They didn’t expect it to be easy, says Matej Polák, director of Slovakia’s leading provider of prehospital care. “We didn’t want to walk the easy way. The easiest road is always down the hill – it won’t get you to the top.”
The top is indeed where you will find ten-times diamond winner ZaMED whose record of success in the EMS Angels Award is unbeaten and probably unbeatable. But their reputation precedes the awards. When the EMS Angels Awards were launched in Lisbon in 2021, partly as the result of Matej’s advocacy, Komárno, where ZaMED is headquartered, was already synonymous with excellence in prehospital care. Their principles had been adopted as the national guidelines for Slovakia, and Komárno Rescue, their annual competition that tests the skills of the best rescue teams in Central Europe, was drawing more participating teams every year.
A close ally of Angels from the start, Matej had been convinced that the positive impact of the ESO and WSO Angels Awards on in-hospital stroke care could be replicated in the prehospital setting. It wasn’t possible to incentivise performance with money or vacations, but Matej believed the combination of personal pride and public recognition would do the trick. The bragging rights that came with winning an international award would help motivate change and encourage paramedics to take the most important step towards change – the first one.
It worked.
Four diamond winners in Lisbon had grown to 45 by Q4 of 2024. The total number of awards is about to pass the 500 mark, and the winners include teams from Pichinca province in Ecuador to Da Nang in Vietnam, from Hong Kong to Chile, from South Africa to Kazakhstan. In cities and regions around the world, more stroke patients are reaching the right hospitals at the right time.
Did the awards exceed Matej’s expectations?
They did not.
They did however meet his expectations, says Matej, noting that these expectations had been very high.
A simple tool set
“High achievement always takes place in the framework of high expectation,” said American engineer Charles Kettering, whose brilliant inventions revolutionized the automobile industry. Within ZaMED the expectations of excellence are high indeed, with monitoring and feedback central to their model. What they have managed to do is infect their employees with the same belief in holding themselves to a higher standard.
“They are competing against each other for who has the shortest time on scene, they compete to be as fast as possible. Our employees now want to get better themselves and they have the tools for it.”
Those tools are simple, Matej insists. “We didn’t invent anything special. Many others use the same tools, maybe just not as consistently or in the same combination or long enough.”
So here, from the horse’s mouth, are the five tools that, if you use them consistently, could bag you 10 diamond awards:
1 Awareness.
They put a lot of effort into raising public awareness about stroke and, among their members, awareness of the importance of EMS care for stroke patients, Matej says. “Ten years ago, stroke wasn’t perceived by paramedics as a supersexy great job. These guys loved blood and broken bones more.” Stroke patients are generally silent and often don’t look like emergency patients, which is why it’s important to make the EMS teams aware that these are cases where every minute counts.
2 Education.
It’s not enough to be aware, you have to know what to do, Matej says. They are strong believers in the value and impact of education. Before Angels, they created their own learning tools, but they now use Angels elearnings, in particular the ASLS course, and compensate ZaMED paramedics who complete the course. They are also, in partnership with the University of Miami, the only ASLS educators in Slovakia.
3 Quality monitoring.
When it comes to quality monitoring, ZaMED goes deep. They monitor performance for 100 percent of their stroke care, which means scrutinizing all the records for every case, and reviewing all the steps, including selecting the right hospital and prenotifying them.
4 Feedback.
Feedback is provided to every employee for every case, Matej says, adding that changing attitudes towards feedback “in a post-socialist society” had been their biggest challenge. They had to convince their workforce that feedback wasn’t negative but in fact a chance to become better.
“Feedback is the most important thing,” says ZaMED education coordinator Patrik Brna whose responsibilities span points 2 to 4 – education, quality monitoring and feedback. It’s no wonder he doesn’t get to work as many shifts in the field as he would like. Patrik believes it’s thanks to feedback that ZaMED paramedics now approach stroke cases as a challenge, trying to outdo each other in the field. The feedback process is also activated for cases of myocardial infarction and resuscitation – one of several instances of stroke best practices having spread to other areas of emergency care.
5 Motivation.
Good work deserves praise, preferably in public – which is one of the premises of the EMS Angels Awards. Winning makes people look good and feel good. “They’re the cherry on top,” Patrik says of the awards, but adds a disclaimer: “The system is the cake. If the system works, if the patient gets the best quality treatment, that is what matters. Diamonds are fancy but the important thing is the patient.”
More winning
Patrik is one of the key organizers of the Komárno Rescue, an event he got to know as a competitor before joining ZaMED five years ago, and of which he is now the main referee. The competition, which was launched in 2013, tests paramedics’ technical and decision-making skills, teamwork and resilience in a series of tasks that simulate real-life situations including stroke. Feedback is instant, which means learning is instant. But Komárno Rescue is also a celebration of their work, Patrik says. It’s quality time with team mates and an opportunity for experience-sharing, brainstorming and making new friends.
Last year’s event was the biggest yet – with 26 teams from five countries competing, including Czech Republic, Austria, Hungary and Slovenia – but the trophy stayed in Slovakia thanks to a winning team from ZaMED.
To people who say winning is easy in Slovakia because it’s an EU country, Matej is quick to point out that the Slovak Republic is one of the poorest nations in the EU. The largest part of their “own” hospital in Komárno was already over 100 years old back in 2014 when their stroke door-to-treatment times beat those of most hospitals in Europe – “it looked like a castle.”
It’s not about resources, he says. “It’s about the mental strength to improve.”
More advice
That ZaMED is the only EMS so far to have earned 10 consecutive diamonds surprised him, Matej says. “I expected many would be that good. On the other hand it has made me happy to learn how much influence a positive example can have.
“I am happy that we became an example, or maybe an inspiration for others. I have been surprised to learn how important a positive example is.”
Does he have more advice besides his five-point plan?
Yes he does.
“Just begin,” he counsels. “Don’t wait until you can imagine the whole road to a 100 percent result. Begin even if not all the areas have been solved. Don’t wait for the 100 percent plan.
“Your effort will bring results even if it is not all satisfactory, and you will solve the rest along the way. I have seen people stop working on improvement just because of some doubt over a single issue – even though the rest of their plan for getting better was perfect. Not knowing how you will resolve all the issues is not a reason not to begin.
“The first step is always the hardest and is rarely perfect. But the most important thing about the first step is that it happened.”
And for those still uncertain about where to begin, he adds: “Just do our five common sense things, it isn’t rocket science. You can improve things one by one, solve problems one by one, deal with other issues one by one.
“But don’t wait. Begin!”
