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Wisconsin Office of Rural Health Interview

In honor of today’s National Rural Health Day, the American Ambulance Association interviewed John Eich, Director of the Wisconsin Office of Rural Health.

The transcript below was lightly edited for clarity.

Amanda Riordan: Thank you for joining us today. My name is Amanda Riordan, and I am the vice president of member services for the American Ambulance Association. I’m also the administrator for the Professional Ambulance Association of Wisconsin. I’m so happy to have the opportunity to interview John Eich, the director of the Wisconsin Office of Rural Health. John is an exceptional contributor to rural health in Wisconsin. He’s also a sterling advocate for the power of EMS to assist with public health in the least accessible areas of Wisconsin. I’ll ask John a couple of questions today about the recent Rural EMS Listening Sessions that he conducted in a number of areas across the state. John, thanks again for joining us. Would you mind telling me a little bit about your background and how you became the director of the Wisconsin Office of Rural Health?

John Eich: I appreciate your inviting me to talk about some of our programs, so thank you. I took a bit of a wandering path: I’ve done everything from carpentry and marketing to social work with homeless teens. I found my way to community [service] down in southern New Mexico. I caught the bug there working on behalf of the community and society at large. When I moved back home up to Wisconsin—I grew up in a rural area here in southern Wisconsin—I saw an opening and at the Office of Rural Health. I’ve been on board ever since, and it’s a lot of fun.

Amanda Riordan: Thanks so much. And we’re so glad you took the position. Would you mind sharing a little bit about why EMS is so important to rural health?

John Eich: If you’re not familiar with an office of rural health, we receive mostly federal funding to work on the state level. There’s an office in every state in the nation. Here in Wisconsin, we are funded mostly, I would say, to work with rural hospitals and EMS, and we find that EMS is one of the areas of greatest need. Every piece of the healthcare delivery system has its challenges and its strengths. EMS, I think by the nature of having formed itself—at least rural EMS formed itself—around the model of volunteer services. In my estimation, it has sort of painted itself into a corner. It started when medicine was not as complicated, and when populations, were not expecting as much. You were helping out your neighbors by getting somebody to a hospital. It has since evolved in a good way.

[EMS has] evolved into a healthcare profession. And so there are a lot more demands. There’s a lot more education; continuing education, learning new techniques that are lifesaving. Society depends on it. But that means that these volunteer services that started off small are under increasing pressure. That’s why we are trying to dedicate as many of our resources as we can to helping out that system within Wisconsin, and it’s paying great dividends. We’ve always really enjoyed our interactions with EMS. I think it takes a particular kind of person to do it. We just really enjoy our time with those who do the work. That led us to doing what we’re calling a “Rural EMS Listening Session.” So we did five of these sessions around the state in rural areas, and we intend to do a few more.

Part of the idea was that so often policy in general happens in urban centers. In EMS policy, because the state capital is down in the very southern part of the state and Milwaukee, the largest city is also down in the southern part of the state, the rural areas of the state (which most of the rest of it) tend to feel ignored or unheard. It’s much harder for them to participate. So if somebody has to drive five hours to go to a meeting that would take [a city resident] 15 minutes to drive to, that’s a disparity in access and it’s a disparity in having your voice heard. So we decided that it was important to go listening where rural EMS is practicing. So we did that, and are continuing to do so.

It’s been very eye opening. Obviously there was a lot that we expected to hear that we did hear. I mean, there’s, there’s not a lot new here. People in EMS know what the issue is as someone said these are the same ideas we’ve been talking about for the last 20 years or more. And that’s very true. We like to believe that it’s time for things to change. We’ve been talking about this long enough. Maybe we should do our best to push the issues forward. And that’s phase two of these listening sessions: take what we heard and get it into the hands of advocates, like the EMS associations, fire associations, et cetera, and other advocates like the Office of Rural Health that try to speak on behalf of the needs of EMS. I do think I’m optimistic that legislators want to help. When they’ve been presented with bills, they’re interested. Money is always an issue, but I would say that they definitely want to be part of a solution. So, it’s all of our jobs to make sure that they have the right solutions and presented to them.

Amanda Riordan: I think that’s a great segue to one of your other very popular innovative programs in Wisconsin. The Office of Rural Health actually helped put together the EMS at the Capital Day event in 2017. Would you mind telling us a little bit more about what that entailed and the groups that participated?

John Eich: Absolutely. So again, as we work with all parts of the healthcare delivery system, we work with hospitals and clinics and providers; physicians, PAs/physician assistants, nurse practitioners, the nurses that staff the hospitals and clinics and home health services. When we look at EMS, it always strikes me how it has a level of splintering that I don’t see in other professions. In other professions, they’ve managed to sort of circle the wagons and get on the same page and present a united face to push forward their vision and their legislative goals. EMS, for whatever reason. I’m not sure why it seems to have done the work but also, identified a number of differences. You can be a paid or career staffer versus a volunteer. You can work in a rural service versus an urban. You can be in fire versus EMS. You could be a Paramedic or you could be a Basic EMT or an Emergency Medical Responder. Each of those areas, each of those groups, sort of huddle and identify amongst themselves. I would like to see them working more cohesively together and I’m sure they would as well.

The effort that that led to an EMS Day at the Capital was to try and get all of the disparate groups together and on the same page. All of them had been working very diligently on the issues that were important to them, and I think there is a lot of overlap. As one of the participants said, “We can agree on a 80 percent of the issues, we may disagree about the 20 percent, but let’s work on the 80 percent and when we get that done, then we can disagree about the rest of them.”

