US Report on Characteristics & Challenges of Rural Ambulance Agencies 

By Robbie MacCue

In this report was published by the The Rural Policy Research Institute (RUPRI) is a national policy research organization with a mission to: (1) undertake unbiased research and analysis on the challenges, needs, and opportunities facing rural America; (2) improve the understanding of the impacts of public policies and programs on rural people and places, using original research and policy analysis; and (3) facilitate dialogue and collaboration among the diverse community, policy, practice, and research interests focused on a sustainable rural America. This report was supported through a cooperative agreement with the Federal Office of Rural Health Policy. 

Written by RUPRI Panel Members Clint MacKinney, MD, MS (Lead Author) and Keith Mueller, PhD, Andrew Coburn, PhD, Alana Knudson, PhD, Jennifer Lundblad, PhD, MBA, Timothy McBride, PhD. 

These statistics and recommendations should be used to educate elected officials and to advocate for expanded funding from local, state, and federal government for improved equity with regards to training, equipment and staffing. The report is summarized in this brief. The full 17 page report can be found here.

In light of this incredible news, and as a special gift, we're sharing our recent EMS Leadership Summit interview with Aidan O'Connor who passionately and eloquently explains how we can all be advocates in his talk: The ABCs of Change (Advocacy Before Complaining).

Join a national association and formulate a plan within your agency to help educate your local elected officials on the importance of this study.

As Aidan said, "Go Forth and Advocate".

Full Interview Transcript

Robbie MacCue (00:01):
Welcome everyone. We are here on the final day, day three with Aidan O'Connor jr. Aidan, thanks for joining us.

Aidan O'Connor (00:09):
Thank you so very much. What an innovative conferences!

Robbie MacCue (00:12):

Yeah, thank you. Thank you. For, for all the people watching. We are, we are excited to wrap up three days talking about leadership at the level of self, at the level of teams within your organization. And day three, a lot of the topics are around leadership externally with your organization and in the community and in government. And I couldn't think of a of a better speaker to talk about advocating for in government and to bring this information forward and Aidan's Oh eight and thanks again for being here, for putting this great presentation together and I'm excited for people to to watch us.

Aidan O'Connor (00:51):

Nah, thank you so very much. And I hope people enjoy the title. ABC is a change. Anyone in EMS should understand that and we're calling it instead of airway breathing, circulation advocacy before complaining. So this is going to be nonpartisan. I know sometimes when we talk about politics and we talk about government they could automatically simulate, you know, back to party. Politics is going to be nonpartisan. It's going to be all about helping our profession and it's very near and dear to me as you mentioned being somebody who was in public office and is still an operating as a paramedic. I believe strongly that any EMS leader currently or somebody who strives to be an EMS leader must advocate for our profession, for our patients and for our colleagues. So we'll jump right in if that's good with you.

Aidan O'Connor (01:33):

Absolutely. All right, so nice to digitally meet all of you. I wanted to give you some background the fact that we're going to speaking back and forth for a little bit. I started, like many of us did as a volunteering EMT. I went on to become a paramedic at a very young age. I was able to become a paramedic at 20 years old, so I couldn't even celebrate at the local pub with my student, my fellow colleagues at SUNY Cobleskill at the time. And from there I saw that there was a lot of things that we could do to make things better. So I quickly became sheriff, our local EMS council, striving to make some changes, bring us back into the 21st century. I became the national association EMT advocacy coordinator. So I've attended many days on Washington in Washington DC and it all made New York advocating for bills and legislation that would make EMS a better place to work better for our patients.

Aidan O'Connor (02:22):

I became president of a County wide, not for profit. And that's really what brought me into advocacy realizing just how much we needed, try both on the local basis, on the state basis, on the federal basis, and we're going to discuss on the global basis. I then entered into public office got elected to our County legislature. I became minority leader in sheriff health services there. And last year in 2018, I ran two bids for New York state assembly. We wanted a special election and won a general election. So a whole mixture of EMS, some EMS leadership, and some public office. And we're going to combine all of that today to give you a quick synopsis on what advocacy looks like. And that'll go right into today's discussion. So long story short, complaining is worthless. Advocacy is priceless.

Aidan O'Connor (03:10):

We've got to advocate we're going to talk about lobbying. And I use the phrase, don't hate the player, hate the game. Because I know some people instantly hear lobbying may affiliate with government and they don't want to discuss it. We are going to discuss it here today and how important that is in the advocacy process. As a leader, I cannot try this enough. If you're not advocating on a daily basis you, you are not being the true EMS leader you could possibly be. And if you strive to be an EMS leader, advocacy's gotta be on your fundamental values. So I will show you today how as a, as a leader you could advocate. And then also all of us, we try to inspire our teams. We try to lead our teams. So I'm going to show you a little bit how your teammates can get involved right away.

