1. Virginia Emergency Medical Services:
Rural Health and Policy Agenda
Rural Health Summit
Danville, VA
March 17, 2010
2. Office of Emergency Medical Services
Mission: To reduce death and disability resulting
from sudden or serious injury and illness in the
Commonwealth through planning and
development of a comprehensive, coordinated
statewide emergency medical services (EMS)
system; and provision of other technical
assistance and support to enable the EMS
community to provide the highest quality
emergency medical care possible to those in
need.
Gary R. Brown, Director
P. Scott Winston, Assistant Director
47 FTEs
3. Office of Emergency Medical Services
Office overall budget - $36.6 Million
– 1.1% Federal $0.4 Million
– 94.8% Special $34.7 Million
Trauma Fund $9.7 Million (Special Dedicated)
RSAF $8.0 Million (Special Dedicated)
Return to Localities $6.5 Million
VAVRS $502,852
EMS System Development $7.5 Million
State Office of EMS $2.5 Million
– 4.1% General Fund $1.5 Million (Poison
Control Centers)
4. Virginia Strategic EMS Plan
Core Strategies
1. Develop Partnerships
2. Create Tools and Resources
3. Develop Infrastructure
4. Assure Quality and Evaluation
5. Virginia EMS Strategic Plan (2007 – 2010)
Vision & Mission Core Strategies Key Strategic Initiatives
To establish a unified 1.1 Promote collaborative approaches
comprehensive and effective 1.2 Attract and support outstanding health
1. Develop care providers
EMS system for the
Partnerships 1.3 Further community based prevention
Commonwealth of Virginia 1.4 Coordinate responses to emergencies both
that provides for the health natural and man-made
and safety of its citizens and 1.5 Elevate EMS care for special needs patients
visitors.
2.1 Facilitate EMS related research and education
2.2 Supply quality education and certification of
2. Create Tools and EMS personnel
To reduce death and dis- Resources 2.3 Endorse risk and liability protection for
ability resulting from EMS physicians and providers
sudden or serious 2.4 Foster appropriate use of EMS resources
injury and illness in the
Commonwealth through
3.1 Adequately staff OEMS & Regional EMS Councils
planning and development of 3.2 Focus recruitment and retention efforts
a comprehensive, 3. Develop
3.3 Upgrade technology and communication systems
coordinated statewide Infrastructure 3.4 EMS funding
EMS system; and pro- 3.5 Enhance regional and local EMS efficiencies
vision of other technical
assistance and support 4.1 Access compliance with EMS performance
to enable the EMS com- 4. Assure Quality and standards
munity to provide the Evaluation 4.2 Assess and enhance quality of education for
EMS providers
highest quality emergency
4.3 Pursue new initiatives that support EMS
medical care possible to
those in need.
6. Virginia Strategic EMS Plan
(2010 – 2013)
Key Objectives
1. Promote collaborative activities between local
government, EMS agencies, hospitals, and
community colleges to support more community
based EMS programs which lead to increased
recruitment and retention of certified EMS providers.
2. Evaluate the impact of an aging workforce on the
EMS system.
3. Develop, implement and promote leadership and
management standards for EMS agency leaders
4. Align all initial EMS education programs to that of
other allied health professions to promote
professionalization of EMS
7. Virginia Strategic EMS Plan
(2010 – 2013)
Key Objectives
5. Develop, implement, and promote a comprehensive
recruitment and retention campaign for EMS
personnel and physicians, supporting the needs of
the EMS system.
6. Support and expand Virginia Recruitment and
Retention Network
7. Develop guidance documents to assist EMS agencies
going through audit processes and accountability for
the use of grant funds.
8. Meet with, and educate local government officials
and the public about assuming a greater
responsibility in the planning, development,
implementation, and evaluation of its emergency
medical services system.
8. State Rural Health Plan
(SRHP) and EMS
OEMS participated in Rural Health Strategic
Planning Summit held in Staunton, VA in July 2007.
Recommendations for updated SRHP released in
2008 were developed by four workgroup: access,
quality, workforce and data/rural definitions.
