Kevin Elliott  0:00  
Kevin, welcome to home safely, a podcast from the National Center for rural road safety. Hi everyone. I'm Kevin Elliott. I'm your host on the podcast, and I'm the marketing manager for the National Center for rural road safety. Each episode on our podcast will bring you stories, strategies and solutions that are helping communities across the country make their roads safer for everyone, whether you're behind the wheel, designing the road, or just a community member, we're all working together out there to get everyone home safely. Enjoy the episode. Hey everybody. I am super excited for our guest today. I'm super excited for you to hear from her and talking about her specialty, which is post crash care. This is Crystal shell nut. She's a regional trauma system development manager for the Georgia trauma care network Commission, which is a very long title with a very important job. I met crystal at a conference in Atlanta a year or two ago, and she was talking about post crash care in Georgia, which is where she from and where she lives, and it was so interesting and compelling and some of the work they're doing in Georgia that within the National Center for rural road safety, we did a forum where we gathered a bunch of people from around the country to talk about applying the safe system approach in rural areas. And when we started asking around our group, who can we get from post crash care crystals, name came immediately to the top, and we had to have her come, and then she did, and she also blew us away with the information she gave us. And so I'm very excited for you to hear these things that that she has on her mind and the work that she does, and explaining the crucial importance of post crash care in rural areas. And it's so important that we made it our theme for Rural Road Safety Awareness Week this year was post crash care in rural areas. So I'll stop talking and introduce you to Crystal, and let her tell a little bit about herself, and then we'll get into the specifics of what post crash care looks like in rural areas, because it looks very different, like a lot of things in rural areas, it looks very different out there, outside l, j looks different than in Atlanta, right? Crystal, so introduce yourself to everybody.

Crystal Shelnut  2:15  
So thank you, Kevin for having me. So my name is Crystal shelnut, and first and foremost, I'm a paramedic. I have been working in EMS for a little over 20 years now. Started my career in the Athens area as an EMT. Went to paramedic school and then quickly started teaching after that, and it really kind of found something that I thrived in was turning on light bulbs for young professionals and kind of enticing people into this world of pre hospital medicine and post crash care. So soon, soon after working as a paramedic, I got involved in in trauma care. So I began working as the the region 10, so that's the Athens Area Regional trauma Advisory Committee coordinator. So basically what that was was an opportunity to work with our rural hospitals. We are fortunate in my area to have a level two trauma center as well and the ambulance services. And the idea was to bring together public health principles mixed with pre hospital medicine mixed with the hospitals and so. So that's really where I kind of started to get a foothold in what is post crash care, and what are policies that we can implement at the regional level to improve it. And like you alluded to, this regional concept is so important because care in the Atlanta area does not look the same as care in South Georgia. Our resources are different. Our hospital facilities are different, and so it matters that we are able to look at a community and decide, okay, what type of infusions of support do they need, and how can we better mitigate their challenges? So I served in that capacity for several years, and then about a year and a half ago, I had the opportunity to go to the Georgia trauma commission full time. So now, instead of working just with region 10, I'm able to do that at a statewide level. So I manage the 10 different R tax or regional trauma advisory committees, help support those coordinators, and then work with our various trauma centers and even non designated hospitals on education initiatives and pre hospital blood initiatives. Basically, if they'll let me into their meeting, I'll attend it.

Kevin Elliott  4:27  
So you talked about the difference in care in post crash care and pre hospital I love that term, pre hospital care that is so crucial. It's different in South Georgia than in Atlanta. Tell the audience a little bit about some of those differences. What is it like for providers in rural areas?

