1. law, govt and politics
2. law enforcement
3. fire department

AUGUST 2009
VOL. 12 NO.8
EMS, FIRE
RESCUE
HAZMAT
DISASTER
MANAGEMENT
In Emergency Services
Quick Look
Sunstar Paramedics
Wins Coveted Award
Sunstar Paramedics of Pinellas
County, Fla., received that state’s
Governor’s Sterling Award of Excellence, one of just four organizations
recognized this year and the first
ambulance service ever. The award,
based on the criteria of the esteemed
Malcolm Baldrige National Quality
Award, recognizes organizations
and businesses in Florida that have
achieved performance excellence
within management and operations.
Paramedics Plus, the ambulance
service operator for Sunstar, also
received an Oklahoma state quality
award in 2002 for its operation
serving Tulsa/Oklahoma City.
Sunstar is the sole ambulance service provider of Pinellas County. Its
516 employees serve a population
of 945,000, in addition to approximately 4 million tourists annually.
It is one of only two EMS agencies worldwide to hold three major
industry accreditations.
Comcare Spins Off
Lobbying Coalition
The Advanced Emergency Communications (AEC) Coalition was
formed from the COMCARE Emergency Response Alliance to serve
as a separate organization that will
lobby Congress and government
agencies for legislation and funding
to advance next-generation technologies to improve lifesaving services.
Advancing emergency communications means promoting innovative
Continued on page 87
Layoffs: How to Help Your
Organization and Employees
Through a Difficult Time
E
By Roberta Jackson
MS organizations have
abundant worries in this
difficult economic climate.
They question if their banks
will continue current loan agreements
so they can meet payroll and maintain
vehicles. They’re concerned that they
may not be able to purchase essentials
to provide proper prehospital care,
train their staff, help their service
grow or even maintain present staffing
levels. At the same time, EMTs, paramedics, dispatchers, call-takers and
support staff fear they may lose their
jobs. When a layoff is the final—albeit
Layoffs can be most
successfully planned for
and implemented with
strategic HR planning,
attention to individual
needs and a strong
communication program.
reluctant—outcome, what can human
resources do to help employers and
employees alike? Let’s take a look.
Take time to plan
Although layoffs realize savings in
the form of lower payroll and tax costs,
reduced benefit premiums and more,
there is an aftermath that must be
planned for. Consider the following:
• What institutional knowledge and
skills will be lost to your organization, and how can that be transferred?
• Will any proprietary information
walk out your front door?
• How can the remaining employees
meet delivery demands?
• How is your company positioned
for security issues?
• How can morale be kept up so
you don’t lose employees your
organization must retain to remain
competitive and successful?
• Can you keep those “forward
thinkers” who could help your
organization expand and grow?
Continued on page 95
Note from the Publisher
86
Research Monitor
90
Quick Look
87
EMS Live @ Nite
92
Leadership Tips
87
Fresh Ideas
94
Washington Monitor
88
Ruminations
96
Leadership Competencies
89
We Recommend
96
In Emergency Services
Publisher
Keith Griffiths
Editor
Carole Anderson Lucia
Contributing Writers
Aimee J. Frank, Joene Hendry
Production Manager
Robyn Thiele
Editorial Board of Advisers
Maggie Adams
Page, Wolfberg & Wirth Law Firm
Bonnie Drinkwater, Esq.
Drinkwater Law Offices
James N. Eastham Jr., SC.D.
Adjunct Professor of Emergency Health Services
University of Maryland–Baltimore County
Stewart Gary
Principal, Fire & EMS Services
Citygate Associates, LLC
Kevin Klein
Director, Colorado Division of Fire Safety
William Koenig, M.D., FACEP
Medical Director, Los Angeles County EMS
Jon R. Krohmer, M.D., FACEP
U.S. Department of Homeland Security
Pete Lawrence
Battalion Chief
Oceanside, Calif., Fire Department
Todd J. LeDuc, M.S., CFO, CEM
Deputy Fire Chief, Broward Sheriff’s Office
Department of Fire Rescue & EMS
Lewis Marshall, M.D., J.D.
Chairman of Emergency Medicine,
Wyckoff Heights Medical Center
Brooklyn, N.Y.
William C. Nicholson, J.D.
North Carolina Central University
Institute for Homeland Security and
Workforce Development
Patrick Smith
President, REMSA
Gary L. Wingrove
Mayo Clinic, North Central EMS Alliance
Best Practices In Emergency Services (ISSN 1540-9015)
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Opinions expressed are not necessarily those of this publication or
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for general guidance only; professional counsel should be sought for
specific situations.
Note
from the
Publisher
A Reminder from Jim Page
by Keith Griffiths
I lifted the lid off a cardboard file box and found a treasure—maybe a
minor treasure, and maybe only to me, but a treasure nonetheless. The box
had belonged to Jim Page, often called the father of modern EMS, who
died in 2004. Jim and I started JEMS, the Journal of Emergency Medical
Services, together and were partners for nearly two decades, creating
magazines, journals, books, newsletters, videos and conferences.
The box was filled with hand-labeled folders of every conference Jim had
spoken at or attended from 1980 to 1982—original conference brochures,
attendee lists, handwritten notes, speeches and even airline receipts. A dozen other boxes contained the rest of his travel folders, starting in 1975 and
ending in 2003.
These files are just a fraction of Jim’s materials—reports, correspondence,
scripts, video, audio and photographs—that will become part of the James O.
