Pulsara Blog

EDITOR'S NOTE: The following is an excerpt from an article by Larry Beresford, originally published on EMS World on April 3rd, 2024. Check out the full article here. 

Telemedicine for the EMS personnel of MedStar Mobile Healthcare, a governmental EMS system in Fort Worth, Texas, is linked through an app on their Android hand-held phones, says Matt Zavadsky, MS-HSA, NREMT, MedStar’s chief transformation officer.

“The crew does everything with their Android phone. They get their calls and their post moves, they get routed by the live routing system, they text with dispatch, they text with each other,” Zavadsky explains. “When they get to the scene of a call, they pop the phone out of its drop-in cradle charger at the front of the truck and bring it with them.”

Telemedicine, which can connect them virtually with physicians from integrative emergency services and the physician with the patient, has been a positive experience for MedStar’s field staff, Zavadsky says. “Every EMT or paramedic who works out in the field knows that a fair percentage, some might say the majority, of our patients, don’t actually need to go to the emergency room.” Is it safe for this patient to go to urgent care? Can they get a prescription written for a new medicine or refill an existing prescription?

A virtual physician visit can answer these questions, and having that telemedicine backup facilitates the paramedics and EMTs to provide more patient-centric care, says Zavadsky, who also takes occasional EMT shifts himself. “We are helping the patient navigate the health care system to the most appropriate setting. One of the tools we use is telemedicine, just like we use a 12-lead EKG monitor.”

EDITOR'S NOTE: This article originally appeared on EMS1.com. Special thanks to our guest author, John Erich, for EMS1 BrandFocus Staff.

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No matter the incident’s size, scanning patient wristbands keeps all responders and clinicians united

Managing patients in the middle of a mass-casualty incident can feel like playing the game of telephone. Essential information is often passed from person to person, misheard, misunderstood, changed, lost, or even forgotten in the chaos.

Ideally, patient communication involves one continuous line of accurate, real-time information on each patient, flowing between EMS, hospital teams, public safety, public health, and emergency management personnel. A dedicated patient “channel” streamlines and improves care for routine cases and MCIs.

This is becoming a reality in several states. They’re implementing statewide patient wristband systems and pairing them with Pulsara, a health care communication and logistics platform, to simplify interoperability. Using Pulsara, responders scan patient wristbands to securely, quickly, and conveniently identify the injured, track what’s been done for whom, and provide the next caregiver a complete picture of the patient’s status – uniting all care teams and coordinators around each patient case in real time.

When William Rice, MBA, MLS, LP, market director of EMS and Air Med 12 at St. Joseph Health in Bryan, Texas, first implemented an effort to pair wristbands with Pulsara, he was met with skepticism.

“In the early days of the wristbands, I regularly had to remind folks in the region that they unanimously voted to support this project. People didn’t understand where the wristbands were going or how it would be helpful,” Rice said. “Once we added Pulsara, the value of the wristbands immediately sold itself because anybody who walks up to that wristband and scans it with Pulsara is now part of that patient care record.”

With a new protocol and Pulsara, Metropolitan Emergency Medical Services can now transport eligible pediatric behavioral health patients directly to behavioral health facilities—resulting in a 44% decrease of pediatric behavioral health patients transported to the ED. 

Metropolitan Emergency Medical Services (MEMS) is a public, non-profit EMS entity serving Little Rock, Arkansas, and its surrounding counties. The organization’s service area covers approximately 1,800 square miles and nearly half a million Arkansans. MEMS transports around 77,000 patients each year. In 2020, MEMS adopted Pulsara to improve communication with area hospitals for time-sensitive emergencies such as stroke, STEMI, and trauma. 

In the wake of the COVID-19 pandemic, MEMS faced a new challenge: a growing number of pediatric behavioral health cases. Between 2022 and 2023, mental health calls accounted for 10% of MEMS’ overall call volume, with a noticeable surge in pediatric mental health cases. MEMS was transporting every behavioral health patient under 18 to Arkansas Children’s Hospital, creating a bottleneck in the emergency department as patients wait to be transferred to a behavioral health facility. Mack Hutchison, Clinical Manager for MEMS, explains: “Many of these patients do not need medical clearance and can occupy a room in the ED for up to 24 hours before a bed is found for them at a behavioral health facility.” Hutchison had an idea: what if those who didn’t need medical clearance could be routed directly to a behavioral health facility, relieving pressure on the ED and getting patients care more quickly?

Download the case study or read on to learn more!

EDITOR'S NOTE: This article originally appeared on EMS1.com. Special thanks to our guest author, John Erich, for EMS1 BrandFocus Staff.

