I received several comments on Wisconsin Law Lowers Ambulance Staffing Standards (12/16/2015). One of the comments came from someone identifying themselves as Chris Schultz. From his comment it is possibly the same Chris Schultz who is identified as the Mountain Ambulance Service administrator in the article and a member of the Taskforce who recommended Act 113.
I appreciate Mr. Schultz taking the time to provide me with his feedback. There are some points that I would like to address, clarify, and expand upon.
From his comment:
Dave, in response to your blog entry, this bill was not the only acceptable method to solve staffing problems throughout Wisconsin that the Taskforce has worked on and completed. It apparently is the only method that you have read and written about. EMS services in our area have worked extensively with local technical colleges to allow for smaller class sizes and outreach centers for EMS classes to allow easier access training. How can you state that our services do not put enough value to entice people to perform EMS services when you have no idea what we offer as value? Services in my area have increased “volunteer” call pay and hourly pay, purchase new equipment far more often than our big city full time counterparts, provided a retirement program for “volunteers”, supply uniforms and equipment at no cost to “volunteers” as a way to entice individuals within our communities to become EMTs and serve their communities. The biggest hurdle that we have is the lack of residents in the area. Our service area is 198 square miles (small compared to many northern WI services) and have a resident population of 1820 full time residents. Since you specialize in Emergency Medical Management, you know full well that not all of those 1820 residents would be able to become volunteers. My department completes regular population studies on all residents and the results are less than 5% are able to be targeted to become “volunteers”.
Mr. Schultz, first thank you for your comment. You are correct that this is the only method I have read and written about that the EMS Task Force of Northeast Wisconsin has pursued in addressing the staffing shortage. Part of the reason for that is, to be honest, I can’t seem to find anything else that the EMS Task Force of Northeast Wisconsin has done. To illustrate my point, I have inserted a screenshot of the Google results for “EMS Task Force of Northeast Wisconsin” to the right of this paragraph. Please note the majority of the articles actually dealing with the EMS Task Force of Northeast Wisconsin are either talking about volunteer agency extinction or mention the legislative Act 113 as a point of relief. I see no mention of any other initiatives in these articles, which is why I have neither read nor written about them. Perhaps had there been a some publicity regarding these efforts, I would have.
I did not just check Google, if that is something you are concerned about. I also checked Facebook where I found the Mountain Ambulance Service Facebook Page. I have included that screenshot to the left of this paragraph to illustrate that it is barren and devoid of any activity. As someone who has personally advocated for EMS Agencies to tell their own story for over six (6) years now, I find this highly disappointing. For an agency, especially one with staffing issues, to have a recruitment and retention strategy is vital. Not having any online presence (as it appears your agency is lacking) will only make it that much harder to reach those you need to and communicate with them.
One of the main things the original article left out was whether or not your agencies were paid services or volunteers. From the comment, it seems to be primarily volunteer. Volunteer agencies are under a lot of pressure to deliver and often without resources due to the nature of their under compensated labor business model. Providing uniforms and equipment is something expected of a quality employer, so you are just meeting expectations instead of exceeding them. Volunteer organizations can often purchase new equipment thanks to their low cost labor force and the ability of grants/funding. Buy all the new equipment you want, but without providing people with a career path within your organization you will not have people to use that equipment.
Please do not misunderstand me, I am not bashing volunteers or volunteer agencies. For that matter, I am a volunteer, have been for over 20 years, and even wrote a book about it. Unfortunately, my volunteer agency does not offer enough incentive for me not to work a full-time job so my time there is limited… just as I imagine the time of all volunteers is limited. Because of their inability to guarantee staffing, they have been relegated to a tertiary service provider. This is something that while we hate to see it, is becoming the norm more and more.
You do mention pay in your comment, so allow me to be more specific regarding value to your members. If you are not paying your EMTs at least $15.00 an hour, then you are not providing them with enough monetary incentive. If you are not providing them with the ability to get affordable healthcare, then you are not providing them with enough beneficial incentive. If you are not ensuring them at least 36 hours a week (or whatever constitutes as full time), then you are not providing them with enough incentive to commit to your agency. If you are doing these three things then why are you on broadcasting that to the world??? My guess, and I stress guess because you did not disclose specifics, is that you are not doing these three things. Perhaps you should consider doing so.
From his comment:
You stated New York staffing requirement minimums are a First Responders (EMR) and an EMT in an ambulance. This is the norm for many states including Michigan and Minnesota. While most services do not plan on utilizing the EMR and EMT staffing configuration as the norm, it does allow for options when staffing shortages occur. It also allows for individuals who wish to “volunteer” another option to gain licensure and help their community.
