Leadership in Action

EMS World and the National Association of Emergency Medical Technicians (NAEMT) established the National EMS Awards of Excellence program to recognize outstanding achievement in the EMS profession.

The 2016 awards will be presented on Tuesday, October 4, at the NAEMT Annual Meeting in New Orleans, LA, held in conjunction with EMS World Expo 2016, and at the EMS World Expo Opening Keynote on Wednesday, October 5.

Award recipients receive a monetary award, a three-day core program registration to EMS World Expo, plus $1,200 for travel and lodging to attend EMS World Expo and the NAEMT Annual Meeting.

We would like to thank the sponsors of this year's awards: Braun Industries, Ferno, Jones & Bartlett Learning, Nasco, North American Rescue and ZOLL.

The nomination period for next year's awards will open in early 2017. Visit EMSWorld.com/awards for more information. To register for EMS World Expo, see EMSWorldExpo.com.

2016 Dick Ferneau Career Service of the Year: New Hanover Regional Medical Center’s Emergency Transport Services, Wilmington, NC

If you want something done, the saying goes, give it to a busy person. Their time may be limited, but what they get done with it so far exceeds everyone else, they’re still your best bet to do it fast and well.

That’s kind of how it is for our 2016 Dick Ferneau Career Service of the Year, New Hanover Regional Medical Center’s Emergency Transport Services, based in Wilmington, NC. They take on a lot of stuff beyond just 9-1-1 response—and they’re really good at it. 

“One of the philosophies we’ve tried to impart here is kind of a foxhole mentality,” says service administrator Terry McDowell, who did 26 years in the Army before joining the service. “When you initially go into a position, you dig a really hasty fighting position—just a hole to get down in. But as time goes by, you add cover, you dig it deeper, you put sides on it. You never stop improving where you’re at. And that’s how I think it is with the leadership team we have here now: We are always constantly looking for the next best thing.”

New Hanover representatives will be recognized at EMS World Expo and the NAEMT General Membership Meeting and Awards Presentation Oct. 4 in New Orleans. For winning they’ll get $1,000 cash, three Expo core program registrations and $1,200 toward travel and lodging. 

There have been a lot of next best things for the service in recent years. NHRMC ETS delivers 9-1-1 response, critical care transport and nonemergent transport by way of 45 ground vehicles and two helicopters that cover more than 1.1 million miles a year. It serves a broad array of patients with wildly diverse needs. 

“The way we lay it out for our folks is, we’re here to take care of our patients,” says McDowell. “If there’s ever a conflict between that and anything else, we’re going to default to taking care of the patient. And our job as leaders is to set the environment through education, training, equipment and everything else so that when our providers are with a patient, all they have to focus on is taking care of that patient.” 

Just some of what that supporting groundwork covers is: 

• Active shooters and the mentally disturbed—As shooting events accumulate, New Hanover enhanced its SWAT medic team with training for all field operations staff. Front-line medics drilled with partners like the FBI, and EMS leaders helped drive creation of the county’s first high-threat response plan for emergency services. 

“Everybody wants to be on the same sheet of music, but I don’t know that we were moving fast enough for things that could happen,” says McDowell. “One of our battalion chiefs and also the EMS chief jumped on it and decided, ‘We have to go ahead and get this done.’ They helped us bring a realistic level to our training, and now everybody knows what the expectations are for fire and police and EMS when we get on scene.”

On a related mental health note, the service partnered with local providers to create EMS-focused crisis intervention training. This equips supervisors and community paramedics to deescalate potentially volatile situations and in some cases has let patients be redirected to mental health services. 

• Sepsis—All transport team members—BLS, paramedics and critical care—have been trained on recognition and early notification for severe sepsis. The critical care side has a comprehensive protocol driven by point-of-care serum lactate testing and three different antibiotics. A sepsis alert protocol speeds ED treatment. In four years, these efforts have driven local sepsis mortality from 47% to 15%. 

