rs
  4. 4. Choose 13 at www.jems.com/rs
  5. 5. The Conscience of EMS JOURNAL OF EMERGENCY MEDICAL SERVICES ® 30 I JEMS 2012 Salary & Workplace Survey I The future looks bright—but how bright? By Michael Greene, MBA/MSHA OctoBER 2012 Vol. 37 No. 10 Contents I 46 42 I Healthcare Reform I Changes present an unparalleled opportunity for EMS By Teresa McCallion, EMT-B 46 I Mobile Warming I Lessons learned in hypothermia prevention under difficult field conditions By 2LT Collin Hu, EMT-E, James Spotila, PhD, EMT-B 52 I A Study on Safety I Highlights from workshop on ambulance patient compartments By Jennifer Marshall Y. Tina Lee 60 I Innovative Design I Departments columns 7 I Load go I Now on JEMS.com 12 I EMS in Action I Scene of the Month 14 I From the Editor I Patches, Pride Patients Pumper/ambulance model takes service to a new level By Bob Vaccaro 64 I Vital Pathways I Detect treat symptoms related to hemorrhagic shock By Peter Taillac, MD, FACEP, Chad Brocato, DHSC, CFO, JD y A.J. Heightman, MPA, EMT-P B 16 I Letters I In Your Words 18 I Priority Traffic I News You Can Use 24 I lEADERSHIP sECTOR I Closed Door Policy y Gary Ludwig, MS, EMT-P B 26 I Tricks OF the TRADE I Warm Enough for Ya? y Thom Dick B 28 I case of the month I Naked Unconscious y Kimberly Doran B 74 77 78 80 I employment Classified Ads I Ad Index I Hands On I Product Reviews from Street Crews I Lighter Side I Clenched Teeth Verbiage y Steve Berry B 82 I LAST WORD I The Ups Downs of EMS I 60 I 64 About Salary Survey, we revisit Flowing Springs EMS from this past year’s survey in an effort to anathe Cover In this year’s JEMS lyze how the economy and the overall structure of U.S. healthcare is affecting typical EMS agencies across the country. And as the subtitle “The future is bright—but how bright?,” hints, we found the data to be (cautiously) optimistic. pp. 30–41. Photo Chris Swabb Premier Media Partner of the IAFC, the IAFC EMS Section Fire-Rescue Med www.jems.com OctobER 2012 JEMS 5
  6. 6. Choose 14 at www.jems.com/rs
  7. 7. LOAD GO  log in for EXCLUSIVE CONTENT A Better Way to Learn JEMSCE.com online continuing education program n us o follow Have you ever considered serving on the board of directors for an EMS agency in your area? Before you consider it, you should be aware of what a director is—and isn’t. Unlike an operations position, which manages the dayto-day workings of an organization, the board of directors is all about leadership and governance. In “View from the Top,” Allison J. Bloom, Esq., discusses what serving on a board of directors involves, including how to set the tone and direction for an organization by engaging in strategic thinking and planning, and providing oversight of corporation management. s jems.com/article/view-from-the-top Photo Pilin_Petunyia/istockphoto.com View From the Top JEMS.com offers you original content, jobs, products and resources. But we’re much more than that; we keep you in touch with your colleagues through our: Facebook fan page; JEMS Connect site; Twitter account; LinkedIn profile; Product Connect site; and Fire EMS Blogs site. EverydayHeroes photo and video contest is your chance to nomiHeroes The Laerdal Everyday nate an individual within your organization to be recognized for exemplary service toward helping save lives. Check out their ad on JEMS.com or visit their Everyday Heroes contest for submissions guidelines. All entries will receive an Everyday Heroes t-shirt and pin. s laerdal.com/EverdayHeroes Sponsored Product Focus EMS ALS App like us facebook.com /jemsfans follow us The EMS Advanced Life Support (ALS) interactive application puts critical information at your fingertips with rich content, detailed illustrations, and pioneering features. It provides fast, easy access to vital assessment information, medications, and drug doses; quick interpretation of 12-lead ECGs; and the latest CPR and ACLS algorithms from the American Heart Association (AHA). This app is now available on the iPhone and Droid platforms. For more information call 888/624-8014 or visit informedguides.com. s Check out their ad on JEMS.com! Seeking EMS Innovators We’re looking for the EMS industry’s newest innovators, and we need your help identifying them. The 2012 EMS 10: Innovators in EMS award program, sponsored by JEMS and Physio-Control, Inc., seeks to recognize 10 people who have stepped outside the box, identified a need and taken steps to advance the art and science of prehospital emergency care. If that sounds like someone you know, nominate them before the Dec. 14 deadline. s jems.com/ems10 twitter.com /jemsconnect get connected linkedin.com/groups? about=gid=113182 ems news alerts jems.com/enews Check it out jems.com/ems-products best bloggers FireEMSBlogs.com www.jems.com OCTOBER 2012 JEMS 7
  8. 8. Conscience of EMS JOURNAL OF EMERGENCY MEDICAL SERVICES The Conscience of EMS JOURNAL OF EMERGENCY MEDICAL SERVICES ® Editor-In-Chief I A.J. Heightman, MPA, EMT-P I aheightman@pennwell.com MANAGING Editor I Jennifer Berry I jenniferb@pennwell.com assistant eDITOR I Allison Moen I allisonm@pennwell.com assistant eDITOR I Kindra Sclar I kindras@pennwell.com online news/blog manager I Bill Carey I bill@goforwardmedia.com Medical Editor I Edward T. Dickinson, MD, NREMT-P, FACEP Technical Editors Travis Kusman, MPH, NREMT-P; Fred W. Wurster III, NREMT-P, AAS Contributing Editor I Bryan Bledsoe, DO, FACEP, FAAEM art director I Liliana Estep I alildesign@me.com Contributing illustrators Steve Berry, NREMT-P; Paul Combs, NREMT-B Contributing Photographers Vu Banh, Glen Ellman, Craig Jackson, Kevin Link, Courtney McCain, Tom Page, Rick Roach, Steve Silverman, Michael Strauss, Chris Swabb Director of eProducts/Production I Tim Francis I timf@pennwell.com Production Coordinator I Matt Leatherman I matthewl@pennwell.com PUBLICATION OFFICE 800/266-5367 I Fax 619/699-6396 ADVERTISING DEPARTMENT 800/266-5367 I Fax 619/699-6722 advertising director I Judi Leidiger I 619/795-9040 I j.leidiger@jems.com Western Account Representative I Cindi Richardson I 661-297-4027 I c.richardson@jems.com senior Sales coordinator I Elizabeth Zook I elizabethz@pennwell.com REprints, eprints Licensing I Wright’s Media I 877/652-5295 I reprints@jems.com eMedia Strategy I 410/872-9303 I Managing Director I Dave J. Iannone I dave@goforwardmedia.com Director of eMedia Sales I Paul Andrews I paul@goforwardmedia.com Director of eMedia Content I Chris Hebert I chris@goforwardmedia.com SUBSCRIPTION DEPARTMENT I 888/456-5367I Director, Audience Development Sales Support I Mike Shear I mshear@pennwell.com Audience development coordinator I Marisa Collier I marisac@pennwell.com marketing director I Debbie Murray I debbiem@pennwell.com Marketing Conference Program Coordinator I Vanessa Horne I vhorne@pennwell.com chairman I Frank T. Lauinger President Chief Executive Officer I Robert F. Biolchini Chief Financial Officer I Mark C. Wilmoth Senior Vice President Group Publisher I Lyle Hoyt I lyleh@pennwell.com Vice President/Publisher I Jeff Berend I jeffb@pennwell.com founding editor I Keith Griffiths founding publisher James O. Page (1936–2004) Choose 15 at www.jems.com/rs Choose 16 at www.jems.com/rs
  9. 9. Choose 16 at www.jems.com/rs
  10. 10. JOURNAL OF EMERGENCY MEDICAL SERVICES The Conscience of EMS JOURNAL OF EMERGENCY MEDICAL SERVICES ® EDITORIAL board William K. Atkinson II, PHD, MPH, MPA, EMT-P President Chief Executive Officer WakeMed Health Hospitals James J. Augustine, MD, FACEP Medical Director, Washington Township (Ohio) Fire Department Associate Medical Director, North Naples (Fla.) Fire Department Director of Clinical Operations, EMP Management Clinical Associate Professor, Department of Emergency Medicine, Wright State University steve berry, NRemt-p Paramedic EMS Cartoonist, Woodland Park, Colo. Bryan E. Bledsoe, DO, FACEP, FAAEM Professor of Emergency Medicine, Director, EMS Fellowship University of Nevada School of Medicine Medical Director, MedicWest Ambulance Criss Brainard, EMT-P Deputy Chief of Operations, San Diego Fire-Rescue Chad Brocato, DHS, REMT-P Assistant Chief of Operations, Deerfield Beach Fire-Rescue Adjunct Professor of Anatomy Physiology, Kaplan University J. Robert (Rob) Brown Jr., EFO Fire Chief, Stafford County, Va., Fire and Rescue Department Executive Board, EMS Section, International Association of Fire Chiefs Jeffrey M. Goodloe, MD, FACEP, NREMT-P Professor EMS Section Chief Emergency Medicine, University of Oklahoma School of Community Medicine Medical Director, EMS System for Metropolitan Oklahoma City Tulsa David E. Persse, MD, FACEP Physician Director, City of Houston Emergency Medical Services Public Health Authority, City of Houston Department. of Health Human Services Associate Professor, Emergency Medicine, University of Texas Health Science Center—Houston Keith Griffiths President, RedFlash Group Founding Editor, JEMS John J. Peruggia Jr., BSHuS, EFO, EMT-P Assistant Chief, Logistics, FDNY Operations Dave Keseg, MD, FACEP Medical Director, Columbus Fire Department Clinical Instructor, Ohio State University W. Ann Maggiore, JD, NREMT-P Associate Attorney, Butt, Thornton Baehr PC Clinical Instructor, University of New Mexico, School of Medicine Connie J. Mattera, MS, RN, EMT-P EMS Administrative Director EMS System Coordinator, Northwest (Ill.) Community Hospital Robin B. Mcfee, DO, MPH, FACPM, FAACT Medical Director, Threat Science Toxicologist Professional Education Coordinator, Long Island Regional Poison Information Center carol a. cunningham, md, FACEP, FAAEM State Medical Director Ohio Department of Public Safety, Division of EMS Mark Meredith, MD Assistant Professor, Emergency Medicine and Pediatrics, Vanderbilt Medical Center Assistant EMS Medical Director for Pediatric Care, Nashville Fire Department Thom Dick, EMT-P Quality Care Coordinator Platte Valley Ambulance Geoffrey T. Miller, EMT-P Director of Simulation Eastern Virginia Medical School, Office of Professional Development Charlie Eisele, BS, NREMT-P Flight Paramedic, State Trooper, EMS Instructor Brent