Category Archives: Politics

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

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

Public Relations Terms

Legitimacy and ethical concerns are quite important to the practice of public relations (Hendrix & Hayes, 2010). With some errant developmental forefathers, such as Edward Bernays (1928) and contemporary deviants, such as Saul Alinsky, and self-proclaimed media watch groups, such as the left-wing Center for Media and Democracy’s PRWatch.org, it is increasingly important to understand appropriate use and context for the influences possible with contemporary public relations concepts (Stauber & Rampton, 1999). In this discussion, I will examine and discuss the appropriateness and ethical use of Blackmon’s (2009) three different public relations concepts: press agentry, promotion, and sales and marketing in light of the six provisions of the Public Relations Society of America (PRSA; 2000) Member Code of Ethics: advocacy, honesty, expertise, independence, loyalty, and fairness.

Press Agentry

According to Blackmon (2009), agentry is a tool to increase notoriety for the sake of notoriety and without any other objective or plan. A good example of press agentry is CNN Entertainment’s coverage of Nadya Suleman and her choice of career (Duke, 2012). Suleman is also known publicly as the Octomom. Although the Duke (2012) article expresses her choices as promotion for her new video, the actual article by Duke is borne from press agentry. Considering the PRSA (2000) code of ethics, it appears that Ms. Suleman’s press agent is acting in her best interests and not promoting Ms. Suleman in an unfair way that is not dishonest to the public. The choice of media outlets to cover Ms. Suleman at the behest of her press agent is entertainment journalism and falls outside of the scope of this discussion.

Promotion

Promotion, according to Blackmon (2009), is similar to press agentry, though with some objective or as a means to an end. Frum (2012) fulfills Sony’s promotional wishes by attending an event devoted to promoting electronic entertainment then writing about his findings. Like the Duke (2012) example above, Frum’s coverage is not the subject of the discussion here; however, the promotional event that Frum covers is. I find the pomp of the event likely needed to draw both consumers and journalists. Additionally, the public relations team that advocated for Sony to promote its new games at this heralded event to be in line with the ethics put forth by the PRSA (2000). Sony is putting its products in the public arena for both celebration and scrutiny, equally.

Sales and Marketing

Over the last few years, Sprint (2012) marketed its Simply Everything ™ plan as its premier-tier plan to include unlimited talk, domestic long distance calling, text, data, and roaming. This plan was marketed towards power users who cannot judge their cellular service usage month to month and are willing to pay a premium fee of $99.99 per month for this service. Recently, Sprint decided that network usage was too overwhelming and unilaterally decided to limit consumer phone data usage by implementing limited hotspot plans. A hotspot, in this case, is the ability of a smart phone to act as a wireless router to allow connections from laptops and other network devices to share the phone’s data connection. Initially, there was a single plan costing $29.00 that merely allowed using the phone’s hotspot feature, but they have since decided to even limit the use of the hotspot, specifically, to a set amount of five gigabytes (GB) regardless of the <i>unlimited data</i> included in the Simply Everything ™ plan (Webster, 2011). Sprint has now decided to discontinue the five GB plan and offer a two GB for $19.99/month and a six GB plan for $49.99/month (Tofel, 2012; Welch, 2012). The marketing plan would be within the PRSA’s (2000) code of ethics; however, the recent unilateral decision by Sprint to limit the users’ data usage under the unlimited plan is dishonest, unfair, and is insulting to loyal customers.

Discussion

The PRSA (2000) has chosen not to enforce their code of ethics; however, it does provide a standard to look towards for guidance in judging the ethics of public relations efforts. Public relations efforts that disrespect the consumer are dishonorable and will ultimately be judged by consumer choice. In all three cases above, the efforts are obviously focused at improving the business model of each subject (Ms. Suleman, Sony, and Sprint); however, the public relations effort is focused to an audience and that audience needs to feel some level of respect when receiving the message. Otherwise, the effort will fail.