Crystal Shelnut  4:49  
A lot of times we think about an EMS agency. We we kind of have that mindset of, what does it look like in a city, right? All of our TV shows are based on what does EMS look like in a city where. You have multiple choices for hospitals and lots of trauma centers and extra help when you have a bad call, and that's just not the case oftentimes for our rural communities, I still work at my rural ambulance service in the county that I live, and we don't have a hospital inside of our community, and that's okay. We've got one two counties over, and it is a trauma center, so we've got a great option, but that presents a lot of challenges. When you're out here, we run four ambulances, and somebody has an emergency, a serious you know, they've been involved in a collision, and if I need help as a paramedic, it's me and my partner. It might take 10 or 15 or 20 minutes for me to get a second ambulance on the scene to help provide additional care. And if we've got something like maybe an extrication that we need the fire department to cut the patient out of the vehicle. Well, in many of our rural communities, actually, probably most of our rural communities, those fire departments are also volunteer, so we've got potentially an extended time period on scene before we can even begin transport to one of our trauma centers that might be 20, 3050, or 100 miles away. So so that's something that as the trauma Commission, we really work to try and mitigate those barriers. How can we increase access to trauma care? And we do that a lot through just supporting increased access to trauma centers so that you've got a better option to transport to or a closer option to transport to

Kevin Elliott  6:33  
these trauma centers. This was super eye opening when when we learned about that, and I'm sure a lot of our audience, and I have heard a lot about this golden hour right after a crash, you have a severe crash, and there's a clock that starts ticking immediately, your chances of survival are much higher if you get that level of care, that trauma center, level of care, within that hour after and when you're naming these time lines right if I need it's gonna take us a while to get out there, and then I have to call a fire truck to extricate that's 1020 minutes. Then it's 100 miles to the nearest Trauma Center, and there's that big clock ticking. Tell the audience a little bit. What does that mean for a patient when you have those distances and those timelines, and that can add up to a very difficult situation. When

Crystal Shelnut  7:23  
we think about that golden hour, I think it's important for everybody to remember trauma is a surgical disease. We we treat trauma through surgery. You fix fractures, you control bleeding, you manage the chest injuries, the head injuries, etc, that's that's done in an operating room. So when we think about the golden hour, that's really what we're thinking about, is, how much time does this patient have to survive until surgical intervention? Right? So you're right. When we start thinking about it's going to take me 15 minutes just to get to the scene of this call, because it's in a really remote, really rural area that's assuming that I can get my ambulance to it, and I'm not having to take now an ATV to get to the deer stand in the woods, or, you know, the the remote area, so so we might have an extended time to make first medical contact. And I think that's one of the reasons why it's so important that we equip our responders, whether volunteer or paid, rural or urban, we need to equip them with the information, the knowledge, the education to manage high acuity trauma patients in the field. Right? Because it there, this patient is already probably 20 to 30 minutes into their life threatening medical event by the time our rural providers get there, the clock is ticking, like you said, but we need to start to really mitigate the big issues that the patient is dealing with is that hemorrhage is it, you know, respiratory and ventilatory injuries? Do they potentially have a head injury? You know, those are the things that we've got to recognize them quickly. We've got to initiate transport as soon as we can, but we need highly skilled and competent providers in the back of the ambulance to provide the treatment in the

Kevin Elliott  9:05  
best of circumstances. Being a paramedic or EMS sounds like an incredibly hard, stressful job, so talk a little bit about what the life of a provider can be like