Myers, MD, MPH, FACEP Medical Director, Wake County EMS System Emergency Physician, Wake Emergency Physicians PA Medical Director, WakeMed Health Hospitals Emergency Services Institute Bruce Evans, MPA, EMT-P Deputy Chief, Upper Pine River Bayfield Fire Protection, Colorado District Jay Fitch, PhD President Founding Partner, Fitch Associates Ray Fowler, MD, FACEP Associate Professor, University of Texas Southwestern SOM Chief of EMS, University of Texas Southwestern Medical Center Chief of Medical Operations, Dallas Metropolitan Area BioTel (EMS) System Adam D. Fox, DPM, DO Assistant Professor of Surgery, Division of Trauma Surgery Critical Care, University of Medicine Dentistry of New Jersey Former Advanced EMT-3 (AEMT-3) Gregory R. Frailey, DO, FACOEP, EMT-P Medical Director, Prehospital Services, Susquehanna Health Tactical Physician, Williamsport Bureau of Police Special Response Team 10 JEMS OCTOBER 2012 Mary M. Newman President, Sudden Cardiac Arrest Foundation Joseph P. Ornato, MD, FACP, FACC, FACEP Professor Chairman, Department of Emergency Medicine, Virginia Commonwealth University Medical Center Operational Medical Director, Richmond Ambulance Authority Jerry Overton, MPA Chair, International Academies of Emergency Dispatch David Page, MS, NREMT-P Paramedic Instructor, Inver Hills (Minn.) Community College Paramedic, Allina Medical Transportation Member of the Board of Advisors, Prehospital Care Research Forum Paul E. Pepe, MD, MPH, MACP, FACEP, FCCM Professor, Surgery, University of Texas Southwestern Medical Center Head, Emergency Services, Parkland Health Hospital System Head, EMS Medical Direction Team, Dallas Area Biotel (EMS) System Edward M. Racht, MD Chief Medical Officer, American Medical Response Jeffrey P. Salomone, MD, FACS, NREMT-P Associate Professor of Surgery, Emory University School of Medicine Deputy Chief of Surgery, Grady Memorial Hospital Assistant Medical Director, Grady EMS Kathleen S. Schrank, MD Professor of Medicine and Chief, Division of Emergency Medicine, University of Miami School of Medicine Medical Director, City of Miami Fire Rescue Medical Director, Village of Key Biscayne Fire Rescue John Sinclair, EMT-P International Director, IAFC EMS Section Fire Chief Emergency Manager, Kittitas Valley Fire Rescue Corey M. Slovis, MD, FACP, FACEP, FAAEM Professor Chair, Emergency Medicine, Vanderbilt University Medical Center Professor, Medicine, Vanderbilt University Medical Center Medical Director, Metro Nashville Fire Department Medical Director, Nashville International Airport Walt A. Stoy, PhD, EMT-P, CCEMTP Professor Director, Emergency Medicine, University of Pittsburgh Director, Office of Education, Center for Emergency Medicine Richard Vance, EMT-P Captain, Carlsbad Fire Department Jonathan D. Washko, BS-EMSA, NREMT-P, AEMD Assistant Vice President, North Shore-LIJ Center for EMS Co-Chairman, Professional Standards Committee, American Ambulance Association Ad-Hoc Finance Committee Member, NEMSAC keith wesley, MD, facep Medical Director, HealthEast Medical Transportation Katherine H. West, BSN, MED, CIC Infection Control Consultant, Infection Control/Emerging Concepts Inc. Stephen R. Wirth, Esq. Attorney, Page, Wolfberg Wirth LLC. Legal Commissioner Chair, Panel of Commissioners, Commission on Accreditation of Ambulance Services (CAAS) Douglas M. Wolfberg, Esq. Attorney, Page, Wolfberg Wirth LLC Wayne M. Zygowicz, BA, EFO, EMT-P EMS Division Chief, Littleton Fire Rescue
  11. 11. Choose 17 at www.jems.com/rs
  12. 12. EMS IN ACTION Scene of the month Photos Roland Webb Off-Road Care R iders collide during the start of day six of the seven-day BC Bikerace, a rugged mountain bike course stretching from Vancouver to Whistler, British Columbia, Canada. According to Roland Webb, course medical manager, the EMS team of approximately 20 paid and volunteer paramedics and nurses treat nearly all of the approximately 520 participants at some point during the seven days, whether for minor or complex injuries. (Top right) A basecamp nurse cleans foreign bodies from a man’s eye after a day racing in heavy rainfall and mud. Performing effective care at the race presents many challenges for EMS, including re-locating daily and dealing with remote locations and potentially challenging extrications, Webb says. “In some places, access is a nightmare, and in others it’s easy, so you have to be flexible and get a clinic staff together for one week a year that can handle it.” 12 JEMS OCTOBER 2012
  13. 13. www.jems.com OCTOBER 2012 JEMS 13
  14. 14. from the editor putting issUes into perspective by A.J. HEIGHTMAN, MPA, EMT-P Patches, Pride Patients Consistent cooperation should be the goal H ave you noticed how well personnel from different agencies—and those wearing different uniforms and shoulder patches—get along and work together during a cardiac arrest or mass casualty incident? Know why that is? It’s because they’re all focused on a common goal: the mitigation of a complex incident or resuscitation of a person whose life will slip away if they don’t focus on the most appropriate care, set aside personal biases about who’s in charge and follow the command system regardless of who’s “in charge.” I’ve found this to be the case during most “big” calls. But when you get public, private, third service and hospital-based EMS system administrators together for a planning meeting or at a city council hearing on the best way to offer EMS in a region, their protective attitudes, operational and staffing biases, and agency loyalties, will often surface like the teeth on a shark that smells blood in the water. It shouldn’t be that way. We should check our egos and biases at the door whenever we leave home to head to work. We should simply focus on the patient and delivering optimal service to the community. Wars have taught us invaluable lessons about strategy development, command and control, and the use of innovative tactics. They have also taught us many hidden lessons about group interaction, the use of limited resources and, most importantly, “blind” faith and cooperation between forces from different service branches without bias or prejudice—particularly when it comes to combat casualty care. The importance of this unbiased attitude and approach to patient care was never more evident to me than in the sad, but powerful, story of the life and tragic death of Sgt. Eric E. Williams, an Army flight medic from Southern California who was killed on July 23 in Afghanistan. At Williams’ funeral, Army Staff Sgt. Michael Constantine told of being on the receiving end of Williams’ care in 2008, and vividly recalled the battle that almost took his life. A bullet tore through Constantine’s ribs and collapsed his lung during a fierce battle in Afghanistan. Sgt. Williams was the flight medic who rapidly arrived on an Army helicopter to attend to him as he gasped for breath, watch High School and later became an EMT for American Medical Response. He did his job then based on what was in the best interest of his community and his patients. Later, while serving as a medic in the Army, he provided care indiscriminately to those in need whether they wore a patch from the Army, Marines, Air Force, Navy or Afghanistan military—or no patch at all. During his memorial service, the last entry in Williams’ Internet blog entry titled “Coming Home” was read. In his short blog message, the dedicated, humble Army medic noted having witnessed “the atrocities of war” and wrote words that sum up why we all work in the field of EMS: “We have thrust ourselves into the midst of chaos in order to do something so important, so visceral, that few will ever understand what it means. We collectively have risked it all and put everything on the line to save our fellow man, regardless of nationality, race, religion or sex.” Remember Sgt. Eric Williams’ ultimate sacrifice and never let personal bias or your agency affiliation stand in the way of patient care or decisions that are the best interest of your patient or the community you serve. We all have to accept and embrace the fact that we will always wear different shoulder patches and have different employer-driven philosophies and service objectives. But we must work cooperatively together, particularly in the years ahead as new approaches to healthcare delivery require a more comprehensive, integrated EMS delivery model. JEMS He never made it home, but the stories of his heroic acts did. 14 JEMS OCTOBER 2012 his vision begin to fade and “tunnel,” and had a significant amount of blood filling his airway. Constantine says, “I had started to give up and let the inevitable rush over me until, in a calm voice, I heard Williams’ voice say ‘Just breathe out.’ So I did.”1 He then felt Williams’ hands repairing his massive, open wound. Constantine says he looked up and searched the medic’s face for some indication of how bad the wound was. He told those in attendance at his funeral that he was met with a reassuring smile and words of promise from Williams, who told him he would do all that he could to save him. Williams and his flight crew members did, in fact, save Constantine, and he never saw Williams again. In July, four years after Williams saved Constantine’s life, he learned that Williams was killed as his second deployment ended. Williams was in transit from his duty station in Ghazni Province, Afghanistan back to the U.S., and his forward operating base came under enemy fire. He never made it home, but the stories of his heroic acts did. The most important part of this story is that Williams grew up in civilian life serving with public and private emergency response agencies. He had served as president of the fire explorers while at Murrieta (Calif.) Valley Reference 1. Kabbany J. (Aug. 4, 2012). WILDOMAR: Region remembers slain Murrieta soldier. In North County Times. Retrieved Aug. 4, 2012, from www.nctimes.com/ news/local/wildomar. Read Sgt. Eric E. Williams’ last blog entry, “Coming Home,” at http://myfriendthemedic. blogspot.com/2012/07/coming-home.html.
