MEDIC’S MISSION: FROM OUR EXECUTIVE DIRECTOR 3 MEDIC’S VISION 4 FINANCE 12 RESEARCH 14 MEDIC’S VALUES 16 AWARD WINNING EMPLOYEES 18 LEADERSHIP 22
101,101 TRANSPORTS 1,214 PEOPLE TRAINED IN CPR
128,772 CALLS FOR SERVICE
10 EMERGENCY DEPTS. SERVED
6,304
COMMUNITY ENGAGEMENT PARTICIPANTS
68% PATIENTS RATE MEDIC’S
501 EMPLOYEES
SERVICE AS EXCELLENT
1,012,539 RESIDENTS SERVED 2
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To save a life, hold a hand, and be prepared to respond in our community when and where our patients need us. Medic’s mission is a noble one, and one that I am very proud to be associated with. The purpose we serve in our community is vital, requiring everyone in this Agency to be laser focused on their responsibilities so that we can appropriately answer the call each and every time we are needed. The people who work at Medic spent a great deal of time this past fiscal year focused on the Agency’s purpose. It wasn’t because we had lost our way; it was because there was a desire, after 36 years of growth and change, to revisit our purpose and make sure that Medic’s mission, vision, and values were tightly aligned, clearly articulated, and reflective of the 500 person Agency we have become. A number of important things became readily apparent through this process. First, the people who choose to work at Medic are fiercely proud of this Agency. The performance expectations are very high and our employees take great pride in finding ways to exceed them. We also saw tremendous alignment in the values shared by Medic employees. Given the nature of our work and the selflessness required to maintain performance at a high level – this should come as no surprise. Lastly, regardless of what role they play at Medic, every employee could clearly see their connection to this Agency’s purpose and ability to fulfill its mission. From the mechanics in our fleet department to the accounting specialists in our finance department – people understand their role and know precisely how it allows this Agency to serve the community. The work we do at Medic is very demanding, but the rewards are unmatched by anything offered in the commercial sector. I believe this is why people choose to work at Medic and why many of them spend their entire career here. I also believe this is why we are able to produce the results we do, which are among the very best in the entire country. I invite you to learn more about the people who work at Medic, and their significant accomplishments, in the following pages. I believe you will be as proud of their results as I am, and glad to know they are prepared to respond in our community when and where any of us should need them.
Josef H. Penner Executive Director
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• Medic will be an adaptable, patient-centered system of care • Medic will be an excellent place for people to work • Medic will be fiscally sustainable Our people. Our patients. Our stewardship. These three elements make up the core of Medic’s purpose in the community, and Agency leadership works to ensure that everything we strive to achieve is in clear alignment with them. The best evidence of this fact can be seen through the numerous performance measures that Medic tracks on an ongoing basis. These measures allow us to monitor everything from the performance of important processes to outcomes associated with specific improvement initiatives. Most importantly, each of these measures clearly aligns with Medic’s mission and supports the Agency’s ability to achieve its vision for the future. Medic’s mission remains a constant; however, the Agency’s vision is something that is built with a 5-7 year look towards the horizon. As any one of a number of variables changes over the years, the vision will need to be revisited to ensure that the path traveled leads to the intended destination. 4
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It takes a well-choreographed system to safely and efficiently respond to emergency medical needs in a community as large as Mecklenburg County. The system that Medic operates starts with a tremendous amount of forecasting and planning to ensure the proper number of resources is available when and where they are most likely to be needed. With resources in place throughout the county, the Emergency Medical Dispatchers in Medic’s 911 Call Center process calls and deliver care instructions to those in need of assistance. While
a given call taker is delivering care instructions over the phone, an Agency Controller will simultaneously identify the closest available resources and dispatch them to the address of the incident. Such resources usually include both a Paramedic equipped ambulance and a first responder unit from a local fire department. First responders play a very important part in Medic’s system of care. Their inclusion helps maximize system coverage, particularly during times of peak demand, in addition to providing vital resources to assist with certain patient care situations.
