Management of EMS full, EMS Incident Management (NIMS), Management of EMS Education, EMS: Terrorism & Disaster Managment, Management of EMS Chapter 1, Management of EMS Chapter 2, EMS 315 test 2, Management of EMS Chapter 1, EMS Management Mid-Term,...

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formulative evlauation

can be used to refine a programs implementation before full scale implementation

web based injury statistics query and reporting system

cdc database, provides customized reports of injury related data, query information by state and cause of death and injury state ems systems or department of highway safety, NFERS

behavior warning signs

chapter 6 slide 143

types of workplace

chapter 7 slide 141

management activities to reduce workplace violence

chapter 7 slide 142

seat time

classroom time, national curricula do not have specific hours in EMS

National EMS core content

comprehensive list of skills and knowledge,

haddon matrix

conceptual model for developing injury prevention strategies, took the public health model a step further by looking at injuries in terms of casual and contributing factors, haddon believed that injuries occur within a certain time sequence, consisting of pre event, event and post event phases, buld up of uncontrolled energy is release in the preevent phase, energy is transferred in the event phase, and factors about the state of the person agent or environment affect what the energy does in the post event phase, points out different areas in which interventions can be applied

EMS education portfolio

contains the examples of educational products (lesson plans) generated by the instructor that allows the instructor to present a representative body of work for review and comment. NHTSA established core curriculum for instructors and the EMS instructor must build an portfolio

5 integral components of EMS identified

core content, scope of practice, educational standards, national EMS program accreditation, certification

crash injury management

created in 1970 by NHTSA, it was a first responder program for law enforcement officers, it was a 40hr advanced first aid class

What is defined as an indication that the service or product does not meet the customer or public's expectations? (Ch. 5, p. 120).

customer complaint

NTI objectives

define and describe concepts of intentionality, explain how injuries are preventable, describe general approaches to prevention, demonstrate how conceptual models are used to describe multiple risk factors

the spectrum of prevention

describes 7 levels at which prevention activities can occur: strengthening individual knowledge and skills, promoting community education, training ems providers, fostering coalitions and networks, changing organizational practices, mobilizing communities and neighborhoods, influencing policy and legislation

predictors of injury

developmental age, rapid and unexpected motor development, drive for autonomy, need to explore environment, cannot control impulses, cannot understand consequences of behavior, unable to comprehend casuality or assess danger and multiple aspects and risks of situation

A deposition may be taken during what phase of the lawsuit progression?

discovery

National training institute for injury and violence prevention

draft set cores of competencies or essential skills and knowledge, fundamental understanding of injury as a public health problem

three es of prevention, haddons matrix

educational interventions, enforcement activities and enactment of laws, environmental interventions

four apporaches for behavioral change

educational, persuasion, behavioral modification, and social influence theory

Integral Monotropic Proteins

embedded in just one side of the bilayer

Orange book

emergency care and transportation of the sick and injured, first curriculum, first authoritative book for ems personnel

EMS agenda for the future 1996

emphasized education system

disease management coordinators

employed by hmos, look at how to reduce medical costs and provide cost effecive activites such as injury prevention

What is an activity which estimates the number and type of personnel needed to meet organizational objectives? (Ch. 7, pg. 156).

employee forecasting

What is developed from providing great internal customer service? (Ch.5, p. 122).

employee satisfaction, employee loyalty, and employee retention.

What is defined as giving people the responsibility for their task or work and including in it the ability to make change and do it their way (Ch. 3, pg. 53)

empowerment

enforcement activities and enactment of laws

enforcement through legislation and enforcement of that legislation

e code

external cause, required on all death certificates

the ______ amendment of the U.S. constitution has made several rulings supporting drug testing of public safety workers where there is reasonable suspicion

fourth

Excellent service to external customers is dependent on what? (Ch. 5, p. 124).

healthy internal customer service practices

national initiative

healthy people 2020

EMS resources are ___________.

human , physical and financial

What management theory on motivating workers encourages use of the participative leadership style to create an environment in which workers can contribute to the limits of their ability? (Ch. 3, pg. 59)

human-resources model

international classification of diseases

icd-9 codes, world classification system of medical conditions, diseases and injuries, billing for medicare and medicaid

affective domain

ideally 1/3 evaluation of new paramedic should be affective domain

DOT and NHTSA updated the view on EMS in 1996

in a document called EMS Agenda for the Future

standardized pt

individuals who are scripted to portray an actual pt with a specific set of sx or clinical findings.

educational approach

individuals will do the right thing if they understand why and how to carry it out

role modeling

is a process in which an individual identifies with and assumes the values and behaviors of another person, ultimately results in behavior mod that is usually permanent

peripheral membrane proteins

lack discrete hydrophobic regions, don't penetrate the lipid bilayer, these proteins are bound to membrane surfaces via weak electrostatic forces and hydrogen bonds

primary EMS instructor

lead instructor, main educator in charge of a group of students who are attending a course, coordinates with other aspects of the course or works closely with the program director

injury

leading cause of death and disability in US

intentional injuries and crime

leading cause of death, homicide and suicide are the 2nd and 3rd leading causes of death for 15 to 24 year olds, suicide is the 3rd leading cause of death for 10-14 year old, homicide is the 4th leading cause of death for 1-9 year old

a systemic approach to injury prevention

learn as much as you can about the problem, select your injury priorities, define prevention strategies, identify resources and potential partners, clarify objections for evaluation

epidemiological model

looks at the environment, the host or human, and the agent or vector and how the three relate, central to the evaluation of public health problems, uncovering multiple causes, and devising multiple solutions to prevent injury,

environmental interventions

make changes to the environment, child resistant pill bottles, soft surfaces for playgrounds

What requires an agency's command officers to make specific requests for special operations equipment?

mutual aid

resources for prevention activities

national center for injury prevention and control, national insitiute of occupational safety and health, maternal and child health bureau, health resources and services administration, ems for children

n code

nature of injury

The goal of skills training is_______, in which EMS personnel can complete more than one skill with ease or limited effort.

nauralization

intern

new to ems system and participates in an orientation and supervised practice program, preceptee

synchronous learning

occurs at specific time when teacher communicates remotely using chat rooms or online bulletin boards. part of distributive learning

asynchronous learning

occurs at various times without the teacher being present often by Web based programs, self study, or CD-ROM. Part of distributive learning

national standards curriculum (NSC)

overseen by NHTSA; undergo periodic revisions and are contracted to researchers or organizations to create, revise and update the content; the minimum number of hours for each curriculum is determined at local or state level

internship

part of the paramedic education program, combined with didactic instruction, skills, labs, clinical instruction

Fair Labor Standards Act (FLSA)

passed to establish minimum wage and protected employees from unpaid overtime.

Who would most likely be responsible for the overall management of patient movement from the scene to the receiving hospitals?

patient transportation group supervisor

persuasion approach

people are motivated after a careful argument triggering of and motivational hot buttons

behavioral modification

people do what they do because they find it rewarding

the environment

physical and social environment

injury

prevention should be integrated into EMS operations

Communications and Information Management

process for 1) Collecting 2) Interpreting 3) Disseminating Information

active learning

process where learners are actively engaged in learning, has students working hands on, seeing, hearing, and touching equipment, mutlidirectional learning experience, involves activity based learning, involves input from multiple sources through multiple senses

the agent

products people use

Sodium-Dependent Glucose Transporters (SGLT)

proteins responsible for sodium symport

public health model

public health approach to injury prevention is an edffective way to proceed, looking at causes and solutions in the community as a whole, requires looking at the multiple causes of an injury and devising multiple solutions

Recognition-Primed Decision Making (RPDM)

retrieval process that draws on past experiences, recalling an incident and responding in a successful way based on what the outcome were from previous experience.

The evaluation of people places or things likely to incur a loss should a hazard actually occur if no protective action is taken to minimize or eliminate the loss is known as___________

risk assessment

best practices in injury prevention

safe communities, the epic medics story: a local paramedic initiative, frisco fire safety town project, seattle bike helmet program

social influence theory

social pressure to conform

epidemiology

study of distribution and determinants of health related states and events in specified populations, and the application of this study to control health problems, focus on description or analysis

National EMS training blue print project

supported by NREMT, goal is to develop national consensus on framework of ems training education policies, recommended 4 levels of providers

the host

the person or people who are injured

injury prevention surveillance

used to identify the greatest risk to the public, as well as to monitor the progress of ems activities as they relate to injury prevention

three questions for program evaluation

what is the program designed to do, is this the program doing it, is the intervention making a difference

secondary instructor

when a person completes an EMS instructor course, can assist with instruction, provide lab instruction and help with clinicals, idea is to ease into primary instructor role

distributive learning

when a portion of a course is outside the physical presence of the teacher

outcome evaluation

whether or not objectives of a particular injury prevention program have been achieved

process evaluation

whether or not program activities and their delivery are being carried out as planned

Risk Management

• Acquired insurance

Risk Management

• Avoid the risk by avoiding the hazard

Risk Management

• Eliminate the risk by removing hazard

Risk Management

• Pool an amount of money to help an EMS organization recover from a loss associate with a risk

Special Atomic Demolition Munitions (SADM)

"Suitcase nuke" designed to destroy individual targets

Garrity rule

-An invocation that may be made by a public-safety employee being questioned regarding actions that may result in criminal prosecution -A public-safety worker is invoking his or her right against self-incrimination -Any statements made after invoking Garrity may be used only for department- investigation purposes and not for criminal- prosecution purposes

near miss

-An unintentional, unsafe act that could have resulted in an injury, fatality, or property damage -Contributing factors: §Situational awareness §Human error §Decision making §Individual action

Brainstorming Process

-Define and agree upon the objective -Brainstorm ideas and have an agreed upon time limit -Categorize, condense, combine and refine -Access and analyze effects or results -Prioritize opinions and rank list them as appropriate -Agree upon actions and time frames -Control and monitor follow up

FICEMS Government Members

-Department of Transportation-DOT (NHTSA) -Department of Homeland Security-DHS (US Fire Administration) -Department of Health and Human Services-DHHS (Maternal and Child Health Bureau) -Health Resources and Service Administration-HRSA (Coordinating care for Environmental Health and Injury Prevention) (CDC) (Centers for medicare and medicaid services) (Assistant Secretary for Public Health Emergency Preparedness) -Department of Defense-DOD (Office of the Assistant Secretary of Defense Health Affairs) -Federal Communications Commission-FCC (Wireless Telecommunications Bureau)

Wallace's Fire Department Strategic Planning Model

-Identify the department values -Plan to plan strategically -Select and recommend a strategic planning process -Identify the departments mandates -Develop the mission of the department -Create a philosophy of operations -Assess the opportunities and the treats of the external environment -Assess the opportunities and threats of the internal environment -Identify the strategic issues of the department -Create strategies for strategic issues -Create the departments ideal future -Conduct operational planning from a strategic perspective

John Bryson's Applied Strategic Planning Model

-Initiate and agree on a strategic model -Identify organizations mandates -Clarify the organizations mission and values -Assess opportunities & threats of the external environment -Assess the strengths & weaknesses of the internal environment -Identify the strategic issues facing the organization -Formulate strategies to manage the issues -Establish and effective organizational vision for the future

NFA Applied Strategic Planning Model

-PLAN TO PLAN -Formulate a mission statement -Perform strategic business modeling -Conduct a performance audit -Perform a gap analysis -Prepare contingency plans -Create integrated functional plans -Implement actions

6 Components of NIMS

1) Command and management 2) Preparedness 3) Resource management 4) Communications and information management 5) Supporting technologies 6) Ongoing management and maintenance

Advantages of the System

1) Common terminology 2) Clear chain of command 3) Unified command 4) Manageable span of control

Flow of ICS

1) First on scene assumes role of incident commander 2) As others arrive, name others as responsible for logistics and operations 3) As the incident continues, divide operations as needed

Command and Management 3 Systems

1) Incident command system 2) Multiagency coordination systems 3) Public Information systems

Five Elements in ICS Structure

1) Incident commander 2) Operations 3) Planning 4) Logistics 5) Finance/administration

Preparedness

1) Planning 2) Training 3) Drills 4) Personnel qualifications and certification 5) Equipment acquisition and certification 6) Mutual aid 7) Publications management

What four factors are necessary for successful delegation? (Ch. 3, pg. 57)

1. Employee has knowledge, skills, and abilities. 2. Task or assignment is properly defined. 3. Resources are available to complete task or assignment. 4. Timeline and final product is agreed upon.