Page Collection at UCLA Library. The James O. Page Charitable Foundation
has sponsored the Collection, with a vision that it will become the basis of a
national EMS library, to ensure that the voices and stories of EMS luminaries
are available for future generations. I was at UCLA with Baxter Larmon, a
volunteer for the Foundation, and Russell Johnson, the library’s archivist, to
help sort out which of Jim’s materials will be made available online when the
Collection’s website goes live later this year.
Jim taught me an enormous amount about leadership, mostly by example.
One of the boxes included correspondence from the early years of JEMS. Jim
and I often exchanged notes about articles, topics or contributors. In one, Jim
referenced a manuscript by a young Denver paramedic that was a work of fiction about the life of a troubled paramedic. Jim was enthusiastic about it and
wanted to run it as a series. I had reservations and in a note back to Jim told
him I thought it had potential, but didn’t think it was appropriate or ready yet,
and why.
I had never seen the rejection letter Jim sent back to the author, but I got
a chance this day at UCLA, 25 years later. Jim told author Keith Neely that
he personally was moved by the manuscript and was disappointed that we
weren’t going to publish it, but that his editor (me) had doubts. Jim included
information from my note, spelling out the reasons the piece was being rejected. He ended his letter by writing that he had learned long ago that he had
to trust the people to whom he had delegated responsibility and accountability,
and that it was my call. (A few years later, Neely submitted a revised manuscript, which we published in book form. Street Dancer was the first novel
about a paramedic, by a paramedic, and I’ve always been proud that our little
company found a way to get it into print. Neely died of cancer in 2001, but not
before he received his doctorate and contributed immensely to the advancement of EMS.)
Jim accomplished so much in his career because he knew how to inspire others to help achieve his vision. His note to Neely was a reminder of a fundamental leadership principle Jim stuck to through thick and thin—hire good people,
give them direction and let them make the decisions you hired them to make.
Sounds easy, but why is it so rare?
Keith Griffiths, publisher of Best Practices, is president of The RedFlash
Group and chairman of the James O. Page Charitable Foundation.
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BEST PRACTICES
Quick Look
Continued from front page
next-generation solutions, such as shared data and information across platforms among different groups, advanced
interoperable emergency services, and everything from health
care records to crash notification to 9-1-1 interface, said Robert Martin of the consulting firm e-Copernicus, whose staff is
helping to launch the new organization. The AEC Coalition
comprises the COMCARE Alliance in addition to individual
stakeholders.
“This is a new, refocused effort for advocacy in advanced
emergency communications across organizations, open to
anyone who cares about those issues,” said Martin. “It should
be an extension of the membership’s own government affairs
programs. So regardless of who your government affairs director is, I encourage you to join the AEC Coalition.” COMCARE will continue its operations under David Aylward.
NEMSMA and Fire Chiefs
Talk Leadership Issues
The National EMS Management Association (NEMSMA)
announced that in a joint meeting with the International
Association of Fire Chiefs’ (IAFC’s) EMS Section leaders,
several areas of agreement developed regarding each group’s
respective roles in the EMS community. The IAFC and other
fire-based organizations, concerned over what they viewed as
their omission from a major Institute of Medicine EMS study,
have since promoted the model of fire-based EMS (see Best
Practices June 2007).
The groups’ principle area of agreement settled over longterm leadership development, according to NEMSMA. The
groups tentatively agreed to the joint and cooperative
promotion of the following:
• The Center for Public Safety Excellence Chief Medical
Officer credentialing program
• The James O. Page Charitable Foundation Project for
Leadership Development
• The Homeland Security Master’s Degree Program offered by the Center for Homeland Defense and Security
of the Naval Postgraduate School
In addition, the IAFC-EMS section board agreed to reconsider its position on the NEMSMA Leadership Agenda after
a discussion of how the chief medical officer and fire and
emergency services higher education competencies fit into the
overall agenda, according to NEMSMA.
Contributing writer: Aimee J. Frank
Leadership Tips
Follow the Leader’s Mood
A boss’s emotional response to any bad news affects
employees more than most managers might think, according
to the Financial Times’ Stefan Stern. University researchers
found that in 70 different teams, people working together in
meetings ended up sharing moods, good or bad, within two
hours. Stern said they found that bad moods spread faster
than good ones. Mood-sharing also starts at the top, because
everyone takes their cue from the leader.
How to avoid panic in the ranks? Catherine Sandler, head
of Sandler Lanz’s executive coaching practice, outlines four
steps managers can take to create a sense of safety among an
anxious workforce:
• Announce that the problem is a priority. Ensure workers
that the best course of action is being finalized but that
solutions take time.
• Anxiety interferes with people’s ability to actually listen,
so calmly repeat the message as often as necessary.
• Maintain or make an emotional connection with employees. Layoffs, financial losses and similar bad news will
lead to sorrow and even shock, and a boss’ aloofness will
feed uncertainty.
• Rally employees to the cause and inspire them to prepare
for better times.
Did Your Employee Really Hear You?
How do you handle that employee who is competent or
better, but who repeats mistakes? Citing a new book by behavioral psychologist Aubrey C. Daniels, Oops! 13 Management Practices That Waste Time and Money (and What to Do
Instead), Anne Fisher of Crain’s New York Business recommends that managers re-examine their performance-review
techniques.
Daniels recognizes that most managers begin a project
evaluation by praising the employee’s overall performance
before zeroing in on elements requiring improvement. Based
on behavioral science research, what the employee hears in
this situation is that you think he’s doing a good job but you
are impossible to please completely, so he tunes out your later
effort to correct his mistakes.