Aidan O'Connor (03:52):

The second you've done with this video here today, so advocacy, what is it? The easiest way to define it is right from Western Webster dictionary. And that is the act or process of supporting a cause or proposal. I, I purposely made act smaller because it truly is a process. You know, some people refer to it as it's not a race, it's a marathon. It's something that we start every single day. Sometimes we have a goal, sometimes we have a finish line, and sometimes it's never going to have a finish line. We just keep on going and it's triathlon and we hand it to the next person and they continue on for legacy. And the important thing is who do we advocate to? What do we advocate for? When do we advocate? These are all questions I hear every day. Hey, when I'm out talking to different EMS associations, leadership and just basic EMT, paramedics who want to get involved.

Aidan O'Connor (04:43):

So we'll start with the first bullet. What do we advocate for every single day when we go to work or we were volunteering for our shift and we respond to a call, we're advocating for something. We're advocating for safety on the way to the call. By the way that we behave by the way that we're thought process works. And we also advocate for our patients. Once we get there, somebody who we don't know, we instantly have empathy for, we instantly want to strive to make them better. We advocate for them. And this particular session I'm gonna talk mostly about how do we advocate to government? How do we advocate to our public officials? So what do we advocate for? I'll give you an example. We, he had a devastating house fire and a local level which had fake calories involved.

Aidan O'Connor (05:25):

We instantly, within a few hours advocated to say we need certain medications. We need certain funding to make sure that we could, to buy things like Sino kits that are very expensive. We advocate for things that we feel as though will improve one of those things, our profession, our patients. And our colleagues. So those are all things and there's probably a thousand things that each one of you could think of today that you could advocate for. But then who do we bring that to? Right? That's the next question is who do we advocate to? We advocate to anyone that could change the change makers on many levels. That's usually the people who are publicly elected in office. So whether, and I know this is international, so I'll use terminology back and forth. It could be town County officials, it can be parliamentarians, it could be state representative, federal representatives.

Aidan O'Connor (06:15):

We bring that to them. And it could be as simple as our message that's usually tied to a story that's very empathetic to be able to go to them and say, this is what you're elected [inaudible] to do and here's your constituents. And we do it in a kind politically correct way. And again, bipartisan, nonpartisan to do so. And there's even days that are, are, are associated every year on your local level, on your state level, on the federal level where you can go along with side of your colleagues, whether they're volunteers with their paid staff, by air, air, medical nurses, associations. We all come together on certain days every year and go to our capital's, whether it's an Albany for me, where I live in New York state or Washington D C, which is called EMS on the Hill day. And we can go and we talk to those individuals, whether it's the office staff of a representative or the representative themselves.

Aidan O'Connor (07:05):

We lay out an agenda that we have. We lay out a quick, clear, concise message of what we want and why we want on it and leave them with that personal story, that personal connection thereafter. When do we have in Kate, I shared that we do it every single day. You will not be able to go to EMS on the Hill day in Washington DC or your annual day that you visit your, your state Capitol or wherever you are in the world. It won't happen in one day. You've got to go to your local town board meetings. You've got to show the community, go to community events, set up a booth, because you don't want to surprise them and teach them on the day that you're visiting. You want them to be able to say, Oh yes, I saw you at the fair. I saw you at that local event.

Aidan O'Connor (07:45):

I saw you in the letters to the editor. I saw it in the newspapers. That ongoing advocacy is just as important as showing up to the Capitol that day with your agenda in hand. And where do we advocate? We, we mentioned that there's so many places, but it really is, and you'll hear this slogan a lot is all government. All politics is local and edit. It's got to start at that process. You've got to have the people who you're serving, the people who are, are in your community. They've got to have your backs first and foremost. So where do we advocate? It could be the blood pressure clinic outside the grocery store. It could be going to the local town board meeting, County board meeting, teaching them how to do CPR. You get to literally at any moment in time when you're on a call talking to a patient, after the patient conditions are done, the assessments are done.

Aidan O'Connor (08:31):

Feel free to give them a quick briefing of who you are, what you do, what inspires you, and, and leave them with that personal connection thereafter. So when they leave, they're advocating on your behalf as much as you are advocating on behalf of the profession. And what does it cost to advocate? Most of the time it costs $0 million for your organization. Cause it's all about the cultural shift of it. It's, it's a matter of making sure your, your employee employees or your volunteers, anyone within the profession has that perspective to say, make sure this is who you can talk to, how we can get involved. A blood pressure clinic costs nothing. A letter to the editor costs nothing. A CPR class a what? Especially if someone is hands only CPR costs nothing. So for the most part it costs very little. And for the big days like EMS on the Hill on a federal level or visiting your state Capitol or your parliament. Those are are, are usually taken on by the association. And we'll talk about how important it is to be part of an association here today.