New Hanover’s critical care division recently became the first EMS system to earn mobile clinical lab accreditation from the College of American Pathologists. It uses epoc lab technology that identifies a baseline serum lactate and permits measurement of arterial blood gas, serum electrolytes, hematorcit and hemoglobin, and whole blood glucose. More than 36% of lab tests directly impact transport patient care. 

“Some of our outlying hospitals don’t have their own full lab capabilities,” notes McDowell. “We can get on scene, draw the labs, get immediate results and start on a sepsis protocol that will be carried through, all while that outlying facility may not even have gotten lab results back yet.”

• Mobile integrated healthcare/community paramedicine—New Hanover’s grant-funded program, focused on readmission reduction and aversion of unnecessary ED visits, had statewide repercussions when leaders briefed lawmakers in Raleigh and got funding, along with two other CP programs, to show the concept works. 

The effort has yielded collaborations throughout the community and enhanced relationships with primary care providers, civic organizations and mental health professionals. A particular group to benefit has been veterans: New Hanover County has a large population, and leaders worked with the CMO of the local VA clinic to improve their services. 

“I’d put our community paramedic program up against anybody’s,” says McDowell. “With the data we’re reporting to the state—for our frequent utilizers, being able to reduce their percentage of ED visits and admissions—there is a huge savings there if we can do that well.” 

The project includes a nurse help line and even a pharmacist who can accompany CPs and deal with medication issues (New Hanover also has an emergency medicine pharmacist  on its clinical outcomes and education committees). All told, the initiatives are thought to be saving around $2.7 million systemwide. 

Other Best Practices

There’s lots more both common to top systems and unique to New Hanover: 

• Pit-crew cardiac arrest care, integrated with local fire departments, that’s helped boost survival to discharge from 14% to 32%; 
• A performance improvement team developed an anonymous safety reporting system that allows staff to raise any operational, clinical or safety issue. Everyone can then view the issue and its resolution; 
• Electronic orientation and testing: New employees get a tablet linked to a personalized cloud-based e-library that contains protocols, checklists, competencies and evaluations. This lets educators monitor new members’ progress remotely and in real time. Deficits can be quickly identified and remedied. It saves nearly $400 per new team member; 
• A research focus that includes a prospective clinical trial on therapeutic hypothermia and eight other publications over the last two years. A forthcoming trial will look at prehospital identification of internal hemorrhage through ultrasound FAST exams; 
• Telemetry-only interfacility transports of certain patients by EMT-Is (and a study showing they can do it as safely as paramedics); 
• Evidence-based prospective critical care utilization criteria to screen every referral, a practice shared with critical care programs in other states; 
• A naloxone partnership with law enforcement; 
• An ED patient arrival liaison medic to speed hospital turnarounds; 
• A focus on safety in patient lifting/movement, with bariatric ambulances and powered lifts, as well as recent evaluations by physical therapists; 
• A bulked-up program of mental health support for employees, plus numerous efforts to enhance their safety and physical health; 
• A project to deliver hands-only CPR training to 200,000 people (plus all nonclinical hospital staff);  • Both the 9-1-1 system and regional air/ground critical care transport teams received 2014 and 2015 Mission: Lifeline Gold EMS recognition. Regional medics can active a STEMI alert without ECG transmission or physician interpretation; 
• Collaboration with hospice on a Sentimental Journey program for dying patients.

Future plans involve seeking CAAS and CAMTS accreditations and exploring the addition of blood and ultrasound to helicopters.

2016 ZOLL Volunteer Agency of the Year: Valhalla Volunteer Ambulance Corps, Valhalla, NY

Thirty miles north of New York City, population 8.5 million, sits a hamlet named Valhalla, population 3,162 as of last Tuesday. There aren’t many similarities between those two places, but here’s one: When residents need an ambulance, they’re going to holler for someone with a stethoscope.

Since 1961, nine years before EMS was chartered in New York City, the Valhalla Volunteer Ambulance Corps has been responding to emergencies. Providing prehospital services has been difficult at times, says Sue Briggs, who earns a living as a nurse practitioner when she’s not serving as a second lieutenant at VVAC.

