Category Archives: Emergency Management

Anthrax Vaccine for Emergency Responders Petition

Anthrax Vaccine for Emergency Responders: Petition in support of the language of H.R. 1300 and S. 1915 to allow emergency responder access to nearly expiring anthrax vaccine from the Strategic National Stockpile

Anthrax vaccine is an important component of ensuring our providers' safety
Photo: D Mackinnon/Getty Images

Act NOW! Sign the PETITION!

Please join the 453 other citizens in signing this petition in support of the language of H.R. 1300 and S. 1915 by adding your name, town, and zip code to the form below. These bills allow emergency providers access to stockpiled anthrax vaccines.  Once enough names have been added to the petition, we will send the list of names to the U.S. Senate and to the President of the United States to ensure your voice is heard in support of the safety for all of America’s emergency first responders.







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(*NOTE: We believe in privacy and will not sell or give your name or email address to anyone and is only used to help ensure against factitious signatories to the petition. The email addresses will be stripped from the petition prior to mailing.)

Background

Federal preparedness leaders are not acknowledging the potential of antibiotic-resistant anthrax and are not fully disclosing that antibiotics and personal protective equipment (PPE) may fail to protect first responders and volunteers as they perform their duties. Moreover, these federal stewards are unwilling or unable to share the anthrax vaccine and the protection it bestows. Instead, each year millions of federal, stockpiled doses of the anthrax vaccine expire, unused.

Project EQUIPP is a grassroots advocacy campaign formed in 2007 on behalf of local emergency responders and civilian preparedness volunteers and helped to develop a consensus paper calling for pre-exposure vaccination against anthrax for emergency responders. Shortly thereafter, the CDC Advisory Committee on Immunization Practices (ACIP) convened a working group that would ultimately revise the CDC guidance on the use of the anthrax vaccine. These CDC Recommendations were voted upon and approved in 2009. In its Notice to Readers published in MMWR in July 2010, the CDC states its support of voluntary, pre-exposure immunization with the anthrax vaccine for “persons involved in emergency response activities including but not limited to, police departments, fire departments, hazardous material units, government responders, and the National Guard.”

anthrax vaccine is the only way to prevent infection from antibiotic-resistant strains of <em>B. anthracis</em>
Bacillus anthracis bacteria, which causes the disease anthrax, is depicted here in a photograph that uses the Gram stain.
Credit: Public Health Image Library (PHIL), Center for Disease Control and Prevention

H.R. 1300: The First Responder Anthrax Preparedness Act

Subsequently, on July 29, 2015, the U.S. House of Representatives unanimously passed H.R. 1300, “The First Responder Anthrax Preparedness Act,” sponsored by Congressman Peter King (R-NY). According to the nonpartisan Congressional Research Service, “The First Responder Anthrax Preparedness Act”…

… amends the Homeland Security Act of 2002 to direct the Department of Homeland Security (DHS), in coordination with the Department of Health and Human Services (HHS), for the purpose of domestic preparedness for and collective response to terrorism, to:

  1. establish a program to provide surplus anthrax vaccines nearing the end of their labeled dates of use from the strategic national stockpile for administration to emergency response providers who are at high risk of exposure to anthrax and who voluntarily consent to such administration,
  2. distribute disclosures regarding associated benefits and risks to end users, and
  3. conduct outreach to educate emergency response providers about the program.

Requires DHS to:

  1. support homeland security-focused risk analysis and assessments of the threats posed by anthrax from an act of terror;
  2. leverage homeland security intelligence capabilities and structures to enhance prevention, protection, response, and recovery efforts with respect to an anthrax terror attack; and
  3. share information and provide tailored analytical support on threats posed by anthrax to state, local, and tribal authorities, as well as other national biosecurity and biodefense stakeholders.

Directs DHS, in coordination with HHS, to carry out a 24-month pilot program to provide anthrax vaccines to emergency response providers.
Requires DHS to:

  1. establish a communication platform and education and training modules for such program,
  2. conduct economic analysis of such program,
  3. create a logistical platform for the anthrax vaccine request process,
  4. select providers based in at least two states to participate,
  5. provide to each participating provider disclosures and educational materials regarding the benefits and risks of any vaccine provided and of exposure to anthrax, and
  6. submit annual reports on pilot program results and recommendations to improve pilot program participation.

Requires the report to include a plan for continuation of the DHS program to provide vaccines to emergency response providers.

Haz-Mat Decon suits can fail - anthrax vaccine is an important component to provider safety
Photo: AR15.com

S. 1915: The First Responder Anthrax Preparedness Act

The Senate version of “The First Responder Anthrax Preparedness Act,” S. 1915, was introduced on August 3, 2015, by Sen. Kelly Ayotte (R-NH) and has been referred to the Committee on Homeland Security and Governmental Affairs where it sits today.

Cost

According to the nonpartisan Congressional Budget Office (CBO):

H.R. 1300 would direct the Department of Homeland Security (DHS), in consultation with the Department of Health and Human Services (HHS), to provide anthrax vaccines from the Strategic National Stockpile to first responders who volunteer to receive them. Under the bill, DHS would establish a tracking system for the vaccine and would provide educational outreach for the program. The bill would direct DHS, in coordination with HHS, to establish a pilot program in at least two states to begin providing the vaccine.

Based on information provided by DHS and HHS, CBO estimates that implementing H.R. 1300 would cost about $4 million over the 2016-2020 period, assuming appropriation of the necessary amounts. Enacting H.R. 1300 would not affect direct spending or revenues; therefore, pay-as-you-go procedures do not apply.

H.R. 1300 contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act and would not affect the budgets of state, local, or tribal governments.

Act NOW! Sign the PETITION!

Please click here to sign this petition in support of the language of H.R. 1300 and S. 1915 to ensure your voice is heard in support of the safety for all of America’s emergency first responders.

 

101 Things We Should Teach Every New EMT

Originally posted at TheEMTSpot

I do not usually steal content or original writings, but this post is too important not to share (and keep for reference).  This was originally posted, with all credit due to the author of origin, at: http://theemtspot.com/2014/03/22/101-things-we-should-teach-every-new-emt/

Though this list is focused towards emergency medical technicians, it has inferred and inherent application in many clinical and non-clinical professions.

1) You aren’t required to know everything.

2) You are required to know the foundational knowledge and skills of your job. No excuses.

3) Always be nice. It’s a force multiplier.

4) There is no greater act of trust than being handed a sick child.

5) Earn that trust.

6) Don’t ever lie to your patient. If something is awkward to say, learn to say it without lying.

7) Read Thom Dick’s, People Care. Then read it again.

8) You can fake competence with the public, but not with your coworkers.

9) Own your mistakes. We all make them, but only the best of us own them.

10) Only when you’ve learned to own your mistakes will you be able to learn from them.

11) Experience is relative.

12) Proper use of a BVM is hard and takes practice.