Aidan O'Connor (09:28):

So one of the things that we we lobbying you know, sometimes lobbying can be a bad word but it does go hand in hand with advocacy. So advocacy when we defined it was purely going after a subject or topic that you need. And it's usually verbally done it and it's done by just meeting with one person and sharing that story. Lobbying on the other hand, same exact concept. You're striving to get something, you're trying to share something with somebody, but it usually has to do with the financial gain of some sort. So I'll give you an example. I was elected office for three years. If somebody came up to me off the side of the road and handed me a hundred dollar bill and said, "Aidan, I want you to take this and go and pass legislation that's going to benefit EMS", that would be blatantly against the law and Aidan would be arrested and you'll not see me again ever again.

Aidan O'Connor (10:14):

At an EMS Leadership Academy seminar, but lobbying is an in between entity usually known as lobbyists. And they could actually take certain money and they will help distribute it through political action committees through various unions and they're individuals who that's what they do, day in and day out. We go take care of patients. We're almost experts at blood pressures, IVs, intubation . These are individuals who know these elected officials. They can wish them a happy birthday, their kids' birthdays, hnd they spend more time with them on a daily, weekly basis. And we spend only one day a year with them. So what do we lobby for? The same exact things that we talked about before, hut this time and usually emphasize with a little bit of backing of money or you're hiring a firm that allows you to have more access to them and more education time with them.

Aidan O'Connor (11:04):

Every elected official around the world only has a little bit of time every year for every single entity that's in a convenient, if you think about everything that goes into making a community, paving roads, growing trees, keeping the water clean, garbage removal, fire trucks, electricity, everything. They only have a few minutes per a year for you to come in and educate them quickly and tell them what you need to pass. These are individuals who get that extra little time and that bonus round makes a huge, huge difference. So we lobby for the same things. We lobby to the same people as we do when we advocate for the costs of lobbying is where it is. And we're going to show you the next screen here is fairly large. When it comes to money, this is the top 10 industries from open secrets.org, and this is in the millions and millions of, so you'll see that pharmaceuticals hit the number one, 2018 is industries who lobbied spending over $280 million on lobbying a year.

Aidan O'Connor (12:03):

And insurance right thereafter electronics and manufacturing equipment. You'll see everything from oil and gas to real estate to manufacturing. And usually this fits what's going on on the national level. And it could even be in your country. Same thing as the things that you hear the most about are things that are being lobbied for the most because they're the most of the amount of time being spent with any elected official to sway their concepts this way. Their ideas, and this doesn't have to be just in favor of a bill that you want to be passed, is also if you have a bill that you heard that you don't want it to pass and you want to prevent from passing there. The number one thing I hear when I go out and I talk to EMS leaders throughout the country and say, make sure you're advocating for your funding that you need is I get a big common misconception and that is "Aidan, my town, my state, my government has no more money. "

Aidan O'Connor (12:54):

They can't collect any more money. I'm here to tell you they already collect them money. Even if you don't want to increase taxes ever again, they already collect money so that we all have a pie and it doesn't matter of who gets a slice to that pie and how big of a slice we get. And I'm telling you it. And you'll see health products and pharmaceuticals aren't one, but you don't see EMS on this list. And you'll very, very rarely ever on a state list see lobbying as EMS even meet the top of the 100 lobbying topics for the year or industries for the year. So I'm, I'm here to tell you, yes, it is possible without raising taxes to go and make sure that the allocation of funds that are currently being set aside come to EMS, come to your organization, come to our profession. It happens. And this is proof to the pudding that it happens in industries. I don't recommend spending 280 million this year, but certainly something is better than nothing for sure in that. Yeah.

Robbie MacCue (13:48):

Aidan. I'd love to interject on that last slide and really to your point people may have heard the phrase all politics is local. So, so when you're talking about advocating at the local level where most organizations have municipal based funding, that's local set at the local level and budgets. And I think back to my experience in being the president of a nonprofit ambulance service and, and working with the local town board and the town supervisor and educating them. These people are generally elected to a position and they're not, they're not all knowing of every intricacy. They have to understand the reason behind why ambulance services bill to offset tax revenue and what the real cost of services would be. Uand I think for me it was a high point experience,uof, of that,uover probably 10 years of, of every year going down to the, to the town board workshop meeting before a town board meeting, educating these elected officials to the point where when a constituent or a public person would come to the town board meetings and ask a question, they were just as knowledgeable and could almost answer the question, "What's the difference between a paramedic and EMT" and "why should we invest in having paramedics in our community?"

