Our Western Brethren

Commonalities of the approach to EMS by our western brethren

Bend Fire & Rescue

By Alan Perry

Where I got my information

I have visited Bend, Oregon on several occasions and found it to be a beautiful community with many natural resources, a pleasant climate and breathtaking vistas. In short a community I would love to live in. I came across the Bend Fire & Rescue Deployment Plan for 2011-2013 while perusing the department’s web site. It is a comprehensive and detailed document available to the public prepared with the help of ICMA data, and the department’s historical data to determine their compliance with NFPA 1710 . It is a document used by the state government to assist departments with identifying their circumstances and creating plans to help them remain viable.

About Bend Fire & Rescue

Bend Fire and Rescue serves a population of approximately 100,000 in an area of 165 square miles much of which is sparsely populated. The City of Bend has a population of 77,000. The annual call volume is around 8000 with 82% of calls being EMS in nature. Their staffing consists of 88 career personnel, 4 part-time and 5 volunteers. The chain of command contains a Chief several Deputy Chiefs including the Deputy Chief of EMS, a Battalion Chief for each of the three shifts, a Captain for each of the five stations on each shift, 6 engineers per shift and 6 ff/medics per shift. The department uses a flexible staffing model were engines and ambulances are at each station, and staffed based on the nature of the call. All-in-all, a very lean operation.

About us

Fire Departments in Southeastern Virginia tend to follow the old school east coast fire service model. It is a well-tested institution known for a strong and rigid structure which does a good job of protecting lives and assets and the jobs of firefighters. We have enjoyed both public and political support, supporting well-staffed  and well-equipped career departments in most major cities. The approach to providing EMS service is widely variable ranging from only providing a first response to being a primary EMS transport provider. In this mix there are also widely varying degrees of support for the EMS mission ranging from treating it as a necessary evil in order to maintain public support and funding, to embracing it, making innovative changes that are needed and addressing public education in EMS.

Common threads to our approaches to EMS

The most common thread among fire departments that have taken on EMS as part of their service mix is the high percentage of our total calls that are EMS in nature. Of equal importance and contrast is that most firefighters do not enter this career with the primary desire to transport the ill and injured on an ambulance. Culturally I think this is a common thread among fire-based EMS systems, one that creates the climate for poor attitudes when making decisions and long-term plans for these systems.

Where we differ

A few highlights of the Bend Fire & Rescue program jumped out at me as being very proactive and engaged in improving the quality of their EMS system; They conduct monthly EMS case reviews with their two physician advisors to include patient outcomes. EMS protocols are updated annually, A service survey is sent out for every 15 EMS calls, They have an EMS public education program even though it is limited to senior communities only at this time. The concept of flex staffing maximizes the effectiveness of a small staff allowing a smaller group of responders to handle a variety of calls whether EMS or fire. Despite the staffing limitations the department has an average response time within the city of 7:33. They have a dedicated training staff and a training facility.

How can Fire-based EMS improve

Bend Fire & Rescue appears to be doing well with the resources they have available but are clearly pushed to the limit in their current circumstances. Like many other departments they are having difficulty with being fully forthcoming about the nature of the fire services relationship with providing EMS. The financial data conveniently lumps both fire and EMS operations costs under one heading and does the same with revenue, this approach could be considered an attempt to minimize the higher operating costs for fire services and the revenue produced from the EMS activities. Being open and honest about these circumstances will better allow the management and the public to make good decisions. Their portrayal is not unique, it is a common tactic used in the fire service. We in the fire service, as public servants, should be more honest with the public and ourselves, the lack of clarity will affect our integrity ultimately. Fire-based EMS systems must look at our perception of EMS and be certain that we are embracing it, constantly looking for ways to improve upon it, and deliver the service as effectively and efficiently as possible.