Daniels recommends that managers separate the good and
bad news. When reviewing an employee’s successful project,
despite its few flaws, praise the employee’s performance.
Wait a day and call the employee in again and suggest how a
few changes to the project would improve it. Daniels and her
colleagues believe this technique will enable the employee to
hear what you are saying and act on your suggestions.
Contributing writer: Aimee J. Frank
AUGUST 2009
87
Washington Monitor
Federal Responders’ Presumptive
Illness Bills Pending
Under legislation [S 599, HR 948] introduced in both houses of Congress, certain diseases contracted by federal firefighters, paramedics, EMTs and related professionals would
be presumed to be work-related, if these employees had been
employed for at least five years. Among the conditions covered are heart and lung disease; brain, bladder, kidney, colon,
liver and testicular cancers; leukemia; and lymphoma (except
Hodgkin’s), to name a few. Covered, with no minimum employment requirement, is any uncommon infectious disease,
such as tuberculosis, hepatitis and HIV, if the Secretary of
Labor determined it to be related to job hazards. The House
bill is in the Subcommittee on Workforce Protections, and
the Senate bill is in Homeland Security and Governmental
Affairs. This legislation has been introduced but failed to pass
in previous Congresses (see Best Practices, September 2008
and April 2007).
Insufficient Hazmat Training
Revealed at Subcommittee Hearing
Firefighters are not adequately trained for hazmat response,
according to testimony presented at the Hazardous Materials
Safety Program reauthorization hearing held by the House
Subcommittee on Railroads, Pipelines and Hazardous
Materials.
The International Association of Fire Fighters representative recommended that firefighters be trained to at least the
operations level to protect nearby persons, property or the
environment, though most firefighters receive only awareness
level or basic training.
Subcommittee Chairman James Oberstar (D-Minn.) warned
that hazmat training funds might not be available after 2009.
Hazmat transporters’ annual registration fees fund the Hazardous Materials Emergency Preparedness grant program,
which funds local emergency responder hazmat training.
The Pipeline and Hazardous Materials Safety Administration
never increased transporters’ fees after Congress doubled the
agency’s authorization in 2005 to $28.8 million, and cannot
now cover the authorized spending levels beyond fiscal year
2009. Testimony is at transportation.house.gov/hearings/
hearingDetail.aspx?NewsID=880.
GAO Calls for FEMA Improvements
The Federal Emergency Management Agency (FEMA)
must complete its mandated task of improving the nation’s
readiness to respond to large-scale catastrophes, and clarify
the roles and responsibilities of federal, state and local
response officials, said a recent General Accountability Office (GAO) report. The GAO recommended that the agency
complete and integrate its planning, exercise and assessment
efforts.
Approximately 68 percent of the Department of Homeland Security’s (DHS’s) plans to implement key policies are
incomplete, such as the National Response Framework (NRF)
and certain operational plans for terrorism response. The
DHS still has not completed such components of the NRF as
the four-response partner guides that would provide stakeholder-specific references describing key roles for federal
and nonfederal leaders, and so those roles cannot be tested
in exercises. Moreover, FEMA never developed procedures
that detail how to work with the Homeland Security Council
to ensure that corrective actions are tracked and implemented
following exercises. Overall, FEMA lacks a program management plan, in coordination with other federal departments
and agencies, to ensure for the development and integration
of outstanding policies and plans.
The GAO recommended that FEMA improve national
preparedness by, among other things, establishing a program
management plan; better ensuring that exercises follow
program guidance; enhancing its project management plan
for assessing capabilities; and developing a strategic plan
that integrates system elements. The DHS concurred with
the GAO recommendations. The report is at gao.gov/cgi-bin/
getrpt?GAO-09-369.
Health Bill Could Fund Emergency
Care Regionalization Pilots
Emergency care regionalization pilot projects were included in the health care reform bill drafted by Senate Health,
Education, Labor and Pensions Committee Democrats, a
result of Advocates for EMS efforts, according to Lisa Meyer
of Cornerstone Government Affairs, a Washington, D.C., lobbyist for Advocates. Four multi-year grants would fund pilot
projects that design, implement and evaluate a regionalized,
accountable emergency care system that would coordinate
public health, safety, trauma and emergency services; facilitate access to the emergency medical and trauma systems
(including 9-1-1 PSAPs); ensure that a patient was directed to
the appropriate medical facility; track hospital resources and
capacity; and coordinate standardized data management for
prehospital, hospital and interfacility support.
Grant applicants must ensure that certain criteria are met
for the proposed system. A report on each pilot would evaluate the factors contributing to the system’s effectiveness and
long-term financial sustainability; the necessary policy and
legislation required for system maintenance; and barriers
and proposed solutions to achieving success. One provision
reauthorizes the Trauma Care Center Grant Program to stabilize existing trauma centers, particularly those serving large
numbers of indigent patients, by providing new and flexible
funding to address trauma center overcrowding and on-call
pay for trauma physicians in shortage areas. The bill is in the
early stages of discussion.
Contributing writer: Aimee J. Frank
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BEST PRACTICES
Leadership Competencies
Defining the ‘Right Stuff’ of Leadership
By Bruce Griffiths
Editor’s note: This begins a continuing series of columns on leadership
and management competencies. The
author has spent his career on the
topic, working with organizations as
large and diverse as the U.S. Coast
Guard, Disney and Dow Corning, and
with smaller, regional groups as well.
