FULL SPEED AHEAD
April 11, 2014
By Audrey Fraizer
From early 2011 to almost the end of 2013, Richard Schreiber can describe his life as a fast-moving train streaking down a single track.
Events have blurred but they all led to his anticipated destination.
When he was finally able to lift his head up, he noticed his son had grown and his daughter was in college. The University of Alabama Crimson Tide was playing against Oklahoma in the Allstate Sugar Bowl on Jan. 2, 2014, in New Orleans, La.
Schreiber also felt relieved, although he only allowed 24 hours of deep breathing, after achieving medical Accredited Center of Excellence (ACE) recognition from the IAED before jumping back into the now-accustomed full-steam ahead mode.
“I went right back to it because this was only the beginning,” he said. “We had made it into the range of excellence and it was time to continue.”
Schreiber is the communication center manager at NorthStar EMS (NEMS), a private ambulance service that covers 10 counties in central Alabama and annually transfers about 75,000 patients, both in emergency and non-emergency situations.
NEMS operates 80 ambulances that deploy about 350 emergency medical technicians, paramedics, and support staff. This past September, NEMS added an advanced life support helicopter that increases service capacity to a 100-mile radius of Tuscaloosa, reducing the time to minutes—instead of hours—for getting help to rural areas.
The NEMS secondary public safety answering point (PSAP) in Tuscaloosa coordinates the land and air resources. The center employs 28 emergency medical dispatchers (EMDs)—nine on the day shift and three or four at night—who handle all medical calls transferred from three primary PSAPs: Tuscaloosa Police Department, Northport Police Department, and Tuscaloosa County Sheriff’s Office.
Schreiber started as an emergency dispatcher at NEMS in 1997, certified as a paramedic, left the center to work in the ambulance, and earned a degree in business administration. In 2006, he went back to the comm. center. Six years later Schreiber was named center manager and in 2013, NEMS became Alabama’s first ACE.
It wasn’t a slam-dunk.
“I knew ACE would be an uphill battle,” Schreiber said. “I knew it would be a struggle.”
Struggle might be an understatement.
City and county level Emergency Communications Districts administer Alabama’s 9-1-1 services. The consolidation of the three primary PSAPs serving Tuscaloosa County had been debated for years with the issue taking on increasing urgency after the April 27, 2011, tornado destroyed the Tuscaloosa County Emergency Management Agency (EMA) facility.
The catastrophic event signaled the practicality to consolidate, to unify existing services to better handle response. Alabama’s 9-1-1 Board funded construction of a new EMA building and levied a $1.60 surcharge on all landlines and cellphones to fund a 9-1-1 facility placing all jurisdictions under one roof. A system for prioritizing EMS dispatch could better manage emergency resources in response to demand.
While the consolidated primary PSAP remains in the planning stages, other steps have been taken toward emergency services consolidation. State-of-the-art CAD systems were installed at the three primary PSAPs and the Tuscaloosa City Council voted in June 2011 to go with a single ambulance service. Three applied.
The five-year contract NEMS won, commencing Sept. 1, 2011, prioritized quality care and management. One medical director oversees pre-hospital care and, as part of the agreement, the dispatch center selected a set of protocols.
Schreiber chose the Medical Priority Dispatch System (MPDS). He had seen the Medical Protocol in action and liked the emphasis MPDS placed on medically validated protocols that included both Pre-Arrival Instructions and a method to establish the priority, and response configuration for every medical call received.
He was also impressed with the system’s ability to find out exactly what happened—the precise situation prompting the 9-1-1 call. If the caller said the emergency involved cardiac arrest, Schreiber knew the protocol system would provide clarification: the how, why, when, and where.
“MPDS is the most highly respected EMD protocol in the country and since dispatch is the all-important first step of EMS, you want to make sure everything is done correctly from the beginning,” he said.
Schreiber also wanted the public to know that NEMS was in the top tier of communication centers. So, as part of the ambulance contract, NEMS attempted ACE within a year.
Suggesting that staff was cautious in shifting to protocol is generous.
MPDS represented major change, and they were comfortable with the way dispatch was done. The Medical Priority Dispatch System would not allow them to vary from the established questions and protocols. Deviation was unacceptable.
And add ACE to the list?
Thirteen of the center’s 20 dispatchers decided to quit over the next year rather than certify.
“Case Entry alone caused all sorts of meetings,” Schreiber said. “When you try to change how people have been doing their jobs for 20 years, it’s tough.”
The seven who stuck it out rallied, a turn-around Schreiber ascribes to the assistance he received from Academy Associate Director Carlynn Page and Priority Dispatch Corp. (PDC) National Qs. PDC Medical/Fire Consultant Gary Galasso was their assigned liaison, spending the next eight months as a Salt Lake City to Tuscaloosa frequent “conference caller” and flier.
“It was an arduous task for them, especially considering the limited amount of time they had to achieve (ACE),” Galasso said. “It was a matter of coming to terms about what they had to do and how we could help them.”
National Q was brought on board. They created checks and balances and kept them on course. Feedback was applied. Dispatchers were made to feel that they were part of the accreditation process.
Initial hesitation was not confined to center personnel. There was one more, possibly heavier straw, threatening the camel’s back.
Not every municipality relying on NEMS was sold on the MPDS. Many didn’t like the questions, arguing that the number of questions required added time to response and, subsequently, posed a potentially negative impact on patient care.
Schreiber demonstrated to the contrary, using “before” and “after” protocol calls to compare time.
“They had tunnel vision,” he said. “They balked at the idea. They said this was crazy. A few refused to transfer medical calls.”
Schreiber pushed back.
“We made it,” he said. “At least, it’s definitely no longer the struggle it once was. They saw MPDS worked. They realized the stuff wasn’t fabricated.”
Schreiber allowed his staff 24 hours to celebrate once the ACE confirmation letter was in his hands.
“I couldn’t be prouder of my communication center team members,” he said. “Our excellent dispatchers make it all work, on every call every time as soon as it comes in. We now look forward to what we can do as an ACE.”
NorthStar EMS President Tony Smelley said achieving ACE has been a great team-building and team accountability process.
“Having trained dispatchers who can step up and offer medically-proven emergency care such as CPR and do it confidently is a public safety enhancement that can’t be overstated,” Smelley said. “We paid special attention to that because you never know when the next call is going to be ‘that’ call.”