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How a state’s wristband system and Pulsara redefined safety at the Texas Renaissance Festival

Imagine you’re an ambulance service director in a rural county. At the last minute, you’re responsible for staffing a 40,000-visitor-per-day event – more than your county’s entire population. In addition, it’s scheduled to last for eight consecutive weekends. This is on top of your already busy 911, nonemergent transport, and standby responsibilities.

Oh, and you only have a month to prepare. Sound daunting?

That’s the predicament Billy Rice, director of EMS for Texas’ St. Joseph Health, found himself in.

After using St. Joseph Health EMS for several years, organizers of the Texas Renaissance Festival decided in 2023 to switch medical providers for the event. As opening day approached, however, they concluded St. Joseph Health EMS was the only provider that could handle an event of the festival’s magnitude.

“About a month before the festival, they realized it wouldn’t work. They called us and asked us to help,” said Billy Rice. “Of course, it’s our people and our county, so we stepped up and pulled it off.”

A major component involved the patient wristbands now being used across Texas, paired with the Pulsara platform for tracking patients and managing events.

Editor's Note: On July 21st, 2023, EMS1, Fitch & Associates, and the National EMS Management Association released their annual EMS Trend Report, proudly sponsored by Pulsara. Because the articles and advice found within contain such critical subject matter, we've elected to publish each segment one at a time here on our blog. Read, enjoy, share, and take to heart the following information brought to you by the most prestigious thought leaders in EMS. This fifth and final entry for 2023 is contributed by  Pulsara.

Pioneering patient management and communication tools may be the answer to enhancing provider job satisfaction and combating EMS retention problems

With staff retention emerging as a top concern in EMS, the need for effective solutions to combat this critical issue is apparent. As revealed by the 2023 EMS Trend Survey – a joint effort of EMS1, Fitch & Associates, EMS Survey Team, and the National EMS Management Association – retention, recruitment, and career development significantly influence the effectiveness of EMS services.

Numerous factors play a role in these challenges, with compensation, leadership quality, late calls, and hospital wait times being the key issues. With a staggering 87% of respondents citing compensation as a major influence on retention, followed by poor leadership (72%), late calls (66%), hospital delays (53%), and the criminalization of medical errors (40%), the complexity and depth of the problem become evident.

However, these hurdles aren’t insurmountable. Innovative strategies such as wellness programs, alternative service models, and technology solutions can help reduce irritations, bolster employee satisfaction, and improve staff retention.

Editor's Note: On July 21st, 2023, EMS1, Fitch & Associates, and the National EMS Management Association released their annual EMS Trend Report, proudly sponsored by Pulsara. Because the articles and advice found within contain such critical subject matter, we've elected to publish each segment one at a time here on our blog. Read, enjoy, share, and take to heart the following information brought to you by the most prestigious thought leaders in EMS. Today's entry is written by Chris Cebollero, nationally recognized EMS leader, advocate, best-selling author, and president/CEO for Cebollero & Associates.

4 Steps to Stopping the Stress Cycle

Let me share a secret: EMS can be a very stressful job. I know what you are thinking: “no joke, Sherlock” (or perhaps a more colorful version). But, if we as leaders know that EMS is a stressful career field, what are we doing as leaders to help our workforce decrease their stress levels?

The EMS Trend Survey identified several factors that compound stress for our workforce. It’s not just the trauma, death, and horrors they experience every day, but also the short staffing, equipment challenges, late calls, and schedules that pile on for them.

Of course, we know that some level of stress is inevitable and unavoidable. Heck, dealing with traffic every day was a horrible source of stress for me in the field. But we know that prolonged levels of intense stress will cause long-term mental and physical challenges for employees. Finding ways to mitigate stress for our workforce must be foremost in our focus as leaders.

Editor's Note: On July 21st, 2023, EMS1, Fitch & Associates, and the National EMS Management Association released their annual EMS Trend Report, proudly sponsored by Pulsara. Because the articles and advice found within contain such critical subject matter, we've elected to publish each segment one at a time here on our blog. Read, enjoy, share, and take to heart the following information brought to you by the most prestigious thought leaders in EMS. Today's entry is written by Anthony Minge, EdD, senior partner at Fitch & Associates. 

A closer look at the causes and effects of pressure, strain, and anxiety on the EMS workforce

Stress is taking a monumental toll on EMS. This year’s EMS Trend Survey found more than 80% of respondents experience moderate job stress, with 11% categorizing it as extreme. Over 40% of those completing this year’s survey felt that stress is negatively impacting their professional development, 30% feel it is negatively impacting the quality of service they provide, and more than 50% feel it is having debilitating effects on their health.