L
et’s start with a common hiring scenario. After a recent
resignation, your organization is interviewing for a
new operations manager. The decisionmakers assemble to compare notes on
the candidates they’ve interviewed. “I
think Susan has the right stuff for this
position,” one says. “She was poised
and radiated confidence when I asked
difficult questions.” Another speaks up:
“I think John fits the bill. He’s energetic and really seems to be a people
person.” A third interviewer prefers
Bill because of his “street smarts and
technical knowledge.”
These opinions represent a lack
of understanding or even a common
vocabulary about what it really takes
to effectively manage and lead. The
ensuing discussion is likely to become
an unproductive test of wills as the
interviewers lobby for their favorite
candidate. To prove this point, imagine
asking the interviewers to independently record and then share their definition
of effective leadership. Chances are
you’ll get as many answers as there are
interviewers! Never fear, though: There
is a solution to this confusion.
The competencies model
Over time, our definitions for what
constitutes good leadership have
evolved; the accepted standard is now
the language of competencies. A single
competency is defined as a cluster of
behaviors representing one facet of
what’s needed to perform a job. For
example, composure is frequently cited
as a personal competency that is im-
portant to many positions. A cluster of
behaviors that demonstrate composure
include:
• Showing patience
• Responding calmly to stressful
circumstances
• Demonstrating control of emotions
Having, and using, this kind of
common vocabulary is especially vital
in judging candidates for complex,
cognitive jobs involving managing and
leading.
A growing body of
evidence points to a
focused subset of six
competencies that are
absolutely essential to
exceptional performance
in managerial roles.
The core concept of a behavioral
characterization of a facet of competence has been fundamental to the
language of competency since someone first articulated the notion that the
best predictor of future behavior is
past behavior (especially more recent
behavior and in a similar context).
Here’s the basic idea: How much
do you really care about what candidates tell you about their underlying
motivation, values, attributes and even
training compared to how they express
these through their accomplishments
and performance? How much can we
really know about what is going on beneath the surface, compared to what we
see in their current and recent actions?
The big six
While most competency models
contain several dozen individual competencies, there is a growing body of
evidence that points to a subset of com-
petencies that are absolutely essential
to exceptional performance in managerial/leadership roles. Using these
competencies to judge candidates (as
well as for professional development)
can be a powerful tool in ensuring that
the best managers and leaders populate
your organization.
Using our Polaris Competency
Model (also called the Career Compass), we’ve assessed thousands of
high-performing leaders at more than
60 different organizations of all sizes
and in many different markets. We’ve
identified six competencies that the
best leaders all have in common:
1.Relationship-building/sensitivity
(emotional intelligence)
2.Communications cluster (clear,
frequent information in the right
medium)
3.Drive/energy (passion to perform)
4.Influence (accumulation and skillful use of power)
5.Organizing and planning (being
efficient and focusing energy on
the right thing)
6.Problem-solving and decisionmaking (creative analysis and
good judgments)
It’s important to note that these “big
six” assume that a candidate already
possesses technical and industry expertise. These “hard” skills are relatively
easy to assess and validate; it is the
“soft” skills represented in the big six
that really define exceptional performance. In fact, it’s an axiom among
human resources professionals that we
tend to hire for the hard skills but fire
for the soft skills.
Stay tuned for future columns,
with tips on how to use the big six to
evaluate candidates—and for your own
personal career development.
Bruce Griffiths is the president of
Organization Systems International in
San Diego.
AUGUST 2009
89
Confusion Linked to EMS Calls for No
Resuscitation Cases
Callers to 9-1-1 may be confused about requirements to
confirm death in hospice patients or individuals with signs of
irreversible death. Mickey Eisenberg, M.D., and colleagues
from the University of Washington and King County Medic
One reviewed 196 “no resuscitation attempted” EMS calls.
Among the 66 calls involving hospice patients, 30 percent of
the callers thought calling 9-1-1 was required by law, while
11 percent called because they needed medical assistance. By
contrast, corresponding figures were 8 percent and 30 percent
among the 130 callers for patients with signs of irreversible death. The researchers suggest improved education may
prevent EMS activation for such patients. — Prehospital
Emergency Care 13(3):335-340, July/September 2009.
Emergency Services as
Public Safety Messengers
Inexpensive, EMS-developed stroke-education programs
increase community awareness of stroke signs and symptoms, found Stephen M. Davis, M.P.A., and colleagues at
West Virginia University in Morgantown. Before-and-after
telephone surveys indicated greater awareness about stroke
signs and symptoms after EMS personnel developed educational posters and community service announcements and
initiated stroke-awareness events. However, when the education programs ceased, awareness dropped, and there was no
positive impact on the public’s likelihood that they would call
9-1-1 for suspected stroke. This suggests the need for further
means of educating the public about calling EMS for stroke.
— Stroke 40:2134-2142, June 2009.
Television news reports of accidental injuries are twice
as likely to carry risk and prevention hints when reporters
interview firefighters and police officers about such incidents,
reported James M. Pribble, M.D., and colleagues at the University of Michigan in Ann Arbor. The researchers analyzed
2,795 newscasts involving car crashes, fires, falls, drownings,
poisonings or recreational/sporting injuries. Of these, 245
featured public-safety personnel interviews, which were 2.5
and 2.75 times more likely to carry prevention/risk-reduction
tips. Though originally published last year, the study was
discussed by public-health and EMS officials at the March
2009 Appleseed Project Workshop, in which they reviewed
collaborative ways to promote the public’s injury-prevention
and overall readiness. — American Journal of Preventive
Medicine 34(5):420-423, May 2008.
