Category Archives: Public Health

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.

 

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

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.

Impact of Technology: Social Media and Cyberbullying

The advent of the internet and social media allows like minded people to easily seek each other out and share their ideas. As I see a growing trend towards anti-sematism not unlike that of the 1930’s, I begin to draw parallels to that time and imagine sociopolitical paths of the likes we never want to tread. It was for this reason and others that I made a simple post on Facebook and Twitter reading “I support Israel.” This proclamation was made to let my Jewish friends know in no uncertain terms that I would never sway towards anti-Jewish sentiment, and it also made my other friends aware that I would not support them if they should harbor such feelings. There is inherent freedom in the idea of free-flowing information; however, this freedom also comes with responsibility. The same technology that promotes freedom also simplifies efforts to conspire against ideas, governments, and sometimes individuals. It is this conspiracy against individuals that has piqued my interest. The use of the internet (and, other technology, such as cell phones) to conspire against individuals can be seen in the act of cyberbullying.

Cyberbullying, according to Bill Belsey, the award winning author of the bullying.org website “involves the use of information and communication technologies such as email, cell phone and pager text messages, instant messaging, defamatory personal Web sites, and defamatory online personal polling Web sites, to support deliberate, repeated, and hostile behavior by an individual or group, that is intended to harm others” (as cited in Li, 2007, p. 1779). Li (2010) goes further to include “exclusion” to this list. Exclusion is the specific and intentional exclusion of an individual from an online group. Further, Li (2007) hypothesizes that internet users are socially isolated and inept. This is certainly not the case. Li also discusses demographic differences in both victims and bullies, but the evidence from other studies prove confounding to any hypothesis regarding specific demographics (Schneider et al., 2011; Slonje & Smith, 2008; Smith et al., 2008; Smith, Mahdavi, Carvalho, & Tippett, 2006). Children do not seem either savvy enough or willing enough to block these communications as they happen (Smith et al., 2008). Further, children and adolescents are not emotionally stable enough to make this type of rational decision when confronted with cyberbullying; however, they also do not seem prepared to become emotionally stable enough to deal with typical adolescent musings when they become persistent, such as rumors posted to a website.

There is a real problem with social media and cyberbullying, but we need to call it as it is: bullying. By attaching the prefix cyber- to the act, we acknowledge the sophistication needed to perpetrate this type of bullying, which might egotize the bully. Most communities respond to cyberbullying by focusing on the technology used to perpetrate the bullying; however, it is more important to focus on the motivations and the social intolerances involved in bullying in general. By losing sight of the cause and focusing on the vehicle, no one will be able to overcome this problem, which is inherent, though sometimes magnified, in normal social adjustment and development of children and adolescents. Communities that wish to address cyberbullying would do well to educate the students about social responsibility, the rights and responsibilities of civic duty, and the different levels of appropriateness of various forms of communication.

References

Li, Q. (2007). New bottle but old wine: A research of cyberbullying in schools. Computers in Human Behavior, 23(4), 1777-1791. doi:10.1016/j.chb.2005.10.005

Li, Q. (2010). Cyberbullying in high schools: A study of students’ behaviors and beliefs about this new phenomenon. Journal of Aggression, Maltreatment, and Trauma, 19(4), 372-392. doi:10.1080/10926771003788979

Schneider, S. K., O’Donnell, L., Stueve, A., & Coulter, R. W. S. (2011). Cyberbullying, school bullying, and psychological distress: A regional census of high school students. American Journal of Public Health. Advance online publication. doi:10.2105/AJPH.2011.300308

Slonje, R. & Smith, P. K. (2008). Cyberbullying: Another main type of bullying? Scandinavian Journal of Psychology, 49(2), 147–154. doi:10.1111/j.1467-9450.2007.00611.x

Smith, P. K., Mahdavi, J., Carvalho, M., Fisher, S., Russell, S., & Tippett, N. (2008). Cyberbullying: its nature and impact in secondary school pupils. Journal of Child Psychology and Psychiatry, 49(4), 376–385. doi:10.1111/j.1469-7610.2007.01846.x