So that was the goal that brought the groups together. So we were lucky to be able to get the two EMS associations in the state, the state fire chiefs, and the professional firefighters. The state EMS board joined in with us as well as they could, in more of a listening capacity. We created a wish list of legislative issues and a lot of it was centered around education: who we are and what we do. And we took that to the state capital. We had tremendous turnout and we had uniforms marching through the, through the offices of the legislature both in the Assembly and the Senate. I like to think we got their attention and we plan to, as I said, take what we’re learning from this rural EMS tour, connect with our urban allies as well, and get EMS advocacy on the same page so that they can do tremendous work together.

Amanda Riordan: It was truly exciting and a privilege to witness everything that happened in November 2017 when the Professional Ambulance Association of Wisconsin, Wisconsin State Fire Chiefs Association, the Professional Firefighters of Wisconsin, and the Wisconsin EMS Association, all came together with the help of your office, the Office of Rural Health, to speak with one voice when meeting with state legislators. I think that by working together they were able to present such an incredibly compelling message to legislators and to key staff that worked with legislators. I think a lot of times people are somewhat unaware that winning over the hearts and minds of critical legislative staff is almost as important as running to over the hearts and minds of legislators themselves.

With that in mind, and with all of the successes you’ve had helping execute your vision of moving EMS and rural health forward in Wisconsin, would you mind telling us a little bit about where you see the future of rural health going in your state, Wisconsin, as well as the country in general?

John Eich: I take it you mean in EMS terms. Because there’s a lot going on in healthcare, as you know! As far as EMS goes, I think the future of EMS care is not a wholly volunteer model. I think it is at least a hybrid model, and I think the industry needs to figure out how to make that transition. I think that’s going to be a difficult and painful transition. I think it’s going to take a lot of education to the local politicians who are used to having their services and frankly to be getting a pretty good deal.

We talked recently to a small community. It was a countywide meeting, but it was held in a small community that had been [served by] a volunteer service. They said they had a core group of about five people. The chief of the service had had volunteered 4,280 hours last year. The rest of his staff [had volunteered] around the 3000-hour level. They were proud of that, understandably. They were also somewhat reluctant to consider another model in their mind. They felt that they were just fine. When I look at that from the outside, I think, “What if one of you tears an ACL as you’re getting off the ambulance rig, what if two of you get the flu really bad? Which happens!” [What happens if] then there are two calls for EMS, at the same time, while two of your staff are bedridden. That’s three people to make all those calls. I struggle with the vision of that is as sustainable.

But when the local community looked at the numbers, they said, well, it looks like as far as the taxes go, that’s about $12 per capita. I was a little horrified, and asked “is that per year?” And they said, “Oh yeah, yeah, that’s per year.” I was struck by the fact that I pay more for Netflix per month than these folks pay per year to have two highly trained individuals show up with the latest technology to save the lives of their loved ones. I’m not criticizing that, but I do think there’s an opportunity there to really examine that in the daylight. And certainly when the board realized that and looked at it, there was a lot of sort of a flurry of questions back and forth. And is this true? On and on.

I think the nature [of the matter is that] if you can possibly put the question to a citizen in a grocery store as they’re walking out with their groceries, “How much would you pay per year in your taxes to have this kind of lifesaving service?” I don’t think the answer would be $12 a year. I think it would be more, but I don’t think most citizens or politicians have been given the opportunity to really look at. I think they assume it’s already paid for. It’s part of their taxes. I think they assume that Paramedics just show up at their door. They don’t necessarily know the difference between a Paramedic and a Basic EMT or EMR. They have a great deal of faith and trust in these people, as they should. I think they’re just not aware—they’re not aware of the challenges and the lack of funding and the way the system is sort of precariously balanced on top of volunteer hours to an incredible amount. I think the future in my mind, if you look at the data and volunteerism trending down, it’s trending down across all sectors, but that is hitting EMS very hard.

If you look at staffing, we’re seeing with low unemployment that means that it’s harder and harder to fill positions. That especially happens in rural areas. People are moving to urban areas for jobs. There’s not as many people there. If they do still live in the rural area, they tend to work in a neighboring larger town or other towns, so it’s harder for them to volunteer. So I just think the data is pretty clear where we’re headed. We just culturally have to try and do some heavy lifting and change the perceptions of what a society should pay for. As Dana Sechler from the Professional Ambulance Association of Wisconsin often says, we pay for garbage collection at $138, the median per capita cost per year. Like I said, some [areas are paying just] $12 per year for EMS. Garbage is very important. I don’t mean to dismiss it, but I think we can do better for lifesavers. I see that as the primary issue.

Garbage is very important. I don’t mean to dismiss it, but I think we can do better for lifesavers. I see that as kind of the primary issue. I think another issue is certainly something we’re hearing that is in rural areas, you have a lot of Emergency Medical Responders (EMRs). They’re taking a class that is 80 hours [in duration] because they want to help their neighbors. They’re not transporting— they are showing up to be of help. But they’re taking the National Registry tests in Wisconsin, and the National Registry tests, for a lot of good reasons, is lifting the industry into a level of professionalism and knowledge that is important and necessary. But I think that certainly what we heard is that an EMR is sort of an entry level to this.

So how can we figure out a way to lower the barriers to participation, without lowering the standards of care? That’s something we need to look at. And I think frankly, as a nation, we need to look at that and have that conversation with the National Registry. I think they’re doing the work that they do, and, and in a lot of ways it’s good work, but I think they need to have feedback from their customers and all of us states are their customers. All of us need to maintain a dialogue with them and say, this is what we need. We may need critical thinking in our clinicians, but do we need it in our technicians? Do we need it in our EMRs? [For EMRs] do we need sort of tricky questions that two of them are correct and you have to sort of guess which correct answer you wanted to give? I think it’s that sort of stuff that demoralizes local people who may not be eager to take a test in the first place and are a little put off by a computerized test in the second place. Then if they don’t pass, they go right back home to their church, their gas station, and their bar and tell everybody how this impossible test is not worth their time. I’m not against the National Registry tests, but I do think that we need to have more conversation about it and we need to find ways to lower the barriers and maybe that’s preparing EMRs in a different way.

