Making a difference: Using EMS personnel and vehicles for more than just saving lives

By Matt Zavadsky

Two of the greatest assets EMS providers possess are our education and passion for making a difference. When we marry these two assets with our regular tools of the trade, magic happens that can do even more than resolving a cardiac dysrhythmia.

Consider a small child with a debilitating medical condition who cannot go trick or treating like normal kids. Or, an elderly nursing home resident who has not been home for Thanksgiving in years, and may not ever get to do so. We can help these patients in immeasurable ways by adding a little compassion and innovation to the mix. We can make a difference in each of these patient's lives, and the lives of their family, by using our assets to create events that enhance the lives of special people in our communities and increase employee morale. They are also public relations opportunities for our agencies.

Here's some insight on how to develop and successfully implement special rider or transport programs like these in your local community.

Selecting an event
MedStar and many agencies conduct Home for the Holidays programs, usually occurring on Thanksgiving. These programs transport patients from nursing homes to their local family member homes for the day, using medically trained personnel and equipment to help assure the patient's clinical needs are met during the transport.

We also do a trick or treat event, designed to take medically at-risk kids out trick or treating with their families. Some agencies, like American Medical Response, do a Sentimental Journey program which transports hospice patients to their favorite location one last time.

These programs are designed to be used by patients and families who would not ordinarily have the financial wherewithal to pay for a transport like this, especially since it is not a medically necessary transport and therefore not reimbursable by third party insurers.

We choose Thanksgiving for our Home for the Holidays program for two reasons. First, it is generally a very family gathering type of day and therefore conducive to bringing patients to be with loved ones in one location. Second, it is not a religious holiday which prevents us from having to offer the program on Christmas, Hanukah, Kwanza, or other religious holidays.

Obviously we do the trick or treat event on Halloween, but the neighborhood selection deserves careful consideration. We've been blessed to partner with a wonderful community in Fort Worth for our trick or treat event. The neighborhood goes all out with signs, banners and even designated ambulance parking locations for the families.

Patient nomination and selection
Nomination of patients for the Home for the Holidays program are generally made by the nursing home staff, in consultation with the family that the patient may be visiting. We notify the skilled nursing homes in our service area that the program is available about 30-days before Thanksgiving.

We promote the trick or treat event through our local media outlets and social media, channels, again about 30-days before Halloween. This helps friends and family of the children know about the event and submit nominations.

During our first event, one of the nominations actually came from a local TV reporter and in our second year, one of the families who participated in the previous year nominated a family for the following year.

We create some general parameters for nominations:

• The pick-up and transport destination needs to be within our service area
• Patient is not able to transported by any other means than stretcher/ambulance due to their medical condition
• For the Home for the Holidays program, the family must able to care for the patient while the patient is in the home so the ambulance crew will not have to stay with the patient
• For the trick or treat event, the family must be willing to go trick or treating with the patient
• The patient and/or family members are willing to share their story with the local media outlets
• Crew selection and participation

For most paid agencies, you cannot ask crews to volunteer to participate in these programs off the clock, so we pay the crews the appropriate rate for the hours they will be working the event. We do solicit dedicated crews to sign up for the shift covering the event, that way, the folks working the event are doing so because they want to, not because they were assigned the detail as part of their on-duty shift. Doing this also helps us assure the patient pick-up and return times can be accommodated, regardless of the activity in the rest of the system.

In some cases during the Home for the Holidays event, families have invited the crews to stay and share some of the Thanksgiving dinner with the family. Depending on the transport load of the crews, we have given permission for the crews to go ahead and stay for the meal if invited.

During the Trick or Treat event, the crews stay with the patient, literally taking the child door-to-door on the stretcher to collect their treats. This past year, one of the MedStar crews participating in the Trick or Treat event took the time to actually decorate the ambulance as a haunted ambulance — much to the joy of the patient and family being transported for the event.

