|Director’s Message: Howard Backer, MD, MPH, FACEP
How to Become a Good EMS Provider
We have all gone through our initial EMS training as well as other general education. But let me explore what happens after our “formal” education. Our work demands intellectual rigor, a commitment to continuous learning, and continuous improvement in our decision-making skills. In medicine, and in most other fields, graduation or licensure is where the learning really begins. We then enter a period of apprenticeship or internship, which is learning on the job. When it comes to patient care, there is no substitute to seeing as many cases as possible and having access to someone more experienced who can be a mentor.
A mentor is a very important relationship. It implies not one of simply teacher and student, but a more personal investment in the relationship; a mentor is an experienced and trusted adviser. It also implies learning more than academic or scientific knowledge from your mentor, but professional insight and personal guidance. Most of us have had a mentor during some period in our life. It may have been the person who inspired you to go into emergency medicine, or who helped you mature in other ways. When starting out in a career like EMS, it is essential to have a mentor that can model the qualities of a good medical provider, including professional judgment, integrity, and compassion. Your mentor may not be assigned to you, and it may not be a formal arrangement. You need to find the person and stick close to them, asking questions, and let them know that you are willing and interested to learn from them.
Those who have served or currently serve as my mentors are highly intelligent and have a broad and deep base of knowledge. They are always learning and always willing to share what they learn in a way that never makes me feel inferior. Most important for me is the way they relate to their peers and their patients. They have time to listen and they respond with understanding and compassion. Despite being a leader, they do not exhibit arrogance or superiority.
It is a responsibility for those of us who have experience in our field, whether five years or forty years to be mentors to our newer colleagues. Every time that I have to discipline the license of a paramedic who was reckless or negligent with their patient’s welfare, or was irresponsible with their personal life through drug use or driving under the influence of alcohol, I am troubled over our collective failure to mentor that individual.
I am not advocating a strictly hierarchical structure. In fact, EMS suffers from the concept of seniority, which is not at all the same. A younger and less experienced person may in fact need to help an older one whose judgment is impaired from fatigue and burn-out. An important quality to develop is being a team player. You are never alone on a case, yet teamwork is often lacking. Teamwork does not mean a strict division of labor, it means using the combined skills and judgment of the team to potentiate one another’s skills. Research across professions shows that disciplined group decision-making consistently outperforms individual decision making. This does not mean there is no role for leadership, but it does mean that a good leader solicits opinions of his team when time and circumstances allow. It is also the obligation for a junior person to offer suggestions if s/he sees wrong decisions being made. I regularly review disturbing cases when the senior health team member used poor judgment but the other team members remained silent, and the outcome was tragic.
One way to avoid this is to foster a true team culture, be willing to take ideas from any member of the team, and ask the team whether anyone has any other suggestions before carrying out a difficult decision. It bears repeating that humility and integrity, not superiority and arrogance, are the virtues in medicine. Experience should certainly be valued, but judgment can be clouded by both professional and personal factors, so we all need to support one another to provide the best care for our patients.
This article originally appeared in Access Magazine, a publication of Sacramento State’s College of Continuing Education (www.cce.csus.edu).
By Mallory Leone, September 3, 2014
It was hot and dry at Moffett Federal Airfield in California’s Bay Area as cars passed through military checkpoints and snaked around the periphery to a designated parking lot. More than 420 medical professionals, disaster coordination team members and student volunteers arrived on that day to participate in Golden Guardian 2013, a large-scale disaster simulation that tested the salt of emergency medical teams from across the state.
Implemented in 2004 by then Governor Arnold Schwarzenegger, the Golden Guardian Statewide Exercise Series coordinates government and private sector organizations in response to catastrophic natural and man-made disasters. This means planning for everything from earthquakes to terrorist attacks, each requiring different equipment and personnel. Planning and systems maintenance is a year-round job, but the best way to test the efficacy of these systems is to vet them in the field.
The California Emergency Medical Services Authority (EMSA) is just one of the government organizations involved in statewide disaster planning and the main organizer of the EMSA Disaster Medical Response Training and Exercises of 2012 and 2013 affiliated with the Golden Guardian series. Simulations include mobile field hospitals, operating and emergency rooms, a central supply area, a trauma ward, an Intensive Care Unit (ICU), a Hospital Administrative Support Unit (HASU) and short-term shelters.