I’ve got a daughter who is preparing for the ACT [college entrance test], and she’s learning the tips and tricks. She’s in a class just to help her take that test, and a lot of it’s not even about the content. Maybe since the National Registry is modeled on these other types of tests we need to train more on not necessarily the skill levels of how to save someone’s life, but how to take a test, which seems a little weird. But if that is our standard, then we need to make sure that our people are prepared when they walk into that room.

Amanda Riordan: That makes a lot of sense. Certainly we hear feedback in both directions from a variety of different stakeholders regarding the increasing professionalization of EMS. On one end, of course, we want to honor and maintain the contributions of those mission critical volunteer providers, particularly in rural areas, and on the other hand we have the push-pull of a Paramedic, in particular, looking for additional certifications and additional recognition of mobile health care as a profession. All of that mixed together with a flat or diminishing reimbursement makes sustaining a mobile healthcare/EMS in all areas really challenging. But of course as you so aptly pointed out, it especially impactful areas of our country and in a state like Wisconsin where you have so much land mass that is in rural areas. [These issues] particularly impact states of that nature is as they look forward to an aging population and the movement of younger people into urban areas. So truly appreciate those insights and those suggestions. And it’s certainly something that I’m sure there will be continued dialogue about for years to come.

John Eich: And I would like to say that I see a real difference between a Paramedic—or in Wisconsin, we also have the Advanced EMT classification—where we are expecting them to have a body of knowledge and to be healthcare clinicians, to be making life or death decisions in the field. Absolutely. Everyone in society wants those people to be the best-trained, the most knowledgeable, at the top of their game. And the tests should reflect that. I do think that if we have someone who is a firefighter who’s driving out to a site to assist, that’s not the same as a Paramedic and I’m not saying that they shouldn’t be trained and there shouldn’t be a gates for them to go through. We need to be sure that they are trained to the best of their scope and to the best of their ability. But I think it’s a different level of care is a different kind of professionalism. So I think we just need to really make sure that we’re doing a service to the rural areas where they are scraping together five people to cover a very large area and they just don’t have time for the level of nuance that you will often see in an urban, metro area where you’ve got, um, you’ve got enough staff to cover these sort of things,

Amanda Riordan: Makes complete sense and certainly something that we know so many communities are wrestling with right now. I thank you for bringing it to everyone’s attention. I think that we will get some lively dialogue in the comments when we get this posted about, as you pointed out, the diminishing volunteerism as well as the other pressures facing most mobile healthcare these days. Before we wrap up here, would you mind giving us some tips or thoughts about how EMS providers, mobile healthcare providers, in Wisconsin can work best with your office? Or if you have any generalized tips about how ambulance services and fire departments across the country can best work with the Offices of Rural Health in their state, we would be very grateful. Clearly you are moving and shaking in Wisconsin and we’d love to see that ripple out to other states.

John Eich: Absolutely. So, I have counterparts in every state and they’re all doing great work when it comes to rural health and rural EMS. If someone in any state simply goes to Google and, enters their state name and “office of rural health,” they’ll get right to them. I think there is a difference between Offices of Rural Health. Many of us are in state government, and so what you experienced there is common of state government—It’s a more bureaucratic system. The websites tend to be a little bit trickier to find the information because there’s obviously a lot going on there and some political considerations. We [here in Wisconsin] are university-based. There’s about 12 of those around the nation, and three that are nonprofit, so, even leaner and more flexible. So every [office] will look differently.

I do think that EMS should reach out to their Offices of Rural Health to let them know about their needs, because when we look at metrics for healthcare and for population health, we see the metrics getting worse. It’s almost like a horseshoe in that they get worse the more rural and remote you are. Suburban areas have the lowest need, and then the inner city tends to be equally challenging. We share a lot of population health issues with inner cities. The difference I think is really transportation. We’re farther away. And if you don’t have a car, you’re really isolated and stuck, so EMS is mission critical.

If you think about that first hour of care being so important to outcomes, [if sick or injured in a rural area] your first half hour could be without care as people are getting to you and you’re trying to find a cell signal to actually call 911. Once they arrive, your rural EMS providers are the people that are giving you that care. So it is vitally important that those people have the resources to do their job the best that they can.

Please reach out to express your needs. One of the things we’ve been talking about based on this Rural Listening Tour and talking with our state EMS office and the associations just yesterday is the idea of some kind of helpline; Somebody to answer the call when a service is identifying that they are really struggling, because [rural services] are a little nervous about calling the state and saying, “Hey, guess what? Things are really rough here. You might want to shut us down.” Nobody wants that. The state EMS office is very clear that it’s not in anybody’s best interest to remove care and burden neighboring services. So getting a helpline with a number of resources and even someone that can drive out and sit across the table and talk through some issues and get some advice would be very helpful for some of these services that are really struggling. Those are some ways that I think folks can get involved, and I’m always interested in hearing more.

Amanda Riordan: John, thank you so very much for your time and insights today. It has been an absolute pleasure talking to you and I’m sure that we’ll be hearing a lot more from the Office of Rural Health, you, and your staff in the years to come. So again, we truly appreciate it and wish you a very happy National Rural Health Day tomorrow, November 15th.

John Eich: Thank you very much, and I look forward to celebrations around the nation.

Spotlight: Gold Cross Ambulance Celebrates 50 Years in Business

Gold Cross Ambulance Celebrates 50th Anniversary!

 

When Gene Moffitt founded Gold Cross Ambulance in March 1968, he didn’t know that 50 years later the company would be where it is today, the longest-running and largest private ambulance service in Utah.

At its core, Gold Cross is a family-run business. In fact, Gold Cross started out of the Moffitts’ home after he rented two Cadillac ambulances. In the beginning, Moffitt and two or three other employees responded to calls from the family home, where his wife, Julia, oversaw dispatch operations while caring for their young children. Julia has been central to the business since the beginning and has played an essential role in Gold Cross’s continued success.

