Report on Rural EMS Needs Assessment and Future Planning. Nan Turner, RN, MSN, EMTP WORH EMS Consultant July 2008

Transcription

1 Report on Rural EMS Needs Assessment and Future Planning Nan Turner, RN, MSN, EMTP WORH EMS Consultant July 2008

2 OBJECTIVES Discuss the process and findings of the 2007 Rural EMS Needs Assessment Discuss the Wisconsin Office of Rural Health s (WORH) current rural EMS - focused initiatives Discuss plans for future WORH rural EMS and community initiatives Provide information regarding WORH Rural EMS Resources and tour the EMS component of the WORH website

3 2007 Rural EMS Needs Assessment Project

4 Goals of Project To determine specific needs of rural EMS providers To include Federal Rural Health concerns in the areas of EMS education, billing/reimbursement, recruitment/retention, and trauma system involvement To determine the greatest needs for FLEX grant funding opportunities To provide information to State EMS Office and other partners for consideration in policy-making

5 Process First surveyed 59 CAH (36 responded) Determined which rural services delivered patients to CAHs Sent 235 WORH EMS Needs Assessments 10 returned - undeliverable Processed 96

6 CAH Questions Please indicate the names of EMS ambulance services who deliver patients to your CAH How many patients were transported to your CAH last year (2006)? Does your CAH provide medical direction for your local EMS ambulance service? (28/33= yes) Do you collaborate or participate in any other activities with your local EMS ambulance service provider? Community CPR Education Fundraising Injury Prevention Quality Assurance Other

7 EMS Needs Assessment: Six Sections Demographics Personnel and Training Ambulance Operations Data Collection Injury Prevention Priority Needs

8 Section One: Demographics Estimated population of service area Approximate square mileage of your service area To which rural hospitals do they transport patients Participation in RTAC

9 Licensing Level of Respondents Paramedic 17% Intermediate 8% Basic 49% I-Tech 26%

10 Section Two: Personnel and Training Difficulties covering shifts Recruitment and retention Training difficulties Who pays for CE Rank methods of instruction

11 Difficulty Covering Shifts NO 25% YES NO YES 75%

12 Difficulty Covering Shifts Holidays 25% Days 31% Weekends 34% Nights 10%

13 Reasons For Not Being Able to Cover All Ambulance Shifts Other 27% Conflicts with Employer 21% Daycare/Childcare 12% Family Issues 19% Distance from employer 21%

14 Other Reasons Limited number of EMTs Short staffed & overworked Bedroom community Low pay Call volume Everyone works out of the area Few EMTs & everyone has so much going on Lack of time available to volunteer Decreasing numbers EMTs have regular FT jobs EMS is not

15 Do You Have a Recruitment & Retention Plan Other 1% NO 56% YES 43% YES NO Other

16 Top Most Successful Methods Used to Recruit Personnel Word of mouth Advertising (Paper, radio, etc) Open House/Community Events

17 Most Successful Methods Your Agency Uses to Retain Personnel Competitive pay Modern equipment Flexibility (scheduling, etc) Treated fairly, with respect Good communication, teamwork, LOSAP Paid education

18 Extent Personal Factors Contribute to Agency s Ability to Retain Personnel Factors Lack of support from non-agency employer Difficulty getting time off from employer for emergency calls Lack of support from non-agency coworkers Out of pocket expenses to volunteer Employment schedule/shift work Time commitment at agency Lack of wage/salary compensation during call time Transportation issues interfere with agency participation Child/Elder care issues interfere with agency participation Family obligations other than child/elder care interfere with agency participation Lack of family support interferes with agency participation Community not supportive of EMT to participate with agency Personal health interferes with agency participation 76 17

19 To What Extent Does Each of The Following Agency factors contribute to your Agency s Ability to Retain Personnel? Factors Lack of emotional support from agency coworkers n/a Effort is not valued by agency Personality issues at agency Lack of respect from physicians Lack of respect from nurses On-call expectations Lack of opportunity to participate at agency Lack of independence Must also be a firefighter Must participate in firefighting Response location Response time requirements Lack of internal structured training program Sufficient similarly certified EMS personnel Lack of adequate EMS equipment Amount of critical incident stress Poor critical incident stress debriefing 88 5 Physical demands of EMS work Shortage of personnel for backup Health and/or safety hazards Legal liability

