EMS World

FEB 2019

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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EMSWORLD.com | FEBRUARY 2019 47 concept of how to best limit ourselves from the land of the cranium-crackers. None of us wanted to say, "How's that working out for ya?" to a peer a la Dr. Phil. One team member, Capt. Matt Biasatti, remembers "wanting to be the bridge. We're all human, and sometimes we all need help getting ourselves across to the right kind of assistance." Our initial setup was simple: Confiden- tiality was essential. Any staf f member could contact us. We also had a list of call types that would automatically trigger our commanders to notif y the peer-support team via an e-mail/text system. The first available member would take the call. From there things got a little murk y. Some peer suppor t occurred in person, some over the phone. Peer support was a visit immediately after the call or next shif t. It also became clear that our nine field commanders were not consistent, and sometimes rightly so. They knew their crews well enough to make good judgements most of the time. We also collected data on which team member pro- vided peer support and for what purpose. Unfortunately our team members were not always consistent with entering data. Did every intended contact actually occur? More Tools In March 2018 these concerns led us to provide more stress-identification tools for our field commanders. The goal was that they might identif y situations more evenly. The training we provided led to an immediate tapering of peer-support noti - fications. No call type led to an automat- ed peer-support dispatch; it was only at the commander's discretion. After about six months we asked ourselves, "Are we leaving anyone behind?" We decided on an anonymous poll to shed some light and improve our process. More than 80% of our staff felt our peer- support team was beneficial. The rest did not have a strong opinion. No one found it useless. While only 28% of our staf f contacted peer support themselves, 70% of them found it helpful. The rest were neutral, with only 8% finding support to be not helpful. Many comments about the team were supportive, but not all. A few folks provided teachable moments: "I've had a peer-suppor t member blow me off" was a stinger. We recognized the importance of follow-up and how a chain of custody might avoid this. It's something we're working on. Nearly three-quarters of our staff have been contacted by peer suppor t due to an automatic ac tivation from a com- mander. Of those only 6% said it wasn't helpful. More than a third (34%) had a neutral experience. Does this mean we should target our crews more effectively for auto-activation? Perhaps it's better to overactivate and have folks who don't need us? Many comment s sug ge s ted maintaining a wide net. The feedback led us to change our contact time win- dow. Our ASAP approach to contact has become an initial contact via text. The text lets the provider know which team member they can rely on, immediately if needed. This sof t initial contact allows the peer an opt-out too. In the tex t we can detail a future contact, giving them time to process and realize what level of support they desire, if any. We don't know if there's a problem until we ask or someone gets hurt. We plan to ask regularly as our peer-suppor t team evolves. Justif y this however you like— just culture, " they're like family," "I'm a mensch." Watson says, "The most impor- tant thing is to get started and adapt as you go." The lives of your peers depend on it. ABOUT THE AUTHOR Dan Cohen, Captain, is a provider of clinical education for Williamson County EMS in central Texas. Call that falls wiithin seven categories of follow-up Commander assesses: Is peer support immediately needed Commander places call in shift report Peer support member is notified to discuss needed response Is a debriefing needed? Debriefing 2 - 5 day follow up One-on-One Defusing Call is assigned to peer support member No No Yes Yes The Williamson County EMS peer-support process flowchart Visual aids raise awareness of support.

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