In this episode of Hexagon’s Public Safety Speaks vodcast series, we talk about the field of emergency medical services (EMS). It’s a field that has been challenged not only by the COVID-19 pandemic, but also the continuing evolution of 911 technology and expectations from the public.
Watch as Hexagon’s Chris Carver discusses these challenges with two EMS veterans, Robbie MacCue from the EMS Leadership Academy and Capt. Matt Parrish of the Columbus Division of Fire.
Watch the video or read the full transcript below.
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Transcript
Chris Carver:
Hello everyone and welcome to the latest edition of Hexagon’s Public Safety Speaks vodcast series. My name is Chris Carver and we’re here this week to talk about a part of the public safety world that experienced, well, a tremendous amount of challenges. Not just in the pandemic, but in sort of the continuing evolution of technology changes to 911, changes in public safety expectations on the part of the public. And a variety of other ways. And that’s the field of emergency medical services (EMS). And I’m privileged to be joined here today by two gentlemen, sort of on the leading edge of those changes and challenges, and how EMS is evolving moving forward. And I’ll allow those two gentlemen to introduce themselves. First, we have Robbie MacCue from the EMS Leadership Academy. Robbie, if you’d come off mute for a second and say hello.
Robbie MacCue:
Sure, Chris. Thanks for inviting me here and happy to be here. Yes, with the EMS Leadership Academy, we’ve had the honor of interviewing leaders from around the globe. I think at this point it’s over 120 leaders featured at our annual EMS Leadership summits. And my background is a paramedic for the last 20 years. It’s been a fascinating journey with the EMS Leadership Academy, just trying to provide more resources and depth of conversation for organizations.
Chris Carver:
Very good. Thank you, Robbie, for being here. Also with us in this episode, we have Captain Matt Parrish with the Columbus Ohio Division of Fire. Matt, welcome.
Matt Parrish:
Hey Chris, thanks for inviting me. Yeah, Matt Parrish. I’ve been with Division of Fire for 31 years now. But I’m a third generation, so my whole life has been around the fire department and EMS. Been a medic since ’94, and I currently serve as the Fire Chief’s chief of staff for the Columbus Division of Fire.
Chris Carver:
Well, welcome Matt, and thank you. And I’ll tell you what, I’ll just stay with you, sort of starting with our theme for today. The pandemic, I think it’s safe to say, truly impacted every EMS agency in the United States, no matter how they’re organized in really significant ways. Captain, how do you think or what do you think some of the key lessons are we learned from the pandemic that we should apply going forward?
Matt Parrish:
Yeah, Chris, it definitely was a challenging time. It wasn’t just the pandemic, but much of the country experienced a civil unrest. Which also put an extra taxing burden on our first responders, along with dealing with the pandemic. And it really exposed a lot of the things that we just take for granted. Supplies always being there, hospitals always having capacity or being open, staffing challenges. But I’d also say we learned a lot. We learned how to use new technology. Zoom meetings or virtual meetings were never a thing before the pandemic for us. So, as much as it was challenging, it also provided opportunity for us to learn and grow.
Chris Carver:
Oh, absolutely. No, I think that’s a hundred percent. And Robbie, I bet with your perspective having spoken with so many EMS leaders from really all around the world, you can probably offer some insight as well about lessons learned.
Robbie MacCue:
Yeah, absolutely. And as Matt said, I mean it was a constant barrage of change. We’re not just talking a monthly or weekly change. We were seeing a daily change in information coming out. And our providers were very resilient and they were just adapting to change. Which I think is a trait of many paramedics out there and many systems. But I think that organization started to see that unless they really valued their people, and by valued I mean they treated people like the most important asset in their organization. Because frankly without people, you have no response. And when we saw organizations who didn’t… And some by no fault of their own, some by just trying to just keep up themselves with the daily priorities of trying to just get through the challenges of response from a slight dip in responses and thus a dip in revenue in the U.S. Organizations certainly saw a struggle to keep people.
You mentioned you had an episode on the staffing crisis and the challenges; We’ve seen organizations, if they’re not valuing their people and making that their number one priority, those organizations probably have a revolving door. And they’re trying to get people in as quickly as people are leaving, unfortunately. So I think there’s a lot of things we can think about when it comes to our budget, when it comes to the cost of preparedness rather than the cost of response that I think many organizations are so tied to these days.
