Monday, May 27, 2013

The Old and the New; Richmond Ambulance Authority

The Old and the New;

Richmond Ambulance Authority embraces needed changes in the provision of EMS services.

By Alan E Perry

Why I checked them out

I was intrigued by the Richmond Ambulance Authority (RAA) web presence which is very active in promoting the organization, its providers and EMS public education. All subjects I like to see EMS systems promote, both for their own well-being and the good of the communities they serve. The web site (http://www.raaems.org/) is well organized and the organization very open about their operations. They pursue a high level of efficiency and hold themselves to high standards for response time and unit utilization using system status management. My interest was such that I inquired about part-time employment to get an inside view of the system, that is still on hold, but I was able to do a ride-along on Medic 483 to see how it all came together on the street. This document is merely my impression of the service based on my own opinions and experiences.

Their unique environment

In March of 1991 the Virginia General Assembly created the Richmond Ambulance Authority for the purpose of providing the City of Richmond with the framework to build a high quality and innovative EMS system. It has been successful; the RAA is accredited by the National Commission on Accreditation of Ambulance Services (CAAS). Their dispatch center is accredited by the National Academy of Emergency Dispatch (NAED), and is one of only eleven EMS systems in the country to possess both. Those of you familiar with these organizations know that obtaining these qualifications is no small task. This illustrates the level of support and singularity of purpose the organization possesses. With this mandate they have developed an entire EMS system focused on efficiency, integration of technology, evidence based treatment protocols and logical operational policies that serve as a model for the provision of EMS anywhere. Richmond has a permanent population of around 200,000 which swells to up to a million on any given work day, their call volume is approximately 60,000 annually.

What seems to work

As an EMS provider I appreciate the seamless functionality of good quality communications and dispatch systems. RAA has its own dispatch center, uses both radio and wireless GPS to locate, dispatch and map units route to calls, units can respond and mark on scene by the push of a button keeping radio channels clear of unnecessary traffic. The GPS system keeps track of all units and facilitates the dispatch of the closest appropriate unit for a call. Software in the dispatch center is predictive of call locations and volume based on historic data allowing units to be stationed in relative proximity to the next expected call keeping response times below 9 minutes. All 911 response units have at least one paramedic on them. All trucks are equipped with power stretchers. Reports are completed on highly functional ePCR software which links wirelessly with their Zoll monitors. Unit inventory is maintained through a sealed bin system, if a bin is opened it is replaced with a new sealed bin, in this way unit inventories are always complete and standardized. RAA appears to have an excellent working relationship with the facilities they serve, the EMS report/break rooms at all facilities are clean and inviting, have well stocked snack boxes and a wide variety of beverages in the refrigerators to keep the providers sustained during their 12-16 hour shifts. RAA has an excellent working relationship with the Richmond Fire Department. Their single facility on Hermitage road houses the administrative offices, dispatch center, training center, supply and equipment warehouse and Ambulance maintenance shop.

Some of the same old problems

Some of the problems remaining are the same that are found in just about every EMS system. There are a large number of non-emergency and nuisance calls, the Police hand off some questionable psychiatric patients, and every call is dispatched as a priority one call until proven otherwise. As a former EMS system manager and Field Officer the issues with unsecured equipment and the general cleanliness of the units and equipment still concern me. Employees suffer from inequality in pay across public safety disciplines frequently working second jobs to make ends meet.

What I would do to improve the system

RAA has an excellent public education and marketing program already in place, this program can be used to address the appropriate use of the 911 system to the general public to reduce the burden of unsubstantiated calls. Build up the value of your employees and attempt to get the compensation more in line with other public safety personnel. The facilities at RAA are already equipped for decon of contaminated equipment, it may be useful to put each unit through a decon process weekly to include thorough cleaning of the box, the cab and all of the equipment on it. Make the VAOEMS regulations part of the training process for all employees to get better compliance with requirements for securing equipment and hygiene. Permit scheduled breaks for crews to eat a meal without having to do so in the cab of the truck, perhaps permitting them to rotate through stations at local ER’s to accomplish this will not disturb the deployment model too much.

Conclusion

RAA has established itself as a proactive, competent and capable resource for the citizens and visitors of Richmond. It is, in my opinion, a shining example of what an EMS system should strive for. RAA has embraced many of the suggestions put forth ten years ago in the EMS Agenda for the Future, an accomplishment for them and an unheeded warning to most other EMS systems in the State and Nation. RAA should be cautious, you can never rest when you are on top, you must take advantage of the position to keep pushing forward. The same CQI process used to evaluate patient care needs to be applied to the entire system. Continued success will require improving operational and patient care efficiency, increasing the value to the community and the providers and building the trust and respect of the public and your employees through continued integrity in your actions.

