The People, Process, & Progress Podcast - Recruitment and Retention Still Plague Emergency Medical Services | BTS34B

Episode Date: August 13, 2019

Many of the same issues are from the 2018 EMS Trend Report. Here I talk about the differences and the ongoing problems in the EMS profession.The full write-up at https://kevtalkspod.com/bts-ep34-b-updates-from-the-2019-ems-trend-report/

Please silence your cell phones, hold all sidebar conversations to a minimum, and we'll get started with Between the Slides in three, two, one. Hey, everybody. Welcome back to BetweenTheSlides.com. I'm Kevin Pannell. A little addendum to episode 34 where I focused on the 2018 EMS Trend Report. I'm going to catch up with the 2019 EMS Trend Report data. I hadn't reviewed that.

It came out in July. Recruitment recruitment and retention still tops of the list. This is after another 3,000 folks were surveyed by Fitch & Associates, EMS1.com, Pulsara, the National EMS Management Association. And so same group. You can go to EMS1.com and download a copy of this. I highly recommend it. There's some really good information in there this year just like last year and the other three.

This is the fourth report. So again, recruitment and retention still top the list. Reimbursement issues for the EMS industry still also very important. And provider mental health. And in the news lately, I've seen a lot, and unfortunately close to home, some of my friends and colleagues have been affected

by the effects of provider mental health, meaning folks that have taken their own life. And if you're listening to this right now and you're in a dark spot and you think you have no help and no one cares, we do. We all do. We have resources for you. We can sit down and talk, have a cup of coffee, whatever. But if you are in that place where you feel like there is no help, where you've seen horrible things, or you just feel like there's just nowhere else to go, there is. There's this life to go. So stay here.

Reach out. Reach out to your coworker or your family or your friends. Just let us try and help you. It's going to be much better for everyone involved if you do, including and especially you and your family because you do not want to leave them behind wondering what could they have done. Should they have called you? Should they have reached out more? And that's the after effects that a lot of folks don't talk about as much is the people

that are left behind. So that's a huge issue. I want all of you, everyone listening, everyone involved in public safety, health, business, whatever, stay in this world, enjoy it, live involved in public safety, health, business, whatever, stay in this world. Enjoy it. Live through the hard times. Push through the hard times. And reach out and ask for help.

And I will post, again, resources. Go back and listen to Episode 28 I had with Ben Gomes. There's a whole bunch of resources on that website as well. There's the Code Green campaign. There's a national suicide hotline. There's many ways to reach out. Start with a simple conversation with somebody that knows you and then go from there. So an area I didn't really talk about was medical director perspective and really well highlighted again in this report.

There's a big pretty big disparity between you know what medical directors think and what field providers think and I touched on that kind of from the overall perspective of a system versus, you know, field providers and what insight they have compared to managers, chiefs, et cetera. And so there was, you know, field providers felt that only 47% of their medical directors were engaged, whereas the medical directors felt like they had a much higher engagement level. So I think maybe increasing some exposure to, you know, an organization's medical director, not just when you're getting cleared or when they come in real quick to say hi, but a regular kind of exposure will be very helpful. Medical directors also thought that the education requirements should be a little higher than field providers thought, particularly for paramedics

when it comes to like formal associates or bachelor's degrees. And they were much more optimistic about the field. About 80% of MDs had a positive kind of optimistic view about the future of EMS. And that's compared to 54% of field providers. So, you know, if you want to do the statistics thing, you could say both had a majority of optimistic view, but a pretty big disparity. And a lot of it has to do with kind of that ground truth. You know, the field providers know what's going on out there. They get abused and talked to certain ways and, you know, have to have that work-life balance a little different than a medical director does. So it's not totally surprising, but it's definitely something, again, for systems to consider. And in addition, overall optimism in the EMS field is down compared, you know, 2018 to 2019. And so the folks that

feel that the overall profession, you know, they have less optimism are EMS educators, field providers, field supervisors, and managers or chiefs. Folks that actually are more optimistic are like flight nurses and paramedics and medical directors. So again, kind of different viewpoints of the same career field, different aspects of what they do each day. So some opportunity to close the loops and the gaps between, you know, who is exposed to what in the system and kind of that perspective, maybe some internal town hall discussions or just better exposure between all the different modalities of EMS providers. 2019 thoughts on what organizations made priorities, and I'll give kind of the field

