The Making of a Marketer

What if there's an emergency and nobody comes?
That's more than just the worst-case scenario that terrifies EMS leaders lamenting the ongoing national shortage of providers. In Raymond, WI, it actually happened. Twice.

There, a house fire in February 2001 drew a response of a single volunteer firefighter. (A neighboring department eventually extinguished the blaze--response time: 24 minutes.) And then, less than a month later, a medical call drew no response at all. (Again, the neighbors stepped in--response time: 26 minutes.)

It wasn't a case of wrongdoing by Raymond Fire & Rescue--they just didn't have the people available. In fact, department leaders had known such an eventuality was possible. They'd seen daytime calls require multiple pages to answer; they'd responded to calls so short-handed that mutual aid had to be called. They'd sought paid staff from town leaders and volunteers from within their community. They got neither.

Obviously, Raymond isn't the only town that has struggled with finding the emergency providers it needs. Many EMS organizations--volunteers in particular--have trouble keeping enough trained and willing personnel available to answer their calls. The reasons are many and have been discussed at length in this magazine. This article looks at what some states are doing about it.

Wisconsin: Marketing 101
In Wisconsin, EMS leaders were well aware of the manpower issues some departments were facing, and they wanted to help. The Wisconsin EMS Association (WEMSA) was already at work on a statewide recruitment program, the principles of which were implemented by leaders in Raymond. The results were good: By late 2001, Raymond's department had seen 12 new volunteers apply and was able to field additional daytime staff.

In May 2002--timed to coincide with EMS Week--WEMSA's initiative went statewide. Training sessions schooled participating locals in effective outreach, and calls for volunteers were spread via TV, radio and newspapers. More than 500 new volunteers were ultimately identified.

The campaign is "basically Marketing 101--there's nothing fancy about it," says Don Hunjadi, WEMSA's executive director. "We've found a lot of things that don't work and a lot of things that do. Some of the things that don't work are just putting a sign in front of your station or a blurb in the newspaper that says 'If you're interested, call.' Without a call to action, people won't come. So our premise is that you bring them into a nonthreatening environment. You tie it in with an open house, or a demonstration, or an EMS Week celebration or something like that. You get people in, then have them sit down for a while and find out what it's like to be an EMT."

The gist of WEMSA's message to local departments isn't particularly sexy: There's no magic bullet to solving personnel shortages. And the state can't do everything for you. You have to put your best face forward, articulate a compelling message and make it easy for your community to embrace you.

"Sometimes it's harder work than people want it to be," says Hunjadi. "When we do our seminars, I talk about losing weight. I can teach you how to lose weight in five minutes, and it really is simple: Eat less, eat better proportions and exercise. Do those things, and you will lose weight. But how many people actually go on to do it? The actual implementation is where it gets difficult."

Accordingly, not everyone in Wisconsin followed through on the guidance they got. But of those who did, nearly all reaped rewards. Raymond's leaders were so pleased with the results that they tapped the well again in 2005, this time locating 24 new possibilities. And state leaders are gearing up for another go-round this year as well, this time supplementing their media message with donated billboard space.

"We're actually expecting more people to participate, now that they've seen the success of the earlier program," says Hunjadi. "We know what works, and if they follow that, we can almost guarantee they're going to find one or two people for every thousand in their service area."

Pennsylvania: Badass in Your Blood
In Pennsylvania, circumstances were aligning ominously. Paramedic positions were remaining unfilled for months in a state that has the second-highest proportion of citizens 65 and older in the U.S.--a proportion that's not getting any younger or healthier. Without action, a crisis seemed likely.

"I wouldn't say things are critical, but they're getting there," says Steve Lyle, executive director of the Emergency Health Services Federation, one of 16 regional councils that oversee EMS in the state. "It's an issue where if we're not aggressive now, in three or four years, it could be harming people."

The state Department of Health, which governs EMS in Pennsylvania, assembled a task force of EMS leaders who came up with a three-phase recruitment plan that kicked off last year. The first phase was startlingly simple, but effective: Letters were sent to former providers who'd let their certifications lapse since 1990, asking them to come back to EMS. Like Wisconsin's efforts, these were timed to coincide with EMS Week, when attention to the field is heightened. As of early January, an estimated 1,300 had done so in response to a mailing last May.

"That's a big number, because those folks will be fairly easy to get back up and running," says Lyle, who chaired the task force. "Once you're an EMS provider, it gets into your blood. You might have a life change--marriage, divorce, illness, a child--that pulls you away, but I think we learned it can be just a matter of asking folks to come back." That simple step could now be repeated yearly.

Part 2 of the plan involves marketing to the younger generation: recent and soon-to-be high school graduates and others who could potentially serve the field for many years. A website was set up (www.rollwithit.com), and a Harrisburg ad agency was enlisted to produce a movie trailer that, beginning over the winter, was shown at theaters throughout the state. The message was also packaged as a TV spot that has been aired during such highly watched events as Pittsburgh Steelers playoff games. A radio ad tailored to an older demographic has also been employed. The interested are given a toll-free number to call for information.

The message to the younger set is distinctly edgy: "You've got to have badass in your blood," the website proclaims, while the trailer blasts fast-paced images of EMS excitement accompanied by rap music. Not everyone has found the approach appealing, but it has undeniably generated buzz. EMS leaders from a number of other states have requested copies of the video.

"They're trying to reach a certain demographic, and they're going after it aggressively," says Rohn Brown, technical assistance coordinator in Virginia's Office of EMS. "We're not getting the 16-34-year-old volunteers, and if you want to get their attention, you have to speak their language. I have a 14-year-old at home, and that's pretty easy to see."