Wednesday, May 22, 2013

Using a noodle instead of a stick

Discipline in the workplace;

Using a noodle instead of a stick

More often than not workplace discipline in EMS and other professions involves using intimidation and negative consequences, a practice that seems to fly in the face of the old adage that a carrot works better than a stick. Perhaps as we make the sweeping changes to our EMS systems that we need to keep up and get ahead of the changes in our industry, we can reflect on that and take this opportunity to recognize that there may be a more efficient and positive way of doing things.

Superior patient care, compliance with local protocols and professionalism are what the public demands, and our profession requires, if we are to mature into recognition as part of a respected group of healthcare professionals. The root of inconsistency and variations in application of protocol and patient care standards in my view is largely a function of education and understanding of the subject material. The most effective way to combat it is by cultivating the noodle (brain).

Those evaluating non-compliance and standard deviation problems in EMS delivery may assume that these events occur due to laziness, incompetence or indifference. I suggest that in most cases it is more likely that there is both a lack of understanding and education among providers in these cases. This is not surprising given the cost of providing adequate training programs that address critical skills and constant changes in “best practices” in our field.

We need to recognize as an industry that the minimum recertification requirements for continuing education are just that- “minimum”. EMS professionals should take it upon themselves to review trade publications, medical journals and studies affecting our practice if we truly want to stay on top of our game; likewise each agency must provide both initial and ongoing training in critical skills, local protocol and operations. Why wait until a problem is exposed to address it.

Our communities depend upon us to act appropriately and provide the best care possible. I suggest that achieving excellent and consistent patient care is more about keeping those noodles sharp than a strong disciplinary policy. Communication of the desires of your OMD, the examination of evidence based best practices, and frequent discussion of the best application of them by all of your staff and administration will go a long way toward achieving that goal. It will be much more effective and less painful than the stick.

Be safe, do good work,

Alan

Thursday, May 9, 2013

Head Injury Study

Applying Sports Concussion Assessment Tools to Pre-Hospital EMS Screening of Head Injuries during Defensive Tactics Training

Alan E. Perry 5/9/2013

City of Chesapeake Fire Department

Abstract

This study examines the usefulness of the Sports Concussion Assessment Tool 2 (SCAT2) as an effective means of predicting the presence of closed head injury in the pre-hospital environment by paramedics with training in the use of the tool. It specifically examines a controlled group of police officer candidates during defensive tactics training evolutions, a group known to occasionally suffer both minor and severe head injury during the course of that training. By comparing baseline test score of the candidates to scores obtained during physical and emotional stress, some anticipated limitations of both the tool and local EMS protocol where confirmed.

Acknowledgments

This study could not have been accomplished without the cooperation of the Officers, Training Staff and Officer Candidates of the Chesapeake Police Department. Their cooperation and interest in the study was absolutely essential to achieving any meaningful outcome. My fellow Officers and Paramedics, who shared in developing and performing this study; Kevin Tam, Christopher Hudspeth, David Rose and Doctor Martin Payne, all provided meaningful input into the design and execution of this study. Doctor Heidi Kulberg, Deputy Director of the Chesapeake Health Department, who introduced and trained the medics in the use of the SCAT2 tool. She selected this tool to address the need for evaluating this type of injury, and reducing injuries among employees participating in Defensive Tactics Training. She provided regular and valuable input throughout the process, and supported this study.

Applying Sports Concussion Assessment Tools to Pre-Hospital EMS Screening of Head Injuries during Defensive Tactics Training

Background

Traumatic brain injury has been a source of concern in sports injury and in combat related incidents involving explosives. Recent tragic events in Norfolk, Virginia involving police recruits during defensive Tactics training, established a clear need for some means to screen for closed head injury (CHI), educate training staff and students, and develop a return to play (RTP) protocol in this setting.

The City of Chesapeake, through the Chesapeake Health Department, sought to minimize the risk involved with this type of training by enlisting the aid of paramedics already assigned to the Police Departments Special Weapons and Tactics team. Medics where selected to monitor these events, evaluate those suspected of having received a CHI, and remove them from the exercise if indicated to avoid more serious injury.