EMS may uniquely identify at-risk elderly patients who
need social service agency follow-up, reports Ricky Kue,
M.D., and colleagues at Johns Hopkins University in Baltimore. While the researchers identified 70 elderly patient EMS
calls that ended in no transport, all patients were referred for
social services—23 by paramedics and 47 by physicians. The
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BEST PRACTICES
patients’ follow-up acceptance rates were higher for paramedic (94 percent) than for physician (28 percent) initiated
referrals. — Prehospital Emergency Care 13(3):273-279,
July/September 2009.
Paramedic Experience Impacts Survival
An assessment of 699 out-of-hospital ventricular fibrillation cardiac arrests linked a 2 percent increase in patient
survival with each year of experience for the paramedic
performing a IV placements, intubations and medication
administration to such patients. The study, by Laura S. Gold
at King County Emergency Medical Services and Mickey S.
Eisenberg at the University of Washington School of Medicine, both in Seattle, didn’t find a link between VF survival
and the experience level of the paramedic who made treatment decisions.. — Prehospital Emergency Care 13(3):341344, July/September 2009.
Flu Protection Lapses in
Health Care Workers
Among 48 doctors, nurses and other health care workers
nationwide with probable or confirmed H1N1 infection as of
May 13, 2009, detailed reports from 26 show that half were
likely infected in a health care setting (five likely via patient
contact). However, no worker reported always wearing complete personal protective gear—gloves, gown, eye protection
and either surgical mask or N95 respirator—reports the Centers for Disease Control and Prevention. Of the 11 workers
reporting any personal protective information, five always
used gloves, two always used masks, and one always used an
N95 respirator, but none used eye protection. These findings
highlight lapses in infection-control practices among health
care workers. — Morbidity and Mortality Weekly Report
58(23):641-645, June 19, 2009.
Local Factors Impede Prehospital TOR
EMS use of national termination of resuscitation (TOR)
guidelines appear locally blocked by payers that provide
incentives for ambulance transports; legislators who develop
state ambulance transport mandates and only allow for narrow use of do-not-resuscitate (DNR) orders; and communities
with cultural norms perceived to impede prehospital TOR.
Comilla Sasson, M.D., and colleagues at the University of
Michigan in Ann Arbor identified these factors during three
focus-group sessions at a National Association of Emergency
Medical Services Physicians meeting in January 2008. Focusgroup participants recommended that national organizations
in support of prehospital TOR—such as the American Heart
Association and the American College of Emergency Physicians—lead measures to remove such barriers. — Circulation: Cardiovascular Quality and Outcomes, published online
June 30, 2009.
Research Monitor
Tasers Zap Suspect/Police Injury Rates
Analyses of use-of-force data from 12 police agencies in
four states have suggested that, overall, Tasers reduce the
likelihood of injuries to suspects and officers. When Geoffrey P. Alpert, Ph.D., and colleagues from the University of
South Carolina in Columbia further analyzed 4,222 use-offorce incidents in Orlando, Fla., over 108 months and 6,596
similar incidents in Austin, Texas, over 60 months, they noted
statistically fewer average monthly injuries after officers were
issued Tasers. Compared with pre-Taser periods, suspect
injuries fell more than 50 percent in Orlando and more than
30 percent in Austin, and officer injury rates fell 60 and 25
percent, respectively. — Newswise, June 30, 2009. Report
summary at http://www.cas.sc.edu/crju/pdfs/taser_summary.
pdf.
Estimating Patient Weight
Underestimating the weight of an obese patient may place
EMS personnel and their patients in significant danger during
air medical flights, yet estimating weight is often no more
than a guesstimation. So Darren Braude, M.D., and his colleagues at the University of New Mexico developed a weightestimation method using patients’ upper-arm circumference
and height measurements (see table below and on page 93).
These easily obtained parameters allowed researchers to
estimate patients’ weight to within 15 percent of their actual
weight nearly 90 percent of the time.
For example, a non-pregnant adult female with a 34
centimeter arm circumference (about 13.3 inches) and 170
centimeters tall (66 inches) likely weighs about 100 kilograms (220 pounds). A similar weight estimate corresponds
to a non-pregnant woman with arm and height measurements
of 36 and 162 centimeters, respectively (the equivalent of
14 and 63 inches). In adult men, arm measurements of 34
centimeters and height of 190 centimeters (about 74 inches)
would correspond to weight of 101 kilograms (just over 220
pounds). Men of the same height with a 40 centimeter (15.6
inch) upper-arm circumference would likely weigh about 20
kilograms more, or about 264 pounds. — Air Medical
Journal 28(3):139-145, May-June 2009.
Contributing writer: Joene Hendry
Predicted Body Weight (kg) for Specified Arm Circumference and Height Measurements for Nonpregnant Adult Females
AUGUST 2009
91
Rural Providers Gain Access to CME Through
Innovative Videoconference Network
By Aimee J. Frank
EMS personnel in remote rural areas
often lack easy access to resources
they need to maintain their medical
certification. Northwest TeleHealth,
an interactive videoconference networking system created by Inland
Northwest Health Services (INHS) in
Spokane, Wash., has found a solution
to this problem. TeleHealth’s service
for rural medical providers, a small but
critical piece of the services the system
provides to medical professionals, is a
lifeline to communities trying to keep
their volunteer EMS services alive.
