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Five Questions With: Bruce Evans, NAEMT President

Jan 26, 2021

[By John Erich at EMS World]

With the new year came new leadership at the National Association of Emergency Medical Technicians (NAEMT). Matt Zavadsky’s two-year term as president concluded, and Bruce Evans took the reins.

Evans, CFO, SPO, NRP, MPA, is chief of the Upper Pine River Fire Protection District in Bayfield, Colo. He previously served 27 years in Southern Nevada, ultimately retiring as assistant chief in North Las Vegas before being lured back to service in the Rockies. He is adjunct EMS faculty at the National Fire Academy, chairs the NAEMT’s Political Action Committee, and has received both the NAEMT Presidential Leadership Award and the James O. Page EMS Achievement Award.

Upon assuming the presidency, Evans issued an introductory video on Facebook. Following that, he answered some questions for EMS World.

EMS World: You had a well-established career in the emergency services before a chance meeting with [past NAEMT president] Ken Bouvier led to becoming involved with NAEMT. Tell us about that taxi ride and how it all began.   

Evans: Well, as anybody who knows Ken knows, he’s a pretty outgoing guy. We were leaving FDIC in Indianapolis, I think it was, and had the same flight out. So we shared a cab on the way, and he just kind of made the pitch to join NAEMT. That’s how a lot of people come to NAEMT, by one of our board or committee members making a pitch to get involved and help out. 

Ken was the incoming president at the time, and they were struggling with the Safety Committee, which had gotten kind of stuck dealing with vehicles and ambulance manufacturing. Obviously safety encompasses a lot more than just ambulances and vehicle design—there’s provider safety, violence, roadway safety, back injuries, gurney drops, patient safety issues. Ken really wanted to expand the scope of that committee at the time. That was how I got involved.

You’ve had leadership roles across a range of organizations, including the International Association of Fire Chiefs and National EMS Management Association. What are some of the lessons you’ve learned about leadership along the way that you can bring to NAEMT?

There’s one thing that’s really been huge, and it’s something you might not think along the way is as significant as it really is. But when you help people grow—when you teach them and mentor them and provide them education and insight and give them an environment where they can improve upon themselves—people value that enormously. It’s like the movie Mr. Holland’s Opus: You want to look back at the students you’ve trained or the people who were on your crew or whom you supervised and know you did everything you could to help them be the best they could be.

I think the people who are in fire and EMS come to work wanting to do the job the best they can. If you can help them do that, you’ll have their gratitude, and they’ll have a rich career. 

That sort of ties into the first of your priorities, which is a mentoring program—an idea I understand originated with the late Jim Page. What will that look like, and what’s going into it?

Jim’s idea was that for this next generation, somebody was going to have to show them the way. There are a lot of bad supervisors and bad organizations out there that tend to beat people down or don’t help them grow and be successful. And he wanted to build a structure and a process that would help upcoming leaders who were really excited about EMS and wanted to make it a career. He wanted to be able to give them all the wisdom he and other senior EMS leaders had acquired, without them getting beaten up or having bad experiences that might turn them off the profession. I think some of that came from personal experiences, as Jim had perhaps been in some unhealthy organizational environments at times.

He wanted it to be easier for people to draw on the wisdom of senior EMS leaders to build more EMS leaders. So he envisioned this national mentoring program that would pair up senior EMS leaders that were good teachers and mentors and role models with the younger generations and help make sure we can sustain our profession with the right types of leaders. 

Several of us have talked about this for a long time, and I think we have some leaders identified. Now what I’ve done at NAEMT is to build a kind of A-list committee to build some structure and put this thing together. What’s it going to look like? How long is it? What kind of education will there be? What should the structure and process of the program look like to get a good outcome? The committee’s task is to determine all that.

The political academy is an interesting idea to develop some much-needed skills. What are the kinds of abilities and activities you want to foster with that?

I equate it to this: Back when the physicians got their funding sources cut and were really getting squeezed by CMS and Medicare and the insurance industry, a few years after that they did something interesting called the “doc fix”: There was legislation that stabilized reimbursement for doctors and other healthcare providers and hospitals. Interestingly enough, the year the doc fix happened was a year that America had an exceptional number of physicians in Congress, so you can put two and two together there!

In EMS we still get left out in the cold for funding and have difficulty getting people to truly understand what we do and how much we can bring to the healthcare system. So I think it’s important that we get people to run for office, so they can tell the other legislators and lawmakers they’re rubbing elbows with what EMS actually is.

We’re making big strides here in Colorado. The Senate majority leader in our state legislature is an AMR paramedic, Leroy Garcia, and he has done a ton of stuff for EMS in the legislature. Colorado is way ahead of many other states in funding and opportunities and organization, and a lot of that is because Leroy and the state EMS office communicate very well. When they come to him with questions, he can speak as an authority. Similarly, we have Sue Prentiss, who just became a state legislator in New Hampshire; a firefighter-paramedic who just got into the state legislature in Oregon; and Dennis Nolan, a longtime state legislator in Nevada who was just term-limited out but spent several years in the Nevada Assembly and Senate. 

All these people bring a lot of skills and abilities in how to fund your campaign, how to market your campaign, strategies to win, and how you play the game. And I think that instead of what some of the other service organizations really advocate, which is how to help your candidate win, I think we need to take that one step further and say, “How do we make our people the candidates?”

As we both know, EMS leaders have been talking about definitive fixes for reimbursement for a long time now. What’s it going to take to finally move the needle on that, and how can NAEMT help get us there?

We have some tremendous folks on the Finance Committee. Matt [Zavadsky] is really gifted when it comes to understanding healthcare financing, especially as it relates to EMS, and then I think there’s enough synergy there now among all the service organizations—whether it’s NAEMT, the American Ambulance Association, IAFF, IAFC, EMS educators—that everybody wants to see reimbursement fixed and that it needs to be equitable. We need to be paid for what we do. 

In my experience in D.C. and trying to lobby for better reimbursement for EMS, there’s one thing the D.C. folks always ask us, whether it’s Medicare representatives or private insurers or legislators: How much does EMS really cost? How much does it actually cost us to roll out the door and provide quality care to, say, a stroke victim and get them to a stroke center? And what is it EMS does that makes a difference and—I hate to put this in dollars and cents—also helps keep the patient from being hospitalized for any longer than they have to be? What is the return on investment to all that?

And unfortunately, there really is no more money. I mean, we keep printing it, but there’s really no extra value or extra revenue that’s out there to be had. So a lot of revenue has to be kind of reappropriated and reincentivized.

An example is Memorial Hermann hospital in Houston. They gave CPAP devices to Houston Fire, and Houston Fire was able to reduce the number of intubations it was doing on congestive heart failure patients. In turn, because they weren’t intubated, they stayed in the hospital less time, yet the hospital was still getting reimbursed for what they call “confinement time.”

So when you drop the confinement time from seven days to two, but Medicare is still willing to pay for three days for it, It certainly makes sense as a hospital to supply those devices to the fire department—they give you a return on your investment. And I think that’s what the federal government and insurance industry have been looking for with us: What can EMS do that helps save money or improve efficiency, so they can reappropriate that money into the actual costs of doing the business or providing the service? And then if you do it really well, how do they incentivize that and encourage you to keep doing it well?