Doctor Kulberg introduced the SCAT2 assessment tool (McCrory, 2008), trained the medics on its application, and walked us through the baseline screening process for all of the Officer Candidates in the test group. It is important to note that prior to the introduction of the SCAT2, regional EMS protocols (Tidewater Emergency Medical Services, Inc., 2010) were the only guideline for medics to follow for head injury. This protocol did not address the less dramatic presentations that could indicate a potential CHI. While the protocol does address more significant events, such as altered mental status, unconsciousness and seizure, it is not adequate for ruling out the presence of CHI, or offer guidance for removing participants from the activity to prevent further injury.

Setting

The SCAT2 is a comprehensive exam which includes subjective and objective data, evaluating symptoms reported by the subject, Glasgow coma scale, cognitive assessment, balance and coordination. A shorter version is applied as a sideline tool, which seems applicable for our purposes. The “Pocket SCAT2” (PSCAT2) is less involved and is condensed to reported symptoms, memory function and balance. It was noted by both Doctor Kulberg, and the paramedics, that the full SCAT2 was very sensitive and should prove useful if performed consistently in controlled environments.

Application of the tools included performing a full SCAT2 on each candidate in a rested state, in a controlled and consistent environment, thereby establishing a good baseline assessment for each. In the event of a suspected head injury, i.e. getting hit in the head, blacking out, becoming disoriented; the participant would immediately be removed from activity, and have a rapid exam using the PSCAT2. Any significant deficit would result in a transport to the Hospital Emergency Department(ED) for evaluation. Minor changes would result in the participant being sidelined, and observed until symptoms resolved, if no resolution occurred they would also be transported to the ED. All events requiring any evaluation by an Ed physician would result in a full SCAT2 being performed by Doctor Kulberg before the participant would be allowed to return to training.

Given the level of sensitivity that the SCAT2 appeared to provide, the incidence of false positives arose in several discussions among those administering the test. While the value of the tool in making more informed clinical judgment decisions was not disputed, the concern of over-treating, or removing from activity for a test variation not attributable to a head injury, was a concern. The SCAT2 does not provide guidance on acceptable test score variation, or define at what point a score is positive for a head injury. Specific symptoms are considered highly suspicious by SCAT2, PSCAT2, and local EMS protocol.

Hypothesis and Questions

There was concern that there may be normal variations in SCAT2 scores caused by factors not related to head injury, such as fatigue, level of exertion, climate, environment, and any number of other external variables that will be unavoidable when conducting this evaluation in the field. To determine if, and to what extent, this may be true the following questions were posed.

1. What level, and types of variation, should be expected and considered normal?

2. Are there certain areas, or specific scores, that will be more affected than others?

3. Can this tool be applied to pre-hospital EMS reliably?

4. If variations are present, do these variations affect the usefulness of the SCAT2 tool?

Study Organization and Methods

Baseline SCAT2 scores were obtained on all officer candidates attending the Defensive Tactics course in a controlled environment. The pool of subjects that completed the evaluation ranged in age from 22 years to 41 years, two females, and five males, three of the seven subjects had a previous history of head injury. SCAT2 scores were placed in each candidates training file for access during the course by paramedics. Any candidate who actually suffered a head injury during the course, or was otherwise removed from the course, was excluded from the study.

Subjects were evaluated on the final day of Defensive Tactics, the most physically demanding portion when candidates must successfully defend themselves from multiple assailants. The candidate was escorted from the exercise and given the PSCAT2 within five minutes. A second exam was given at one hour. These evaluations were not performed in the same environment as the baseline exam because that was not possible, however all subjects were evaluated by the same person, in exactly the same way. Test results were compiled and compared to their baseline SCAT2 scores to determine what variations exist.

Results

All subjects exhibited a decline from their baseline scores immediately following the defensive tactics exercise, with the most commonly reported symptom being fatigue, followed by balance and orientation score(time of day) deficits. Most subjects returned to their baseline within 1 hour, none had more than one remaining deficit and several actually improved from their baseline assessment values. No significant variations were evident between age groups, sexes, or those who had previous head injury.

Limitations of the study

The value of this study is limited since the number of final subjects is few and it is based on only one scenario. Since the purpose of the study was only to determine if there may be some normal variations, and in what areas these might occur, the data still appeared to be useful. Additional study seems to be indicated to establish thresholds in the scoring matrix that reflect a point at which to transition from observation to treatment.

Conclusions

The observed decline in scores seems easily attributable to the muscle fatigue immediately following such an exercise, and not associated with a head injury. The physical and mental state of the subject appears to have a measurable effect on their test score as well. The return to baseline for the majority of the subjects validates the approach of the SCAT2 system of monitoring of minor symptoms for improvement, and only taking action if they worsen or do not resolve. The results suggest that minor deviations from the baseline SCAT2 score are to be expected immediately following physically demanding, or emotionally stressful events. The results do not lessen the value of the tool for predicting head injury when performed serially over a longer term, and in controlled environments. The development of a more detailed neurological assessment for pre-hospital use appears to be warranted since many of the criteria of the SCAT2 do not appear in EMS protocol decision points. Existing protocol would fail to detect and properly treat patients suffering from less severe traumatic brain injuries that could easily worsen with continued activity. A protocol adapting the criteria of the PSCAT2 and current EMS protocol could satisfy that need (see appendix A). As with any patient assessment tool, it is only a tool; the good judgment of the provider must also be incorporated into any decision and treatment plan, always erring on the side of patient safety.

Bibliography

McCrory, P. e. (2008). Consensus Statement on Concussion in Sport. Zurich: 3rd International Conference on Concussion in Sport.

Tidewater Emergency Medical Services, Inc. (2010). Tidewater Emergency Medical Services Regional Protocol. Norfolk.

Recruitment and Retention

What are the best solutions for increasing

volunteer resources in Wintergreen?

Alan E. Perry

June 12, 2011

SUMMARY

Wintergreen Fire and Rescue, like most other departments in the State, is suffering from a decline in volunteer membership. In addition to issues affecting the general decline in volunteers, Wintergreen adds three additional challenges; it is a combination department, it has a disproportionately low number of young adults from which to draw volunteers, and it has a very low volume of fire calls. The administration of Wintergreen Fire and Rescue wishes to restore its volunteer staffing to a workable level and needs to attract and retain capable individuals. The specific request from the agency’s administration is for information regarding the best practices for recruiting and retaining volunteers in a predominantly paid system and what needs to be done to give volunteers a sense of their importance in the system. This research paper explores the causes of volunteer decline in emergency services, evaluates recently published studies and programs in this same venue, and suggests strategies that should be effective in Wintergreen’s circumstances.

BACKGROUND

The volunteer pool for both fire and rescue services has been in a steady state of decline since the early 1980’s throughout the nation(Smoke, 2005 p84). Wintergreen Fire and Rescue (WFR) and Nelson County (Nelson) have not been immune to the phenomenon. Causes for the decline among volunteer fire and rescue organizations have been broadly studied and identified by nearly every State, the Virginia Office of Emergency Medical Services (VAOEMS), The United States Fire Administration (USFA), the National Volunteer Fire Council (NVFC), the Virginia Fire Chiefs Association (VFCA) and most regional EMS councils. WFR and Nelson fall into the unique subset of combination departments with both paid and volunteer personnel. The necessity for a combination department arises from the confluence of the decline in volunteers and the need for reasonable response from emergency services by the public(Carter & Rausch, 2008 p201). The emergence of combination departments itself has been indentified as both a response to, and cause of, volunteer decline(NFVC & USFA, 2007 p70).

CAUSES OF DECLINE

Before an informed decision can be made on methods for recruiting and retaining volunteers there must be some discussion of the causes for the decline. The NVFC has a fairly complete listing of possible causes for diminished volunteer participation on their website, many of which are directly applicable to Wintergreen. Additional specific information unique to the organization was provided by Chief Sheets of WFR. A list of common causes for volunteer decline roughly matching the publication “Retention and Recruitment for the volunteer Emergency Services: Challenges & Solutions” published jointly by the NVFC and USFA is outlined here.

Time Demands

Less “free time” to volunteer due to other commitments
Two-income families or working multiple jobs
Competition with other activities & organizations

Training Requirements

More time now required for training and recertification
Increased public expectation for level of services
Addition of EMS training for firefighters

Nature of Calls

Fire Dept. is now first response for EMS calls
Inappropriate use or abuse of emergency services
Aging population with more chronic health issues
Volunteers arrive behind paid staff
Fewer fire calls

Social Changes

Decline of community involvement, pride and support
More transient populations don’t get involved
Less support for volunteer from family & employer
Greater economic pressure

Leadership Issues

Management techniques have changed, or should have
Formal leadership training may be lacking
Ineffective recruitment & retention efforts
No Succession management

Organizational Issues

Inadequate program for recruitment
Inadequate program for retention
Inadequate rewards or recognition for service
Marketing efforts not pursued or misdirected