Glycogen Breakdown

1. Glycogen converted to Glucose 1-Phosphate via Glycogen Phosphoylase 2. G-1-P converted to Glucose 6-Phosphate via Phosphoglutamase 3. G-6-P converted to Glucose via Glucose-6-Phosphatase 4. Glucose transported to blood stream via Glucose Transporter

What seven essentials are necessary for success in a manager-leader position? (Ch. 3, pg. 53)

1. Keen perception 2. Broad-base knowledge 3. Critical Thinking 4. Mature Judgment 5.Clear Communication 6. Common Sense 7. Ethical Conduct

Master Plan

10-20 year plan

In about how many days does an employee's skills decline if they are not used or reinforced with another methodology?

180 days

NFPA (National Fire Protection Association)

1896, world leading advocate of fire prevention and authoritative source on public safety

Highway Safety Act

1966, Addressed EMS issues by developing specifications covering ambulance attendant TRAINING< EQUIPMENT REQUIREMENTS and DESIGN OF EMERGENCY VEHICLE

Creation of the NHTSA

1966, First federal standards in EMS and established The Highway Safety Act

Report on Accidental Death and Disability

1966, The White Paper from the NAS (National Academy of Science)

Wedworth-Townsend Act

1970, provided the first legal definition of paramedics and listed them as "mobile intensive care paramedics"

Star of Life

1972, National EMS symbol

Emergency Medical Services System Act

1973, Federal funding for improved EMS through development of Regional EMS systems. First federal or national initiative on EMS.

A written strategic plan has ________ sections

8 Executive Summery Problems Definition Assessment of critical factors Intervention Strategies Stakeholders Organizational objectives Budget Plan Evaluation

ABCD Method to writing objectives

A Audience- Who will do it? B Behavior- What will be done? C Conditions- By when, where and how? D Degree- What is the quantity and quality expected?

SWOT Analysis

A Resource analysis process that identifies strengths and weaknesses and examines the opportunities and threats the program or idea will face. STRENGTHS-WEAKNESSES-OPPERTUNITIES-THREATS

Bacteria

A member of a large group of unicellular microorganisms that have cell walls but lack organelles and an organized nucleus

Contagious

A state of high communicability

What is the most important aspect of delegation? (Ch. 3, pg. 57)

Accountability

Risk Management

Activity that involves the evaluation or comparison of risks and the development, selection, and implementation of control measures that change, reduce, or eliminate the probability or the consequence of harmful actions.

Rough ER

Adds on carbohydrates to glycoproteins Folding of Polypeptides Removal of misfolded proteins Assembles multimeric proteins

What type of skills involve planning, negotiating, and coaching? (Ch. 12, pg. 301)

Administrative skills

Mutagen

Agent that mutates, damages and changes the structure of cells

LD50

Amount that will kill 50% of people exposed to agent

Toxin

An antigenic poison or venom of plant or animal origin, especially one produced by or derived from microorganisms and causing disease when present at low concentration in the body

Administrative Law

An area of civil law that pertains to the government's authority to enforce its rules, regulations, and status through criminal penalties, fines, seizures, or liens.

Emotional Intelligence

An emerging science that looks at how to control emotions to recognize triggers and avoid negative response.

Smallpox

An extremely contagious disease. Lesions will be identical in development

Indirect Transmission

An inanimate object serves as a temporary reservoir for the infectious agent.

Economy Scale

An increase in production efficiency as the number of goods or services being produced increases

Virus

An infective agent that typically consists of a nucleic acid molecule in a protein coat, is too small to be seen by light microscopy, and is able to multiply only within the living cells of a host

Organizational objectives

An overview of of the strategies and measurable objectives that have been identified.

In day to day operations, what describes a sentinel event? (Ch. 3, pg.55)

An undesirable event or phenomenon which triggers the need for further analysis and investigation.

risk management defined

risk management

Any activity that involves the evaluation of or comparison of risks and the development, selection, and implementation of control measures that change, reduce, or eliminate the probability or the consequences of harmful actions •Risk management in EMS: -Preventing monetary losses -Preventing disability -Preventing loss of life -Preventing irreparable business damage •Risk management in EMS involves: -Direct, "hands-on" patient care -Indirect aspects of patient care, such as development of effective training programs and selection of qualified personnel •Risk management has five strategies: -Eliminate the risk -Avoid the risk -Acquire insurance -Pool financial resources -Transfer the risk

Weapons of mass destruction

Any agent designed to bring about mass death, casualties, and/or massive damage to infrastructure

Radio active material

Any material that emits radiation

What is the key to customer service? (Ch. 5, p. 121).

Applying continuous quality improvement by refining, designing, and improving the delivery of service and placing the patient's expectations first.

What is activated if necessary , depending on the complexity of the incident and span of control considerations?

Area command

Fixed expenses

Aspects of the service that continue to be the same regardless of the level of activity. (salaries, vehicle maintenance)

What is the preferred method of selecting managers and upper level administrators within an organization?

Assessment center process

Assessment of critical factors

Assessment of the 3 critical factors of project management. Time Cost Performance

Methods of Managing Risk

Avoidance of risk activity. Policies such as refusing to allow relatives to ride in ambulance during patient transport or refusing to allow EMS providers to perform medical procedures without express authorization by the medical director.

What term is given to people born between 1946 and 1964 and perceive today's generation as lazy and egocentric? (Ch. 7, pg. 157)

Baby Boomers

Which generation are deemed as goal oriented, function well in team-centered activities, and sees recognition from newsletters or press releases as an incentive? (Ch. 7, pg. 157)

Baby Boomers

Anthrax Routes of infection...

Bacterium that lays dormant in a spore until exposed to optimal temperature and moisture Inhalation Cutaneous Gastrointestinal

Balanced Score Card (BCS)

Base on a principle that what gets measured gets done an that financial performance is not the only measure of an agencies success

What is a term used to describe a means of determining which public and private EMS agencies are doing the best job of customer service and complaint resolution then using that information to improve their agencies performance? (Ch. 5, p. 102)

Benchmarking

What is used to measure performance against a standard? (Ch. 13, pg. 318)

Benchmarks

Miosis

Bilateral pinpoint constricted pupils

B-NICE

Biological Nuclear Incendiary Chemical Explosive

Pathogen

Biological agent that cause disease or illness in a person.

Vesicants

Blister agents; contact

What is a strategy used to determine how to prevent customers from being dissatisfied? (Ch. 5, p. 102)

Call Avoidance

G agents

Came form early nerve agents, produced by Germans between WWI and WWII

Communicable Disease

Can be readily spread from one person to another.

Dirty bomb

Carries potential to injure victims with radioactive and explosive material

Ricin (from castor bean)

Causes pulmonary edema, respiratory and circulatory failure Inhalation Ingestion Injection

Variable expenses

Change with the level of activity

Lymphatic system

Circulatory system that bathes body in lymph and works with immune system

Problem Definition

Clear and concise definition of the problem

V agent (VX)

Clear and oily, orderless, looks like baby oil 100 times more lethal than sarin Extremely persistent Contact hazard

What is an activity through which managers can work with subordinates to foster skill development, impart knowledge, and instill values and behaviors that will help them achieve organizational goals and prepare them for more challenging assignments or performance? (Ch. 3, pg. 68)

Coaching

CAAHEP

Commission on Accreditation of Allied Health Education Programs; the committee that is nongovernmental, independent collegial process of self and peer assessment, ensures that an independent review of an institutions or programs quality measure up to national standards.

SMART Method

Commonly used method for creating goals in EMS Specific Measurable Attainable Realistic Tangible

!5 Original Components of and EMS SYSTEM

Communications Training Manpower Mutual Aid Transportation Accessibility Facilities Critical Care Units Transfer of Care Consumer Participation Public Education Public Safety Agencies Standard medical records Independent review and evaluation Disaster linkage

What requires general analytical ability, logical thinking, and conceptualization of complex and ambiguous relationships? (Ch. 12, pg. 301)

Conceptual skills

Ambulance Diversion

Condition or event in which an ambulance is sent by radio or computer program to another hospital instead of to the closest facility or hospital of choice.

Cross contamination

Contact with a contaminated individual that has not been decontaminated

Mark 1 DuoDote Auto-Injector

Contains 2.1mg of atropine and 600mg of 2-PAM

Mark 1 Nerve Agent Antidote Kit (NAAK)

Contains two medications-2mg of atropine and 600mg of pralidoxime chloride (2-PAM)

CECEBEMS

Continuing Education Coordinating Board for EMS; approves refresher courses

Syndromic surveillance

Continuous, systematic collection, analysis and interpretation of health-related data needed for the planning, implementation, and evaluation of public health practice

core elements

Core elements in EMS education: pt assessment, airway, breathing, circulation, musculoskeletal, children and OB/GYN, behavioral, med admin, neurological, environmental, EMS systems, ethical/legal, communications, documentation, safety, triage and transport

Capital expenses

Costs of property and any item over $5000

Hemoptysis

Coughing up blood

Intervention strategies

Created using research and problem identification efforts and should identify both the potential and the selected intervention strategies that reflect the mission.

What law is the most important to consider?

Criminal law

What is a pattern of artifacts, behaviors, values, beliefs, or assumptions that may provide cues that guide employees in performing their functions? (Ch. 3, pg. 51)

Culture

Hydrogen cyanide (AC) and cyanogen chloride (CK)

Cyanides

Pulmonary agents (choking agents)

Damage lung tissue allowing for fluids to leak, pulmonary edema develops

Reactive Change

Decisions about change that are made in response to crisis in an organization.

Mission Statement

Defines the reason that the organization , committee or group exists or what action it is expected to take.

By law, the arrangement by which a paramedic practices under a medical director is known as_________.