Robbie MacCue (15:06):

And to see them reiterate the facts over the years because we've educated them. "Would You like to breathe through a bar straw for the next 40 minutes waiting for a paramedic" "that they bring the emergency room to your living room and they can do a bedside EKG and bypass the emergency room and get you up to that, to clear that blockage". So to hear these elected officials, it really paid off again educating people at the local level who are controlling the budgets. And we doubled the funding from our municipality because of those educating on the cost of the services and really breaking it down to the smallest number and saying that "it costs more for a month of cable than a year's worth of ambulance service in this town" to, to have paramedics and just bringing it down to the smallest possible numbers. And, and it really does pay off over time to have those elected officials get behind your ambulance service. So, yeah,

Aidan O'Connor (16:05):

That is a perfect story because it really is that work up to it, whether it's attending the meetings, educating your public officials, going right up to the point of showing that and what it costs. And, and I will say a story that that's similar to your mirror image. Yours is I, while in the County legislature we caught hands only CPR and how to use an AP to the 14 legislators. And I was hoping to get a few eighties automatic external defibrillators for my community and the legislators were so fascinated with how simple it was and how productive it is when it works and when it works quickly that we purchased before I left over 30 new ads for the community. We were putting them in gas stations and restaurants and they thought it was the coolest thing ever. So just like you said, sometimes it's, it's the, the truly new local smallest than you think you could do, makes the biggest impact.

Aidan O'Connor (16:54):

And for anyone who's out there that is looking at this and says, well, you know what, you haven't met my public official. They don't care anything about saving lives or about EMS. I'll tell you this too. You mentioned it Robbie and I, and I failed to mention it before, is if they don't have that empathy of saving a human life and, and truly rendering prehospital care to somebody, put it into numbers, show them just at what one taxpayer having a resuscitation successfully brought to the hospital, then brought home from the hospital and pays their real estate tax again. And pays income tax for them, showed them the number. You know, our, our small community had six reversals in one year, six times a, an average property tax of $5,000 plus 30% income tax and federal tax out of their paychecks. That's a hefty amount of money that you could show them, Hey, even if you want to be fiscally conservative, here's a way to make sure it continues to happen and more taxes get paid.

Robbie MacCue (17:48):

And what you mentioned with empathy,

Robbie MacCue (17:50):

It, it is very, very important. And my, one of my greatest friends would tell me that the, it's the emotionally connecting stories. And so some people are moved by the numbers and are purely by the numbers and don't want to hear the stories. The other half of people or the other part of most, most elected officials, they want to hear the stories. They want to hear about the, the fact that they're, that because of that cardiac arrest save that there are two children, ages four and six didn't have to go to their mother's funeral, that they got to celebrate Christmas together. And they get to grow up as, as a tight knit family together because somebody had an add, somebody new CPR, we had paramedics there within minutes. We invested in mechanical CPR devices and we had such a good outcome.

Robbie MacCue (18:35):

So, so I think it's both a combination of bringing the stories, bringing the empathy, bringing and having those numbers and being able to, to just bring up the actual numbers is so important.

Aidan O'Connor (18:49):

Absolutely. And that's the beauty of our profession is not only do we have those empathetic stories that are very heartfelt, but we also have the numbers. So no matter who you talk to, we have a message that you can give that is going to resonate with somebody. For sure. Thank you very much for that, Robbie. That was great. This is personally my favorite slide. That that really gets into the fact that if, if you are somebody who is leading an EMS agency each one of these applies to you you know, budgets and we're all responsible for a budget or have been responsible or will be in our, in our leadership roles.

Aidan O'Connor (19:23):

And, and none of us are sitting there saying, we have too much money. I've never heard a name as leader. Say I have too much money. I don't know what to do with it. And typically what we look for is we'd go and we educate our local officials. We have contracts that get signed or we have some sort of reimbursement scale. I can tell you grants are very limited for EMS and every place in the country and around the world. So the more we can do to advocate for grants, to find the ones that are out there, and if they're not grants accessible to you, create them. That's the other thing I hear people all the time say, well, Congress doesn't open up grants for us. The state doesn't open up grants for us. Okay. With develop a grant process, find out where those funds could come from in the budget, do all the background work for them, and then present it to your local representative.