13) OPAs and NPAs make using a BVM less hard.

14) Master the physical assessment. Nobody in the field of medicine should be able to hold a candlestick to your physical assessment skills.

15) Keep your head about you. If you fail at that, you’ll likely fail at everything else.

16) There is a huge difference between not knowing and not caring. Care about the things you don’t yet know.

17) Train like someone’s life depends on it.

18) Drive like nobody’s life depends on it.

19) Pet the dog (even when you’re wearing gloves).

20) Have someone to talk to when the world crashes down.

21) Let human tragedy enhance your appreciation for all that you have.

22) Check the oil.

23) Protect your back. It will quite possibly be the sole determining factor in the length of your career.

24) Say please and thank you even when it’s a matter of life or death.

25) Wipe your feet at the door.

26) When you see someone who is really good at a particular skill say, “Teach me how you do that.”

27) Nobody can give you your happiness or job satisfaction; it is yours and yours alone, and you have to choose it.

28) We can’t be prepared for everything.

29) We can be prepared for almost everything.

30) Check out your rig. It’s more meaningful that just confirming that everything is still there.

31) Tell your patients that it was a pleasure to meet them and an honor to be of service.

32) Mean it.

33) Keep a journal.

34) Make it HIPAA compliant.

35) Thank the police officer that hangs out on your scene for no good reason.

36) Recognize that he or she probably wasn’t hanging out for no good reason.

37) Interview for a job at least once every year, even if you don’t want the job.

38) Iron your uniform.

39) Maintain the illusion of control. Nobody needs to know that you weren’t prepared for what just happened.

40) Apologize when you make a mistake. Do it immediately.

41) Your patient is not named honey, babe, sweetie, darling, bud, pal, man or hey. Use your patient’s name when speaking to them. Sir and Ma’am are acceptable alternatives.

42) Forgive yourself for your mistakes.

43) Forgive your coworkers for their quirks.

44) Exercise. Even when it isn’t convenient.

45) Sometimes it’s OK to eat the junk at the QuickyMart.

46) It’s not OK to always eat the junk at the QuickyMart.

47) Don’t take anything that a patient says in anger personally.

48) Don’t take anything that a patient says when they are drunk personally.

49) Don’t ever convince yourself that you can always tell the difference between a fake seizure and a real seizure.

50) Think about what you would do if this was your last shift working in EMS. Do that stuff.

51) Carry your weight.

52) Carry your patient.

53) If firefighters ever do #51 or # 52 for you, say thank you (and mean it).

54) Being punched, kicked, choked or spit on while on duty is no different than being punched, kicked, choked or spit on while you’re sitting in church or in a restaurant. Insist that law enforcement and your employer follow up with appropriate action.

55) Wave at little kids. Treat them like gold. They will remember you for a long time.

56) Hold the radio mike away from your mouth.

57) There is never any reason to yell on the radio….ever.

58) When a patient says, “I feel like I’m going to die,” believe them.

59) Very sick people rarely care which hospital you’re driving toward.

60) Very sick people rarely pack a bag before you arrive.

61) Sometimes, very sick people pack a bag and demand a specific hospital. Don’t be caught off guard.

62) Bring yourself to work. There is something that you were meant to contribute to this profession. You’ll never be able to do that if you behave like a cog.

63) Clean the pram.

64) Clean your stethoscope.

65) Your patient’s are going to lie to you. Assume they are telling you the truth until you have strong evidence of the contrary.

66) Disregard #65 if it has anything to do with your personal safety. Trust nobody in this regard.

67) If it feels like a stupid thing to do, it probably is.

68) You are always on camera.

69) If you need save-the-baby type “hero moments” to sustain you emotionally as a caregiver you will likely become frustrated and eventually leave.

70) Emergency services was never about you.

71) The sooner you figure out #69 and #70, the sooner the rest of us can get on with our jobs.

72) People always remember how you made them feel.

73) People rarely sue individuals who made them feel safe, well cared for and respected.

74) You represent our profession and the internet has a long, long memory.

75) Don’t worry too much about whether or not people respect you.

76) Worry about being really good at what you do.

77) When you first meet a patient, come to their level, look them in the eyes and smile. Make it your habit.

78) Never lie about the vital signs. If the patients vital signs change dramatically from the back of the rig to the E.R. bed, you want everyone to believe you.

79) Calm down. It’s not your emergency.

80) Stand still. There is an enormous difference between dramatic but senseless action and correct action. Stop, think and then move with a purpose.

81) Knowing when to leave a scene is a vital skill that you must constantly hone.

82) The fastest way to leave a scene should always be in your field of awareness.

83) Scene safety is not a five second consideration as you enter the scene. It takes constant vigilance.

84) Punitive medicine is never acceptable. Choose the right needle size based on the patients clinical needs.

85) Know what’s happening in your partner’s life. Ask them about it after you return from your days off.

86) If your partner has a wife and kids, know their names.

87) No matter how hard you think you worked for them, your knowledge and skills are not yours. They were gifted to you. The best way to say thank you is to give them away.

88) Learn from the bad calls. Then let them go.

89) When you’re lifting a patient and they try to reach out and grab something, say, “We’ve got you.”

90) Request the right of way.

91) Let your days off be your days off. Fight for balance.

92) Have a hobby that has nothing to do with emergency services.

93) Have a mentor who knows nothing about emergency services.

94) Wait until the call is over. Once the patient is safe at the hospital and you’re back on the road, there will be plenty of time to laugh until you can’t breathe.

95) Tell the good stories.

96) You never know when you might be running your last call. Cherish the small things.

97) You can never truly know the full extent of your influence.

98) If you’re going to tell your friends and acquaintances what you do for a living, you’ll need to embrace the idea that you’re always on duty.

99) Be willing to bend the rules to take good care of people. Don’t be afraid to defend the decisions you make on the patients behalf.

100) Service is at the heart of everything we do. The farther away from that concept you drift, the more you are likely to become lost.

101) There is no shame in wanting to make the world a better place.

See more at: http://theemtspot.com/2014/03/22/101-things-we-should-teach-every-new-emt/

Changing the Paradigm of the Emergency Medical Services

 

Can the Emergency Medical Services Evolve to Meet the Needs of Today?

Click here to view the PowerPoint PDF

The emergency medical services (EMS) provide a means of rapid treatment and transportation to definitive care for those people who suffer immediate life-threatening injuries or illnesses (Department of Transportation, National Highway Traffic Safety Administration, n.d.; Mayer, 1980). There are a number of models across the country and the world that are seeking to redefine EMS in a way that is more meaningful in both of its missions, public safety and public health (Washko, 2012). However, financial constraints and overzealous regulations serve only to pigeon-hole EMS into the decade of its birth and refinement, the 1970s, by restricting incentive and growth and limiting the efficacy of directed research and its application towards the much needed restructuring of EMS.