Crystal Shelnut  9:15  
right now, the average we'll call it the lifespan of an EMS provider, the career path of an EMS provider is an abysmal five to seven years, and that's for EMTs and for paramedics. Now, by the time I had completed EMT and paramedic school all the clinical that goes along with that, it was about a two and a half year education. So to think that we are only keeping those providers for five to seven years is terrible. Now we can speak a lot to the reasons why compensation. If they're compensated, as you said earlier, many of these are volunteer agencies, but compensation is low. For health care, we've got burnout and fatigue. The medics often work multiple jobs. Um, because of the compensation and sometimes just because of the community need. You know, I've certainly been suckered into staying for an additional shift because the ambulance was going to get shut down if I didn't stay for that extra 24 hours. And I feel like that's the case for many of our rural providers as well. So So you combine low wages with your every day at work is dealing with the worst day of somebody else's life, right there it is their true emergency, whether it's a cardiac or a respiratory, you know, hopefully it's not, but if we have sick kids, that's a really difficult thing for the provider to deal with in process, and that's every day you go to work. You know you're dealing with that, and in rural communities, maybe, maybe we're only running a handful of calls a day, so maybe you don't have a high acuity patient every single shift. But the threat is always there. The risk is always there and and so one of the things that's really important that we do is and complacency is a difficult thing, right? But it's important that when we go to work, we spend some of that time training or reading or researching, because if you're not running the call right now, you might tomorrow, right So, so that's one of the things that that we try and support, is that increased access to training, because if you're at a low call volume service, you're still running the really high acuity are really sick trauma patients, and it's even more important to keep the equipment and resources in front of them that helps with the burnout, that helps with turnover, if you if people feel like they're equipped to manage the everyday emergency. So for our rural providers, again, that's kind of a point of focus for us, but, but it's a difficult job, and as you alluded to, the recruitment is also difficult. Many of our volunteer services have an aging workforce that it's difficult to recruit, whether it's other jobs or, you know, or other economic factors in a rural community, it's difficult to get people to sign up for these workforce trainings. One of the things that we do at the commission is we fund about 45 EMT programs a year, specifically to try and mitigate that that the small services are able to host EMT courses in their community free of charge to the participants, to try and increase that workforce engagement. Now, the piece that we haven't figured out yet is, okay, we got them in the job. How do we keep them? We need to develop things like career ladders, pension programs, you know, other things that kind of incentivize us and support medics to stay in the profession long term. That that five year mark for me, it's just horrifying to think about. You know, I've been doing it for a long time now, and I still get nervous every time the tones drop, but at five years I had not learned the things that I needed to know yet. You know, I feel like I was a decent paramedic, but experience really matters in the profession.

Kevin Elliott  12:59  
So crystal, we're talking about professional EMS and even these volunteer but but skilled and trained EMS people. But in rural areas, these communities are tight knit. They all know each other, and sometimes it comes down to just the people who live in in the area, whether they're trained or not helping their loved ones. So if they see a crash and they just meet a farmer or something. This may be the first one to show up. What are some things that just local people who live in the area can do to help learn and further and improve post crash care? Because a main component of the safe system approach is safety is a shared responsibility, where we are all in this together, and in rural areas, literally, because this is, this is their their town. It's

Crystal Shelnut  13:43  
a great question, and a very important impact on our trauma patients is controlling bleeding, right? You know, we've already covered that, that oftentimes in our rural communities, we might have an extended response time. It might take 10 or 15 or 20 minutes to make it to the scene of a collision, and in those cases, our community responders and bystanders can administer the life saving treatments of controlling bleeding. So one of the things that we do here in Georgia is we were early adopters and huge supporters of the stop the bleed campaign. So the stop the bleed campaign teaches all levels of responder, from from community to, you know, to trained medical providers the importance of timely bleeding control care. So how to apply a tourniquet, a commercial tourniquet, quickly and effectively, how to do things like wound packing in the event that they have a junctional emergency, and how to to manage some other types of injuries and keep the patient warm, which is all really important for for managing trauma patients. So in Georgia, we we do this program where every quarter we have a grant that's open, applications are open, and we provide 12 bleeding to. Kits to every public school in the state, and we've got 99% completion with that program, that if they're a public school, they've got at least 12 trained responders and kits available in the school. And we had tremendous success from that. So the next wave was the Commission said, Okay, well, we now we want every school bus in the state to have a trained responder in a bleeding control kit. And so we've got 94% completion with that project. So if you're in an MVC in Georgia and somebody can see a school bus, they've got the equipment to save a life on it, tourniquet and wound packing materials. So again, 99% schools, 94 approximately, for the busses, and the next wave in 2022 was we said, okay, government other so law enforcement, fire departments, rec departments, courthouses, if they are a government agency, we're able to support them with both training and bleeding control kits. So we've got about 60% of our counties that have been impacted by that project, but again, that that really speaks to the commitment and the investment required from our community responders. Because if somebody has life threatening hemorrhage, and we make no efforts to control it until the ambulance gets there 15 minutes later, unfortunately, whole blood or not, that patient has a very poor prognosis. It's really important that we teach people how to be prepared for these emergencies, and we can do that in about a 15 to 30 minute class. Stop the bleed.org. Has a really great online training that you can kind of click through it, some of the interactive videos, and then go to your local ambulance service and get checked off on the skills. Wonderful.