Logistics
Once the patients participating in the program have been selected, a representative from your agency should visit the patient and family in advance. During this meeting, you can identify any special medical needs for the patient, discover if there is anything unique about the patient, their family, or the event that you can share with the media; pre-screen the layout of the residence to see if there will be any complicated egress issues; and complete any media releases necessary to meet the guidelines for releasing medical information about the patient to the media.

If there are interesting tidbits about the patient or family, share this with the crew assigned to the transport. We have found that in some cases, the crew will do something special for the patient to make the event even more memorable. For example, one patient in our Home for the Holidays event was 103 years young and a die-hard Texas Rangers baseball fan. The crew arranged for a special Texas Rangers blanket and ball cap the patient wore during the transport and then kept as our gift. This was a huge hit with the local media covering the event.

On one of the Trick or Treat events, the entire family dressed up as characters from Alice in Wonderland. This was shared with the media in advance, and one of the reporters came to the event dressed up as a character from Alice in Wonderland as well!

Media coverage
Programs like this are a huge hit with the media and the local community. If the patient and family agree to media coverage and sign the appropriate releases, prepare a media release describing the basics of the transport, the anticipated date, time and location of the pick-up location, as well as anything unique about the patient or family.

Send this media notice out two days prior to the event, as well as the morning of the event. We generally offer to the families to be the media coordination agency to help prevent too many media representatives converging on one family. As such, we do not release the contact information for the family, nor the address of the residence in the media release. If a media outlet wants to cover the event, we coordinate the arrivals and interview slots for the family and share this information as needed.

We subscribe to a media clipping service called TVEyes. If local media does cover the event, we clip the video or print story and give that to the patient and family as a remembrance of the event.

Cautions
A couple of caution notes for a Home for the Holidays event. Some compliance officers have ruled that doing this type of event may violate Anti-Kick Back rules concerned that this event is providing something of value to a nursing home that may refer Medicare or Medicaid patients to your agency.

Our attorneys have reviewed the Anti-Kick Back statutes and have determined this is a concern for two reasons. First, the facility is not receiving any benefit from this program, the patients are receiving a benefit. Second, we are an exclusive provider market and as such, the facility has to use us for medically necessary ambulance transport regardless. Nonetheless, you should clear this program with your local compliance officer before undertaking the program.

Our compliance officer and legal eagles have not raised any concerns about the Trick or Treat event. We transport these children typically from home and not from a facility.

Another caution is assuring the medical suitability of the patient. Be sure the patient is not so unstable that a trip out of the facility would place the patient at risk for significant harm. We do not enroll patients for this program that are on a ventilator, one or more vasoactive drips, or who have other high-risk medical issues. This helps prevent catastrophe while the patient is out of the facility. We do however take patients on suction, oxygen, or who have issues such as seizures or respiratory difficultly. All these issues can be monitored and mitigated by the crews assigned to the events.

Wonderful for morale and community relations
Above all, have fun! The employee morale and community relations value of these programs cannot be overstated. Each year we have done the Home for the Holidays and Trick or Treat programs, the events have been the lead stories in our local media. We keep in touch with the families, share Christmas cards, stories, joys and sorrows.

When one of the children we took trick or treating passed away a year later, some of us attended the memorial service and cried with the family. The family mentioned that the one time they got to all go trick or treating together was one of their most wonderful memories.

Use the assets you have to make difference for patients, families and your community in innovative ways and trust me, you will get back tenfold what you invest in programs like these.

View media coverage of MedStar's Home for the Holidays and Trick or Treat events.

If you would like more information on how to conduct these types of programs, feel free to contact me.

About the author
Matt Zavadsky, MS-HSA, EMT, is the public affairs director at MedStar Mobile Healthcare, the exclusive emergency and non-emergency EMS/MIH provider for Fort Worth and 14 other cities in North Texas. He has 34 years' experience in EMS and holds a master's degree in Health Service Administration with a Graduate Certificate in Health Care Data Management. Matt is a frequent speaker at national conferences and has done consulting in numerous EMS issues, specializing in mobile integrated healthcare, high performance EMS system operations, public/media relations, public policy, health informatics, costing strategies and EMS research.

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