Pennsylvania's final component involves putting local-level folks to work, going to things like high school career days and other community events where they can show the video, distribute handouts and promote EMS as a career. A "tool kit" from the state will provide them with supporting materials.

The latter endeavors are still in their early stages, so it's hard to gauge their success, but Lyle is optimistic.

"EMS can be a really nice thing to sell," he says. "We haven't done ourselves justice in selling EMS. What we do is something that tastes pretty good, and I think it's something a lot of folks would want to be part of if they know what it is and it's packaged right."

Tips for Volunteer Recruitment
Running a regional EMS council in New York requires involvement in recruiting new providers. Raphael Barishansky is also a longtime volunteer himself and has written on recruiting for this magazine (see Practical Techniques for Effective Volunteer Recruitment, June EMS 2005). He offers these tips:

• Review your expectations: Are you asking too much? Can you be flexible with schedules, training, meetings, etc.? Make it easy for people to help you.
• Ensure good management: Complaints about management are a common cause of people leaving EMS. Even volunteer agencies need leaders with good grounding in management principles.
• Promote yourself: Every news account of your work is an opportunity for outreach. A PIO can help spread the good word.
• Corporate culture: Avoid cliquishness that can alienate outsiders.
• Cast a wide net: Don't shy away from younger or older volunteers. High school juniors/seniors or recent retirees can help.
• In-kind assistance: Not everyone has to ride the truck. Might that local CPA do your books gratis? Could a willing mechanic fix your rigs at cost? There are many ways to help.

Virginia: Getting/Keeping the Best
Reviewing the Pennsylvania video is but one of the steps taken in Virginia, where leaders have embarked on a comprehensive, research-backed quest emphasizing not only recruitment, but retention as well.

This has a number of elements. One is a recruitment campaign centered around the late actor Christopher Reeve, whose paralyzing horseback-riding accident occurred in the state.

"He experienced all phases of EMS in Virginia, from on-site assistance to medevac transport to the trauma center," notes Ruth Robertson, public-information coordinator for the state's Office of EMS. "He was a visible person who'd been through our whole system."

Reeve agreed in 2004 to become a spokesperson for the campaign, and was scheduled to speak at that year's Virginia EMS Symposium. He died first, but with the blessing of his estate, the office continued its campaign, utilizing raw footage recorded before Reeve's death for a four-minute video it showed at the symposium and distributed, along with printed materials, to state EMS agencies. "I still get requests for that video every week," says Robertson. "It's incredibly popular."

The state also offers grants that can assist locals with getting and keeping people, and features an online recruitment/retention directory on its website. It has reached into high schools with a scholarship program and a training program that allows students to earn college credit while exposing them to EMS. And it has established an awards initiative designed to recognize and draw attention to skilled EMS providers.

Virginia has also been active in trying to keep what it has. An array of state officials and consultants researched extensively to determine why providers leave EMS and what might keep them in it. What they found underlies the state's Workforce Retention Project and an accompanying tool kit for local agencies.

Central to this effort is a series of workbooks entitled Keeping the Best. The first presents the principles of retaining people; the second addresses retention problems and solutions; the third, released in late 2005, focuses on rapidly expanding services that may be experiencing growing pains, and the fourth, currently in development, will deal with ALS services. These workbooks, along with the findings that begat them, are available on the state EMS office's website (www.vdh.state.va.us/oems).

"You can throw money at anything," says Scott Winston, assistant director of Virginia's Office of EMS. "But for it to be effective, you have to design and develop a program that will really address your particular need. We feel like we've done that. We've put a lot of work in on the front end, and hopefully we'll reap a lot of benefit."

The Heavy Lifting
Efforts like these may portend increasing involvement by states in recruiting issues. Other states are engaged and weighing what they might do.

Pennsylvania's video project, for example, has caught the attention of officials next door in Delaware.

"It's excellent work they did up there," says Steve Blessing, director of the state's Office of EMS. "Up in northern Delaware, we get all the Pennsylvania television stations, so we've seen the ad, and we're hoping to piggyback a little bit on it. We're also having discussions with some of our fire-service counterparts to gauge their interest in doing something. We're trying to work ahead of the curve."

Minnesota brought Hunjadi in to share Wisconsin's techniques at its EMS meetings.

"Don has a really neat little presentation," says Tom Vanderwal, of Greater Northwest EMS in Bemidji, who's overseeing the effort. "He does a tremendous job of saying 'Guess whose responsibility it is to make sure recruitment and retention work? It's you, buddy, sitting in that chair listening to me.' Everybody wants people to drop out of the sky, and they just don't. We need to be in the mode of being marketers. You have to sell yourself, and that takes work."

That's the bottom line here: The state can provide some resources and direction, but really, the work necessary to sustain EMS at the local level has to come from that local level. If your state can help, great. But recruitment is, at its core, the problem of those agencies answering the calls.

"We feel like we've provided some good tools, and when people use them, they're effective," says Virginia's Brown. "But they're called workbooks for a reason. People have to open them up and put pen to paper. They're not 'how-to' books; they're intended to get the user engaged, and help them solve their own issues."

"The state can help you develop infrastructure, but the real heavy lifting is going to come at the local level," says Raphael Barishansky, executive director of the Hudson Valley Regional EMS Council in Newburgh, NY, and a 15-year volunteer who has written on the subject of volunteer recruitment (see sidebar on page 67).

"Unless there's a real awakening, for lack of a better term, and a coordination of efforts at the local level, all of that background work by the states will be for naught."