Government Regulation

Staffing rules preventing entry in structure fires (two in, two out)
Interpretation of Fair Labor Standards Act affecting volunteerism
EPA & DEQ effect on live burns resulting in fewer “live fire” trainings

Paid Fire & Rescue Staff

Potential negative psychological effect on volunteers
Conflicts between paid and volunteer staff
Disparate treatment of either party

Aging population

No longer able to volunteer in a full capacity
Fewer young people are volunteering
Baby boomers are hitting their 50’s

These are all possible causes that should be considered, but does not suggest that these situations currently exist. Determination of the actual existence of any of these factors will require an in depth study of the organization. A reliable study will require significant personal observation, collection of data via questionnaire and exit interviews of volunteers who have resigned over the past few years. A study should be undertaken in addition to addressing the probable causes already identified in nearly all reviewed sources. Funding for such studies can be obtained through Staffing for Adequate Fire and Emergency Response (SAFER) grants and Rescue Squad Assistance Funds (RSAF). One such program using a DHS SAFER grant has already begun in Virginia conducted by VFCA; the study closed at the end of May this year and is expected to produce results by August and fund programs by years end. It is important to note that volunteerism in general has increased nationwide and most communities have volunteer rates of 14-40%(Dye & MacManus, 2009 p421). The issue is more an emergency services volunteer issue than an issue with volunteerism in general.

The challenges of a combination system

Combination systems such as WFR face the expected volunteer challenges already noted in addition to the introduction of a paid staff and command structure. The dynamic between the two “separate but equal” groups affects the performance of the entire system. In most cases such systems are implemented to alleviate staffing shortages due to decreased availability of volunteers during normal business hours and assure citizens of a reasonable response to an emergency. The paid staff is intended to be working for and assisting the volunteers in the performance of their mission, not replacing them. The NVFC/USFA publication “Retention and Recruitment in the Volunteer Fire Service: Challenges and Solutions”, identifies four common sources of friction in combination departments as;

A feeling that one is better trained or more experienced than the other,
A feeling that one is more physically fit than the other,
A feeling that one dominates and has little regard for the others needs or opinions,
A feeling that one misrepresents itself to the public.

Clearly any one of these would cause serious conflict, in combination, or in addition to other known challenges it may become unbearable. The leadership of the organization bears the responsibility for monitoring and quickly resolving any display of favoritism, preferential treatment or intimidation by members on either side of the line regardless of rank or tenure and promoting an atmosphere of mutual respect, appreciation and teamwork. One study of a similar size combination department in Pennsylvania found that over 50% considered leaving because they where unable to meet the time requirements, nearly 30% had conflicts with career personnel and about the same number expressed issues with organization leadership (Switala 2006).

Wintergreens unique circumstances

Wintergreen has several other circumstances that further exacerbate the problems of both recruitment and retention. The community has a disproportionately larger number of citizens over the age of 40 (Movoto 2011). While the community does put forth a significant number of volunteers, their talents and abilities are not consistently ideal for the task of structural firefighting or emergency medicine. There is a small population of adults in the 19 to 39 age group from which to attract volunteers. As such WFR must recruit from outside the community adding the additional obstacles of time and distance to an already difficult sell to the potential volunteer. Chief Sheets of WFR also points out that the call volume in Wintergreen is extremely low which creates problems on two fronts; getting recruits released on working incidents, and keeping all interested in the endeavor.

Scope of the problem

The Wintergreen community is not alone in its need for volunteers; the 2009 Virginia Fire Service Needs Assessment identified staffing as the number one issue facing all volunteer departments in the state while VAOEMS considers retention the greater problem. Due to these circumstances it cannot be expected to draw from other areas without difficulty, however because the problem is widespread some additional resources are now available to address it at both the state and federal levels in the form of funding for recruitment and retention projects and incentives for volunteer service.

The value of volunteering

The fire service in America has historically been a predominantly all volunteer organization composed of citizen participants in a community effort to protect each others lives and property from the effects of fire and other disasters (NFPA 2006 p5). The decision to volunteer comes from a sense of duty to our community, the need to belong to a well regarded group, the sense of achievement, recognition for service and to develop relationships with others who have them same interests. Others do so out of necessity for protection services, for the work and/or leadership experience it can provide, or simply for the thrill. Changes in our social, political and economic circumstances have changed this model in many locations, but its value to the community, local government and the individuals involved is profound and worthy of every effort to preserve it.