OEMS staff participated on Workforce and
Data/Rural Definitions workgroups.
EMS is a sub-committee of Access Council (access
to quality, affordable and accessible health care
services)
9. State Rural Health Plan
(SRHP) and EMS
Emergency medical services (EMS) is
the umbrella term for a continuum of
health services including pre-hospital
medical services, emergency services
provided at the hospital or health
center, and the trauma system.
10. EMS related recommendations
in State Rural Health Plan
(SRHP)
Hold rural EMS Summit to address rural EMS issues,
including
– Availability of EMS and who is responsible
– EMS leadership and management (Budget Model
Workshop, Rural EMS Managers Awareness
Program, etc.)
– EMS integration into rural health care
infrastructure.
Begin discussions on how to identify areas where
EMS is a major issue/trouble spot
Present and disseminate findings from 2007/2008
CAH EMS assessments.
11. Projected
Impacts/Outcomes
Results of Rural EMS Summit will lead to
development of a white paper detailing
parameters of rural EMS in VA.
Results of Rural EMS Summit will lead to
development of EMS legislative package for
VA General Assembly.
Recommendations from CAH EMS
assessments will assist in strengthening
existing EMS structures.
12. Rural EMS Roundtable and
Summit
Identified key rural/frontier issues in Virginia
at Rural EMS Roundtable held in March
2009
Prioritized issues at Rural EMS Roundtable
Identified strategies (problem, solution,
outcome measure) and partnerships for the
next steps at Rural EMS Summit in
December 2009.
14. Virginia Rural EMS Roundtable
Priority Issues (03/11/2009)
EMS Agency Leadership and
Management
Local Government
Involvement/Accountability
Recruitment and Retention
EMS Resource Management
EMS Dispatch
15. Virginia Rural EMS Roundtable
Priority Issues (cont.)
Quality of EMS Education and Training
Evidence and outcome based patient
care
Initial EMS Education
Fee for Service/Revenue Recovery
EMS Continuing Education
Expanded Scope of Practice
16. Review of EMS in VA by JLARC
(2004)
EMS Agency Survey (278/712
respondents)
85% of volunteer EMS agencies and 58% of
career EMS agencies reported R&R as one of
top three issues.
EMS agency leaders reported top reasons
EMS personnel left were:
– Personal
– Not enough time to volunteer
17. Review of EMS in VA (2004)
EMS Personnel Questionnaire (892
respondents)
40% of EMS personnel indicated they had
considered leaving their agency within the
last year
Top two reasons for leaving
– Poor leadership and management
– Low pay
18. Review of EMS in VA by JLARC (2004)
Recommendations
Amend Code to require local governments
to ensure EMS provision
Allocate state grant funding for R&R
initiatives
Require leadership & mgmt. training
Improve access to ALS training
Better publicize volunteer length of service
award program (VOLSAP)
19. Distribution of Certified EMS
Personnel
Affiliation of Certified Personnel by EMS Agency Type
Non Affliated
Federal 26%
2%
Volunteer
Commercial
33%
4%
Non Profit
1%
Industrial
2% Government
32%
21. Where do we want to be?
Adequate supply (to meet the
predicted demand) of volunteer and
career EMS personnel that is well
educated and trained, competent and
prepared who are valued and
respected
Empower our sales force of influential
EMS leaders to show the importance
of the “soft skills”
22. How do we get there?
Develop strategies, identify solutions and partners
to enhance and improve the recruitment and
retention of volunteer and career EMS personnel in
Virginia.
Provide technical assistance and develop resources,
materials, guides, educational programs and tools
designed to be used by EMS leaders as part of the
day-to-day operation of their agency.
Create a “buzz” about the EMS workforce
recruitment and retention
Create a cultural shift by getting more EMS
agencies to buy into the retention principles and
other concepts
23. Keeping The Best! EMS
Workforce Retention Tool
Kit
Four workbooks targeted
at volunteer and career
EMS agencies. EMS
leaders use these as self-
help guides to evaluate
and strengthen their
retention efforts.
