Breaking Down the Silos

So there I was, watching Sesame Street with my son as fluffy characters talked about Co--Op--Er--Ation! Still being a kid at heart, but an old paramedic, I sensed some wisdom here. But how does Sesame Street apply to EMS? We can learn a lot from children by observing how they interact, how they play and how they cooperate. As we go about our business of saving lives, we must cooperate, break out of our silos and overcome territorial attitudes. This article discusses some of these concepts and presents a case study of cooperative success.

In 1966, Morton Grodzins and Daniel J. Elazar described complex governmental interaction using a "marble cake" analogy. This model demonstrates that cooperative relations result in an intermingling of activities, much like light and dark batter intermingle in a marble cake. While this may help us understand the actions of some agencies, this is an overly simplistic view and does not take into account the "silos" that many agencies operate in. For someone who grew up in rural west Texas wheat country, the silo imagery is very familiar. Perhaps for the more tactical-minded folks, think missile silo.

Unfortunately, we sometimes see a marked lack of cooperation in EMS or public safety. Organizations have a tendency to be territorial or operate within their own silos, especially when dealing with a business competitor. In our world, multiple agencies interact on many emergencies. We have a definitive need to cooperate for the patient's best welfare, but too often agencies are backbiting, arguing, and some are even coming to blows on scene! How do we break down these silos, turn competition into "coopetition" and improve our collective EMS systems for better patient care? Competition and isolationism are not restricted to rival EMS agencies. We see these manifested between fire and EMS, law enforcement and EMS, or in any combination.

Interagency Cooperation

As EMS providers, how many times have you been scolded or strongly told to move your ambulance out of the way? Law enforcement folks, how many times have you been frustrated with crime scene compromise or inability to complete tasks while patients are being cared for?

Following is a short case study on interoperative cooperation between agencies and the success they have had breaking out of silos.

My friends at San Antonio AirLife have taken a few steps to foster "coopetition." AirLife works in conjunction with a tremendous interagency cooperative organization known as the Southwest Texas Regional Advisory Council for Trauma (STRAC). STRAC has become a premier organization and opportunity center to bring agencies together.

AirLife covers a large service area roughly the size of Iraq. They deal with many entities and face the same challenges any other EMS or flight service faces. How do they get along? It takes work.

One way is by sponsoring a Customer Advisory Panel. Leaders from agencies within the service area come together to advise AirLife how they can do things better or how they have done things right. This is a two-way dialogue. AirLife provides feedback to EMS agencies as well. The key is information-sharing among entities. Responders get out of their collective silos and talk.

San Antonio is a large city with busy air traffic, both civilian and military. Every April, AirLife participates in an area operators meeting called "Safer Skies," where representatives from law enforcement, media, fire, military and civilian organizations come together to discuss issues pertinent to all who fly in the San Antonio area. What a great concept! How many helicopters were at your last major incident? Large municipalities can have multiple air medical, police and news helicopters at a single event, so it pays to cooperate and communicate.

For regional matters that involve multiple agencies and organizations, STRAC has created several committees and subcommittees that foster communication and cooperation. Here are a few examples: