The Membership Organization of State Offices of Rural Health
By: Beth Blevins
Rural EMS organizations in Wisconsin are learning to work together and rally for their needs, as evidenced by the recent EMS Day at the Capitol.
The event grew out of an effort begun in 2015 by the Wisconsin Office of Rural Health (WI-ORH) to assess rural ambulance services in the state. That initial work also has generated targeted technical assistance, system-wide collaboration, and other types of advocacy.
Over 100 EMS providers from across Wisconsin gathered in Madison to visit with their legislators for EMS Day at the Capitol.
EMS Day at the Capitol, held on November 1, 2017, had 105 attendees, including representatives from 50 EMS agencies. “Several people said if we get 30 people we’ll be doing well because it’s a long drive and they would have to take the day off—but the registrations just kept rolling in,” said John Eich, WI-ORH Director. “For a first-time event, that was exciting.”
The group met with 97% of their senators and 70% of their representatives. “First and foremost, the purpose was to introduce themselves and start building a relationship, with the promise that ‘you’re going to hear from us more often’,” Eich said. The attendees were from four associations representing EMS providers: the Wisconsin State Fire Chiefs Association (WSFCA), the Professional Ambulance Association of Wisconsin (PAAW), the Professional Fire Fighters of Wisconsin (PFFW), and the Wisconsin EMS Association (WEMSA), as well as the State EMS Advisory Board.
“Fire and EMS don’t have any conflict in doing the work,” Eich continued. “But they sometimes have conflicting goals legislatively. And that can lead to bruised toes and a wariness to collaborate.”
In addition, Wisconsin has two separate EMS associations. “They had had a very acrimonious split many years ago, so part of our goal was to get them working together again,” Eich said. “The bait was the legislation coming up, which was something people were willing to set aside their differences for and show a united front. And they blew us away with how well they did that.”
The group had “three asks” before the legislature, Eich said. “First, the community paramedic bill before the Senate; second, a bill giving tax credits to volunteers; and third, a public safety exemption to state-mandated community levy limits.”
The EMS Day activity received television and other media coverage in the state. Perhaps more importantly, according to Eich, “The people who met with legislators came back with huge smiles on their faces—they were really enthused.”
Although the event was planned in only two months, its seeds were planted two years earlier, when WORH convened a national group of EMS leaders to help design an assessment of what makes a successful rural ambulance service. That work became a springboard for other EMS activities.
“That assessment put us on the map for all the state associations because, in order to do it, we had to email every EMS provider in the state—all 19,000 of them—from paramedics to first responders,” Eich said. “It made them aware of who we are, what we were doing, and helped establish trust in our intent.”
Then in the summer of 2016, Eich was asked to be part of a state legislative study group on rural EMS and firefighters. “That helped to rally EMS folks the following spring, because from that committee came some proposed legislation,” Eich said. “We reached out to those four associations and the EMS Board, and got together every quarter in our conference room. We started with developing a legislative plan, and out of that came the advocacy day for EMS.”
“For all of this, we served as the convener and host.” Eich said. “As with many of our counterparts in other states, we can’t advocate directly, but our university (where WI-ORH is housed) is comfortable with us facilitating a process for others to advocate on their own behalf.”
Funding for most of WI-ORH’s EMS work comes through Flex funding since that federal program was started as a merger of rural hospital and rural EMS federal grants. Their work on EMS Advocacy Day was funded through non-grant sources, such as their fee-for-service work.
The group is already planning to hold the next EMS Day at the Capitol, finding a time that fits the legislature’s biennial calendar.
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Wisconsin Office of Rural Health’s assessment tool, Attributes of a Successful Rural Ambulance Service, is available online for free for any ambulance service or organization working with ambulance services in any state.
Does your SORH have a “Promising Practice”? We’re interested in the innovative, effective and valuable work that SORHs are doing. Contact Beth Blevins at bblevins@nosorh.org to set up a short email or phone interview in which you can tell your story.
NOSORH, National Association of State EMS Officials, The Joint Committee on Rural Emergency Care, and the Arizona Center for Rural Health invite you to join them on April 24-25 in Tucson, Arizona, for the 4th Annual National Rural EMS & Care Conference. Invited attendees include rural EMS directors, medical directors and officers, rural health care providers, state EMS officials, state rural health officials, hospital administrators, elected officials, federal agency officials, and other EMS partners.
The conference will be held at the Westward Look Wyndham Grand Resort, 245 E. Ina Road, Tucson, AZ. To book a room, please call 800-722-2500 and reference the “National Rural EMS & Care Conference 2018” to get the $91 + tax room rate. You may also book online by clicking here. Conference registration will be made available soon.
The EMS Grant Writing 101 Institute starts next month! This 3-part webinar series introduces EMS agencies to the basics of grant writing, how to connect with funders and partners, and where to find funding. Please share this information with EMS agencies and partners in your state and encourage them to participate. The Institute begins on July 11 and will be held on three consecutive Tuesdays at 3:00 pm ET. All sessions will be recorded.
