Prehospital Profiles: Becoming An Effective Supervisor

It's no secret that city and county departments work better together when personnel are all on the same page in terms of rules, regulations and standard procedures.

EMS World recently spoke to Melissa Dixon, EMT-P, paramedic supervisor for Caroline County Department of Emergency Services, who took part in the first class in 2009.

Who was eligible for the skills-building class?

A list was created of all those county employees who would be eligible or up for promotion in the near future, excluding anyone who was already a supervisor. There was a second class in 2010, and they asked some of us to come back and help teach certain parts of it.

The curriculum used was one already established by ICMA. Was it flexible enough to be adapted to your special interests?

Yes. The textbook used was Effective Supervisory Practices, published by ICMA, and the workbook was Effective Supervisory Skill Building, but they added some things to the curriculum like accident forms that are specific to our county, as well as how to handle overtime, how to discipline, how to correct certain behaviors and how to lead by example. There was a lot of role-playing and group activities that addressed issues like: How would you handle this situation? How do you motivate people? How can you get your employees excited about what they're doing? How do you delegate?

After two successful classes, the program is now on hold. Does the county plan to resume the program in the near future?

It seemed to be productive and very useful, so I assume it will continue when the budget allows. We got paid to go to the class, so there was always a question of whether they had to fill our spots when we were in class and it got to be a budget issue. Each department paid salary for employees to attend, and I believe HR absorbed the cost of books and materials, but I'm not sure where that money came from.

Although specifics were added for our county, the general class could be used anywhere. Having all of the departments represented was good, since we never work with those people. Group activities were helpful in getting to know each other, and just hearing other employees talk about their jobs made us all aware that things aren't always greener on the other side. The most valuable part for me was learning directly from department heads like the director of HR saying, "This is how we want certain issues handled." A difficulty for EMS is shift work, and working with a lot of different supervisors who all do things a little differently you don't always get uniform information. For me, it was good to know "here's what they're looking for; here's what they expect," so when I eventually got promoted I would know what to do.

DEPARTMENT PROFILE: CAROLINE COUNTY (MD) DEPARTMENT OF EMERGENCY SERVICES--EMS DIVISION

Type of department: Third-service-county government combination.

Number of employees: 54 full/part time, all uniformed.

Service area: 34,100 population; 320.8 square miles.

Call volume: Estimated 5,500 calls/4,200 transports.

Number of vehicles: EMS Division: 5 ALS/BLS transport-capable ambulances, 2 utility body ALS chase vehicles, 1 4x4 SUV-type supervisor ALS unit, 1 Crown Victoria ALS division chief unit. Volunteer units: 8 ALS/BLS transport-capable ambulances in operation, depending on volunteer staffing availability and supplemented by career staff.

Annual operating budget and major source of operating revenue: $2.197 M—FY2012 budget for career EMS Division; $1 M revenue. EMS billing is split: VFCs receive 35%; 65% goes to county's general fund; K revenue—EMS subscription plan.

What makes your service different or unique?

There is no hospital or EMS transport-capable ED in the county. We provide ground transport to seven out-of-county hospitals, including three out of state. Specialty referral and trauma patients are often transported directly from the scene via rotor-wing, primarily by the Maryland State Police medevac program. Caroline County is the only county in Maryland without a hospital or emergency ambulance receiving facility located within its boundaries.

We are a combination career/volunteer system comprised of eight volunteer fire companies--one located in a different county and one in a different state.

Career personnel are used to supplement staffing on volunteer ambulances. Some stations use volunteer drivers from 1900 to 0500 hours to provide ambulance assistance to career paramedics.

What recent changes or improvements have been undertaken to offer better care/service?

• Continued development and implementation of a STEMI program.
• Improved relationships with VFCs to centralize billing, inventory control and quality assurance/improvement initiatives.
• Excellent multi-agency "trunked" radio system shared with neighboring counties gives full interoperability.

What recent technology or equipment upgrades have you made?

• Implemented automated CPR devices on primary staffed ALS transport vehicles
• Implemented oxygen-driven ventilators/CPAP devices
• Using IO drills for rapid IV/IO access
• Using carbon monoxide monitoring devices
• Added hydraulic stretchers and ergonomic stair chairs
• Purchased ALS-configuration 2009 Horton/Chevy 4500 series ambulance with integrated safety features.

Do you have any new or unusual protocols?

EMS units respond to many fire emergencies, including structural responses, natural cover fires and hazardous materials incidents. Personnel perform "rehab" duties to ensure the safety of volunteer fire personnel.

What special projects or programs have you recently conducted or participated in?

BLS protocol for glucometer usage.

Maryland has recently designated STEMI and stroke centers. Patients often bypass the closest facility in order to arrive at an appropriate center; transport to the center may be 60 minutes or more.

How do you reduce costs or maximize limited funding?

• Strategic placement of units/staffing configuration to efficiently allocate EMS resources throughout the county
• Administrative functions handled primarily by EMS staff
• Volunteers supplement coverage by staffing units during special events, weather emergencies and at other times as needed
• County has purchased used ambulances and "rehabbed" two of the non-transports to extend vehicle life.

What are your plans for the future?

• Replace/update EMS fleet at regular intervals and incorporate latest safety features
• Integrate "real-time" patient charting and telemetry transmission
• Improve and increase training and educational initiatives
• Trend toward purchasing EMS units with state-of-the-art safety features for crew and patients.

Website: Caroline County Government Department of Emergency Medical Services