The People, Process, & Progress Podcast - 5 Ways to Reduce Level Zero Incidents in EMS and Improve EMS Employee Retention | KEV Talks #33

Episode Date: June 27, 2023

In 5 Ways to Reduce Level Zero Incidents in EMS and Improve EMS Employee Retention, I elaborate on how Emergency Medical Services (EMS) leaders can improve EMS worker retention and reduce the risk of having "level zero" EMS systems.

What if you called 911 and nobody showed up? What if you and your community called 911 6,300 times and nobody immediately showed up because there was no staff? Well, according to the Bureau of Emergency Communications data for Multnomah County, Oregon, that happened between January 17th and June 8th, where there were level zero incidents. Level zero means there's no crews available, which is an awful place for an emergency medical services system to be, but it happened. But it's not just this example. It's also seeing employee retention always an issue on emergency medical services, surveys, reports, industry kind of papers. And I'm going to share on KevTalks episode 33, five ways I believe we can improve employee retention, which then by default will help us reduce level zero incidents in the emergency medical system. But first, it's time to lace up, chalk up, get logged in and get locked on to the KevTalks podcast. By way of enlightening guest

interviews and solo episodes with me, your host, Kevin Pinnell, I will share people's intriguing stories, industry-leading best practice processes, so that team leaders like you can make progress. Thanks for being here. Please subscribe and share the show and go to the KevTalksPod.com website for more information. Now, let's get into this episode in 3, 2, 1. Hey, everybody. Thanks for sticking with the show. So let's jump right into this list, KevTalks 33, how to reduce level zero incidents and improve employee retention in EMS.

The first thing I think is EMS has to be further professionalized along the lines of how fire departments and police departments do that. And what I mean is that they typically have a very stringent screening process, right? Background checks. Some have polygraphs to be police. They have an academy. So once you've gone through the initial application, you take a test, then you have interviews,

right? Including with the chief, you then, like I said, police take a poly. Then you have interviews, right, including with the chief. You then, like I said, police take a polygraph for fire, not necessarily. And you can have a panel interview with your peers, things like that. And then there's a physical screening test. And I'll get into that as my number two, honestly, for EMS. And then you have an academy, a paramilitaryilitary academy right for a given length of time and it can depend right from a month two months depends on the departments and then after that

you're out on the street you're with a training officer and you're shadowed before you're released to work by yourself probably more so police fire you're the rookie right you do that kind of thing you've seen fire movies or shows that's that's real that happens but you're the rookie, right? You do that kind of thing. If you've seen fire movies or shows, that's real. That happens. But you're out there doing the job, and now you're going to work. You have standards you have to meet to get advanced. So it's a very well-structured program within police and fire. Now, that's not to say that, and some of you that are listening, let me know at kevin at kevtalkspod.com email address if you want, or comments on this post on the

kevtalkspPod.com email address if you want or comments on this post on the KevTalksPod.com website. There are some elements of that in some EMS departments, but not a lot, right? And by EMS, I'm really talking to the emergency medical systems departments that don't necessarily fall under a fire department where it's a fire EMS department, but where it's a standalone or they're not held to the same standards. I think they should be. I think I, when I got into EMS, didn't really get a physical test. It was a test on a machine where you move weight with your legs and your arms and can you move your shoulders. And it's super easy, right?

It's not really a test of having to carry a med box and the EKG up three flights of steps and then being able to talk or being able to do CPR or carry a chair, you know, a stair chair, but it should be, it should be a functional test. One of the screening tests for the fire department is you do this sequence kind of obstacle course thing where you carry equipment, you raise a ladder, you crawl under a tunnel, you pull hose. So things you're going to do in the job EMS industry could easily have a standard like that, right? Of pulling a stretcher out that's weighted or lifting something up. Like if you've seen a landmine workout right? Of pulling a stretcher out that's weighted or lifting something up. Like if you've seen a landmine workout where one end of a barbell

is on the ground and you lift one end, something to simulate. I'm lifting the end of something. I'm carrying two things in my hand. I'm going to sit and do CPR for a minute. I'm then even going to maybe have to jog a little bit. I'm going to put on a vest and a helmet. You know, now in the days of active shooters, a lot of departments have tactical gear, so see what that's like. But you can see EMS isn't as professional from the standards of the entry point and then the evolution of it across the board for advancement, for rank promotion, things like that. And it should be. I think that gives people purpose. It gets you better people coming in, right? That if I'm going to work harder physically to be in better shape and I have to, to get this job, then it's also going to help me manage stress down the line.

