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A New Start in New Orleans

In June 2019 William (Bill) Salmeron succeeded Carl Flores as chief of New Orleans EMS (NOEMS). Prior to this Salmeron was the city’s coordinator of special events and planning/interim deputy chief of operations.

His appointment was the latest stage of leadership changes enacted by New Orleans Mayor LaToya Cantrell. When she took office in May 2018, Cantrell replaced the city’s eight-year director/medial director, Jeffrey Elder, MD, with pediatric emergency physician Emily Nichols, MD. New Orleans’ Times-Picayune newspaper noted Nichols’ lack of administrative background and experience running a department.                                                                                            

The newspaper’s story also cited a report from outgoing Mayor Mitch Landrieu’s administration that said, “The trend of increasing demand has made it difficult for New Orleans EMS to keep up with the national standard for response times… Meanwhile, employees in the department have gone without raises since 2008, and there are concerns about employee morale. The department’s uniform allowance is the lowest of the three city’s first-responder agencies.”

Solving these problems is now Salmeron’s responsibility. He commands about 160 EMS employees and 150–200 volunteers. They serve a sprawling urban/rural jurisdiction of about 350 square miles that includes some outlying swampy zones that can be tough to get ambulances into. NOEMS cares for a population of about 423,300, plus 17 million tourists who visit New Orleans annually.

EMS World recently had a one-to-one conversation with Salmeron to learn about his plans for these and other NOEMS issues.

EMS World: NOEMS has been working to improve Code 3 response times. Where does your agency stand today?

Salmeron: Over the years our response time compliance has been between 68%–70%; we’re currently at about 68%. That means that our higher-priority calls are answered within 12 minutes.

Response time compliance is important, but it can’t be improved by just throwing more staff at it. Even if we do, there will always be more calls that need to be answered that will put the system under stress. So I think we have to find creative ways to triage calls, deploy our units throughout the city, and also manage our patients’ expectations.

The bottom line is that if you don’t have units available, they’re just not available.

What are you dealing with in terms of EMS calls?

An average of about 50% of our calls are higher-priority calls, which means they’re Code 3. That’s shortness of breath, chest pain, shootings, stabbings, cardiac arrests, and things like that.

We also transport about 88% of our patients on average, which is a high percentage. This means that our units are on call longer because they have to take the patient to a hospital and then often wait there.

The reality is that we respond to about 100 calls every 12 hours, and we’ve put more people and units on over the years to deal with it. But this isn’t enough; we need to really find creative ways to improve our response times, and I think we’re doing that.

Community paramedicine could be part of the solution. This involves utilizing our staff to go out to the homes of people who are high users of EMS and ask them, “Why do you call 9-1-1 10 times a day? What are some things that we can do, or resources we can connect you to, to lower that number of calls?”

The Times-Picayune article mentioned employee morale and low uniform allowances at NOEMS. What steps have you taken to address these issues?

We’ve developed an Employee Wellness Committee, which consists of people from all levels of our organization, mainly from our field staff. Their job basically is to look at employee morale in real time and figure out what we can do as a department to help with that.

Last year we did an employee wellness survey of our staff, and we got some great feedback on some things we can do as a department to people them feel better about their jobs and be happy. I think we’re moving in the right direction with that. We are helping.           

Pay is also an issue. In 2018 we had a 10% pay increase across the board in the city, so all our staff got a boost in pay. As well, we have incentive pay for our lower-level staff, EMTs and advanced EMTs; and a college degree incentive to where you may get a 2.5%–7% pay increase if you graduated from college.

We also increased our uniform allowance last year to $750 per person, which is an increase of $500 from what they previously had.

Employee security has become a big issue for EMS services across the country. How do you keep your providers safe on the job?

We work with local law enforcement. Our police department is a great partner, and we work together to ensure our folks are safe when they respond. In potentially dangerous situations we make sure the police are there, and everything we do is within safe parameters.

We’re looking at training: What are some defensive tactics with which we can train our folks to protect themselves in case they’re attacked by a patient or in a violent encounter?

We’ve had opportunities to provide our EMTs with ballistic protection as far as personal ballistic vests. We also have active-shooter kits available throughout the department—if we have an active shooter, we can deploy upward of probably a dozen kits, including ballistic-protection vests and helmets.

What other challenges are you facing?

Our issues aren’t uncommon to other departments. I think we have a community that’s highly dependent on EMS, just like around the country. People call 9-1-1 for a lot of different things, and people use the emergency rooms as a source of primary healthcare in today’s world. We are often that vehicle to bring a lot of people to the ER for various reasons, whether it be a nonemergency or an emergency. So we definitely have a high call volume.

We find it challenging to find qualified folks in our area to come work for us. As a result, we have to find creative ways of partnering with other organizations or agencies as far as training or recruitment of people from around the country.

Since A&E’s Nightwatch profiled NOEMS, we’ve had a large influx of people come work for us from around the country. We really got some great people out of it.

We also find it challenging to help our EMTs do what’s required to keep their licenses, because we’re such a busy service and time is a precious commodity. So again we have to find creative ways to help our folks grow, not only as EMTs or paramedics but just as people.

Looking ahead, what are your future goals?

Our main goal is to help our staff be the best they can be. We want to make sure they have everything they need to do their jobs, make sure they have the best equipment—all our fleet is 10 years old or less—the best training and best support possible.

It’s important that we support all our staff with whatever they need, because that’s what they deserve, and our community deserves that. We want to provide the best prehospital care possible, and we can only do that as a group.

James Careless is a freelance writer and frequent contributor to EMS World.

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