Aidan O'Connor (20:07):

Say, here I found a new Avenue for grants, or create a new grant in memory of somebody. And that's another one. Another empathetic pull the account on. Somebody. Government reimbursements are incredibly low. Uif you have anyone who's doing accounting or billing for your agency, you know that the significant well over the majority, usually typically high as high as 70% of the patient population that we see are in government and assistance of some sore and they only pay for less than 30% of the total costs of doing that call or operating budget. This is one of the most key components that we have. And not just for tomorrow's bill, not for tomorrow's call, but we got to see these projections based off of age of our residents off of the aging expectancy of, of the number of residents or is it influxing in decreasing increasing government and reimbursements can either make or break an organization locally.

Aidan O'Connor (20:59):

We've had two EMS organizations to close their doors, both very high in Medicaid and Medicare populations to have said if the reimbursement's up, we would have our doors open, but we cannot afford to keep doing EMS. And they literally closed their doors and their citizens how to find a plan B private insurance the same way. You saw in the last lie insurance was in the top 10 investments in the lobbying in 2018 and we've had it on a local level. I've been to the state Capitol in I and said, you know, we have these bills that would improve EMS reimbursement tomorrow morning if you, if you passed it. We've done it for seven years. And yeah, and I'll, I'll tell you, a personal story. Legislator came to us and said, look, I love what EMS does. You know, I'm at every pancake breakfast, every CPR class you have.

Aidan O'Connor (21:44):

But the health insurance lobby is too strong, too powerful. They have too much of a motor block for me to go against them. So I will never pass it. This bill will never pass in our state legislature. And still to this day, nine years later, it has not. So, you know, again, we've got to continue. We've got to have, we've got to come together and build coalitions between ourselves, between the nurses union, between the fire unions and associations and come together and really show them this is going to make it better because legislators at the other day, they do have to worry about money when it comes to reelections and they do have to worry about voter blocks. And we need to unite to become one big ginormous voting block unfunded mandate to something that you hear from your, when you go to your elected officials and anything we could do to offset those unfunded mandates and find other avenues of income, the better we can be, a safety standards, something that we don't think enough about.

Aidan O'Connor (22:37):

I was appalled the first time I went to a demonstration of an an ambulance accident through a demo and seeing how as easy as a stretcher prior to electric stretchers and self-loading stretchers more than 15, 20 miles an hour, the structure was coming undone and was most likely going to harm or kill both the patient and the person in the back and provided in the back. And I said, well, Whoa, why aren't we, why, why is this not mandated that every ambulance company does this? Why are we not, you know, looking at stretcher solutions that are upwards of 55, 60 miles an hour. And they said, "it's not a standard. It's not something that's ever been promoted." so as simple as that to say, look, you know, we see what the issues are we're learning about the issues are, let's turn that into some sort of standard.

Aidan O'Connor (23:22):

We have to do, we're always looking at whether you're for or against, and again, we're going to keep this very nonpolitical employer volunteer restrictions when it comes to sleep deprivation. When it comes 24 36 hour shifts. These are topics that are swirling around the country right now. There's articles made national news. It's something whether you're for or against, again, advocacy is going to be to show up, to make sure you have the data focus and data have that education. And these are topics that are kind of come to us. We're hearing it now, the assault and mistreatment of EMS providers do. Does your state, does your country have a law right now that says that it's a felony to spit on to assault? If not, we've, you've got to advocate to your representatives to say, you know, just like law enforcement, just like fire, just like nurses, you know, we, we endeavor these same exact incidents, same it back, same exact, that instances and we need to make sure that our volunteers and our employees are safe.

Aidan O'Connor (24:21):

Protocols I mentioned before things like Cyano-Kits after, after fires video laryngoscopy people told me when I was president, my agency, they're too expensive. We can't afford it. Don't even try. Well, when we showed them the data that it increased the 20, 30% fold and said, hold your breath for 10 minutes and we'll see if you want a video versus a traditional. We very quickly got our budget that we needed for those types of things. So always look forward to that. Right now, professional development, I think there's one on a, huh. Highest stakes that we have at the moment. When we're looking across the country when it comes to wages, when it becomes to education reimbursement here in state of New York we have increasing wages for everyone in the state of New York, but we're not seeing that the real wages of EMS providers match that same growth year over year.

Aidan O'Connor (25:11):

Same thing with education reimbursement. We're reimbursing our educators back in the day the same education site and that we were paying in the 1990s. So it just isn't feasible for our profession and it's directly impact both your organization and also the patients in the future when it comes to retaining EMS providers to have institutional knowledge, institutional education. That last one there defined as a central or professional. There's bills across the country right now that are trying to say that we are a true profession. You might not know this, but there are departments in different States that will actually determine what is it considered a profession. And in many States, EMS is not considered a profession or essential. So it might be mind blowing to you. Don't worry, I find you all to be very professional, all very essential.