Chris Carver:
So it sounds like maybe you would characterize, just to paraphrase your experience and the experience you’ve heard. Sort of, three of the fundamental challenges that we want to address going forward are staffing, funding and really mindset. And I think you hit the nail on the head about so often in public safety we’re reactionary, but there’s such a benefit to being visionary. At least a little bit, right? And proactive. Would you agree that those, Robbie, are the three kind of primary things you would see going forward? Or would you add anything to the list?
Robbie MacCue:
I think that’s a perfect three bullets to really touch on. And I think organization leaders need to be more self-aware of when they’re using some of their leadership tools. Unfortunately, some people only have one tool in the toolbox. And it might be that command-and-control mindset, which really should be reserved for the 1% of the time. The life-or-death situations, not the 98%, 99% of the time where we’re dealing with very human systems and human issues and human behavior. Where command-and-control just isn’t going to work. And I think organizations, the more they can invest in their people, the more they can see them as again, the most valuable asset and build a bunch of leaders, build their leadership capacity. Especially before folks are thrust into leadership roles. I think it’s such a valuable lesson for organizations to again, get away from that command-and-control mindset. To get away from the problem-fixing mentality that is just by default. I think paramedics are really good problem fixers. Somebody’s bleeding, we want to stop that bleeding. It doesn’t work well when we try to apply that to organizations though.
Chris Carver:
So I’m very glad you brought that up because Captain Parrish, you obviously are, as I know, but most of those not in the Columbus area, maybe do not know. You’re heavily involved with some of these efforts to reimagine how public safety interacts with the community. So could you kind of dovetail off of what Robbie said, but share your own experience in that department?
Matt Parrish:
Yeah, it’s great to hear Robbie say that. I think historically we’ve trained our leaders that command-and-control, complete a task, move on and not worry about downstream, whether it really fixed the underlying issue. And I think the pandemic really opened our eyes to, we have to learn, we have to be open to doing things different. We have to be open to doing things in different ways within our framework, and start to make those organizational and cultural changes. A lot of great ideas that were implemented in our organization. We immediately went into an ICS command structure, which involved a lot more leadership from lower ranks. And some of the ideas that they brought forward to, as we build our ongoing incident action plans. I think we reached 110 versions of it. A lot of those ideas came from below, but in that traditional hierarchy, it would have just been pushed down from the top.
So in identifying partners that you normally wouldn’t work with was another key aspect. They brought something else to the table during the pandemic. And also reimagining public safety is, how we’re responding to mental health calls. Low-acuity EMS calls where we’re tying up units that are not necessarily needed on this call. So we’ve done a lot here in Columbus, we’ve been working at it for a while. And one thing I was really proud of during the pandemic was, because of our training in infectious disease and having proper PPE, we kept operating when a lot of organizations were just trying to protect their own organization.
Chris Carver:
No, thank you for that. And I think that speaks well to yet another sort of whole category of change and transformation that’s going on in public safety. Which is nontraditional medical responses, or right resource at right time. One of my rants I often go on is about resource management and making sure we get the most effective use of the limited personnel we have. To make sure they’re going to the right type of emergency. So thank you for that. And of course, one of the tools that will help that, or is already helping that, is technology. So I’ll start with you, Captain Parrish. How do you see the role of technology assisting in this evolution that public safety EMS agencies are making all across the United States and beyond?
Matt Parrish:
Yeah, again, like I said, I was pretty lucky. My father opened our current 911 center here as a lieutenant with the fire department back in the early 90s. So I’ve been exposed to the 911 side of EMS and fire for quite a while. And the technology’s great, but it’s outpaced our ability to respond. We keep making it easier and easier for people to request services through 911. Whether that’s text 911, push buttons, call buttons and next it’ll be mental telepathy. I just need to talk to 911. But we’ve tried to keep up with that on the response side, and the technology’s outpacing us. So how do we use that in our benefit? And to your point, Chris, the right response for the right call in the right amount of time at the right cost with the right personnel rates. There’s so much that goes into that.