References

Bernays, E. L. (1928). Propaganda. Retrieved from http://www.historyisaweapon.com/defcon1/bernprop.html

Blackmon, M. (2009). Public relations terms [PowerPoint slides].

Duke, A. (2012, June 5). Octuplets mom Suleman books stripper gigs to save home. CNN Entertainment. Retrieved from http://www.cnn.com/2012/06/04/showbiz/octuplets-mom-stripping/index.html

Frum, L. (2012, June 5). Sony highlights mature games, cross-play at Electronic Entertainment Expo. CNN Tech. Retrieved from http://www.cnn.com/2012/06/05/tech/gaming-gadgets/e3-sony/index.html

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

Public Relations Society of America. (2000). Member code of ethics. Retrieved from http://www.prsa.org/AboutPRSA/Ethics/documents/Code%20of%20Ethics.pdf

Sprint. (2012). Plans: pricing, individual, business. Retrieved from http://www.sprint.com/landings/indirect/sprintplans.pdf

Stauber, J. & Rampton, S. (1999). The father of spin: Edward L. Bernays and the birth of PR [Book review of same title]. PR Watch, 6(2). Retrieved from http://www.prwatch.org/prwissues/1999Q2/bernays.html

Tofel, K. C. (2012. May 22). Sprint bumps per GB price on hotspot plans for phones. GigaOM. Retrieved from http://gigaom.com/mobile/sprint-bumps-per-gb-price-on-hotspot-plans-for-phones/

Webster, S. (2011, September 22). Sprint to cap mobile hotspot plans at 5GB per month in October. CNET. Retrieved from http://www.cnet.com/8301-17918_1-20110106-85/sprint-to-cap-mobile-hotspot-plans-at-5gb-per-month-in-october/

Welch, C. (2012, May 22). Sprint kills 5GB mobile hotspot plan, offers less cost-effective 2GB and 6GB plans to fill void. The Verge. Retrieved from http://www.theverge.com/2012/5/22/3036211/sprint-mobile-hotspot-tethering-plans-updated

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.

Grant Sources: Proposing a New Treatment Program

As grant funding is one of the largest sources of state revenue, it would be remiss for any program administrator facing financial difficulty to not leverage these available funds towards their program (Menifield, 2009). With this in mind, I will create a fictional program and discuss many of the points worthy of mention when completing a grant proposal for such a program, as presented by Markin (2006). The fictional program will provide an opportunity for the criminal justice system to intervene with young offenders during enrollment in the probation program to prevent recidivism.

The Proposal

Statement of the Problem

The juvenile recidivism rate in the State of Connecticut is approximately 33-36% (University of New Haven, 2010). Though the recidivism rate is not counted through the transition from juvenile to adult, it is widely believed that most adult offenders have committed offenses as juveniles (Burnette, 2004). According to Stone (2010), interdicting juvenile offenders at the time of first offense reduces the overall risk of recidivism.

Goals, Objectives, and Performance Measures

Goals of this program should be directly measurable. For one, the immediately obvious goal for this program would be a measurable reduction in juvenile recidivism. Objectives could be relative to benchmarks within the program to show periodic compliance, such as the absence of drug use by participants and evaluation of test scores. Another goal of this program could reduce first adult offenses by juvenile offenders.

Program Design

The development of this juvenile offender outreach program takes into consideration three different evidence-based programs that show promising reductions in juvenile recidivism. The first program is a 12-step program, called Moral Reconation Therapy ® (MRT). According to Burnette et al. (2004), MRT involves reprogramming of the participants’ sense of self, sense of others, attitudes towards risk-taking, and provides a foundation of support and improved moral reasoning. MRT is credited at reducing relative recidivism by 39-60%.

The second program is a mentor program that can be easily integrated with MRT. The mentor component focuses on the importance of vocation and work ethic (Stone, 2009). The vocational mentor program has shown to reduce recidivism by 50-65%.