Aidan O'Connor (26:01):

However your state doesn't, and advocacy is the key to changing, not I've heard from people time and time again. Let's go back to complaining. They complain every day that they're not a profession or not on essential. Stop complaining. Find a way to advocate for it in a clear, concise, respectful way and deliver that to your, your local official. All politics is local. And, and Robbie mentioned this as simple as contracts every year. Having that open opportunity, even if the contract is $0 dollars, I, I'm telling you, using a contract, a paper that goes to the town board every year that guarantees you to have that conversation during renewal every year is a good thing to have, even if it's $0 dollars. Because again, you want to show up in five years when all of a sudden you do need payments and you've never talked to these individuals. They don't know anything about your organization, what you do and the calls that you've had.

Aidan O'Connor (26:52):

So try to infuse, like Robbie mentioned, that institutional knowledge and education to them. It goes a long way that in five years when you do need to start raising money they're well aware of that and share their five year plans with them. As simple as proclamations and awards. You know, the people that are on the front line who go and do great cardiac arrest reversal who go above and beyond. You want to celebrate them. And it's very nice for these providers and their families to be able to go in front of any sort of elected a group of officials and receive a proclamation and award. They could hang it on your wall. And the same thing for organization. It's a great Testament when you walk into an organization, you see a word hanging up in your mall. So another great way to advocate eight for that and general support and wellbeing.

Aidan O'Connor (27:38):

This one encompasses pretty much everything. We are out there to do the same thing. Elected officials are we're out there to take care of our neighbors together, take care of our communities and what better way, but then through pre hospital medicine to be guaranteed that whether you're driving through here, our community or you live here to know, Oh, that when you pick up the phone, you're going to have people who respond to you in a quick way with the best tools possible, with the best education possible while making a living and feeling refreshed. And then you get to sleep in your bed and maybe more than once or twice a week. It means a lot. So all of this, this schematic scale, I can guarantee you if you mention it in your organization, there's a place for advocacy in it. And it's gonna make your life easier. It's going to make the life of your, your professional organization ways here.

Aidan O'Connor (28:25):

So now that you know that it's a fundamental task for you to do as an EMS leader, how do you do it? And we mentioned many of these. So these are just going to be a little take home points. Go to your local meetings. Whether they're hospital meetings inner agency, first responder meetings with your dispatch center, with fire, with law enforcement, anything. Public health is another big department. We leave out sometimes any meeting that you can go to and be at the table of, you've got to show up first and foremost before anything else could be done. The fact that you're showing up is half the battle. The other half is that education segment and showing them the right data, whether it's empathy or true science data, a statewide a 10 year association, statewide meetings. There's usually a few meetings per year that revolve around advocacy and the Capitol.

Aidan O'Connor (29:12):

And then there's one or two days per year where people all ascend on the state Capitol. They parked the animals outside. They turned on the lights, they drive Brown with their sirens on anything to make it known that they're there and advocate for what they're doing. And huge state associations. If you're not part of the state association today or your organization isn't a part of the state association, you are, you are truly, truly a at harm of and risking what the profession could be and making your job way easier. So please out there, and again, I'm not affiliated with any one, a state association. I don't get paid for membership dues at a association. They are so essential or it will show a few of those. Federal right now there's one EMS on the Hill day. It's amazing people from across the country, the national association EMT has put this on fantastic day where they meet with hundreds of, of representatives and their staff and they've made huge strides in just the last few years.

Aidan O'Connor (30:08):

Whether it's the Memorial monument that now is going to be in Washington DC for EMS providers or bills like the veterans bill where combat medics could now come back and find a much easier pathway to certification than once was. So they've had some really big wins over the years and it's purely because of the people who showed up on that day in Washington DC. And I put global on here. And I, and I know some people might go, is there a truly global advocacy now in the day and age where you're sitting through a conference that is digital that is so innovative? I'm here to tell you, yes, not only is it possible it's happening. Go to international conferences and share those ideas on social media, share good legislation that you have in your country. Bring it back to our country, our country.

Aidan O'Connor (30:54):

Bring it to other countries, you know, share that same data. If you do a small little local study that shows that TXA was beneficial during the summer hours, summer days for motorcycle accidents. Share that with another place in the country that might have that same population, that same mechanism of, of injury. And you'd be shocked at how far that goes and that has to happen. And when it comes to legislation. Now, legislation when in Australia is as successful here because we know that that at least there's been a platform, there's been precedents set and that we could potentially have that same piece of legislation passed. So we are a global community when it comes to our profession. And like any good leader, you're, you're hopefully guiding a team or at least going to have the ability to inspire and reach a team. And, and your teammates are, are everything right?