Editor's Note: On July 21st, 2023, EMS1, Fitch & Associates, and the National EMS Management Association released their annual EMS Trend Report, proudly sponsored by Pulsara. Because the articles and advice found within contain such critical subject matter, we've elected to publish each segment one at a time here on our blog. Read, enjoy, share, and take to heart the following information brought to you by the most prestigious thought leaders in EMS. Today's entry is written by Kerri Hatt, Editor-in-Chief of EMS1.

Adopting programs to improve service delivery and agency culture

Our goal in measuring and analyzing EMS trends is to identify areas for growth: both where it is needed and where it is succeeding at improving operations. When agencies and providers are feeling the brunt of staffing challenges in levels that have nearly half of providers (45%) considering leaving EMS, and 97% of agencies struggling with turnover – it’s time to change the way we deliver EMS.

In year-over-year comparisons, we’ve seen incremental growth in agencies adopting alternate service models and tools, including telemedicine, nurse triage of 911 calls, alternate means of transportation, and alternate destinations. By getting patients to the right definitive care and reducing the volume of patients delivered straight to the ED, patients are better served and turnaround times are decreased, reducing the burden on providers.

While these downstream impacts of adjusting service delivery will improve EMS for providers, we cannot ignore the impact leadership has on their stress. EMS Trend Survey respondents made that impact loud and clear, citing agency leadership and their direct supervisors as the biggest drivers of stress in EMS.

We asked a panel of EMS innovators and experts to share their experiences, successes, and tips for adopting programs to both improve EMS service delivery and agency culture – creating a safe space where wellness is appreciated, and seniormost staff lead the ship – rather than create additional stress. Here’s what they have to say.

Editor's Note: On July 21st, 2023, EMS1, Fitch & Associates, and the National EMS Management Association released their annual EMS Trend Report, proudly sponsored by Pulsara. Because the articles and advice found within contain such critical subject matter, we've elected to publish each segment one at a time here on our blog. Read, enjoy, share, and take to heart the following information brought to you by the most prestigious thought leaders in EMS. Today's entry is written by Jay Fitch, PhD, founding partner at Fitch & Associates. 

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EMS1’s state-of-the-industry survey provides targets for reducing stress, staffing challenges, and leadership shortfalls

For the past 8 years, the EMS Trend Survey has chronicled what our profession feels are key concerns. Several overarching issues that continue to impact EMS include the post-pandemic labor environment, financial factors that appear to be causing EMS to careen toward financial ruin, as well as an increase in violent interactions. These issues certainly provide a context against which we can interpret the survey results.

Labor shortages across all business sectors (including EMS) have continued since the pandemic. Retention has remained the No. 1 critical issue facing EMS for 4 straight years. In EMS, recruitment and retention efforts have been exacerbated by the inability of agencies to provide competitive compensation packages as compared to other healthcare and public safety positions. For the past 2 years, pay and benefits have been consistently identified by nearly 9 out of 10 respondents as an issue impacting retention. Interestingly, career development and advancement were rated as a higher critical factor than in past years, which is also likely impacting retention.

EDITOR'S NOTE: This article originally appeared on EMS1.com. Special thanks to our guest author, John Erich, for EMS1 BrandFocus Staff.

Once you’ve determined what your program will do, you face some practical questions

The proverbial table is set, and you’re ready to begin your EMS agency’s community paramedicine program. You’ve evaluated the needs of your patients and community, identified care gaps you can fill, planned how you’ll do it, and lined up appropriate partners to assist.

Now, however, you face a new round of challenges – and these are more practical than theoretical. Who will comprise your team? What tools will they carry? How will they communicate and document care? And, once they’re out in the field and helping people, how will you evaluate their success?

Alexandria Fire Department in Alexandria, Virginia, chose fall prevention for its initial foray into community paramedicine back in 2017. Focusing on falls made a lot of sense for a new program with limited means: Data on local frequent fallers was available and accessible, and the interventions that could help them – good shoes, handrails, securing rugs, controlling pets – were low-cost and straightforward. The program would be a manageable lift to get off the ground.

And, given its targeted scope, easier to keep upright as it found its footing and began moving forward.

“You have to figure out what’s easy,” said Jeff Woolsey, a department captain and registered nurse who took over Alexandria’s program in its early days. “Pick something you know you can succeed at – and falls are something you can succeed at. If you go out there and say, ‘I want to solve mental health! I want to solve drug addiction!’ you’re going to lose. There’s just no way, without 14 people in your program and a 10-bed hospital someplace, that you can manage those things.”