  15. 15. Choose 18 at www.jems.com/rs
  16. 16. Just Words? Perhaps it’s not surprising that JEMS readers had a lot to say about the August feature article by Rollin J. Fairbanks, MD, MS, that discussed how to combat the longstanding issue EMS providers have with being referred to as “ambulance drivers” in the media and elsewhere (“More than Words: how we can influence the ‘ambulance driver’ media epidemic.”) Is there a solution, or will this continue to be a problem for the profession? If you want to advance and improve our profession (and help make it a profession) then you will understand that a single, simple collective term of identity is necessary for the media to describe us and what we do. We have to make it easy for THEM to get it right. When I’ve had this conversation with media representatives (and I have), they say, “Oh, OK.” The Canadians and Australians have figured this out. Those who work on ambulances are all paramedics, just like those who work on fire trucks are firefighters, and those who work in police cars are police officers. It has worked well enough that they have a public identity in those countries that is substantial. How about we “real” paramedics get over it and share our “elite” (cough, cough) title with the others who work with us. We should all be paramedics. I don’t care; we can be called “BLS paramedic,” “ILS paramedic,” “ALS paramedic,” “critical care paramedic,” “tactical paramedic” or “flight paramedic,” etc., etc., ad nauseam infinitum amen. The bottom line: They’re all paramedics. Skip Kirkwood Via jems.com New Zealand still uses the generic term “ambulance officer” to describe those at all clinical levels, be they a technician, a paramedic or an intensive care paramedic. Technician level officers are overwhelmingly volunteers; they complete a six-month block course, perform a limited number of procedures and dispense a limited number of drugs (about 10). It’s not appropriate to call them a “paramedic,” and it’s certainly not appropriate to call an American EMT who, under the EMS Agenda for the Future, completes a course of less than 200 hours and has oxygen, aspirin and glucose, a “paramedic.” Elsewhere in the world, a paramedic must go to college for three years to earn the right to use the title. As much as I applaud Canada for its use of the titles, primary and advanced care paramedic, 16 JEMS OCTOBER 2012 I’m going to have to play devil’s advocate a little here. Sorry folks. Ben Hoffman Via jems.com We are ambulance drivers. We work with fire truck drivers and police car drivers to provide first aid and a ride to the hospital. Once we arrive there, the vital sign takers, bed makers and report takers help the prescription writers and test orderers take care of the medical services consumer. After all, it’s all about the words, isn’t it? Christopher Black Via jems.com I am an ambulance driver. I’m probably a decent EMT as well. I teach the Emergency Vehicle Operator Course (EVOC) after spending years of white knuckle driving. My primary focus when teaching a class is to impart the enormous responsibility involved in driving an emer- gency vehicle. In addition to being an emergency room on wheels, that truck is a billboard for your service, and potentially an instrument of destruction. If I haven’t scared the crap (spark) out of my students before the road test, I haven’t done my job. When I stand in front of or behind the ambulance during the road practical, I make it clear that my life and that of those in the truck as well as on the road is in their hands. They are proud of that accomplishment when they receive their EVOC certificate. Yet some consider being called “ambulance driver” the equivalent of a racial slur? Get over yourself. Nancy Magee Via jems.com Thank you for a great article. The term also leads to a misconception about what the ambulance is used for. I can’t tell you how many times nurses or unit secretaries have asked us as we’re leaving to take someone home because we happen to be going “his way.” When I politely decline, they usually become irritated and say things to the effect of “what good is driving an ambulance if you don’t drive people places?” We in EMS have a long way to go, but I think we all collectively appreciate your effort and your article. Thanks again. Geoffrey Horning Via jems.com Nice article. After almost 30 years at this, I still don’t like being called an “ambulance driver.” However, I also wish the media would use a thesaurus: The only verb they have for us is “rush.” It doesn’t matter what we do, the standard line is, “And EMS rushed the victim to the hospital.” As long as all we do is “rush,” then I guess our primary job is driving. JEMS Sam Benson Via jems.com illustration steve berry monkeybusinessimages/ istockphoto.com LETTERS in your words
  17. 17. Choose 19 at www.jems.com/rs
  18. 18. PRIORITYUSE TRAFFIC NEWS YOU CAN Hurricane Isaac HITS Crews Activate Response Plans A Photo Associated Press/Gerald Herbert s Hurricane Isaac headed toward the Gulf Coast region in the end of August, residents were figuring out to ways evacuate, and EMS operations were swinging into full gear in their efforts to receive for back-up assistance. With the potential of a major storm hitting a wide swath of land, officials initiated emergency plans and waited out the weather early on. Acadian Ambulance An uprooted tree lies across Poydras St. in New Orleans as Hurricane Isaac made landfall with 80 mph winds, making it a Category 1 storm. Photo Associated Press/Eric Gay On Aug. 26, with the storm just two days away, Acadian Ambulance in Lafayette, La., activated its Evacuation Response Operations Center (EROC), a system borne out of responses to previous storms, to specifically handle the evacuations of healthcare facilities. “Compared to other storms of the past 10 to 15 years, it was not one of the most challenging we’ve had,” says Jerry Romero, senior vice president of operations at Acadian. “But, we had to execute our disaster plan.” Part of this plan included having 40 additional ambulances in service. The EROC system was created after hurricanes Gustav, Katrina and Ike struck the regions Acadian serves. Evacuating healthcare facilities and nursing homes is a major part in the storm preparation process. To meet that need, Acadian activates a separate communications center to handle only those types of evacuations, rather than have those calls bog down the normal 9-1-1 system. For instance, during Hurricane Katrina, Acadian evacuated more than 2,000 patients. During the first day of the EROC operation for Hurricane Isaac, the company transported 150 people. Hurricanes are challenging for EMS organizations. Officials are faced with calling in extra staff at a time where the staffers’ families and homes may be in danger. This happens at the same time that government officials are asking residents to evacuate the area where first responders are being sent to wait. The result, however, can sometimes be a shortage Trevelle Bivalacqua, 12, at right, helps firefighters and other volunteers evacuate residents from the Riverbend Nursing Center as Hurricane Isaac makes landfall in Jesuit Bend, La. of employees physically unable or unwilling to return to work. “Our employees are pretty hurricane savvy,” says Romero. “At the beginning of hurricane season, we put out our employee update to remind them of the points to have a family plan prepared, to know what you’re going to do, and have a three-day supply of clothes and food in case you don’t get home. We get a lot of people who call in and volunteer.” SunStar EMS Officials at SunStar EMS in Pinellas County, Fla., like others, began altering their hurricane response plans in 2004 and have upgraded NIH creates Office of Emergency Care Research: www.jems.com/article/nih-creates-office-emergency-care-resear 18 JEMS OCTOBER 2012
  19. 19. Comprehensive, Credible, Educational... JEMS Products Help You Save Lives. Jems, Journal of Emergency Medical Services jems.com Website With content from writers who are EMS professionals in the field, JEMS provides the information you need on clinical issues, products and trends. Your online connection to the EMS world, JEMS.com gives you information on: • Products • Jobs • Patient Care • Training • Technology Available in print or digital editions! Product Connect jems.com eNewsletter Sign up now for the weekly JEMS.com eNewsletter. Get breaking news, articles and product information sent right to your computer. Read it on your time and stay ahead of the latest news! Giving you the detailed product information you need, when you need it. We collect all the information from manufacturers and put it in one place, so it’s easy for you to find and easy for you to read. Go to www.jems.com/ems-products FREE WEBCASTS did you Miss a live webcast? Check out the archives at www.JEMS.com/webcasts. • Securing the Airway: The expanding role of extraglottic devices • Maximizing Your Revenue • May the G-Force Be With You • ‘Posting’ Is Not a Dirty Word • When You Leave a Patient Behind: Refusals, Non-Transports Best Practices for Documentation • The Mobile Transformation • EMS Strategies for Improving Cardiac Arrest Survival • Are You Bagging the Life Out of Your Patients? • Drug Shortage Action Plans for EMS • Statewide Trauma System Enables Multi-Agency Coordination with Trauma Centers to Improve Patient Outcomes • CPAP in EMS: The Standard of Care Argument • Top 5 Ways an In-Vehicle Router Improves EMS Operations Patient Care • CPR Quality Improves Survival • Breathe Deeply: How CPAP and Ventilation Can Help Your Patients • Simulating Work: How to Effectively Incorporate Simulation into Prehospital Care • CPAP: Filling The Sails to Respiratory Relief Go to www.JEMS.com
  20. 20. continued from page 18 Photo courtesy Mark Postma Two must be on duty at all times, which gives the other providers a chance to check on their families. Another 250 go to the company headquarters. Bringing everyone in inevitably involves logistical challenges for managers, such as the feeding and housing of staff. And once a storm begins, there will ultimately come a point where the crews can’t go out. SunStar EMS hurricane deployment units prepare and debrief “We’ve kind of learned from during the Republican National Convention at Tropicana Field other hurricanes that have hapas they mobilize for Hurricane Isaac response. pened,” says SunStar Vice President Mark Postma. “We’ve tried to be as them after every storm since then. SunStar’s current plan includes a man- flexible as we can.” Early on, it appeared the region covered datory callback for all employees, and it also includes provisions to make sure by SunStar might get hit by Hurricane Isaac. employees’ family concerns are taken into However, the storm track went further west. consideration. For instance, six responders The plan has been tested several times, though and an ambulance are placed in 20 hotels it’s been activated only once since its implethroughout SunStar’s response area—and mentation, Postma says. SunStar was prepared, however, says geographically near the responders’ homes Richard Schomp, director of operations. to assist families if needed. The company had already activated special EMS coverage for an event staged for the A Word of Encouragement Republican National Convention on the SunEditor’s note: Jullette M. Saussy, MD, served day before the storm. That coverage, says with NOEMS during hurricanes Katrina and Schomp, included 14 additional ambulances, Gustav. She provided this message to EMS extra management and a mass casualty supcrews responding to Hurricane Issac. ply vehicle. “I’d already staffed up the system to handle It’s incredibly difficult to be so far away and yet an extreme amount of volume,” Schomp says. to still feel the deep longing to be right beside “With the storm coming, we maintained that each of you as this hurricane approaches. Katrina high amount. It had very little impact, but we in 2005, Gustav in 2008, and now Isaac in 2012—all were ready.” on or about the same day seems more than just Typically, EMS operations experience a statistically impossible. large influx of 9-1-1 calls after a storm when For those of you who have been through this residents have no power. Romero says there’s drill, I know it brings up all kinds of emotions. It often a jump in heat-related calls, chainsaw has for me, and I’m not even there. For the newcuts and falls from roofs as homeowners est members of the team, take a few lessons work to rebuild. from the seasoned men and women of New Getting crews time to rest, especially when Orleans EMS (NOEMS.) If they seem on edge, it’s they’re stationed over a wide geographical for a reason. Be patient. If they seem emotional, location, is one of the largest challenges, it’s for a reason. Be patient. If they tell you to do Romero says. However, each storm, Romero something, it’s for a reason. Do it. says, helps the company prepare for the next You have capable leaders, and they need the one. Hurricane Isaac was no different. team to pull together and perform at their high“Katrina, Rita, Gustav and Ike taught us a est capacity. We have one mission and that is to lot,” says Romero. “We’ve gotten better every stay safe and to keep our citizens and visitors time. We can always improve and will consafe. Stay focused on that, and you will succeed. tinue to improve after this one.” Thank you for the work you do each day. —Richard Huff, EMT-P —Jullette M. Saussy, MD Remembering an EMS Pioneer Robert Forbuss was an EMS advocate, speaker, author, leader and pioneer known for promoting EMS, EMS careers and high-quality private and public ambulance services. He died in August after a long battle with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease. He was 64. Janet Smith, a former Mercy Ambulance employee and colleague of Forbuss’ says, “The Bob Forbuss story is about how a man in an emerging new healthcare service in the 1970s, leveraged his company’s position in a growing Nevada metropolis to open political and strategic access to the power structure of the city and county his company served.” Co-founder and subsequent president of the American Ambulance Association (AAA), Forbuss presided over the National Showcase for EMS in Washington, D.C. He served on the AAA committee to institute the process for ambulance accreditation from which the Commission on Accreditation of Ambulance Services (CAAS) was formed. Jay Fitch, PhD, founding partner of Fitch and Associates, LLC, reflects, “He was my second private client, the best thing that could happen to a young consultant. Energetic and passionate, I came to admire his leadership.” Forbuss served as the industry’s spokesperson during the national Ford ambulance crisis and was named EMS administrator of the year at the EMS Today Conference Exposition in 1988 for his work during that crisis. Forbuss coordinated the ambulance and walking wounded components at the 1980 MGM Grand and 1981 Hilton high-rise hotel fires, an effort JEMS founder James O. Page described as a “command performance.” Smith reflects, “Who knows how many have lived to see another birthday, a graduation or a grandchild’s first steps because of him, his influence, his care in countless cities and towns throughout America and especially in those communities where CAAS Accreditation is the benchmark. He will be missed.” —Mike Ward, EMT-P Halloween safety tips: www.jems.com/article/don-t-get-spooked 20 JEMS OCTOBER 2012