BY FIRST RESPONDERS
1. Carolina 198 2. Charlotte 73771 3. Cooks 466 4. Cornelius 1626 5. Davidson 844 6. Huntersville 1233 7. Idlewild 1949 8. Long Creek 549 9. Matthews 2267 10. Mint Hill 2769 11. North Meck 2248 12. Pineville 2015 13. Providence 81 14. Robinson 717 15. Steele Creek 545 16. West Meck 901
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Abdominal Pain, 3,627 4%*
Unconscious / Fainting, 10,755 11%*
Assault, 3,937 4%* Convulsion / Seizure, 4,428 4%* Unknown Problem (Man Down), 5,563 5%*
Breathing Problems, 10,712 11%* Ten most frequent calls equate to 76% of all Medic call volume. *Percentage of overall calls
Chest Pain, 8,892 9%*
Sick Person, 10,073 10%*
Falls / Back injury (traumatic), 9,089 9%*
Traffic Accident, 9,690 9%*
FY '13
FY '14
101,101
118,578 93,964
114,579
106,338
91,664
FY '10
86,535
FY '09
82,827
98,872 76,333
FY '08
96,273
93,392
88,737 FY '07
73,839
FY '06
71,904
64,600
FY '05
71,224
63,439
60,000
82,555
80,000
84,077
100,000
110,180
120,000
128,772
140,000
40,000 20,000 -
Transports
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Responses
FY '12
FY '15
AS DETERMINED BY MEDIC CAREGIVERS Life Threatening, 4,668 5% Non-Emergency Transport, 16,932
Potentially Life Threatening, 11,329
17%
11%
Non-Life Threatening, 68,172 67%
99%
98.20%
> 90% GOAL OUTCOME: MET 98.28%
98% 97% 96% 95% 94% 93% 91.82%
92% 91% 90% 89% 88% Life Threatening Potentially Life Threatening
Non-Life Threatening
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Everything we do at Medic starts and ends with our patients. Clinical outcomes are the most important measure we look at when it comes to our patients, but it is far from the only one. The overall experience of a patient when in Medic’s care matters greatly. The Agency randomly surveys 200 patients each month through an independent third party. The results of this survey are analyzed and shared with caregivers to help improve the overall experience for our patients.
Over the years we have learned that there are many different elements that drive a patient’s overall satisfaction with the care delivered. These include items such as their comfort in the back of our ambulance, their perception of the communication provided by their caregiver, and the degree of pain relief administered. We will continue to focus on such key drivers with the aim of constantly improving the patient experience while in our care.
100% 90% 80% 70%
68%
68%
68%
69%
70%
71%
FY '09
FY '10
FY '11
FY '12
FY '13
FY '14
68%
63% 60%
54%
54%
50% 40% 30% 20% 10% 0%
8
FY '06
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FY '07
FY '08
FY '15
90%
83%
80%
78%
80%
70% 60% 50%
50%
52%
54%
FY '10
FY '11
58%
56% 43%
40% 30% 20% 10% 0%
FY '07
FY '08
FY '09
The stakes don’t get any higher than when one of our teams responds to a patient in cardiac arrest. The science behind successful cardiac arrest survival is becoming increasingly clear, and the research that Medic has conducted to help drive improvement in this critical area has led to unparalleled performance.
FY '12
FY '13
FY '14
FY '15
Medic is among the top 1% of EMS Agencies in the country in terms of patient outcomes with cardiac arrest victims. Simply stated, there is nowhere else in the country you would rather be if you or your family member were going to suffer an episode of cardiac arrest.
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Rapid diagnosis and treatment at a cardiac catheterization lab is crucial when experiencing a heart attack. As the heart is deprived of oxygenated blood, tissue begins to sustain permanent damage. The faster a blockage is treated, the more likely it is that a patient will fully recover. It is with this knowledge that Medic focuses on two key measures relative to the treatment of heart attack victims. The first is the degree of accuracy with which blockages are diagnosed by Medic’s clinicians. The second is the total elapsed time from phone pick up in Medic’s 911 Call Center to 10
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treatment in an approved catheterization lab. If performance in these two areas is at or above the Agency’s targets, patient outcomes will be positively impacted. Medic’s time to treatment for heart attack victims is among the fastest in the entire country, greatly outperforming published national standards. This would not be possible if not for the strong relationships and collaboration Medic enjoys with both area hospital systems and their affiliated cardiologists.
