Category Archives: Emergency Services

Pinch Hitting

Source: Michelle Ancell, State Legislatures, Vol. 41, No. 8, September 2015

Doctor shortages in rural America have paramedics stepping up to the plate when needed. … Community paramedicine systems are popping up in Colorado, Maine, Minnesota, Missouri and Nevada to provide health care where few services exist. Often, they save money for patients, hospitals and insurance companies, mostly in avoided costs. A leg amputation, for example, costs around $76,000. That’s about what it would cost to fund community paramedic home visits to Robert for 11 years. Minnesota reported that because of the paramedicine program there, Medicaid providers serving 100,000 residents spent $10.5 million less in 2014 than analysts projected they would. ….

The New EMS Imperative: Demonstrating Value

Source: ICMA, InFocus, 2015

Despite a tremendous diversity in how emergency medical services (EMS) are provided in municipalities around the country, most U.S. EMS systems share one commonality: They remain primarily focused on responding quickly to serious accidents and critical emergencies even though patients increasingly call 911 for less severe or chronic health problems.

Recent efforts in health care to improve quality and reduce costs pose significant challenges to the existing EMS response model. Health care payers have become increasingly unwilling to reimburse for services that fail to prove their value. As a consequence, EMS agencies will soon be required to demonstrate their worth like never before.

It’s critical for city and county managers to know that despite these challenges, the changing health care landscape also presents opportunities for EMS systems to evolve from a reactive to a proactive model of health care delivery—one that better meets the needs of their communities by preventing unnecessary ambulance transports, reducing emergency department visits, and providing better care at a lower cost. This InFocus is intended as a guide to identify challenges and opportunities and help you measure your efforts and define success.

The association between weekly work hours, crew familiarity, and occupational injury and illness in emergency medical services workers

Source: Matthew D. Weaver, P. Daniel Patterson, Anthony Fabio, Charity G. Moore, Matthew S. Freiberg and Thomas J. Songer, American Journal of Industrial Medicine, Early View, Article first published online August 25, 2015
(subscription required)

From the abstract:
Objective: Emergency Medical Services (EMS) workers are shift workers in a high-risk, uncontrolled occupational environment. EMS-worker fatigue has been associated with self-reported injury, but the influence of extended weekly work hours is unknown.

Methods: A retrospective cohort study was designed using historical shift schedules and occupational injury and illness reports. Using multilevel models, we examined the association between weekly work hours, crew familiarity, and injury or illness.

Results: In total, 966,082 shifts and 950 reports across 14 EMS agencies were obtained over a 1–3 year period. Weekly work hours were not associated with occupational injury or illness. Schedule characteristics that yield decreased exposure to occupational hazards, such as part-time work and night work, conferred reduced risk of injury or illness.

Conclusions: Extended weekly work hours were not associated with occupational injury or illness. Future work should focus on transient exposures and agency-level characteristics that may contribute to adverse work events

Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers

Source: U.S. Department of Labor, Occupational Safety and Health Administration, OSHA 3148-04R, 2015

Healthcare and social service workers face significant risks of job-related violence and it is OSHA’s mission to help employers address these serious hazards. This publication updates OSHA’s 1996 and 2004 voluntary guidelines for preventing workplace violence for healthcare and social service workers. OSHA’s violence prevention guidelines are based on industry best practices and feedback from stakeholders, and provide recommendations for developing policies and procedures to eliminate or reduce workplace violence in a range of healthcare and social service settings.

These guidelines reflect the variations that exist in different settings and incorporate the latest and most effective ways to reduce the risk of violence in the workplace. Workplace setting determines not only the types of hazards that exist, but also the measures that will be available and appropriate to reduce or eliminate workplace violence hazards.

For the purpose of these guidelines, we have identified five different settings:
■ Hospital settings represent large institutional medical facilities;
■ Residential Treatment settings include institutional facilities such as nursing homes, and other long-term care facilities;
■ Non-residential Treatment/Service settings include small neighborhood clinics and mental health centers;
■ Community Care settings include community-based residential facilities and group homes; and
■ Field work settings include home healthcare workers or social workers who make home visits.

Indeed, these guidelines are intended to cover a broad spectrum of workers, including those in: psychiatric facilities, hospital emergency departments, community mental health clinics, drug abuse treatment centers, pharmacies, community-care centers, and long-term care facilities. Healthcare and social service workers covered by these guidelines include: registered nurses, nurses’ aides, therapists, technicians, home healthcare workers, social workers, emergency medical care personnel, physicians, pharmacists, physicians’ assistants, nurse practitioners, and other support staff who come in contact with clients with known histories of violence. Employers should use these guidelines to develop appropriate workplace violence prevention programs, engaging workers to ensure their perspective is recognized and their needs are incorporated into the program….