Kevin Elliott  16:44  
That sounds like a wonderful program, and this is, I think, in a lot of ways, uniquely suited to rural areas, because, again, these are tight knit communities that want to help each other for sure. Hey everybody, we're having a great conversation with crystal shell nut regional trauma system development manager for the Georgia trauma commission. We'll be right back after this short break. This year, Rural Road Safety Awareness Week is July 14 through 18, and we're shining a light on something we don't talk enough about post crash care. This year, our theme is big league safety, and we're highlighting the Dream Team of first responders out there saving lives on rural roads, and these people face significant challenges, and so that's why we're celebrating them this week. So join us this July 14 through 18th, as we honor the people who respond support and save lives after the crash, and learn how your community can be part of getting these people what they need. Visit ruralsafetycenter.org to get involved. Share your story and find resources that could save lives in your community. Together, we can make sure people get home safely. You've mentioned a few things that you all at the trauma commission are doing to help rural providers. We want to set up the challenge that rural areas face, but we don't, I mean, we don't want to set a bleak picture and not talk about maybe solutions or things, or even things that, hey, listen in a dream scenario, or what, what rural areas can do to help these people. You just mentioned these volunteer programs where they train people, and it sounds like just a lot of encouragement and equipping. What are some successes that you've seen, or ideas that are out there, that you all are trying, or you've seen in others around the country that are maybe helping mitigate some of this, to get and keep folks, but also empower them to get to that dear stand quicker if they need to.

Crystal Shelnut  18:33  
So again, the Workforce Development for initial education is a really important component, and that's a significant part of our EMS education funding budget every year. But the other portion is continuing education. We have got to have meaningful, engaging continuing education opportunities for again, for all of our providers, but especially in our rural areas where, you know, a needle decompression is a life saving intervention for a trauma patient that has a chest injury. As a rural provider, once I got out of the urban area where I worked, I've only performed three of those in about 15 years. It's important that we train people on those regularly. And again, that's bringing people into an education setting. We're kind of exciting them again for the profession and what they do, you know, the what, why, when and how, of some of those high, high acuity skills. So, so I think that that's important and just kind of one way to manage it. Another thing is that developing a career ladder, it five to seven years if they're getting the itch of, hey, this is not what I want to do long term, or I can't handle the stress, or the nights away from my family. We've got to have other roles that they step into. And at a typical rural service, your options are street medic, supervisor, Director. That's the entire career ladder. So unfortunately, a lot of times we're losing these good medics that they go. Okay, well, I'm going to go to nursing school now, or PA school, or I'm going to go back to med school, and that's great, because we have an EMS advocate in those roles. But how do we keep them inside the profession? Well, one of the creative ideas is the idea of a community paramedic or an advanced practice paramedic. Really interesting models across the country now, and we've got some some pilot programs and a couple of programs up and running in Georgia. But basically the idea is, we have a medic that has a caseload, basically in their community of high risk population. So maybe they're they're frequent users of EMS that they have disconnects from other public health programs about, you know, getting their prescriptions or managing their conditions. So this paramedic would be able to go out and check on them and say, Hey, do you have your drugs? Are you taking them? You know, those types of things. And then another one is so think about your post heart attack patient, right? They've they've had coronary artery bypass, they've been sent home from the hospital. It's really important that they're doing follow up, care, lab work, EKGs, things like that. But in rural communities, transportation is often difficult, right? So what if your community paramedic can go out and do all of those things? Those are all in a paramedic skill set. And let's face it, we're a lot cheaper than the hospital is. So there's a there's a lot of utility of using your paramedics, or in other EMS, providers in kind of non traditional roles, and that serves our profession as a career ladder. But think about it, that community paramedic is also available for the high acuity trauma patient that comes out, and now we've got another set of hands, skilled hands in the back of the ambulance. So so that's one model that I think is creative, but also just a really functional role. And think about we've got rural hospitals that are closing all over the country. We've got funding gaps everywhere in many of our communities. EMS is the only access to healthcare inside the county, maybe inside of multiple counties. That's an opportunity that we should be leveraging a little bit more. I think,