Dr. Howard Backer, director of EMSA, leads the organization in establishing and enforcing state and federal disaster preparedness standards. “Large-scale functional exercises are very complex and involve a huge amount of planning and logistics,” explains Backer. “We have a very small staff, so supporting administrative tasks isn’t possible without the help of an organization like Sacramento State.”
In conjunction with EMSA, Sacramento State’s College of Continuing Education (CCE) coordinated the logistics and planning of both Golden Guardian exercises. From securing sites to coordinating travel and working with numerous volunteers and vendors, the CCE team provided logistical coordination, training supplies and materials, transportation, lodging, training equipment, audio/visual support, sanitation, security, and food and beverages.
“This is about as close as one could get to a real-life disaster without being in harm’s way,” says Backer. “Although we plan for disaster response year-round, nothing compares to putting medical and administrative personnel into a full-scale exercise with a realistic scenario to ensure readiness.”
Preparedness training on this scale is specifically designed to better equip some of California’s finest medical volunteers, whose mission is to rapidly deploy and treat patients within hours of a large-scale disaster.
A Symbiotic Relationship
The scene at Moffett Airfield’s Hanger #3 in 2013 was as realistic as it gets, especially when the “victims” arrived. Sac State emergency medical technician and paramedic students were assigned various crush injuries associated with the simulated earthquake scenario and professionally moulaged. They then demonstrated appropriate symptoms so the disaster health care volunteers could triage, treat and transport victims just as they would in real life. Student participation in the event directly aligns with CCE’s vision to “transform lives by providing innovative learning opportunities regionally and globally.”
Susan Gonzalez, director of CCE’s Conference and Training Services Unit, describes the partnership with EMSA as a service to the agencies involved, as well as to the student participants. “We’re not only helping to meet the training needs of professionals in the health care and emergency response industries, we’re providing real-world experience to our students. Delivering rich experiences outside the classroom is key to a robust education.” The students also had an opportunity to job shadow the medical teams, ride along with paramedics and visit the observation area.
“We examine every CCE partnership through a lens of creating win-win scenarios like this one,” says Gonzalez. “Our students gain invaluable insights into their fields while providing volunteer services. And in the end, we’re all dedicated to saving lives.”
Through its work on the simulations, the Sac State campus and staff have become integral to the state’s overall disaster preparedness plan. Bill Campbell, a contract manager for EMSA, works closely with the university. “The Sacramento State team was instrumental in planning and coordinating the event,” says Campbell, “which also includes the mandated cycle of disaster training and evaluations.”
“We love to engage in projects that run full cycle where we not only help with planning and logistics on the front end, but also work with the client to create after-action plans for retraining on areas that demonstrate challenges,” explains Gonzalez. For Golden Guardian, EMSA creates an extensive after-action report to analyze medical, transport and communications systems to identify gaps and areas for improvement.
After taking corrective action, EMSA repeats the cycle with a stronger skill set and a new disaster training scenario.
Saving Lives through Disaster Preparedness
California, with all its beauty and grandeur, is a high-risk disaster prone state. “We know we’re going to have large-scale earthquakes, not just in one area, but throughout,” says Backer. “There can be a plan in place, but unless you practice what that entails, there will always be questions of the plan being realistic.”
In addition to creating the necessary infrastructure and training, the Golden Guardian event remains an important place for emergency medical responders to network and share ideas.
Michael Petrie, EMS director and chief for Santa Clara County, has been involved in emergency preparedness and disaster planning for almost 20 years and insists that interagency partnerships and long-term relationships are priceless when a disaster actually hits.
“Anyone can call a number and get a laundry list of referrals, but after years of creating friendships at events like these, I’m able to call someone’s personal cell phone for recommendations. That can mean a world of difference in a time of crisis,” says Petrie. “These types of comprehensive exercises are the most difficult to pull off, but they’re the only kind that allow you to validate that the processes work.”
The agencies and disaster medical volunteers are also looking for flaws. “That’s why we do this,” explains Lee Sapaden, assistant division chief at EMSA. “Identifying what doesn’t work now means we can fix flaws before real disasters strike.” The disaster simulations test, validate and strengthen systems, build relationships and give volunteers an opportunity to put their training to work.