Emergency Management and the Management of Emergence: Climate Change and Crowdsourcing

Source: Bruce J. Perlman, State and Local Government Review, Vol. 47 no. 1, March 2015
(subscription required)

Taken together, the two articles in this issue of the State and Local Government Review’s (SLGR) Governance Matters (GM) section might be said to be as much about the management of emergence as they are about emergency management. Although both articles focus on the administrative practice of emergency management in state and local governments, they do so without focusing on suddenly developing crisis events or predetermined, agency-based reaction to them. Rather, they emphasize slowly developing, less specific (yet potentially as disastrous in the long run) occurrences like climate change as well as broad-based, decentralized (although likely as sound) possibilities for developing responses. They combine the ideas of emergency and emergence in a unique way….

Local Governments and Climate Change in the United States: Assessing Administrators’ Perspectives on Hazard Management Challenges and Responses
Source: Brian J. Gerber, State and Local Government Review, Vol. 47 no. 1, March 2015
(subscription required)

From the abstract:
Local governments in the United States have become central actors in addressing climate change as a hazard management challenge. Using evidence from a purposive sample of 10 U.S. cities, this article examines how local government officials view climate change in hazard vulnerability terms, what motivates local efforts in this area, and how officials initiate internal collaboration and external stakeholder outreach. The findings suggest level of hazard risk does influence a city’s efforts to address climate change, as does resource availability. In contrast, geographic location and associated hazard type (drought vs. flooding) does not appear to be a key driver of a municipality’s actions in this domain. Further, the results point to how addressing the climate hazard and improving commitment to emergency management is relevant to increasing community resilience for future emergencies and disasters.

Embracing Crowdsourcing: A Strategy for State and Local Governments Approaching “Whole Community” Emergency Planning
Source: Jesse A. Sievers, State and Local Government Review, Vol. 47 no. 1, March 2015
(subscription required)

From the abstract:
Over the last century, state and local governments have been challenged to keep proactive, emergency planning efforts ahead of the after-the-disaster, response efforts. After moving from decentralized to centralized planning efforts, the most recent policy has returned to the philosophy that a decentralized planning approach is the most effective way to plan for a disaster. In fact, under the Obama administration, a policy of using the “whole community” approach to emergency planning has been adopted. This approach, however, creates an obvious problem for state and local government practitioners already under pressure for funding, time, and the continuous need for higher and broader expertise—the problem of how to actually incorporate the whole community into emergency planning efforts. This article suggests one such approach, crowdsourcing, as an option for local governments. The crowdsourcer-problem-crowd-platform-solution (CPCPS) model is suggested as an initial framework for practitioners seeking a practical application and basic comprehension. The model, discussion, and additional examples in this essay provide a skeletal framework for state and local governments wishing to reach the whole community while under the constraints of time, budget, and technical expertise.

Outbreaks: Protecting Americans from Infectious Diseases

Source: Jeffrey Levi, Laura M. Segal, Dara Alpert Lieberman, Kendra May, Rebecca St. Laurent, Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF), December 2014

From the summary:
The Outbreaks: Protecting Americans from Infectious Diseases report finds that the Ebola outbreak exposes serious underlying gaps in the nation’s ability to manage severe infectious disease threats.
Half of states and Washington, D.C. scored five or lower out of 10 key indicators related to preventing, detecting, diagnosing and responding to outbreaks. Maryland, Massachusetts, Tennessee, Vermont and Virginia tied for the top score – achieving eight out of 10 indicators. Arkansas has the lowest score at two out of 10.

Protecting worker and public health during responses to catastrophic disasters—learning from the World Trade Center experience

Source: David M. Newman, American Journal of Industrial Medicine, Volume 57, Issue 11, November 2014
(subscription required)

From the abstract:
Despite incremental lessons learned since 9/11, responder and community health remain at unnecessary risk during responses to catastrophic disasters, as evidenced during the BP Deepwater Horizon spill and Hurricanes Katrina, Rita, and Sandy. Much of the health harm that occurs during disaster response, as distinct from during the disaster event itself, is avoidable. Protection of public health should be an integral component of disaster response, which should “do no additional harm.” This commentary examines how challenges and gaps the World Trade Center response resulted in preventable occupational and environmental health harm. It proposes changes in disaster response policies to better protect the health of rescue and recovery workers, volunteers, and impacted worker and residential communities.