REACH OUT & Touch Someone

     One thing that's clear as EMS enters its fifth decade is that if you want to thrive, you have to play the game. The self-promotion can seem far removed from the true calling of helping patients, but prosperity requires talents beyond the back of the rig. You have to work money and favorable legislation out of lawmakers. You have to be known by people who recognize the value of what you do. You have to be visible and appreciated across a range of levels.

     Achieving that in Washington and at the statehouse is important, but this story deals with the bottom-most of lines: the community you serve, and the citizens who will be calling you for help when they're injured or ill. As EMS must view politics, these are politicians too.

     What does Joe of Your Town think of his local EMS provider? Does he know how hard you work and all the ways you can help him and his family? How can you reach out to him, impact his life for the better and make sure he appreciates all you do before that next bond measure?

     There are many outstanding models for the kinds of effective community outreach practiced by wise organizations. Here we examine NorthStar EMS of Farmington, ME, and Friendswood EMS of Friendswood, TX. Both have recognized that proactive involvement in their communities can realize two important goals: achieving a safer, healthier and better-prepared population, and ensuring that it recognizes, respects and just plain likes its ambulance provider.

Scrub Club: Exposing Kids to Careers in Healthcare
     If the children are our future, we'd best mold them to our liking now. That means giving them an appreciation for EMS. That was one of the goals of the Scrub Club camp offered to 11–14-year-olds this summer by York County Community College in Wells, ME. The camp exposed kids to healthcare settings and activities and, hopefully, intrigued at least a few in potential healthcare careers.

     Over five days in August, campers received AHA first aid/CPR training, tried their hands at boarding and bandaging, and got tours of facilities like a fire station and a hospital, with opportunities to pose questions to caregivers.

     "We tried to make it fun," says camp coordinator Dan Limmer. "I think we had a good balance of material, and almost all the kids said they'd come back if we did it again. It was a great experience."

     In teaching kids about EMS, much as with teaching adults, it's important to keep them stimulated and engaged. This meant saving the more active stuff--the tours, etc.--for the afternoons, when drowsiness might creep in, and splitting up lengthier instruction--e.g., CPR--into little bits each day. Downtime was filled with diversions like anatomy coloring books, the game Operation and even a short skit.

     On the final day, campers demonstrated what they'd learned for their parents, acting through scenarios with bleeding, choking, backboarding and CPR. In addition to sending the kids away with a sense of achievement, this also underscored the camp's value to their parents.

     "To a certain extent, parents are the real customers," Limmer notes, "so putting on a show at the end really let them see what they'd done."

     Services considering this kind of outreach (especially without an existing support structure, as York had) must approach it with solid plans based on the age range and anticipated number of attendees. Have enough for them to do, make sure it's diverse, and be able to fill schedule voids if things run short.

     "Dealing with a bunch of kids is something dramatically different than EMS usually does," Limmer says. "It's a big thing to bite off. It's worthwhile, but there are a lot of logistics involved."

What Else They're Doing: Friendswood
     Other Friendswood outreach efforts:

• Photo ID kits for kids--When delivering vaccinations, Friendswood providers weigh, measure and photograph kids and provide the compiled information and portrait to their parents for emergency use.
• Safety clowns--A grant funded stage and sound equipment, and several members went to clown college. They now teach safety to kids throughout the area. "We do some really good skits," says EMS Chief Lisa Camp. "We have good imaginations."
• National Night Out--Friendswood providers utilize this national law enforcement-based initiative to help inform residents about their ambulance service and safety in general. "We go on bikes and in the ambulances to tell them about safety and what our department can do for them," says Camp. "Sometimes people just don't know what services are available."

What Else They're Doing: NorthStar
     Other NorthStar outreach efforts:

• Lifeline--The service is a certified installer of the national medical-alert system and responds to calls from its users.
• Operation Santa Claus--Last year, crews delivered thousands of donated Christmas presents to local families in need. "The crews loved it," says director David Robie. "Folks are always apprehensive when an ambulance turns down their street, so when we come out bearing presents, seeing their faces makes a big difference."
• Babysitting class--Unhappy with other options available, the service turned within, and medic Peter Wade developed a daylong babysitting class. It covers health-and-safety basics like CPR, as well as responding to emergencies and other skills.

