It is no secret that a thriving workforce is critical to maintaining an organization, in any industry, and this includes finding the right people to fill open positions, both now and in the future. Headlines and research over the past few years have demonstrated a workforce shortage across the State of Indiana, and this includes health care, with its effects being felt by Indianapolis Emergency Medical Service (IEMS). As fewer students enter and pass emergency medical technician (EMT)classes, and more experienced EMTs exit the field, the need for innovative programs to develop the workforce have become critical to provide skilled talent locally and statewide. “We saw this developing statewide four years ago,” said Leon Bell, IEMS chief of academic services. “[We] began thinking about how we could recruit and keep good students who would become good EMTs and employees.”

These good EMTs and employees were found within the ranks of everyday citizens, looking for a change in their everyday lives. In 2016, IEMS launched the Civilian EMT program targeting people interested in making a change and pursuing a career in health care, specifically EMS.

The logistics of the Civilian EMT program brought its own unique barriers, specifically with the needs of the participants. These are people who have family and financial commitments, and might not be able to meet the requirements and pace of EMT class. The solution was to hire the students and pay them to become certified EMTs. Applicants applied for the program in the same fashion they would apply for any job with IEMS. Once selected, they became paid employees of IEMS and completely focused on becoming an EMT. While the curriculum of the Civilian EMT program is the same as the traditional one, the pacing is very different. Participants are moved through at a rapid but thorough pace. According to Chief Bell, “Our program is a brain-burner. You are immersed in EMS 40 hours each and every week. You live EMS every day.” In the timeframe of one semester of traditional EMT education, Civilian EMT participants receive the entire program curriculum and complete all the required clinical and field experiences. They are then sent back out for four additional IEMS ride-outs, working with a preceptor, to gain more real-life experience and improve their decision making and leadership skills while on-duty. The program culminates with students taking the national EMT exam to become certified and move through the IEMS orientation to meet the required competencies to work along with a paramedic partner. Once that is completed, the new EMT may continue employment with IEMS or pursue employment elsewhere in the state or country.

The Civilian EMT program is already paying dividends for IEMS. Since its launch in 2016, 16 people signed up with 12 going onto employment with IEMS by years end, with exciting plans for the future. “It is a solution to our labor needs,” concluded Chief Bell. “It adds jobs in the community and provides people with a long-term, benefited career path. The program prepares students to be good employees wherever they go. It also prepares them for the importance of being on time, dressed in uniform, respecting the chain of command [and] learning job protocols. It also gives our city essential employees for a noble job.”

Those interested in applying for the Civilian EMT program should visit our job board and apply for the EMT Trainee position.

IndyCARES increases survival rates and creates heroes out of everyday people.

Heroes are found everywhere; in all walks of life and in all places. There is one thing we know for sure, the world needs more heroes. As EMTs and paramedics, IEMS providers are trained to perform acts of heroism on a daily basis. From stopping blood loss, to reviving a victim of cardiac arrest, to administering life-saving treatment to someone experiencing an overdose, we are trained to think and react quickly to increase the chances for survival. In situations where quick actions are critical to success, EMS agencies worldwide are always looking for ways to provide lifesaving treatment faster, often before an ambulance can arrive on the scene. In order to do this, we must call on the general public to assist and provide them with the necessary equipment and knowledge to become heroes. The Automatic External Defibrillator (AED) placement program was part of the federal grant from the U.S. Department of Health and Human Services to the Health Resources and Services Administration (HRSA) for public access AED placement and compression only CPR training. The goal of this program was to improve cardiac arrest survival in high risk areas around Marion County. Placement and training were managed by the IEMS IndyCARES division, which is committed to improving the survival rates of people who suffer out-of-hospital cardiac arrests.

Sites were selected throughout Marion County to receive AEDs based on location, access, number of persons served, and the current rate of cardiac arrest in the area over time. Locations included churches, homeless shelters, public memorials and community centers. “These were areas and populations at risk who now have the necessary tool to respond quickly to victims of cardiac arrest,” said Dr. Dan O’Donnell, IEMS medical director. The grant also provided for free adult compression only CPR training to those receiving the AED and the citizens in the surrounding area. In the training sessions citizens were taught when to call 911, how to recognize the signs of adult cardiac arrest, proper compression depth and rate, and AED placement and use. The program also brought new partnerships within Marion County further improving the chances for survival. Whenever someone called 911 Dispatch to report a cardiac arrest, the caller was informed of the location of an AED placed within a three block radius, ultimately leading to faster response times.

In 2016, 49 public access AED’s were placed in the Marion County area, 27 AED’s were placed in the squad cars of all IMPD officers who completed the EMT course and maintained their certifications, and two AED’s were placed in the response vehicles of the IEMS Tactical Emergency Medical Service (TEMS) members. Also, in 2016 the IndyCARES division trained 980 people in adult compression only CPR, empowering everyday citizens to perform extraordinary acts of heroism.

In Marion County and across the nation, there are factors that drain the resources of EMS services and their capabilities to provide the appropriate care, when needed.  One issue being addressed is recidivism to an emergency medical facility, even though treatment is accessible.  Through community outreach programs, such as CORE, IEMS is addressing the issue of repeat hospitalization by meeting the needs of vulnerable and high-risk populations and working in partnership with others to address specific issues contributing to the strain on our emergency medical system.