The third program, a restorative justice mediation program that allows “offenders … to brainstorm with the mediator and the victim on how best to make reparations” (University of New Haven, 2010, para. 3). UNH Associate Professor and Director of the Legal Studies Program Donna Decker Morris (as cited in University of New Haven, 2010) advocates this program and credits the program with 40-45% reductions in recidivism rates.
By integrating all three programs into a single cohesive approach, recidivism rates could be reduced by as much as 90-95%; however, this is an estimate and requires close and frequent assessment.

Organization & Management

Though it is beyond the scope of this fictional presentation, Markin (2006) shows the importance of providing the names and credentials of the professionals who will be working within the program.

Funding

The primary source of funding for programs such as this is grant funding (Menifield, 2009). One grant opportunity, Serving Juvenile Offenders in High-Poverty, High-Crime Communities (SGA-DFA-PY-11-09; U.S. Department of Labor, 2012), focuses on improving the long-term labor market prospects for youths aged 14 and above. This grant is focused towards high-crime, high-poverty areas and, therefore, provides for the opportunity for high impact.

As the program focuses on impacting juveniles and increasing their focus towards vocational contributions towards society and their community, this grant opportunity is appropriate to fund this program.

Discussion

Whether in hard times or easy times, we live in communities and want to contribute to the improvement of society, though most of us do this passively. A program such as the one outlined above can have significant effects at improving society by reducing crime, removing first-time offenders from the criminal justice system, and increasing employability of those offenders thereby decreasing the overall unemployment rate. Programs such as these can have far reaching and immeasurable effects on each member of the community.

Government realizes that it is highly ineffective at controlling local programs and provides grants to states and localities, as well as not-for-profit organizations, to help administer programs that it feels would be beneficial to society as a whole. This process assists states and localities by positively impacting directly the lives of those living within the community.

References

Burnette, K. D., Swan, E. S., Robinson, K. D., Woods-Robinson, M., Robinson, K. D., & Little, G. L. (2004). Treating youthful offenders with Moral Reconation Therapy®: a recidivism and pre- posttest analysis. Cognitive Behavioral Treatment Review, 3, 14-15. Retrieved from http://www.moral-reconation-therapy.com/Resources/Treating%20Youtful%20Offenders.pdf

Markin, K. (2006, September). How to write a proposal for an outreach grant. The Chronicle of Higher Education, 53(4), C1, C4.

Menifield, C. E. (2009). The basics of public budgeting and financial management: a handbook for academics and practitioners. Lanham, MD: University Press of America.

Stone, K. (2009). Vocational mentoring program for youth [Grant proposal]. Retrieved from http://www.jud.ct.gov/recovery_act/Mentoring.pdf

University of New Haven. (2010, January 12). Breaking the cycle of juvenile crime: UNH study shows mediation effective in reducing juvenile recidivism. Retrieved from http://www.newhaven.edu/news-archive/35806/

U. S. Department of Labor, Employment and Training Administration. (2012, April 4). ETA grants. Retrieved from http://www.doleta.gov/grants/find_grants.cfm

Budget Forecasting Models

Forecasting, according to Menifield (2009), is an important component of budget preparation and analysis. Using the Putnam police department (Putnam, CT) as an example, I will show how forecasting can benefit the budget process.

The Putnam police department is a small local department that relies heavily on public support. In order to forecast the economic condition that provide insight to the budgetary needs of the department, I would normally suggest using simple time-series forecast model. Due to the wavering economy over the last few years, however, I would start to consider using a multiple regression model that could take into account decreases in property taxes, real inflation, and the poor business environment for many of the small businesses that contribute a sizable portion of the tax base (Spencer, 2009). Menifield (2009) suggests that many localities can get by using the simpler, non-multivariate analysis, though as I point out, economic trends should be considered, lately.

The Putnam police department has annual purchases very typical of other similar sized departments and the single capital program (for the K-9 division) is being paid for by grants and donations. It is these donations that promote the need for additional fiscal responsibility; the public may be less willing in the future to offset major purchases through donations if property taxes rise significantly.

References

Menifield, C. E. (2009). The basics of public budgeting and financial management: a handbook for academics and practitioners. Lanham, MD: University Press of America.