Kevin Elliott  22:03  
wow. Only access people have that is that's a difference, right? And we're a challenge in in these rural areas. That's remarkable to me. So can you talk a little bit about this? Was something too that I've that I've learned that is also shocking to me, that in lots of rural areas, EMS is not what they call an essential service. The way I understand that is calling something an essential service, then ties state funding to it, right? So there's an income stream if you call it essential service, I would think just me, personally, I live in a rural area in North Florida. I would just assume that the EMS folks that were going to come to me out there if something happens, are funded right there properly. But I learned a lot at that, when we were all together in Montana, that that's not the case everywhere. So if you could talk a little bit about the funding streams and essential service versus not, and what the situation is like, the

Crystal Shelnut  22:58  
essential service component is a very frustrating one for me. So there are 37 states that do not consider EMS an essential service, and in every one of those 37 states, law enforcement and fire are considered essential services, and that's a big obstacle that EMS has to overcome. That one, I think that speaks to we don't have a really strong advocacy and lobby to support that. But also, to your point, why doesn't the public know that? I feel like they should, if, if we're not an essential service, one that that does limit federal grants. There's a very large grant called the AFG grant. It's, it's done annually. They've, they've distributed over $8 billion only 2% of that can go to non fire EMS agencies. There. There are no other large grant pools like that that are available for our EMS providers. So, so what does that mean if we're not eligible to get state funding because we're not essential, and we're not eligible for large federal grants. That leaves our local municipalities to pay for all of it. So we do have some modest millage rates that do support many of our rural services. And then, of course, you've got a fee for service, right? You call we haul, we bill type, model, but, but even in that, the reimbursement rates compared to cost are so low, right? So I did. I reached out to my rural service this morning just to to ask, what are our reimbursements rates like right now? What do we charge? And so the fees are kind of divided up whether you receive basic care. So a BLS, a basic life support treatment, an advanced life support or an advanced life support too. So that's the highest billing level in my rural community. Our highest billing level is $782

Kevin Elliott  24:56  
for a major intervention to save a

Crystal Shelnut  24:59  
life. So. This is a multi system trauma, a cardiac arrest. I think the rules say that they have to receive at least two medications and interventions to be categorized as a als two. The the thought that that would cover what, what it takes to be ready for for an emergency in your community is just, it's laughable, right? Ambulances cost over $200,000 now, if you can buy them, the equipment continues to go up the you know, it's a it's an insurance policy that we have to have is that we have readiness for any emergency that could happen in our community. And I think without at least acknowledging that the profession matters by making it an essential service, we're going to consider, continue to see some of the lapses in care that we have. And I think that if there's anything that I could urge, it's people to acknowledge that and to reach out to anybody that will listen, that EMS should be considered an essential service and should be supported as such