EDITOR'S NOTE: This article originally appeared on FireRescue1.com. Special thanks to our guest author, Courtney Levin, for FireRescue1 BrandFocus Staff.

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Building muscle memory eases stress during critical emergencies

According to the U.S. Census, 29.15 million people lived in Texas in 2020. Estimates for 2022 show that figure has likely surpassed the 30 million mark as the Lone Star State continues to see a huge influx of new residents. Providing emergency medical care to that many people is an extraordinarily tall task, but one the state has worked to improve upon in recent years.

The tipping point came in 2020 as COVID-19 presented the United States with unprecedented medical challenges. Residents in Texas who needed specialized hospital care due to the virus were often caught in a tangle of delays, as medical teams weren’t always working from the same playbook.

“We heard stories across the state where multiple fixed-wing aircraft showed up at the wrong airport to pick up the wrong patient,” said Joey Branton, senior vice president of strategic initiatives at Pulsara. “They were making a minimum of 30 phone calls per patient transfer.”

While the pandemic put immense pressure on first responders and the health care system, mass casualty incidents like active shooters and natural disasters didn’t stop. It quickly became clear that those in Texas needed a better way to manage patients from start to finish.

A statewide wristband system was put in place to give every patient a unique ID that could be used across organizations. But it was the coupling of that initiative with the Pulsara platform which enabled fire and EMS providers to significantly improve their level of care.

Pulsara helps streamline communication between first responders during single-patient events and mass casualty incidents. As with any skill, confidence in using this tool comes through the muscle memory built up through regular use. “First responders in Texas realized to be truly proficient at using the efficiencies provided by the Pulsara platform, they needed to use it every day,” said Branton.

EDITOR'S NOTE: This article originally appeared on EMS1.com. Special thanks to our guest author, John Erich, for EMS1 BrandFocus Staff.

It’s not as hard to get started as you might think – follow these initial steps

Few experienced paramedics need to be persuaded of the value of community paramedicine – they’ve seen the repeat 911 callers, the chronic problems and the social factors that trap people in cycles of poor health. But against so many problems so large, it’s hard to know where to begin. Who should a CP program serve? What should it try to do?

The good news is, the answers to those questions aren’t unknowable, and it’s not as hard as you might think to get a basic program up and running. Here is a guideline for departments willing to take that step toward more comprehensive care for the vulnerable in their communities.

Step #1: Assess your needs

You might have certain interventions in mind from the outset. But whatever your program does should be based on data, not impressions or anecdotes. Focus on what your population needs, not what you want.

“It really is important that you do what’s right for your community,” said veteran EMS writer and educator Hilary Gates, MAEd, NRP, director of educational strategy for Prodigy EMS and a volunteer paramedic with the Alexandria Fire Department in Virginia, whose community paramedic program she helped found in 2017. “If you start by saying, ‘I’d like to help solve the opioid crisis,’ you might find there’s actually more meth in your community than opioids.”

Identifying appropriate areas for intervention best begins with a needs assessment – an evaluation of areas where current conditions fall short of expectations. Veteran providers may already have a sense of such areas in their communities, and agency ePCR data can yield insights into call types and frequencies. Sources like NEMSIS (the National EMS Information System), CARES (the Cardiac Arrest Registry to Enhance Survival) and top EMS software companies can also provide data to get you started.

EDITOR'S NOTE: This article originally appeared on EMS1.com. Special thanks to our guest author, Carol Brzozowski, for EMS1 BrandFocus.

EDITOR'S NOTE: This article originally appeared on firechief.com. Special thanks to our guest author, John Erich, for FireRescue1 BrandFocus Staff.

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Triage at major events can be slow, and tracking patients can be difficult – Pulsara’s new functionality is aimed at improving both experiences

As it prepared for takeoff, the 737 couldn’t avoid the speeding rental truck that came crashing toward it through the fence beyond the airport tarmac. The resulting collision killed 14 of its passengers and crew, as well as the driver of the truck, and left 56 more injured.

First responders from multiple agencies rushed to the scene that morning last October at Preston Smith International Airport in Lubbock, Texas, to respond to the full-scale mass-casualty exercise. Medical personnel triaged the wounded and gave them special armbands the state now uses for patients experiencing time-sensitive emergencies, including victims of mass-casualty incidents. The bands contained individual barcodes that, with a quick scan, would take any responder at the scene to a dedicated care channel for that patient, where the provider could then enter the patient’s identifying and treatment information.

The testing of that technology – new functionality from Pulsara designed to help responders triage and track patients in major incidents – was one of the goals of the exercise, which simulated the kind of MCI that often overwhelms unprepared systems.