Delegated practice

DHS

Department of Homeland Security

DOT

Department of Transportation

The key benchmarks of a healthcare system with EMS integration

Detection Notification Dispatch Pre-arrival On-scene Transport and faculty notification Emergency department/ receiving facility Interfaculty Critical care In patient care Rehabilitation Follow up

Star of Life 6-barred cross represents

Detection Reporting Response On scene care Care in transit Transfer to definitive care

Smooth Er

Drug Detox Carb Metabolism Calcium Storage Steroid Synthesis Synthesis of membranes

Primary blast injury

Due to the direct pressure wave on the body, effects almost exclusively the hollow organs of the body

What is defined as an indication that patient care or EMS service did not meet the customer's need or standard of care? (Ch. 5, p. 120).

EMS complaint

80%

EMS has spent approx _ of its time, money, and expectations on advanced life support upgrades to provide hgh end services such as cardiac and trauma res. promising to res. expired vitims. no increase in survival rates

Stationary Cisternae Model

Each Cisterna in the Golgi is a stable structure, transport of materials is mediated via shuttle vesicles, bud off from one cisterna to another in cis-trans sequence

Communicability

Ease that a disease spreads between humans

CRM eliminate barriers

Eliminate barrier Communication Situational awareness Decision making Teamwork

management eliminate barriers

Eliminate barrier Communication Situational awareness Decision making Teamwork

What does the internal customer rely on as a key indicator of customer satisfaction? (Ch. 5, p. 118)

Employee Satisfaction

What is a key performance indicator in an EMS organization?

Employee turnover and satisfaction

Strategic Map

Enables EMS managers to define and communicate the cause and effect relationship between monies spent on EMS and their EMS organization's value to the community

Ionizing radiation

Energy emitted in the form of rays or particles

Buboes

Enlarged lymph nodes

Supporting Technologies

Ensures communication systems are 1) Functional 2) Interoperable

Components of a Government Business Plan

Executive Summery History, mission, and goals Analysis of services Information technology Human resources planning Asset management Finance Performance measures Marketing and public information Appendix

Infectious

Exposure to illness and when exposure has occurred to be sure providers get the medical attention they need.

DHS has two key federal agencies that provide EMS training and resources

FEMA and NFA

SAFETEA , authorized a federal oversight committee for EMS called

FICEMS (Federal Interagency Committee on EMS

Points of distribution (PODs)

Facilities that are established in time of need for the mass distribution of antibiotics, antidotes, vaccinations and other medications and supplies

James O. Page

Father of EMS

Consolidated Omnibus Budget Reconciliation Act (COBRA)

Federal law with subsection that regulated the public access to emergency care and mandated emergency care or evaluation of non-insured people; defines when a person is on hospital property and the parameters for a person to be transferred to another hospital.

Strategic Maps apply the planning process to an organization using four perspectivesL

Financial Customer Process learning and Growth

2 distintive parts of a strategic plan

GOALS OBJECTIVES

What is a frequent source of litigation and states that no employee shall be compelled to testify against himself? (Ch. 7, pg. 174)

Garrity Rights

What term is given to people born between 1965 and 1980 and normally when unhappy in the workplace, usually quits? (Ch. 7, pg. 157)

Generation X

Which generation are great at multi-tasking and operates well with little instruction? They need a leadership style that does not micromanage and sees time off as the best motivator? (Ch. 7, pg. 158)

Generation X

What generation of EMs professionals must be constantly challenged with continuous learning and building skills?

Generation Y

What term is given to most recent college graduates born after 1980? (Ch. 7, pg. 157)

Generation Y

Which generation needs to be constantly challenged with continuous learning and skill building? They respond best to coaching and upbeat messages through informal communication. (Ch. 7, pg. 158)

Generation Y

Cisternal Maturation Model

Golgi cisternae are transient compartment, gradually change from CGN cisternae to medial cisternae to TGN cisternae. Enzymes that aren't needed in later compartments are returned to earlier compartments via vesicles.

Tabun (GA)

Half as lethal as sarin and 36 times more persistent Fruity smell Contact and inhalation hazard

Multipass Proteins

Have 2-20 (or more) transmembrane segments

singlepass proteins

Have the C-terminus extending from one surface of the membrane and the N-terminus from the other

Sarin (GB)

Highly volatile, orderless Inhalation hazard LD50 of 1,700mg/70kg (about 1 drop) Off-gasing effect

Stakeholders

Identified, listed and discussed. Should also address their anticipated level of involvement in the project.

Executive Summery

Identifies the key issues related to the plan

Plan evaluation

Identify how, when and what will be evaluated

PERT Planning Process

Identify the specific activities and milestones Determine the proper sequence of the activities Construct a network diagram Estimate the time required for each activity Determine the critical path Update the PERT chart as the project progresses

What law was enacted to limit the liability or cap the award settlement of lawsuits filed against government operated EMS and fire agencies?

Immunity Laws

The Griggs Decision

In 1971 the Supreme Court issued a unanimous opinion in the case of Griggs v. Duke Power Co. It held that for purposes of hiring and assignment to a laborer position, an employer's use of a high school diploma requirement and two standardized written test, each of which disqualified a higher percentage of blacks than whites, violated Title VII of the Civil Rights Act of 1964.

Disease vector

Infected animal that spreads disease to another animal

Bubonic plague

Infects lymphatic system, causes lymph nodes to become infected and grow round and large, forming buboes; will spread through system and cause sepsis

transmembrane proteins

Integral proteins that protrude on both sides, are generally anchored to the bilayer via one or more hydrophobic transmembrane segments

14 Attributes of EMS

Integration of health care services EMS research Legislation and regulation System finance Human resources Medical direction Education systems Public education Prevention Public access Communication systems Clinical care Information systems Evaluation

Secondary device

Intended primarily to injure responders and secure media coverage. Can be cell phones or pagers that detonate when "answered"

What type of skills involve the ability to understand feelings, attitudes, and motives of others from what they say and do? (Ch. 12, pg. 301)

Interpersonal skills

Aging

Irreversible cell binding

Describe the concept of 360 degree customer service. (Ch. 5, p. 118).

It assesses the level of service at each point where the customer experiences agency service standards.

What is a concept of rotating to different assignments so that an individual does not become obsolete in his/her position? (Ch. 12, pg. 302)

Job Enrichment

What is a program that encourages a continuous and gradual improvement through evolution, rather than through revolution? (Ch. 13, pg. 316)

Kaisen

What are signs of failure in the coaching process? (Ch. 3, pg. 70).

Lack of commitment, unrealistic expectations, defensiveness, playing a passive role, playing it safe, failing to involve others.

IAFF EMS division

Leader in using geographic information systems (GIS) mapping to improve EMS funding and response times.

What is defined as the process of guiding others towards accomplishing goals? (Ch. 3, pg. 60)

Leadership

Malcolm Baldige Heath Carle Criteria: Organizational Profile Environment, Relationships and Challenges

Leadership Strategic Planning Focus on patients, other customers and markets Measurement, analysts, and knowledge management Staff focus Process management Organizational performance reports

Government budget

Legal document that is often passed by the legislature, city council, fire or EMS board or county commission and approved by the chief executive.

What can supervisors do to foster a position for employees to problem solve and find reasonable solutions? (Ch. 3, pg. 56)

Listen carefully to employees and only intervene when there are inconsistencies with organizational values or practices.

Pneumonic plague

Lung infection, results from inhalation of plague bacteria

What is associated with the rational assessment of a situation; development of goals and strategies; and the design, organization, direction and control of the activities required to attain the goals? (Ch. 3, pg. 60)

Management

What is defined as the process of prioritizing jobs and applying the right combination of resources and talents to achieve an acceptable outcome? (Ch. 3, pg. 50)

Management

Proactive Change

Managerial decisions are made to try new things in and anticipation of changes in the environment

Dissemination

Means by which a terrorist will spread the agent

Who has supreme authority over providers as they deliver care and must monitor their competency?

Medical director

What is the act of offering advice, information, and guidance by a person with useful experiences, skills, or expertise for another individual's personal and professional growth? (Ch. 3, pg. 70)

Mentoring

Cyanides

Metabolic agents Almond like odor Affects bodys ability to use oxygen Kills within seconds to minutes

Resource Management

Methods to 1) Inventory 2) Disperse 3) Track 4) Return resources

Nerve agents

Most deadly chemicals; can cause cardiac arrest within seconds to minutes of exposure

Neurotoxins

Most deadly substances known to humans. 15,000 times more lethal than VX and 100,000 times more lethal than sarin Toxins produced by plants, marine animals, molds and bacteria

Criminal Law

Most important law to consider, it's established by legislatures to indicate public wrongs or crimes against the state. Prohibits actions that are harmful

Botulinum

Most potent neurotoxin, produced by bacteria, diminishes voluntary muscle control as toxin spreads Respiratory arrest occurs

What type of experiences improves employee attitudes, confidence, and performance? (Ch. 3, pg. 59)

Motivational and Inspirational

Transfers

Must be done by qualified personnel, hospital with specialty capability that receive Medicare funding cannot refuse patients.

Sulfur mustard Type of agent... Persistent or volatile?

Mutagen; brownish, yellowish oily substance; smells of garlic or mustard Slow onset Vesicant; contact Persistent

NAS

National Academy of Science

NFA

National Fire Academy

NHTSA

National Highway Traffic Safety Administration

NIMS stand for

National Incident Management System

What is defined as the building of cooperative relationships with people who can assist you in reaching a goal? (Ch. 3. pg. 65)

Networking

Which generation are most recent high school graduates, fairly new to the workforce, and are accustomed to technology, but have poor communication skills and need for personal gratification in everything they do? (Ch. 7, pg. 157)

Nintendo Generation

Pulmonary blast injuries

Occur as contusion and hemorrhages

When should an EMS manager attempt to resolve customer complaints? (Ch. 5, p. 121).

On first contact, as this will reduce cost by eliminating unnecessary additional contacts and subsequently build customer confidence.

Strategic Planning Cycles

Overlap to create a comprehensive plan. HOW and WHY

What should be a priority for system managers because it determines how a system is perceived as a public service entity, and at budget time whether it is worth the cost? (Ch. 5, p. 103)

PIER - public information, education, and relations.

Secondary blast injury

Penetrating or non-penetrating injury that results from flying debris

In quality improvement, what is used in continuous comparison of the system to itself? (Ch. 13, pg. 315)

Performance Measures

Incubation

Period of time between the person be exposed to agent and when symptoms begin

Persistency vs. volatility

Persistent: Agent that remain for long periods; hours-weeks-months Volatile: Evaporates within seconds to minutes

Workload Indicators for EMS

Population served Total responses Rescue/EMS calls Transports Training contract hours Special events Stand by for police /fire Special operation calls Response times Responses by units

Values Statement

Positive and inspiring and provide an focus to the organization

Civil Law

Private law that is established between two recognizable parties, which may include corporations, partnerships, quasi-government structures, or other public entities. Involves plaintiff and a defendant.

Job-Task Analysis

Procedure that begins, then organizes tasks into duties and areas of responsibility, and finally converts this information into job performance requirements.