Actually, that was not what I stated. I stated: I think it is important to clarify that my own state, New York, does NOT require two EMTs on an ambulance. Although this not a requirement, in the garages I have overseen I have exceeded the State requirements in staffing and ensured that there were two EMTs. The requirement for the second person on an ambulance, aside from the EMT, is that they be licensed to operate the vehicle. This is how it has been since the 1970s when NYS DOH Part 800 was enacted. Ideal? Hardly, which is why in the garages I managed I exceeded the requirements and provided my reasoning for doing so.
There are many people who disagreed with me on my standard, but it was my standard and I stuck to it even though I didn’t have to. Sure, I didn’t always have the newest equipment and I seemed to specialize in the oldest ambulances of the fleet, but there would be no question as to the qualifications of my ambulance crews.
From his comment:
EMTs are notoriously horrible drivers? I can bet that most of our peers within the EMS community will disagree with you. Who do you have drive your ambulances? In WI, EMRs thru Paramedics must submit their driving record to obtain a license. Any infraction must be explained and paperwork submitted before a licensed is issued.
It’s amazing that 50% of the comments I received seemed to focus on an in parenthesis statement of opinion, which really just goes to show what people focus on. I am going to follow this up in depth a bit more, but I will say that having driving records and infractions explained does nothing to qualify someone to drive an ambulance. As a Coaching the Emergency Vehicle Operator III (CEVO) instructor, I have first hand knowledge of the skill level EMTs have straight out of EMT school in driving the ambulance. To illustrate my point, just look and see how many articles about ambulance crashes you can find on EMS1.com, JEMS, or EMS World. Those are just the crashes that have made the news, usually first amongst the mainstream media, and I would guess they represent less than 1% of the actual motor vehicle collisions involving an ambulance that occur on a daily basis. Furthermore look at how many Line of Duty Deaths from the National EMS Memorial mentioning “motor vehicle” and you’ll see how many deaths possibly may have been prevented by ambulance driver training. This is the basis of my assertion that EMTs are notoriously horrible drivers, and allow me to assure you that when I started I was no different.
What will qualify someone is the amount of training/experience, didactic and practical, that they receive in order to operate an ambulance. So my question is how many hours of ambulance driver training does a Wisconsin EMT or EMR receive in school? How many hours of ambulance driver training does your agency provide your members? I am going to make another guess, but please correct me if I’m wrong, that your state courses provide zero (0) hours ambulance driver training and that your agency provides less than ten (10) hours ambulance driver training. This seems to be the trend, but perhaps your state and agency exceed those averages and that is yet something else you should be promoting.
From his comment:
Act 113 is law for the entire State of Wisconsin. It does not include any municipality over 20,000 residents and a waiver must be gained between 10,000 and 19,999. This addendum was placed into the law by larger EMS services, mainly fulltime union services. According to 2013 populations, there were under 40 cities that had populations over 20,000. That leaves most of the state with the ability to utilize this new law.
I’m glad to hear that the majority of the state will be able to utilize the law. One of the things that irks me about mainstream media coverage of EMS issues is that they don’t necessarily answer the questions those of us in the industry have regarding such occurrences.
From his comment:
You have many “I Wish” statements in your blog. Realize that many of your “wishes” have already come true and many are in the works for the near future, you have not read about them. One small change in law is not going to fix the staffing problems in my state, but it may provide some relief for services until the next solution is found and completed.
While I am happy to take your assurance that many of my “wishes” have come true and others are coming soon, I would like to read about them as well. I’m sure your community would like the same opportunity, so perhaps you can add that to my wish list and make that happen as well.
There was a lot covered in this post, and if you even reached this point, kudos and thank you.
I think the issue here has more to do with agencies stuck in tradition and the old way of doing things than anything else. We often find this problematic and intolerable when it comes to the clinical side of the industry, so why we are so ready to continue accepting it from the management side is beyond me. In order to be successful serving a community agencies need to do more than be in service to answer calls. They need to understand what the communities need, what they want, and what they expect. The only way to do that is to communicate with them and one of the most effective ways to do that today is, at least in my opinion, still through Social Media.
Lowering your standards without that communication is only doing your community a disservice, no matter what type or how small/large your agency and community are.
Again, thank you to Mr. Schultz for his comment. I honestly look forward to reading more about what the EMS Task Force of Northeast Wisconsin will be doing in the future. I’ve even set up a Google Alert for it.