Link to Bend Fire & Rescue Deployment Plan

http://www.bendoregon.gov/Modules/ShowDocument.aspx?documentID=6919

EMS Pub Ed program outline

EMS Public Education Program

Program length: 1 Hour

Program format:            Informal lecture, handouts, power point, question and answer

Target Group:               Teens-Adults

Preferred venue:           Public/private group meetings of 12 or more

Target Groups: Civic organizations, Houses of worship, Clubs

Program development timeline:

·        Review and approve course syllabus and curriculum.

·        Solicit interest among target groups & schedule presentations.

·        Collect feedback, analyze and refine program.

·        Develop interest list for additional/related programs.

Resources needed:

·        Room with chairs

·        Computer with projector and screen for ppt

·        Related program handouts

Course description:

            This is a one hour presentation provided by the  Fire department for the purpose of encouraging greater public understanding and support for the mission of their emergency medical services(EMS) system. The activities of the Fire Department in prevention, emergency and non-emergency responses, will affect nearly every citizen at some point in their lives. Most do not require direct services with any frequency however, all benefit from and observe our actions in their daily lives. This presentation seeks to inform the participant of the department’s goals, practices and activities, and solicit discussion and active participation in improving the quality of EMS within the city.

Course Outline:

·        Introduction

·        Audience experiences

·        Overview of current EMS response

o   Reaction to event

o   Call taking/Dispatch/Response

o   Treatment/Transport

·        The role of citizen participation

o   Preparation, recognition and reaction to EMS event

o   Pre-arrival treatment and preparation

o   Treatment/Transport

·        Potential gains with citizen involvement

o   Improved outcomes

o   Quicker/Appropriate response

o   Less friction between responders & family

o   Less time on-scene/More accurate information=Better treatment

·        Other available programs

o   Hands-only CPR

o   Basic first aid

o   SCAN

o   File of Life

o   CARE

o   Project Lifesaver

Presentation:    

Introduction

·        Introduce presenter (name, rank, position)

·        Introduce and thank host/host organization

·        Thank participants for their time and interest

Opening

·        Good morning/afternoon/evening,

·        My goal here today is to convey information to you about your EMS system.

·        I also hope provide you with some tools and ideas you can use in a medical emergency.

·        I hope to address any questions you have about the Fire Department's activities, as well as our practices and goals in our delivery of service.

·        I will inevitably use a term or expression you may not recognize. I apologize in advance, please stop me and I will gladly explain.

Exercise 1- show of hands……questions will be answered later

·        How many of you have been exposed to a emergency medical services call in the past 5 years?

·        How many of you had questions about the process?

·        How many are comfortable with their ability to react properly to a medical emergency.

·        How may are willing to participate in the preparation for and response to a medical emergency?

Here is the way our system currently operates

·        Keep in mind that this is a continually evolving process that is driven by the city budget, State and Federal regulation, ongoing research and the input of the public.

·        A medical emergency occurs

·        Someone calls 911

·        Dispatcher collects information, dispatches appropriate resources

o   Ambulance, ALS or BLS

o   Closest Engine company for ALS calls, accidents

o   EMS supervisor, as closest ALS or for complicated calls

o   ALS unit, co-responds with BLS ambulance for ALS calls

o   Squad truck, Battalion chief, helicopter, sky is the limit if needed

·        Personnel collect ringdown, find address on map

·        Apparatus rolls out the bay (goal is under 2 min. longer at night)

·        Apparatus arrives on scene (goal is 6min.)

·        Personnel and equipment arrive at patients side (8-10 min)

·        Patient is assessed,  treatment begins, patient is packaged for transport, personal health information, history and list of medications are obtained if possible (20 min. elapsed)

·        Patient is transported, treatment continues, hospital is contacted en route

·        Patient arrives at ER, turnover to RN (30 min.)

·        Ambulance is restocked, patient care report completed and left with hospital (1 hr.)

·        Ambulance returns to service

·        Did any part of that process surprise you?