A growing need was identified and a partnership was formed between IEMS and Riley Hospital for Children to address how to conduct in-home interventions for high-risk pediatric asthma patients. According to the Indiana State Department of Health, asthma is the most common chronic childhood illness, affecting one in 10 children under the age of 18. Thanks to a nearly $1 million grant from the Health Resources and Services Administration (HRSA) in 2013, “Treat the Streets” was launched to improve how childhood asthma is medically managed, in an effort to reduce hospital readmission.

Potential “Treat the Streets” participants are identified simply by admission to inpatient, observation, or the emergency department for primary diagnosis of asthma, and have met other standard criteria of being between the ages of two to 17, and live in Marion County. Once parental consent is given, an appointment is made to have an IEMS paramedic, along with a CORE social worker visit the patient at their home to conduct a medical and environmental assessment, plus asthma education to the patient and their family.  Other resources may also be available on a need-by-need basis, including furnace filters, vacuums, pillow cases and free smoking cessation provided by the Marion County Public Health Department, who may also be contacted for environmental or housing issues.  This approach is to address gaps in care that exist after the child is discharged from the hospital.

Overall, the goals of Treat the Streets are to:

1. Prevent emergency department and hospital readmission
2. Improve health care access with an integrated health care model to ensure that the right care is available to patients at the right time and in the right environment
3. Develop a workforce of specially trained out-of-hospital care providers to implement various prevention and intervention strategies
4. Conduct research, analyze data and disseminate results regarding the impact of the pediatric community paramedicine model of emergency department recidivism rates and enhanced paramedic scope of practice
5. Recommend strategies for bundled health care services, provided by Indianapolis EMS, ensuring sustainability of the program
6. Final data analysis is expected sometime in 2017, but Treat the Streets has already shown the power of strong partnerships and the effectiveness of CORE’s service delivery model to reach into the community to focus on specific needs of a wide variety of residents.

As with many major metropolitan areas in the country, the story of Indianapolis can be divided into a tale of two cities. One side is the explosive growth of the tech industry and thriving, health care community. The other is pockets of generational poverty and helplessness. One organization committed to improving the quality of life for its neighborhood residents is Shepherd Community Center, located in the 46201 zip code where there are four times more overdoses than the rest of the city and the infant mortality rate ranks the highest in the state.

In 2015, Shepherd launched the Shalom Project to focus on the root causes of poverty, crime and despair in the area. Key to this initiative was hiring a community police officer, dedicated to the neighborhood. It didn’t take long for the Shalom Project to reveal that the community’s issues were more than crime, and that medical assistance was needed to address a variety of issues, ranging from addiction and mental health, to understanding treatment plans and taking a proactive approach to one’s care. IEMS and CORE were ready to expand their reach and meet the needs of our area’s most vulnerable populations.

In 2016, IEMS/CORE paramedic Shane Hardwick teamed with Indianapolis Metropolitan Police Department reserve deputy Adam Perkins to focus on building relationships and making positive changes within the community, through understanding of available resources and empowering residents to take a proactive approach to their wellness. The two executed CORE’s delivery model of meeting with individuals and families to identify unmet health and social needs, and work to reduce 9-1-1 calls and emergency room visits, averaging 120 contacts per month. Perkins and Hardwick believe they are making a difference by developing these relationships with the patients in their moments of crisis. “It’s not just an ambulance ride to the hospital,” said Hardwick. “It’s sitting with them in their homes making sure they know when their follow-up appointment is, if they have transportation, and did all prescriptions get filled.”

Prior to 2016, EMS and emergency departments were quite limited in what they could do for opioid overdose patients. Often they were left with the unsatisfying job of medically clearing them and then sending them out the door.

In an effort to address the growing epidemic of opioid overdoses and deaths in Indianapolis, Project POINT was developed to provide outreach, intervention, and treatment to patients suffering from an acute opioid overdose. “For 20 years the healthcare system has treated drug use as the moral failing of individual patients,” said Krista Brucker, Eskenazi Health physician. “We’ve judged and stigmatized and a lot of people have died unnecessarily.”

The implementation of a multi-disciplinary team approach would aim to break the addiction cycle. Initially funded by a small grant from Drug Free Marion County a multidisciplinary team was formed to acutely intervene on overdose patients brought to the Michael & Susan Smith Emergency Department at Eskenazi Health. The team consists of a CORE social worker, addiction councilor, peer recovery coach, and addiction psychiatrist. During the day a peer recovery coach will meet with the patient bedside in the emergency deparment to do an assessment and to make sure they have all the resources needed for recovery. The peer recovery coach will also continue to follow the patient through their recovery process. During the evening an overdose patient will meet with an addiction councilor for an assessment of readiness for change. The addiction councilor is also the project coordinator and oversees the grant. Although the social worker has no direct patient contact they provide clinical supervision to the peer recovery coach and will provide additional resources. As the overdose patient is released from the Michael & Susan Smith Emergency Department and commits to treatment, they will meet with an addiction psychiatrist at Eskenazi Health Midtown Community Mental Health for medication and intake. This pilot program was expanded in January 2017 thanks to a large grant from the Richard M. Fairbanks Foundation.

The goal of Project POINT is to link people to treatment and services, address specific barriers the patient may have to treatment and collect data for improvement and eventual dissemination. In the end, the ultimate goal is to reach the addict when they are most vulnerable and attempt to break the cycle of addiction. This is the time when their addiction has almost ended their life and they are more receptive to rehabilitation and life style changes.