Today Gold Cross employs over 500 people, operates around 140 ambulances, and responds to hundreds of 911 calls a day. Despite this growth, Gold Cross remains a family business with deep roots in the community—something that the Moffitts are very proud of.

Gene Moffitt
Early Days of Gold Cross Ambulance

Moffitt points to a couple of factors that have made Gold Cross’s journey a successful one. First, he’s always had a knack for being in the right places at the right time. But he believes that being honorable to the commitment he has made to provide high-quality healthcare to the people of Utah has been critical to his company’s ongoing success. “Success has not come to Gold Cross without much sacrifice over the years,” Moffitt says. “Growing and expanding has not been an easy process, but with dedication and a bit of luck, Gold Cross has been able to overcome the many trials and tribulations we’ve faced.”

Of course when you’ve been in business for 50 years, you’ll have seen many changes to your industry. Moffitt says one of the biggest changes he’s witnessed has been the buyouts of many ambulance services over the years, and that’s something he believes has been both good and bad for the industry. “When large companies buy out smaller ones,” he explains, “the connection of the ambulance service to the community that there was in the past is lost.” Moffitt notes that Gold Cross has never tried to go into another area unless it has been asked to. “Going into a new area to provide service is a delicate process,” he says. ”You must re-prove yourself to the community while being sensitive to the locals and to employees who may come over from the previous provider.” As a family-run business, nurturing the bond between Gold Cross and the communities it serves has always been very important to the Moffitt family.

Looking back on a more personal level, Moffitt has many memories he is proud of. The other day he came across a photo of one of the first babies that Gold Cross transported by ambulance in 1968 or 1969. Gold Cross worked closely with Dr. Larry Jung, a pioneering neonatologist, to help him provide life-saving care to children in Utah. “I’m in awe of how the medical community has really evolved over the last 50 years to give sick newborns and infants a better chance to live,” Moffitt says, smiling. “The baby in that photo would now be 50 years old!”

Gold Cross was also involved in the first heart transplant that took place in Utah. Gold Cross helped the hospital move the patient back and forth with the tremendous amount of equipment necessary for the procedure. The company also played a large role in the Salt Lake City Olympics back in 2002.

Moffitt also made many lifelong friendships because of his involvement with the AAA, including through  his work as a past President of the association. He notes that the early AAA days were very important to his work at Gold Cross, giving his ambulance service access to resources and information that Gold Cross would not have had on its own. “The AAA helps foster a friendly relationship amongst providers,” he adds, “and members are very willing to share information about best practices and other experiences.”

Moffitt is working on bringing the company’s past and present together very visually, while giving a confident nod to the future. Gold Cross is refurbishing its remaining 1960 Cadillac ambulances and has also purchased a new ambulance to celebrate the 50th anniversary. When the brand-new ambulance is shown off alongside the 1960s ambulance, it will give a clear picture of where Gold Cross has come from and where the company is going.

Gold Cross Restored Cadillac Ambulance
New Gold Cross 50th Anniversary Ambulance

And of course there will be numerous celebrations with staff and family, both of whom have been critical to Gold Cross’s success over the years.

One thing that has stayed exactly the same? Moffitt’s vision for Gold Cross—“to provide quality medical care and customer service to anyone, regardless of race, creed, color, religion, or the ability to pay.”

Please join the AAA in congratulating Gene, Julia, the Moffitt family, and Gold Cross Ambulance on 50 years of providing high-quality healthcare to the people of Utah.

Congratulations, and here’s to many more successful years!

Spotlight: SSM Health Cardinal Glennon Children’s Hospital STARS Program

The Special Needs Tracking & Awareness Response System (STARS), was founded just over two years ago at SSM Health Cardinal Glennon’s Children’s Hospital in St. Louis, Missouri. The team at Cardinal Glennon realized that they needed to do something to address the growing number of children in the U.S. with special health care needs, many of whom are at a higher risk for repeated ambulance transports.

As an EMT for over 18 years, Patricia Casey, the Missouri Coordinator of the STARS Program, knows how intimidating it can be for a first responder to walk into a home that in many ways may look like a hospital room. Children with special health care needs can require many different types of in home medical equipment that first responders are often not familiar with. The STARS Program aims to make the job of the first responders easier while making children with medical needs and their parents more comfortable with ambulances in case they need to be transported in one.

Cardinal Glennon works with local ambulance districts to enroll children with special medical needs in that district’s STAR Program. Once a child is registered in STARS, they are given a unique patient identification number and a home visit is scheduled with the patient and their family to compile pertinent medical history. Participating ambulance companies then create a book with all of the stars in their area so that their first responders have access to the medical information on the go. If a STAR needs to be transported, their caregiver can relay their STAR number to the dispatcher who will then let the first responders know. First responders can then look up crucial medical information about the STARS patient, so they can be better prepared when they arrive on scene.

Knowing that many medical devices in the homes of the STARS may be foreign to first responders, Cardinal Glennon’s staff provides free necessary trainings all around Missouri and now Illinois. Shelby Cox works as the Team Lead for EMS outreach, and Josh Dugal, RN, is the EMT-P STARS Coordinator for Illinois. Together with Casey, they help keep the program running smoothly. Each participating ambulance company appoints a STARS coordinator on their staff who will make biannual home visits and make sure the STARS medical information is up to date. Cardinal Glennon also sets up regular opportunities for STARS to visit their local first responders. Giving STARS the chance to get familiar with an ambulance and their local first responders prior to a medical emergency has been proven to help out both parties when an emergency occurs.