Community preparation and reaction can have dramatic effect on the system’s performance

·        Preparation

o   Well marked address

o   Keeping list with Med Hx and medications in accessible location

o   Taking first aid and/or CPR class

o   Knowing what to expect (todays class)

·        Recognition of medical emergency

o   Check if unsure

o   Call sooner rather than later (stroke/chest pain)

o   Be sure of situation and location

o   Do not approach violent people

·        Reaction to a medical emergency

o   Call 911

o   Render aid and/or follow dispatcher instructions

o   Collect relevant medical information for EMS (Hx, Meds, ID etc)

o   Assist by clearing path to patient and removing obstacles

These critical actions will save lives and improve patient outcomes

·        Patient outcomes are directly linked to the time it takes to receive initial care and definitive care

·        Patient care can begin with the lay-rescuer, by following dispatcher instructions and/or attending CPR and first aid training.

·        Stroke/Heart attack/Cardiac arrest….all very time critical

·        Witnessed cardiac arrest……Brain death in 4 min. without bystander CPR most will die. Some communities have achieved survival rates of better than 40%

·        A quick and appropriate response by the public reduces miscommunication and enhances the efficiency and effectiveness of the EMS response.

·        Better understanding of the system leads to better communication during emergency

·        Better communication means more accurate information and better patient care

Resources available

·        Hands-only CPR classes

·        Basic first aid

·        SCAN program

·        File of Life program

·        CARE program

·        Project Lifesaver

Questions?

Foundation Building

Foundation Building

By Alan Perry

I made my presentation for an EMS public education program to my chain of command some 8-9 months ago, after a brief conversation I was given permission to move forward with the project with a few limitations. Basically there would be no funding from the department, no overtime could be used, and any activity on-duty could not interfere with station duties and/or calls for service. I really did not expect any more than this; I was just hoping to get some buy-into the concept from the administration. That was almost a year ago, my life and other department assignments have kept me from moving forward with the project…until now.

The complete plan that was developed was a comprehensive program involving, public awareness training & outreach, community CPR, first aid & AED training, marketing and research. It is clear the ambitions of the initial proposal will have to be pared down. This article addresses that process; I intend to chronicle the adaptation of key parts of the program that one or two individuals can achieve with limited resources and time. Hopefully in this process some public and department interest will be generated, some positive changes will occur and more support for the program can be found to achieve the primary goals of improving patient outcomes, public satisfaction and system performance.

The nucleus of the program is public education; this seems like a good place to start. By developing and refining a short program that generates public interest and support I believe the program can begin to gain traction. The initial proposal included a 15 minuet power point presentation that outlines the emergency response process, the need for public involvement and proper reaction, and resources available to the public from their fire department and other sources. This presentation will be offered to small groups, clubs, community organizations, church groups, scouts, schools, etc. I am sure it will need a few tweaks depending on the presenter and the audience but it is basically ready to go as-is, I just need to find audiences and presenters.

So that is where I am with this, it’s time to put it out there. I will contact the administration and seek permission to solicit within the department for interested personnel to present the program and seek to have the program publicized on the city/department web pages. I suspect that getting the program off the ground will require getting on the phone or hitting the streets to secure presentations until the program can gain some recognition. I will not be able to do this alone, and anyone attempting this outside my department should consider asking for help as I am here. All I can promise you at this point is a chance to get into this program early and help develop it into something very useful.

Full program proposal can be found here:

http://bravenewemsworld.blogspot.com/2013/05/ems-public-education.html

Marketing Plan

Waynesboro First Aid Crew

Marketing Plan for EMS Public Education, Recruitment and Retention
prepared by: Alan Perry 12/5/2012

Background

The Waynesboro First Aid Crew is a volunteer/career combination non-profit public safety organization that provides primary 911 emergency medical treatments and transport to the citizens of Waynesboro and surrounding Augusta County.  The organization currently spends less than $50,000 annually for volunteer recruitment and retention and has no budget for public education or promotion of volunteer contributions to the community. This expenditure represents less than 5% of the organizations budget for 2012. The lack of any marketing program to attract new volunteers or inform the public of the need and value of volunteers is having a negative effect on the organizations ability to attract and keep new members to sustain its operations. Failure to address the issue will require the employment of additional paid staff and increasing operating costs that the organization will not be able to support indefinitely.