Because that's another huge issue. And I'll get into that too. It's on this list is stress and burnout, PTSD, and all the horrible stuff that public safety people see. EMS workers, paramedics, EMTs are not immune to that. So first for me is you got to further professionalize it, right? Set some national standards that folks can use as an outline, set some state standards, and then go from there. The second is that to increase physical fitness requirements to get in and stay in EMS. And this has to do with the first one, but there should be a standard by and large. When, if you look at pictures, photos of EMS on the street compared to police and fire, and that doesn't mean that everyone in police and fire is a triathlete, um, they're out of shape.

Right. And that's unfortunate. And it's not good for you. And I talked about this on the EMS one stop podcast with Rob Lawrence about health and safety. You know, you eat in EMS rooms, which are typically at hospitals filled with snacks after you've dropped your patients off. It's all processed. Some have salads and better sandwiches, and that's awesome to see better drink choices. There's a lot of parking and eating at fast foods, fast food places. It's hard to, you know, it's more work rather. It's not that hard to pack your lunch and take healthier choices or in the EMS room, you know, help revise those from hospitals and make more vegetables and fruits available and things like that. And like I said, some places are

doing that, but there should be physical fitness requirements, a screening test that mirrors what you're going to do in EMS, the type of work. There should be more interview screening. And I was fortunately a part of an organization that did pretty good interview screening. The physical screening was easy. That's when I mentioned the machine. That wasn't helpful. But there was a panel interview, individual interview. So it was pretty good.

And it was a process that I would emulate for sure. But just to get in, folks should know you have to be able to do this many push-ups, maybe walk this or run this amount. You could mirror it off a police fire test and it shouldn't have to be quite as high. But let's say I'm an EMS provider, I'm an EMT or a paramedic, and I want to go work with police as a tactical medic. Well, you do have to meet physical standards there because you got to be able to keep up and pull patients and all that. So it doesn't have to be the extreme of a SWAT team level test, but there should be minimum entry standards of physical fitness and health for EMS. And if you don't meet them, then they shouldn't get hired because it's

for the benefit, not just of the system to stay staffed, but of the individual to stay healthy and manage their stress and have lower blood pressure. All the good reasons that physical fitness exists. So first, professionalized EMS like police and firearm more so within the way they bring folks in in the screening process. Second, physical fitness standards for EMS workers, you know, set a standard and folks have to meet it. The third is to provide better mental health. Unfortunately and unfortunately, this has happened more in the past probably three or

four years, you know, especially with COVID and burnout. But a lot of folks don't get good help. And often EAP, Employee Assistance Program, doesn't fit the bill. It doesn't work. Or they don't want to use it. So better peer support programs. And I've had folks on this podcast when it was called Between the Slides years ago that talked about peer support. And I'll link to that in the description on the show about EMTs talking to EMTs, medics to medics, nurses to nurses, that kind of stuff. That makes

a difference, right? But we're trained. We're not just having a chat over drinks and things like that. And this is then connected to, to me, kind of the weakness of our overall mental health system, right? The crux of our mental health system to me is we have community service places and then all these online services. Right. But I don't see a lot about mental health services like, you know, years ago there were mental health hospitals and they weren't always super duper. But the infrastructure for mental health was a lot better. And so I think we should, you know, reuse some of these billions of dollars we're given other other countries or devoting to research on things that are just someone's pet project. There's a lot of money out there that we could use for this. But better mental health, making sure that after critical calls, we have interventions,

that we do debriefs, that we give folks time off. Part of that mental health has to do with their shifts. Don't let people work above a certain number of shifts. That was a great thing that my leader supported that I put in place of you can't work more than X number of hours a week because it's not good for you. You never know we're going to have that bad call. And even if you have a bunch of basic life support, boring calls in a row after 50 of those, you're exhausted, all the things, right? It's not safe for you to drive. It's not safe for you to

make medical decisions while treating somebody. So part of that mental health can start at your organization, at your EMS system by looking at how long you do or don't let people work. Do you have staff or therapists on site, right? Or resources that you can co-op with your city or county or locality or township. For my peeps in Pittsburgh where my family's from. So think about that. How can you shore up the mental health for your EMS providers so they don't get burned out, they don't develop PTSD as early, or they can talk about it. And we reduce suicide from public safety folks and then keep folks in the job that they want to do or they wanted to do when they

started because we're there for them. So we've screened them harder. We've said you have to be in this certain amount of shape for their own good and for the good of the system. And now we're going to provide better mental health either on site in partnership with our localities or get them subscriptions to those online help things. They can use it when they want. And the fourth thing to me is that because it's easy to blame the locality, right? Like Multnomah County to say, oh, it's your fault. Or, oh, in this instance, it was a company AMR. It's your fault. But you know what?