A paramedic who has responded to STARS calls explains that “the STARS system permitted me to have advanced medical knowledge before I walked through the door. There was no time lost backtracking to learn the patient’s history or baseline in the midst of a chaotic scene”. In addition to helping the first responders, the STARS program has been a huge reassurance to the parents of STARS whose children may often need medical assistance.

To learn more about Cardinal Glennon’s STARS program, visit their website or check them out on Facebook. Also check out Patricia Casey’s Article on the STARS Program which includes testimonials from both parents and first responders who have participated in the program.
Thanks to the entire team at Cardinal Glennon for your great work!

Do you know of other innovative programs being run by ambulance services? Share with the AAA so that we might feature those programs on the AAA Blog as well.

Staff Visit to Richmond Ambulance Authority

Last week, American Ambulance Association staff took a road trip south to tour the Richmond Ambulance Authority. Known across the country and around the world for their innovative approach to EMS, RAA certainly did not disappoint.

Thank you to Chip Decker, Rob Lawrence, Dan Fellows, Elizabeth Papelino, Danny Garrison, Dempsey Whit, Jason Roach, and the whole RAA team for the hospitality and generosity with their time!

The Acadian Effect

By Desiree LaFont, Education & Events Director, American Ambulance Association

October 2015

In a previous life I worked for a hospitality-related association. Within that industry there was something known as the “Gaylord Effect”—when Gaylord Hotels would open a property in a city, all of the other businesses in the area, including other hotel brands, benefitted. High standards, a sterling reputation, and the ultimate in customer service meant Gaylord booked convention and leisure business on a scale few could rival. Everyone from the local cab drivers to the bartenders to the surrounding hotels profited from the huge influx of travelers. Where once feared as the luxury brand that would crush the competition, they were soon seen as a desirable ally. So fast forward a few years, and I have a new life working for the American Ambulance Association (AAA), but I often think about the Gaylord brand and their ability to change a city with their commitment to their customers. If you are wondering what any of this has to do with ambulance services, I’m about to get to that.

On a recent trip to Louisiana to document the tenth anniversary of Hurricane Katrina and the role AAA members had in the recovery, the AAA’s Director of Membership, Amanda Riordan, and I had the opportunity to visit Acadian Ambulance. Armed with a local videographer, a short list of questions, and a crippling doubt in our ability to capture what is arguably the most important private EMS story in recent history, we arrived at Acadian’s Air Med Station in Lafayette, Louisiana.

Lafayette Headquarters

Our first interview was with Marc Creswell, Acadian’s Air Med Operations Manager. Marc’s story is incredible for a number of reasons, and I won’t attempt to retell all of it here, but I will tell you Marc is the kind of guy that could have inspired the phrase, “when the going gets tough, the tough get going.” This is the guy you want in your foxhole. And to be honest, we could have completed our interview with Marc, packed up, and had more than enough material to tell a great story about Acadian and Katrina, but Acadian was just getting started.

We spent the remainder of the day interviewing Dee Dee Sewell, their Critical Support Intervention Specialist; Clay Henry, Acadian’s Vice President of Operations, Communications Center; Blane Comeaux, President of Acadian Total Security; and Chairman and CEO Richard Zuschlag. Everyone, including Mr. Zuschlag, gave us more time then we could have hoped for and held nothing back. They shared a great many operational details, but always through the lens of the story of the people behind all those unseen efforts and rescues.

Downtown New Orleans

Dee Dee at work in Lafayette
Dee Dee at work in Lafayette

The next day we visited downtown New Orleans to meet with Steven Kuiper, Regional Vice President for Acadian. Within minutes, I felt like I was hearing the story of Katrina for the first time. Steven shared facts, but, once again, it was wrapped in the story of the people around him—the suffering and the heroism he personally observed on the ground.

And, then came the big finish; Janie Fuller, Paramedic Field Supervisor and lifelong resident of St. Bernard Parish. Janie accompanied us to the Mayor’s Office to interview Deputy Mayor Andy Kopplin and New Orleans Director of EMS Dr. Jeffrey Elder. She then gave us the insiders’ tour of her parish and showed us exactly where the levees were breached. Her entire hometown was under eighteen feet of water in 15 minutes, but by nightfall Janie had commandeered an airboat and was taking a cardiac patient to I-10 and Causeway for evacuation. Needless to say, Janie is a force of nature herself, and no matter what dark alley a call takes her down, this lady is coming out alive and so is her patient.

Telling the Story

[quote_right]What also emerged during our visit was Acadian’s ability to tell the human side of what it means to be in EMS. They tell the Katrina story and the story of their company with humility, grace, and a deep appreciation for their colleagues and the many other services that stepped in to lend a hand.[/quote_right]What emerged over the course of those two days of interviews was the amazing story of what Acadian, and private EMS, were able to accomplish in the midst of the hurricane’s devastation. Hospitals were shuttered, law enforcement was overrun, citizens were cut off, and conditions for everyone—including EMS—were unspeakable. Despite this, medics in the area stayed and other ambulance services rolled in.

Hundreds of ambulances with trained medics rolled in to help New Orleans and countless communities throughout Louisiana, Mississippi and Alabama. Whether or not they knew how bad the situation was, they still went in. No one can ever calculate what that response meant to the City of New Orleans and the other affected areas, but I think we all have a sense of how much worse it would have been without the timely response of private EMS. What also emerged during our visit was Acadian’s ability to tell the human side of what it means to be in EMS. They tell the Katrina story and the story of their company with humility, grace, and a deep appreciation for their colleagues and the many other services that stepped in to lend a hand.
So after an incredible 48 hours in Louisiana we had to head home, and I left with a heavy heart. I wanted to stay a little longer. No, I wanted to stay a lot longer. But why? As I sat on the plane home, it hit me. It was the Acadian Effect. Acadian is that big, shining example of what an innovative, self-determined private EMS company can mean to the population they serve. How you can put people first and come out a winner. How when you put people first everyone benefits. Telling the incredible Acadian success story benefits all of EMS because it typifies the EMS culture of going beyond what’s required and how maintaining human dignity is an essential part of patient care.