Aidan O'Connor (31:41):

They're the ones who were seen by the community the most are the ones who are actively doing the call. They usually live in the communities. They work multiple jobs. Had them be members of the local EMS council advisory boards, show up, even if it's just to give an update on what's going on. The good, the bad because the good is what we could all celebrate and share from. It's best practices. But the bad is also good or good to know because of the fact that we need to be able to say a few steps ahead had to make it not a crisis. That's always our goal is, is what can we do now to prevent that. Because if you're having something bad happen to your organization, most likely it could potentially spread to our organization. The second one is pretty unique and it's starting to happen quite a bit. Create a government relations coordinator or manager position. This is somebody who you can then offset too and send to these EMS on Hill days, once a year to your state Capitol. Once a year. Go to the town board meetings. It's only a few hours per month that would be dedicated. And, and let me tell you the return, if successful could mean the difference between and millions dollars. It can mean to somebody returning home from a call safely versus what could potentially be devastating. So you know, to consider, and it could be volunteer, it could be paid, it could be siphoned. Feel free to reach out if you have any questions about that. Cause we are seeing more and more organizations invest in these government relations coordinators and manager positions unions, whether you love them, hate them. Again, not going into that. But if you do have an EMS union support what they do, because they are also somebody who considered lobbying.

Aidan O'Connor (33:11):

They usually have a lobbying firm of some sort or they have what's called a political action committee, a PAC which will then be able to endorse candidates. So you could actually then through a pack, you can go forward with your union can go and endorse a candidate running for local, state or federal level. And what they do is they bring in that representative and they make sure that they understand what EMS is, fine terms. They don't want them in a, in a mass on CNN using the terminology ambulance driver. So they'll make sure they know defined terms, they'll understand the profession and do they agree with the legislation that you've already put forth on an agenda? And will they vote in favor of it if you support it? And will they try to block legislation that goes against you? It is the number one way to know right away if your representative goes on there.

Aidan O'Connor (33:59):

You know, there's whole lot of these on here, but one of the ones that is my personal favorite is run for public office. There is nothing preventing you as an EMS ride on a town, local, state level running. When I ran for state assembly in our, in our New York state, I would have been the first paramedic ever on the state legislature. And that's scary. There's 150 representatives every two years. Why have we not had a paramedic and had that voice and taught CPR everyday to constituents. When I went out and I wanted to meet people, I didn't do justice area typical, come hear me speak, we taught CPR in the beginning and then we had conversations thereafter you can make a difference by running for office. And Robbie mentioned it, he's had great success with the education segment and, and being close and have an open channels of communication with his representatives.

Aidan O'Connor (34:49):

As a County legislator, we are able to get 1.3 million, which is the highest we've ever had contributing to EMS. So if you're around the table and you and you know what it needs and you battle for that you can be very, very central. And that last statement there is every action, every interaction is advocacy. When you'll no longer be the person on the front page of the paper for good or for bad with just your name, you will be your name plus an EMT, a paramedic affiliated with an organization. So every interaction you have when you go in and get coffee in the morning from Dunkin donuts or Starbucks, that interaction that you have with a smile that's courteous, that's kind the way your uniforms all makes a huge difference. That's truly the, the, the first step in advocacy every single day, day in and day out.

Aidan O'Connor (35:36):

I'll show you a few associations, again, not affiliated, but as many as you could support associations or easiest way to help every single day because you send them a check once a year, they accumulate their budgets and they split them up between lobbying, between advocacy, support staff, public education. So right away, these are organizations who are 24 hours a day, seven days a week. Answer is five days helping you, who are helping you as leaders who are helping your staff. We're helping our patients, we're helping our organizations and we've, and we've got to support them in every way possible. And this is just a few out of hundreds. If not,

Robbie MacCue (36:14):

And if we can go back to that side quick, I think it's important to point out that it's reciprocal. So, so you're joining these associations and even if you're not a part of the national association of EMS positions, that group is reciprocating to other associations. I, I looked back at a recent story January of 2019, where the New York city mayor de Blasio made comments about when asada, an unrelated press conference about the pay disparity between EMS workers in the city and their department versus other forms of public safety, the fire departments, the police department, and even sanitary workers and the pay disparity and the pay gap was massive. And he said in his comments not exact, almost exactly where, well, I have great respect for our EMS providers. The work is different and that spurred, if anything for the good a lot of people to advocate for their own profession and, and educate these people because the, the bringing up the story of the 2017 murder of EMT, a yarrow, a mother of two, I believe, who was pulled out of her ambulances and killed working an incredible amount of overtime.