Phosgene

Product from textile fires or burning Freon, smells of freshly cut grass or hay. Often large amounts enters unnoticed

Grievance Procedures and Discipline

Progressive disciple is a process for dealing with job related behavior that does not meet expected and communicated performance standards.

How can a supervisor improve the decisions a subordinate makes and build on the skills of that employee for the benefit of the employee and the organization? (Ch. 3, pg. 57)

Provide gentle corrections and coaching

Critical Path Method (Dupont Chemical)

Provides a graphic view of projects and predicts the time required to complete a project by showing which activities are critical to maintaining the program or the construction of the physical plant. Six-Step Process

Covert

Public has no prior knowledge of time, location or nature of attack

Malcolm Baldige Quality Award

Public-private partnership to improve the performance of national organizations.

Chlorine (CL)

Pulmonary agent

What program has the responsibility to evaluate utilization of staff, deployment of vehicles, and capabilities of the sytstem of EMS ?

Q I

What employs the process of audit, review, and evaluation of performance after the fact? (Ch. 13, pg. 318)

Quality Assurance (QA)

What activities are essential to keep the workforce motivated, provide excellence in patient care, and reduce the risk to the organization? (Ch. 13, pg. 312)

Quality Improvement

What is known as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge?

Quality of care

Lewisite (L) and phosgene oxime (CX) Type of agent... Persistent or volatile?

Rapid onset Vesicant Volatile

Weingarten Rights

Refers to the right of employees to be assisted without prejudice by an advisor who may be an attorney or union official

Tertiary blast injury

Results from whole body displacement and subsequent traumatic impact with environmental objects

Budget

SWOT analysis (Strengths, Weakness, Opportunities and Threats)

SAFETEA

Safe, Accountable, Flexible, Efficient Transportation Equality Act. Signed into law in 2005

SLUDGEM/DUMBELS

Salivation, Sweating Lacrimation (excessive tearing) Urination Deification, Drooling, Diarrhea Gastric upset and cramps Emesis Muscle twitching/ Miosis Diarrhea Urination Miosis Bradycardia, Bronchospasm Emesis Lacrimation Seizures, Salivation, Sweating

Who is responsible for ensuring that all agencies, both public and private, adopt and utilize the NIMS ICS guidelines?

Security of Homeland Security

What is a signal that signifies the need for management to take action? (Ch. 3, pg. 55)

Sentinel Event

What is the first task of an EMS leader or manager when it comes to analyzing the EMS system for strengths and weaknesses?

Service audit

Ethics

Set of principles or a standard of conduct. Doing the right thing, whether someone is watching or not.

Strategic Planning

Set of processes and behaviors that an organization uses to identify, prioritize, focus and schedule action in order for it to remain viable in the future.

Vision Statement

Sets the stage for a mission statement Provides a futuristic look at broad guidance for the EMS agency or system

Department of Homeland Security Advisory System levels

Severe (red): Severe risk of terrorist attacks High (orange): High risk of terrorist attacks Elevated (yellow): Significant risk of terrorist attacks Guarded (blue): General risk of terrorist attack Low (green): Low risk of terrorist attack

Operational Plan

Short Term 3-5 years

What term is given to people born before 1946 and feels uncomfortable turning over hard work and sacrifice of a lifetime to younger workers? (Ch. 7, pg. 157)

Silent Generation

Which generation rather communicate face to face or by phone rather than electronic communication and responds to recognition in traditional forms such as plaques, awards, or pictures with their boss or supervisor? (Ch. 7, pg. 157)

Silent Generation

What is a statistical measure of performance or a product and is a way to manage an organization by putting the customer first, using facts and data to find better solutions to service? (Ch. 13, pg. 316

Six Sigma

Objectives

Specific description of an expected outcome to be attained over an identified period of time.

CDC

Standards for blood borne pathogens and matins the Strategic National Stockpile (SNS)

What office has the responsibility to evaluate education and practice for reciprocity and legal recognition?

State E M S office

What process allows for highly qualified people in all positions at present and in the future? (Ch. 12, pg. 308)

Succession Planning

What provides a way to recruit employees, develop their skills and abilities, and prepare them for advancement while retaining them to ensure a return on the organization's training investment? (Ch. 12, pg. 308)

Succession Planning

First Prehospital care was provided during

The Napoleonic War in the late 18th early 19th century

Situational Awareness

The ability to generate actionable knowledge through the use of timely and accurate information.

Lipid-Anchored Membrane Proteins

Their polypeptide chains are located on the surfaces of membranes, are covalently bound to lipid molecules embedded in the bilayer. Proteins bound to the inner surface of the plasma membrane are linked to fatty acids, or isoprenyl groups

What is a system aimed at continuously improving performance at every functional level, focusing on customer satisfaction? (Ch. 13, pg. 315)

Total Quality Management (TQM)

Fn of Lipid Rafts

Transporting nutrients and ions across membranes Binding activated immune system cells to their microbial targets Transporting cholera toxin into intestinal cells

Soman (GD)

Twice as persistent as sarin and five times as lethal Inhalation and contact hazard Fruity odor, typically colorless Aging effect

What type of incident management team consists of federally or state certified personnel that are the most robust IMT with the most experience

Type 1

Observations for terrorist event

Type of location Type of call Number of patients Victims' statements Preincident indicators

First Ambulance service

Union Army in 1862

Routes of exposure; Vapor Contact

Vapor: Enters through respiratory tract Contact: Enter through skin

Off-gasing

Vapors continuously released over a period of time

Jim MacKay's Strategic Planning Matrix

Vertical axis- technology and the uncertainty of the environment Horizontal axis- How clear and how well defined and communicated the organizations goals are 1st BOX- Rational Strategic Planning "Plan, Act, Evaluate" 2nd BOX- Commitment Planning "Find Common Ground" 3rd BOX- Incremental Planning "Act, Evaluate, Plan" 4th BOX- Inspirational Leadership "Follow My Idea"

Chemical agents are...

Vesicants (blister agents) Respiratory agents Nerve agents Metabolic agents (cyanides)

Primary biologic agents

Viruses Bacteria Toxins

Viral hemorrhagic fevers (VHF)

Viruses that cause blood in the body to seep out from the tissues and blood vessels

PERT Program Evaluation and Review Techniques

Way to organize activities that have more random completion times. Used for complex strategic projects that may take years to develop and bring on line.

What guarantees an employee rights to assistance from union representatives during an investigatory interview and to have access to procedures for securing the appearance of witnesses in disciplinary hearings and to receive a timely and impartial decision? (Ch. 7, pg. 174)

Weingarten Rights

Direct Transmission

When an agent that causes disease, especially a living microorganism such as bacterium or fungus, is transmitted directly from an infected individual one who had been uninfected.

Emergency Medical Treatment and Active Labor Act (EMTLA)

a U.S. Act of Congress passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act; requires hospitals and ambulance services to provide care to anyone needing emergency treatment regardless of citizenship, legal status or ability to pay.

access, interpret, use and present injury data

access to good injury data makes it possible to identify and understadn the local community injury problem, helps prioritze a list of problems and determine how large specific problems are, enables you to note patterns of when and how injuries occur and to monitor trends to determine if injuries have increased or decreased over time, data can help assess emerging injury issues and identify behavioral and environmental risk factors so you can design, implement and evaluate an effective injury prevention program, data can help answer the who how where what and when questions that are important to selecting a cause of injury to address a target population and other issues related to choosing an appropriate intervention

What do community special events require?

additional planning , preparedness and mitigation

affective domain

addresses interest, attitudes, opinions, appreciations, values and emotions. Often new employees dont share same values as leadership, aligning the differences is challenging. Ideally 1/3 of evaluation should be affective domain. Comm skills, customer service skills, pt advocacy are all reinforced by using affective domain

opportunites for ems

adjust from a primarily reactive service to one of injury prevention, community wide approach to healthy living, must accept responsibility for providing health services beyond emergency response to citizens, bicycle hempets, child safety seats, smoke detectors, poison control services

When operating under a state certification or license and you violate a protocol you can be charged under what law?

administrative

skills decline

after 180 days after course of not used, skills decline

injury

as healthcare costs continue to increase, there remains a need to allocate more money toward preventing injury

attributable risk

assesses the ways in which a particular type of injury is associated with a particular exposure within a population

What is the minimum amount of time that EMS managers should keep records of employee training and certification?

at least 7 years

educational interventions

attempts to initiate behavioral changes by informing a target group about potential hazards, explaining risks, and persuading people to adopt safer behavior

Dispatch centers can send or request what , without a command officers input for equipment based information from the 911 call?

automatic aid

objective structured clinical examination (OSCE)

based on planned clinical encounters in which the EMT interviews, examines, informs or interacts with a standardized pt. (scenario)

national initiative

benchmarks give ems leadership goals to work toward, reduce numbers by targeting specific injuries, reduce hospital emergency department visists, reduce the incidence of drowning, reduce the incidence of hip fractures in fall related injuries

Risk Management

• Transfer the risk

hazardous materials response

•"Worker Protection Standards for Hazardous Waste Operations and Emergency Response" or the HAZWOPER standard, 1989 •Requires all emergency services to develop and implement a written incident plan to handle hazmat emergencies •The Department of Transportation has issued hazmat guidelines and recognition tools, OSHA has mandated training for emergency medical responders, FEMA is providing funds for training, and the EPA is providing hotline support •The crossover to hazmat response has also resulted in funding requirements for personal protective clothing and equipment •Must ensure adequate training to protect the health and safety of EMS members as well as provide the protocols and SOPs necessary to ensure the delivery of quality medical care