So let’s tell that story! Let’s tell the story of Acadian and Katrina. Let’s tell the story of Sandy, Joplin, the Boston Bombing, and the thousands of times a day private EMS responds to 9-1-1 with compassion and highly skilled medical knowledge because that’s your chosen profession. Let’s tell the story until the press, the public and the legislators are telling it for us.

Our heartfelt thanks to Acadian and every AAA member we have the privilege of serving.

Want More?

Watch AAA’s Katrina & Rita retrospective video that features many of the subjects of this blog post.

Spotlight: Kathy Lester

Kathy Lester, MPH, JD
Washington, DC
Healthcare Consultant to AAA

Tell us a little about yourself, please.

I am from Indianapolis, Indiana.  I graduated from Warren Central High School, best known for being the high school of Jane Pauley and Jeff George.  My undergraduate degree is from DePauw University.  I had a double major in biology and English literature, with a minor in violin performance.  I also loved philosophy and political science course and was the editor-in-chief of the college newspaper.  I received my JD from Georgetown University Law Center and my Master of Public Health (MPH) from The Johns Hopkins School of Public Health and Hygiene, now known as the Bloomberg School of Public Health.

After law school, I clerked on for The Honorable Michael S. Kanne on the U.S. Court of Appeals for the Seventh Circuit.  I have also worked in all three branches of government.  In addition to the courts, I worked on the Hill for Sen. Richard G. Lugar (R-IN) and in the General Counsel’s Office at the Department of Health and Human Services.

My husband and I met while both working for Senator Lugar.  He retired from the Senate after 20+ years.  We have two children and are trying to succeed in having tropical fish survive for more than a few months.

When and how did you get involved with AAA?

I began working with the AAA several years ago when we began developed recommendations for a quality program.  I believe my first meeting with the group was in Las Vegas.

How do you help AAA?

Currently, I assist on the public policy issues.  This includes working with the Congress to protect the add-ons, as well as develop payment reforms to create stability for Medicare rates.  I help to draft materials for the Hill and legislative language.  As part of this effort, I help with developing more comprehensive Medicare reform recommendations.  I also assist with the regulatory agenda and engage with Centers for Medicare and Medicaid Services (CMS) and other federal agencies.  In addition, I continue to work on quality structural and measurement issues.

What is your typical day like?

Unpredictable and fun!  My days vary greatly.  I can find myself on the Hill or driving to Baltimore to meet with CMS.  I also spend a lot of time talking with AAA members and the staff team.

What are the biggest challenges you foresee for our industry?Any tips or last thoughts?

[quote_right]

It is more important than ever to understand the cost of services and to be able to articulate why these services are necessary.

[/quote_left]All of healthcare is at a crossroads.  While federal policymakers have successfully reduced spending in the Medicare program, the focus for the foreseeable future will be how to reduce the cost of providing services.  It is more important than ever to understand the cost of services and to be able to articulate why these services are necessary.

For ambulance providers and suppliers in particular, there is great promise in the innovative payment models, because they would most likely recognize the high quality of health care services provided by ambulance providers and suppliers.  However, there is also the potential that ambulance services could become subordinate to larger provider organizations.  As this debate unfolds, it is critically important that data drive any reforms and that the industry look carefully at how programs such as value-based purchasing, the Medicare quality reporting programs (facility compare websites and the five star rating programs), and coordinated/integrated care models have worked for other Medicare providers.  At the end of the day, ambulance providers and suppliers need to understand their care and cost models and articulate use these data points to develop meaningful and sustainable reform options.

Acadian’s High School Champions Program Leads the Way

Founded in 1971 in with just eight staff and two vehicles, Acadian Ambulance has grown over the years to more than 4000 employees with a fleet of 400 ground ambulances, helicopters, fixed-wing airplanes, and van and bus transports. Their territory has expanded from Lafayette Parish, Louisiana, to stations spanning large swaths of Louisiana, Texas, and Mississippi.

How does such a large and varied service feed their talent pipeline? In addition to many other strategies, Acadian is leading the industry in its efforts to engage young adults in EMS through its High School Champions program, a division of their National EMS Academy.

Porter Taylor, Acadian's Director of Operations
Porter Taylor, Acadian’s Director of Operations

To learn more about the ins-and-outs of the program, AAA caught up with Porter Taylor, Acadian’s Director of Operations. Taylor has been in EMS for 29 years, since he joined Acadian Ambulance as a college sophomore. “I love making a difference in people’s lives. When I was working on a unit it was the patient, and now, almost 30 years later, it is the employees that I love helping.”

Establishing High School Champions was not a linear path. Initially, Acadian would send medics to career fairs and school functions to introduce the field and promote its National EMS Academy (NEMSA) as an opportunity after graduation. “There are a lot of technical grants out there, and a critical staffing need for EMS in general. We wanted to create an avenue for educating students about the benefits of becoming EMTs to support our staffing needs long term,” said Taylor.

Although these medic visits were effective, Acadian wanted to expand the fledgling program’s scope and reach. He began visiting area high schools and meeting with school boards and directors more than a year ago to build relationships and explore opportunities. The partnerships he built added another facet to the High School Champion initiative wherein Acadian continues to promote NEMSA, coupled with an effort to get the schools to incorporate an EMT program as an elective prior to graduation. “[I wanted] to introduce them to our company and our support of this technical career path. My goal was to let the teachers and technical program directors know that Acadian has jobs for their students upon the successful completion of the program. Once students turn 18, Acadian will be able to offer them a rewarding  position with good pay and benefits and with continuing education opportunities.”

Acadian Operations Manager Justin Cox was instrumental in the implementation at Livonia High School, a recent addition to the program. In concert with his professional know-how, Cox had a personal connection to the school—his thirteen year old daughter attends Livonia.