Spencer, M. (2009, January 5). Current economic situation vs. the Great Depression: Striking comparisons with the current economic situation to the Great Depression. WTVY.com. Retrieved from http://www.wtvy.com/home/headlines/29813759.html

Government Budgets

Every line item of a government budget must be an expenditure necessary to achieving the goals of the organization (Menifield, 2009). The governmental budgetary process provides transparency to the economic demands of the organization allowing for oversight by the people directly and by committees of elected officials dedicated to fiscal responsibility. It is this fiscal responsibility that ensures government spending is controlled and necessary for the purposes of government.

As Menifield (2009) points out, there are four dominant areas of concern, typically, when addressing governmental impact: political, tax, demographic, and administrative. Within each of these areas of concerns, aspects of efficiency, effectiveness, and equity must be addressed. While political concerns are more about the soundness of the overall plan, other concerns are more focused on specific aspects of the plan, such as who will be impacted and how

The budget process is the government’s means of allocating funds to departments within its jurisdiction in order to perform efficiently and effectively. The transparency of this process allows the people to offer criticism and promote their values and views on the process. This is important to ensure that people understand the necessity of each expenditure.

Though there are few people that pay attention to every aspect of the budget process, there are programs, usually expensive ones, that empassion people towards action in the way of participation in the process. Politicians should envision and anticipate many of the questions and concerns that the public might have for any program that they are seeking to funding. By being prepared, politicians will serve their constituency well by allaying fears and providing information.

References

Menifield, C. E. (2009). The basics of public budgeting and financial management: A handbook for academics and practitioners. Lanham, MD: University Press of America.

Political and Technical Budget Strategies

When preparing an agency or department budget, two strategies may be employed, usually in combination: political budgeting and technical budgeting (Menifield, 2009). While most budgets are defended politically, the technical budgeting stategy is most useful when defending mandatory and base expenditures of a legally mandated service, such as a police or fire department (Menifield, 2009). New programs, especially those viewed largely as ancillary, or “nice to have,” would be largely defended using a more polital than technical strategy.

Menifield (2009) explains the technical budgeting strategy as “[concentrating] on the numbers or budgetary facts [and] split into two categories: mandatory, [sic] and discretionary spending” (p. 43) with base expenditures “to maintain the same level of service” (p. 44) identified for each. Efficiency and productivity are foci of the technical budgeting strategy. The political budgeting strategy, according to Menifield (2009), is used to “sell” a program based more on its merits or public demand than on mandate or efficiency and productivity.

In the emergency medical services, since its provision is usually not a legal requirement of the government, it would make sense to defend the budget politically if the service was started within the last few years; however, a more technical budget in continuing years might help to buttress the perceptions of the public that it is actually a needed service. Continuing to defend an emergency medical services budget with a more political strategy could make it actually appear less important and subject to tighter budget controls. Additionally, as the emergency medical service is the only public safety entity that routinely charges user fees, the structure of a technical budget would plainly show revenue offsetting expenditures, making it less likely to suffer cuts. Again, both strategies would be used proportionally to their need.

References

Menifield, C. E. (2009). The basics of public budgeting and financial management: A handbook for academics and practitioners. Lanham, MD: University Press of America.

Mind Your Own Business: Health Care Economics

Regardless of funding levels or overhead, health care must be provided ethically. The goal of the health care industry is to improve health, and unlike other industries, this market is driven not by choice but by need. Other markets perform, according to Friedman and Friedman (1980) and Smith (1910), only when mutual benefit can be achieved, that is, without external force, coercion, or unnatural limitation. Penner (2004) presents the economy of health care representative of many of the ideals that were accepted at the turn of this century. However, the current state of health care economics is the result of the unnatural force of these ideals in attempting to mold the market against natural market pressures, as described in detail and warned against by Friedman and Friedman and Smith.

