This is How

We Share a
Foxhole:
Leveraging ePCR Data
to Identify the Risk of
Post-Traumatic Stress
Jonathon Feit, Beyond Lucid Technologies

Ron Nichols, Chambers County EMS (TX)

Robert Brader, Atchison County EMS (KS)

Special Thanks to Art Groux, Bennington Rescue (VT)

Something we can all agree on:
(Almost) Everyone Hates ePCR

WHY? They’ve been associated with:

1. Billing (most people don’t care)
2. Legal trouble (most people fear)
3. Busywork (most people prefer to get
sleep, eat, and end their shift on time)
 BUT…

What if an ePCR could

also save your life?
 An ePCR is nothing more
than the summary of
your clinical expertise
and experience with the
patient during any
particular incident.
Any other way of describing what an ePCR is for (e.g., billing, legal.) is a corruption of its fundamental purpose.
 It therefore also offers
a snapshot of what
you went through
while dealing with the
patient (i.e., what you
dealt with on the job).
Admittedly – it doesn’t directly capture potentially relevant details about life outside of work at a given moment.
As an indicator of who
needs to talk, could
ePCR data eliminate
the stigma associated
with mental wellness in
Mobile Medicine?
HOW?
 ANYONE can catch a
bad call. What if we
never had to impose on
team members to raise
their own hands to say:
“I need help” ?
Imagine the impact we
could have – measured
by jobs, hours, dollars,
even lives that might
otherwise be cut short –
if data empowered
mangers to say:
“I already know that
you need to talk to
someone. Let’s talk.”
 “These mountains
that you are carrying,
you were only
supposed to climb.”
Introducing:
Robert Braeder

• His experience.
• Where we were.
• Where we are.
• Where we can go.
Introducing:
Ron Nichols
• The Approach Used
by Chambers
County EMS (TX)
Inspired this
Presentation
Perspective from in the Trenches
 Mental Health Awareness
~ 1 in 25 adults ~ 18.1% of adults
~ 1 in 5 adults
Serious mental illness / year experience an anxiety order
experience mental illness
(interfering with or limiting (including Post-Traumatic
per year
1+ more major life activity) Stress, OCD, phobias)

3rd most common cause

~ 50% of adults
of hospitalization in U.S. for Each day 18-22 vets
suffering from a substance
age 18-44 is mood disorder
use disorder also have die by suicide
such as bipolar disorder or
mental illness
major depression

First responder suicide is only reported about 40% of the time

Mental Health Among Responders
2015 Florida State (FSU) Study of 1,027 firefighters
➢ 46.8% of responders reported suicide ideation (thoughts)

➢ 19.2% reported having had plans of death by suicide

➢ 15.5% reported having attempted death by suicide

➢ 16.4% reported having inflicted non-suicidal self-injury

A separate study demonstrated the relation between PTS symptoms and suicidal
thoughts. SOURCE: https://psy.fsu.edu/~joinerlab/, and an Australian study
found that 14.6% of all EMS workers had PTSD (Source: Art Groux, BRS)
Practical Steps Worth Taking
➢ Create protocols and check list for exposure to
occupational stress.

➢ The Trauma Screen Questionnaire

➢ Transition for EAP programs to Behavioral

Health Assistance to provide clinicians with
experience and exposure to first responders.

➢ “Hot-Wash” post incidents

Why the Data Matter
➢ On average a system with 10,000 calls annually will have an average
of 50% of those calls be a PTE (potentially Traumatic Event)

➢ A PTE can occur in a 20 year career first responder or a new recruit

➢ What factors are you going to look for

• Utilize dispositions in your ePCR as a trigger for a “Protocol Request”
o Any Cardiac or Respiratory Arrest
o Any Pediatric call
o Major Trauma
o Any Sentinel Event you would review through your QA/QI process
Use a Checklist Method
➢ We do this daily at work, from truck checks, narcotic checks, drug
checks, daily activity logs, etc. Creates a rigorous positive habit.

➢ Create a checklist for your mental health awareness program

(CCEMS is called “Resiliency for Total Wellness” It incorporates
our County Wellness program including our physical health
screenings, as well.

➢ Have a checklist for Post-Incident “hotwash as well as the

Trauma Screening questionnaire.

“Hotwash”: “hotwash is the immediate "after-action" discussions and evaluations of an agency's (or multiple agencies')
performance following an exercise.” See also FEMA’s “Hot Wash Form.”
https://training.fema.gov/is/flupan/references/02_course%20forms%20and%20templates/02_hot%20wash%20form-508.pdf
Leverage Existing Systems
➢ Every medic does a PCR post call. Build surveys into your
ePCR including your hot wash check sheet, TSQ, or any
other checklists.

➢ Create analytics report to track your data / monitor results.

➢ Currently CCEMS has seen an overall boost in morale

as well as a 15% reduction in PTS and ATS symptoms
since instituting our program in July 2020.
Introducing the
Economic Point
• Can you afford not
to engage in data-
centric programs
that will improve
provider wellness?
Puzzling that health & wellness
issues have taken so long to
become areas of focus.
Implications
1. Morale & turnover (expensive!!!)
2. Clinical quality
3. Revenue capture
4. Legal risks
Economic Snapshot of
Post-Traumatic Stress
• Acute Stress Disorder is diagnosed 3-30 days post incident, and
50% of all people with Acute Stress Disorder develop PTS(D)…but
you have to wait 30 today to receive a post-traumatic diagnosis.
➢ RISK OF WAITING VS. BEING PROACTIVE?

• VA reports that treating a soldier with PTSD only cost $8300 in

the first year.
➢ Compare to the costs of attrition?

SOURCE: Art Groux, Bennington Rescue Squad, Vermont

Economic Snapshot of
Post-Traumatic Stress
• American Ambulance Association employee turnover study found
that EMS experiences a 25% turnover in staff every year. Job
stress was one of the top 5 reasons that people leave.

• Fitch & Associates reported that onboarding a new employee costs

between $10-$20,000 per person (based on service-level factors).

• 26 U.S. states currently require workers comp coverage for PTSD,

with legislation in the works in others.
 Case Example:
Michigan EMS
• 28,804 licensed EMS Providers & 819 life support agencies (8/2019).
➢ Assume 70% are actually working → 20,162 are seeing patients.
➢ If 14% (or in 5) develop PTSD → 2,822.
➢ Cost of one year of care = $23 million ($8,150 each)

COMPARE:
• If just 5% of the workforces leaves because of stress = 1,008 per year.
➢ With cost training and attrition, “doing nothing” cost $17.9 million
($16,865 each)…in ONE STATE…for ONE YEAR.
➢ Plus: increased workers comp costs that can extend over years.
 Cautionary Tale:
Community Paramedicine
• Mobile Medical providers learn to compartmentalize
…they have to. But trauma and gore are part of the job.

• However, who learns—on the job, or even in life—to

manage the effects of a broken heart?
➢ Risk: Extreme burnout to some of the most qualified

• Community Paramedics get to know their patients, who

are often sicker than average. Life usually ends in death,
which means CPs constantly face “normal” feelings of
failure – plus an enhanced feeling of personal loss.

https://bit.ly/PTSD-in-Community-Paramedicine CREDIT: Brian LaCroix, Pat Songer, Monique Rose

Contact info:
• Ron Nichols:
➢ 409-267-2491
➢ Rwnichols
@chamberstx.gov

• Jonathon Feit
➢ (650) 648-3727
➢ Jonathon.Feit@
beyondlucid.com