provider perspective. Field providers thought that both patient safety and provider safety actually was a pretty high priority up in the 50, 60 percentiles. What was viewed as low was the mental health priority, And some of this may have to do with resources available. And Ben and I, Ben Gomes and I, again, in episode 20, talked about this. There's the employee assistance program. We get five free visits and you get what you get depending on who you talk to. And then there's professional stuff that costs more money. Then there's the ability to have time off. And I think there's a lot of factors in that. And so that probably varies by EMS system on what they provide beyond EAP and what they do in-house. The other area was provider fatigue that field providers felt their

organizations didn't have as a high priority. And that, I think, comes to the balance of having to cover shifts or make the pickups for dialysis to get the funding, the reimbursement that helps pay for everything. It's a tough cycle. I think for leaders out there in EMS, it's just really trying to make that balance of let's not have any more than three shifts in a row and you can't work more than X number of shifts every two weeks or thinking of that way. And so then you can start to stagger your shifts so you're still covering the demand need but you're not burning out folks who are working four or five shifts eight twelve hour shifts that's even if it's an eight hour shift it's

not really it's like a nine hour shift ten hour shift if they get held over or they get stuck in report or something like that so just really consider how you can maximize your coverage while minimizing provider fatigue. An area that really stood out to me or a data point was that 16% of respondents stated that they were not at all prepared for active shooters. And this is providers. And in this day and age, that's not a huge percentage, but it's way more than I would think should be reported. So does that mean that it hasn't been talked about, even discussed, tabletop, let alone functional or full scale, or are we doing some kind of truncated tactical emergency combat care course, or are we just doing

stop the bleed or pre-hospital trauma life support? All those are applicable to active shooter for EMS because unless you are an EMS agency that's super progressive and you're paired up with your police and you're doing rescue task force and you're wearing armor and helmets and all that kind of stuff, you're going to be staged until such time that you can get to the patients a bit more safely. So the fact that we're not closer to single digits of being not at all prepared, hopefully that would just be like the brand new folks that hadn't happened to be trained that were surveyed, is kind of surprising and a little shocking in this day and age. So highly recommend. There's

so many ways to be prepared. And to remove not at all, just watch the run, hide, fight video, right? Then you're more than not at all. And then the difference is, okay, now here's the difference. You're going to be that second or third wave of first responders in there after the police come in and secure whatever they do to the bad guy and tell folks and clear them out, and then you're going to start treating patients. So right there you can know, boom, that's more. You can get into the details of exactly what you're going to do after that, but I think that number needs to go down pretty significantly.

So the future of EMS. So how many providers out of these 3,000 or folks would recommend this as a profession to their children or young folks? Well, 40% according to the study. So, you know, not a majority and reasons are low pay. And an example that's always stuck in my head about low pay for EMS is I remember driving by, you know, a sign for Burger King that was hiring down the road and their starting pay was higher than the starting EMT pay, you know, which is pretty crazy. So that, you know, pay gap, the disparity of pay between agencies, between positions, between, you know, upper positions, lower positions, and there's a lot of different factors there, but someone that's out driving an ambulance, whether it's taking someone to dialysis that keeps them alive or they're going emergently to someone that's bleeding out that keeps them alive, I would say should probably get paid a little more than someone that's preparing my burger and fries. That doesn't disparage the folks that work at any fast food place.

It's just I think there should be a priority standard that's a little bit higher for life-saving professions. Physical and mental stress, we've talked about that on a few different podcasts. You all that are out there know this profession is chock full of both physical and mental stress. That's not going to go away. I think it's how we manage it. I've said before, I'm a big advocate of exercise for that, talking to people. It really makes a big difference. Low respect from colleagues, public safety, and healthcare. I'll just say earn it. Respect is earned. It's not free. It's not given. I talked It really makes a big difference. Low respect from colleagues, public safety, and health care. I'll just say earn it.

Respect is earned. It's not free. It's not given. I talked about a lot of that in the professional part of last podcast. If you want to be respected, then act respectful. Look respectful. Be respectful. Show your skill set.