And we created a right response unit within our radio room to transfer low-acuity calls to a mental health clinician, triage those calls. And then dispatch a more appropriate resource than a whole lot of police cars, a whole lot of firetrucks and ambulances to those calls. And a lot of those calls, we were able to actually just connect that caller with a community-based service and not have to respond at all.
Chris Carver:
Oh, thank you. I think that’s a very important development. Robbie, how about you? Are you seeing that trend globally as well in terms of shaping the response perhaps better to match the reality on the ground? Or the reality that that particular patient needs?
Robbie MacCue:
I think I’ve heard from a lot of different organizations from really large systems, I think to the BCEHS up in British Columbia. How they’ve really embraced change and have been leading the ideal response. Talking about both advancing clinical pathways, creating medical triage lines like Matt mentioned. And really to your earlier point of Matt’s point and Chris, your comment about re-imagining EMS response. I think so often we tend to focus on the problems. Like we have to fix a problem and people have to realize that people are not a problem to be fixed. If we can get out of that problem-fixing mentality and we can think about solutions from an ideal, what do we really want? Not, what’s just going to stop the pain a little bit? Or what’s going to put a bandage on something? And that’s the problem-fixing mentality.
But it’s the, if anything were possible, unlimited budget, unlimited time and resources, what do we really want from a response? What do we really want our organization to look like in five years? We love engaging the minds of leaders, when we do our training and our curriculum to get them into this idea of design thinking, appreciative inquiry. Really pulling out these ideas of intentional change theory to think about not what do we want less of. Because I think we could all come up with lists and lists of problems and things that we want to stop. But what do we really want? And especially when it comes to technology, what’s the ideal scenario here? Not, what do we think can just work. What do we think based on our constraints and our limitations that we might be able to make happen? I think those are two completely different worlds that unfortunately a lot of us tend to get stuck into that problem-fixing mentality where there’s a lot of past-based thinking, right?
We’ve all, we’ve heard of a solution and, “Oh, I’ve thought of that before.” Or somebody proposes a new idea and immediately our minds jump back to when a new idea didn’t work. So I get really excited about talking about, how do we create the ideal future. And how do leaders really start those conversations? And I’m not talking about 100% of the time. I’d love if it were just 50/50 or 20% of the time they were talking about what they wanted as opposed to what problem are they trying to fix that’s out there.
Chris Carver:
Right. And I’ll tell you what, I think we’re going to have time at the end. I’m going to return back to that topic, because I think there’s a lot to discuss there. But I think one of the other important parts of the EMS response environment or resource book, if you will, is the public, really. And how they interact with, and Captain Parrish, you mentioned it, we have so many different ways to report emergencies today and that’s not going to decrease, right? So how do you see the public engaging with EMS in these coming years through all these different forms of technology? And how can the public be a better or more effective part of the EMS response system?
Matt Parrish:
Yeah, again, I think a lot of it goes back to the technology. We call them the cell phone Samaritans, right? You see something, say something. You pick up your phone, you just call and say, “I saw this.” And the call taker may ask, “Did you stop and see if they needed help?” “No, I just drove by.” And then there’s an obligation to send a response to that. So even just education and people understanding that they can get involved, they should get involved. A lot of communities are developing community response teams. We do a citizen responder training. There’s four things that any layperson can learn: How to use Narcan, how to do CPR, how to apply a tourniquet and how to use an AED. And we incorporated that in some of our citizen responder training. So there’s a lot of different ways for them to get involved. I think some of the technology that’s coming online with the NextGen stuff, being able to access their phone and see a video of what’s actually going on may help improve our ability to send the right resource.
But really, it just comes back to people taking an investment in their community and trying to help out. And not solely relying on 911 as the only option.
Chris Carver:
No, absolutely. Robbie, how about you? The engagement of the community into EMS and ensuring it’s effective?
Robbie MacCue:
Sure, sure. I feel like because of the pandemic, we’ve seen the public embrace technology quicker than any before. Whether it’s from QR codes that we’re putting out there on public flyers. Or it’s telemedicine and the concept of explaining to somebody that, “Look, we can bring a physician right to your bedside, rather than you going to an overcrowded emergency room where you’re going to sit and wait in a waiting room with a bunch of sick people for the next four hours.” People like that concept. They’re used to it. And I feel like that’s made our job a bit easier. And how do we best empower our paramedics to help navigate the complex healthcare system that is out there? I feel like our paramedics are wearing multiple different hats from social worker to life-saving paramedic to community educator. And really it’s our responsibility, I think as EMS leaders to be our own advocates to help educate the public.