24. EMS Retention Principles
The Life Cycle Model
0 1 2 3 4 5
Average =Life Cycle Time Line in Years
Community Invest/ Active Lead/
Resource Train Involvement Mastery
Common
Retention
Barriers
The Life Cycle Principle – EMS personnel stay longer
when leaders take specific actions at specific times in
the retention life cycle.
25. EMS Retention Principles
The Belonging Principle - EMS personnel stay
longer when they feel welcome, needed and
respected.
The Success Principle – EMS personnel stay
longer when they achieve success in important
personal goals.
The Friends and Family Principle - EMS
personnel stay longer when they develop strong
personal relationships within their agency.
26. Survival Guide To
EMS Retention Problems
“Quick read” guide features 13
common EMS retention
problems and solutions.
Some of the problems and
solutions include:
Slackers and the Generation
Gap
Your Attitude Stinks
Inter-squad War Games
How to Burn Out Good People
Are Your Leaders Ready to
Lead?
27. Maximizing Your Retention
Efforts
Designed for the larger and more
complex EMS agencies facing
retention problems driven by growth
and change.
Chapters include:
The Crisis of Change
Making the Marriage Work-
Volunteer & Career
The Recruiting Process
The Retention Process
Moving from Good Intentions
to Results
28. How to Retain ALS Providers
Most analytical of the
workbooks
Employs quantitative and
qualitative analysis of
current workforce.
Guided visioning helps the
EMS leader define and
quantify the desired ALS
workforce in the next 2- 5
years.
29. Workforce Utilization Model
Define the Current Define the Desired
ALS Workforce Future ALS
Workforce
Fill the Gap
Monitor and
Re-evaluate
30. Recruitment & Retention
(R&R) Initiative -Financial
Assistance to EMS Agencies
– A total of $432,888 has been awarded to
non-profit EMS agencies between
December 2004 and June 2007 for
Recruitment and Retention related
grants.
– Projects include Leadership &
Management training, advertising,
recruitment materials, displays and
building signs.
31. R&R Initiatives
EMS Workforce Development Committee
One of 16 standing committees of the state
EMS Advisory Board
Formed to work through EMS recruitment,
retention, leadership and management
issues.
Two subcommittees
– Standards of Excellence
– EMS Leadership and Management Standards (I –
IV)
32. R&R Initiative - Technical
Assistance
Virginia Recruitment and Retention
Network
34. R&R Initiatives
EMS Agency Management Series
EMS Strategic Planning
Discipline and Due Process for the EMS
Agency
Funding your Future, Establishing Fee-for-
Service Programs in Non-Profit EMS
Agencies
(EMS Revenue Recovery through Billing for
Services: An Introductory Kit )
35. R&R Initiatives
Focused EMS Management Training in Rural Areas
Cooperative effort with the Office of Minority Health
and Public Health Policy
Budget and Financial Management Training, on-line
EMS Medical Director training and on-line
management for new EMS supervisors.
Priority shall be given to EMS agencies serving
Critical Access Hospitals and participants in the
Virginia Small Rural Hospital Improvement
Program.
36. R&R Initiatives (other)
Creating a diverse workforce in Fire and EMS –
completed in cooperation with the VA Fire Chiefs
Association and the VA Dept of Fire Programs.
Serve as a clearinghouse and information center for
rural EMS agencies starting recruitment, retention,
management and leadership projects and
programs.
Dual enrollment High School based EMT training
program
Rural EMS Blog, MySpace, Facebook, Twitter,
YouTube, ListServes, etc.
37. R&R Initiatives (other)
On-line EMS Recruitment Directory
Provide grading assistance to the Financial
Assistance Review Committee for recruitment,
retention, management and leadership related
grant applications.