Smith, P. K., Mahdavi, J., Carvalho, M., & Tippett, N. (2006, July). An investigation into cyberbullying, its forms, awareness and impact, and the relationship between age and gender in cyberbullying (Report to the Anti-Bullying Alliance, Brief No. RBX03-06). Retrieved from https://www.education.gov.uk/publications/eOrderingDownload/RBX03-06.pdf

Coordinated Community Response to Special Populations

Being a victim of crime, especially a crime of a violent nature, one suddenly finds his or her self in a state of personal emergency that requires finely developed coping mechanisms in order to rationalize the situation. In addition to the need of a sound mind, a sound body is required in order to defend one’s self from harm in all but the most benign cases (Roberts & Yeager, 2009). The elderly population is characterized as having the predisposition of declining mental acuity as well as declining health and increasing frailty, as many of the elderly have disabilities related to their advanced development (Heisler, 2007). It could be stated that the elderly make for the perfect victim. However valid this statement may or may not be, it stands to reason that the elderly are at risk for being taken advantage of, at risk of injury from others, and at risk for both emotional and physical decline due to unwarranted stress (Heisler, 2007).

Elder abuse, which includes physical abuse, sexual abuse, emotional/psychological abuse, financial and material exploitation, neglect, and abandonment, “is being recognized as a … complex societal problem” (Heisler, 2007, p. 161). Heisler (2007) states that “in physical abuse cases, men are usually the abusers” (p. 169), yet it stated that men only account for 53% of the abuse, which is much closer to ‘half’ than ‘usually’, so it seems that both men and women are just as likely to abuse. The National Center on Elder Abuse (as cited in Heisler, 2007) also describes “self-neglect” as a type of abuse; however, this appears to fall under neglect and abandonment. Elder self-neglect should not be treated as a crime but should be addressed with the elder’s emotional and psychological well-being in mind.

The elderly are a vulnerable population due to their complex and specific needs and tend not to report abuse for fear of losing their support structure and further undermining their independence. According to Acierno et al. (2010), Podnieks (as cited in Heisler, 2007) and Wolf (as cited in Heisler, 2007), the one-year prevalence of elder abuse appears to fall between 4-5.6%, though the exact numbers have been difficult to quantify. It is this difficulty in identifying the abuse accurately that creates difficulty in responding to the crime. It is for this reason that every state and Washington, D.C., has enacted legislation that mandates the reporting of suspected elderly abuse by certain authorities (e.g. doctors, nurses, police, EMS, social workers, et al.).

In order to further develop coordinated community responses to elderly abuse, we must further understand the prevalence and intricacies of the abuse and its particular effects on the victims. It is imperative to bolster social support with prevention initiatives in order to address the prevalence of elder abuse in all of its forms.

References
Acierno, R., Hernandez, M. A., Amstadter, A. B., Resnick, H. S., Steve, K., Muzzy, W., & Kilpatrick, D. G. (2010). Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: The national elder mistreatment study. American Journal of Public Health, 100(2), 292-297. doi:10.2105/AJPH.2009.163089

Heisler, C. J. (2007). Elder abuse. In R. C. Davis, A. J. Lurigio, & S. Herman (Eds.), Victims of crime (3rd ed.; pp. 161-188). Thousand Oaks, CA: Sage.

Roberts, A. R. & Yeager, K. R. (2009). Pocket guide to crisis intervention. New York, NY: Oxford University Press.

Coordinated Community Response – Terrorism, Hate Crimes

In a previous paper, I describe a coordinated community response to individual crime; however, when considering terrorism and, to some degree, hate crimes, we need to understand the more comprehensive needs of effected communities more so than the individual, yet, we still need to address individual needs (Schadone, 2011). According to a U.S. Department of Justice (2000) report on responding to victim needs after a terror event, comprehensive victim assistance centers should be centralized for ease of identification and resource management. This report acknowledges victims, family, and responders as potential users of victim assistance resources.