20 Technical College Ability to Meet Needs Other 27% Classes not conveniently located 30% Class times not convenient 15% Class scheduled at wrong time of year 6% Cost 17% Lack of quality instruction 5%

21 Other Responses Not offering level of education we seek (EMT-P) Minimum number of students/class Lack of having choices Have to travel so far Instructors not following state standards Class start of 5:30PM is too early for day shift workers Difficult for staff to get off Inadequate amount of classes being offered Not enough courses/classes offered due to lack of instructors Poor communication with training center 7 answered have no problems..tc is Great Having classes twice/week No options; internet, various times, etc

22 Order of Preference for Types of Educational Opportunities Most to Least Preferred: Hands on skills practice Classroom Video CD/DVD Internet & Interactive video tied Correspondence

23 Section Three: Ambulance Operations Number of ambulance runs (2006) How and by whom is billing done Types of reimbursement difficulties

24 Unknown Distribution of Number of Ambulance Calls, > 2001 Total Number of Ambulance Calls 0-49 Percentage of EMS Providers

25 Who Does Ambulance Billing? 62.5 percent of services directly bill for their services 35.4 percent contract their billing to an outside entity two services do not bill for their services.

26 Reimbursement Difficulties low reimbursement large number uninsured slow reimbursement by payer complicated billing procedures and types of services covered by insurers were also indicated by 25 percent of the respondents.

27 Section Four: Data Collection Familiarity with WARDS Do they have a computer Do they have internet access What type of internet service do they have Are they using EMSS

28 Familiarity With the Wisconsin Ambulance Run Data System (WARDS) ALL BUT ONE FIRST RESPONDER GROUP SURVEYED INDICATED THAT THEY HAD HEARD ABOUT WARDS

29 Computer Availability NO 27% YES NO YES 73%

30 Where are Computers Located? 12% 8% 20% 60% Station Hospital Member's Home Ambulance

31 Does Your Service Have Internet Available? NO 28% YES 72%

32 Type of Internet Service Types of Internet Service T1 13% Other 6% Dial-up 7% Cable 28% DSL 46%

33 Using EMSS All but 10 Services answered Yes Reasons listed for non-use: Do not know anything about it In the process of establishing Have no computer (3) Not comfortable using the internet Have no interest to access it Time

34 Section Five: Injury Prevention What types of injury prevention programs are available in their community

35 Community Public Awareness Education Programs Available Access to EMS 15% Other 11% None 4% Poison Prevention 4% DNR 8% Seat Belt Awareness 13% Violence Prevention 5% CAH 6% Water Safety 6% Drug/Alcohol 11% Child Safety Seats 17%

36 Other Programs Ask a Medic Program Bicycle Safety CPR Fire Safety in Schools P.A.R.T.Y. Program Every 15 Minutes Program Juvenile Decision-making Safety Camp for Second graders (PD) All Awareness done through Public Health Internet

37 Section Six: Priority Needs Two major areas: Asked what they would consider their agency s top 5 needs Asked what are they would consider their 5 greatest challenges as a manager of an EMS service

38 Agency s Top 5 Needs Not enough grants for non-fire based services Time for Quality Assurance (QA) & Quality Improvement (QI) Increased medical director involvement Projector & laptop for in-house training More funding from State More people who will volunteer to help us Hiring Full time staff Advance to higher level of care Growing our response area No problem, usually if needed, I just buy it!! Allowing EMTs to work at highest level of licensure Flexibility with refresher courses More grants for EMS CPAP

39 5 Greatest Challenges as a Manager of an EMS Service The number one response was budget, followed by personnel issues/staffing and communications (includes staff, policy makers, patients).