“When I came here 12 years ago, we couldn’t manage our call volume with volunteers alone. It was particularly hard during the day. We had to hire an EMT or driver to fill in about 60 hours a week.”

Given the growing use of paid providers by other EMS organizations since then, it wouldn’t be surprising if Valhalla’s reliance on per-diem people had been increasing. According to Briggs, though, VVAC has moved in the opposite direction.

“As of about five years ago, we were down to 12 paid hours a week,” says the 30-year EMT. “Now we’re at zero. We’ve been all volunteer since 2014.”

Hard Work Between Calls

Briggs attributes VVAC’s expanding membership to a combination of hard work and word of mouth.

“We do a lot of promotion in the community—demonstrations, CPR courses, advanced classes in PHTLS and GEMS. We even offer EMT originals and refreshers on occasion. Usually we’ll get at least one new member from each of those classes.

“We don’t put people on the road right away. Even if they come to us as EMTs, we train them and expect them to ride under preceptors until we feel they’re ready. We don’t ever want to put them or their patients in jeopardy.”

Retaining members, some of whom come from as far away as the Bronx, is as much a challenge for VVAC as for any volunteer organization.

“We’ve redone our building to give our people a nicer place to relax, study, practice their skills—anything to make them happy and keep them here,” says Briggs. “Still, there are times when you worry if you’ll ever get another new member.

“Things are pretty good right now because we have a lot of college kids who are home for the summer. But when September comes around and those members go back to school, we’re going to wonder, will we have to go paid again?

“Our captain, Steve, is a miracle-worker with duty rosters. He always manages to finagle staffing, but he worries about the future every Wednesday when he puts out a new schedule.”

Steve Marello is Valhalla’s chief, and one of only five officers among 100 members. VVAC also has five “project coordinators” who hold key positions that are practically full-time jobs.

“Between the officers and the project coordinators, we keep it together,” Briggs says of an organization that answers over 700 calls a year in Valhalla and North White Plains. Members, about half or whom are EMTs, do their duty tours at headquarters unless they live within four miles of the building.

Small Town, Big Responsibilities

As a BLS service, VVAC relies on Westchester EMS paramedics to manage critical cases, but the squad has embraced a number of prehospital interventions that had once been ALS only.

“We’ve been doing glucometry for two years and added Narcan about a year ago,” says Briggs. “That’s a big help in differentiating the cause of altered mental status.

“We’ve heard 12-lead EKGs will be available at our level, too. We wouldn’t be interpreting the rhythms, but we’d be able to send them to someone who can.

“Back in the days of Johnny Gage, they didn’t have all the assessment tools we have now. The additional training that comes with that is worth it to be able take better care of our patients.”

Briggs says modernization isn’t limited to the field; Valhalla has been working on integrating ePCRs for 18 months.

“It cost us about $11,000 to get ePCRs up and running. We struggled with finding the right vendor and the right package. The state seems to be pretty happy with our progress, though; they’ve given us a grade of 97% which, according to them, is very good—especially for newbies.

“Our officer who oversees the program is able to QA every PCR and get back to people with problems.”

A Defining Moment

On February 3, 2015 at 6:30 p.m., a Metro North commuter train slammed into an SUV at a Valhalla crossing and caught fire. Five passengers and the SUV driver were killed; 15 were injured—10 seriously. Sixty VVAC members responded to the scene. Briggs was one of them.

“It was below freezing,” she recalls. “There were patients coming off the train right at us. We didn’t know what to do with them. We finally had a building opened up nearby so they could go in and stay warm.

“We’ve learned from that; we know we have to continuously train for those kinds of calls.”

Volunteers often bond over shared sorrow. That was true at VVAC during post-crash CISD sessions, but members were close even before that MCI.

“We are a united team,” says Briggs. “Any time you come in here and say, ‘I need help at home,’ someone will offer it. It’s one big family. Age, race, experience—they don’t matter; if you need something, we’re here.”

Sounds like a pretty good deal for members—and for patients.