Kevin Elliott  26:02  
excellent we'll talk more about that and how people can get involved. After this short break in rural communities, a crash doesn't just happen on the road, it ripples through the whole town. This year, Rural Road Safety Awareness Week shines a light on something we don't talk about enough post crash care, because survival doesn't end at the moment of impact. It depends on what happens next. Our theme is big league safety with a spotlight on post crash care, because in life's biggest moments, we need an all star team, responders, dispatchers, medical crews, law enforcement and communities who know how to move fast, work together and save lives. So step into the lineup. Learn how your community can improve post crash care and be part of big league safety. Visit ruralsafetycenter.org to find resources. Share your story and join the team that's helping rural America get home safety. You You introduced me to a term last time we were together that blew me away, whole blood and the importance of whole blood in these scenarios, in these post crash care. So the worst has happened. You all are heading out there to help, to help a person talk a little bit about the importance of whole blood, what that even means. First of all, because I was that was like, what does that mean? Crystal? And then he told me, and then I was, my mouth hung open, and then what that would mean for rural health after from post crash care, and then also to some ways that maybe we can start to incorporate it. So just give it. Give us the story of whole blood. This

Crystal Shelnut  27:43  
is one of the most exciting interventions that I've seen in pre hospital medicine that we talked earlier about, the golden hour, right? We've got one hour, because trauma is a surgical disease. What we do by introducing whole blood into pre hospital care is we extend that time period for our rural providers or for our rural patients. So the idea is that we carry either whole blood, it's usually low titer O negative blood on the ambulances, or plasma or some variation of component therapy, platelets and red blood cells. It kind of varies by area. But the idea is that we administer product to patients who have they're in hypovolemic shock, right? They're losing blood volume because of their traumatic injury, and instead of pumping them back up with normal saline, right? It's just salt water. Instead of doing that, we put back something that has oxygen carrying capacity, you put back in red blood cells that can keep the tissue oxygenated. Whole blood has clotting factors in it. It has a normal pH. It helps to restore kind of that normal sense of the body, right? And the sooner we can administer that to patients, the better their prognosis is. There are several programs now running in the state of Georgia, and we've got one very large metropolitan service that has had such tremendous success with their whole blood program that survivability of trauma patients has increased, literally, by 60% or more in the course of a year. So imagine if we can translate that into our rural communities, the amount of impact that it's going to have, because our patients are oftentimes 50 or 60 miles from a trauma center, right? They, just because of their geography, they might automatically fall outside of that golden hour. So this is a it's kind of a difficult program to manage, because blood bank people tend to be a bit ticky, right? So it's really important that temperatures are monitored correctly. We've got to keep the blood product cold, but then when it's time to give it to our trauma patients, we have to warm it back up.

Kevin Elliott  29:59  
Okay? So that. What you mean by ticky is, like, it's particular the blood has to be handled in a very particular

Crystal Shelnut  30:04  
really does imagine a blood bank at a hospital the amount of oversight that they have and the constant monitoring of everything. You know, there's lots of federal regulations and guidelines on how blood products are to be stored, and so when this idea first kind of came about. They're thinking, Okay, we've got these, you know, $10,000 coolers that manage our product and the temperature, and EMS is like, yeah, we'd like to put that in a medical grade beer cooler and send it out in the field, right? So it took a lot of work to kind of navigate some of those things, of, how can we maintain temperature in an unpredictable environment and have connectivity so that the blood bank can have real time monitoring of that these these coolers and the temperature monitoring systems will give us high temps and low temp alerts, so that a provider can go out and change out an ice pack before product goes bad. And so those are some of the obstacles to getting it in the field. There's also a significant startup cost. The cooler and the warmer are about $10,000 just to get into the product. And now let's think about, okay, well, now we have to buy the product and administer it. So plasma very beneficial for our trauma patients, normal pH, clotting factor, lots of good stuff going on for it. It's about $60 a bag. Okay, low titer O negative whole blood is about 600 so let's think about this critical trauma patient. They get two units of whole blood. We've got to have the tubing that warms it. That's another $100 just at the whole blood product, we're at double the ALS two charge. This is why we need support, because these are life saving interventions that your services don't have, oftentimes, the financial support to come out of pocket, right? But we do know that it makes a tremendous impact on outcomes. So we're the trauma commission is now investing in a lot of these startup grants, but we're also trying to manage some of the relationships of how can we get EMS services access to blood banks right? And by setting up consistent protocols, consistent training and consistent equipment, we believe that will help to break down some of the

Kevin Elliott  32:19  
barriers. When we met last in Bozeman, we were at that forum. The whole theme was how to apply the safe system approach in rural areas and a big you just hit, a big one, which is just talking to each other, going across, whether it's agencies or departments or individual human beings, and just having conversations like this, and say, Okay, this is a hard, hard nut to crack, no doubt about it, but if you have this one area that's in a year, seen 60% improvement in survivability. I mean, I remember you told me at scale, whole blood can rival seat belts when it comes to saving lives.