360 degree evaluations

•A 360-degree performance appraisal allows peers, subordinates, and superiors to rate the employee on his or her performance

handling a crissi

•A crisis is an unstable event, critical time, or state of affairs in which a decisive change is impending and a possibility exists of a highly undesirable outcome •Some media encounters are a surprise or occur during unexpected, escalating events where there is insufficient information •It is important to require the job of an EMS manager to include the skills for dealing with the media •Identify potential scenarios along with guidelines for management and publicity •Do not permit the staff to berate the media during training exercises

resolving customer complaints

•A customer complaint can be defined as any indication that the service or product does not meet the customer or public's expectations •Government agencies aspire to resolve complaints at the earliest possible time in the lifespan of the complaint •When complaints are not resolved, frustrated citizens redress problems to other levels of government, causing duplication of services and compounding the cost as managerial time is used to resolve the complaint

ambulance membership programs

•A fixed-price pre-payment of all or part of fee-for-service ambulance service bills for a certain period of time •Two types of subscriptions: -In first type, provider may not bill third party payers; all costs are supplied by membership -In second type, provider may bill and collect from third party payers; co-pays are taken care of by membership •Linked to the goals of the organization •Can provide additional personnel, equipment, enhanced training, a mechanism to improve marketing and customer service •Works best when the public is sensitive to ambulance rates

medical exams

•A hands-on physical by a physician with evaluation of respiratory, cardiac, ENT, neuro, musculoskeletal, genitourinary tract, and lymphatic systems •A critical assessment for chemical agents, physical agents, and carcinogenic exposures, with all vital signs such as height, weight, color vision, and blood pressure •An in-depth patient history (review past occupational exposures, personal/family health, and vaccinations), an extensive blood-work review for exposures, spirometry/pulmonary function test, electrocardiogram, chest X-ray, and annual TB test •If available, the hepatitis B vaccine series

calculating unit hour cost

•A measure of the total cost of providing coverage during a given accounting period divided by the total number of unit hours of coverage provided during that same accounting period •This measurement can be used to identify whether or not unit-hour costs can help identify excessive cost compared to the quality of care being delivered

upbilling

•A misrepresentation of provided services by billing for more expensive service -For example, if an agency performs an ALS assessment on every patient in an attempt to gain ALS reimbursement •Can result in fines, criminal charges, or suspension of Medicare benefits

physical abilities test

•A nationally validated physical-abilities test with a Department of Justice evaluation does not exist for EMS personnel •A popular physical-abilities test for fire-based personnel is the IAFF and ICHIEFS Candidate Physical Ability Test (CPAT)

national credentialing system

•A nationwide system for credentialing has been established under the IMAS initiative •Currently, FEMA has established a nationwide system of credentialing by working with existing state or discipline-specific credentialing bodies towards national recognition for multi-jurisdictional response under mutual-aid agreements •Current credentialing bodies will continue to issue the credentials; however, those credentials will be entered into a national database and validated •The nationwide credentialing system will be used to request and credential people before they are placed in the role at an emergency scene or at the site of a disaster

conducting appraisals

•A performance appraisal should be conducted annually or when an employee finishes a probationary period after promotion or job change •The time period during which an employee's job performance is observed is called the appraisal period •Raters should be honest, open, objective, and non-threatening and should focus on the specific and observable behavior •Raters should ask for input and feedback from the employee, remain open to ideas or suggestions, and change the appraisal in response if appropriate •Treat the session as a problem-solving session and emphasize performance and expectations, not personality characteristics, which employees are more likely to perceive as threatening and difficult to change •Avoid focusing only on negatives or positives •Establish future performance goals -Develop specific, behavioral performance goals/objectives jointly with employees -Make certain the goals are within the employee's ability and control to accomplish, and are realistic -Establish followup procedures for measuring progress toward goals •EMS managers and leaders should praise and reward performance on an ongoing basis following appraisal •Provide frequent, specific feedback on job performance •Coach and counsel as necessary to provide encouragement, support, assistance, and adjustments as the employees works toward goals •Feedback is most effective when it is timely and noticeable •Evaluations should be applied consistently, and the same evaluation criteria should be applied to all employees •The evaluator has to be a manager or a supervisor with first-hand knowledge of the quality or work performed, and the personal behavior of the employees •Maintain control by establishing ground rules •Stay focused on the topics at hand and keeps the employee from going off in a different direction

collective bargaining

•A process often mandated that outlines what can or will be negotiated between an employer and a labor group •Is governed by federal and state statutory law, administrative agency regulations, and judicial decisions •It is an accepted practice to meet and confer about the requirements of the bargaining process •The Bureau of Labor Statistics is authorized by the Labor-Management Relations Act of 1947 to mandate collective bargaining in labor agreements •What are mandatory subjects of bargaining? -Required to bargain over wages, hours, and other terms and conditions of employment §To include wages and fringe benefits, grievance procedures, arbitration, health and safety, nondiscrimination clauses, no-strike clauses, length of contract, management rights, discipline, seniority, and union security §Agreements include the establishment of a procedure to settle differences in contract interpretation §The grievance procedure is usually the means a worker has of enforcing the contract §Mediation and arbitration need to be detailed in any contract negotiation

provider feedback and access

•A quality-improvement program needs management support and marketing, and the best way to achieve this is to communicate the program and its results •Statistical information can be analyzed on a quarterly basis to produce trends in patient care and EMS operations •Results from quarterly audits will need to be provided to the QI committee and the EMS medical director •Evaluation of those results by the quality-improvement committee and the EMS medical director will be provided to EMS leadership and the EMS chief

automated resource management system

•A secure system that maintains an inventory of typed federal, state, local, and privately owned resources •Has four main functions: -Locating, requesting, ordering, and tracking resources •A long-term goal of ARMS is to expand to include GPS/GIS and mapping capabilities in the future •Will not play a role in prioritizing resources requested during multiple events

assessment center

•A series of exercises with which an employee is given the opportunity to demonstrate skills to a group of trained observers •The observers are called assessors and are usually above the level of the person testing for the position •Assessment centers are commonly held over two or more days

civil rights

•A significant rise in civil rights violations and wrongful deaths has emerged in EMS •Most of these cases involve a patient being restrained or handcuffed and not closely monitored by paramedics or law-enforcement officers

procurement process

•A simple approach to procurement is to apply the incident management system under the title of a procurement or specification committee •The committee will have an EMS leader that manages the process •The operations person will supervise, research and evaluation of the products •A planning section will create the request for proposal (RFP) or bid request •The logistics person will arrange for the testing and demonstration, and will make sure that coordination of facilities is achieved •Lastly, a finance person will qualify bidders, account for cost, monitor budgeting, and ensure payment and transfer of money •Each of these sections needs to be populated with field personnel and end users of the equipment •Timeline should be established and a budget arranged with a 10% to 15% emergency allocation or reserve fund for unforeseen issues •Notes and records need to be kept on the decision-making process

crew resource management

•A system of layers that makes an attempt to trap human errors at various levels by employing a system to reduce risk •Key components: -Communication -Situational awareness -Decision making -Teamwork -Barriers •Focuses on the communication model -Speaking directly -Speaking respectfully

crew resource management

accident reports

•Accident history and repair cost need to be recorded, and a number of analysis reports produced

verifying and maintaining checkout

•Accountability for the inspection and inventory of equipment and vehicles should be imbedded as part of an organization's culture •It is important for EMS leadership to instill in the company officers, paramedics, and EMT's that regular inspections need to be conducted every shift, cycle, and monthly by on-duty EMS personnel •Equipment check should be established as the first action at the start of the shift •Ensuring the equipment is ready for service should be reinforced during employee orientation, taught during in-service training, and included in management objectives as the very first thing to be done at the start of a shift •Routine inspections should be conducted every day, on every shift and equipment not used very often should be inspected monthly •Vehicle checkouts should be completed during every shift on mechanics as well as fluids, belts, and tires •Vehicles should be inspected on the outside for damage and leaks, and to ensure working lights and warning devices •Mileage and engine hours should be recorded daily •Critical medical equipment should be included on the vehicle-checkout list including oxygen, backboards, and soft supplies •Any equipment that requires batteries, such as suction devices, laryngoscope handles, and cardiac monitors must be checked before any vehicle is made available for a call •Responding to a call without working equipment has resulted in significant litigation and financial losses for EMS organizations •Two of the first items usually requested by attorneys in medical malpractice cases are the prehospital care reports and the vehicle checkout report •Regulatory inspections are inspections conducted by the government authority that licenses ambulances •The regulatory agency inspects the vehicles for items mandated by law or regulation •Frequently, expired drugs or equipment that is on a state inventory, yet rarely used within the agency, are found to be missing •Regulatory inspections also verify insurance coverage, proper licensing, and personnel certification •EMS employees should have their driver's licenses inspected regularly to identify those whose licenses who have been reported revoked or suspended •Any of the inspections can occur on a random basis •As a management tool, EMS leadership should conduct random audits or inspections to ensure compliance with check out procedures •Most accreditation agencies will conduct spot checks when conducting a site visit •Management must establish the importance of checkout procedures to avoid any errors or interruptions in EMS service

off line medical direction

•Activities include the implementation of standing orders, protocol development, training, and certification •Medical audits are part of the off-line responsibilities of medical direction -The physician should review procedures, provide direction of remedial education, and limitations of patient care -Exceptional or best practices by a crew •Field audits or observations should be random •Two approaches to field observation can be beneficial: -In a vehicle circulating in the city and randomly responding to calls to provide a more objective view of the care -Ride with the crew as part of the shift work •Testing is another form of medical control -Standards and practices of the organization •Medical direction should evaluate prospective CME programs for content •EMS management and the medical director should develop a process to evaluate providers skills and knowledge on a routine basis

replacement considerations

•Agencies should have a written replacement policy that is calculated using economic factors such as depreciation cost, increasing maintenance cost, service life, and warranty limits •The goal is to reduce overall equipment costs •EMS vehicles and their equipment should be replaced if the annual maintenance cost plus trade-in/replacement value exceeds the cost of a new vehicle

vehicle incidents

•Ambulance personnel responding to or returning from an EMS call are four times more likely to be involved in a crash versus people in their own personal vehicles •Annually, there are approximately 12,000 ambulance crashes and 120 deaths per year •Often the injuries caused by the incident are more serious than those that generated the original call.

scoring and evaluating bids

•An easily understood scoring process is beneficial •A simple 100-point scoring system that weighs the specifications from most important to least important helps secure the best vendor •A point system needs to reflect each area, including finance, operations, background with customer service, vendor presentation, and functional ability •Field evaluations of equipment must be part of the process

sentinel events

•An unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof •It signals the need for immediate investigation and response •When a sentinel event, occurs an analysis and action plan should be done to correct the causes within 30 to 45 days

third party billing

•Anyone other than Medicare, Medicaid, or self-paying patient •Private insurance companies -HMOs, workers' compensation insurance •Commercial automobile insurance •Homeowner insurance •Restitution from crime victims •Bankruptcy, probate, small claims •Service organizations, travel insurance, embassies

ems system risk management questions

•Are new-member orientation and preceptorship programs providing inexperienced EMTs with sufficient information and training? •Are the organization's selection techniques effectively identifying the most qualified personnel for employment? •Are members from a particular training institution consistently lacking in skills? •Are continuing-education programs consistently well-attended?

risk management questions

decontamination areas

•Areas assigned for storage, cleaning, and disinfecting of medical equipment and uniforms •Contaminated equipment or clothing should not be taken home for cleaning •NFPA 1581 -Room separated by four walls -Vented to the outside -Floor drains -Biohazard waste under hazmat laws

ALS Level 1

•At least one ALS intervention is performed -"Medically necessary" ALS assessment §An assessment that requires the use of ALS evaluation tools (such as ECG)

top 5 injuries for ems workers

•Back injuries -Majority of workplace injuries •Injuries sustained on scene -Average of 110 firefighter line-of-duty deaths each year in the United States •Exposure to infectious diseases •Vehicle crashes -Responding Code 3, lights and sirens -Unrestrained occupants -Riding in patient compartment associated with greater injury severity •Assaults on EMS

top five injuries for EMS workers

what causes QI efforts to fail

•Barriers to success in QI activities can be divided into three levels: -Knowledge, attitudes, and behaviors •Often the failure is in the leadership, and the lack of management buy-in is reflected by leadership's attitude toward the program •QI program can be seen as a cause for punitive actions to providers, which may cause EMS providers to develop an attitude that they need to cover themselves •Late feedback and not communicating the results devalues a quality- improvement program •Creating performance measures that are unattainable signals that the program is not important •Adult learners and employees in empowered organizations require feedback •Quality-improvement programs need to be included in the strategic planning and should be reviewed periodically for effectiveness

calculation of ambulance fees

•Base rate adjusted for geographical cost differences •Geographic physician cost index (GPCI) •National base rate of $204.65 •Take 70% and apply the GPCI -The remaining 30% of the $204.65 is added to the adjusted figure