100% 90%
91%
87%
88%
86% 86%
80%
81%
82%
70% 69% 60% 50% 40% 30% 20% 10% 0%
FY '08
FY '09
FY '10
FY '11
FY '12
FY '13
FY '14
FY '15
96:00 84:00
86:46
82:57
72:00
84:52 80:08
78:55
77:28
79:07
78:34
60:00 48:00 36:00 24:00 12:00 0:00
FY '08
FY '09
FY '10
FY '11
FY '12
FY '13
FY '14
FY '15
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Medic is a Joint Government Agency formed through an agreement between Mecklenburg County and the Charlotte Hospital Authority. As such, Medic serves at the pleasure of the Mecklenburg County Manager’s Office, the Board of County Commissioners, and the Agency’s Board of Commissioners. Medic is not operated with the goal of producing a profit. The Agency is, however, tasked with operating in a fiscally responsible manner and within a set budget each fiscal year.
In FY 2015, Medic operated under an overall budget of $51,838,393; of this amount, 24% was provided through county funding ($12,430,000). The remaining funding was generated by Medic primarily through the collection of fees for service and grants. Medic successfully operated Mecklenburg County’s EMS system within this budget while managing a call volume increase of 8% for the year.
FY 2015 Revenue Encumbrances for 2014 Assigned Fund Balance Total Available FY 2015 Expenditures FY 2015 Encumbrances Total Spent Excess Revenue vs. Expenditures Excess Revenue vs. Expenditures, Percentage Unassigned Fund Balance Assigned Fund Balance
$50,949,673 $4,165,370 $1,500,000 $56,615,043 $51,688,130 $2,562,770 $54,250,900 $2,364,143 4% $1,502,956 $7,352,032
FY 2014 & FY 2015 City/County Funding
CFD $108M
CMPD $215M
Medic $12M
Total Budget (City/County) Total Budget Percentage Population Per Capita Tax Funding Per Capita Cost
$2.1B 5% 797K $136 $136
$2.1B 10% 797K $269 $269
1.5B 0.8% 1.1M $12 $49
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$500 $450
$429
$400 $350 $300 $250 $200
$332 $287 $234 $218
$209
$230
$198 $204
$202 $203
$209 $211 $174 $180
$150
$182 $123 $143
$100
$132
$50 $-
FY '97 FY '98 FY '99 FY '00 FY '01 FY '02 FY '03 FY '04 FY '05 FY '06 FY '07 FY '08 FY '09 FY '10 FY '11 FY '12 FY '13 FY '14 FY '15
The cumulative impact of healthcare reform has yet to be fully understood. What is abundantly clear, however, is that healthcare costs continue to grow while the level of reimbursement being afforded to healthcare providers continues to decrease. In light of these facts, Medic leadership continues to work to find ways to deliver the quality of care expected in this community in the most cost effective manner possible. Through the years, im-
provements have been made to system deployment techniques, unit hour utilization, scheduling patterns and service demand prediction, to name a few. This ongoing commitment to process improvement has yielded efficiencies that can be best seen through the county funded cost per transport figures displayed on the above chart. The County funded cost per transport in FY 2015 was $123, setting a new benchmark for Agency efficiency.
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PAPERS IN REFEREED JOURNALS Hauck M, Studnek JR, Heffner AC, Pearson DA (2015). Cardiac arrest with initial arrest rhythm of pulseless electrical activity: do rhythm characteristics correlate with outcome? American Journal of Emergency Medicine. July; 33(7)891-4. Asimos AW, Ward S, Brice JH, Enright D, Rosamond WD, Goldstein LB, Studnek JR (2014). A Geographic Information System Analysis of the Impact of a Statewide Acute Stroke Emergency Medical Services Routing Protocol on Community Hospital Bypass. J Stroke Cerebrovasc Dis. Nov-Dec; 23(10):2800-8. Asimos AW, Ward S, Brice JH, Rosamond WD, Goldstein LB, and Studnek JR (2014). Out-of-Hospital Stroke Screen Accuracy in a State With an Emergency Medical Services Protocol for Rout ing Patients to Acute Stroke Centers. Annals of Emergency Medicine. Nov; 64(5):509-15. Infinger AE, Vandeventer S, Studnek JR (2014). Introduction of performance coaching during cardiopulmonary resuscitation improves compression depth and time to defibrillation in out-of-hospital cardiac arrest. Resuscitation. Dec; 85(12):1752-8. Infinger AE, Studnek JR (2014). An assessment of pain management among patients presenting to emergency medical services after suffering a fall. Prehospital and Disaster Medicine. 2014 Aug; 29(4):344-9. Schenfeld EM, Studnek JR, Heffner AC, Nussbaum M, Kraft K, Pearson DA (2014). Effect of prehospital initiation of therapeutic hypothermia in adults with cardiac arrest on time-to-target temperature. Canadian Journal of Emergency Medicine. Aug 1;16(0):26-33.