2016 NAEMT/Braun Industries EMT of the Year: Nicole Richards, EMT, Burlington, CO

Nicole Richards, a dedicated volunteer EMT for Kit Carson County Ambulance Service, has used her own physical and personal pain to provide better care to her patients. “Her commitment and compassion for patients, as well as her personality, were cemented into her character after being a trauma patient herself,” says Scott Sholes, president of the EMS Association of Colorado, an organization in which Richards is a member. A letter submitted by the Kit Carson County Board of Commissioners stated, “She has a gift for helping patients remain calm during treatment. As an EMT, she has the utmost regard for her patients and after they have been delivered to the hospital, follows up to see how they are faring.” Richards is outgoing and consistently seeks ways to improve her skills and knowledge. A former patient said, “She is a prime example of all Kit Carson County Ambulance Service represents.”

2016 NAEMT/Nasco Paramedic of the Year: Bryn Arnold, Paramedic, Indianapolis, IN

Bryn Arnold works for Indianapolis EMS and was nominated by Tom Arkins, IEMS’s section chief, who said, “She is one of those paramedics who has the gift of being great at her job. She is not only a stellar clinical provider; she is an overall great person. Bryn shows compassion for all of her patients no matter the circumstances.” Arnold has been acknowledged for her leadership skills and for taking new employees, students and observers under her guidance. “When they spend time with her, I know that they are not only receiving good clinical education but are also being taught humanity, humility and compassion for patients,” continued Arkins. This year, Arnold was awarded the Indiana EMS for Children’s Pediatric Hero Award for keeping a child calm and comfortable in the emergency department. Joseph Calwell, a colleague, wrote: “Bryn understands that 90% of this job isn’t about high-priority or critical runs. Ninety percent is holding people's hands when they are scared and telling them that no matter what happens, we are prepared to help them.”

2016 NAEMT/Jones & Bartlett Learning EMS Educator of the Year: Leaugeay Barnes, Paramedic, Tulsa, OK

Leaugeay Barnes, EMS program director at Tulsa Community College, helped develop TCC’s online hybrid and traditional EMS programs and training partnerships with local fire and police agencies. She has guided paramedic students to become instructors, was involved in the National Registry of EMTs (NREMT) psychomotor competency portfolio project, and has served on the National Association of EMS Educators (NAEMSE) Board of Directors and as a representative to the NREMT Board. According to Jeffrey Goodloe, medical director, “She has proven to instill a sense of duty and drive in her faculty and students.” Barnes is an editor and has written articles for several industry publications. She also received an Oklahoma EMT Association’s educator of the year award. “I have never observed an educator genuinely care so much about each individual student. She will do anything to help a student be successful,” stated Joseph Sherrell, EMS officer, city of Tulsa.

2016 NAEMT/North American Rescue Military Medic of the Year: Ernest Parrish, Paramedic/SOCOM Medic, Sergeant, U.S. Army, Joint Base Lewis-McChord (JBLM), Washington

Sgt. Ernest Parrish distinguished himself while serving in Afghanistan where he, despite his own wounds, treated and coordinated the medical evacuation of three very seriously wounded casualties. Medical Director Charles Moore stated, “Sgt. Parrish’s superior professionalism, expertise and unwavering commitment to excellence contributed saving the lives of these three casualties.” Gen. Daniel Allyn, vice chief of staff of the U.S. Army, referred to Sgt. Parrish in a speech citing “the amazing passion, creativity and skill of Army Ranger medics.” Sgt. Parrish loves to teach and has served as an Advanced Ranger First Responder (A-RFR) instructor on four separate occasions. He believes in the importance of developing junior medics and conducting special training to ensure they are trained and prepared for whatever they encounter on the battlefield. Sgt. Parrish works to expand his medical proficiency and has a passion for prolonged field care. Gen. Allyn once remarked, “There is not another Army on this planet that provides the same level of medical care as ours does, and that amazing care is due to our outstanding military medics, like Ranger Sgt. Ernie Parrish.”