EMS Grant Writing 101 Institute Flyer
To register, go to https://www.regonline.com/EMSGWI17. The deadline to register is June 30.
For more information, please contact Kassie Clarke at kassiec@nosorh.org.
NOSORH is launching another EMS Grant Writing 101 Institute this July. This 3-part webinar series introduces EMS agencies to the basics of grant writing, how to connect with funders and partners, and where to find funding. NOSORH will also provide templates to help agencies get started with the writing process. The series begins on July 11 and will be held on three consecutive Tuesdays at 3:00 pm ET. All sessions will be recorded. Please share this information with EMS agencies and partners in your state.
EMS Grant Writing Institute Flyer
To register, go to https://www.regonline.com/EMSGWI17. Registration ends June 30.
For more information, contact Kassie Clarke at kassiec@nosorh.org
by Beth Blevins
A study commissioned by the Georgia State Office of Rural Health is looking at the feasibility of regionalizing 911 emergency services in rural counties in the state.
Between 2010 and 2016, six rural hospitals closed in Georgia, and others reduced their service lines in an effort to save money. As a result, emergency services were left to fill the gap. This led to an increase in 911 calls and in the distance ambulances traveled to transport patients to an appropriate facility, sometimes leaving no coverage in the county. As rural county tax revenues decreased, the idea of “regionalization” seemed promising.
“Since 24/7 response-ready EMS is expensive, and each small rural county seemed to be duplicating the efforts of the surrounding counties, it seemed logical that having three to four counties join together in a regionalized effort would be an efficient and effective way to provide quality patient care while reducing operating costs,” said Nita Ham, director of SORH Programs at the Georgia Office of Rural Health (GA SORH).
When approached to find funding for a regionalization pilot project, Ham said she was worried that an unsuccessful first attempt would prevent anyone from trying again. “We decided to commission a solid, comprehensive study first, to evaluate if the climate was right for Georgia to attempt something that had never been fully attempted before,” she said.
The grant for the study was awarded to the Association County Commissioners of Georgia (ACCG), which, Ham said, “has a strong working relationship with all counties in Georgia and has been directly involved in EMS issues.” She also noted that the relationship between SORH and ACCG is invaluable. “Since the ACCG has such an intimate working knowledge of county needs, finances, and local government, we have recognized that including them in our discussions and projects is extremely helpful,” she said. “They can give us insight to how well a project may be received, or potentially rejected, based on the local budgets, community relationships, needs, and political climate.”
According to Ham, the intent of the study was to present the information as research findings and to allow state, regional, or local leaders to decide if, how, or when they will use the information. Since the report was issued last June, the findings have been widely distributed at ACCG meetings, as well as state and local EMS meetings.
“The primary takeaway from these meetings, so far, is that there probably will be an effort to consolidate some aspects of daily EMS operations such as purchasing, medical direction, training, and CQI programs,” Ham said. “Some stakeholders also noted a potential benefit in forming a multi-county consortium to fund one ambulance for 12 hours per day to cover gaps within those counties when the primary unit leaves the county for a long-distance transport.”
Ham said it could take one to two years before they can expect to see changes in practice as a result of these efforts. “Accepting ‘change’ as well as budgeting for that change will take time,” she said. She added, “The Georgia State Office does intend to use these findings to guide other future projects, and will also monitor any programs that may be created within the state as a direct or indirect result of the Study.”
The Georgia State Office is making the EMS Regionalization Feasibility Study publicly available. “Through this, we are hoping to perhaps engage with other states and counties that are considering regionalizing their services,” said Patsy Whaley, the Executive Director of the GA SORH.
Following the NOSORH Annual Meeting, the Joint Committee on Rural Emergency Care (JCREC) invites you to join a learning session on Friday, September 9, from 8:00 am– 12:00pm. Breakfast will be provided. Topics include an introduction to “FirstNet”, an update from the National Highway and Transportation Safety Administration, information on State and National Policy Impact on Rural EMS, and much more. “The JCREC learning session is a great opportunity for SORHs and state EMS leaders to share information about EMS issues. SORHs are encouraged to invite leaders from their state to attend,” said Teryl Eisinger, NOSORH Executive Director.
Click here for the agenda. To register for the JCREC learning session, please click here. If you have already registered for the Annual Meeting and would like to register for the learning session, simply edit your registration. The deadline to register is August 8. There is no charge to attend.
NOSORH is offering a 3-part “EMS Grant Writing 101 Virtual Conference” starting in June! Rural EMS agencies and other interested partners will learn how to write and submit a complete grant proposal, understand rural relevant data important to EMS and identify funding opportunities.
Session 1: June 15 at 3:00 pm ET Getting Started: Understanding Need, Collecting Data and Developing Community Support
Session 2: June 22 at 3:00 pm ET Building Your Proposal: Telling Your Story
Session 3: June 29 at 3:00 pm ET Connecting with Funders to Submit a Successful Proposal
Click here for more information and a link to register. The deadline to register is June 8.