VFIS risk management formula

•Based on three components: -Severity §Lost time or equipment, injury, death, and adverse publicity -Probability §How many accidents or failures will occur if exposed to the hazard -Exposure §Amount of time, number of events, and people or equipment involved

vfis risk management formula

levels of EMS service

•Basic Life Support (BLS) •Advanced Life Support 1 (ALS 1) •Advanced Life Support 2 (ALS 2) •Specialty Care Transport (SCT) Units •Paramedic Intercept (PI) •Fixed Wing (FW) •Rotary Wing (RW)

media mitigation

•Before a crisis happens, it is important to establish good media relations •During a crisis is not the time to avoid the media and it is certainly not the time to begin a relationship •Prepare a media kit for your agency that includes a description of your agency, the population served, square miles, the number of stations, and staff contact information •When an event happens, it is important to tell the truth to the media •Not being honest in communication can damage the agency's credibility •If the EMS agency is handling the media attendance, remember food, water, mints, a smoking area, and aspirin. •The site should be set up with phones, faxes, a copier, computers with email and Internet access

creating an environment of sharing and helping

•Begin creating this atmosphere by providing the example with how you treat your fellow employees and other departments •Exceed your internal customers' expectations •Say "thank you"

benchmarking

•Benchmarking -The process of identifying, understanding, and adapting outstanding practices form organizations anywhere in the world to help your organization improve its performance -A means for determining how well a unit or organization is performing compared with similar units in the organization or externally -Is about systematically learning from the best in business or government and using that information to improve one's own performance -An organization needs to understand the gap between its own performance and best practices and take actions to close that gap -Any aspect of an EMS operation can be benchmarked •Benchmarks have to be realistic, and setting the bar for attainment of a goal requires proficiency •Results have to provide opportunities to educate providers and staff •Everyone is accountable in a quality- improvement system, and evaluations need to be adjusted

ems service benchmarking

•Benchmarking is a means of determining which public and private EMS agencies are doing the best job of customer service and complaint resolution, and then using that information to improve an agency's performance •Studying the gap between your organization and the best in the business will help you determine where your agency is on the customer-service continuum

billing service

•Billing and collection is often contracted to a vendor or firm with expertise •EMS agencies should develop a list of the services required before looking for billing services •Billing services can provide training and may improve collection rates •Billing contract inclusions

image building

•Branding -A process that establishes direction, leadership, clarity of purpose, inspiration, and energy for an agency's most important asset: its brand -Branding differs from agency identity §Identity refers to a logo tagline and is usually paired with an image •Logos should be clean, simple icons that become everlasting over time and represent the total organization -Should be visible on all communications including Web sites, press releases, business cards, newsletters, and signage •Brands are built from four components: -Accuracy -Consistency -Repetition -Reach

financial policy

•Budgets -Basic, ongoing, or continuous expenses should be calculated §Equipment and supplied, vehicles and fuel, medical supplies, facilities, communications, personnel, training, and licensing -Indirect cost §Resources used that are necessary for logistics or infrastructure •Budgets (Cont.) •Indirect cost §Cannot be traced directly to a specific product or service provided by the EMS agency •Insurance, legal and consultation, medical directors, billing services, contract service -Variable cost §Changes in total proportion to changes in the related level of total activity or volume -Fixed costs §Remain unchanged in total for a given period of time

benchmarks of unit hour utilization

•Can be challenged as a measurement tool applicable only to private industry •Three additional measurements are made in some high performance or heavy workload systems: -Unit-hour utilization-transport -Unit-hour utilization-responses -Unit-hour utilization-total deployment •Seasonal variations

occupational exposure

•Centers for Disease Control (CDC) has published post-exposure management procedures •Rapid HIV test standard of care •Treatment should begin immediately -Administration of antiviral therapies

occupational exposures

•Centers for Disease Control (CDC) has published post-exposure management procedures •Rapid HIV test standard of care •Treatment should begin immediately -Administration of antiviral therapies

subsidy price trade off

•Collect all the estimated and total payments for all emergency and non-emergency services from all sources -Includes HMO contracts, Medicare, Medicaid •Number is then divided by the population of the primary service area and plotted on the horizontal axis of subsidy price trade-off chart •Second point on the chart is calculated by estimating the current average total bill, which includes the base rate, mileage, and all add-on charges •The average is then graphed on the vertical axis, and a line is drawn between the two points •The diagonal line can be compared with proposed changes in the service or budget

other considerations

•Colored cones and paint for marking •Photographs -Skid length -Road width -Area of impact -Gouges and scuffs -Debris field -Point of rest

community relations and citizenship

•Community relations programs: -Make the right call -Explorer post/junior paramedic -Pre-EMS and CPR training -Baby-sitter training -Health fairs -Community emergency response teams -House numbering

cost per mile

•Cost per mile is calculated by taking the specific vehicle cost, including the fuel, insurance, maintenance, and indirect cost to support that vehicle in a budget cycle or calendar year, and dividing it by the annual mileage accumulated on that vehicle

complaint databases

•Databases should include: -Complaints from all sources, including telephone calls, surveys, focus groups, correspondences, complaint/concern cards, and personal visits •Key to customer service is to apply continuous quality improvement -Refine, design, and improve the delivery of EMS, placing patient expectations first

investigating EMS system failures

•Define the system affected to analyze •Define failure •Conceptualize or diagram contacts •Calculate the gap •Develop data-collection tools •Develop schedule and conduct interviews

investigating ems system failures

•Define the system affected to analyze •Define failure •Conceptualize or diagram contacts •Calculate the gap •Develop data-collection tools •Develop schedule and conduct interviews

quality assurance

•Defined as a system for the maintenance of medically correct and consistent level of pre-hospital care •Ideally, QA processes include: -Identification of errors or deficiency in patient care -Verification of proper completion of run reports •Ideally, QA processes include: -Verification of completion of prehospital personnel procedures and skills -Identification educational opportunities, including opportunities to improve writing, grammar, and spelling •Data collected on each run should include: -Dispatch and system response (times, and so on) -Patient prehospital treatment -Patient turnover status -Patient outcome (ED and post-ED) •The system must also include minimum and measurable performance standards

building an infection control plan

•Designate an infection-control officer •Define an exposure and related key terms •Training and education •Vaccination and testing •Personal protective equipment •Post-exposure management program •Compliance monitoring •Record keeping

cost per response

•Determined by dividing each provider's total expenses by the total number of responses •Cost of service must include overhead that is allocated in a one-month period divided by the total responses in the same one-month period •Used primarily for purposes of comparison to other service delivery models in EMS

the DACUM process

•Develop a curriculum -A process that involves the organization's "top performers" -The top performers are assigned to a short-term committee with a qualified DACUM facilitator -They become the panel of experts who collectively and cooperatively describe the occupation in the language of the occupation -The panel works under the guidance of a trained facilitator for two days to develop DACUM research chart -The chart contains a list of general areas of competence called duties, along with several tasks for each duty -Brainstorming techniques are used to obtain the collective expertise and consensus of the panel -As the panel determines each task, it is written on a card -The cards are attached to the wall in front of the panel -Altogether the cards form a graphic profile of the duties and tasks performed by successful workers in the occupation •The DACUM process has multiple uses: -Can be used for job analysis, occupational analysis, process analysis, functional analysis, and conceptual analysis -Its use with many companies, community colleges, and government agencies has also shown the process to be very effective, quickly accomplished, and low cost -Works because expert workers can describe and define their jobs more accurately than anyone else

QI performance

•Developmental stages are: -Building potential for success by developing an awareness and appreciation that QI is a worthwhile endeavor -Expanding workforce knowledge of and capability in QI practices and techniques -Fully integrating the strategic quality- planning process and related quality-improvement actions into the daily EMS operation and education programs •Conduct QI courses for front-line employees, including listening techniques, sensitivity training, and cultural diversity •Establish patient-to-provider networks to provide effective, on-going communication for feedback and information gathering, (civic groups, call-in phone lines, surveys) •Solicit feedback through newsletters, Internet home-page postings, local television spots, and articles in local newspapers •Expanding knowledge -Emphasis is placed on ensuring that the entire workforce of an EMS organization or system is informed about and participates in the development of the strategic quality-improvement plan -Paramedics, and EMTs need a working knowledge of basic QI philosophy, tools, and techniques so they can be full partners in the strategic quality-improvement planning process -EMS workforce members should be able to identify their internal and external customers, how to measure the quality of the services provided or received, and how to identify and resolve quality problems in their own work •Full integration and monitoring -EMS workers must feel empowered to take action in work settings to identify, set up, and assesses new patient-care methods and approaches -EMS crews can take self-correcting action by assessing timely information on performance levels for IAFF or NHTSA key quality indicators -EMS management gives way to leadership that helps the workforce maintain and improve the quality of its work

mode of transmission

•Direct transmission -Pathogen is transmitted directly from an infected individual to an uninfected one •Indirect transmission -Inanimate object serves as a temporary reservoir for the infectious agent •Routes of exposure -Inhalation, contact with blood or body fluids, ingestion, fecal-oral, intermediate carrier (tick)

dmat

•Disaster medical assistance teams (DMATs) -A group of professional and para-professional medical personnel designed to provide medical care during a disaster or other event -Each team has a sponsoring organization, such as a major medical center, public health or safety agency, non profit, public, or private organization that signs a memorandum of agreement (MOA) with the DHS -Sponsor organizes the team and recruits members, arranges training, and coordinates the dispatch of the team -To supplement the standard DMATs, there are highly specialized DMATs that deal with specific medical conditions such as crushing injury, burn, and mental-health emergencies •Deploy to disaster sites with sufficient supplies and equipment to sustain themselves for a period of 72 hours •Members are required to maintain appropriate certifications and licensure within their discipline •When members are activated as federal employees, their licensure and certification are recognized by all states

documentation

•Documentation -Validates testimony -Enables retrospective review •Documentation that identifies a problem: -Must indicate what action was taken to correct the problem -The task was completed successfully •Record-keeping policies

infectious disease exposure factors

•Dose -The amount of organisms that enter the body •Virulence -The strength of the organism •Host resistance -The ability of the immune system to fight infection

drug testing

•Drug testing public-safety personnel may be performed at pre-employment, post-accident, return to duty, when reasonable suspicion, and randomly •The common drugs tested for are alcohol, methamphetamine, marijuana, cocaine, PCP, and opiates •National Treasury Union v Von Raab -Supreme Court ruled that a government employee handling narcotics could be compelled to submit to random drug testing -This would allow for testing of paramedics who have the responsibility for drugs regulated under the Narcotics Act, such as Valium or morphine •National Labor Relations Board says that if an employee is in a safety-sensitive position, he or she may be subject to random drug testing •Often, drug-testing rules fall under a strong management rights clause and become part of the work rules •Drug and alcohol policies should be part of every collective-bargaining agreement and should be negotiated in a collaborative work environment

