The third busiest 9-1-1 provider in the state of Missouri is Christian Hospital Emergency Medical Services (CHEMS), which provides 9-1-1 and inter-facility transportation to the St. Louis metropolitan area, serving more 250,000 people and responding to approximately 46,000 calls annually.
But go beyond call volume to everything else CHEMS is involved in and it’s hard to fathom how any agency is busier. Whether its launching a successful mobile integrated healthcare (MIH) program this year, partnering with other organizations on a number of research projects, promoting a variety of community education campaigns, or making it easier for employees to further their education and improve their wellness, CHEMS is expanding the scope of what EMS means throughout the communities it serves.
CHEMS’ fleet consists of 22 ambulances and two command/triage vehicles staffed by 80 full-time first responders and 40 on-call responders. In addition, there are eight full-time dispatchers providing services for CHEMS and Alton Memorial EMS. But that’s just a snapshot of what CHEMS is. According to Chief of EMS Chris Cebollero, CHEMS is leading the way in hospital-based mobile integrated healthcare.
“There are a number of different programs in action presently,” Cebollero says. “The Community Health Access Program (CHAP) is dedicated to improving the overall health and wellness of our community. We work with patients who utilize EMS and the ER for non-medical emergencies. Using the Omega designation of the priority dispatch system, we not only send a responding unit but also an advanced practice paramedic (APP) to the same call. Patients receive a full medical screen and at that time the determination is made if a medical emergency exists. If a medical emergency does exist the patient will go to the hospital as normal. If a medical emergency does not exist the APP, in coordination with the patient, will choose one of several options,” all of which are designed to keep the patient out of the hospital and connect them with a primary care physician (PCP).
“To date we have decreased EMS non-emergent volume by 11% and ER non-emergent volume by 11%,” says Cebollero. “More impressively, we have assisted 52 patients with finding their very own PCP since our February 3, 2014 implementation.”
Other CHEMS MIH programs include its High Utilizer Program, Length of Stay (LOS) Program and Accountable Care Organization (ACO) Program, all aimed toward reducing hospital visits and stays, and saving money. Since the February 3 implementation of the High Utilizer Program, for instance, high utilizers needing EMS and the ER have decreased by 63%. And though the LOS and ACO programs are both too new to have reportable data, Cebollero says, early signs already point to substantial savings.
CHEMS has also been active in several research projects. Cebollero says CHEMS is one of few EMS agencies in the country whose medics are all trained under the Collaborative Institution Training Initiative (CITI) Human Subjects Research Program. The world-renowned program teaches best practices in human research subjects’ protections. The completion of CITI training programs enables CHEMS to conduct human clinical trials in EMS.
One of the organization’s current projects includes assisting with enrolling patients into a Fall Risk Assessment Project. This program is designed to identify potential fall risks in the home and at workplaces. Then, with the help of occupational and physical therapists, the project helps mediate fall risks for citizens, says Cebollero.
CHEMS is also working in coordination with the Washington University School of Medical Research on a possible grant. “During this time we are researching employee wellness and the lifting equipment used in the career field,” explains Cebollero. “In addition to CHEMS and Wash U., we are working with the Occupational Health, Compliance and Ergonomics departments at Christian Hospital. To date we have identified all work injuries related to lifting from 2013–14, completed an anonymous survey of the department to measure employee wellness and all 2013 patient care records have been searched for times when lifting equipment has been used.”
If CHEMS is selected for the grant, Cebollero says it would use the resources to increase education to its workforce and career field, ensuring there was good data as to which equipment works best to minimize employee injury.
CHEMS prides itself on taking a proactive approach to continuing education. According to Cebollero, every year employees take a 100 question general knowledge/protocol exam to determine base knowledge. From there individual development plans (IDPs) are created for each employee based on scores. This gives the department and employee the opportunity to work on challenges and turn them into strengths. In addition to the CHEMS also takes into account individual IV and intubation success rates. Individuals who fall below the system average will be placed in busy hospital areas to assist with developing needed skills.
CHEMS also offers Web-based training and podcasts for EMS employees and system first responders. The training includes skills of the month, protocol of the week, and any other education needed as deemed by their CQI process. This additional method of education delivery allows the CHEMS department to keep a great flow of education streaming regardless of the day or hour.
The training opportunities don’t stop there either. Christian Hospital developed a partnership with St. Louis University in which EMS employees wishing to go to college to achieve a degree are given the opportunity via online or classroom learning. The students do not have to worry about payment, Cebollero says, as the agreement allows for St. Louis University to bill tuition benefits directly. Thirty-seven percent of department personal are enrolled in completing their degree, and 100% of the leadership team members are pursuing advanced degrees.
“Christian Hospital and its EMS managers have put forth tremendous effort to make CHEMS a fulfilling and enviable place to work.” Cebollero says. To that end, the organization offers a comfortable and progressive workplace where an open-door management style benchmarks mutual respect and a willingness to listen to new ideas and issue resolution from field members’ perspective. Most recently, the leadership began promoting its new philosophy of “servant leadership,” whereby employees are empowered to work alongside the leadership team, in an environment where leaders are humble stewards of their organization’s resources. In fact, according to an annual employee satisfaction survey, 86% of Christian Hospital EMS employees are satisfied with their jobs. Additionally, CHEMS has an employee turnover rate of just 5%.
In addition to providing flu shots and free health screenings for employees through the hospital, CHEMS also conducts a Biggest Loser-style weight loss competition every three months and all employees have access to yoga classes provided by the hospital. And, Cebollero says, CHEMS reduced the number of provider back injuries due to lifting patients by 22% last year through a number of back injury prevention initiatives.
With its public education efforts, CHEMS focuses on teaching children about 9-1-1 and emergency situations. Its “No Panic Please!” program is designed to teach children that during an emergency they should remain calm, regardless of how they feel or how others are behaving around them.
Cebollero says CHEMS also utilizes a “clown posse” of EMS personnel dressed up as clowns to teach children and nursing home/assisted living residents when to call EMS. And CHEMS runs a Public Access Defibrillator Program with the aim of having an AED placed in as many public gathering locations as possible.
“CHEMS recently implemented a Vial of Life program in the St. Louis communities we serve,” adds Cebollero. “The vial contains important medical information that can assist emergency personnel in administering patients’ proper medical treatments. CHEMS developed and promoted the Vial of Life program in St. Louis County to encourage residents’ participation in the program. As a result, medical information is more easily accessible by emergency medical personnel, speeding up EMS response and enhancing the efficiency of patient care.”