Here’s a look at how INHS set up this
innovative system—and how you can
do so in your community.
The little network that could
TeleHealth began as a videoconferencing network for use among Spokane
hospitals. It has grown to connect EMS
responders from rural areas of five
states—Washington, northern Idaho,
Oregon, Montana and Alaska—through
its EMS Live @ Nite program.
INHS is in its seventh year of offering EMS Live @ Nite. The program
offers classes over the TeleHealth
videoconferencing network that fulfill
EMS providers’ CME requirement.
INHS plans to expand to include the
non-skills-building portion of EMT
basic certification and more, according
to Renée Anderson, the EMS Live @
Nite program director and professional
education coordinator at INHS.
The program got its start when
James Nania, M.D., FACEP, medical
director for Spokane County EMS and
the Deaconess Medical Center emergency department, began taking a critical look at TeleHealth’s possibilities.
“One of the questions of this network
was whether we could do the same
training through a program that was
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BEST PRACTICES
live and interactive, and that would
give a good-quality, one-hour CME
and also be able to entertain questions,” he says. Nania and volunteer
instructors agreed to provide the CME
lessons, INHS agreed to deliver the
program over the TeleHealth network,
Anderson won a federal grant to get
the program started, and EMS Live @
Nite was born.
Anderson located existing videoconferencing facilities in the remote
areas where EMS responders and other
medical professionals who wanted to
take the CME classes for credit could
plug into TeleHealth. (Almost every
community in the country has teleconferencing capacity, she says.) Anderson
also contracted with the four state EMS
officials outside of Washington. “We
worked with EMS state officers to get
permission to host these classes and allow their students to receive continuing
education credits for recertification,”
she explains.
With approximately 60 remote sites,
EMS Live @ Nite hosts an audience of
almost 300 people the second Tuesday
of each month. In small communities,
an EMS responder, often the only one
serving his or her community, can remain in town while taking class, even
while on duty.
Long-distance learning
Because protocols vary from state
to state, and often county to county,
instructors must discuss points of
relevance for advanced life support and
paramedic-level participants, but their
core talks are at the basic EMT level.
“We craft the presentation [toward a]
certain disease or type of injury, and
why it’s a problem, as well as basic
principles and then specific techniques,
that are mostly in line with the national
curriculum,” Nania says.
The instructors give participants a
pre- and post-test to judge what has
been learned from each lecture. The
materials are reviewed each night so
instructors are sure everyone understands the presentation fundamentals.
INHS requires that attendance be taken
and maintains all records for five years.
INHS also surveys students on the
quality of the instructor, presentation
and materials. It also asks students
which courses they’d like to take in
the future, which helps the team plan
classes.
Launching a network
With teleconferencing available
in virtually every community, Nania
says a TeleHealth-like network can
be launched almost anywhere. Here’s
how:
1.Ask EMS officials at the state,
regional or county level if they
know of responders in remote rural
areas who could benefit from a
teleconferencing program.
2.Determine how you’ll fund the program. Anderson won a grant to start
TeleHealth’s CME program, and
now the program runs via volunteers and INHS’s support. This type
of program can be funded in other
ways as well. For instance, states
receive federal funds—what Anderson calls flex dollars—that usually
go to the community health section
of the Department of Health. These
funds may be able to be directed
toward videoconference classes.
3.Have a great curriculum, consistent
with local protocols, to pitch the
officials and medical responders.
4.Identify providers who might be
interested in the program.
5.Put together a telecommunications
system. Universities and hospitals
may already have such a system,
even if it is not yet tied into rural
areas. Contact the board of health,
community colleges and public
school districts to find out where
the networks are so they can be
linked together later.
6.Determine your equipment needs.
Each classroom site needs only a
camera and a microphone to connect to the main site.
7.Design the program. Good instructors and a tough curriculum, based
on students’ needs, will create a
good program.
More than CME credit
According to Nania, responders are
gaining more than CME credits from
their time spent in class. They develop
camaraderie with their peers, have
begun to share best practices across
a five-state region and, hopefully,
are learning that their contribution is
valued. “It’s pretty amazing that you
leave some life-and-death treatments
and care to a totally volunteer orga-
nization,” he says. “Yet increasingly,
we’re taxing them and making them
pay for testing and CME, as opposed to
rewarding them and making it easy to
volunteer their time to participate.
“Hopefully we’re doing them a
little favor by making the education
somewhat easier, less burdensome and
of a high quality,” he adds. “They are
heroes.”
Aimee Frank is a contributing writer
for Best Practices.
Estimating Patient Weight Continued from page 91
Predicted Body Weight (kg) for Specified Arm Circumference and Height Measurements for Adult Males
AUGUST 2009
93
Fresh Ideas
America’s Cup Skipper Bill Ficker Shares Lessons
on Management, Leadership and Winning
By Lauren Simon
Everyone who was on hand for the 1970 America’s
Cup knows that the Gretel II was the faster boat. But the
Intrepid won this quintessential competition because of the
commanding way in which skipper Bill Ficker managed
his young crew, sailing what Sports Illustrated called “a
nearly flawless race.” Nearly 40 years later, Ficker’s feat
still holds lessons for managers and leaders who want to
inspire their workers to world-class performance.
“In a sense, it’s more important to have knowledge of
how to form a good corporation than to be able to sail a
boat fast in this competition,” says the now-80-year-old
Ficker, who has shared his winning ways with corporate
leaders at Time Inc., the Upjohn Company, IBM and
Harvard Business School. “When I became skipper, it was
as if I took over all the responsibilities of a corporation,
including cost accounting, personnel, administration—and
turning a profit. That’s the kind of responsibility a skipper
in the America’s Cup must carry.”
Use precision when building a team
Ficker began his path to success when he was asked to
head up the America’s Cup and made a commitment to
build a winning team. That meant finding and hiring expert
technicians to develop and manufacture the sails, rigging
and other working parts of the 12-meter yacht with the
finest precision and workmanship. (The boat itself was
not new. It had already won the Cup in 1967, before being
redesigned by Britton Chance Jr. for the 1970 race.)
“To get people to work together is so important,” Ficker
says. “There are so many people who can steer a boat well
but never succeed in racing because they don’t know how
to put together a team and gain loyalty.”
In addition to assembling the technical experts, Ficker
interviewed about 75 people for a dozen spots on the crew.
With an average age of 23, the sailors he hired were the
youngest ever to compete in the America’s Cup.
“At that time, people were looking for sailors with lots
of experience,” Ficker says. “I think when you have a
limited amount of time, too many people with too much
experience doesn’t necessarily work. It might be better to
have some good leadership and have everybody recognize
that this is the way we’re going to do it correctly.”
94
BEST PRACTICES
Cultivate team pride
Once he had hand-selected his crew, Ficker went to work
making each man feel valued and important to the team’s
success. One way he did this was through uniformity.
Ficker likes to tell the story of Larry Suter, a champion
small-boat sailor, who showed up for his interview with
long hair and a beard.
“When we were all through with our interview, he said,
‘Mr. Ficker, I understand you don’t like long hair and
beards.’ So I said, ‘Larry, I’d very much like to have you
on the team, but if it’s more important for you to have long
hair and a beard, I respect that,’” Ficker recalls. “A few
weeks later, I went back to New York, where I did the final
interviews, and he showed up with a blazer and tie and his
hair cut.”
A disciplinarian, Ficker made sure sideburns were neatly
trimmed, too, and he required his crew members to dress
for dinner each night. “We’d go back to the house and everybody would shower, then we’d have a cocktail hour and
a sit-down dinner,” Ficker says. “Everybody wore a coat
and tie. They took great pride in that.”
Stick to a schedule
Ficker borrowed one of his management tactics from
legendary basketball coach-turned-author John Wooden,
who cautioned against practicing to the point of exhaustion. Unlike his competition, who would practice until
dusk, Ficker set up a rigid schedule that demanded everyone eat breakfast together, then wash up and be ready to
sail by 10 a.m. They practiced only until 4 p.m., regardless
of how well they had performed.
“I really felt if everybody knew we were going to practice setting spinnakers or racing from 2:00 to 4:00, they
worked hard in order to finish everything we had to do by
4:00,” Ficker says. “We never, ever dropped our spinnaker
in the water or made a mistake with handling or anything
like that.
“You want to end the day with everything going perfectly,” he adds, “and with everybody getting off the boat
with pride.”
Ficker was equally disciplined about his boat and
learned everything he could about aerodynamics, engineer-
ing and boat design. “The most important character trait in
winning is to be prepared and be sure your equipment is
prepared better than your competitor’s,” he says.
Ficker prided himself on being prepared for every
contingency and on having such a great ability to focus
that when competing, he saw “nothing but water ahead.”
He did not tolerate distractions and insisted on “absolute
silence under way except for commands and essential
working conversation.”
So what’s the take-away message for you? Be organized
and manage your effort down to the smallest detail. “Don’t
spend a lot of time or energy or take risks for a very small
benefit,” Ficker advises. “Focus on things that will truly
minimize risk and maximize benefits.”
Lauren Simon is the founding editor of Best Practices.
Layoffs Continued from front page
A detailed review of your employee
handbook is vital prior to the announcement of a layoff. Are there any
promises in that handbook that you
will be obligated to follow, such as last
paychecks and payout of accumulated
vacation time? What are your policies
about severance agreements? Examine
and change policies where applicable
now so they are effective prior to a
layoff.
You also need to make arrangements
for the actual day of layoffs. Before
individual employees are spoken with,
train managers so they are able to give
the same consistent message. Compassion is the most essential part of every
downsizing conversation.
Making the announcement
Let’s face it: Announcing a layoff is
hard, but it’s harder for the people being laid off. So be as kind and compassionate as possible. The kinder you are
to your departing employees, the better
chance you have of rehiring them when
conditions improve and your service is
hiring again.
Planning for a layoff
has implications at the
state, federal and local
level. Union agreements,
where applicable, must
also be taken into
account.
What about severance agreements?
Severance agreements are useful in that they not only reduce the risk of employee litigation but also provide a cushion, even if small, for exiting employees. These are written as releases and must be prepared so they are compliant
with the Older Workers Benefit Protection Act.
If at all possible, offer outplacement
services and take time to help each
departing employee in any manner
feasible. Ask your HR department to
have a workshop on resume-writing
tips. Give departing employees a list
of job boards and government agencies that can assist them in securing
work. Think about how to process their
benefits and how to manage COBRA
for them, being mindful of the new
American Recovery and Reinvestment
Act of 2009.
Remember, you want to re-hire these
people if possible. Reinstating productive employees is faster and significantly less costly in terms of dollars, effort
and time when compared to those hired
for the first time. Perhaps as important, returning employees help create a
culture of commitment. It matters most
how employees exit your organization
when they later evaluate their tenure
with you. It is what your current and
former employees portray about your
organization that helps to shape its
culture and reputuation in the field.