NORTHSTAR: 'THE CITIZENS DO SEE IT'
     Leaders of NorthStar EMS had a unique opportunity in 2005. Their service was newly created, through the consolidation of five related smaller services, and with its new name came the chance to forge an identity essentially from scratch. Though it represented the same hospital as its predecessors, NorthStar, both name and concept, was largely a blank slate.

     The first priority to address was, of course, the medical component. That wasn't hard to establish, as the services from which NorthStar was created were well-regarded. But beyond that, NorthStar enthusiastically embraced a mission of community service. Among other efforts (see sidebar top right), it offers things like CPR instruction and child safety seat installation/inspection. Members even volunteer each year for the governor's Keep ME Warm campaign, which provides needy seniors help in winterproofing their homes.

     "The program provides the materials to go in and weatherize homes--put up plastic over the windows, change furnace filters, seal in cracks and holes," explains operations manager Mike Senecal. "They had 50 homes to do that first year and not enough volunteers, so we stepped in and helped winterize 40-some homes. And we've done that for three years now."

     Like so much of the best outreach EMS can do, this has a dual benefit: It helps prevent health problems among a vulnerable population, and it's a great get-to-know-you opportunity.

     "It gives us a chance to be out in the community and talk to people and educate them about EMS," says Senecal. "Some of the homes I was at, they weren't sure, with the consolidation, exactly what had happened to their ambulance service, so we explained where the ambulances came from, the different levels of service, and some of the other programs we offer."

     Taking that idea even further is a program called Housecalls. This entails bringing the care to the people proactively--in effect, community paramedicine. It started as wellness checks for elderly and shut-in types in remote parts of the service area. These soon escalated to things like blood pressure checks and injury prevention. "We hope," Senecal says, "to be able to expand that for chronic illness prevention and maintenance of things like CHF and diabetes and hypertension."

     One of the consolidated services fielded a bike team that NorthStar inherited, providing another opportunity for outreach. Team members work the usual fairs, parades and other mass gatherings, but also deliver bicycle-safety training to riders. The team sponsors bike rodeos, where members educate kids and provide helmet fittings and sales at cost.

     In many cases, what a service gets from all these efforts is hard to quantify. But they certainly should endear a hardworking ambulance provider to the people it serves.

     "It's like advertising," says the service's director, David Robie. "You may not recognize it at the time, but there's a cumulative effect. The citizens do see it. We're tax-supported, and the people who are active in their communities and in positions of decision definitely recognize what we do."

Pre-EMS Care: Filling the Gap
     All those defibrillators, and who's using them? All that talk about CPR, and who's doing it?

     In both cases, too darned few people, says Frank Poliafico.

     "The EMS system has a major gap in it, and that gap is what can be called pre-EMS," says Poliafico, a longtime RN and advocate for out-of-hospital emergency care. "When EMS shows up on scene, rarely is anybody doing anything for a patient in a life-threatening emergency."

     That's the dilemma that faces even communities heavily invested in efforts like CPR education and public-access defibrillation programs. They can place AEDs and offer emergency-care classes, and still few people will act when they witness an arrest or collapse.

     People just aren't comfortable, says Poliafico. Making them more so is a goal of the Initial Life Support Foundation (formerly the AED Instructor Foundation), of which he is executive director. The ILSF works for the development of onsite emergency-care preparedness programs as effective components of community EMS systems. It partners with local EMS agencies, CPR/AED instructors and emergency-care trainers and consultants to help create and maintain effective programs to prepare civilian "first detectors."

     The key is the verb prepare. To work optimally, Poliafico says, such programs must go beyond simple training. "Training's a one-time event; preparation's an ongoing process," he says. "Training is a part of preparation, but without ongoing learning, management and supervision, there is no preparation."