Crystal Shelnut  32:59  
Absolutely obviously, the impact of seat belts has been tremendous on on injury prevention and on survivability from MVCs. This is the next seat belt, though, you know the the idea that we need to manage patients with the appropriate intervention, and that that should not be dictated by your geography or by your weather. You know we we need broad access to this type of thing. And again, just by that one agency, their ability to take patients shock index greater than one. So really simple metrics. It's their heart rate is higher than their blood pressure, and they have some serious injury, and they fill them back up with blood. Kevin, they're actually changing their protocols to resuscitate before intubate, because these patients are conscious going into the hospital that otherwise would have been critically ill. Chest cracked in the ER intubated, all of that we're bringing these patients in conscious. They're able to have imaging before surgery. This is wild, you know, this is, this is a huge innovation in trauma care and and it's our EMS providers leading the way. And I think that's another important take home message of EMS is healthcare. We are definitively healthcare. There's this weird space of just like, are we public safety? Are we healthcare? And I think very safely, we can say that we fall in both of those categories. Another really exciting thing about pre hospital blood is that, you know, we've got National Blood shortages. That's not new, but in some of the early trials, we're seeing less in hospital blood use if the patient is administered pre hospital blood, right? So the overall use of the system is going down just by looping in our EMS providers, in addition to the wild survivability. So like

Kevin Elliott  34:44  
working with engineers and transportation agencies, they talk a lot about lifecycle costs, right? If we, if we the whole cost of the of the project, or whatever it is, if you invest in, and this is common sense, right, you invest better materials or something upfront, you. You can save more money on the back end, or last longer, or whatever. So there, there sounds like, I mean, there is a total life cycle cost or something like that. You know that maybe could be made is for investing in this and and again, our job is not to advocate. Our job is to our job at the center is we just are like, these are the people who live this stuff every day in every area and every municipality and every state is going to handle this stuff differently, but we, we wanted people to hear that, hear these things, that this is what the life of a rural EMS provider is, and this is the real situation. And here's some, some sounds like some significant hope out there, and some innovations that if people can start to even just understand that they exist. Because I didn't understand any of this existed. I thought I, you know, I pushed 911, and the ambulance shows up and, and they do, by the way, but, but, uh, it's much more complicated than that.

Crystal Shelnut  35:58  
It is. And unfortunately, if we don't, if we don't make some fixes. Now, there's a time in the maybe near future, and in many communities now, that when you do call 911 you don't get an ambulance, or you don't get an ambulance for 30 minutes or an hour. You know, again, it's an insurance policy. No. Nobody really likes to think about when they're going to have to call 911, but it's something that that kind of as a society and as individual communities, we need to recognize that those are our insurance policies for our friends and our loved ones and our community, and it's worth investing in it now.

Kevin Elliott  36:34  
Crystal anything else about your job, or about about this kind of care, or about the work that you do, or anything people would need to know about in this vein, is rural post crash care that I haven't asked you about.