Desired goals of this program

The primary goal of this marketing and retention program is to educate the community of the need and value of the volunteer in the community, and thereby generate interest by individuals in joining this or similar organizations within this community and the surrounding area. While the focus of this program is specific to the needs of the Waynesboro First Aid Crew, it acknowledges that other similar organizations may benefit from it and seeks cooperative alliances with other volunteer organizations to achieve a broader goal of raising public awareness and participation in such activities regionally. In achieving the first goal the second goal of improving volunteer morale will be realized and retention rates will improve.

Specific Request

Establish a marketing program in direct mail, newsprint and other media, that is coordinated and consistent in its message and delivery in such a way as to constantly, and in varied ways, attract the attention of and support of the general public for volunteer EMS services.

$15,000           Direct mail program to the entire City of Waynesboro delivered quarterly and staggered among neighborhoods so that recruitment rates can be quantified by neighborhoods within the city based on response rates during each mailing cycle. Mailer would be sturdy and contain useful information suitable for posting such as a medical history card, Hands only CPR instructions or event calendar.

$15,600           Newsprint campaign once a week ¼ page advertisements to promote the volunteer, announce WFAC activities and events, provide information about how to volunteer and the value of the contributions of volunteers to the city, and the value of volunteering to the individual.

$3,000             Develop an online presence and marketing program incorporating social media, web search engines and online media sources such as the Augusta Free Press, Facebook and Google to broaden the reach of the organizations message and reach newer volunteers and citizens that are connected to this medium.

$12,000           Produce a yearlong advertising campaign on local cable TV NBC-29, 30 second spots highlighting EMS activities in the community, Public events, Training, needs and rewards of being a volunteer EMS provider. This includes production of 4 spots ($650), and airing of 30 spots a month, twice a day during the first two weeks of each month @$30 each, or $900/month. Rate is based on non-profit discounts.

$16,000           Upgrade exterior signage with high visibility graphic display to promote activities, current events and provide public safety announcements. Replace interior bulletin board/calendar with graphic video display informing members of schedules, classes, announcements and achievements and relevant operational information.

$61,600           Total commitment required for the initial one year program. The intensity of this combined marketing plan will get measurable results within a few months, volunteer numbers and the public image of the organization will improve. Investments in future periods will not have to be as intense, however the message will still have to be played in the media to maintain awareness by the public and local government. It is expected that the investment in future years could be cut by as much as 50% but will remain a permanent cost of retaining volunteers and maintaining an informed public.

EMS Public Education

EMS Public Education Proposal

Alan E. Perry

5/9/2013

Abstract

This proposal reviews new practices for public education in EMS, elaborates on the benefits of these practices to the public and the organization, and contrasts these with current Fire prevention activities. Consideration is given to public awareness, and public education in first aid, CPR and AED use as a starting point for improving community reaction and knowledge of these events. It also suggests topics for internal training and action that affect perception of our activities by the public relevant to patient family advocacy, and relationships with patient care partners. The goal desired is a more efficient, and effective system, that seeks community involvement and support for the mission of the Fire Department.

EMS Public Education Proposal

Introduction

The power of public education has been demonstrated by the results of Fire Safety and Prevention programs nationally. It seems reasonable to conclude that the same methods and tactics can be applied to Emergency Medical Services (EMS), with similar results. Advocacy and collaboration in the field of EMS are a stated goal of the National EMS Management Association’s Strategic Plan (NEMSMA, 2010, p. 4) , and others (IAEMSC) (NAEMT) (NHTSA, 2006, p. 8) (VAOEMS, p. 5)who have conducted recent research toward improving EMS system performance. Many systems have already documented the effectiveness of such programs in improving patient outcomes (Neumar, 2011), reducing nuisance calls (Johnson, 2011), improving public reaction to medical emergencies, improving employee morale, and reducing costs. Any one of these benefits is desirable and seems to justify exploring these programs. No national standard currently exists for EMS public education although it is clear the field of EMS is headed in that direction. A proactive approach to EMS system management will place the organization in a positive light with all stakeholders, and demonstrate to the public and employees, that the Department is competent to continue providing this service.