Coordinated community response programs should also be comprehensive and modular in order to provide services during normal day-to-day operations and to be able to coordinate for larger undertakings, such as those in the wake of large-scale emergencies. The U.S. Department of Justice (2000) report recommends being mindful of victim rights and including victim services representatives in planning, ensuring timely death notifications to family of the deceased, creating centralized centers to provide information, crisis counseling, and privacy, planning for transitioning short-term mental health counseling to long-term mental health care, streamlining victim compensation programs, organizing committees to ensure that unmet needs are identified with provisions of responding to these needs are created, creating an emergency fund for immediate payment for resources or victim compensation when other directed funds are inadequate or delayed, and creating processes for recruiting and preparing volunteers to assist in response efforts.

According to Roberts and Yeager (2009), crisis intervention counselors should take some specific steps in counseling individual victims of large-scale events. Initially, triage and remove victims from the scene as soon as possible to limit exposure to the aftermath of the event, considering the breadth of possible injuries and always taking into account the potential for responders’ needs following their exposure. Next, victims should be assessed medically to ensure that all physical health needs are identified and addressed, including their level of responsiveness, both in general and in light of the recent trauma. At this phase of the response, crisis counselors could assist other responders by obtaining demographic information (i.e. name, address, phone numbers, next of kin, medical history, current medications, and allergies) of victims being prepared for treatment and transport. Talking to and reassuring victims in a general sense would also be helpful by connecting to the victim on a personal level and establishing a rapport, acknowledging the victim’s concerns, and grounding the individual while ensuring that he or she knows that he or she is now safe. Further into the response, provide directed support to victims while allowing them to express their ordeals while providing them opportunities to acknowledge the reality of the situation. Some may benefit by providing assistance to other victims while others may require lengthy counseling sessions in order to move forward.

Any coordinated community response for large-scale incidents need to focus on health and safety, mental health, financial health, and the preservation of rights during the response. These coordinated community response programs should be comprehensive and modular while both giving and receiving assistance to and from state and federal victim assistance programs that might also be effective during the immediate aftermath of the event.

References
Roberts, A. R. & Yeager, K. R. (2009). Pocket guide to crisis intervention. New York, NY: Oxford University Press.

Schadone, M. (2011, November 6). Coordinated community response to crime. Unpublished Manuscript. Walden University, Minneapolis, MN.

U.S. Department of Justice, Office of Justice Programs. (2010, October). Responding to terrorism victims: Oklahoma City and beyond. Retrieved from http://www.ojp.usdoj.gov/ ovc/publications/infores/respterrorism/welcome.html

Human Resources & Challenges in Health Care

The function of human resources is not without its challenges and difficulties. No matter the industry or organization, acquiring and managing a pool of employees can be overwhelming (Thompson, 2012). Human resources managers in health care organizations seem to face more challenges than most. From nursing and physician shortages to attracting innovative and contemporary researchers, health care organizations seem to search within thinning pools of prospective employees, yet still demand the best and brightest (Keenan, 2003; Lewis, 2010; Thompson, 2012).

One of the most challenging issues to health care over the last few decades has been a significant nationwide nursing shortage (Keenan, 2003; Lewis, 2010). Thompson (2012) outlines both a declining skilled workforce and an increasing population contributing to the problem. Both Keenan (2003) and Lewis (2010) cite the aging babyboomer population adding to the increased need for nurses through 2020 and beyond. Novel human resources strategies can result in an augmented workforce designed to meet the continually growing impact these forces have on health care organizations, specifically those with emergency departments.

One novel strategy includes consideration of other highly-skilled clinicians that do not traditionally work in hospitals. As Oglesby (2007) considers the possibility, paramedics are, by far, one of the best examples. By introducing paramedics into the emergency department, a hospital can redistribute the nurses to clinical areas more suited towards their training, decrease the patient-to-nurse ratios (thereby increasing patient safety and maximizing outcomes), and tap into a new pool of prospective employees that are well-suited to rise to the stressful demands of the emergency department (Keenan, 2003; Swain, Hoyle, & Long, 2010). Additionally, organizations employing paramedics can augment both their emergency department operations and home health care operations by sending paramedics to certain patients to mitigate their complaints and minimize the number of inappropriate patient transports to the emergency department (Swain, Hoyle, & Long, 2010). This alone would decrease emergency department overcrowding and maximize revenue and efficiency in the delivery of care. Additionally, turn-over rates should be significantly lower with a more productive work environment where stress is managed, outcomes are met, and patients are care for more effectively.