I like what Matt was saying about community response with Narcan training. How do we make sure that we’re effectively meeting people where they’re at when it comes to simple trainings? Hands-only CPR, AED awareness. So it also comes back to us I think, in our responsibility to train, to educate the public about what the differences are in our community. It’s having a well-funded EMS system that’s out there, what that requires. All too often people talk about the cost of response instead of the cost of preparedness. What is that system? We know in the US that I think 25% to 30% of our care goes unreimbursed. And then the amount of calls that are reimbursable are usually under the cost of care. So how do we help educate our elected officials to really embrace and invest in a system that’s going to be there for the next pandemic, for the next major response, for the response to the active shooter threat and make sure that our providers are very well-trained and ready for response?
Chris Carver:
So there’s a couple follow-up questions I’d like to ask. The first one, and I’ve noticed that neither one of you… You mentioned it in our conversation, I think it’s great. Because there seems to be this, when somebody involved in EMS wants to stir up a whole bunch of people on LinkedIn or social media and get all kinds of people excited, they go down the rabbit hole of what’s the best type of EMS delivery model? Is it fire-based? Is it third service? Is it private provider doing transport with fire department first responder? Or is it law enforcement first responder? I noticed neither one of you have touched on that at all. Do you think that, really, that’s almost like a false flag, if you will? And we need to focus on getting the most effective system that we can for the reality that we have in our community, and that may look different everywhere? Do you think that’s sort of the reality of the EMS world that we’re in today? Matt, I’ll start with you.
Matt Parrish:
Yeah. I’m in a large metro fire-based EMS system that does EMS transport. We do not do inter-facility transport. We do emergent interfacility transports. But it really depends. One thing coming from the fire side is we don’t send every type of apparatus, a ladder truck, a rescue, an engine company to every call. We try to right match that response with the type of vehicle, with the right personnel on it, with the right tools and equipment to address and mitigate that. And a lot of EMS systems don’t have the ability to do that because it’s either an ALS or BLS and they don’t have a lot of resources. Here in Columbus, we have a mobile stroke unit, so we can get that truck rolling to do a CT right on the scene. I don’t know if there’s a perfect system or which one is better. I think there’s benefits to both.
One thing that I feel very strongly about on the fire-based one is we understand prevention and prevention work. And if we can use that and apply that model to the EMS side of things, that may help us downstream. And again, to Robbie’s point, it’s about preparedness, community risk reduction and working with partners, not just your agency.
Chris Carver:
No, absolutely. Robbie, how about you?
Robbie MacCue:
I think there’s a lot of lessons we can learn from the fire services, from the police services out there. I would invite EMS leaders to slow down. It’s a constant barrage of change in trying to put out fires, figurative fires. But if we can slow down and have leaders and point them to successful systems in other areas of the world. To show them what a provincial-wide system or a statewide system in Australia can do. I think to Ambulance Victoria in Australia. It’s a statewide system with a $1 billion a year budget. And they’ve got thousands of providers in that system. Whereas you look at the US, it’s a lot of fragmented, very siloed organizations. So what are the lessons that we can learn from each other? Certainly, I think it’s advocating for better funding. It’s advocating for any funding, depending on your community. And really thinking about what service is really working in our community. And how can we best work with and make sure there’s interoperability between other systems.
Because I come from a municipal-based third service, where we’re fortunate to have a certain amount of resources and benefits. And I look to our counterparts in the capital region here in New York, and we’re surrounded by fire department-based systems. There’s private-based systems, there’s nonprofit based systems. But I think there’s a lot to learn from each other. And how do we slow ourselves down as leaders? How do we think about, how do we reimagine our EMS response? How do we reimagine, what does funding look like? How do we reimagine what sharing information looks like and working together?