  21. 21. Choose 20 at www.jems.com/rs
  22. 22. continued from page 20 When Patients Don’t Stay Put W e’ve seen some tragic headlines recently that should be a cause for concern: Aug. 19, 2012: “Woman Dies After Jumping from Ambulance” (Calif.) March 12, 2012: “Patient Jumps from Ambulance Only to be Struck by Truck” (Nev.) Dec. 23, 2011: “Naked Man Jumps from Ambulance, Dies on Freeway” (Calif.) Oct. 13, 2011: “Patient Jumps Out of Ambulance and Into River” (Okla.) Is this a trend? How can these incidents happen in the first place? We don’t know the statistics, but we do know that patients who unexpectedly leap from your ambulance—while you’re with them in the patient compartment—not only can get injured or killed, but can also present huge liability issues for you and your EMS agency. Dealing with patients with psychological issues is a big challenge. They may appear “fine” and “calm” one moment and then they snap into another person the next second. They often don’t have any outward physical injury, so they almost appear “normal.” This is when we may let our guard down ever so slightly, and bang: The next thing you see is the rear door flapping open and no patient in your vehicle. Not a good scenario. We need to always remember to strive to never let something bad happen to a patient while they’re under our care. We don’t want them to be worse off than when we first found them, because if they are, then the obvious question from a “fact-finder” will be: “Did the EMS crew do enough to prevent this unfortunate incident?” And if the answer is no, then you may be looking at a negligence or wrongful death action against your agency. Follow these tips for reducing your risk when transporting patients who have a “questionable” mental state: Always be attentive: Keep your eye on the patient at all times in a faceto-face position. The first sign that the patient is about to escape may be a change in their facial expression. You can’t see that sitting in the captain’s chair texting a friend, staring out the side window, or chatting with the driver. We must be totally attentive to the patient every second they’re with us. Being complacent or distracted leads to dead patients in these situations. Follow your protocols: Most systems have a protocol for dealing with a patient who may have psychological issues or has exhibited signs they may hurt QUICK TAKE PennWell Acquires Elsevier Public Safety; JBL Acquires EMS Product Line On Sept. 14, PennWell Corporation announced the acquisition of Elsevier Public Safety, the publisher of JEMS, from Elsevier, Inc. The deal also includes JEMS.com, the EMS Today Conference Exposition (the JEMS Conference), EMS Insider, FireRescue magazine, FirefighterNation.com, FireEMSblogs.com, Law Officer magazine, LawOfficer.com and the publishing contract for APCO’s Public Safety Communications magazine. Elsevier Public Safety, a division of Elsevier, Inc., was founded in 1980 as JEMS Communications, with JEMS, one of the most iconic brands in the EMS market. During the past 32 years, Elsevier Public Safety expanded to become the themselves. Make sure you review that protocol and follow it. Your protocol will usually be the patient care standard by which you will be judged in a negligence lawsuit. Get good Information at the scene: Ask lots of questions of the facility staff or family members concerning mental stability, suicidal ideations, and so forth. Document exactly what the patient, nursing staff and bystanders tell you. Never accept a patient who looks “fine” without a good explanation as to why you’re taking them. Don’t hesitate to call law enforcement: True, police officers are not always helpful, but it’s best to err on the side of calling them, and then keep them there for the remainder of the transport or ask an officer to ride in the back if possible. Always consider the option of an involuntary mental health commitment in accordance with your state law, if you’re concerned. Use two people in the back: If you question the mental stability of a patient, it’s always best to have two providers in the patient compartment— positioned strategically so that the patient can’t escape easily. Someone should definitely be between the patient and the rear door of the ambulance. Don’t make it easy for them to escape. Use restraints when needed: We’re not talking about the cot straps, which by the way, should always be in your complete view so that you can see them if a patient is trying to get unbuckled; never cover buckles under a blanket. Chemical restraints may be the safer way to go and can reduce patient anxiety. Don’t hesitate to use them or ask your medical command physician. Keep in mind from a risk management standpoint, it’s far better to get sued for false imprisonment for excessively restraining a patient, than to get sued for wrongful death if the patient jumps from your ambulance as you look up and it’s too late. There are only a few lawsuits where EMS providers were sued for taking a patient involuntarily, but there have been hundreds of lawsuits against EMS for negligence when the patient is left worse off than when you found them — regardless of your defense. The authors are all attorneys with Page, Wolfberg Wirth, a national EMS law firm. Visit the firm’s website at www.pwwemslaw.com for more information on a variety of EMS law issues. only media company serving all four key public safety segments—EMS, fire/rescue, law enforcement and communications. The management and staff will join PennWell, a diversified global media and information company, and will remain based in San Diego. PennWell conducts more than 50 conferences and exhibitions, including the Fire Department Instructors Conference (FDIC), and has an extensive line of trade publications, including Fire Engineering and Fire Apparatus magazines. PennWell will bring its trade show management knowhow to the EMS Today Conference Expo, held annually each spring. EMS Today celebrated its 30th anniversary this year and in 2013 will be held March 5–9 at the Washington Convention Center in Washington, D.C. For more information, visit www.jems.com/article/ news/pennwell-acquires-elsevier-public-safety. For more of the latest EMS news, visit jems.com/news 22 JEMS OCTOBER 2012 Pro Bono is written by attorneys Doug Wolfberg and Steve Wirth of Page, Wolfberg Wirth LLC, a national EMS-industry law firm. Visit the firm’s website at www.pwwemslaw.com for more EMS law information. In other acquisition news, Jones Bartlett Learning (JBL), a division of Ascend Learning, acquired the EMS product line from Elsevier, Inc., closing the deal in July, according to JBL Executive Publisher Kimberly Brophy. EMS education resources previously published under the Elsevier brand are now part of the JBL EMS product line, including those marketed under the Mosby, Saunders and Churchill Livingstone imprint. The added value, Brophy notes, is that customers can now order a large variety of titles from one publisher. JBL is a provider of instructional, assessment and learning-performance management solutions for the secondary, post-secondary and professional markets. JBL will continue to support and enhance EMS products, domestically and internationally. Customers should note that Elsevier will be responsible for accepting returns on any products purchased directly from Elsevier through April 30, 2013.
  23. 23. Choose 21 at www.jems.com/rs
  24. 24. LEADERSHIP SECTOR presented by the iafc ems section by gary ludwig, ms, emt-p Closed Door Policy Keeping lines of communication open can help you your staff I recently received an e-mail that told me of an innovative new management principle that most major business schools, such as Wharton, Harvard and Yale, would soon be scampering to teach. The e-mail added that management books would need to be rewritten and this new management practice would set teaching of leadership and management back 200 years. Intrigued, I couldn’t resist reading further into the e-mail about this earth-shattering management principle. I was curious about what was so tremendous and incredible. Could I possibly be on the brink of some utterly fantastic discovery that maybe somehow I could share with fellow EMS managers? Closing the Door As I read further, I discovered that the writer was being facetious. He was being tonguein-cheek and not really writing about an earth-shaking innovative or unfounded management application. What the author wanted to share with me was what the management at his EMS service had distributed to its employees; a memorandum appropriately called the “Closed Door Policy.” The memorandum basically said that managers were too busy to deal with employees when they had an issue that needed addressing. Here is what the memo said (with the names deleted). To All Employees, During business hours (9–17), [name deleted] and [name deleted] are being bombarded with operational issues every five minutes. This makes it impossible to complete our tasks and work assignments. We are tired of answering the locked door that specifically says, “AUTHORIZED PERSONNEL ONLY” to find out that you need to talk about scheduling, supplies, etc. Although we appreciate all your concerns, unless it’s on fire, please e-mail us. We will get back to you in a timely manner. You cooperation is much appreciated and no exceptions will be made nor tolerated. Please take this seriously. We have a larger work load and get seriously behind due to constant visitors. 24 JEMS OCTOBER 2012 Surprisingly, this wasn’t a large service where 1,000-plus employees would keep the head of an EMS organization from doing their job because they were inundated with employees knocking on the door. So when I read the memo, I was baffled. Leading with Your Feet Management does need to prioritize tasks. And, as I have always preached, management shouldn’t be bogged down in minutia and should focus on strategic issues. However, I have also advocated they can’t sit in their offices behind closed doors and not interact with their employees. They need to find a balance between staying focused on strategic issues and getting out of the ivory tower to find out what’s happening in the operation. When you get out and talk with employees, you find out what’s working and what’s not. As I’ve often said, you don’t want to wake up in the morning and read in the paper what’s happening in your operation. A label for this practice is “Management by Walking Around,” or MBWA. I have always felt this concept was misnamed and would be better termed “Leadership by Walking Around.” After all, we manage budgets and inventories; we should be leading people. Nonetheless, this spontaneous practice in an unstructured manner allows managers to randomly check with employees or equipment to find out what is happening in the operation. My favorite method to do MBWA is to stop by one of our busier hospitals in Memphis where I know I’m going to find three or more Memphis Fire Department ambulances dropping off patients. It gives me the opportunity to randomly and spontaneously meet with personnel. It allows me to talk with them, and it allows them to ask me questions, let me know about any issues that need addressing, and, my favorite—deny or confirm rumors they’ve heard. This is probably one of the best tools I have to discover what’s wrong and needs to be fixed, build rapport with employees and receive feedback. I may hear things I don’t want to hear, but that comes with the job and I would prefer employees to be honest. Sometimes it seems like it’s a small problem. But I’ve discovered if you don’t deal with the small problems, they can become big problems. A Balancing Act It’s important to point out that, if you’re going to use MBWA, you have to do it the proper way. You can’t just walk around to say “Good morning.” Don’t criticize. Don’t create an atmosphere of fear that causes your employees to get scared and “clam up” when they see you coming. And, most importantly, EMS managers can’t just sit in locked offices and shelter themselves from what’s happening outside the confines of their office. Maintaining that careful balance between becoming a recluse and interacting with your employees can allow you to truly find out what’s happening within (and around) your operation. JEMS Gary Ludwig, MS, EMT-P, has 35 years of EMS, fire and rescue experience. He currently serves as a deputy fire chief for the Memphis Fire Department. He’s also Chair of the EMS Section for the International Association of Fire Chiefs. He can be reached through his website at GaryLudwig.com.