In this brief literature review, I will examine the roots and context of EMS, its mission and current application, as well as possibilities for research, growth, and development. It is important to recognize that EMS is a grand resource for both public safety and public health, especially in light of the growing body of legislation that officials are using to redefine the current health care system within the United States. As we continue to develop EMS, other nations will look to us as they have in the past to adopt and adapt our system for use throughout the world.

A Brief History of Contemporary EMS

There were many forms of organized out-of-hospital medical aid provided throughout history from the biblical good Samaritan to the triage and extrication from the battlefields of the Roman conquests and the Napoleonic wars through the U.S. Civil War and every major war and conflict in U.S. history; however, it was not until the advent of combined mouth-to-mouth resuscitation and closed chest massage (what we know today as cardiopulmonary resuscitation, or CPR), enhanced 9-1-1 for use by the public in summoning emergency services, and the release of a 1966 white paper prepared by the Committee on Trauma and Committee on Shock of the National Academy of Sciences, National Research Council, that we have the EMS system that we are familiar with today (Department of Transportation, National Highway Traffic Safety Administration, 1996). It was about this time that the Department of Transportation (DOT) was given purview over EMS at the national level with the passage of the National Highway Safety Act of 1966.

During the 1970s, EMS had transitioned from mostly untrained funeral home drivers to providers trained by emergency physicians to treat many of the life-threatening scenarios that prevent people from seeking medical attention at hospitals, such as traumatic injuries, cardiac arrest, and many breathing problems. Since this time, there have been a number of concerted efforts and official recommendations by the DOT to augment and improve the delivery model of EMS throughout the country (Department of Transportation, National Highway Traffic Safety Administration, n.d., 1996, 2008). As early as 1996, the DOT published the vision of the future of EMS:

Emergency medical services (EMS) of the future will be community-based health management that is fully integrated with the overall health care system. It will have the ability to identify and modify illness and injury risks, provide acute illness and injury care and follow-up, and contribute to treatment of chronic conditions and community health monitoring. This new entity will be developed from redistribution of existing health care resources and will be integrated with other health care providers and public health and public safety agencies. It will improve community health and result in more appropriate use of acute health care resources. EMS will remain the public’s emergency medical safety net. (Department of Transportation, National Highway Traffic Safety Administration, 1996, p. iii)

Even as today’s emergency rooms, operating suites, and trauma centers throughout the world are overflowing capacity with an increasingly deficient workforce, EMS is expected to answer the call for help as the front-line of a fractured and inefficient health care system (Kellermann, 2006; Mason, Wardrope, & Perrin, 2003; O’Meara et al., 2006; Washko, 2012).

Hampered Efforts

EMS is known throughout the United States as rapid responders in times of medical and traumatic emergencies; however, ever-increasingly, EMS is being used as the front-line alternative to primary care for the non-emergent uninsured and under-insured patient population (Heightman & McCallion, 2011; Washko, 2012). There is a limited number of ambulances, EMTs, and paramedics available at any given moment, which is subject to financial constraints, and non-emergent use of these resources prevents their availability for when a true emergency arises. Secondary to the mission of providing care to the public, EMS is also needed to provide services for fire department and police department operations, such as firefighter rehabilitation at fire scenes and tactical medicine in concert with bomb squads, S.W.A.T. teams, and hazardous materials teams.

EMS resources are costly, and overburdened systems are negatively affected when these resources are misused, especially by those who are unwilling or unable to pay for the services.

Financial Impact

According to the DOT (2008) EMS workforce report, employers reported difficulties in retaining EMTs and paramedics partly due to the inability to raise wages or provide better fringe benefits. The report goes on to show that EMTs and paramedics suffer a wage disparity when compared to other similar public safety ($12.54/hr vs. firefighters: $26.82/hr; police officers: $22.25/hr) and health care workers (licensed vocational nurses and licensed practical nurses: $16.94/hr; respiratory therapists: $21.70/hr; registered nurses: $26.28/hr). In the five years leading up to 2005, the average wage for EMTs and paramedics grew only by $0.29/hr. It is important to note that these numbers do not take cross-trained firefighters and police officers into consideration.

Furthering the concern of wages, as the DOT (2008) report shows, is the lack of growth potential within EMS as most systems lack the ability to provide a meaningful career ladder to the EMTs and paramedics in their employ. These circumstances together create the scenario that EMS is an underpaid dead-end job causing high attrition as most EMTs and paramedics either suffer from burnout, culminated psychological stress from the job, or use the profession as a stepping stone into other health care fields, such as nursing, respiratory therapy, or physician-level medicine.

The DOT (2008) report provides evidence that transport-based reimbursement policies are likely to blame for the unusually low profit margin in EMS (Heightman & McCallion, 2011). The Medicare and Medicaid programs, as well as many private insurers, require documentation that the transport of a patient be medically necessary before they will pay; however, the Medicare and Medicaid reimbursement rates are very low and do not cover the cost of EMS operations. To complicate the matter, EMS providers are mandated by law to provide care to the public regardless of their insurance status or ability to pay (Heightman & McCallion, 2011). EMS is subsidized by either taxes or insurance reimbursement or some combination of the two.

Broad Mission

In addition to providing for the mundane care and transportation of the ill and injured and performing ancillary duties for the police and fire departments as noted above, EMS is tasked with disaster preparedness – preparing for the major incident that is highly unlikely to occur but would be devastating to lives and infrastructure if it does. That is if the EMT or paramedic is employed for an emergency service. Many of the EMTs and paramedics, today, are employed by private ambulance services who transport non-emergent patients to and from skilled nursing facilities and doctors’ offices. The multitude of these EMTs and paramedics are not considered when planning for emergency response schemes.

I consider EMS to be the caulking used to fill many of the fractures and gaps in today’s health care system. If it occurs outside of the hospital, then EMS will take responsibility, yet, they seldom get paid for their actions.

Proposed Solutions

There has been much talk over the past few years regarding the efficacy and efficiency of EMS, and all agree that the current definitive model is inefficient with, at best, questionable efficacy. Washko (2012) describes in detail the number of EMS schemes and their shortfalls. In his article, Washko is correct in stating that transport-based reimbursement policies fail to reward the greater EMS community for their willingness to take on further responsibility within the two scopes of operation: public health and public safety.

Wingrove and Laine (2008) explore the opportunity for training and equipping the most experienced paramedics for a public health centered role delivering community-based care. These community-based paramedics are described as augmenting the traditional emergency responder role with opportunities to direct patients to more appropriate care, such as doctor’s offices and urgent care centers instead of hospital emergency departments when appropriate to their condition. This model was researched recently in Australia with good results, and is now a recommended career path both there and in the United Kingdom (Mason, Wardrope, and Perrin, 2006; O’Meara et al., 2012). In the U.S., EMS professionals feel a responsibility to participate in disease and injury prevention efforts, and research on models that utilize specially-trained paramedics to perform home safety inspections, hazard mitigation, and reduce the risks of injuries to children have proven effective (Hawkins, Brice, & Overby, 2007; Lerner, Fernandez, & Shah, 2009). Hennepin Technical College, in Minnesota, now offers certification in Community Paramedic training when the recommended curriculum is provided by an accredited college, according to Wingrove and Laine.