There's a reason for it. So be honest with yourself. Be honest with the profession. be honest with your organization, and earn the respect of your colleagues, public safety, and the healthcare folks that you're going to take patients to or transport them from. We touched on career advancement last time, and that's a big factor too with satisfaction. So if we could get those, like I mentioned, EMT 1 and 2 and senior and sergeant, same kind of career step that other public safety agencies have, I think that would pay really big dividends for EMS workers. A cool feature that's in this study after kind of most of the big data dump is called Ask My Mom by Chris Null from Pulsara. And just a very quick breakdown, I recommend it. It's just kind of like, you know, going with the mom principle in EMS where it talks about, you know, use simple communication,

but straightforward and have good discussions. Have real-time data gathering and discussion so you can make decisions with it and evolve with technology, right? So I'm 45. My parents are in their 70s. There's other folks listening, you know, if you're a bit older, it's been even for me. So I went from vinyl to cassettes to CDs to, you know, the first MP3s to iPods to etc. So I've seen a huge change in technology. Well, that's been applied through emergency medical systems as well. And emergency medical systems, healthcare in general have had to adapt and we have to if we want to reach that pie in the sky, connected EPCRs, patient care records, or health information exchanges. And so it's also only going to help you as a skill set to not hold on to the old ways of just wanting to use some old whatever system, taking notes, and then batch charting, whatever

it is. One, it doesn't help the patient as much. And two, it doesn't help with connected care across the continuum of wherever that person may go. They're on vacation somewhere. Imagine a world where everybody charts well and full and it's all connected and they're at the beach somewhere and they get hurt and anyone can just pull their record up and see that they have this allergy to this or that. It's just a great opportunity. So really cool kind of ask my mom segment there. So in 2019, why are folks leaving? Low pay, we touched on that. That's a huge dissatisfier. And so the pay standard has to change for EMS. The whole discussion nationally about minimum wage certainly should apply.

That should be at a minimum what an EMT and then above get paid. And beyond that, you know, just got to figure out ways to do that. Augmented with grants, increased budget, something like that. The career investment, so we touched on that a bit. Career change, so some folks, if you reach kind of the end of your rope and you are just done and you realize, you know what, I need to get out of this because it's not good for me, that's 100% legitimate. Then that's just going to be a reason why you leave. So good for you.

Give yourself a break. Or they want to go to the fire department from EMS or law enforcement or wherever else, become another level provider or completely get out of it. But that's another factor. Some folks are retiring. So the folks that have actually stayed on, you know, in the systems for a few decades are just retiring. So there's some of that turnover. And that's always an issue for any agency really is, you know, you'll have kind of waves of folks that came in together that will then retire so you use you lose all that institutional knowledge and I think

a way to shore up that gap is kind of what I talked about are we always training our replacements so that when the senior folks step out we have folks that are never going to make up their experience until they get the same but still they can help you know still have a highly skilled highly experienced provider right behind them to help take their place. Mental health, we've talked about that quite a bit, but again, it's huge. You see horrible things, you have to have your hands on horrible things, body parts that normally you shouldn't see other than medical books. So we've got to, from day one, like I talked about in the last episode of keeping it real with folks, through regular pulse checks, after actions, debriefs, and then ongoing care and peer support.

Just need to keep up on that. And then provider safety. So are we teaching our folks defensive tactics, situational awareness, making sure that they're living healthier lifestyles, running on caffeine and nicotine and empty drinks and Gorana or whatever's in all this stuff. It's not good for you. EMS rooms are getting better in some places.

In other places, it's just a junk food drawer. So provider safety and mental health can be helped quite a bit through, again, increased activity and better training in those instances. So brief episode. Hope this helped. Gave kind of an update. Please go check out the 2019 EMS Trend Report on ems1.com. Thank you, everybody, for listening, subscribing. Reach out to me.

Had some folks reach out on LinkedIn and emails lately with some questions or discussions about future topics like incident management but information technology. Some folks from the Forest Service. So thank you all very much for reaching out. It means a lot that folks are out there listening. I hope this helps. That's always the goal of this show. Penel KG on Instagram and Twitter. We've got a Facebook page, Between the Slides, BetweenTheSlides.com. We're on iTunes, Spotify, Stitcher, and iHeartRadio and Blueberry.com, which is my host. So thank you to them as well. Thank you to everybody that's helped make this show. Godspeed.