State Rural Health Plan
Annual state EMS Symposium – Leadership and
Management certificate, $5K Scholarship for HS
Senior and Job Fair
39. CAH Facilities
Bath Community Hospital – Hot Springs
Dickenson Community Hospital – Clintwood
Giles Memorial Hospital – Pearisburg
Page Memorial Hospital – Luray
RJ Reynolds Patrick County Memorial Hospital – Stuart
Shenandoah Memorial Hospital – Woodstock
Stonewall Jackson Hospital - Lexington
41. Scope of Evaluation
1. Examination of Network Agreements for CAH Certification
2. Study Survey
2a. Questions for EMS Personnel for assessing EMS capabilities in agencies
in areas served by the CAH.
2b. Develop questions for CAH personnel for the purpose of assessing the
overall function of the local EMS system
3. Study Components
3a. Demographics of the CAH area
3b. Staffing of the local EMS System
3c. Placement of units on basis of call volume and population density
3d. Training Initiatives
3e. Communications
3f. Resource Management
3g. Fiscal Support
3h. Medical Direction
3i. Quality Assurance
3j. Mass Casualty Preparedness
3k. System Partnerships
3l. Hospital Capabilities
4. Recommendations
42. Site Visits
Site visits were made to CAH
facilities and EMS agencies during the
evaluations, to get a feel for the
environment, and the “on the street”
perspective. It was important to see
what rural EMS agencies and the CAH
faces first hand.
43.
44.
45. Where can I find copies of the
report recommendations?
http://www.vdh.virginia.gov/oems/
Click on “Localities and EMS Officials” and
look under “Rural EMS”
Giles, Patrick, Rockbridge, Dickenson,
Page, and Shenandoah reports now online
46. Resources and New
Information Outlets
Virginia Office of EMS
(www.vdh.virginia.gov/oems)
Online Recruitment Directory
(www.vaemsjobs.com)
EMS Leadership Challenge
(www.vavrs.com)
OEMS/VDFP bookstore
(www.vafire.com/bookstore)
47. Resources and New
Information Outlets
Rural EMS Blog
(http://ruralvaems.wordpress.com)
MySpace (www.myspace.com/virginiaems)
Twitter (http://twitter.com/virginiaems)
Facebook
(http://www.facebook.com/profile.php?id=1
332796920&ref=ts)
48. Office of Emergency Medical
Services
Goals reached in 2009:
– Training & Certification of over 35,000 EMS
providers, licensing of 700 EMS agencies,
permitting of 4,132 EMS vehicles, 22 Paramedic
and 15 Intermediate Accredited Training
Program Sites conducted by 14 of 23 Community
Colleges in VA, and over 600 certified EMS
Instructors eligible to apply for contracts to
teach courses that meet the national educational
standards and national scope of practice.
49. Office of Emergency Medical
Services
Goals reached in 2009 (cont.):
– Implementation of the EMS Registry, a major IT
project under VITA, that replaces an outdated
data collection system with web-based,
electronic medical record technology that
conforms to the new national EMS dataset which
will allow collaboration on the local, state, and
national level.
– 100% of funding distributed per the Code of
Virginia to support the Commonwealth’s EMS
System through EMS training contracts, Regional
EMS Councils, Grants to Rescue Squads, Funding
to local governments for EMS support, etc.
50. Office of Emergency Medical
Services
2-3 major challenges:
– Demand for EMS providers will continue to grow
to meet the estimated 12% population growth
through 2010 and the increasing EMS call
volumes while the pool of volunteers is
decreasing due to competing demands placed on
them by family and employers.
– As the public’s expectations for EMS services
increases, local governments and EMS agencies
will seek the assistance of OEMS to increase the
level of patient care while finding ways to
maximize the impact of public funds.
51. Office of Emergency Medical
Services
2-3 major challenges (cont.):
– Health care delivery issues such as declining on-
call availability of physician specialists, diversion,
hospital overcrowding, difficulty of access to
primary care, uninsured patients and increasing
EMS call volume will require the state Office of
EMS to play a significantly larger role in
community health delivery and coordination of
services.
52. Questions?
Scott Winston, Assistant Director
VA Department of Health
Office of Emergency Medical Services
scott.winston@vdh.virginia.gov
804-864-7606
www.vdh.virginia.gov/oems