This document represents the first installment of a plan for comprehensive EMS system improvement which will bring the organization in line with the best practices in EMS across the country. As with any major change, it is best managed incrementally, it must be supported by the administration, line officers and individual providers. All stakeholders will benefit from the effort.  Additional programs will need to be developed to address other related system issues (appendix), improve employee morale and improve system efficiency. Some related areas of concern are; efficient and effective use of technology,  improving EMS v. Fire cultural differences, staffing and system management issues, healthcare system integration, quality control and quality improvement, and employee retention and training.

What is EMS public education?

EMS public education is a tool; a tool which will accomplish the goals of improving patient outcomes, system performance, system efficiency, provider morale and public awareness. Through education the organization’s goals can be communicated clearly and consistently to the public. The key components of EMS public education are awareness of the function, capabilities and needs of the EMS system, proper reaction to EMS events, and how to participate in and facilitate the operation of the EMS system. Through such programs the community may become involved to whatever extent each individual is comfortable doing so, while building trust in, and understanding of the organization. Such education is preferable to the speculation, rumor and disinformation that may fill the void in the absence of a solid public education program. Fire and Life Safety programs do not fully accomplish the goals of EMS public education.

How will EMS public education benefit the patient?

Patient outcomes are directly linked to treatment throughout the continuum of care, from the initial public reaction to the event, through discharge from the hospital and beyond. EMS public education should seek to add the general public or layperson to that healthcare team, and thereby improve the quality, and efficiency, of the delivery of care. By doing so, recognition and appropriate reactions are achieved, and initial care is provided within the critical window required for survival from the most serious medical events. Even in less serious medical emergencies, the time to an initial intervention has an effect on morbidity and mortality (National Highway Traffic Safety Administration, 1996, p. 37).

How will EMS public education benefit the public?

The public has a vested interest in the performance of the municipal EMS system. This system affects the quality of life in the city, intermittently touching the lives of nearly every citizen. A system that can operate efficiently and produce superior outcomes is an asset to the taxpayer, both as a resource and an investment. EMS public education programs provide a benefit to the public, and simultaneously improve the performance of the system. The monetary and human cost savings that can be realized should be considered when calculating the cost of providing this service and determining the level of support it receives.

How will EMS public education benefit the Department?

Offering citizens participation in the system, gives the public a shared stake in our performance. The benefits of greater community involvement extend beyond the effect on outcomes and efficiency. Greater understanding of the EMS system, its challenges, needs, and goals, by the public, will lead to greater support on a wide range of issues. An effective EMS education program will inform the public, and garner their support for our goals of improving patient outcomes and overall system efficiency. With this knowledge, they will be able to exert influence for our benefit during emergencies, when decisions are being made by local government, or when legislation at the state or federal level is presented that affects delivery of EMS services. The department may also realize improvements in employee morale and a reduction in unreimbursed nuisance calls as a result of improved communication with the community.

How will EMS public education be paid for?

Cost is understandably an obstacle in the current economic climate. These programs may not require any additional funding. As written, they will require some collateral duty assignments which could be voluntary, or assigned to specific positions suited for that role. A no, or low cost method of putting these into play, without taking away from existing fire and life safety programs, could be achieved by assigning these duties to individuals, engine companies, and EMS supervisors willing to perform the task on-duty.  Positive results may support funded positions when fully implemented, these costs may be completely or partially offset by system efficiencies, and a measurable improvement in patient outcomes. As a temporary solution some funding may be available through VAOEMS, DHS, and other federal legislation such as H.R.3144 (GovTrack.US) if passed. A less attractive method would involve using volunteers from CERT or FireCorps programs, or even volunteer career staff. The choice will be dependent on the level of commitment the Department is willing to make.