“These things make a tangible difference in the safety of California residents.” “It’s not a matter of if,” says Gonzalez, “It’s when.” With trained and ready medical agencies throughout the state, money and resources won’t be wasted in the frenzy that can occur during disasters like the ones EMSA and like agencies prepare for.
Disasters have no economic, social or political boundaries and people expect their government to protect and serve. “Ultimately it’s about saving lives,” says Gonzalez. “The more prepared disaster responders are, the more organized we are as a community, the better off we’ll be in the event of a disaster.”
Republished with permission of Sacramento State (www.cce.csus.edu).
2015 EMS Law Books Now Available
Hard copies of Health and Safety Code, Division 2.5 – commonly referred to as the “EMS Act” – are available in hard copy, while supplies last.
Complete a request form (sold out). Electronic copies are also available for download (no longer available).
Community Paramedicine Update
California’s Community Paramedicine (CP) pilot project met an important milestone on February 19th: the UCLA Center for Prehospital Care, under the direction of Dr. Baxter Larmon, finalized the coordination and delivery of the core CP training program curriculum.
Delivery of CP curricula relies on faculty comprised of nurses and physician educators who are experienced in educating health care professionals. To date, 77 paramedics training at eight locations across California have successfully completed the core CP training program.
The core training program is composed of 152 instruction hours – 96 classroom based and 56 independent study. Before being admitted to the program, a paramedic must first have a minimum of four years field experience and be sponsored by a LEMSA medical director. A successful candidate must have 100% attendance, complete all assignments and a cumulative oral exam administered by a medical director.
Members from UCLA, EMSA and UCSF (independent evaluators) monitor the training curriculum delivery via virtual online accesses as well as on-site visits.
Pilot sites have begun their site-specific local training which is required to be completed prior to the implementation phase, anticipated to begin this June. The eight pilot site locations include Butte County, Alameda County, Solano County, Stanislaus County, Ventura County, San Bernardino County, Los Angeles County and San Diego County.
Learn more about California’s Community Paramedicine pilot projects.
NREMT Pass Rates: California vs. the Nation
California exceeds the national average when it comes to first attempt pass rates for both written EMT and paramedic exams.
California’s first attempt pass rate for the 2014 paramedic exam (pdf) was 83%, compared to a national average of 76%. In the same year, California’s first attempt pass rate for the 2014 EMT exam (pdf) was 71%, compared to a national average of 70%.
It is no wonder that California’s EMS personnel are among the best trained, most competent and professional in the world.
EMSA Welcomes New Employee
Kenneth Campbell is a new employee in the Paramedic Licensure Unit since early March, filling our vacant office technician position. Some of Ken’s tasks are EMT billing and payments, administrative law judge reimbursements, printing EMT and paramedic cards, purchase orders, payments for paramedic initial applications and renewals, dishonored checks, paramedic accreditation, answering phones, and the reception desk.
Ken comes to us from Walmart where he was a direct receiving associate. Ken is a Navy veteran with nearly 21 years of service in various capacities, most recently as an administrative assistant. He served in Iraq for one year during his service.
Ken and his wife Tara are celebrating five years of marriage and have known each other since they were ten years old. He has a son and two stepdaughters. Ken enjoys watching his favorite team, the Detroit Redwings, trips to Bodega Bay, movies and lounging around the house.
Hospital Incident Command System Translated in Japanese
EMSA is the copyright holder of the Hospital Incident Command System (HICS) materials that are used nationally and internationally to bring Incident Command System (ICS) concepts and principles into hospitals.
A workgroup at the University of Tokyo has undertaken a project to translate the recently released Fifth Edition of the HICS materials into Japanese.
EMSA was very pleased to host Jun Tomio, MD, MSc, PhD of the University of Tokyo during his visit to Sacramento on March 5th and 6th. Dr. Tomio is an Assistant Professor, Department of Public Health, and Graduate School of Medicine. He is leading the group working on the translation of HICS from English to Japanese.
Disaster Healthcare Volunteer Program
Disaster Healthcare Volunteers, (DHV), is a statewide program administered by the California Emergency Medical Services Authority and operates in coordination with county operational areas to recruit, register, credential, track, identify, deploy, and maintain currently licensed volunteer health care professionals for the purposes of responding to emergencies, disasters, and terrorist incidents in California and throughout the nation. The DHV program is California’s model for the federally mandated Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP).