Collaborating with the administration, Acadian now works with schools like Livonia to introduce EMS career paths at the end of high school, a time when students are making key choices about their futures. Students can start the EMT training program as an elective prior to graduation and take the national certification exam upon turning 18. Students spend 2-3 hours 3 days a week, during their junior and senior years preparing. “It is a joy to work on this program,” said Taylor, “It is a privilege to help young people make a career choice that is full of rewards.”

Does your service have a great program that is making a difference in your area? Let us know in the comments section below, or email ariordan@ambulance.org.

Spotlight: Sean Kukauskas

Sean Kukauskas
Boston, MA, USA
Director of Ambulance Services, Spaulding Rehabilitation Hospital
Member, AAA Education & Membership Committee

Tell us a little about yourself, please.

I was born and raised in Massachusetts. I have three children, two boys and a daughter. My oldest son, Tyler (20 years old), is in the U.S. Army stationed at Ft. Bliss in Texas. My daughter, Kaylin (19 years old), is a college student, and my youngest son, Sean, is 14 and will be a high school freshman this fall. I am an avid long distance runner. I recently completed my first marathon earlier this year, the 2015 Boston Marathon.

How did you come to work in the industry? How long have you been involved?

Kukauskas, Sean - Spaulding - 2015.07.15 - FamilyAfter high school I joined the U.S. Navy as a mechanical calibration technician for nuclear powered submarines. After getting out of the service, I eventually found myself looking for a solid career. I always had an interest in medicine, so a friend of mine who was an EMT helped me get into EMT school. I have been involved in EMS since then, eventually earning my certification as a Paramedic. I just celebrated my 23rd year in EMS.

I spent the majority of my career working for private fire-based and hospital-based EMS services as a field provider and educator. I have spent the past four years as the Director of Ambulance Services for the Spaulding Rehabilitation Hospital. Spaulding Hospital Ambulance Service is one of the largest hospital based services in Massachusetts. We have 17 vehicles that provide over 16,000 ALS, BLS, and chair car transports annually. Our primary focus is the non-emergent interfacility transportation of patients between the four hospital within the Spaulding Network and our affiliated acute care hospitals.

What do you enjoy most about your job?

As cliché as it sounds, I enjoy making a difference. Whether it is to my patients or for my staff. I like the ever changing envrionment of EMS. Each call, each day, is something new.

What is your biggest professional challenge?

Trying to find that right balance of service and performance while maximizing revenue. At the same time employee engagement and retention are just as importand and challenging.

What is your typical day like?

My typical day starts early to face commuter traffic coming into Boston. Once in my office, I will review the stats from the previous day, respond to emails as needed, and work on the tasks for the day—whatever they may be at that time. I may jump on a truck for the day or for a call. Meetings and then more meetings. At some point during the day I try and get a training run in. Usually I try to finish up some light work at home later in the evening.

How has participation in AAA membership and advocacy helped your organization?

I have found the networking to be invaluable. Chances are someone in in the AAA has encountered a similar situation or issue before. Having a network of colleagues from across the country gives you an avenue to discuss what has worked and what hasn’t.

The AAA helps me grow and improve my department with fresh ideas. The education offerings, the networking opportunities, and reimbursement advocacy all help strengthen our profession. I have been a member of the Education and Membership Committee for the AAA for about two years. I really enjoy working with the other committee members to find and develop new and creative ways to improve the AAA Annual Conference and Tradeshow as well as exploring new opportunities for our members.

Spotlight: David Tetrault

David Tetrault
Farmington, MO, USA
Administrator/CEO, St. Francois County Ambulance District
Director, AAA Board, Region 4

Tell us a little about yourself, please.

I grew up in Jennings, Missouri, a small town in St. Louis County. I’m the baby of six kids—four brothers and a sister. I am very proud of my twin girls who just graduated from high school while simultaneously completing their associates degrees. They are now off to college to Rolla, Missouri, to finish their bachelors degrees. In addition to sharing time with my family and friends, I enjoy softball, camping, swimming, tennis, and walking.

How did you come to work in the industry? How long have you been involved?

David with some of his staff at a recent AAA workshop.
David with some of his team at a recent AAA workshop.

Years ago I was involved in part of the law enforcement arena called “Police Explorers”, primarily because my brother was a police officer. From there, I progressed through many different facets of law enforcement. The one thing that sticks out in my mind is that every time I was involved in an incident including a sick person or trauma, I really felt as if I would filling my calling. I could calm people and make them feel better, even when at that point I had only first responder training.

I have been involved with EMS for more than 30 years now, from my early days as a dispatcher, then up the ranks to Training Officer, then Manager, and now CEO/Administrator here in St. Francois County.

What do you enjoy most about your job?

I enjoy working with the public, people in our community, and my staff. They are my second family.

What is your biggest professional challenge?

Dealing with the younger spirited individuals coming into the world of EMS. Understanding the different challenges in funding, retention of our employee’s, the right mix of people and balancing the good/bad at the same time.

Making sure the Emergency Medical Services is not the forgotten one in the mix of Fire and Police. We all have a very important roles and the same amount of responsibility.

What is your typical day like?

My day typically starts with putting out fires and finishing my to do list from the previous day. Having 24/7 responsibility for a large program has its ups and downs—including sometimes getting called into work in the middle of the night. By sunrise, I have usually been up and on the highway for several hours. During typical office hours, I attend meetings and handle projects, budgeting, scheduling, and other tasks that need to be completed to keep our service operating. I also address any concerns or needs of the board of directors.

How has participation in AAA membership and advocacy helped your organization?

The American Ambulance Association has bridged the gap for me in my role as a service Administrator/CEO. AAA has many valuable resources, and provides me access to a vast network of ambulance services across the United States. My fellow AAA members as well as staff are always available to answer questions.