dumping

•Dumping is when a patient is transferred by one hospital to another for insurance reasons or the lack of ability to pay •Under EMTLA rules, a patient with an emergency medical condition that has not been stabilized cannot be transferred unless he or she has been offered stabilizing treatment and informed of the risk of transfer

facilities

•EMS facilities are often co-located within fire facilities •It is important to ensure that existing facilities are budgeted for maintenance and are on a replacement or rehab cycle much like EMS equipment •Any master plan that includes current EMS facilities should also be able to identify the city-, county-, or agency-owned land •The age, condition, and serviceability, should be evaluated against changing response patterns, street, traffic conditions, and demand patterns

ambulance specifications

•EMS managers and the organization should create specifications for EMS vehicles within the system An ambulanceis defined as a vehicle for emergency medical care that provides a driver's compartment; a patient compartment to accommodate an emergency medical technician or paramedic, and two litter patients so positioned that the primary patient can be given intensive life support during transit; equipment and supplies for emergency care at the scene as well as during transport; two-way radio communication; and, when necessary, equipment for light rescue/extrication procedures •Local health departments often have standards for EMS vehicles and mandated equipment, usually listed in the local board of health regulations or in an operating agreement •State EMS authorities usually have specifications for EMS vehicles that are reflected in state law or state statue •Federal Specification for the Star-of-Life Ambulance (KKK-A-1822E), prepared by the Government Services Administration in June 2002

conflict resolution

•EMS managers in their day-to-day operation will occasionally generate conflict •Conflict is a natural part of any workplace and, given the level of emotion in the EMS profession, a lot of conflict is generated and will need to be managed just like any other work process •Conflict is best managed in municipal EMS organizations by using a collaborative approach •When conflict is being addressed, an EMS manager should start by asserting common interest -This sets the tone of further actions, develops a cooperative spirit, and promotes a positive attitude •Develop criteria for what is a good solution by defining ideal solutions that consider the interests of both parties with a focus on interests and not positions •Generate clear actions that define the problem including symptoms, causes, and barriers •Generate broad solutions to the problem, and suggest specific actions to address problems •Develop ideas that are detailed, and make sure the other side agrees with the concepts •Implement the best suggestions and communicate with the that modifications will take place •Evaluate results -A specific timeframe for reevaluation should be set by management and labor to ensure progress is being made

medical equipment

•EMS managers will be responsible for the maintenance, specification, and purchase of biomedical equipment •Biomedical equipment is any medical device, medical supply, or tool used to take care of a patient •The cost-effectiveness of such equipment is rarely tracked or rationalized before budgeting •EMS agency defibrillators, ancillary equipment, biomedical services for preventive maintenance on defibrillators, routine non-warranty work, training equipment, and trainer/provider certification become part of the expense of implementing new equipment

generational bridges

•EMS mangers and leaders will face an ever-changing workforce dynamic •Silent generation -People born before 1946 -They are uncomfortable turning over the hard work and sacrifice of a lifetime to younger workers •Babyboomers -People born between 1946 and 1964 -Perceive today's generation as lazy and egocentric •Generation -People born between 1965 and 1980 -Sees the boomers as demanding, not creative, and having no fun in the workplace •Generation Y -Most recent college graduates -Born after 1980 •Nintendo Generation -Most recent high school graduates, taking technical training and foregoing college -Latest group to enter into EMS training -Accustomed to technology -Poor communication skills -Need for personal gratification

citizen relations

•EMS member participation in community affairs, such as civic groups, school boards, and neighborhood associations •EMS member participation in civic activities, such as community clean-ups, Habitat for Humanity, and charity fundraisers •EMS services should maintain and vigorously promote a speaker's bureau on EMS topics •Periodically survey public opinion to stay in touch with community needs and perceptions concerning the service -Town hall meetings -Facility tours

recruiting

•EMS must start to think differently about how to find and secure providers •Finding paramedics will become more difficult as baby boomers place a higher demand on the medical system

due process and ems performance

•EMS operations at some point will need to discipline or discharge an employee from the organization •Some situations, such as criminal acts, serious property damage, and lack of honesty, require immediate action •Grievance -An official disagreement that is placed in writing -Grievances proceed to discussions between management and labor, and if both sides stand firm, the grievance will be placed in an alternative dispute-resolution system, sent to an arbitrator, or referred to mediation -If all of these processes fail to reach a mutual agreement, a grievance can be sent to district court to be ruled on by a judge

medical leadership

•EMS providers serve as an extension of their system's medical directors •The medical director is the key to quality patient care and the competency of EMS members •Paramedics are empowered by the medical authority or bureaucracy within the city, state, or local government to practice under the license of a physician •The medical director extends medical accountability and clinical supervision, and provides clinical training and continuing education of pre-hospital providers •Provides his or her medical license to the EMS members •Delegated practice •EMS systems must have a single medical authority that oversees patient care and holds providers responsible for delivery of that care to industry standards •Medical director's role must be clearly defined in department SOGs, SOPs, or contracts •Recommends certification, recertification, decertifications or suspension of prehospital personnel •Oversees development and management of a medical oversight board to review medical issues •Medical director: -Is a liaison with the medical community including the emergency departments, physicians, prehospital providers, and nurses -Needs to develop and maintain a network of other physicians with specialties to keep an EMS system functioning effectively -Serves as the interface and liaison between the EMS system and the medical community •Medical director: -Must ensure compliance with patient care standards - commonly referred to as clinical supervision -Clinical supervision of EMS members may be prospective, immediate, or retrospective §Prospective supervision (off-line/indirect) refers to written standards, policies, procedures, and treatment protocols •Medical director: -Immediate supervision (on-line) §Involves real-time medical direction by a physician to a field provider; on-line direction requires that medical director knows the capabilities/limitations of providers, their treatment protocols, and their standing orders -Retrospective supervision (off-line/indirect) §Includes medical audit of a specific response or overall system quality management

ems quality improvement

•EMS quality improvement officially began with an initiative from the NHTSA •"A Leadership Guide to Quality Improvement in Emergency Medical Services" •National seminars on basic quality improvement •Most EMS systems are operating under standards that where designed years ago with little or no scientific background to determine if the service was efficient and effective •EMS providers will be confronted with threats of reduction of service hours, staffing decreases, or budget reductions •It is important to evaluate the EMS system to determine the value of the service provided and to carefully examine the medicine for outcomes •Analysis of the quality of EMS services is either a qualitative or quantitative measurement •Quality improvement requires a genuine drive to provide good patient care; evaluate health-care costs; analyze policy, patients, and the system; and defend against litigation •Quality of care -The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge -Quality is often seen by the provider as getting what they want, and often that is a quick response and ride to the hospital -Many EMS organizations have attempted to establish quality measurements and standards §NFPA 1710, CAAS, ASTM F-30, and the American Heart Association, along with local and state health authorities, have attempted to establish consensus standards •Accreditation is a process by which an agency evaluates and recognizes a department or organization as meeting certain predetermined standards or qualifications •Quality improvement is a necessity for attaining accreditation from the Committee of Fire Accreditation International and from the Commission on Accreditation of Ambulance Services •It is important through a labor- management partnership that EMS agencies identify, define, and develop EMS system indicators of quality •A performance indicator is a point of comparison used to answer the question "how are we doing" for a specific issue •Key components of performance indicators focus on providers, standards of care, hiring processes, the training process, supervision, system certification, appropriateness of vehicles and equipment, hospital facilities, CQI programs/process, clinical education, and anything else that either directly or indirectly affects patient care •In EMS, quality becomes a measure of how well customers are treated clinically and how well their expectations of care and service are met •Patient care and operations in most systems are conducted by a retrospective process -More traditional approach to quality management -Tends to look back at system performance -Chart reviews are often the most common type of quality-assurance activity conducted in an EMS agency •Prospective activities include observing and conducting primary EMS and recertification training •Case reviews, clinical rotations, and quarterly skills practices are required to ensure skills and proficiency •Attendance at outside continuing- education conferences and ongoing modification in clinical protocols and policies are considered prospective •This includes research and following the medical advances and changes in the practice of EMS

medicare part B

•EMS systems are classified according to the level of service provided •ICD-9 coding -Not required on most ambulance claims -Does not generally trigger a payment or a denial of a claim •ICD-9 coding -Each patient receives a primary and alternative code -Primary code §Reflects condition on scene -Secondary code §Reflect on scene changes from the dispatch information versus what was found on scene

building a successful program

•Early stages of implementation of a quality-improvement process require strong leadership and commitment at the local, regional, and state level to: -Learn and understand quality-improvement strategies -Assess thoroughly the present situation of each EMS organization or system -Establish action plans for training and orientation in quality improvement •Service audit -An assessment of all services being provided by the organization -Analysis of the EMS system for strengths and weaknesses •Establishing goals -Establish achievable goals for every behavior inherent in the system -When goals that are compatible with your system do not exist as a local, state, or national written standard, you are faced with either guessing or studying available data •Identify and develop standards of care -EMS managers should look for recognized standards on a national level -EMS standards need to be designed based on the components that focus on measurements encompass, a structure, process, or outcome •Identify and develop standards of care §Structure results focus on the necessary resource components of the system §Process results examine the effectiveness of the design and delivery of work processes, productivity, and operational performance §Outcomes look at the effectiveness of patient care, support services, and fulfillment of public responsibilities •Objectives and performance indicators -Whether a standard is developed around a structure, process, or outcome, it must relate to the organization's objectives §Objectives are measurable statements that are consistent with the system's or agency's mission, vision, and key drivers •Objectives and performance indicators §Performance indicators sometimes are called key performance indicators or key drivers are quantifiable measurements that reflect the critical success factors of an EMS organization •The goals for a particular driver may change as the organization's goals change or as it gets closer to achieving a goal •Performance indicators are available to EMS agencies from NHTSA, IAFF, and the National EMS Management Association •Objectives and performance indicators §Performance indicators sometimes are called key performance indicators or key drivers are quantifiable measurements that reflect the critical success factors of an EMS organization •The International Association of Firefighters has a validated set of indicators free to IAFF fire services, and the NHSTA minimum data or NEMSIS set are available through the federal government

methods of assessing job standards

•Eight commonly accepted methods are used for establishing job standards: -Job-performance requirements -Functional analysis -Observation -Self-description -Work profiling -Position analysis questionnaires -Checklist or inventories method -Interviews

human resources activities

•Employee forecasting -Activity that estimates the number and type of personnel needed to meet the organizational objectives •Demand analysis can be conducted by either a top-down approach or bottom-up approach -The top-down approach uses trend analysis, indexing, or simulations •Trend analysis -Focus on past hiring •Indexing -Uses ratio of workload to employee based on increases in call volume or other EMS organization activities, such as injury prevention and pubic education •Simulation -Uses computer modeling and predicts employee needs on data collected in the computer-aided dispatching software or run-volume statistics •Delphi technique -Method for obtaining forecasts from a panel of independent experts over two or more rounds •Skills inventories consist of each person's education, work experience, occupational interest, and skills