Other, more immediate (but, arguably, less meaningful) solutions, as Washko (2012) describes, are incorporating operational tactics that better utilize ambulances by attempting to predict call volumes and locations based on historical data, the high-performance model. This, however, creates high-call volume, less resource driven scenarios with ambulances idling on street corners awaiting the next call. As mentioned earlier, attrition is a significant concern in EMS and these tactics are demanding on providers physically and psychologically leading to high incidences of burnout and injury (Department of Transportation, National Highway Traffic Safety Administration, n.d., 2008).

Discussion

The standard operational benchmarks of EMS – response times and mortality and morbidity of cardiac arrest – are antiquated measures and typically distract policymakers when they are considering financial incentives for EMS (Heightman & McCallion, 2011; Washko, 2012). EMS needs to evolve with the changing health care system, and I feel that it is poised, specifically, to help address disparities in health and health care. Using the community-based paramedic model of health care delivery, we can address many public health concerns, provide for public safety, and still maintain the traditional role of emergency responder. The community-based paramedic model will provide an acceptable alternative to the options that lie ahead.

The economics of health care is a reality that must be considered by every EMS operation when approaching growth and change. As long as EMS can fill the gaps in the current health care system, it will be worth the money required to subsidize a robust, well-trained, and well-equipped contingent of emergency medical professionals. In the meantime, though, EMS agencies will have to seek more efficient models that maximize reimbursement while minimizing costs.

References

Committee on Trauma & Committee on Shock, Division of Medical Sciences, National Academy of Sciences, National Research Council. (1966). Accidental Death and Disability: The Neglected Disease of Modern Society. Washington, D.C.: Author.

Department of Transportation, National Highway Traffic Safety Administration. (n.d.). A leadership guide to quality improvement for emergency medical services (EMS) systems (Contract DTNH 22-95-C-05107). Retrieved from http://www.nhtsa.gov/people/injury/ems/Leaderguide/index.html

Department of Transportation, National Highway Traffic Safety Administration. (1996). Emergency medical services: agenda for the future (DOT HS 808441 – NTS-42). Retrieved from http://www.nremt.org/nremt/downloads/EMS%20Agenda%20for%20the%20Future.pdf

Department of Transportation, National Highway Traffic Safety Administration. (2008). EMS workforce for the 21st century: a national assessment. Retrieved from http://secure.naemse.org/services/EMSWorkforceReport.pdf

Hawkins, E. R., Brice, J. H., & Overby, B. A. (2007). Welcome to the World: Findings from an emergency medical services pediatric injury prevention program. Pediatric Emergency Care, 23(11), 790-795. doi:10.1097/PEC.0b013e318159ffd9

Heightman, A. J. & McCallion, T. (2011). Management lessons from Pinnacle: Key messages given to EMS leaders at the 2011 conference. Journal of EMS, 36(10), 50-54.

Kellermann, A. L. (2006). Crisis in the emergency department. New England Journal of Medicine, 355(13), 1300-1303. doi:10.1056/NEJMp068194

Lerner, E. B., Fernandez, A. R., & Shah, M. N. (2009). Do emergency medical services professionals think they should participate in disease prevention? Prehospital Emergency Care, 13(1), 64-70. doi:10.1080/10903120802471915

Mason, S., Wardrope, J., & Perrin, J. (2003). Developing a community paramedic practitioner intermediate care support scheme for older people with minor conditions. Emergency Medicine Journal, 20(2), 196-198. doi:10.1136/emj.20.2.196

Mayer, J. D. (1980). Response time and its significance in in medical emergencies. Geographical Review, 70(1), 79-87. Retrieved from http://www.ircp.info/Portals/22/Downloads/Performance/Response%20Time%20and%20Its%20Significance%20in%20Medical%20Emergencies.pdf

National Traffic and Motor Vehicle Safety Act of 1966, Pub. L. No. 89-563, 80 Stat. 718 (1966).

O’Meara, P., Walker, J., Stirling, C., Pedler, D., Tourle, V., Davis, K., … Wray, D. (2006, March). The rural and regional paramedic: moving beyond emergency response (Report to The Council of Ambulance Authorities, Inc.). Retrieved from http://www.ircp.info/Portals/22/Downloads/Expanded%20Role/The%20Rural%20and%20Regional%20Paramedic%20Moving%20Beyond%20Emergency%20Response.pdf

Washko, J. D. (2012). Rethinking delivery models: EMS industry may shift deployment methods. Journal of EMS, 37(7), 32-36.

Wingrove, G. & Laine, D. (2008). Community paramedic: A new expanded EMS model. Domain3, 32-37. Retrieved from http://www.ircp.info/Portals/22/Downloads/Expanded%20Role/NAEMSE%20Community%20Paramedic%20Article.pdf

EMS Research: Using t Tests

When considering the emergency medical services, there has been much discussion regarding the utility of advanced life support and its effectiveness within the emergency medical services (Stiell et al., 2005; Stiell et al., 2003; Stiell et al., 2002; Stiell et al., 1999). One of the most basic skills that paramedics use exclusively is intravenous cannulation and the subsequent delivery of isotonic intravenous fluid. Intravenous cannulation is one of the first advanced skills that paramedics utilize within the course of treatment as it allows to correct for shock, provides a means for administering parenteral medications, and provides a means for drawing blood for testing either in the field or upon arrival at the receiving emergency department. As the body’s stress increases when dehydration is present, it is imperative to correct dehydration during the course of treating most ailments; otherwise, the body’s own compensatory mechanisms can fail despite otherwise adequate treatment (Wakefield, Mentes, Holman, & Culp, 2008). Additionally, dehydration can mask some critical tests, such as other blood values and radiological findings (Hash, Stephens, Laurens, & Vogel, 2000).

Though the research is limited, it is also important to note that judicious use, or overuse, of intravenous fluids can be detrimental in some cases (Rotstein et al., 2008). In order to test the effectiveness of paramedic treatment of co-morbid dehydration, we can observe for fluid status before and after treatment as well as between those patients transported by paramedic ambulance as compared to patients who present to the emergency department by other means (e.g. basic life support ambulance, walk-in); however, it is first important to understand if those patients who present to the emergency department are, indeed, dehydrated.

In order to study if paramedics have an impact in treating co-morbid dehydration, there has to be an assumption that a) most people are not dehydrated and b) people who present to the emergency department (the dependent variable) are more dehydrated (independent variable) than most of the population. As we can never be sure of the hydration status of the entire population at any given time or the standard deviation of the entire population, we can use the normal mean blood urea nitrogen value of 10 mmol/L and assume a normal distribution (Hash et al., 2000).