Robbie MacCue (37:26):

And again, a person of color, a woman. We're, we're looking at a city as one of the most diverse departments of, of women and people of color. And they're almost being marginalized and taken advantage of if you look at it from a certain perspective that this, this woman was forked a 14 year veteran of the department and and other services were making almost twice as much after five years. So, so the national association of EMS physicians, the reason I bring that up came out with a beautiful policy, not a policy statement, but a support statement, a really saying that they support the EMS professionals, the work that they do and that they were advocating for more pay equity and representation in fairness for the profession. So again, even if you're a part of just one of these associations, it does have a ripple effect and these other associations will reciprocate. So it didn't mean to go on for too long with that, but I think it's an important point to bring up. And reason for joining associations.

Aidan O'Connor (38:30):

It's incredibly important. You're absolutely right there. They form their own coalitions and a lot the legislation that impacts, you know, one organization, especially in the EMS will impact the other for good or for bad. And so they're constantly working together. But you know, you mentioned another subject that was interesting is you hit on a few different issues that happen in EMS and obviously the mayor's comments as hard they were to hear were great in the sense that it finally brought unity to a lot of EMS across the country who said, yes, you know what, we are different, right? And this is why but I will say, I love that you just brought it back and I want to bring it back for a second too, is how often do we go to work on shift? And during shift change during the day, we hear people complain about the fact that I want to carry blood products because if I had what products that would have saved my life, the patient, or I'm working 180 hours, you know, this week just to make ends meet.

Aidan O'Connor (39:25):

Or the fact that, you know, they're working three jobs but they don't have health insurance themselves and they're afraid of going bankrupt because of the fact that they don't have health insurance. We take all of these things and what are they? They're complaints, right? And they're completely justifiable complaints. We have some significant issues. And we have some opportunities that we just don't have capable right now to us that I believe could make better patient outcomes and make pre hospital safer and healthier. But those are all complaints and there are things that I'm, I promise you we can solve if we, if we come together we, we support our state associations and don't I think for one second, if you're listening to this and you're somebody who says, "I can't make that type of change", "that's a drastic, ginormous change that, you know, I don't even know where to begin". I promise you, you can absolutely make that change. Start making notes, start showing data, look up things, Google things. Put together a small paper and bring it to your manager, your leader of the organization. Bring it to the regional EMS council or, or medical advisory committee or physician groups or local ER, and start having those conversations. You can make such a dramatic change when you have the data and you have the heart to change it. I promise you that. And your study association will help.

Aidan O'Connor (40:44):

So leading onto that, if you do have that idea, don't necessarily share it with me, but if you ever need help to inspire you to share it with somebody who can make a big changes, certainly always feel free to follow me on LinkedIn, Twitter send me an email. I'm about two weeks behind on my email as Robbie probably knows very well at this moment in time. And, and I challenge each of you who are watching this. I was trying to find a really good advocacy quote and I came up with dr Seuss was the best one I've found. So I'm hoping that I could in the future use one of yours when I see a massive legislation that's improving EMS, keeping us safer, improving professional development or patient outcomes. I hope to be able to use your quote in the future because of how much you believe advocacy has worked and that as an EMS leader, you must this as a fundamental point.

Robbie MacCue (41:34):

Well, folks,uthanks again,uthank you to in O'Connor jr for joining us, for putting together this incredible presentation, talking about advocacy in, in, in the world of the stressors of what we do. It is so easy by default to complain, and I think we've got a framework. We've got the inspiration here and that we need to really be the change we want to see in the world and make this,ubring this to fruition. So Aidan couldn't thank you enough for, for joining us and,uon behalf of all of our people watching from across the country and other countries,uwe appreciate your time.

Aidan O'Connor (42:11):

Thank you so much. Go forth and advocate.

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Robbie MacCue

Robbie is the cofounder of the EMS Leadership Academy, host of the EMS Leadership Summit, and paramedic captain in Albany, NY where he serves in the Special Operations Division for ground rescue, flight, & tactical medicine. He performs international medical flights with North America's largest fixed wing Air Ambulance service. For more than 14 years, Robbie served as President of a non-profit EMS organization advocating for increased funding and raising the bar of excellence. In addition, Robbie is an American Heart Association advocate who is passionate about empowering others to save more lives. He has taught physicians, nurses, and other medical providers Advanced Cardiac Life Support at medical schools and hospitals throughout Manhattan. Robbie has undergraduate degree from Rensselaer Polytechnic Institute, and a MBA from Case Western Reserve University and provides business consulting that combines his love of technology with healthcare.

Robbie MacCue

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