40 Other Challenges Radio communication Training/continuing education Time management Customer service Recruitment / Retention Trying to get our EMT s to use computer Trying to keep up with all the new things coming out Finding time to do administrative work Municipal Gout lack of understanding of EMS Education availability and cost Building a satellite station Enlarging our coverage area Getting qualified/experienced EMT & paramedics Maintaining good skill levels

41 Other Challenges Conflicts between Fire and Police Departments Having to have Village Board approval on most everything Having on-call room for EMTs during their shift Keep Basic services in business Meet community s needs for EMS Keep politics out of patient care Getting WARDS up and running Long hours (my wife and I cover 24 hrs/day/7days/week with very little relief) Lack of understanding by the community of EMS Keeping the good crew I have now Finding time to be responsive to the concerns and wants of personnel Keeping skills current with low call volumes WARDS Small town rumors Political pressure to provide interfacility transfers for our hospitals I have to take call when others can not no freedom Lack of support from administration Retiring seasoned EMTs Road construction and visible fire numbers

42 Recommendations Support legislation to protect the volunteer EMT Improve communication with stakeholders Provide education for Grant writing/fundraising Statewide coordinated Recruitment/retention strategy Statewide EMS marketing campaign Support funding for equipment and facilities Offer benefit incentives to volunteers Support improved local and regional evaluation and QI programs Provide funding opportunities, such as mini grants, to assist rural EMS systems in purchasing equipment, education, facilities, etc Provide one central location for information and minutes from RTACs, EMS Advisory Board and subcommittees, grant opportunities, etc Continue to pursue various education delivery modalities for continuing education

43 Recommendations Incorporate Rural EMS System specific issues into the 2008 EMS State Plan Improve data collection Develop public education strategies Provide injury/illness prevention programs Investigate strategies to integrate CAH and EMS efforts to promote healthcare to their communities Consider utilization of the RTACs for EMS group buying, CLIA waivers, rural prevention education program development, equipment and personnel sharing Promote and provide EMS leadership education to rural EMS service directors Foster the development of a culture volunteerism and community service through local schools in partnership with community agencies.

44 Where Do We Go Now?

45 Current WORH Initiatives Grant Writing Workshops Inclusion in FLEX Mini-grants Continuation Web EMS Resources

46 Grant Writing Workshop WORH sponsored two Grant Writing Workshops. Next one will be held in Rice Lake on July 23 at the Microtel Inn from 9 AM to 3 PM.

47 Strategic Planning 2009 Sessions were held in 2008 Attended by many EMS Stakeholders Federal Rural Health continues to place emphasis on EMS

48 Rural Community Grant Deadline is Thursday, August 7 WORH will award 5 additional points to coalition proposals that include EMS as a major partner and that addresses an EMS issue in their community

49 Proposal(s) for 2009 FLEX Grant - EMS Rural EMS Manager/Director Course Utilization of a variety of education delivery methods Continuation and expansion of EMS web site component Study of EMS, CAHs and rural hospitals shared staff services (for both hospital-based and non hospital-based ambulance services) Possible pilot project EMS specific grant writing workshop and discussion

50 Rural EMS Manager/Director Course Needs Assessment Strategic Planning Session Interested partners Wisconsin Ambulance Association and State EMS Office

51 WORH Web Resources - EMS

52 Parts II and III EMS Educational Sessions Date is Monday, July 28 Part II is scheduled from 9AM 12 Noon, which includes presentations from members of all advisory bodies to the State EMS Office Part III is scheduled from 1 PM 3 PM and includes presentations by several members of the State EMS Office

53 Vision Statement Rural and Frontier EMS Agenda for the Future The rural/frontier EMS system of the future will assure a rapid response with basic and advanced levels of care as appropriate to each emergency, and will serve as a formal community resource for prevention, evaluation, care, triage, referral and advice. Its foundation will be a dynamic mix of volunteer and paid professions at all levels, for and determined by its community.

54 Questions Thank you This presentation will be archived and available on the website under the EMS section

55 TOUR EMS Component of the WORH Website and Resources