retention

There is a predictable life cycle in the careers of volunteers. The VAOEMS study “Keeping the best: How to leverage Retention of Virginia’s EMS Professionals, Research Phase Report” (2005) identifies retention as a priority over recruitment and considers understanding this life cycle as one of four principles that need to be understood by leaders. The volunteer life cycle on average takes about five years to go from recruitment to a state of commitment and mastery of the required skills. At any point therein the challenges will arise, and if not addressed properly, individuals may be lost. Understanding the cycle and the reasons people leave will enable leaders to take proactive steps to meet those needs that they have some control over. As noted earlier the remaining principles are those of achievement, affiliation and relationships. Without retention you cannot develop trained and qualified members or leadership, without good leadership recruitment and retention will fail. The NVFC/USFA study adds these expectations that volunteers have of the organization:

That it be a rewarding experience worth their time.
That training requirements are not excessive.
That time demands are reasonable and flexible.
Good leadership is present which minimizes conflict.
There is ample public support for the organization.

Clearly these can be very subjective criteria and depending upon your personal, social and educational background, the expectations can vary considerably. Not only has the nature of the job changed, but also the viewpoint and needs of the 19-39 year old target audience for recruitment. The expectations of volunteers increasingly clash with the demands and training required for the task.

Solutions

Understanding the barriers to volunteering, from the most common and well understood to the more specific, is the first step to defining possible solutions. Most of the commonly recognized problems have solutions and programs available in the sources cited and listed at the conclusion of this article. The obstacles facing combination departments have also been well researched. The more difficult issues are the ones unique to WFR’s demographics; the aging population, lack of residents in the appropriate age group and the relative scarcity of affordable housing in Wintergreen. A successful recruitment and retention program will not be any single activity; it will require a complete multi-faceted approach to be effective and sustainable. This will require a plan, time, effort and dedication to see it through and make the entire organization own it and further develop it as a tool for its future success. There are many strategies that WFR can adapt to their specific circumstances.

Strategies applicable to all volunteer emergency services

Marketing

· Promoting the volunteer organizations mission publicly & persistently

· Educating the public about the critical need for volunteers

· Market volunteers value to the community; safety, protection, insurance rates and taxes

· Market the value of the organization to it’s members; it’s contribution to community, education and socialization

· Use of Local media; radio, television/cable and print

· Use of Internet, Facebook^©, Twitter^© and other social networking outlets which younger adults use extensively (only four squads in Nelson have websites, three are publicly accessible on Facebook^©).

Education

· Education of children in grade schools, incorporation of fire and EMS programs in secondary and technical schools.

· Educate the general public about value of volunteers as well as appropriate use of emergency services.

· Educate businesses owners and managers about the value of volunteers, the occasional inconvenience may one day save their own business. Need for other forms of support such as non-cash incentives for volunteers in the community.

· Educate other volunteer organizations about the value of fire and rescue work, solicit their help in finding and supporting those who will volunteer for the task.

· Educate community leaders about the value and need for volunteers, solicit their help in securing State and local funding for programs that will improve volunteer participation or alleviate some of the financial burden involved.

Volunteer Training Programs

· Modify training to fit around work schedules

· Create or use existing online training and testing programs

· Make training fun, useful, flexible and accessible

Business Involvement

· Supporting the mission by allowing volunteers to respond from work

· Incentives for volunteers such as discounts, passes, perks

· Sponsorships for those wishing to pursue education and training in Fire/EMS

Public Events

· Perform regular stand bys at sporting or social events to improve visibility, socialize and recruit

· Explore fund raisers that are fun and useful to the community and the organization

· Have regular open houses, career days, community education events

Group Events

· Create fun team building events for career and volunteers together regularly

· Have Family events for both paid and volunteer staff and their families like cookouts, days at the lake, golf, etc.

· Promote the sharing of hobbies and professional skills by creating an organizational directory of goods and services

Strong Leadership

· Promote leadership development voluntarily among all staff

· Make formal leadership training a requirement for promotion by all staff

· Administrative support for tracking, monitoring and mentoring volunteers

· Develop step up organizations to provide a place for volunteers to start and grow

· Boy/Girl Scouts through explorer programs

· Civic & Religious organizations, attend meetings, explain the need for volunteers

· CERT, Medical Reserve Corps, and Fire Corps can be formed to involve those who do not want to be firefighters right now, and to interest those that discover they do.