Chris Carver:
And so to that point, and I would say that especially from a Hexagon perspective, we get the opportunity to work with agencies all around the world. And help folks figure out how to share information, when to share it, what type of information to share and how to get better results. That’s a universal challenge. But I would also offer, it’s a universal opportunity. So how do you think we help make that conversation happen? And I know both of you have experience doing this, getting a bunch of diverse folks in the room to kind of talk through how we can make this better. Captain Parrish, I’ll start with you.
Matt Parrish:
Yeah, I think one of the keys is first recognizing that EMS is an essential service. As essential as law enforcement, a 911 system, fire based. And getting some dedicated funding and guidance on what each community should have to meet best practices. That’s what’s going to, I think, bring everybody together and level the playing field a little bit. We’re very fortunate being a metro base that we have funding through the fire department. Where I was just in a class last week with folks from all over the country and learned a lot about a lot of different systems. And I couldn’t say one of them was better or worse than the other, as long as it was good for their community.
Chris Carver:
Very good. Robbie, how about you?
Robbie MacCue:
I would echo Matt’s comments about making EMS an essential service. Absolutely. And making sure that it’s not only considered legislatively essential, but it’s funded as an essential service. And also not forget our 911 telecommunicators and dispatchers. Because without them being really well trained and taken care of, none of us can get to any of these calls, police, fire or EMS. There’s such an opportunity in there working with our 911 tele-communicator counterparts in enhancing survivability from sudden cardiac arrest. Really helping them improve telephone-initiated CPR, recognition of somebody that needs that CPR. So I think there’s a lot of areas that we can all work together towards. And one of the best tools in probably a leader’s toolbox is the word curiosity. How do we just get curious? How do we stop thinking that we know it all? How do we stop assuming that we have all the answers and just get curious about whatever you’re feeling stopped by? Whatever you’re feeling that just isn’t working. Just get curious and ask somebody. It’s been amazing to get people in the same room with diverse perspectives and opinions and have them talk through what challenges they’re facing. But again, what do we really want to create here? What do we want to work towards? And I think that’s such a powerful concept. And a lot of people just don’t have awareness that we’re over here doing all of this super important, very busy work, but we’re operating in a bit of a silo. And I think that’s the power of just sharing information and getting people in the room.
Chris Carver:
And it’s also a challenge too, I think, right? Because so many agencies are dealing with so many problems every day. I am so blessed to have so many friends in fire department, in EMS and law enforcement leadership roles. And many days they’re just treading water. They’re trying to find, “How in the world do I replace the people that just retired? How in the world do I respond to all these FOIA requests? How in the world do I manage a new technology project?” So what do you say to the leader that, maybe is out there right now, pounding their fists on a desk going, “Robbie, for God’s sake, I don’t have time to be curious. I have to staff the night shift tonight. What do you get me to do?” So what do you say to the folks that are in that role? And I’ll ask you both. I’ll start with Robbie.
Robbie MacCue:
Yeah. To your point, we ask leaders and we poll leaders all the time. What’s the number one issue that keeps you up at night? And I would say about 90% of those responses are the schedule, staffing, staffing crisis. And my invitation to you is to go upstream. That the staffing challenges are a symptom of a bigger problem. And what I say by upstream, there’s a quick story of, there was once a responder out there that was seeing people, figuratively. Seeing people floating down a river and they frantically went out to pull the body out and rescue that person. And then all of a sudden more people started to come down that were drowning. And so you’ve got this frantic responder that’s constantly going down there trying to pull the people out of the water. And they turn around and their partner is gone. And so then they’re thinking all these other thoughts of, “Geez, how could they? How dare they? Where are they?”
And then all of a sudden the people stop coming down the river because their partner… When they found them later asked, “Where the heck did you go?” And they said, “I went upstream to stop the people from jumping in the river.” So how do we go upstream to create an ideal system where people are taken care of, where the schedule is full. Where people can bring their best in a less than 40 hour a week schedule. Not working 40 to 60 to 80 hours trying to fill the schedule mandatory overtime. And all these other tools that are being used to treat the symptom of a bigger problem that’s out there. So that’s my invitation, is to go upstream. Think what is at the source of these issues? And how do I address that as opposed to constantly trying to put out all these fires.
Chris Carver:
Thank you very much. I love that story. Captain, how about you?