What EMS public education is appropriate for the Fire Department?

Public education in EMS comes in many forms; some are directed solely at the public, others involve educating our healthcare partners. The two areas of focus that may be most beneficial, easiest to implement and least expensive are directed at the general public and are the primary subject of this proposal:

·       Awareness programs for communities, civic organizations, and businesses

There are many communities and civic organizations that would welcome any form of EMS education we are willing to provide. Assisted living facilities, Girl/Boy Scout troops, Churches, businesses and other City departments are likely target groups. The information we can share could include injury prevention, simple operational information, and how to receive basic first aid and CPR training for their members or staff. A successful program would bring these groups to bear in the community as our allies. Through this type of outreach and public relations effort, the goals and practices of the Department will be better understood by the public. This improved understanding and knowledge should induce a better reaction and cooperation during actual EMS events in the community. CERT and Citizen CORPS (FEMA) programs could be an extension of this type of program.

·       Community first aid, CPR and AED training

The public is not integrated into our current EMS system. Most see an ambulance for the first time when they call 911, or are on the receiving end of our services. Very few know CPR or basic first aid, which makes them less likely to react properly, or be willing to follow CPR instructions effectively, if at all. Training in these skills will instill proper reaction to these events, and effective intervention by the lay-public prior to our arrival. An involved and educated public can improve patient outcomes and reduce unnecessary calls. Many agencies, including King County, Washington (Seattle & King County EMS, 2011), Boston EMS, and FDNY (New York City Fire Department), have already demonstrated the effectiveness of this training. Several organizations; Medtronic, Leardal, and the American Heart Association (AHA), offer programs and resources to accomplish basic first aid, hands-only CPR and AED training. 

·       EMS family advocate

In addition to public education there is a demonstrated need for education within the department. The easiest and most beneficial programs are EMS family advocacy and EMS liaison training.Our providers and Officers should be trained to act as family advocate on critical calls where family need emotional support, explaining the care being given, the necessity for treatment, and the need for cooperation during a significant event involving a loved one. By providing kind and compassionate care for the family as well as the patient, the department will enhance its public image and avoid causing undue distress to friends and family of the patient. Other agencies, such as King County, Washington (Neumar, 2011, p. 2900), have demonstrated the effectiveness of treating significant EMS incidents much like a fire incident, with assigned roles, a command structure, which would include a family advocate position, and tracking of benchmarks.

·       EMS Liaison for health care facilities

 Many facilities we deal with on a daily basis are not aware of the capabilities of our system or the needs of our providers when requesting patient transports. This leads to misunderstanding, frustration, and inappropriate use of resources. For a relatively small investment in time, our patient care partners could be educated to understand our needs when transporting a patient, and the available non-emergency capability we possess through our NETCARE program. This type of interaction with our counterparts will establish a good starting point for bringing greater healthcare system integration as suggested by the IAFF (IAFF-Department of Emergency Medical services, 1997, p. 18). Such a program also compliments suggested changes proposed by The EMS agenda for the Future (National Highway Traffic Safety Administration, 1996, p. 10).

How will EMS public education be implemented?

The implementation of these initiatives should involve personnel that embrace the EMS mission of the department, and the goals of this education program. Making duty assignments for personnel otherwise inclined will inhibit the success of the program, allowing a further digression of morale within the department. The programs should be pushed out, promoted, and implemented as quickly as possible to maintain momentum and achieve measurable results in a reasonable time. The entire process needs to be open, keeping in mind that the cooperation, and involvement of the members of the department, is as important as that of the public. EMS public education needs to be completely separated from existing fire prevention programs, including fire truck demonstrations and station tours, to avoid being marginalized or lost in the more dramatic fire prevention and life safety messages. Perhaps with time this perception and promotion issue will abate. As an additional resource, NHTSA (NHTSA, 2006) has published an implementation guide for the EMS Agenda for the Future, which contains specific recommendations directly related to this issue. This proposal incorporates many of these recommendations and suggests this outline for the programs proposed:

Awareness program

1.     Identify qualified and committed personnel.

2.     Develop a general information program about our mission and validate it.

3.     Create list of potential organizations without prejudice (include all).

4.     Make contact with community, provide information, and offer services.

5.     Schedule presentations and dedicate time to complete program.

6.     Give presentation, encourage feedback and record comments.

7.     Provide report, need for re-contact for training.

Community first aid, CPR and AED programs

1.     Identify qualified and committed personnel.

2.     Adopt or develop curriculum and validate it.

3.     Promote the program within the community.

4.     Create target group list, use contacts from awareness program.

5.     Make contact with organization, explain and schedule the program.

6.     Conduct class on schedule without interruption.

7.     Issue certificates, publish roster in local paper.

8.     Create database of attendees for follow-up.

EMS family advocate

1.     Create curriculum for EMS PIO course, validate.

2.     Consider making the curriculum part of regular re-certification requirement for all providers.

3.     Identify who must assume this responsibility during calls.

4.     Require this course for all EMS supervisors and company officers.

5.     Create SOP or directive to address responsibility and performance expectations.    

6.     Follow up on any questions not answered during presentation.

EMS liaison for healthcare facilities

1.     Identify qualified and committed personnel.

2.     Identify issues and create talking point list, validate.

3.     Create list of facilities to contact.

4.     Include hospitals.

5.     Schedule visits and dedicate time for meeting.

6.     Listen to their needs and present our concerns.

7.     Develop plan jointly to improve performance.

8.     Create facility point of contact list.

9.     Follow-up on issues, work toward resolution.

Conclusion

These proposals are ambitious; there will undoubtedly be some push-back until everyone understands the full scope, goals and benefits of these programs. With time a perceptible change in attitudes toward EMS, and EMS education within the department, and among the public should be observable. This can be enhanced and reinforced by making the other necessary system changes as well. The Department’s position as EMS provider  is already under scrutiny; many systems across the nation have been dismantled, or reorganized, because of failure to adapt to changes in the field of EMS system deployment, resource management, and patient care standards. The fire service should consider the merits of these programs and develop them for the good of the public, the providers, and the organization.

References

AHA. (n.d.). Hands only CPR. Retrieved March 18, 2012, from American Heart Association: http://www.handsonlycpr.org/

FEMA. (n.d.). Citzen CORPS. Retrieved April 4, 2012, from http://www.citizencorps.gov/index.shtm

GovTrack.US. (n.d.). H.R. 3144: Field EMS Quality, Innovation, and Cost Effectiveness Improvements Act of 2011. Retrieved April 8, 2012, from Govtrack.us: http://www.govtrack.us/congress/bills/112/hr3144/text

IAEMSC. (n.d.). IAEMSC-homepage. Retrieved April 8, 2012, from International Association of Emergency Medical Services Chiefs: http://www.iaemsc.org/

IAFF-Department of Emergency Medical services. (1997). Emergency Medical Services-Adding Value to a Fire-based EMS system. International Association of Fire Fighters.

Institute of Medicine of the National Academies. (2007). Emergency Medical services at the Crossroads. Washington D.C.: National Academies Press.

Johnson, K. (2011, September 18). Responding Before a Call is Needed. Retrieved April 4, 2012, from New York Times: http://www.nytimes.com/2011/09/19/us/community-paramedics-seek-to-prevent-emergencies-too.html?_r=3

NAEMT. (n.d.). NAEMT-Mission Statement. Retrieved April 8, 2012, from National Association of Emergency Medical Technicians: http://www.naemt.org/about_us/our_mission.aspx

National Highway Traffic Safety Administration. (1996). Emergency Medical Services Agenda for The Future.