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Thanks to a $900,000 grant awarded in September of 2013, Medic is currently collaborating with the Houston Fire Department and Milwaukee County EMS on research aimed at improving prehospital care administered to pediatric patients.
The outputs of this collaborative will be submitted to the Pediatric Emergency Care Applied Research Network (PECARN), which will then analyze and recommend changes to prehospital care for pediatric patients across the nation.
These three Agencies were chosen to work on the initiative due to the size and scope of their respective areas of service combined with their robust history of conducting successful EMS research projects, inclusive of randomized clinical trials.
The trio is currently engaged in research aimed at assessing barriers to pain management in pediatric patients, alternative pain management therapies, alternative therapies for managing seizures in children, and the development of a prehospital decision aid to help identify severely ill patients.
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High frequency users of the 911 system who do not have emergent needs are a challenge that has plagued EMS systems over the years, Medic included. In 2014, having sized up the Agency’s issues and its impact to the healthcare system as a whole, Medic leaders began reaching out to community stakeholders to see if there was a shared interest in collaborating on a solution in the greater Charlotte area. As it turned out, the shared interest was wide spread and strong. Since this time, Medic has been working closely with several key community partners including Cardinal Innovations Healthcare Solutions, Charlotte Housing Authority, Urban Ministry Center, Community Care Partners of Greater Mecklenburg (CCPGM), Centralina Area Agency on Ag-
ing, Community Support Service of Mecklenburg County, Novant Health, Carolinas Healthcare System, and the Department of Social Services. Together, this collaborative has developed processes for identifying frequent users, ascertaining gaps in care and helping these individuals get the appropriate support they need. The program is still young, but the early returns are very promising. Several frequent users of the system have been redirected to appropriate care and support systems that have either significantly reduced or eliminated their reliance on the 911 system for non-emergent issues completely. This program will continue to develop in the coming year with the goal of helping these patients find the support they need.
100 90 80
76 71
75
TOTAL TRANSPORTS
70 60
55
53
50
42
40 31 30
22
20
16
14
10 0
-4
-3
-2
-1
0 1 INTERVENTIONAL PERIOD
2
3
4
5
This chart represents the number of monthly transports of ten high frequency users before and after intervention.
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In the simplest sense, values are a person’s principles – what they hold as important in life. The type of work we do at Medic clearly draws people who hold a very similar set of values or this Agency would not be as successful as it is. Values like compassion, integrity, and accountability run deep at Medic, and they show up every day in numerous ways across the Agency. By keeping the Agency’s core values in mind when making decisions and building plans for the future, we are assured that we will not only achieve the Agency’s mission, but we will do so in the right way.
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The people who choose to work at Medic are the reason why this Agency is such a special place. They are caring, passionate, committed and reliable. They know the importance of their work in this community and the impact they make on people’s lives each day. Though very rewarding, a career in EMS is also quite challenging to both the mind and body of a caregiver. It is for this reason that Agency leadership is always trying listen to the needs of its people, in search of ways to make Medic the most enjoyable and supportive work environment possible. Employee satisfaction surveys are conducted on a monthly basis and shared with Agency leader-
ship quarterly for in-depth follow up and engagement. This process has yielded very useful input that has directly led to several initiatives including better processes for gathering employee input on improvement projects, more frequent communication from Agency leadership relative to ongoing projects, and a project aimed at providing more accessible communication tools for on duty field personnel. Medic is all about people; the people who work here and the people we collectively serve. Meeting the needs of both of these groups is of paramount importance to Agency leadership, which is why we remain committed to the focus required to achieve this goal.