Matt Parrish:
Yeah, Robbie, that story’s spot on. I think it’s a biblical story too, but it’s definitely looking at alternative solutions. And so much in my history has been… Or the answer has been, let’s throw more money and more manpower at the problem. And I think with the limited resources that are available in today’s world, looking at alternative ways to accomplish what your mission or your goal is, is how we’re going to make change and be effective. And not being afraid to fail. So often in my career, I’ve seen leaders implement a new program and it’s not working. And their answer has been, “We got to try harder.” And it wasn’t that we weren’t trying hard enough. The plan wasn’t good. We need a new plan. And they’ll stick with it because they’re afraid to fail. And it’s, learning from it is not a failure, if you have the awareness to move on and try something different. So I think that’s what I like to see in our organization.
We’re trying to use everything, the way we know things weren’t that way 50 years ago. And understanding some of that history and realizing there’s got to be an evolution in learning from the past and not repeating those mistakes. But the last five years has been really amazing for us here in Columbus, because we have implemented so many new programs that are working and adjusted those programs when they weren’t. And keep being curious to try new ways.
Chris Carver:
Thank you for that. And so here’s my last question for us as we wrap up today. And I’ll start with you, Captain Parrish. Given everything you’ve experienced over the last five years, but also knowing some of the challenges and adversity that we’re facing in public safety and specifically EMS, are you hopeful for the future and where we’re going? Do you think it’s going to get better? And do you think we’re going to see a new dawn of EMS and the way it’s delivered as we combine technology and learning and sort of best practices out of the pandemic and everything else that’s happened?
Matt Parrish:
Yeah. Maybe not in what I have in the remainder of my career left, will I see the change that I’m really hopeful for. But I am hopeful that we’re heading in the right direction. I think one of the topics, EMS body cams, it’s coming. If you’re not ready for it, if you’re not thinking about it. But that also brings additional opportunities to livestream video to a healthcare provider to help with diagnosing something or treating something situational awareness. The evolution of multidiscipline response teams. Right there, we can expand our workforce by not having multiple individuals doing the same type of work. But having one individual of a different discipline working on a team to respond to some of these calls that take multiple agencies to respond to. So I’m very hopeful with the direction we’re heading in. And I think there’s a lot of energy behind developing those, but it’s definitely going to take leaders to realize that they’re going to have to get out of their comfort zone a little bit and try some new things.
Chris Carver:
Absolutely. And Robbie, how about you? The future of EMS? Are you hopeful based on everything you’ve seen and heard?
Robbie MacCue:
I’m usually a pretty optimistic person in general. And I am hopeful certainly about the future of EMS. Especially hopeful for the leaders that I’ve met, the people on this call, the people I’ve had the opportunity to interview out there, that there are other leaders out there. There are leaders who are willing to slow themselves down. To be able to respond rather than react, that are open and willing to see things differently. Because until you can see things differently, you can’t start to live life differently. And I think once I’ve seen leaders slow down to have that big aha moment, that they’re being really influenced by their past. Or they’ve identified one of their blind spots through some training that we do, it’s pretty optimistic. It’s pretty hopeful.
And again, I’m not talking that people have to be in general, we’re not talking about positivity in general. But certainly folks that are willing to slow themselves down, that are willing to talk about creating an ideal future and not being stopped by circumstances or the past. Those are the people that I get excited to be around and that I’ve been excited to train with.
Chris Carver:
Excellent. Well, very good. I’m happy to hear from both of you that you’re hopeful to some degree about where we’re going. And that we’re making progress. And that’s certainly in no small part due to the efforts of folks like yourselves. And on behalf of the public safety community, I thank you for what you do and every day. In terms of providing leadership and supporting the advancement of EMS and public safety across your own communities, and really across the United States and beyond. So, thank you. And with that, that concludes this episode of Hexagon’s Public Safety Speaks. I thank you both, Matt and Robbie for joining us today and again for your service. If you have any questions for follow-up or additional information, please do not hesitate to reach out to me. There’ll be a link provided as you view this particular vodcast.
And until next time, we wish you a safe and an enjoyable springtime. And look forward to speaking again about the challenges facing public safety and the opportunities for us all to move forward in an upcoming episode of Hexagon’s Public Safety Speaks. Thank you again. Be well. Stay safe.