Safety advances have been broadly implemented in many healthcare settings, similar to aviation and other high-consequence fields. Aviation, with its long history of reporting systems, has shown that event reporting systems can yield previously unknown, but safety-critical information for developing a proactive approach to managing human error. Despite many similarities between health care and aviation, event-reporting systems have not been well received in health care. (AHRQ. Advances in Patient Safety: Vol. 3 – Identifying Barriers to the Success of a Reporting System. Michelle L. Harper, Robert L. Helmreich) According to this report, some physicians are still reluctant to participate in event reporting, and it is as difficult for Emergency Medical Services (EMS) professionals; however, this is exactly what the The Center for Leadership, Innovation, and Research for EMS is trying to change.
The Center for Leadership, Innovation, and Research for EMS (CLIR) is a non-profit organization that is advancing the safety culture in EMS through a variety of efforts. EMS safety must include responders, patients and members of the public. The ultimate goal is to help organizations create an environment that encourages individuals to report mistakes by using a method that has proved to work in the aviation industry.
Based on the Pennsylvania State EMS Event Reporting system, CLIR developed a national event reporting system for EMS called E.V.E.N.T. (EMS Voluntary Event Reporting Tool). E.V.E.N.T. is an anonymous, event-reporting system that collects and analyzes patient safety incidents, near-misses and violence against paramedics and EMTs. This gives any EMS system a free and easy way to identify trends and share information across regions.
Anyone involved in EMS systems can go to www.emsEVENTreport.com and submit one of three different kinds of anonymous reports.
Once submitted these anonymous reports are reviewed by EMS safety experts who remove any identifying elements and then share the report with the state EMS office in which the event was reported to have occurred. The state name is then removed and the record is shared through the E.V.E.N.T. Google Group and kept for a summary report. The data collected is used to develop policies, procedures and training programs to improve the safe delivery of EMS. The confidentiality and anonymity of this reporting tool is designed to encourage EMS practitioners to readily report EMS safety events without fear of repercussion.
CLIR wants to support organizational culture that is able to receive information about someone making a mistake without punishment. They want to help EMS providers become more engaged as healthcare providers instead of just being seen as “ambulance drivers.” E.V.E.N.T. was launched five years ago and has helped identify issues, learn from them and then help others across the country take steps to make sure it doesn’t happen in their system.
CLIR recently posted 4th quarter 2014 and calendar year E.V.E.N.T. summary reports. You can access these reports and prior period reports by going to www.emseventreport.com, click on each EVENT type at the top and then look on the left side of the screen for download links by year. To access the 4th quarter and calendar year 2014 reports individually without navigating the website, use these links:
4Q2014 Provider Violence Summary
CY2014 Provider Violence Summary
Please consider helping CLIR advertise the availability of the report by pointing your colleagues to www.emseventreport.com. If you would like to receive emails of all reported events send an email to clirems@gmail.com with your name and EMS agency or affiliation and you will be added to the distribution list.
If you are interested in building a reporting site specific to your organization CLIR can help through it’s Patient Safety Organization (PSO) called EMERG. The Emergency Medical Error Reduction Group (EMERG) helps organizations use identified, non-anonymous data to drive improvement and advance their own safety culture, protecting patients and providers. All information collected is protected under federal law (“The Patient Safety and Quality Improvement Act of 2005 (PSQIA)), ensuring that the collected and analyzed incident data is not legally discoverable, above and beyond your existing state peer-review protections.
For more information about EVENT or EMERG please visit http://www.clirems.org/ or contact Matt Womble or Gary Wingrove.
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The hotel group rate deadline is extended to April 10th! We are expecting over 150 attendees. Thanks to the following sponsors: The State of North Dakota, the State of Wyoming, NOSORH, National Association of State EMS Officials, Helmsley Foundation, and Physio Control.
The National Rural EMS Conference: Building Integration & Leadership for the Future in Cheyenne, Wyoming on May 5-6, 2015 will feature hands-on learning and demonstrations of Simulation in Motion. In addition, conference participants will learn about the future of rural EMS, community paramedicine, systems of care, performance improvement, ambulance service sustainability, rural EMS education, and much more. The cost to attend the conference is $200 and includes food. Online registration is now open. Sign-up today to reserve your spot!
Vendor space is still available. Contact Stephanie Hansen (steph@nosorh.org or 208-375-0407) or register online to reserve your organization’s spot.
AGENDA: Click here.
REGISTRATION: https://www.regonline.com/EMS15
CONFERENCE WEBSITE: https://nosorh.org/calendar-events/national-rural-ems-conference/
VENDOR OPPORTUNITIES: Click here.
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The redesign of NOSORH’s website allows for all presentations, publications, webinars, and toolkits to be “tagged” when posted. This creates the “Key Issues” word cloud on each page, which provides for easy searches with links to every resource. The next time you visit www.nosorh.org, check out all the topics on the right hand side of the page.
Rural EMS is one of the most posted resources on the site. We have over 23 resources pertaining to this topic alone. You can find more information here.
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