H0:μ=10: Patients who present to the emergency department are not dehydrated (BUN = 10 mmol/L)
Ha:μ>10: Patients who present to the emergency department are dehydrated (BUN > 10 mmol/L)

Once the random sample of BUN values have been obtained, I can use the t-distribution to find the value of the t-test statistic:

t = (x̄ - μ) / (s / √n)

Next, I would compute the degrees of freedom (it is important to note that the sample size [n] must be greater than 30 as the standard deviation of the population is not known):

DOF = n - 1

As this test is one-tailed (specifically, right-tailed), and I am concerned with a 95% CI, I would compare the t-value with the t-table row indicated by the DOF. If the t-value is greater than the t-value corresponding with the DOF, then I will be able to reject the null hypothesis; otherwise, if the computed t-value is less than the table value, I will not be able to reject the null hypothesis.

References

Hash, R. B., Stephens, J. L., Laurens, M. B., & Vogel, R. L. (2000). The relationship between volume status, hydration, and radiographic findings in the diagnosis of community-acquired pneumonia. Journal of Family Practice, 49(9), 833-837.

Rotstein, C., Evans, G., Born, A., Grossman, R., Light, R. B., Magder, S., … & Zhanel, G. G. (2008). Clinical practice guidelines for hospital-acquired pneumonia and ventilator-associated pneumonia in adults. Canadian Journal of Infectious Diseases & Medical Microbiology, 19(1), 19–53.

Stiell, I. G., Nesbitt, L., Pickett, W., Brisson, D., Banek, J., Field, B, … & Wells, G., for the OPALS Study Group. (2005). OPALS Major Trauma Study: impact of advanced life support on survival and morbidity. Academy of Emergency Medicine, 12(5), 7.

Stiell, I. G., Nesbitt, L., Wells, G. A., Beaudoin, T., Spaite, D. W., Brisson, D., … & Cousineau, D., for the OPALS Study Group. (2003). Multicenter controlled trial to evaluate the impact of ALS on out-of-hospital chest pain patients. Academy of Emergency Medicine, 10(5), 501.

Stiell, I. G., Wells, G. A., Spaite, D. W., Nichol, G., Nesbitt, L., De Maio, V. J., … & Cousineau, D., for the OPALS Study Group. (2002). Multicenter controlled clinical trial to evaluate the impact of advanced life support on out-of-hospital respiratory distress patients. Academy of Emergency Medicine, 9(5), 357.

Stiell, I. G., Wells, G. A., Spaite, D. W., Nichol, G., O’Brien, B., Munkley, D. P., … & Anderson, S., for the OPALS Study Group. (1999). The Ontario Prehospital Advanced Life Support (OPALS) Study Part II: Rationale and methodology for trauma and respiratory distress patients. Annals of Emergency Medicine, 34, 256-262.

Wakefield, B. J., Mentes, J., Holman, J. E., & Culp, K. (2008). Risk factors and outcomes associated with hospital admission for dehydration. Rehabilitation Nursing, 33(6), 233-241. doi:10.1002/j.2048-7940.2008.tb00234.x

The Arby’s Public Relations Failure

Using Research in Planning

Hendrix and Hayes (2010) outlines the typical course of public relations using effective means to address the concerns of all stakeholders while promoting the course as the best option. This is only effective, however, if the course is actually the best option. This is where research becomes important. Public relations depends on research to get a true sense of the stakeholder when considering marketing decisions and how the stakeholder might be affected. This research can be useful in both determining the course of action necessary to move forward and to communicate these decisions to the stakeholder in a manner most effective. Without this research to guide decision-making, a company can easily upset an important segment of stakeholders while intending to be portrayed in a very different light.

The Importance of Social Media

Social media outlets (e.g. Twitter, Facebook, YouTube, et al.) provide a rapid means of communicating with stakeholders. Social media is a useful tool for public relations practitioners to use when addressing concerns of or making assurances to stakeholders (Coombs, 2012; Fearn-Banks, 2011; Hendrix & Hayes, 2010). Lynn Kettleson and Jonathan Bernstein (as cited in Horovitz, 2012), both crisis managers, recommend using social media to quickly assess the public conversation, contribute to the conversation by providing factual and compassionate reassurance, and most importantly, put a corporate face on the response by having a senior executive respond to provide a sense of responsibility to the stakeholders.

Arby’s Social Media Failure

On April 4, 2012, the corporate Twitter account was used to respond to another Twitter account recommending that Arby’s stop advertising on the Rush Limbagh radio show (@Arby’s, 2012). Although Arby’s did not currently advertise on the aforementioned radio show, the response indicated that efforts to “discontinue advertising during this show as soon as possible” are being undertaken. The controversy, however, began when customers replied with their concerns via Twitter. According to The Blaze (Adams, 2012a, 2012b) and Forbes (Walker, 2012), instead of making a public statement regarding the controversy or even addressing the concerns of their customers on Twitter, the customers who complained to the Twitter account were summarily blocked. Walker (2012) decries this action as pathetic, stating “any major corporation […] needs to be able to accept and listen to criticism from customers [….] but using a coercive measure like blocking flies in the face of everything the social media space is supposed to be about” (para. 1).

Just as quickly and quietly as the Twitter accounts of those customers were blocked, they were unblocked (Adams, 2012b). This decision was, again, met with disdain as the company failed to apologize or address the issue publicly.

Arby’s Fails Again

On the heels of the Rush Limbaugh and Twitter controversies, Arby’s, again, finds itself in the midst of a public relations crisis. A month later, A USA Today article (Horovitz, 2012) describes a Michigan teen finding the fingertip of an employee in a sandwich ordered at Arby’s. Though the response from an Arby’s spokesperson was public and included an apology to the teen, it was criticized as being inadequate and potentially harmful to its already damaged reputation. Horovitz (2012) states that no mention of the incident was made on the corporate website, Facebook page, or Twitter feed.

Discussion

The directions of this assignment were to find an incident that was significant or complex enough to require involvement from senior management and, although in both incidents senior management failed to respond publicly and comprehensively, I feel that these two cases did, in fact, require senior management involvement. A rapid response by the public relations team could have addressed the concerns of the company’s apparent political actions towards Rush Limbaugh and reinforce commitments to the customer to provide good and fresh food.

The second controversy could have been addressed quickly by using social media outlets to assure customers that, although food preparation can result in minor accidents for employees, these problems are unusual and every possible step is being taken to ensure the safety of the employees and the safety of the food being served. This would also provide an opportunity to further the corporate image as a caring and compassionate company that understands the importance of a trusting relationship with the customer.

As stated in the opening of this paper, research is important to any public relations program. Tools, such as the survey provided in the appendix, are useful in determining the needs and desires of the various subgroups and demographics of the corporate stakeholders. The data provided by these types of tools can provide direction to future public relations efforts.