  25. 25. Choose 22 at www.jems.com/rs
  26. 26. TRICKSour patients ourselves OF THE TRADE caring for by Thom Dick, EMT-P Warm Enough for Ya? Preventing failures to start 26 JEMS OCTOBER 2012 Photo Thom Dick “I ’m melting, I’m melting!” So said the Wicked Witch of the West just before she magically shriveled her way into history. I’m beginning to sympathize with that cranky lady. At the time of this article’s writing, my state has had a record-breaking summer of wildfires after more than a month of temperatures in excess of 90° F and multiple strings of 100-plus days in the mix. And the calendar says our summer is still ahead. We need rain. One of my duties is to oversee the maintenance of a small fleet of six Type III Ford ambulances. They’re all 7.3-Liter PowerStroke Diesel chassies with LifeLine boxes. We’ve hung onto the 7.3s because we don’t generate a lot of miles, and those engines and their TorqShift transmissions have been bulletproof. Just as importantly, the quality of the boxes has supported our continued investments in chassis maintenance. In fact, so far we’ve sent two units back to the factory in Sumner, Iowa, to refurbish and return them to service. When I was originally assigned to take care of this fleet, we were having two kinds of starting failures. One was an easy fix: We began replacing the batteries annually. The other, which had plagued us for years, was alternator failures—especially of the upper alternators. Of course, the easiest way to correct that would be to switch to Type I ambulances. One of the disadvantages of a cutawaybased Type III chassis is its teeny engine compartment. There’s not enough room in there for an alternator big enough to supply the needs of an ambulance (or a leprechaun to service it). So Ford resorted to a pair of alternators: one mounted high and the other one low. A Type I chassis has a longer hood, like a pickup truck, that offers much more space. But our garage bays aren’t physicially deep enough to accommodate Type I ambulances. And Colorado’s range of temperatures can Maintaining proper vehicle temperature isn’t rocket science, but it does require proper training. reach 110 degrees winter to summer. So you pretty much have to keep an ambulance garaged. Neither of those alternators is just a spare; if one fails (usually the upper one because of heat), the other will follow soon enough. You can minimize the load on them by switching your emergency lighting from incandescent to high-intensity LEDs. LEDs produce a lot of light with a little energy. Decreasing the load on an alternator should lower its operating temperature, minimize the wear on its drive belt and improve its reliability. But LEDs require a lot of rewiring, and that’s pricey. You can’t just replace bulbs. You can idle a diesel all day long, even on a hot summer day with a heavy electrical load (including both air conditionings on full-blast). But when you turn the motor off, the radiant heat of all that metal has nowhere to go. So your underhood tem- peratures will rise. If the cooling system is in good shape and your coolant is mixed at the proper concentration, it should be OK up to a temperature of almost 300° F. But the underhood temperature won’t be constant. It’ll be hottest up high (like where the upper alternator is) and not so hot down low. We talked to our friend Cap Unrein at Rocky Mountain Emergency Vehicles (EVMARS) of Denver, who does our maintenance. Cap recommended the basis of the following hot-weather procedure. We leave an ambulance running when we park it outdoors for just a few minutes. Nobody wants to climb into a 120° F ambulance, right? EVMARS installed externally accessible security switches that either lock or unlock all of our doors simultaneously. So we can leave a locked vehicle idling, yet we can access it quickly for a call. Then, when we return to quarters, we turn off the engines and leave the hoods open. Looks funny. Makes sense. Obviously, we try not to leave the hoods open in public. Our crews don’t post on street corners, and they’re mindful of the temperaturesensitive contents of their compartments, so they normally return to quarters between calls. And we don’t know yet if this will even work. But it makes sense for any vehicle, whatever its design. And in this heat, we’ve gotta do something. I have to tell you, there’s one more component to this plan. The crews have to understand their instruments—and the mechanics of their vehicles—well enough to make it work. To my way of thinking, that requires training and experience. Neither of which happens by magic. JEMS Thom Dick has been involved in EMS for 41 years, 23 of them as a full-time EMT and paramedic in San Diego County. He’s currently the quality care coordinator for Platte Valley Ambulance, a hospital-based 9-1-1 system in Brighton, Colo. Contact him at boxcar414@ comcast.net.
  27. 27. Choose 23 at www.jems.com/rs
  28. 28. CASE OF THE MONTH DILEMMAS IN DAY-TO-DAY CARE BY Kimberly Doran Naked Unconscious Crew’s misdiagnosis could have cost patient her life Arrival at the ED On arrival to the ED, the medic hands over the loaded syringe containing 2mL of unidentified solution, as well as the empty vial of Solu-Cortef and the bottles of dexa- 28 JEMS OCTOBER 2012 Photo BigshotD3/istockphoto.com A call comes in to 9-1-1 dispatch. “Help” is all that’s spoken before the operator hears the phone hit the floor. The 9-1-1 dispatcher calls back only to get a busy signal. Police and EMS are dispatched for a well-being call. On arrival, the front door is found to be slightly ajar. The crew knocks, but there’s no reply. Entering the home, the crew sees a young woman lying on the floor in a pool of vomit. A syringe with an unknown substance is on the ground nearby. Suspecting a drug overdose, the EMS crew begins treatment. The patient is unconscious with emesis about her head and face. Her vital signs are blood pressure 60/45, heart rate of 130 bpm and respiratory rate of 10. The patient shows no signs of waking. The crew clears the airway and administers oxygen. An IV is established and the patient is readied for transport. As the crew leaves the scene, one of the medics turns to shut the door and sees a vial under a chair. He retrieves it and notes that the label says Solu-Cortef (a glucocorticoid). He bags it for the emergency department (ED). Following his instinct, he looks around the area for medications and finds two bottles. One is labeled dexamethosone and the other is labeled fludrocortisone. He takes his findings and rushes out the door into the awaiting ambulance. During transport the patient continues to deteriorate. The medic administers 0.5 mg of narcan and a 500mL bolus of normal saline with no response. He radios ahead to let the hospital know that they’re en route. Now questioning the original diagnosis of drug overdose, he reports the medications he found on the scene in hopes it will help the receiving physician determine the cause of the patient’s condition. Symptoms of adrenal insufficiency can mirror a drug overdose, so providers need to be wary. methosone and fludrocortisones. As they arrive at the hospital, the ED physician meets the crew and informs them that he’s familiar with the medications and they’re all used for people who have various forms of adrenal insufficiency (AI). The symptoms seen in this patient coincide with life-threatening adrenal crisis. The physician administers 100mg of Solu-Cortef via IV and within minutes, the patient rouses. In 30 minutes, she can explain what happened in the desperate moments before her crisis. Adrenal Insufficiency The adrenal medulla (inside of the adrenal gland) secretes epinephrine and norepinephrine. The adrenal cortex (outer layer of the adrenal gland) secretes cortisol and aldosterone. Cortisol, a glucocorticoid, is often called the “stress” hormone. One of the things cortisol in the body is responsible for is elevating blood glucose levels in times of stress. It also functions as a mediator for several inflammatory pathways. Absence of cortisol can result in hypotension, hypoglycemia and death. Aldosterone, a mineralocorticoid, is responsible for the regulation of sodium and water. Absence of aldosterone can result in hypotension and electrolyte imbalance. AI is a life-threatening condition in which the body is unable to produce enough cortisol to sustain life. In other words, their adrenal cortex is “asleep.” People suffering from AI take daily cortisol/glucocorticoid steroid replacement because whatever adrenal function they have is depleted. These patients are glucocorticoid dependent. In times of injury, dehydration, illness or surgery, they require an injection of Solu-Cortef. Solu-Cortef contains both glucocorticoid and mineralocorticoid properties, helping the body to compensate during a stress event. AI in the prehospital setting may be difficult to recognize in the absence of a good history, including medications, to point providers to the cause of the problem. Two conditions associated with AI include hypotension and hypoglycemia. If not managed, these two conditions are life threatening. Prehospital treatment should include management of the patient’s airway, vascular access and fluid resuscitation. If blood glucose levels are low, the patient should receive dextrose per local protocol. It’s important to complete a thorough physical assessment and obtain a complete patient history. Providers may confuse patients having an adrenal crisis with drug overdose patients because of their similar symptoms. Although the condition is rare, it should still be considered as a potential diagnosis. Authors’ note: Parts of the above case are taken from a true story. However, the difference is that there was no syringe on the floor, no vial under the chair and no one found the medications. The patient was diagnosed as a drug-overdose patient and treated with charcoal. She likely would have died, but her mother charged into the ED and expressed the need for Solu-Cortef. Security was called, but luckily someone listened, researched and called the patient’s treating physician. The patient was treated and released. JEMS Kimberly Doran is medical liaison for Adrenal Insufficiency United. She is committed to bringing about awareness and proper medical care and treatment for all who suffer from various forms of adrenal insufficiency. She can be contacted at docs4aiu@gmail.com. For more information about this condition, go to www.AIUnited.org.