90% 80% 72%
75%
76% 78%
75%
74%
70% 70% 60% 50% 40% 30% 20% 10% 0%
FY '09
FY '10
FY '11
FY '12
FY '13
FY '14
FY '15
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Several members of the Medic community were recognized this year for their outstanding service and dedication to the Agency’s mission. STARS OF LIFE Three Medic employees were honored this spring in Washington D.C. as “Stars of Life” recipients. Each of the three were nominated by their peers for this prestigious award and stood out among 34 other nominees. Medic Paramedics Allison Brinzey and Hillary Ramsey and Paramedic Relief Operation Supervisor Anthony “Scottie” Carriker joined EMS personnel from across the nation for three days of workshops, team building and meetings with congressional representatives on Capitol Hill. BURNETTE NOBLES Each year the Charlotte Association of Insurance Professionals recognizes area first responders for their work and commitment to the community. The award is named after fallen CMPD officers John Burnette and Andy Nobles, who were killed in the line of duty in 1993. Paramedic Kariena “KC” Bernesser was Medic’s honoree this past spring. Among her many efforts to help protect this community, KC trains with the Bomb Squad and its technicians and volunteers to train K-9 dogs for search and rescue missions. UNSUNG HEROES Medic is a very complex organization that requires the collective work of many to be successful. This Agency is blessed with numerous leaders who stand out from their peers as they visibly lead the way. Then there are those silent leaders, whose work is paramount to the Agency’s success even though they are far more comfortable letting their work speak for itself; they are Medic’s Unsung Heroes. This year’s recipients of the Unsung Heroes Award are Paramedic Crew Chief/Education Specialist Malcolm Leirmoe, Paramedic Crew Chief Anne Pentland, and Quality Improvement Analyst Allison Infinger. TOP CALL This year’s Top Call award went to Medic Telecommunicator Dominic Taylor. Dominic’s calm demeanor and quick thinking while faced with a very challenging set of circumstances ensured 18
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a positive outcome for a mother who was giving birth in the back of her car in a dark parking lot on a rainy evening. On top of the difficult setting and stressful circumstances, Dominic also faced a language barrier with the initial caller. Thankfully a bystander stepped in who was able to communicate with Dominic and follow his instructions, aiding the mother in birthing the child. Once the child arrived, a new problem quickly arose that no one could see due to the dark conditions; the baby’s umbilical cord was wrapped tightly around its neck. With the baby in distress and no clear reason as to why, Dominic quickly asked the caller to use the flashlight feature on her cell phone to better assess the situation. She did so and immediately recognized the problem. Dominic talked her through instructions for safely removing the cord and the baby’s condition immediately improved. Both mother and child were safely transported to an area hospital and went on to make a full recovery. MEDAL OF VALOR The 2015 Medal of Valor was awarded to Paramedic Crew Chief Marie Hildreth. This past summer Marie was vacationing with her family on Oak Island, NC, when screams swept over the beach. A child had been seriously bitten by a shark in the waters right outside her house. Marie and her family members quickly ran to the girl’s side to see if they could help; what they found was shocking. The young girl’s arm was amputated just below her elbow and one leg had also been badly bitten. Both extremities were bleeding profusely and the girl was slipping into shock. If immediate care was not rendered, the girl would likely bleed to death before area Paramedics could arrive. Marie quickly fashioned two make shift tourniquets out of cords she cut from a nearby boogie board and tent. She applied the tourniquets to control the bleeding and then worked to keep the girl calm until the EMS team arrived. The girl’s condition stabilized and she was successfully transported to an area hospital where she received additional care. Thanks to Marie’s quick thinking and selfless intervention, the 12 year old girl survived this horrible ordeal that nearly took her life.
DISTINGUISHED SERVICE AWARD Operations Manager Bob Francis has been with Medic for over 37 years. As the Agency’s most tenured employee, he helped build Medic from the ground up. As Bob progressed from Paramedic Crew Chief to Operations Supervisor to Operations Manager, Bob positively influenced the de-
velopment and careers of hundreds of caregivers over the years. In addition to his vast EMS experience, Bob is widely respected by his peers for his candor, integrity and loyalty. To a person, there is no doubt that Bob’s career is befitting of the Distinguished Service Award. medic911.com
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The commitment to the community by Medic employees extends well beyond emergency response and care. Helping the people of Mecklenburg County stay safe, healthy, and prepared to handle a medical emergency are equally important cornerstones of the service we provide. Each year, Medic invests thousands of hours back into the community through events like CPR training, AED use and placement guidance, pool safety education, health screenings, and various educational programs aimed at children in our school systems.
impact on such patients. It is for this reason that Medic has worked to train thousands of community members in hands only CPR over the years. LUCKY HEARTS Another vital piece of Medic’s community work is with its Lucky Hearts Campaign. In FY 2015, Medic donated its 117th Automatic External Defibrillator (AED) to a local church. Medic caregivers also provided CPR and AED usage training to over 50 church members as part of the donation.
