EMS has many challenges, and in today's environment, it's imperative that leaders understand their role in their organizations and communities and in the fire and EMS profession as a whole. A good leader understands that accountability, ethics and collaboration are keys to success. What we're doing, how we're doing it and who we're working with to achieve a successful outcome have become standard questions in measuring our performance.
However, there are still a number of areas where organizations simply don't know what they should know.
Some things are relatively easy to measure and know. Clinical performance indicators, such as the number of successful IV starts, endotracheal intubations, cardiac-arrest save rates and compliance with cardiac or stroke protocols, can be captured, reviewed and disseminated within your organization on a regular basis. These metrics can also be used to compare your performance against other organizations of similar size and operation to establish benchmarks for what you want to achieve.
Time is another performance measurement that's relatively easy to capture but challenging to interpret. The key here is to ensure that you clearly identify what your time measurement is, such as time of 911 call to unit arrival or time responding to time on scene. This is especially important when comparing against benchmarks or other agencies.
I would challenge everyone to think about the outcomes associated with time. If only 2% of our calls truly require a response time of less than eight minutes, perhaps time doesn't matter for the other 98%. Or does it? Without knowing patient outcomes, we simply can't truly know if time matters.
These metrics are pretty standard in fire and EMS systems, but do we know what our community wants?
If you've developed a strategic plan, you should know what your community wants through meetings with business owners, HOAs, civic clubs/groups, etc. Do they really care what the patch on your sleeve says or what color the truck is? What level of service do they want and what are they willing to pay for? What do your elected officials want? What don't we know about the political landscape?
Your medical director has a vested interest in your operation and will be looking at your clinical performance in addition to the community expectations. Have you asked their opinion? And of course, what about your employees or volunteers?
Two documents have been instrumental in questioning the performance of fire and EMS systems, both by Dr. Jay Fitch: 50 EMS System Benchmarks, and 20 Tough Questions to Ask Your Fire Chief.
These documents have caused many a headache for the unprepared fire and EMS leader, but answering the questions Fitch raises proves invaluable. For many leaders, these have been about what we don't know. Accreditation adds another layer of complexity to these baseline documents, but if done correctly, will help you answer most of these questions.
Finally, none of this matters when a leader's ethics are questionable. The quickest way for an organization to fail is through a failure in ethics. We've seen a number of instances recently where EMS systems have come under significant scrutiny, and leaders have even been criminally charged for ambulance billing fraud, narcotics diversion, significant equipment and fleet failures, consistently failing to meet standard accepted response levels, and the list goes on.
Just log on to any EMS website and look at the daily headlines; you'll find plenty of stories that result from a failure of ethics, and they don't discriminate between types of organization or whether their leaders are paid or volunteer.
EMS is facing some of its most challenging times ever. With increased call loads, diminished reimbursement and funding, and the potential looming changes associated with the Patient Protection and Affordable Care Act, now more than ever we need to be working to discover what we don't know.