In conclusion, intelligent and novel planning of the workforce can, itself, lead to increases in recruitment and retention; however, efforts still need to focus on each individually in order to attract, maintain, and develop a first-class workforce (Thompson, 2012).

References

Keenan, P. (2003). The nursing workforce shortage: causes, consequences, proposed solutions (Issue brief #619). The Commonwealth Fund. Retrieved from http://mobile.commonwealthfund.org/

Lewis, L. (2010). Oregon takes the lead in addressing the nursing shortage: A collaborative effort to recruit and educate nurses. American Journal of Nursing, 110(3), 51-54. doi:10.1097/01.NAJ.0000368955.26377.e1

Oglesby, R. (2007). Recruitment and retention benefits of EMT—Paramedic utilization during ED nursing shortages. Journal of Emergency Nursing, 33(1), 21-25. doi:10.1016/j.jen.2006.10.009

Swain, A. H., Hoyle, S. R., & Long, A. W. (2010). The changing face of prehospital care in New Zealand: the role of extended care paramedics. Journal of the New Zealand Medical Association, 123(1309), 11-14. Retrieved from http://journal.nzma.org.nz/

Thompson, J. M. (2012). The strategic management of human resources. In S. B. Buckbinder & N. H. Shanks, Introduction to Healthcare Management (Custom ed.; pp. 81-118). Sudbury, MA: Jones & Bartlett.

Prior Proper Planning …

… Prevents Poor Performance

I am in the midst of planning an ad hoc merger of a number of local emergency medical service agencies into a single regional provider to reduce overall costs while maximizing revenue, improve training and the delivery of care, and to streamline the operational processes that support our providers in the field. Unfortunately, I have found that there are many obstacles that need to be dealt with at every step before moving on to the next. My research has certainly opened my eyes to developing a useful approach to these problems.

Planning “[provides] the appropriate focus and direction for … organizations” (Zuckerman, 2006, p. 3). Without planning, organizations risk stagnation and obsolescence. For any organization to succeed (and continue to do so), the strategy needs to focus both on the contemporary traditional needs as well as those anticipated in the future, but this focus needs to be comprehensive. Bartling (1997) writes of 25 different pitfalls any health care organization might face when considering strategic planning. These 25 pitfalls are just some of the issues I hope to avoid.

One of the largest difficulties in planning for emergency medical systems, however, is the sense of ‘fiefdom’, or an assertion of organizational ownership — in a truly feudal sense. A fiefdom is a literal power trip. In this area, there are 10 towns with an average of two ambulances each, and each department’s administration will fight tooth and nail to keep the organization from outgrowing them. What is interesting about the area is that many of the members of one department work for at least two of the other departments, also. This is because the pay is so meager they have to work as many hours as possible, and there is no chance of working more than 32 hours at any one service in any given week. The pay is low as is the quality of care. This needs to change, but how do I create an amalgumated organization from the bits and pieces that I have to work with? Add to that my lack of formal authority in this process. My vision is to reduce the number of ambulances by staffing eight ambulances at all times and tactically positioning them around the region. This alone would create 48 well-paid jobs, using the same 40 people who currently job share across organizational lines.

In reviewing the available resources, I have learned that there is no particular process or flow-chart pathway to effective planning (Bartling, 1997; Begun & Kaissi, 2005; Zuckerman, 2006). Critical forward thinking is needed, instead. Some of the particular issues that Bartling (1997) discusses and I foresee might be particular to my planning process are: inadequate planning, short-sightedness, underestimating the complexity of the process, post-merger angst, analysis paralysis, and lack of evaluative criteria, to name a few. Politics plays a large role in many of these issues I mention.

Inadequate planning, short-sightedness, and a lack of evaluative criteria are closely related. I see in the present that the system does not work as well as it should (short-sightedness), and I want to develop a plan that can be implemented immediately (probably suffering inadequate planning). This would leave me with a fragmented system devoid of vision and, therefore, crippled from improving (lacking that evaluative criteria). These are pitfalls that I need to avoid. These issues would give rise to the others dooming my effort to failure and, possibly, leaving the system in even worse shape than it began.