At the local level, DHV volunteers are coordinated by county DHV system administrators and Medical Reserve Corps (MRC) unit coordinators. All DHV volunteer health care professionals are local volunteers who make themselves available to their communities in time of need.
DHV system administrator training has been provided to all 58 counties as well as 39 of the state’s 42 MRC units. Currently there are over 21,000 active volunteers registered on the system. DHV electronically verifies the license and credential status of 49 types of health care professionals every 24 hours via the licensing/credentialing department/agency (image: Lauran Capps and Eric Fu).
Don’t Wait, Nominate!
Reinforcing the notion that California’s EMS personnel are indeed true professionals dedicated to their craft, just four months into the new year and we have already seen news headlines out of Orange County lauding the efforts of off-duty medics who saved a man on an airplane, and out of Kern County recognizing an EMS team who rescued an alleged drunk driver that had crashed into their own marked vehicle.
EMSA’s annual EMS Awards Ceremony seeks to honor these types of special accomplishments, along with meritorious and heroic acts, as well as innovations or fresh ideas to improve EMS in California. This year’s luncheon will take place on Wednesday, December 2nd at the Marines’ Memorial Hotel in San Francisco and we are working on a number of exciting improvements and enhancements to previous years’ ceremonies.
Don’t wait, nominate! Take a moment to recognize exceptionalism when you see it – nominate a deserving EMS professional today using our web-based fillable form (form no longer availible).
Regulation Revision Update
Epinephrine Auto-injector Regulations
Following the chaptering of Senate Bill 669 (Huff, Chapter 725, Statute of 2013), EMSA has been charged with promulgating regulations to establish lay rescuer epinephrine auto-injector training standards and certification. The new law also directs EMSA to review and approve training programs that will train the lay public in the use and administration of an epinephrine auto-injector to assist a person suffering from anaphylaxis.
Proposed regulation text is available for public comment from March 6, 2015 through April 20, 2015 and will be followed by a public hearing on April 21, 2015 from 10 a.m. to 12 p.m. at EMSA headquarters, located at 10901 Gold Center Drive, Suite 400, Rancho Cordova, CA 95670.
The notice of proposed regulations, initial statement of reasons and the proposed regulation text are available for review on EMSA’s public comment webpage. Contact Corrine Fishman with questions concerning the epinephrine auto-injector training program at (916) 431-3727 or email her at email@example.com.
Senate Bill 1438 (Pavley, Chapter 491, Statutes of 2014) directs EMSA to adopt training standards for naloxone use and to include naloxone administration in the basic scope of practice for EMTs by July 1, 2016.
A stakeholder workgroup has been convened to revise the Chapter 2 EMT regulations and had their first meeting on March 3, 2015. Formal rulemaking through the Office of Administrative Law is anticipated to commence in June 2015, offering the opportunity to receive public comment. Contact Corrine Fishman with questions concerning the EMT regulations at (916) 431-3727 or email her at firstname.lastname@example.org.
Chapter 1.5 Public Safety Regulations
Following several public comment periods, EMSA’s proposed revisions to the Chapter 1.5 First Aid and CPR Training Standards for Public Safety Personnel regulations were approved by the Office of Administrative Law and will become effective April 1, 2015.
The revised regulations replace outdated training standards with the current national EMS education standards and update training standards for first aid and CPR to include AED training. Further, training standards were added to address emerging health and safety issues including anaphylaxis, drug overdose and response to active shooter type events. The proposed regulations clarify which skills public safety personnel are authorized to perform following training and demonstrated competency, and add optional skills that may be approved by the local EMS agency medical director.
EMS Plan Appeal Regulations
EMSA has opened the public comment period for the draft regulations on the appeal proceedings to the EMS Commission.
There is currently no established appeal process that permits local EMS agencies (LEMSAs) to appeal a determination by EMSA in relation to an EMS plan decision. The purpose of these appeal regulations is to avoid serious harm to the public peace, health, safety, or general welfare by implementing an appeal process for LEMSAs when an EMS plan is disapproved by EMSA.
The draft regulations may be viewed on EMSA’s public comment webpage.
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