Health care demand is based on need. Within that need, demand is reflective of pricing. For example, patients do not elect coronary bypass surgery, but if needed, the demand could be reflected by pricing constraints realized in negotiations of hospitals and insurance carriers. In this case, the patient may be transferred to a center that has negotiated reduced rates with the carrier for coronary bypass procedures. Ergo, health care demand is reflective of patient need and is variable only in the context of insurance pricing. It is within this negotiation that the aspects of quality, access, and cost are accounted. Government policy, however, has a negative and downward effect on these negotiations. If health care institutions are perceived to be able to provide the same services at discounted prices for government payors, then the institution should be able to provide these same services to private payors for the same or similar cost. This cost adjustment conversely affects quality and access.

Penner (2004) makes a logically flawed argument in respect to regulation arguing that increases in skilled nursing facility (SNF) safety regulations created a demand for more nursing assistants; however, this is an increased input to be provided by the SNF, not an output to be demanded by the patient. The cost will be borne by the private insurance payor, ultimately, and not the regulatory agency or the patient, which increases premiums decreasing access to private health insurance. Regulations negatively impact the relationship between supply/demand, quality, access, and cost. This is not to say that safety should not be a concern, as it is one of the few areas that I agree should be regulated, though, minimally.

Penner (2004) goes on to state “one role of government is to intervene in cases of market failure” (p. 21), using the pharmaceutical industry as an example. Unfortunately, with the focus on the new and significant health care and health insurance legislation and regulation, many academic discussions surrounding health care economics are now outdated and trivial. Without entertaining a constitutional debate, recently, governmental involvement has shown to have a negative effect on the health care industry actually causing market failures instead of alleviating them. Recent over-regulation by government on the pharmaceutical industry has resulted in a significant and dangerous shortage of life-saving emergency medications (Malcolm, 2012). This economic constraint will lead to higher demands of other, inferior, medications and increase the price, effectually increasing cost and decreasing both access and quality. This effect is also seen in the emergency medical services when states fix the price that can charged to users leaving the municipal taxpayer to face tax increases or decreases in access to emergency services and the quality of the services delivered (American Ambulance Association, 2008). Over-regulating an industry without regard to survivability is inefficient and unethical, limiting access and quality while increasing costs.

Insurance companies have sought to minimize their exposure to the rising costs of health care (Penner, 2004). By developing common sense incentives, insurers can advocate for their customers financially while expressing desire for optimal outcomes. By maximizing consumer and provider choice, these incentives can be used as natural pressures within the market to improve upon cost, quality, and access (Penner, 2004). This realization, according to Penner (2004), resulted in the emergence of the health maintenance organization (HMO) — the first widely accepted form of managed care. Unfortunately, HMOs faced scrutiny in the 1990’s and later augmented business models to reflect newer preferred provider organizations (PPO) and point-of-service (POS) plans. PPO and POS plans were created to promote the more inexpensive use of general providers and those providers that have negotiated fees. Unfortunately, Penner writes, the pressures of these PPO and POS plans on the consumer limit choice within the market; however, the consumer still has a choice of insurance carrier, which minimizes the pressure faced within each plan. This freedom is not expressed in governmental plans, such as Medicare and Medicaid.

As health care costs rise, the writings of Friedman and Friedman (1980) and Smith (1910) would suppose that we lessen regulation within the industry, allow new and novel approaches to insurance paradigms, and create an environment with as little unnatural market pressures as possible in order to allow natural market pressures to ensure equitable cost, access, and quality through competition

References

American Ambulance Association. (2008). EMS structured for quality: Best practices in designing, managing and contracting for emergency ambulance service. Retrieved from fitchassoc.com/download/Guidebook-April08-V2.pdf

Friedman, M. & Friedman, R. D. (1980). Free to choose: a personal statement. Retrieved from http://books.google.com/

Malcolm, A. (2012, January 4). Vast web of federal regulation causing drug shortages. Investor’s Business Daily. Retrieved from http://news.investors.com/article/596775/201201041859/big-government-behind-drug-shortages.htm

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

Smith, A. (1910/1957). The wealth of nations (Vol. 1). Retrieved from http://books.google.com/