Aftereffects of the layoff
As mentioned above, it’s essential to
retain key employees as long as possible. Think about how you will manage
each one so he or she is engaged and
committed after a layoff is announced.
One way of doing this is by offering a
stay bonus.
Also be sensitive to those employees
still on board. What effect do the layoffs have on them? How much do they
trust the organization, and what are the
effects of any survivor guilt they may
have? Are they looking for alternate
work, thinking they will be next? How
can you help remaining employees
manage a growing workload?
Honesty, respect, transparency and
opportunities for employees to express
their thoughts and fears are invaluable. You can help both departing and
remaining employees deal with the
emotional toll of layoffs. Ask your
employee assistance plan provider how
it can help.
Finally, be patient. Help your
workforce get back on track, focus and
move forward. It is up to you to create
a culture of openness, honesty and
fairness in which all employees know
they matter.
Roberta Jackson, SPHR, GPHR,
is the president of Navigations for
Leadership in Brooklyn, N.Y. A human
resources consultant with specific
experience in EMS, she has domestic
and global expertise in organizational
development, training, HR process
improvement, employee relations and
talent management.
AUGUST 2009
95
Ruminations
We Recommend
Getting Things Done
If you’re like us, you’ve got more
on your plate than you can handle, with
more on the way. This best-selling book
by David Allen describes his system for
organizing all your stuff and prioritizing
the things on your to-do list. Even if you
consider yourself on top of it all, this
little gem will make you better at getting
things done and reducing your stress in
the process. After you read it, give it to
the person in your life who means well
but can’t be trusted to consistently follow
up, hit deadlines or complete assignments. Get it at davidco.com.
GoToMeeting
Tired of the scheduling hassles involved in getting busy people in different
places to agree on a time for a teleconference? This free software doesn’t have all
the bells and whistles of some, but we’ve
found it easier to use than most and definitely better than those irritating e-mail
chains. Sign up at GoToMeeting.com.
Hand-written Thank You Notes
Who sends a thank you card with a
hand-written note anymore? If you’re
smart, you do, realizing that in the age of
ubiquitous e-mail, something that comes
through the mail is different, noticed and
more likely to be appreciated (and often
cherished). Keep a stack of cards handy
and make it a regular practice.
flu.gov/“The Great Influenza”
Feeling the need to be better prepared for flu season? This federal site
collects everything you ever wanted to
know about H1N1, avian, pandemic and
seasonal flu, all in one place. Want to dig
deeper? The Great Influenza by John M.
Barry is a highly readable history of the
pandemic flu that hit the world in 19181919 and killed an estimated 60 million
people. It reads almost like a mystery as
it explores the origins of public health in
the context of fighting the disease. Warning: It will inspire you to stop shaking
hands.
96
BEST PRACTICES
A Brief Tale About
Selecting Good Leaders
By John Becknell
When the venerated chief of a department filled with talented people announced he would be retiring in 18 months and recommending a replacement
from within the department, all of the would-be chiefs took notice. There was
no obvious successor, and each began to think, Maybe I can be the next chief.
A powerful air of competition swirled around the department as each of
the intended stood up straight, tucked in his or her uniform shirt and attempted
to be unique among the many. Ideas exploded, egos ran rampant. Each had a
plan to fix the budget, improve response times, strengthen community image,
and inspire the rank and file to keep stations clean and vehicles shiny. There
was strutting and puffing; criticism of one another abounded. Staff meetings
were filled with hot debates. The would-bes came in early and stayed late,
frequently appearing at the chief’s door looking for ways to make conversation and appear ready.
As the time drew near for the chief to make his recommendation, he
called for resumes and letters of interest. Over several days, he called in each
candidate for an interview. He listened intently as each explained his or her
qualifications, strengths and vision for the department. Toward the end of the
interview, he asked, “If for some reason I do not recommend you, who else
in the department would you recommend for chief?” Almost universally, the
prospectives recommended one person.
The person they recommended was an unassuming but respected member
of the department who had not interviewed. When the chief had announced
his upcoming retirement, this seasoned veteran kept doing what he had always
done: He performed his job as expected, suggested ideas when they came,
and continued working toward the collective betterment of his peers and the
department. He did not try to outperform anyone. In fact, he continued to go
out of his way to make his peers successful, helping them with their projects
and using his talents to make them shine. He helped one perfect and animate
a PowerPoint presentation to showcase her idea for reducing overtime. He
stayed late to help another catch up with data entry. He helped yet another
polish up his resume.
When would-be-chiefs talked about their plans for the department, he listened. When they spoke about their accomplishments, he praised them. When
they bragged about their qualifications, he acknowledged that there were
people in the organization who did many things better than he. When one
was challenged at a community meeting, he proudly stood and defended the
colleague. There was nothing new about his actions; these were the things he
had always done without trying to outperform anyone.
When colleagues asked about his interest in the chief’s position, he acknowledged that it would be an honor to lead so many talented people, but
with a department brimming with talent, he was confident the old chief would
recommend the right one.
The right one, the chief recognized, was this unassuming, respected member of the department. He was right, not because he had led with his ego and
pushed his accomplishments to the fore, but because he came with the highest
recommendation any one can have: the recommendation of one’s peers.
The founding publisher of Best Practices, John Becknell, has worked in emergency services for more than 30 years. As a consultant, he assists individuals
and organizations in uncovering and telling their stories. You can reach him
at [email protected].