Perhaps, my only chance of fulfilling this process is to first perform a limited situational assessment by identifying the mission, vision, and values of all of the stakeholders and show how a streamlined process can better fulfill their visions (Casciani, 2012). By gaining stakeholder support, I might better leverage my idea against those who fear change.

References

Bartling, A. (1997). 25 pitfalls of strategic planning. Healthcare Executive, 12(5), 20–23.

Begun, J. & Kaissi, A. (2005). An exploratory study of healthcare strategic planning in two metropolitan areas. Journal of Healthcare Management, 50(4), 264–274.

Casciani, S. J. (2012). Strategic planning. In S. B. Buckbinder & N. H. Shanks (Eds.), Introduction to healthcare management (Custom ed.; pp. 3-23). Sudbury, MA: Jones & Bartlett.

Zuckerman, A. (2006). Advancing the state of the art in healthcare strategic planning. Frontiers of Health Services Management, 23(2), 3–15.

Self-Assessment: Finding My Niche

 Combining the business-sense with the altruistic nature of health care, a health care manager is truly unique in focus. Some of the virtues and qualities a health care manager must posses for a long and rewarding career include a high sense integrity and of one’s self, emotional intelligence, the ability to think critically and globally, and must be equitable and just to both colleagues and clients, customers, and patients (Buchbinder, Shanks, & McConnell, 2012; Buchbinder & Thompson, 2010a).

A qualitative self-administered inventory instrument, presented by Buchbinder and Thompson (2010b), provides some insight into the qualities and virtues useful and, perhaps at times, necessary to pursue a management career in health care. The instrument, designed in Likert fashion, presents quality statements with which the subject is to agree or disagree, whether strongly or not (Likert, 1932). Although this instrument is based on the authors’ opinion, albeit expert, and there is no scoring mechanism recommended aside from high is better than low, I performed the inventory as a self-assessment to help identify some of my strengths and weaknesses (Buchbinder & Thompson, 2010a). The scoring was performed by assigning values to the the statements: 5 for strongly agree, 4 for agree, 2 for disagree, and 1 for strongly disagree, and dividing the sum of the answers scored by the median neutral value of 3 (Garland, 1991; Likert, 1932).

My score using the instrument was 153 out of 180 (85.00%). According to Buchbinder and Thompson (2010a), I possess more skills than not for a management career in health care. The lack of import placed on time management and project management seem to be two of my weaknesses, according to the instrument; although without further scrutiny, it is hard to tell if these particular items may actually suggest otherwise (Buchbinder & Thompson, 2010b; Clason & Dormody, 1994). The instrument helped to identify my critical thinking skills and my communication skills as strengths that would be useful in a health care management career (Buchbinder & Thompson, 2010b). It also showed that I have a strong ethical focus on integrity and equity.

Qualitative self-assessment instruments, such as the one developed by Buchbinder and Thompson (2010b), allow the subject insight as to the appropriateness of something like a career choice or lifestyle. Being honest with one’s self in using these self-assessment tools will also help to inform the subject of characteristics in need of cultivation.

References

Buchbinder, S. B., Shanks, N. H., & McConnell, C. R. (2012). Introduction to healthcare management (Laureate Education, Inc., Custom ed.). Sudbury, MA: Jones and Bartlett.

Buchbinder, S. B. & Thompson, J. M. (2010a). Career opportunities in health care management: Perspectives in the field. Sudbury, MA: Jones and Bartlett.

Buchbinder, S. B. & Thompson, J. M. (2010b). Healthcare management talent quotient quiz. Career opportunities in health care management: Perspectives in the field (pp. 5-7). Sudbury, MA: Jones and Bartlett.

Clason, D. L. & Dormody, T. J. (1994). Analyzing data measured by individual Likert-type items. Journal of Agricultural Education, 35(4), 31-35. doi:10.5032/jae.1994.04031

Garland, R. (1991). The mid-point on a rating scale: Is it desirable? Marketing Bulletin, 2, 66-70. Retrieved from http://marketing-bulletin.massey.ac.nz/V2/MB_V2_N3_Garland.pdf

Likert, R. (1932). A technique for the measurement of attitudes. Archives of Psychology, 22(140), 1–55.