Mentoring & Succession management

· Use mentoring is a tool for developing and retaining new members

· Use succession management to assure continuity of quality leadership within the organization

Strategies applicable to combination departments

Uniform expectations for career and volunteer staff

· Training requirements should be the same for any given position

· The physical fitness standard should be uniform and attainable

· Verifiable performance & competency in required skills

· A standard for discipline should exist in writing and be enforced (WFR SAP ADM01-002 satisfies this requirement)

· The dress code should be as similar as possible, a professional appearance should be required at all times

· Promotion standards should be based on both performance and qualification for officers and command staff.

Training together

· Will build mutual respect

· Will build trust

· Will improve operational efficiency

Team building

· Discuss problems before they get out of hand

· Joint social/family events like outings, cookouts, movie night etc.

· Joint station/department projects evenly distributed among all shifts and personnel

Collaborative and Strong Leadership

· Effective, efficient and frequent communication

· Involve all leaders in any decision process consistently

· Leadership is the role model for all to follow, set a good example

Strategies to address Wintergreen’s unique problems

Targeted marketing to specific age groups

· Adolescents and young adults, as a challenge; they can obtain good leadership and management training, and network with others.

· Professionals, Veterans and tradesmen/women; appeal to civic duty and challenge.

· College Students; can benefit from work experience and possibly a “live in” program.

Incentives

· Wintergreen resort and golf courses; discounts, passes and memberships.

· Other Businesses; restaurants, campgrounds, markets, professionals etc.

· Paid training, uniforms, insurance.

· Nelson County; tax credits, fee discounts (some already in place).

· Volunteer retention grants; stipend and/or pay per call programs.

Change emphasis of recruitment job description

· Not just fire anymore

· Emergency Medicine

· Technical Rescue

· Incident management

· Community assistance

· Public education

· Leadership skill development

Outside the box

· Similar organizations have had success with volunteer “live-in” programs

· Paid on call programs have alleviated some financial burdens of volunteers responding to calls in other localities within the State of Virginia.

· Stipend programs cost little but provide sufficient incentives to attract and retain more volunteers.

Developed Resources

Virginia Office of Emergency Medical Services (VAOEMS)

Rescue Squad Assistance Fund (RSAF) grants
EMS workforce retention tool kit
Retention research and publications

Virginia Recruitment and Retention Network

Informal idea & information sharing

Virginia Fire Chiefs Association (VFCA)

Current study funded by SAFER grant
Networking

United States

Fire Administration (USFA)/National Fire Academy (NFA)

Leadership training
Recruitment and Retention Publications

National Volunteer Fire Council (NVFC)

Junior Firefighter Program
Multiple print resources and media packages

Federal Emergency Response Agency (FEMA)

Community Emergency Response Team (CERT)
Medical Reserve Corps (MRC)
Fire Corps
SAFER grants

Resources with potential for development

Monitor outcome of VFCA study

New programs will be developed
Take advantage if possible

Nelson County

Pursue subsidy of recruitment and retention programs to control cost in addition to the benefits the County already offers.

Pursue Fire & EMS programs in public schools.

State Legislative actions

DMV fee waivers
Income tax credits
Job protection similar to National Guard or Reserves

CONCLUSION

Wintergreen Fire and Rescue can take actions to recruit and retain volunteers through a variety of programs that can benefit both Wintergreen and Nelson County.

All people have basic needs which must be met in order to be happy, those who volunteer are no different, they still get paid but the currency is respect, recognition and a sense of accomplishment and civic duty. In this way they should be paid well. This can be accomplished with a sincere effort to assure their organization is responsive to their needs, provides a positive work environment, promotes their mission, their value to the community, and provides regular recognition and acknowledgement of their contributions. This sounds easy, but many obstacles can arise within the organization itself, the local politics, the economy and the community. The best approach is simple, genuine and persistent. Persistence is required in the circumstances Wintergreen finds its volunteer system. It will take time to get the message out, alleviate skepticism, and get the attention of qualified and dedicated individuals. Outlined below are specific actions Wintergreen can take to begin, and then solidify improvements in volunteer staffing long term.

Recommendations

Ø Consistently market a positive image of the Wintergreen Volunteer to the community, the value of volunteering to the public, and the positive returns to the individual who volunteers through various available media. The use of low or no cost printed sources such as local newspapers, flyers and electronic media (internet, Facebook^©, Twitter^©, etc.) would be preferable. Doing so will enhance the image of Volunteers, Attract others to the activity and satisfy the need for recognition among the volunteer staff. If cost becomes a factor consider taking the program to the County or Regional levels to secure government or grant funding.