NEMSMA. (2010). National EMS Management Association Strategic Plan 2010. Retrieved April 8, 2012, from National Emergency Medical Services Management Association: http://www.nemsma.org/AboutNEMSMA/StrategicPlan/tabid/420/Default.aspx

Neumar, R. e. (2011). Implementation Strategies for Improving out-of-hospital Cardiac Arrest in the United States: Concensus recommendations From the 2009 American Heart Association Cardiac Arrest Survival Summit. Circulation: Journal of the American Heart association, 2900.

New York City Fire Department. (n.d.). CPR to Go program website: http://www.nyc.gov/html/fdny/html/general/registrations/cprtogo/index.shtml. New York, New York.

NHTSA. (2006). National Highway Transportation Safety Administration; Implementation Guide- EMS Agenda for the future. United States Department of Transportation.

Seattle & King County EMS. (2011). 2011 Annual Report to the King County Council, p32. Seattle & King County, Washington.

VAOEMS. (n.d.). Virginia Office Of Emergency Medical Services State Strategic and Operational Plan 2010-2013. Virginia Department of Health.

Appendix I

Opportunities for Improvement

Staffing- Create a staffing model that is flexible and reliable

·       Role of EMS Supervisors- oversight, training, administrative, caregivers, coach.

·       Create clear career path for battalion level EMS officer, examine rank structure.

·       Create equity among various classifications- no divisions in workload based on level of EMS training; everyone should be involved in providing EMS service and transport.

·       Examine and identify ways to increase numbers of paramedics to facilitate move to all/more ALS apparatus.

Deployment- Create a more equitable and responsive deployment model

·       Seek to distribute call volume among all units more equally.

·       Cover areas with high call volume with multiple units.

·       Create flexible company structure that permits deploying assets based on nature of call.

·       Consider options to sending entire engine companies to EMS calls, public assists and courtesy calls.

Training- Create EMS training that is innovative and supportive

·       Move to competency based system.   

·       Role of training division- more emphasis on EMS topics.

·       Use of training medic for monthly skill drills.

·       Use of some sick leave for elective training.

·       Annual MCI training & drills.

·       Quarterly BLS/ALS protocol and medication test (exambuilder).

·       Integrate new education standards to lessen hardship of transition.

·       Include training/obstacle course for patient lifting and moving.

Providers- Enhance the competency, consistency and confidence of EMS providers

·       Monthly skills drill based on EMT practical tests.

·       Encourage outside and elective EMS training.

·       Encourage/train in injury reduction practices related to lifting/moving.

·       Scenario based team management training.

Apparatus- Assure apparatus functionality and reliability

·       Better oversight of repair & maintenance.

·       Reduce cost through preventive services, reduced down time & repeat services.

Administration- Be part of an enabling and responsive administration

·       More involvement with front line staff.

·       More involvement regionally, i.e. TEMS, other localities, VAOEMS.

·       Open communication policy.

·       Transparency in decision making process.

·       Create a Citizen advisory board.

Communications- Improve communications practicality and efficiency

·       Implement true EMD system- priority dispatch single unit based on nature of call.

·       Correct shortcomings of HealthEMS- system speed, web filtering, spell check, terminology, use of station computers, additional fixed data entry stations at hospital.

·       Integrate/eliminate redundant systems that increase workload with no benefit.

·       Examine alternative platforms i.e tablets, ipads, iphones

·       Install appropriate mounts in patient care area on medics for laptops.

·       Perform hearing protection study, and install headsets on all medics if warranted.

Public Education- Develop or enhance education programs that will benefit citizens.

·       Build a pro-active public education program to dovetail with fire prevention programs.

·       Investigate and implement program to facilitate proper medical emergency reaction from public.

·       Provide more EMS education opportunities for the public.

Volunteers- Improve volunteer recruitment and retention

·       Investigate attitudes and barriers to EMS volunteerism.        

·       Develop pool of potential career providers.

New Opportunities- Look for new opportunities to improve efficiency and value

·       Develop new delivery methods- community para-medicine, well checks.      

·       Create liaison for nursing facilities & assisted living facilities.

·       Investigate provision of transport services for non-emergency patients.

·       Integrate with public health, community services, social services and hospitals.