AAA has been the leader in ambulance services resources for many years, and they continue to strive to be the best in everything they offer. I enjoy the daily updates, and feel that the work AAA does with benchmarking and standands forms the backbone of the industry. The American Ambulance Association is truly a leader for EMS.

 

Spotlight: Matt Zavadsky

Matt Zavadsky
Fort Worth, TX, USA
Public Affairs Director, MedStar Mobile Healthcare

Tell us a little about yourself, please.

Originally from Connecticut and have lived in Lincoln, NE; Augusta, GA; Orlando & Daytona Beach, FL; Lacrosse, WI and now Fort Worth in the Republic of Texas since 2008. Married to my best friend, Tessa, and we each have grown children, and one grandchild (so far!). Aside from doing what I love at work, Tessa and I are avid Harley Davidson Riders (“it’s not a motorcycle, it’s a lifestyle”). We also do a lot of volunteer work with the North Texas Patriot Guard Riders and the Fort Worth Police Code Blue Citizen’s on Patrol program. I’m also a licensed amateur radio operator and certified storm spotter working with the Tarrant County (TX) Radio Amateur’s in Emergency Service (RACES) program.

How did you come to work in the industry? How long have you been involved?

My dad died suddenly in 1979. The hometown Trumbull, Connecticut volunteer ambulance crew that came to help him so impressed me that I signed up to volunteer the week he died. I started as a “driver” at age 17 and was originally trained in a High-Top Cadillac ambulance (the best unit I ever worked in!).

aaa emt membershipWhat do you enjoy most about your job?

Two things. First, making a difference! Whether you are an EMT, Paramedic, EMD, billing specialist, maintenance tech, logistics tech, scheduler, whatever—what we do MATTERS in people’s lives. Second, is the innovation occurring in the healthcare system, and the role the ambulance industry is now playing in the healthcare system every day, literally! The ability for us to define and redefine our profession’s future is an incredible in the environment we are in today!

What is your biggest professional challenge?

Keeping up with the rapid pace of change in the healthcare environment AND helping others see the future. There are a handful of leaders in our profession who can truly see the opportunity that lies ahead of us and are daring enough to take the risk to do something totally different. At the same time, helping our own folks, the people who really matter at the patient contact level, understand how important they are to our future as an industry.

What is your typical day like?

Up at 3:10 a.m., workout with Tessa at the MedStar gym, in the office by 6:00 a.m. to get more done before 8:00 a.m. than I’ll get done the rest of the day. Run from meeting to meeting to community events, in between try to get projects done until I leave for home at 6ish to finish up emails in the evening…

How has participation in AAA membership and advocacy helped your organization?

The education and communication is invaluable. The daily happenings updates, the education at events like the Annual Conference and Tradeshow, combined with the collaborative work with committees for things like government affairs, professional standards and reimbursement reform is invaluable. The ideas shared by visionary entrepreneurs that do this work every day helps make our profession stronger, both locally and nationally.

Spotlight: Aarron Reinert

Aarron Reinert
Isanti, Minnesota, USA
Executive Director, Lakes Region EMS
Treasurer, American Ambulance Association

Tell us a little about yourself.

This is my 25th year as a paramedic. I began my EMS career as a volunteer in a small rural ambulance service in central Minnesota. During my career I have had a number of different leadership experiences, including leading small rural services and large metropolitan services, as well as working for theMinnesota state EMS office.

Today I serve as the Executive Director for Lakes Region EMS. Lakes Region EMS is a rural ambulance service serving Minnesota and Wisconsin composed of 73 full-time staff with a Paramedic/EMT staffing pattern. Previous to Lakes Region EMS, I was the Field Services Manager for the Minnesota Emergency Medical Services Regulatory Board. At the EMSRB, my projects included creating and implementing a statewide web-based data collection system, developing statewide EMS communication systems, and coordinating EMS bioterrorism preparedness.

I am also active on behalf of our industry on the national level. I serve on the board of directors for the National Registry of EMTs (NREMT), am a past board member for Advocates for EMS, and National EMS Management Association (NEMSMA), and was the chair for the National EMS Advisory Council (NEMSAC). NEMSAC is a statutory advisory board whose members are appointed by the Secretary of Transportation to advise all of the federal government on EMS issues.

How did you come to work in the industry? How long have you been involved?

25 years. I was attending college in Willmar, MInnesota studying computer science and needed a part time job. The local ambulance service was looking for volunteers. As a former Boy Scout and Eagle Scout I thought the EMT class would be easy and fun, and, long story short, I fell in love. I left college, went to paramedic school, and continued with the volunteer service where I became the leader in 1994.

What do you enjoy most about your job?

I love working with my team. For me, they are my family. I am humbled and honored every day with the incredible things they do.

What is your biggest professional challenge?

Finding the time to do what I know is most the most important, listening to my staff, and deeply understanding their needs.

What is your typical day like?

I travel for my organization and our industry almost half the time. My day might be in a meeting in D.C., or meeting with my team at our offices. No day is the same.

How has participation in AAA membership and advocacy helped your organization?

Too many ways to list, but a few examples:

1.     Helping me to grow as a leader

2.     Connecting with experts all across the nation

3.     Learning new and better ways to lead my organization.

Spotlight: Scott Moore

Scott Moore
Somerville, Massachusetts, USA
Scott’s LinkedIn Profile
Director of Human Resources at Cataldo Ambulance Service
Co-Chair, Education & Membership Committee at AAA

Tell us a little about yourself.
I grew up twenty minutes north of Boston, MA. I have a wife, Marianne, and two daughters, Emily (9), and Elise (7). I have been in EMS for 25 years and have worked as a Call Fire-Fighter in my town for the last 10. I have a bachelor’s degree in psychology and a Juris Doctor from Suffolk University Law School.

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