Crystal Shelnut  36:48  
So I think the other really interesting thing about our organization that I've shared with you before is our funding structure. I think that that's something unique, and we found a tremendous amount of success in Georgia. So the Georgia trauma commission receives revenue from a program called the Georgia super speeder. So what that is is if people are traveling more than 75 miles an hour on a two lane road, or over 85 on any other roadway, and they receive a ticket, there's this additional addendum of $200 and so that's how we pay for all of these initiatives that the trauma Commission is doing across the state. 80% of our funding goes to trauma centers, so levels one through four receive a certain amount of support to to ensure that they have readiness cost for managing these critical trauma patients. That's sometimes uncompensated care, it's education, and it's other like administrative support type things, and then the other 20% goes to our EMS providers. And so we fund vehicle equipment grants. So every licensed 911, ambulance in the state receives a certain amount of money per ambulance to ensure that they have basic trauma equipment that's available on it, and then we do a lot of education, so those are the EMT classes and advanced EMT classes and a lot of our continuing education initiatives. And then now this pre hospital blood support as well. So I think that when we think about our funding structures, you know, it's unreasonable for many rural communities to be able to come out of pocket with a multi million dollar ambulance service, right? We've got to get creative and and supporting our EMS agencies and initiatives with super speeders really has been an effective metric for Georgia. So I just encourage people, when you're thinking about how to support rural ambulance services, just you might have to think outside the box a little bit, yeah,

Kevin Elliott  38:41  
I'm glad you mentioned that super speeder program, because that was a when I heard you talk about that in the whole room when we were in Atlanta. You were explaining that people went, Oh, because, like, speeding was a is a past theme of Rural Road Safety Awareness Week for us, because speeding is usually, if not the top contributor, it is a top three contributor to almost every major crash people are driving way too fast. And so the idea behind this project, or the logic behind this program, and I remember when we were in Atlanta, there was a Georgia State Trooper there talking about it from from their end as well, is that, listen, if you're going to do these, like, really, really speeding. Not five over. This is, this is a, you're really a super speeder. Then you're, you're adding risk to the system that we know. And therefore it is logical that you would help us pay for the effects that these risks inject into the system and then give them to the people who have to, frankly, come and mop up those

Crystal Shelnut  39:39  
problems. And ideally it's a deterrent. That's what we want, is people to, you know, not significantly exceed the speed limit, because we know that that just amplifies the risk. But if you're gonna do it, we do want you to support the trauma system. So,

Kevin Elliott  39:56  
right, yeah. So a novel approach. Super interesting. Seems successful again. This is why we wanted to have you on because we know in Georgia, you all are experimenting with this and working and working out ideas to help make this situation better. Prevention, of course, is what we're all after. But if all of the preventative measures fail, you need that ambulance to show up, and you need competent, enthused, well equipped people to get to you or your loved one to make sure that you extend their life. And sounds like they're in Georgia, you all are working on some programs that are starting to see, starting to see that progress, and that's super exciting. So I appreciate you being on Crystal. This was just as great as I thought it was. I know our listeners are going to really, really be impressed, just like I was the times that that we've been together with the Georgia trauma commission. You all are pushing boundaries on this and doing really, really important work. And so we encourage everybody to look up some of what they've been doing in Georgia, that super speeder program, these, these whole blood programs, and really bone up a little bit about what it's like in rural communities. In the post crash care community, you have some these people have big hearts, and they're doing this stuff as volunteers a lot of times, and they're just out there trying to help their their loved ones and their friends. So crystal, thank you for coming and representing that whole community, and for being such a great voice and articulate person and passion for this, this entire field,

Crystal Shelnut  41:28  
I've enjoyed it and will continue to advocate. We do have a really great website, trauma.georgia.gov, that details all of the super speeder everything from the law to the revenue streams all of our grant programs, and of course, my contact information is there. We are happy to support anybody else's initiatives and share wholeheartedly what we've learned throughout the process.

Kevin Elliott  41:52  
Love it. Thank you so much crystal. I hope to see you again soon.

Crystal Shelnut  41:54  
Absolutely. Thank you.

Kevin Elliott  41:58  
Thanks for riding along with us on home safely. If you liked this episode, please subscribe, leave a review and share it with others who care about making rural roads safer for more resources training or upcoming events, visit us@ruralsafetycenter.org and until next time, stay safe. Stay connected, and let's all get home safely. You

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