Ø Evaluate the internal dynamics between the paid staff and volunteers to assure that a healthy attitude is present on both sides. Likewise, look at the command staff and administration and assure cooperation and mutual respect is present between paid and volunteer staff. If problems exist here they will spread throughout the organization and cause poor retention and participation due to the conflict.

Ø Provide avenues for paid and volunteer staff and their families to interact in social settings to build a cohesive team that respects and trust the capabilities and intentions of the other. Make the fire stations the social center for these activities as much as practical, but schedule and support other excursions as well.

Ø Restructure training programs to be more flexible by utilizing DVD and internet based instruction, verify acquisition of knowledge via written test and/or practical exercises for both paid and volunteer staff performed jointly as much as possible. Make the learning environment accessible, fun, challenging and supportive.

Ø Provide incentives for volunteers solicited from area businesses and the resort itself. Discounts, perks, passes, memberships and other non-cash incentives can be negotiated that provide both an inducement to volunteer and a reward for service while providing local business interests with an outlet to support a worthwhile activity.

Ø Fund directly, request funding from Nelson County, or apply for grant funding for a pay-per-call or stipend program for volunteers who meet all of the minimum requirements for training, staffing and calls. The amounts are not great and are merely intended to offset the cost of fuel and time lost at work. They will provide a sense of reward to the volunteer for meeting their obligations.

Ø Create an associate program for volunteers of other squads who meet the qualifications and minimum training and duty requirements. This will allow other individuals in surrounding areas to benefit from Wintergreens incentive program, while Wintergreen benefits from improved staffing.

Ø Create a live in program for single volunteers who may be willing to give up a little personal space and a lot of volunteer time in exchange for a room with a bed. A minor change to WFR SAP ADM02-003 (sleeping facilities) could accomplish this.

Ø Conduct exit surveys to determine the actual reasons that volunteers are leaving to allow the creation of a more targeted and efficient retention program.

The intended effect of these recommendations is to remove barriers, provide a supportive environment and sufficient incentives to attract and retain volunteers. Even if recruitment and retention goals can be met, a continuous publicity and support program should remain in place to promote the spirit of volunteerism and guarantee an acceptable level of retention and recruitment long term.

References

Cited sources

Carter, H., Rausch, E. (2008), Management in the Fire Service, NFPA,

Quincy, MA.

Dye, T., MacManus, S., (2009), Politics in States and Communities 13^th ed. P381, p421, Pearson Education Inc. Upper Saddle River, NJ.

Smoke, C. (2005), Company Officer 2^nd ed., Thomson Delmar Learning,

Clifton Park, NY.

Movoto 2011, Nellysford community statistics, Movoto website:

http://www.movoto.com/neighborhood/va/nellysford/22958.htm

National Fire Protection Association (2006), Fire Officer; Principles and Practice,

Jones and Bartlett Publishers, Sudbury, MA.

National Fire Protection Association, U.S. Fire Department profile through 2009 (2010), NFPA. Quincy, MA.

National Volunteer Fire Council, Fact Sheet (2011), NFVC website:

http://www.nvfc.org/files/documents/NVFC%20Fact%20Sheet_2011(1).pdf

National Volunteer Fire Council & United States Fire administration,^Retention and Recruitment for the Volunteer Emergency Services: Challenges & Solutions. (2007), FA-310,

Switala, C. (2006), Declining Volunteer Firefighter Response, Mount Lebanon Fire Department, Mount Lebanon, PA.

Virginia Department of Fire Programs (2010), 2009 Virginia Fire Service Needs Assessment Vol. VI, Jan. 2010, VDFP, link:

http://www.vafire.com/fire_data_statistics/needs_assessment/2009%20Needs%20Assessment%20Report%20Final%2012-28-09.pdf

Virginia Department of Health-Office of Emergency Medical Services (2005), Keeping the Best; How to Leverage retention of Virginia’s EMS Professionals, Research Phase Report.

Other Systems with successful programs

City of Virginia Beach Recruitment video & statistics

http://www.vbems.com/

TEMS/PEMS BecomeEMS.org

http://www.vdh.state.va.us/OEMS/news_page/BecomeEMSOrg_Article.pdf

City of Chesapeake CERT program

http://www.cfdcert.org/

Chesapeake Public Schools Fire/EMS program

http://www.cpschools.com/Schools/CCST/Courses0910.pdf

Virginia Association of Counties, County Incentives for Volunteer Firefighters and Rescue Squad members

http://dls.state.va.us/GROUPS/volunteers/meetings/082307/incentives.pdf

Rocky Mount, Virginia Volunteer Fire Department Stipend program