  29. 29. Choose 24 at www.jems.com/rs
  30. 30. The future looks bright—but how bright? photo vu bahn About the Data The Web-based survey consisted of approximately 150 questions. It allowed participants to voluntarily “skip” sections they considered “not applicable.” Two hundred twenty-one organizations (N=221) initiated the survey - a return rate of 10% from a distribution of 2,411 invitations. Survey participation was open for a five-week period during May and June 2012. Figure 1, p. 32, shows the breakdown of provider types and their call volumes. The median of respondents serves populations of 50,000 and responds to 5,000 calls annually. Total respondents are noted as “n =” for each dataset where possible. In some instances, data was limited, not available or not applicable for all respondents. For example, respondents may answer call volume but not provider type, which means that “n” can change from dataset to dataset. A representative sample of participation from provider organizations in each region of the U.S. and across all system model designs (see Figure 2, p. 34) was achieved. All 10 federal regions are represented in this year’s data national salary rollup, however several job classes and regions did not reach required participation for reporting. Salary reporting follows Department of Justice and Federal Trade Commission issued Statements of Antitrust Enforcement Policy in Health Care.1 The text of the guidelines as they relate to salary surveys can be accessed online; the following are the most relevant extracts: The agencies will not challenge, absent extraordinary circumstances, provider participation in written surveys of a) prices for health care services, or b) wages, salaries or benefits of health care personnel, if the following conditions are satisfied: The survey is managed by a third party (e.g., a purchaser, government agency, health care consultant, academic institution or trade association). Information provided by survey participants is based on data more than three months old. There are at least five providers reporting data on which each disseminated statistic is based, no individual provider’s data represents more than 25% on a weighted basis of that statistic, and any information disseminated is sufficiently aggregated such that it would not allow recipients to identify the prices charged or compensation paid by any particular provider. 1 30 jems | october 2011
  31. 31. short course By Michael Greene, MBA/MSHA I n the JEMS 2011 Salary Workplace Survey, we followed a long day in the life of fictional character Duke Gracie, a field training officer and veteran paramedic at Flowing Springs EMS (FSEMS). For 28 years, running the JEMS Salary and Workplace Survey, conducted in cooperation with EMS consulting firm Fitch Associates, provides insight and understanding on key human resource topics. Continuing on the narrative from a year ago, we’ll check in not only on the fictional Duke Gracie, but also his boss Margaret Taylor and FSEMS. Potential bias/limitations This year, participating EMS organizations were given the option to complete the survey anonymously. Thirty-six respondents selected this option. With this selection the author and research staff are “blinded” to the e-mail or IP address of the respondents. Regardless of how information is submitted, raw data is only available to the research staff and author, and only aggregate data is published. Data accuracy is a primary objective. Survey results may be limited by the accuracy of respondent submitted data, organizational selective participation and an inconsistent pool of respondents year-toyear. Ambiguous, unclear or incomplete answers were unilaterally excluded from the dataset, rather than interpreted by the author, thus creating a potential additional bias. The survey represents all federal regions. But the individual states not responding were Massachusetts, New Hampshire, Vermont, Delaware, District of Columbia, Nevada and Wyoming. In total, 221 survey participants resulted in a 10% response rate. The median population of respondents is 50,000. Median annual call volume is 5,000. Nearly one-third (27.5%) of responses were from multirole fire services. In a 2011–2012 comparison, some salaries have declined. However, wage growth between 2006 and 2012, including the recession years of 2008–2009, ranks high among U.S. jobs (8%). Word of mouth and electronic media were the top tools used to find potential job candidates. New employees spend less time in orientation, 160 hours vs. 240 in 2011 and less time in field training, seven weeks down from 10 in 2011. One-third of employees are cleared to work after training without ever meeting with a medical director, with more than 20% “never” meeting with a medical director. Fourteen of 19 job categories experienced wage gains in 2012. Of 25 employee benefit categories, 15 were reported as being “reduced” and 14 were “eliminated.” The “JEMS Salary Workplace Survey” is a joint research project in collaboration with Fitch Associates, LLC (www. fitchassoc.com). For 28 years, Fitch Associates is the leading international emergency services consulting firm and serves a diverse range of clients. www.jems.com | october 2011 | jems 31
  32. 32. JEMS 2012 Salary Workplace Survey continued from page 31 This year, we find Duke as a newly minted Director Maggie Taylor leverages the same community paramedic, looking like a new technology in her recruitment strategy as man who is refreshed and self-assured. In a her industry colleagues. Recruitment via an freshly pressed uniform, Duke steps out of a “agency website” (31%) takes a narrow secFlowing Springs EMS Community Paramedic ond to “employee referral” (32%) in this year’s rig and pulls his sunglasses down over eyes in survey results. Other job websites, such as the bright early morning sunlight. “Another Monster.com and CareerBuilder.com (10%), day in paradise, saving lives and stomping as well as electronic mailing/list-servs (7%), out disease,” he thinks as he smiles to himself. round out the technological approach to In EMS, the human element—be it patient recruiting. Trade journal ads (4%) and conferor provider—is the driving force in the sys- ence booth recruiting (6%) are the least-used tem. As Michael F. Staley wrote in Igniting tools to find new employees, while local EMS the Leader Within, “Knowing how to motivate training programs (23%) continue to be fertile a person in emergency medical services ground to fill job openings. requires that you understand the person, the passion and the pay- Figure 1: Participant Distribution Survey Respondent Mix check—in that order.”2 After his internal struggle in Survey Responses n= 221 this past year’s survey, Duke is Regional Distribution now passionate about his work. See Regional Map (Figure 2), p. 34 “It’s not like building widgets Provider Model Distribution in some factory,” he tells fam% NUM ily and friends. “I save lives, and City/county third-service governmental 21.7 49 get paid for doing it. I can’t imagPrivate, not-for-profit organization 15.9 36 ine doing anything else!” (Doing Hospital-based 11.9 27 something else was exactly what Duke was pondering a year ago, Private, for profit company 8.8 20 but more on that later.) Fire department, single-role 0.9 2 Recruitment, Hiring Retention “I haven’t been ‘texted’ about open shifts in months now,” Duke comments as he walks into the FSEMS Communications Center. “Maggie must have gotten my replacement hired.” “Yup, you’ve been replaced,” replies Lyndy Grayson, the communications supervisor. “We got hundreds of hits on Monster and our Facebook page, tens of qualified candidates from Maggie’s Tweet and a huge response from the buzz on the streets. Your job was as hot as a software IPO [initial public offering].” “Tweet, Monster, Facebook, IPO … this sounds like ‘Maggie speak’ to me,” Duke responds with a snort. “Kids these days don’t use the same language as they used to.” Although these terms might sound unfamiliar to Duke, Flowing Springs EMS Executive 32 JEMS OCTOBER 2012 Fire department, multi-role 26.5 Seventy-six of 221 agencies reported vacancies within their organizations. They reported an average of three vacancies in 2012, down from five in 2011.3 Additionally, agencies continue to use part-time EMS personnel (67%) with nearly 30% reporting an increased interest from applicants in parttime employment. Of key frontline EMS positions, organizations continue to report a shortage of paramedic staff (39% vs. 40% in 2011) with an increase in a shortage of emergency medical dispatchers (28%), which is up 10% from 2011. The EMT-Basic category continues to exhibit a low percentage of reported shortages (18%). When positions are available, Flowing Springs EMS is able to hire qualified candidates that they recruit. Similarly, 83% of survey respondents report “hiring as usual” with a single-digit minority saying “hiring is on hold or frozen” (greater than 6%). Training, Education Medical Control 60 Public utility model 1.8 4 Other 12.4 23 Total Population Served n=201 % Less than 5,000 NUM 7.5 15 5,001-10,000 5.5 11 10,0001-25,000 21.9 44 25,001-50,000 15.4 31 50,001-100,000 12.9 26 100,001-250,000 15.4 31 250,001-500,000 10.0 20 500,001-1,000,000 9.0 18 More than 1,000,000 2.5 5 Call Requests vs. Transports Responses n=199 Transports n=199 % NUM % NUM Less than 1,000 15.1 30 22.6 45 1,001-5,000 37.2 74 36.7 73 5,001-15,000 17.6 35 17.6 35 15,001-30,000 12.6 25 9.5 19 30,001-50,000 7.0 14 8.5 17 50,001 - 70,000 5.5 11 2.0 4 70,001-90,000 2.5 5 2.0 4 Greater than 90,000 2.5 5 1.0 2 “Turn and burn,” quips Duke. “Those newbies are in and out of orientation quickly; they’re in the field at breakneck speed.” “It’s like a well-oiled machine,” Lyndy comments. “We’ve got the orientation process dialed in.” Little has changed this year over last in the subject matter covered in new employee orientation (e.g., policies, patient care guidelines and customer service). What has changed are the average hours the employee spends in orientation. In 2011, respondents indicated that 240 was the average number of hours of orientation training required for new EMS employees. The average number of hours in orientation has dropped to 160 hours for 2012. A concurrent drop in the “average length of time (weeks) an employee new  to your organization spends in the clearance/probation process before they are considered a fully functional and independent member of field staff” is noted in 2012 data. This is down from 10 weeks in 2011 to seven in 2012.
  33. 33. Choose 25 at www.jems.com/rs
  34. 34. JEMS 2012 Salary Workplace Survey continued from page 32 illustration amane kaneko Figure 2: Participant by Region Note: The number in parentheses is the number of respondents from that region. Standard Federal Regions established in 1974 by the Office of Emergency Management and Budget. The same regions are used by the federal Emergency Management Agency and the Centers for Medicare Medicaid Services. organizations, more frequently “What’s Dr. Mark’s stance on Figure 3: Participant Unit Hour Utilization than monthly at 27%, quarterly this ‘speed training’ process?” Avg Unit Hours/ Avg Call Volume/ Avg Unit Hour Response Volume at 16% and on-demand at 13%. Duke asks Lyndy. Week (A) Week (A) Utilization (B/A) “I guess I don’t know,” she Less than 1,000 (999) 310 19 0.06 responds. “He’s been a bit overDoing More 1,001–5,000 (4,999) 755 96 0.13 committed to the new commuDuke’s former partner and field 5,001–15,000 (14,999) 892 288 0.32 nity paramedic (CP) training. trainee Dave stops as he’s walk15,001–30,000 (29,999) 1,338 576 0.43 “Between that and trips to the ing by. He leans in the door, 30,001–50,000 (49,999) 2,002 960 0.48 rural health clinic, he hasn’t been “Hey old man, how’s it going as hands-on as in the past,” she with the new job?” Duke stands 50,001–70,000 (69,999) 3,278 1,344 0.41 adds, looking at a closed office and they shake hands and 70,001–90,000 (89,999) 4,258 1,728 0.41 door marked with “Mark Manexchange backslaps. Greater than 90,000 (99,999) 4,541 1,920 0.42 gus, MD—Medical Director.” “Good,” Duke responds. Duke thinks about how unusual that is, that it “believes that all aspects of the orga- “We’re always doing more; it’s job security, remembering the days when he and Mangus nization and provision of basic (including you know.” first responder) and advanced life support ran calls together. “It’s not enough to be a paramedic and field “Maggie needs to talk to him,” Duke tells emergency medical services (EMS) require the training officer. No, Duke’s got to be a comLyndy. “Now that the CP program is up and active involvement and participation of phy- munity paramedic too,” mocks Dave. “Looksicians.”4 How much time does your medical ing to the future’s not a bad thing,” responds running, he needs to get back in here.” Only 30% of “new employees who have director spend one-on-one with field staff? Duke, “Do more, or someone else gives you completed their probationary credentialing Few organizations report that continu- more to do. Besides, if I can make the system process must complete an interview with a ing education (CE) content is developed and work even better, then I’ve made a difference.” medical control physician as the final step delivered solely “in-house” (9%) or entirely “It’s all about productivity,” Lyndy chimes to clearance.” “outsourced” (15%); in fact, most use “both” in. “I’d rather be in Duke’s shoes than handing Worse yet, following the probationary (76%). CE occurs in a “traditional classroom” out parking tickets.” credentialing process, some field employees at 40% of the agencies responding. Less than City managers in a Tennessee commu(22%) “never” meet one-on-one with the med- 2% use “distributive methods” (e.g., video and nity may have found a win/win on producical control physician. Furthermore, in 2012 the Internet) exclusively; most, or 58%, use tivity and budget. Firefighters in Oak Ridge organizations reported field staff only met both methods. Monthly CE occurs at 49% of will be issuing parking tickets according to with the medical director “when one online publication.5 Whether it’s needed” (67%). to generate revenue or boost proFigure 4: Unit Hour Utilization Calculator Although the American Colductivity, doing more with less is the Total Unit Hours per Week = (A) lege of Emergency Physicians new norm. (Total number of staffed hours per week) (ACEP) doesn’t specify how As director of Flowing Springs EMS, Average Call Volume per Week = (B) much face-to-face time a mediMaggie knows it’s imperative that the (Total number of responses per week including transports, refusals, no transports, etc.) cal director needs to spend with service operates in an economically Unit Hour Utilization = (B/A) EMS caregivers, ACEP has stated sustainable and accountable model. 34 JEMS OCTOBER 2012
  35. 35. Choose 26 at www.jems.com/rs
  36. 36. JEMS 2012 Salary Survey continued from page 34 Mention productivity to staff, and you can see a visible shudder. If she mentions unit hour utilization (UHU), she can almost hear the chorus of moans. As a visionary leader, she sees great potential for a win/win in her new community paramedicine program. As uncertainty over the financial impact of the Patient Protection and Affordable Care Act (PPACA) leads the media headlines and political campaigns, some EMS systems are looking to expand their role in healthcare. PPACA places increased priority on prevention, wellness and improved outcomes within a healthcare system. According to Wikipedia.com, “An accountable care organization [ACO] is a Job Descriptions for Salary Data ChristopherBernard/istockphoto.com Choose 27 at www.jems.com/rs Choose 28 at www.jems.com/rs 36 JEMS OCTOBER 2012 Emergency Medical Technician (EMT-B): This section inquires about your full-time emergency medical technicians with basic EMS skill levels that may include additional skills, such as defibrillation, assisting patients with medications, and first aid based on the current National Standard Curriculum. Emergency Medical Technician-Intermediate (EMT-I): A full-time emergency medical technician–intermediate based on the current National Standard Curriculum. Emergency Medical Technician-Paramedic (EMT-P): A full-time emergency medical technician at the paramedic level based on the current National Standard Curriculum. Emergency Medical Dispatcher (EMD): A full-time emergency medical dispatcher that includes frontline communications positions. Duties include call taking, dispatch, or both. This person may also be certified as an EMT or paramedic. Communications/Dispatch Supervisor: A first-line supervisor of emergency medical dispatcher(s). Duties may include shift supervision, scheduling, performance evaluation as well as call taking, dispatch or both. This person may also be certified as an EMT or paramedic. Communications Manager: A senior management position of the EMS communication center. This position may oversee all operations, budgeting, hiring, quality and strategic planning. Field Training Officer: A full-time field training officer whose duties include field training of new employees or EMT students at all levels. This may be a full-time position or performed as part of regular shift work. Education Coordinator: An entry-level management position. This position may be charged with providing or coordinating continuing medical education, overseeing field training and supporting recertification of staff. In some organizations, duties may be blended with the quality management functions. Quality Coordinator/Manager: Traditionally, an entry-level management position that may be charged with coordinating and managing key clinical performance indicators (e.g., cardiac arrest survival) and quality assurance (e.g., run form review and complaint investigation). In some organizations, duties may be blended with the quality management functions.