References

@Arby’s. (2012, April 4). Response to @StopRush [Twitter post]. Retrieved from https://twitter.com/#!/Arbys

Adams, B. (2012a, April 6). Arby’s responds to annoyed Limbaugh fans by blocking them on Twitter. The Blaze. Retrieved from http://www.theblaze.com/stories/arbys-blocks-twitter-accounts-of-customers-upset-over-limbaugh-announcement/

Adams, B. (2012b, April 9). Backpedal: Arby’s immediately regrets its decision to block customers on Twitter. The Blaze. Retrieved from http://www.theblaze.com/stories/back-peddle-arbys-immediately-regrets-decision-to-block-customers-on-twitter-not-ready/

Coombs, W. T. (2012). Ongoing crisis communication: Planning managing, and responding (3rd ed.). Thousand Oaks, CA: Sage.

Fearn-Banks, K. (2011). Crisis communications: a casebook approach (4th ed.). New York, NY: Routledge.

Hendrix, J. A. & Hayes, D. C. (2010). Public relations cases (8th ed.). Boston, MA: Wadsworth Cengage Learning.

Horovitz, B. (2012, May 17). Finger incident places Arby’s reputation in jeopardy. USA Today. Retrieved from http://www.usatoday.com/money/industries/food/story/2012-05-17/arbys-finger-crisis/55046620/1

Walker, T. J. (2012, April 15). Arby’s makes social media blunder. Forbes. Retrieved from http://www.forbes.com/sites/tjwalker/2012/04/15/arbys-makes-social-media-blunder/

Appendix

Sample customer survey.

1. How often do you eat out at restaurants?

a) very infrequently (less than once per year)

b) annually

c) monthly

d) weekly

e) very frequently (more than once per week)

2. How often do you visit an Arby’s restaurant?

a) very infrequently (less than once per year)

b) annually

c) monthly

d) weekly

e) very frequently (more than once per week)

3. Do you prefer to receive offers from your favorite restaurants?

a) yes

b) no

4. How do you prefer to communicate on the internet (check all that apply)?

a) email

b) websites

c) social media (Twitter, Facebook, etc.)

d) text messaging

e) other: _____________________________

5. In the past year, have you provided a compliment, complaint, or suggestion to any of your favorite restaurants using the internet?

a) yes

b) no

6. How often do you visit the websites of your favorite restaurants?

a) very infrequently (less than once per year)

b) annually

c) monthly

d) weekly

e) very frequently (more than once per week)

7. Do you feel that restaurants can provide meaningful communication to customers using the internet?

a) yes

b) no

8. Are you more likely to visit a restaurant if it was more accessible on the internet?

a) yes

b) no

9. What is most important to you?

a) quality of food

b) price of food

10. Is corporate responsibility to the community and environment important to you?

a) yes

b) no

Crisis as Opportunity

Through the last few weeks, we have explored various means of saving the reputation of an organization in crisis. From reframing arguments to apologizing and promising to making it right, we have many tools at our disposal to turn the conversation in a way that is, at most, beneficial to the organization’s reputation or, at least, less harmful to it. But, what happens when the crisis is so detrimental to the organization’s reputation due solely to flagrant immoral or illegal conduct? Can a crisis communications plan be of any help?

On November 5, 2011, former Penn State assistant football coach Jerry Sandusky was arrested facing 40 counts of criminal activity, including a number of counts of sexual assault on a minor for incidents relating to Penn State’s association with The Second Mile charity, founded by Sandusky, over the course of 15 years (Garcia, 2011; “Sandusky,” 2011). Two days later, Penn State athletic director Tim Curley and senior vice president for finance and business Gary Schultz surrender to police to answer charges for failing to notify authorities for suspicions of sexual abuse of a minor (“Officials,” 2011; “Sandusky,” 2011). In two more days, football legend, Joe Paterno, head coach of the Penn State football program, resigns amidst the controversy surrounding the university and its football program (Garcia, 2011; “Sandusky,” 2011). Within days of the arrests (and, before all the facts are known), the university is being excoriated in the news (Zinser, 2011). This, I believe, constitutes a public relations nightmare.

Trivitt and Yann (2011), of the Public Relations Society of America, present the case of the Penn State crisis as a reminder that public relations and crisis managers cannot fix every problem: “we think it’s important that, as a profession, we don’t overreach and try to uphold our work as the savior for every societal tragedy and crisis. Doing so makes us look opportunistic and foolish considering the gravity of the situation” (para. 13). In the case of Penn State, there were a number of opportunities for the assaults to be reported to the authorities, yet Sandusky was allowed to remain in close unsupervised contact with young boys until, finally, one of the victims contacted the authorities in 2009 and an official investigation was initiated (“Sandusky,” 2011). The best thing that Penn State could have done was to report the accusations to the proper authorities as soon as they were made aware, saving the administration from allegations of a cover-up or their collective morals being called into question (Sudhaman & Holmes, 2012). The perception, now: cover-up and morally corrupt. There were a number of moral obligations that representatives of the university failed to abide over the preceding years, and the reputation of Penn State will suffer for it.

Immediately following the break of the scandal, the Penn State administration scrambled to make appropriate efforts towards repairing the poor reputation of the university, including donating $1.5-million of football profits to sex crimes advocacy programs, suspending the school newspaper’s sex column, and holding a town hall type meeting where students can pose questions and concerns directly to school administrators (Sauer, 2011). Though these steps are good, ultimately, the only means of recovering the reputation that Penn State once held is time and a changing of the guard; however, this does not mean that Penn State is suffering. According to Reuters (Shade, 2011), applications to attend Penn State are up from last year, and the current school administration, as well as alumni, are coming together to strengthen the trust between the school and students. Further, Singer (2011), a crisis communications and reputation management specialist, describes the steps the university can take in the coming years to truly restrengthen its brand. Singer emphasizes <em>cleaning the slate</em> by firing any other employees directly associated with the scandal, <em>creating a team-centric leadership culture</em> by limiting the political power of any one person within the university (especially the head coach), and <em>living the values</em> put forth by the university (e.g. “Success With Honor”). So long as the crisis is handled appropriately since the mass firing of school officials, the school’s reputation will be judged on the response to the crisis and not the crisis alone.