It's everyone's fault. Did the locality agree and help fund the EMS department or help hold their standards? Or are they partnered in public safety? They've not talked to each other. Is it the agency's fault because they didn't backfill and manage their staff and their shifts well enough? I think it's a combination. But a problem is if people aren't paying and it's a bill for service type EMS organization and people aren't paying, then that organization isn't making money. And how are they going to pay people to stay on the job that are more professional and

in better shape and getting better mental health? What I think for number four is that that federal funding that we're spending on random stuff, we can use and put in the EMS systems throughout the United States to help replace lost revenue, right? Because that's a huge factor of how EMS systems are struggling or can't keep people staffed or give them raises to keep them on the job and have that retention or use the money for recruitment, which is another thing that's always on EMS surveys that's a challenge.

Because non-payment, when someone uses the EMS system to go to the doctor and it's not an emergency emergency is a huge practical negative hit that has probably negatively impacted that organization and many organizations across the country. And so federal or money that the federal government's given to states subsidize EMS agencies, right? Whether they're a local entity or a private industry, it's a critically important role that EMS plays in the community that they're in. And so why not use some of this money that we have sitting around for whatever random, you know, toilet seat in space research that we're doing or some random thing and give it to EMS

systems. They have to meet qualifications, do the whole grant application thing, all that jazz, but have it available. The fifth thing to me is a way to expand the resources that you have. And that's to use more basic life support crews. And here's what I mean by that. If you're not in public safety, basic life support is like an emergency medical technician. I'm not necessarily starting an IV. I'm not going to put a breathing tube in someone's throat. I'm not scoped to do that. And I can't push most medications or certain medications. There's some advanced emergency medical technicians that can start IVs and give fluid and do those kinds of things. But by and large, it's breathing tubes, drugs, and kind of higher level IVs and interventions that EMTs don't do. Now, before you can do any good advanced life

support, which is those things, the breathing tubes, the medications, the shocking at a higher level. And when I say shocking, that's what those like an AED, you have automated external defibrillator in your workplace. Anybody can use those in EMT for sure, or they can use the defibrillator on that mode where it works like that. But to that extent, you have to have good BLS before you can have good ALS. And a lot of the calls that happen on the street can be taken by basic life support crews, right? It's not a critical injury. And now, of course, if there is, you send an advanced life support provider there, they could have a single vehicle or you have advanced life support crews as well, but also

basic life support crews. And again, this is a practice that I was fortunate to be part of where I worked before, where basic life support crews do the non-emergent stuff. Advanced life support crews do the emergency calls. That means you have a paramedic and an EMT on the ambulance. But then also getting into, hey, there's an emergent call, but it's not critical. It's, you know, I have a sore elbow. We'll send two EMTs. They can cover that.

And if they need help based on the discretion they have as certified EMTs, and we've signed them off after our orientation because we're a more professional organization, then they can say, oh, you know what? I need ALS because now this person fainted and we're doing CP, right? They can escalate the resource request as needed. So I think that's a huge advantage in using resources that you have because paramedics are going to cost more, you pay them more. There's probably less of them than EMTs, right,

because it takes, what, a year and a half, two years to get your paramedic, depending on the program that you're doing. And not every call needs them. So I know it's not as simple as these five things, but I think these are a good primer for EMS systems or anyone that's related or listening that is in the public safety industry is to me to help with retention that then helps us reduce level zero incidents. Got to make EMS more professional, number one, have a better entry point, have some sort of academy, right?

Paramilitary type thing, hold people to a higher standard. Number two, part of that higher standard is better physical fitness for EMS. EMS is out of shape. Got to get in better shape. Number three, provide better mental health support on site and in partnership with local folks and online resources. Number four, federal funding to make up the gap for folks that aren't paying. And that's a lot. That's a big, big financial hit. And number five, use basic life support crews more for emergency calls that aren't requiring advanced life support. I hope this is a helpful primer. I'll share this, of course, on KevTalksPod.com. And you can follow me at KevTalksPod on Twitter and Instagram. I've got a YouTube channel as well called KevTalksPodcast. Go figure.

You can find me on LinkedIn, Kevin Pinnell, PMP, Project Management Professional. Thank you for coming back to the KevTalksPodcast, for staying here, for being here throughout this podcasting journey. Have some great conversations coming up with interesting people in the future and more helpful topics like this. So remember, everybody, have that plan so you can keep your teams aligned. Stay informed with facts, not fear, so you can make good data-driven decisions. And get involved so you and your team can make a difference.

Godspeed, y'all.