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Many municipalities are pressured by shrinking budgets, how can leaders do more with less for EMS? Learn about the issues and how to proceed with expert intel.

It’s clear there is increasing interest among EMS leaders in using data to improve our ability to monitor our systems—often in real time—and to translate that data into information that can improve systems and ultimately patient care. Powered by Fitch & Associates’ experience in all 50 states over three decades, the series will be an up-to-date overview of how agencies can—and are—using their data.

Rarely does a week go by without another news report about an ambulance service or hospital under investigation by the federal government for fraud or abuse related to billing for transport services. Whether willful or unintentional, negligence that results in the billing of transport services at inappropriate levels is leaving many hospital-operated ambulance services at risk. And the scrutiny is only increasing.

We asked the members of the National EMS Management Association (NEMSMA) what they thought were the most critical issues plaguing EMS. Though members acknowledged significant concerns, including patient safety, fiscal sustainability and caregiver well-being, there were still some unrecognized elephants in the room that no one wants to see, hear or talk about. Here are those 10 harmful realities of modern EMS and proposed strategies to overcome them.

In the hours after a train derailed in Philadelphia, killing eight people, news reports were already stating that the engineer’s recent work schedule would be examined. This wasn’t surprising, given that just weeks earlier, the National Transportation Safety Board stated that operator fatigue was partially to blame for another train crash that occurred in Chicago last year. Anyone who’s worked in the fire service knows that fatigue can impact one’s work performance. In the aftermath of major incidents, we don’t always focus on fatigue as a factor—and it’s often extremely difficult to know just what role it plays when it comes to vehicle crashes, fireground injuries, or medical errors. One thing is clear, however: employee fatigue impacts every fire department, no matter how big or small, or what type of shift schedule. It’s an issue that no fire chief should ignore.

What the question really means: Evaluating your communications center’s performance is about more than whether the center is private or public, staffed with sworn or civilian personnel, or a single-agency or multi-agency dispatch center. The cornerstone of assessing your communications center is the use of evidence-based standards rooted in industry best practices—and analyzing the impact they have on your department’s operations.

Increased attention on ambulance use demonstrates the need for compliance plans to include emergency and non-emergency ambulance operations. The HHS OIG has published voluntary compliance program guidance for ambulance suppliers. Ambulance billing should reflect the care provided by the EMS personnel, not the hospital diagnosis of the patient. Training for billing personnel and EMS providers on documentation and billing for ambulance services is often inadequate. Ambulance suppliers should conduct regular claims reviews to ensure problems are identified and corrected prior to an audit.

Amidst growing concern about the mental health of EMS professionals, a Fitch & Associates’ Ambulance Service Manager Program Project Team recently surveyed more than 4,000 EMS and fire professionals about critical stress, suicide, and available support and resources.1 The results were stark.

Our peers in helicopter emergency medical services (HEMS) have been catching a lot of flack in the media recently, due to several high-profile incidents and government investigations. Maybe you’ve been thinking, Thank goodness it’s them, not us. But what are you doing to achieve the safest environment for your staff and patients? You may find my opinion harsh or even critical, but I don’t see much activity at the grassroots level in making ground EMS operations safer. There seems to be an intense focus on “the box,” meaning the area behind the ambulance cab, but not much activity out of (and beyond) the box. Where are the vision, the commitment, the tools and the passion to meet our guiding mission, “First do no harm”?

This report is part of a continuing leadership series developed for Best Practices in Emergency Services. It shows leaders of emergency medical services (EMS) and fire departments how the concept of organizational agility can be applied in their agencies. Organizational agility originated in the context of flexible manufacturing and later emerged as a business model in service industries and healthcare. Researchers from diverse disciplines approach organizational agility from a variety of perspectives. Most agree that when organizations are not agile, they become less effective and “fragile,” or susceptible to factors that can impair their ability to survive.

Scrutiny. It may arrive at your doorstep in a variety of forms and perhaps when you are least prepared to deal with it. Increased scrutiny could arrive in the wake of questionable performance, like when a victim dies after a delayed response to a fire. It could be the result of a probing investigation by the media during budget debates. Perhaps your agency is in the middle of a contract negotiation that raises the level of interest in its internal operations. Or the heightened scrutiny could come even with the arrival of a consultant that you or your supervisors invited to appraise and advise the agency. As the Fire Chief—think of yourself as the CEO of the department—you cannot afford to be surprised or ill prepared for any of these events.

Good fire chiefs understand the importance of assessing risk in their communities. But the most progressive chiefs are actively working to reduce that risk by implementing Community Risk Reduction programs. They are shifting their stance on risk from reactive to proactive—all in the name of better service to their communities.

Despite a tremendous diversity in how emergency medical services (EMS) are provided in municipalities around the country, most U.S. EMS systems share one commonality: They remain primarily focused on responding quickly to serious accidents and critical emergencies even though patients increasingly call 911 for less severe or chronic health problems.

Six steps to address caregiver suicide & improve mental wellness

Despite a tremendous diversity in how emergency medical services (EMS) are provided in communities around the country, most U.S. EMS systems remain focused on responding quickly to serious accidents and critical emergencies, even though patients increasingly call 911 for less severe or chronic health problems.