“We were looking for ways to improve patient tracking and incident awareness for all command staff on scene,” said Logistics Chief and Emergency Preparedness Specialist Brent Fox, NREMT-P, of University Medical Center EMS in Lubbock. “Pulsara allowed everyone on scene to have full visibility from any location once they joined the incident.”

That quick, easy shared awareness – with everyone who’s part of the response having access to the same information – is among several important benefits of the new tool responders to the Lubbock exercise got to experience firsthand.

Pulsara's Chief Growth Officer, Kris Kaull, recently had the opportunity to sit down with Rob Lawrence on the EMS One-Stop podcast. In this episode, Rob talks with Kris about history taking and how to improve communication and gather better intel. Kris shares his top 10 hacks to improve your history taking, including thinking like a detective, thinking outside the box, understanding medical medicine, being a good listener, and more.

This podcast originally aired on EMS One-Stop on November 17, 2022. Check out part 1 of our blog coverage here, and then listen to the podcast and check out the full transcript of part 2 below.

Pulsara's Chief Growth Officer, Kris Kaull, recently had the opportunity to sit down with Rob Lawrence on the EMS One-Stop podcast. In this episode, Rob talks with Kris about history taking and how to improve communication and gather better intel. Kris shares his top 10 hacks to improve your history taking, including thinking like a detective, thinking outside the box, understanding medical medicine, being a good listener, and more.

This podcast originally aired on EMS One-Stop on November 17, 2022. Listen to the podcast and check out the full transcript below. 

Prior to the COVID-19 pandemic, Teller County, Colorado, had a successful community paramedicine program in place. But as the pandemic hit the U.S., they knew they'd need to leverage new tools to continue treating their patients. Fire and EMS leaders partnered with Pulsara to enhance their community paramedicine program with telehealth. Since then, the program has evolved into a thriving partnership between EMS and a local organization of board-certified emergency physicians, allowing them to work together via telehealth to help address healthcare disparities and improve access to care in rural areas.

In a recent webinar, EMS leadership in Teller County, Colorado, shared their experiences around building the program, and how they are using telehealth as a force multiplier to preserve resources while also better meeting the needs of their community. Here are 7 top takeaways from their experience. 

Prior to the COVID-19 pandemic, Teller County, Colorado, had a successful community paramedicine program in place. But as the pandemic hit the U.S., they knew they'd need to leverage new tools to continue treating their patients. Fire and EMS leaders partnered with Pulsara to enhance their community paramedicine program with telehealth. Since then, the program has evolved into a thriving partnership between EMS and a local organization of board-certified emergency physicians, allowing them to work together via telehealth to help address healthcare disparities and improve access to care in rural areas.

In a recent webinar, Dr. Jeremy DeWall, EMS Medical Director at UCHealth Pike's Peak Regional Hospital, and James McLaughlin, Director of Community Paramedicine at Ute Pass Regional Health Service District, shared about their experience with building the program, and how they are using telehealth as a force multiplier to preserve EMS resources while also better meeting the needs of their community. 

The key is to remember that kids get sick differently than adults and that physical findings may be more subtle

EDITOR'S NOTE: This article originally appeared on EMS1.com. Special thanks to our guest author, Jonathan Lee, for EMS1 BrandFocus.

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I have been fortunate during my career to be able to specialize in pediatrics, which has given me a unique perspective. It is pretty common to hear paramedics say that kids are difficult, but the truth is, kids are just different. When it comes to trauma, the basics are all the same: ABCs, bleeding control, and rapid transport. There are a few things that I do differently with children than when managing adults, and I am certain these can make things better for both you and your patient.

Editor's Note: On August 1st, 2022, EMS1, Fitch & Associates, and the National EMS Management Association released their fifth annual EMS Trend Report, proudly sponsored by Pulsara. Because the articles and advice found within contain such critical subject matter, we've elected to publish each segment one at a time here on our blog. Read, enjoy, share, and take to heart the following information brought to you by the most prestigious thought leaders in EMS. Today's entry is written by Kerri Hatt, Editor-in-Chief of EMS1.

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Proven recruitment and retention strategies: Readers sound off on what’s attracting new talent and keeping members satisfied

Our goal with the EMS Trend Survey and Report is not just to identify areas of change, growth, and stagnation, but to also source solutions to shared challenges. Nearly all (97%) of the 3,000- plus respondents to the 2022 EMS Trend Survey reported some level of difficulty with recruitment and retention. We asked readers to share their innovative ideas to improve recruitment and retention, and any creative practices that are proving successful to improve staffing. We received thousands of comments, from those in services with above-average compensation and a track record of adequate staffing, to those whose organizations had recently implemented a change and were fully staffed for the first time in years.