     It's not enough, in other words, to impart the skills and move on. The skills need to be regularly refreshed. To be performed smoothly under duress, they must be practiced. They must be supported and promoted and reinforced.

     "There has to be ongoing learning," says Poliafico. "There has to be management, supervision. Not in a big, bureaucratic way; you don't necessarily need the outside expert to come in every month and drill you. But somebody should be bringing it up in safety meetings. You ought to be showing videos throughout the year."

     This can inculcate the comfort that's so important to acting in an emergency. People must have enough familiarity with and faith in their knowledge and abilities to overcome natural reservations and leap to a stranger's aid.

     EMS folks can relate, and that's what makes them uniquely suited for involvement in these types of programs.

     "EMTs don't finish school and go out by themselves on day one," Poliafico notes. "They have mentors, they have supervisors, they have preceptors. Somebody's helping them develop a comfort level. And without that comfort level, without that emergency mind-set, there is no response--that's human nature."

     Where EMS is involved in community preparation programs, the results have often been good. And beyond the obvious medical benefits, there are nonmedical advantages as well.

     "No. 1, you build constituency in your community--you begin to identify to the public who EMS is," Poliafico says. "No. 2, you recruit. Once I train someone and they're comfortable with it, a lot of times they'll get the bug and want to do more. And No. 3, it generates revenue. There are just phenomenal benefits."

     For more, see www.ilsf.info.

FRIENDSWOOD: 'MORE WAYS TO HELP PEOPLE'
     Volunteers exemplify community service by their nature. If you're willing to give of your time and talents when those in your community are hurting, it's not a big leap to doing it at other times as well.

     "Our whole theme is neighbors helping neighbors--that's what we come in committed to do," says Friendswood EMS Chief Lisa Camp. "And when you start helping people, then you see other things you want to change, and you start realizing more ways to help people."

     For Friendswood, that's meant a steady stream of efforts aimed at improving constituents' safety. Many of these focus on kids--a sure way to win hearts and minds.

     Seeing too many pediatric patients, the service developed a car-seat program, which includes free seats for those who can't afford them, and a bicycle-safety program (it also has a bike team). In 1999, seeing too many unvaccinated children, it started working through a state program to offer free vaccinations.

     "People can't afford these vaccines, and there are all these kids out there who don't have any way to get them," says Camp. "So we do three clinics a month now where we give free vaccines. Last year we vaccinated 3,000 children in our Galveston County/Houston/Harris County area."

     This year, in conjunction with the local high school, Friendswood is undertaking a major DUI education project called Shattered Dreams. Developed by the Texas Alcohol and Beverage Commission, the program starts with a staged wreck complete with EMS and police response, transport and hospital treatment, family notifications and the arrest of the student portraying the intoxicated driver. Throughout the rest of the day, a Grim Reaper appears periodically to select "victims" who are removed from classes as "dead." These students are made up and returned to classes to demonstrate the actual toll taken by drunk drivers.

     "The kids have to write their obituaries, and that night they're taken to a facility, usually a hospital, where there are counselors, and they don't get to go home," explains Camp. "Their parents have to write letters to them as if they'll never see them again. Then they'll have a big presentation the next day focusing on the impact on students' lives and families and the school."

     As part of Friendswood's volunteer fire department, the EMS service can work jointly with it to educate and serve its community. This status also gives it access to grant monies that help fund its efforts. Camp says the fire side is fully supportive of the EMS mission, and together they've earned the affection of their citizens.

     "Our community likes us," she says. "People donate money, and they'll do things like bring us cookies and cakes. Out of the clear blue, somebody will say, 'You helped me two years ago, and I never got to say thank you.' That's probably one of the best benefits I've ever received. They don't forget you. We are neighbors helping neighbors, and our neighbors know us."

CONCLUSION
     There are few true win-win situations in life, but vigorous community service and outreach by EMS is one. The community gets the professional assistance it needs to be safer and healthier. EMS becomes known and admired, makes some money when it can, and fosters a population that will, knock on wood, need it less in the future. Taken jointly, it's a good case for getting involved.