The most visible impact we see from these engagements occurs with sudden cardiac arrest victims. Immediate administration of bystander CPR is one of the most critical factors that will have a positive
45% 40%
40% 38%
35%
42%
40%
FY '14
FY '15
39%
31% 30% 25% 23%
20% 15% 10% 5% 0%
FY '09
FY '10
FY '11
FY '12
FY '13
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Medic is a Joint Government Agency formed through a partnership between Mecklenburg County and the Charlotte Hospital Authority. The Agency is governed by a Board of Commissioners comprised of three members each from Novant Health and Carolinas Healthcare System, along with one representative from the County Manager’s Office. All Agency BOARD OF COMMISSIONERS • Tanya Blackmon - NH • Mark Foster - MC • Matthew Hanley, MD - CHS • Katie Kaney, Vice Chair - CHS • Dennis Phillips - CHS • Amy Vance, Chair - NH • Tom Zweng, MD - NH
MANAGEMENT COMMITTEE VOTING MEMBERS • Carol Hickey, Chair - MC • Katie Kaney - CHS • Amy Vance - NH
board members are appointed by the Board of County Commissioners. The Agency also receives oversight from a Medical Control Board and a Quality Management Committee. The members of these two groups are appointed by the Agency Board of Commissioners.
AGENCY OFFICERS • Joe Penner, Executive Director • Doug Swanson, MD, Medical Director • Shelly Forward, Finance Manager
MEDICAL CONTROL BOARD VOTING MEMBERS • Carlene Kingston, MD - NH • Mike Gibbs, MD - CHS • Scott Alter, MD - CHS • Gary Niess, MD - NH NON-VOTING MEMBERS • Greg Clary, MD - P /NH • Joe Penner, Executive Director • Randolph Cordle, MD, Chair - • Barry Bagwell, Deputy Director CHS • Marcus Plescia, MD, Medical Di• Peter Fischer, MD - CHS rector, MC • Sid Fletcher, MD - NH • Kevin Staley, Deputy Director
NON-VOTING MEMBERS • Joe Penner, Executive Director • Doug Swanson, MD, Medical Director NON-VOTING MEMBERS • Shelly Forward, Finance Manager • Joe Penner, Executive Director • Doug Swanson, MD, Medical Director • Tracy Forster, NH FINANCE COMMITTEE • Jon Hannan, City of Charlotte VOTING MEMBERS Fire Department • Bill Lyle, CHS • Jason Schwebach, CHS • Carol Hickey, MC • David Leath, Mint Hill Volunteer • Melissa Masterton, NH Fire Dept • Marcus Plescia, MD, Medical Director, MC • Community Representative NON-VOTING MEMBERS • Shelly Forward, Finance Manager • Joe Penner, Executive Director
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QUALITY MANAGEMENT COMMITTEE VOTING MEMBERS • Doug Swanson, MD, Medical Director • Mike Gibbs, MD - CHS • Jason Mutch, MD - NH • Stuart Ramsey, RN - NH • Suzie Rakyta, RN - NH • Eric Hawkins, MD - CHS • Gary Niess, MD - NH
MEDIC LEADERSHIP TEAM • Joe Penner, Executive Director • Doug Swanson, Medical Director • Barry Bagwell, Deputy Director • Kevin Staley, Deputy Director • Jeff Keith, Deputy Director • Jon Studnek, Deputy Director • Shelly Forward, Finance Manager
LEGEND
Mecklenburg County (MC) Carolina Healthcare System (CHS) Novant Health (NH)
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4525 Statesville Road Charlotte, NC 28269 p. 704-943-6000 f. 704-943-6001 medic911.com 24
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facebook.com/MeckEMS
@MecklenburgEMS