  37. 37. healthcare organization characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients.” Can EMS do more? For a UHU calculator, see Figure 3, p 34. Using this year’s respondent data, participant UHU is presented in Figure 4, p. 34. Reported annual response volume and average unit hours were distributed by 52 weeks per year to determine an average UHU. Comparing that UHU to several published benchmarks the conclusion is clear.6–8 There’s capacity to do more within many EMS Financial Officer/Manager: A full-time management position focused on budget and finance that may also have blended duties related to the oversight of billing operations. Billing/Reimbursement Clerk: A frontline position responsible for processing patient care records, billing payers and collecting reimbursement for services. Billing/Reimbursement Manager: Traditionally a middle management position responsible for supervising the processing of patient care records, billing payers and collecting reimbursement for services. Fleet Mechanic: A frontline mechanic in fleet services whose duties may include preventative maintenance, scheduled/unscheduled maintenance, vehicle remounting/replacement and purchase specifications. Fleet Manager: A middle management position charged with leading fleet services. Duties may include supervising mechanics, coordinating preventative maintenance, vehicle remounting/replacement and purchase specifications. Information Technology/Systems Manager: This position may or may not be a management position. Responsibilities may include maintaining technological infrastructure (e.g., e-mail, servers, networks, etc.) for the organization. Logistics/Supply Manager: May be management position or not. Responsibilities may include supply purchasing, storage, distribution and tracking. This position may also manage restocking of stations or ambulances. EMS Operations Manager/EMS Chief: A middle- to upper-management position responsible for managing day-to-day operations. This position may have field supervisors and other frontline leadership positions reporting directly to them. Administrative Director/EMS Administrative Chief: A senior-level management position that traditionally includes oversight of all nonoperations functions and may include finance, billing/reimbursement and human resources. Executive Director/Highest-Ranking EMS Chief: A senior leader of all EMS functions whose duties include strategic planning, constituent relations and leading senior management team. Choose 29 at www.jems.com/rs www.jems.com OCTOBER 2012 JEMS 37
  38. 38. JEMS 2012 Salary Workplace Survey continued from page 37 to healthcare, personal care and social assistance … are projected to have Quality the fastest job growth between 2010 Education EMT EMT-I EMT-P EM Dispatcher Assurance and 2020.”14 Coordinator Manager Listed as one of the “top five industries for salary growth,” health2006 Average (Max.) $39,143 $37,485 $51,537 $40,845 $63,444 $65,073 care workers have gained the biggest 2012 Average (Max.) $45,179 $40,059 $55,696 $46,777 $58,342 $69,017 changes in wages, 9.4%, since 2006.15 Loss/Gain (+/-) 15% 7% 8% 15% -8% 6% What does that mean to EMS workers? There’s reason for some optimism Note: Survey results for the following are available at jems.com: Communications supervisor, communications manager, chief financial officer, billing manger, fleet mechanic, information technology manager, operations manager, administrative director, executive director. in EMS wages. Twelve job categories from the 2006 JEMS Salary and Workplace Survey were compared to 2012 data organizations, whether it be writing parking of Labor Statistics (BLS) reported that the tickets or becoming more accountable for unemployment rate ticked up a tenth of (See Figure 5, at left).16 Despite losses in two the health of your community. If you had to percent to 8.2.13 Yet a February 2012 BLS individual categories, EMS salaries increased choose between the two, it doesn’t seem to be report on employment projections opened 8% over that timeframe. This increase places a difficult decision; EMS is at its best when it’s with, “Industries and occupations related EMS with general healthcare as one of the caring for patients. Can CP programs make a dif- Figure 6: Existing Employee Benefits ference? According to the Agency Partially Not Paid by Reduced Eliminated for Healthcare Research and QualPaid by N this Year this Year Applicable Employer ity (AHRQ), they do.9 MedStar Employer Health’s Community Health ProNew Employee Relocation Expenses 98% 1% 6% 0% 4% 112 gram in Fort Worth, Texas, has Life Insurance 17% 58% 26% 0% 0% 113 saved millions in emergency room Line-of-Duty-Death Insurance 41% 46% 13% 0% 0% 113 charges and reduced 9-1-1 use.10 The Centers for Medicare and MedMajor Medical (Employee) 5% 26% 68% 1% 0% 112 icaid Services (CMS) must think Major Medical (Employee’s Family) 14% 11% 73% 2% 1% 114 so as well. In July, the CMS Health Short-term Disability 28% 42% 28% 1% 1% 111 Care Innovations Grant program Long-term Disability 31% 38% 29% 2% 0% 109 awarded Prosser Memorial Hospital in Washington almost $1.5 Employee Assistance Program 18% 72% 11% 0% 0% 113 million to develop and provide a Dental 17% 18% 65% 1% 0% 113 community paramedic program.11 Optical/Vision 25% 15% 55% 3% 1% 110 Which model for community paramedicine should you Liability Insurance 36% 53% 9% 1% 1% 110 choose? It could be a “new niche EMS Tuition Reimbursement 19% 40% 33% 3% 5% 113 for EMS,” according to the August College Tuition Reimbursement 43% 13% 35% 3% 6% 111 JEMS article “It Takes a Village.”12 Scholarship Fund for Employee’s Children 97% 0% 2% 1% 0% 111 The article identifies the key component of the multiple CP modRetirement or Pension Plan 8% 13% 74% 3% 2% 115 els as the needs of and resources Retirement or Pension Plan 86% 5% 5% 1% 1% 111 in the community. “They all feaProfit Sharing 96% 1% 2% 0% 1% 113 ture aspects of home assessment, Stock Purchase Program 74% 26% 0% 0% 0% 112 home care and patient followup. They all focus resources on Shift Differential Pay 12% 73% 14% 0% 2% 113 target population, follow-up care Uniform Allowance 64% 16% 18% 1% 1% 110 and prevention,” the article states. Health Club Membership Reimbursement 27% 69% 4% 1% 0% 113 The take-home message: “Community need” should drive model Paid Time Off (PTO) Combined Benefit 97% 0% 2% 0% 1% 110 Leave development and implementation, creating a partnership in the Daycare Reimbursement 94% 6% 0% 0% 1% 111 healthcare of the community. Dry-cleaning of Uniforms 95% 2% 3% 1% 0% 112 Figure 5: Annual Salary Growth Index from 2006 to 2012 With Less? Meal Service 99% 1% 0% 0% 0% 110 In May 2012, the U.S. Bureau Concierge Service 98% 1% 6% 0% 4% 112 38 JEMS OCTOBER 2012
  39. 39. National Region X Region IX Region VIII Region VII Region VI Region V Region IV Region III Region II Show Me the Money “Daylight is burning,” declares Duke as he ends the conversation and heads toward the Communications Center for a schedule of today’s community visits. During his workday Duke will visit a number of “frequent flyers” that have been identified within the healthcare community as needing screening and help with chronic care. One of Duke’s congestive heart failure patients wrote in recent thank-you card to FSEMS that Duke saved him from an ambulance trip to the hospital. “He listened to me breathe, took a blood pressure and made a complete assessment. Then he called my doctor, who adjusted my pills. He did all of this before I was really sick,” Mr. Write wrote, adding that Duke even stopped by later to check on him again that day, concluding with a thank you to both Duke and FSEMS for good community service. National salaries for 2012 are broken down into several categories and stratified by region (see Figure 7, at right) and call volume (see Figure 8, p. 40). The job descriptions used in the survey are also presented in “Job Descriptions for Salary Data,” p. 36–37. Regional data is reported where antitrust guidelines were achieved. All wages are adjusted to reflect a 40-hour workweek for comparison. See Figure 9, p. 40, for instructions on calculating wages for comparison to different shift lengths. Author’s note: Comparing 2012 salary data to 2011 appears unreliable due to a qualitative participation bias. Data reported for 2011 national average salaries was significantly higher than data EMT   n= Average 10th 25th 50th 75th 90th Max Hourly Average n= Average 10th 25th 50th 75th 90th n= Average 10th 25th 50th 75th 90th n= Average 10th 25th 50th 75th 90th n= Average 10th 25th 50th 75th 90th n= Average 10th 25th 50th 75th 90th n= Average 10th 25th 50th 75th 90th n= Average 10th 25th 50th 75th 90th n= Average 10th 25th 50th 75th 90th n= Average 10th 25th 50th 75th 90th n= Average 10th 25th 50th 75th 90th EMT-I EMT-P 105 $27,747 $10,400 $18,342 $20,800 $26,398 $32,885 $66,789 $13.34 3 N/A N/A N/A N/A N/A N/A 6 $25,441 $17,520 $20,300 $29,443 $33,181 $33,852 11 $28,115 $19,635 $21,226 $25,230 $33,134 $41,021 11 $25,402 $17,977 $19,559 $22,763 $26,731 $35,547 23 $27,685 $21,062 $24,357 $26,499 $28,850 $38,759 7 $35.254 $18,698 $23,000 $31,434 $42,127 $55,220 17 $25,824 $19,215 $20,800 $25,938 $28,787 $32,349 9 $28,929 $19,479 $22,693 $29,203 $33,301 $40,652 12 $27,723 $17,385 $20,592 $23,017 $31,808 $46,475 5 $28,418 $20,202 $23,504 $26,578 $34,008 $37,603 39 $29,542 $16,672 $19,366 $23,050 $27,040 $32,051 $66,480 $14.20 1 N/A N/A N/A N/A N/A N/A 0 N/A N/A N/A N/A N/A N/A 3 N/A N/A N/A N/A N/A N/A 8 $23,965 $18,273 $21,458 $23,837 $26,287 $28,792 7 $31,501 $26,333 $27,872 $29,869 $36,090 $37,440 1 N/A N/A N/A N/A N/A N/A 5 $33,132 $21,919 $22,880 $31,117 $35,657 $47,101 5 $28,615 $22,010 $23,024 $23,400 $28,600 $39,470 3 N/A N/A N/A N/A N/A N/A 6 $35,057 $24,835 $26,559 $29,947 $34,887 $50,388 109 $37,909 $21,174 $26,000 $29,000 $35,818 $43,867 $79,040 $18.23 4 N/A N/A N/A N/A N/A N/A 4 N/A N/A N/A N/A N/A N/A 13 $37,258 $26,789 $27,851 $34,299 $44,286 $51,027 14 $34,328 $24,425 $26,242 $31,986 $41,776 $53,400 22 $37,185 $28,291 $29,796 $33,966 $40,082 $46,413 8 $39,857 $27,331 $33,704 $37,183 $48,607 $52,134 15 $38,950 $26,525 $27,602 $33,342 $42,949 $61,113 10 $39,388 $28,596 $31,767 $37,835 $47,060 $54,199 11 $37,189 $22,384 $33,280 $38,251 $43,212 $47,445 7 $41,438 $29,993 $35,981 $39,000 $42,026 $54,134 Field Training Officer 35 $45,055 $21,840 $25,552 $30,319 $40,128 $55,959 $95,000 $21.66 0 N/A N/A N/A N/A N/A N/A 2 N/A N/A N/A N/A N/A N/A 5 $35,784 $28,392 $30,888 $39,175 $40,128 $41,251 2 N/A N/A N/A N/A N/A N/A 9 $42,521 $23,587 $25,520 $30,992 $58,032 $64,856 3 N/A N/A N/A N/A N/A N/A 2 N/A N/A N/A N/A N/A N/A 2 N/A N/A N/A N/A N/A N/A 7 $45,424 $24,111 $31,338 $37,272 $56,145 $71,633 3 N/A N/A N/A N/A N/A N/A EM Dispatcher Education Coordinator 44 $36,327 $20,096 $23,036 $29,900 $35,770 $42,583 $61,714 $17.47 2 N/A N/A N/A N/A N/A N/A 3 N/A N/A N/A N/A N/A N/A 7 $33,585 $24,369 $27,872 $32,531 $34,029 $44,040 6 $38,294 $29,204 $36,006 $38,480 $41,922 $47,199 10 $32,662 $25,228 $28,642 $31,934 $36,494 $41,292 2 N/A N/A N/A N/A N/A N/A 5 $37,325 $28,445 $36,011 $40,000 $42,213 $43,885 4 N/A N/A N/A N/A N/A N/A 5 $38,420 $26,170 $35,280 $43,750 $45,136 $46,758 0 N/A N/A N/A N/A N/A N/A 45 $55,570 $30,160 $39,092 $43,867 $52,894 $63,128 $89,837 $26.72 1 N/A N/A N/A N/A N/A N/A 1 N/A N/A N/A N/A N/A N/A 5 $52,537 $47,520 $52,998 $60,008 $76,460 $79,718 8 $58,405 $39,822 $48,203 $57,662 $67,345 $80,334 7 $50,337 $41,191 $46,500 $52,000 $53,040 $56,431 4 N/A N/A N/A N/A N/A N/A 6 $47,981 $31,080 $34,497 $46,693 $57,849 $66,171 5 $66,083 $55,371 $60,000 $66,560 $72,800 $76,382 6 $51,549 $37,482 $42,115 $50,397 $56,684 $66,768 2 N/A N/A N/A N/A N/A N/A www.jems.com Quality Assurance Manager 28 $60,502 $29,719 $45,608 $52,894 $58,016 $66,919 $91,243 $29.09 1 N/A N/A N/A N/A N/A N/A 1 N/A N/A N/A N/A N/A N/A 5 $53,150 $48,639 $52,582 $52,998 $56,160 $57,264 3 N/A N/A N/A N/A N/A N/A 5 $51,134 $36,177 $45,864 $53,227 $60,300 $64,056 3 N/A N/A N/A N/A N/A N/A 2 N/A N/A N/A N/A N/A N/A 5 $65,358 $59,779 $62,400 $65,562 $67,995 $70,878 3 N/A N/A N/A N/A N/A N/A 0 N/A N/A N/A N/A N/A N/A Billing Clerk Supply Clerk 47 $33,397 $20,509 $25,651 $27,040 $31,200 $37,380 $62,387 $16.06 3 N/A N/A N/A N/A N/A N/A 1 N/A N/A N/A N/A N/A N/A 10 $31,801 $25,097 $27,238 $31,325 $34,679 $37,502 8 $29,463 $26,824 $27,028 $29,040 $30,679 $32,475 9 $33,532 $26,000 $26,624 $34,195 $38,813 $40,718 0 N/A N/A N/A N/A N/A N/A 4 N/A N/A N/A N/A N/A N/A 5 $37,417 $30,716 $36,712 $40,685 $41,371 $41,508 4 N/A N/A N/A N/A N/A N/A 0 N/A N/A N/A N/A N/A N/A 22 $48,511 $18,720 $25,272 $35,261 $44,023 $64,067 $97,850 $23.32 1 N/A N/A N/A N/A N/A N/A 0 N/A N/A N/A N/A N/A N/A 3 N/A N/A N/A N/A N/A N/A 6 $58,423 $32,001 $41,241 $61,845 $64,592 $81,425 3 N/A N/A N/A N/A N/A N/A 3 N/A N/A N/A N/A N/A N/A 3 N/A N/A N/A N/A N/A N/A 4 N/A N/A N/A N/A N/A N/A 2 N/A N/A N/A N/A N/A N/A 0 N/A N/A N/A N/A N/A N/A Note: Survey results for the following are available at jems.com: Communications supervisor, communications manager, chief financial officer, billing manger, fleet mechanic, information technology, operations manager, administrative director executive director. Figure 7: Salaries by Region Region I best jobs for wage growth. Not all the news is good. Organizational “belt tightening” is reflected in the 2012 Employee Benefits data (See Figure 6, below left.). Twenty of 25 benefits categories were reduced or eliminated this year. Taking the biggest hits, the categories of EMS reimbursement (5%) and college tuition reimbursement (6%) and new employee relocation expenses (4%) were eliminated by organizations reporting. JEMS 39 OCTOBER 2012
  40. 40. JEMS 2012 Salary Workplace Survey continued from page 39 Figure 8: Salaries by Call Volume Less than 1,000 1,001 - 5,000 5,001 - 15,000 15,001 - 50,000 Greater than 50,000 n= Average 10th 25th 50th 75th 90th n= Average 10th 25th 50th 75th 90th n= Average 10th 25th 50th 75th 90th n= Average 10th 25th 50th 75th 90th n= Average 10th 25th 50th 75th 90th EMT-I EMT-P Field Training Officer EM Dispatcher Education Coordinator Quality Assurance Manger Billing Clerk Supply Clerk 14 5 17 5 6 5 5 6 5 $19,917 $23,858 $30,674 $35,957 $44,993 31 $20,851 $24,003 $30,659 $34,739 $35,673 11 $25,578 $31,846 $38,195 $40,976 $46,883 30 $26,707 $30,888 $40,128 $52,000 $69,934 7 $31,429 $33,119 $36,161 $42,173 $43,846 16 $44,450 $52,998 $60,000 $81,120 $81,582 13 $48,805 $52,998 $58,000 $62,400 $79,706 9 $26,671 $26,996 $28,915 $33,755 $40,092 14 $34,212 43,410 $60,320 $69,000 $72,112 6 $18,699 $19,864 $23,754 $28,694 $34,545 27 $17,160 $22,151 $23,442 $30,670 $46,717 8 $26,169 27,945 $34,320 $41,481 $54,199 25 $37,183 $37,734 $39,175 $45,594 $56,584 7 $21,934 $29,250 $35,646 $41,259 $42,401 9 $36,858 $51,144 $52,285 $61,300 $71,552 15 $52,308 $55,994 $60,300 $65,000 $67,009 6 $24,923 $26,109 $31,325 $36,778 $40,348 15 $32,760 $37,700 $43,118 $59,384 $66,387 5 $19,386 $23,601 $27,642 $31,317 $35,260 13 $21,996 $25,350 $29,132 $31,558 $33,540 7 $27,144 $29,709 $34,112 $42,308 $46,263 17 $24,048 $28,256 $45,302 $54,713 $61,318 9 $28,417 $35,528 $41,600 $45,000 $45,294 7 $40,782 $42,934 $52,894 $59,266 $76,935 5 $50,148 $54,573 $66,770 $85,868 $89,655 5 $27,040 $27,581 $31,200 $37,877 $54,898 5 $19,402 $20,426 $63,369 $65,000 $84,710 2 $24,011 $27,579 $35,755 $41,856 $46,432 6 $22,233 $23,335 $25,506 $28,808 $36,660 3 $27,275 $28,148 $42,389 $49,140 $62,519 5 $34,924 $37,088 $44,822 $51,019 $60,872 1 $31,889 $35,262 $37,844 $41,427 $43,704 1 $40,230 $40,455 $41,126 $44,871 $50,627 3 $49,559 $50,612 $52,368 $57,659 $60,834 1 $32,292 $32,967 $34,592 $36,242 $36,961 2 N/A N/A N/A N/A N/A 1 $17,091 $17,328 $17,723 $19,822 $21,081 N/A N/A N/A N/A N/A $22,425 $22,823 $23,486 $24,149 $24,547 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Note: Survey results for the following are available at jems.com: Communications supervisor, communications manager, chief financial officer, billing manger, fleet mechanic, information technologymanager, operations manager, administrative director executive director. EMT   reported in 2010 and 2012. Figure 9: Calculating Alternative Shift Schedule Wages As previously noted, selective See bonus salary All wages are calculated based on 2,080 hours annually (40-hour work week). participation and a different figure online at jems. To calculate alternative shift schedules, divide an annual wage for a position by 2,080 hours to pool of respondents year-tocom/journal. find the hourly rate and then multiply the result by the annual number of straight hours for the shift type of interest. Below are examples for the three most common average weekly hours. year creates this situation outA just-released Pew side of survey and researcher Research Center survey Average Work Week Straight Hours x 52 weeks/year Annual Straight Hours control. Visit jems.com/jourreports that a $70,000 annual 40 hours 40 straight hours x 52 weeks 2,080 hours nal and click on the salary surincome is needed for a fam48 hours 52 straight hours x 52 weeks 2,704 hours vey for an extended figure with ily of four to lead a middle56 hours 64 straight hours x 52 weeks 3,328 hours additional job categories not class lifestyle in the U.S. Using shown here as well as a comthe Pew study definition of EMTs and education coordinators demon- middle-class lifestyle, only three of the EMS plete comparison of 2011–2012 data. Out of 19 job categories, 14 reported sal- strated a moderate loss in wages, minus two job categories—operations manager, adminary growth in comparison to 2010 wages. The and minus four percent respectively. Chief istrative director and executive director— billing manager position showed no growth financial officers (CFO) and supply coordina- would allow a single-income family of four in wages between 2010 and 2012 (see bonus tors took the greatest wage losses at -9% and to live middle-class lifestyle .17 In comparison, -14%, respectively. salary figure online at jems.com/journal). a registered nurse receives an annual salary 40 JEMS OCTOBER 2012

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