References

Garcia, T. (2011, November 9). Paterno announces retirement, says Penn State has bigger issues to address. PRNewser. Retrieved from http://www.mediabistro.com/prnewser/paterno-announces-retirement-says-penn-state-has-bigger-issues-to-address_b29902

Officials seeking alleged abuse victims. (2011, November 9). ESPN.com. Retrieved from http://espn.go.com/college-football/story/_/id/7203566/penn-state-nittany-lions-sex-abuse-case-officials-arraigned-police-seek-alleged-assault-victim

Sandusky, Penn State case timeline. (2011, November 9). ESPN.com. Retrieved from http://espn.go.com/college-football/story/_/id/7212054/key-dates-penn-state-sex-abuse-case

Sauer, A. (2011, December 1). Penn State bogs down in PR crisis, but a turnaround already showing. brandchannel. Retrieved from http://www.brandchannel.com/home/post/2011/12/01/Penn-State-Bogs-Down-In-PR-Crisis-120111.aspx

Shade, M. (2011, December 1). Penn State officials say applications up despite scandal. Reuters. Retrieved from http://www.reuters.com/article/2011/12/01/us-crime-coach-students-idUSTRE7B00GD20111201

Singer, J. (2011, December 7). The Penn State scandal: crisis as opportunity. The Business of College Sports. Retrieved from http://businessofcollegesports.com/2011/12/07/the-penn-state-scandal-crisis-as-opportunity/

Sudhaman, A. & Holmes, P. (2012, January 25). The top 10 crises Of 2011. The Holmes Report. Retrieved from http://www.holmesreport.com/featurestories-info/11377/The-Top-10-Crises-Of-2011.aspx

Trivitt, K. & Yann A. (2011, November 9). Public relations won’t fix Penn State’s crisis. PRSay. Retrieved from http://prsay.prsa.org/index.php/2011/11/09/public-relations-wont-fix-penn-states-crisis/

Zinser, L. (2011, November 9). Memo to Penn State: Ignoring a scandal doesn’t make it go away. The New York Times. Retrieved from http://www.nytimes.com/2011/11/10/sports/penn-state-fails-a-public-relations-test-leading-off.html?_r=1&ref=sports

Public Relations and the Media

Using a fictitious scenario about an international airline company addressing the media after one of its planes had crashed, I will examine the usefulness and limitations of a crisis communications plan. It is also worthwhile to note that although the messaging is important, the manner in which the message is delivered is also important. Battenberg (2002) lays out a compelling case of which tactics to use and which to abandon when dealing with a media frenzy.

Media Questions

As a member of the media, there are some very specific questions that need to be addressed. For instance, was the crash a result of weather, aircraft maintenance, or was this a terrorism event? In addition, recent layoffs of its mechanics coupled with its aging fleet of aircraft might have contributed to the crash and needs to be addressed. Other employees were laid off in addition to some mechanics. It would be important to know if more experienced members of the flight crew were among the lay offs, as this flight was trans-Atlantic and might require some specialized expertise.

Public Relations Response

According to Coombs (2012) and Fearns-Bank (2011), the response to the media needs to be truthful and humble. The cause of the crash will eventually be determined by the federal investigators, and any assumptions now would be premature. This should be clearly stated to the media along with a statement that every effort to assist in the investigation will be made. In regards to the lay offs, it should be made absolutely clear that, along with our dedication to safety, the lowest performing mechanics and pilots were the ones laid off, keeping the most experienced and skilled mechanics who would never sign off on any unworthy aircraft. An example statement might include: “In our corporate culture of safety, we allow any of our employees to trigger a grounding and complete safety check of any of our aircraft for any reason, even with our recent financial difficulties. If we do not fly safe, then we do not fly.” If the company would ground all similar aircraft for an immediate safety check, it would be helpful to reinforce the ideals of the corporate culture of safety.

Analysis

As the public relations officer addressing these media concerns, I would be sure to answer these questions as humbly and honestly as possible. I would try to rely on the messaging provided in the crisis communication plan. However, in light of recent financial difficulties and layoffs, the plan may prove partially inadequate, though it will provide, at least, a framework to ensure the messaging is consistent (Coombs, 2012; Fearns-Bank, 2011). Obviously, information will be limited as the crash just occurred; however, the concerns of the recent layoffs and service expansion still need to be addressed. Any assurance of safety that is less than matter-of-fact might not be convincing enough to the flying public (Stevens, Malone, & Bailey, 2005). Fortunately, I am able to cite the impeccable safety record and award-winning corporate excellence and customer service. Additionally, other sections of the communication plan, such as messaging involving lay offs and other financial issues, might prove useful to help the public and the media further understand the company’s dedication to safety, ensuring that any problems identified will be quickly rectified (Coombs, 2012; Stevens, Malone, & Bailey, 2005).

Though the position of defending the corporate image in light of tragedy is not an enviable one, a strong and ethical corporation deserves to enjoy business continuity even after such a tragedy (Stevens, Malone, & Bailey, 2005). Having an effective communication plan in place and utilizing the plan in an honest, humble, and transparent manner can promote the corporate image even while suffering crises (Coombs, 2012; Stevens, Malone, & Bailey, 2005).

References

Battenberg, E. (2002, December). Managing a media frenzy. Public Relations Tactics, 9(12), 1, 15. Retrieved from http://library.waldenu.edu/

Coombs, W. T. (2012). Ongoing crisis communication: Planning managing, and responding (3rd ed.). Thousand Oaks, CA: Sage.

Fearn-Banks, K. (2011). Crisis communications: a casebook approach (4th ed). New York, NY: Routledge.

Stephens, K. K., Malone, P. C., & Bailey, C. M. (2005). Communicating with stakeholders during a crisis: Evaluating message strategies. Journal of Business Communication, 42(4), 390-419. doi:10.1177/0021943605279057

Crisis Counseling: Senior Management

As a crisis management professional, it would be my job to assess the situation, define the crisis, and develop a plan that would address stakeholder concerns allowing the company to move forward with, hopefully, minimal negative and maximal positive impact to the organizational reputation (Coombs, 2012). The Intel Pentium flaw did not impact Intel’s reputation in 1994 as much as preceding inattention to quality that modeled consumers’ perceptions and production and marketing irregularities that computing insiders were quite aware (Mihaiu, 2001). Even as recently as last year, Intel has been plagued with poorly performing processors (Fontevecchia, 2011). I believe that many of the processor issues were merely a result of being cutting-edge in a fast-paced competitive environment, though Intel’s reputation need not suffer from inattention to that fact. The problem: convincing the CEO that a) there is a crisis, b) this crisis needs to be dealt with (costing money), and c) it needs to be dealt with openly and ethically in order to maximize the reputation of the company.

Previously, as a computer programmer and analyst, I was intimately familiar with Intel line of processors, and I can attest to the overall positive reputation Intel has enjoyed since moving into the consumer computing arena; however, as stated above, the company’s reputation was not always seen in a positive light. Using my familiarity with Intel, my primary suggestion to the CEO regarding the Pentium debacle would be to remain honest and open with external publics while making the situation right. The honesty of the situation should be accepted by many consumers so long as Intel garners a net positive reputation. This net positive should be reinforced with the professed willingness of correcting the situation. The message should be: “We are on the cutting-edge of computing and consistently push the envelop in leaps and bounds, and we cannot always get everything right, but we can make it right… and, we will!”

The CEO, however, may decide that the situation is minimal and not unlike others that the company has faced in the past. Dealing with these issues previously may have created an air of complacency that needs to be countered in order to prevent further cumulative effect on the reputation of Intel. Regardless, as Coombs (2012) points out, if implementing a crisis management plan “improve[s] the situation and benefit[s] the organization, its stakeholders, or both” (p. 125), the situation should be approached and handled as crisis. The ethical dictum of “do the right thing” should provide for, at least, the fundamental guiding principles in responding to any issue, which would help to ensure that negativity is deflected and minimized appropriately. A CEO who has no appreciation of the gravity of the circumstances may need to be reminded of this in order to prod him into action.

References

Coombs, W. T. (2012). Ongoing crisis communication: planning, managing, and responding. Thousand Oaks, CA: Sage.

Fontevecchia, A. (2011, January 31). Chip recall hurts Intel’s reputation, tablet fears a bigger problem. Forbes. Retrieved from http://www.forbes.com/sites/afontevecchia/2011/01/31/chip-recall-hurts-intels-reputation-tablet-fears-a-bigger-problem/

Mihaiu, R. (2001, July 3). Intel’s tricks! Retrieved from http://mihaiu.name/2001/intel_tricks/

Paying for Health Care, Today and Tomorrow

Before delving into the substance of this discussion, I must say that my personal beliefs are contradictory to many globalized health care efforts. Penner (2005) discusses some benefits of discussing and comparing health care economics between various nations. However, as we combine efforts to target specific health concerns across the globe, we lose the ability to innovate, promote evidence-based discussion, and promote the sovereignty of each country involved in the global effort. This globalization of health care deteriorates the ability to compare and contrast best practices of various countries. Unfortunately, most of the published works promote an insidious form of social justice and do not address how globalization efforts reduce the sovereignty of nations and people. Huynen, Martens, and Hilderdink (2005) support this deterioration by promoting a foundation for a global governance structure that would lead to better dissemination and control of globalization efforts.

Campbell and Gupta (2009) directly compare some claims that the U.K. National Health System (NHS) has worse health outcomes than the traditional U.S. model. Though Campbell and Gupta provide evidence disparaging many of these claims, they also seem to provide some insight as to the woes the NHS has recently faced and are working to correct. Under a system promoted by Huynen, Martens, and Hilderdink (2005), we would ultimately lose the comparison between nations as to best practices. The U.S. is currently debating the value of nationalizing health care, and similar arguments are arising based on the inability for interstate comparisons of effective and efficient delivery of health care among the various states.

References

Campbell, D. & Gupta, G. (2009, August 11). Is public healthcare in the UK as sick as rightwing America claims? The Guardian. Retrieved from http://www.guardian.co.uk/society/2009/aug/11/nhs-sick-healthcare-reform

Huynen, M. M. T. E., Martens, P., & Hilderink, H. B. M. (2005). The health impacts of globalisation: a conceptual framework. Globalization and Health, 1, 1-14. doi:10.1186/1744-8603-1-14

Penner, S. J. (2004). Introduction to health care economics & financial management: fundamental concepts with practical applications. Philadelphia, PA: Lippincott Williams & Wilkins.

Discussing Cost-Effective Analysis

This week I was directed to provide insight to the cost-effective analysis (CEA) provided by Penner (2004) in A Cost-Effective Analysis for Proposed Alternative Interventions to Post-Procedure Surgical Pain Reduction. Within the CEA, three alternative treatments (guided imagery, hypnosis, and biofeedback) are proposed to reduce post-operative pain. The CEA is used to determine the efficiency that each intervention offers comparably to each of the other two alternatives.

I developed a PowerPoint™ presentation [click here] to provide a summation of the CEA and visually present the information for a quick rationalization of the chosen intervention. I will explain each slide of the PowerPoint™ as it pertains to the CEA.

The Cost-Effective Analysis

The CEA provided by Penner (2004) describes the various costs and benefits of using guided imagery, hypnosis, and biofeedback therapies to reduce post-operative pain (as defined on slide #3), which improves the overall healing process. The objective, as noted on slide #2, is the importance of effective pain control. The author of the CEA concedes that all three interventions similarly meet the therapeutic objective of limiting post-operative pain in a safe and low-risk manner; however, the cost differences are significant.

Benefits

As provided in the CEA, the most significant tangible benefits, as mentioned above, are providing effective pain management in a safe, low-risk manner. Additionally, and as a result of reducing pain effectively, increased patient satisfaction, better patient compliance, and overall better healing leads to reduced costs associated with post-operative recovery, such as reduced length of stay and reduced need for post-surgical care (e.g. nursing care, physician care, rehospitalization, medications). Slide #4 of the presentation outlines these similar benefits.

Costs

The costs of each intervention are significant factors in deciding which intervention to promote. Once the annual cost for each intervention if figured, each of the identified costs are distributed across the expected patient volume of 197 and further distributed over the likelihood of each of three surgical procedures (spinal fusion, total hip replacement, and auto hema stem cell transplant) being performed. Though this is largely unnecessary, it does provide perspective for how the costs will be distributed and raise the overall cost for each surgical procedure performed, as shown on slide #8. The total annual cost for each intervention, as well as the per-patient cost, is outlined on slide #5 and graphed on slides #6 and #7.

The fixed costs for guided imagery include a psychology consultant, a surgery PA coordinator, wages for clerical staff, and training for the surgery PA.

The fixed costs for hypnosis includes a psychologist skilled in hypnotherapy and wages for clerical staff. The amount of resources for hypnosis are significantly less than for guided imagery; however, the intervention is more substantial requiring significantly more hours per week paid (12 for hypnosis vs. 2 for guided imagery).

The fixed costs for biofeedback are more equivalent to, though slightly more than, those of guided imagery. Biofeedback requires a psychology consultant, a surgery PA coordinator, wages for clerical staff, and training for the surgery PA, but the fixed costs for biofeedback also include specific equipment, including skin sensors, two video monitors, VCRs, and carts.

The total identified costs for guided imagery is 32.18% less than biofeedback and 64.56% less than hypnosis.

Result

Based on the CEA, the most cost-effective intervention for impacting and controlling post-operative pain on patients undergoing one of the three surgical procedures outlined is guided imagery. This result is stated on slide #10.

Discussion

The appropriate management of pain is crucial to patient care. Assuming that the three interventions investigated are equally effective towards the objective of reducing and controlling pain, the cost of each intervention is the deciding factor when considering which of the three interventions to employ. In this case, guided imagery is the most cost-effective intervention and is the recommended intervention, per the CEA.

It is important to understand that these costs will be borne by not one but three different departments – the pain clinic, the orthopedic surgery department, and the patient education department. This cost-sharing removes the burden of providing the intervention from a single department and disperses the burden over the budgets of three different departments.

References

Penner, S. J. (2004). Introduction to health care economics & financial management: fundamental concepts with practical applications. Philadelphia, PA: Lippincott Williams & Wilkins.