medicare

•Established in 1965 by the Social Security Act -Covered only those older than age 65 from 1965 to 1972 -In 1972 expanded to cover those with disabilities -Transferred to Health Care Financing Administration in 1997 §In 2001 restructured Centers for Medicare and Medicaid Services •Provides coverage for low-income families; aged, blind, and disabled; and those eligible for federally assisted income

ethics in ems

•Ethics -Set of principles or standard of conduct term comes from the Greek word ethos, meaning character or custom •Ethics -There are commonly five ethical models: §Utilitarian, rights, fairness or justice, common good, and virtue •Utilitarian -Chooses actions that will produce the greatest good for the greatest number •Rights -Operates on the concept that people have free will to choose their actions -There are commonly five ethical models: §Utilitarian, rights, fairness or justice, common good, and virtue •Common good -Based on the belief that society is made up of individuals, and the ethical behavior of those individuals is linked to the community and bound by common interests and values •Fairness or justice ethical perspectives -Evaluates decision making on the fairness of an action and whether it treats everyone the same way or shows favoritism and discrimination -There are commonly five ethical models: §Utilitarian, rights, fairness or justice, common good, and virtue •Virtue -Uses certain ideals toward which people should strive, and which provide for the full development of each individual's humanity •Ethical conduct requires doing the right thing, whether someone is watching or not •Ethical conduct involves beliefs, values, standards, and the principles of honor and morality •Ethics is concerned with how one should behave, and values determine how a person actually does behave •When faced with a choice, EMS employees should ask several key questions. -What is the impact? -Is that impact safe, legal, within policy, and productive? -What is the cost of that impact? •When faced with a choice, EMS employees should ask several key questions. -What might be impacted? -What might be compromised? -How would my family feel if this decision on the news?

employee assistance programs

•Every emergency services organization should have an Employees Assistance Program (EAP) •What people see and experience has a profound effect on mental health •The EAP provider or contractor refers employees to a counselor, mental-health professional, or doctor •Most Employee Assistance Programs are corporate providers and have clients all over the United States •When employees encounters a stress-related problem that affects job performance, they can call the EAP •The EAP will then analyze the situation over the phone and in many cases set up a counseling session with an approved or contracted EAP therapist •With most EAP contracts, the first three to seven counseling sessions are paid by the EAP •The therapist can then recommend whether or not the patient needs further counseling •EAP can help with martial conflicts, stress, gambling, emotional conflicts, and drug or alcohol abuse •The patient, employer, or insurance will cover the cost of continued counseling sessions •This varies by circumstance and company or insurance policy

assessing customers

•Every patient needs to be treated as you would want your family member or relative to be treated •Customer •Internal customers -Individuals, entities, and organizations who are involved in or with the operation of the EMS system •External customer: -Traditionally known as "Mrs. Smith" -Mrs. Smith represents anyone who calls 911 and experiences service from the fire, EMS, and communication-center staff -Also include hospital staff, nursing-home staff, law-enforcement agencies, neighboring fire and EMS agencies, contracted services, and elected officials - 360-degree customer service

fact finding and nonbinding arbitration

•Fact finding -A step taken to avoid labor impasse that occurs before mediation and arbitration -A neutral third party is hired to review the relevant labor dispute and to render a finding of fact -The finding of fact is the independent arbiter's view of what has occurred in the labor dispute and what decision the arbiter would have made had he or she been empowered to make it -The difference between fact finders and nonbinding arbitration is that fact finders are usually those that are hired independently by either party -Nonbinding arbitration occurs when both parties agree to present their dispute together -The purpose of fact finding and non binding arbitration is to push along negotiations by having an unbiased third-party opinion -Typically, one side then uses the findings as a crutch in negotiations

system failure

•Failure is a loss of asset availability, failure of or unavailable equipment, and deviation from the status quo (protocol or SOG) •Failure modes and effects analysis (FMEA) -Looking into the future for potential system failures -Looking at past failures •Sentinel events

for labor standards

•Fair Labor Standards Act, 1938 -Established a minimum wage and protected employees from unpaid overtime -"7K exemption" §This provision states that fire and law-enforcement employees can work more than 40 hours without overtime pay §Defines an employee in fire-protection activities as one who has the legal authority and responsibility to engage in fire suppression •Juan Vela vs. City of Houston •Quirk vs. Baltimore County •Horan vs. King Co., Washington •Edwards vs. City of Memphis •Christensen vs. Harris County, Texas

fixed wing and rotary wing

•Fixed and rotary wing aircraft -Covered when point of pickup is inaccessible by a land vehicle, great distances are involved, or other obstacles that are not defined by the rule-making committee

cost tracking software

•Fleet Accounting Computer Tracking Systems (FACTS) or another computer-based system that tracks all information about vehicles, should be in place •The system links specific information on each vehicle with operational data, such as labor hours, costs of parts, and frequency of parts usage, so that the office can assess its performance against established targets •Most fleet-management software enables automated parts ordering and allows users to determine which parts are in stock •A fleet-management software system should use the information to calculate costs for vehicles by type and age, which helps planning for future purchases and maintenance •Fleet software systems allow EMS managers and front-line supervisors to collect and analyze performance data and establish benchmarks to continue improving competitiveness •EMS managers can use tracking programs to track the initial cost of the vehicle, set up a preventive-maintenance schedule, issue work orders, and do fuel and warranty tracking

crew management decision making skills

•Focuses on giving and receiving information through a closed feedback loop •Ensures that all messages are repeated or acknowledged

decision making skills

•Focuses on giving and receiving information through a closed feedback loop •Ensures that all messages are repeated or acknowledged

immunity from liability

•Good Samaritan legislation -Reduces the liability of a would-be rescuer of a victim or injured person -Several conditions must be established to support a Good Samarian defense in a medical-liability case §The rescuer cannot seek compensation from the victim, act recklessly, or intentionally do wrong -Cases of gross negligence have often violated Good Samaritan standards and resulted in monetary awards against volunteers and other EMS providers •Gross negligence -A severe violation of the standard that is expected of a reasonable provider and is essentially similar to recklessness and willful and wanton misconduct •In many states, legislatures have enacted immunity laws for fire and EMS providers -To limit the liability or cap the awards settlement of lawsuits filed against government-operated EMS and fire agencies

the griggs decision

•Griggs v. Duke Power Co. -For the purposes of hiring and assignment to a laborer position, an employer's use of a high school diploma requirement and two standardized written tests, each of which disqualified a higher percentage of blacks than whites, violated Title VII of the Civil Rights Act of 1964 -When testing for new EMTs or paramedics, the assessment tools must reflect a "business necessity," the yardstick for assessing the legality of such standards -The Court held if an employment practice that operated to exclude blacks could not be shown to be related to job performance, the practice was prohibited -The Court did not provide additional guidance regarding the meaning of the phrase "business necessity."

ems all hazards approach

•Hazards analysis -All-hazards approach is a process by which hazards in a community are identified •Vulnerability analysis -Identify and quantify the persons or segments of the population that are vulnerable to the hazards •Risk analysis -Refine the projected vulnerabilities after mitigation actions have been identified -Once it is determined who is at risk from which identified hazards, you must prioritize planning efforts based on the most urgent needs •Plan components: -Hazards analysis -Vulnerability analysis -Basic plan consideration (e.g., scope, activation, authorities, and concepts of operations) -Resource identification -Support functions or mechanisms for resource deployment -Recovery activities

privacy law

•Health Insurance Portability and Accountability Act (HIPAA) -Has several key components that cover privacy, patient rights, and business administrative requirements

academic predictors

•Health occupations aptitude examination -Can predict an individual's readiness and capability for successful completion of an educational program •(HOBET) -Provides an objective measurement of a person's critical reading ability and compares that ability to the level of mastery required for success in college health programs -Evaluates basic math skills -Identifies how a person approaches study and which approach is most effective for that person

financial reports

•Help provide accountability •Required by law •Identify the health of the organization •Components of an EMS financial report: -Total gross billings, collection rates, billing mix, ALS versus BLS, miles billed, transfers versus primary 911 billings, payee mix, accounts receivable turnover rate, bad debt expenses, contractual allowances, write-offs

ambulance diversion

•Hospital diversion -A condition or event in which an ambulance is sent to another hospital instead of to the closest facility or hospital of choice -Has become a real problem in almost every EMS system •Hospital diversion -Is a detriment to patients and puts an undue strain on the EMS system when ambulances are not available for calls in their first-due district or high-priority staging location -Increases the time on task for an ambulance, increases response times, and often has some seasonal peaks

managing unit hours

•How many EMS units does a system need? •Formula -Calls per hour X average time for each call divided by 60 minutes X unit-hour utilization

unified command and area command

•ICS incorporates a unified command (UC) and an optional area command when important elements need to be managed in multi-jurisdictional or multi-agency domestic incidents •UC is applied to assure participation of all agencies with jurisdictional authority, or functional responsibility for any or all aspects of an incident, as well as those able to provide specific resource support •The UC structure works best when the following conditions exist: -Contribute to the process of determining overall incident strategies and selecting objectives -Ensure that joint planning for tactical activities is accomplished in accordance with incident objectives -Ensure the integration of tactical operations -Approve, commit, and make optimum use of all assigned resources •An area command is established either to oversee the management of multiple incidents that are each being handled by a separate ICS organization, or to oversee the management of a very large incident that involves multiple ICS organizations, either of which is likely for incidents that are not site specific, geographically dispersed, or evolve over longer periods of time •Area command avoids unnecessary competition for the same resources, such as when there are a number of incidents in the same area and of the same type •Might include the activation of emergency operations centers and/or a unified command

Gordon graham

•Identifies five causes of loss in the field of EMS: -Lack of quality people -Policy -Training -Supervision -Organizational discipline

gordon grham

•Identifies five causes of loss in the field of EMS: -Lack of quality people -Policy -Training -Supervision -Organizational discipline

myers briggs

•Identifies valuable differences among people •Is the most widely used instrument for understanding normal personality differences •Explains basic patterns in human functioning •Is used for a variety of purposes in public-safety organizations

conducting an investigation

•Identify the root cause -Determine the who, what, where, and significance •Supervisors' response -Safety of crew and civilians -Photograph the scene §Sketches, video -Interview witnesses

reimbursement involving death

•If death is pronounced before the ambulance is called, then no reimbursement will be made •If death is pronounced after transport has begun, then normal nonemergency rates apply but no mileage and before arrival on scene •If death is pronounced during transport, normal reimbursement rates apply

BLS

•If the state allows EMT Basics to initiate IV lines or administer medications, regulations mandate reimbursement at the basic life support level

single command with assisting agencies

•In most command scenarios, EMS will be an assisting or cooperating agency •Under the ICS system, a single command may request help from other agencies for specific issues without developing a larger command structure •Assisting agency -An agency directly contributing tactical or service resources to another agency -A supporting agency is an agency supplying assistance other than direct tactical or support functions or resources to the incident-control effort

collective bargaining

•In public-safety collective bargaining there are some different approaches to the labor contract •Most collective-bargaining agreements in EMS have formal written agreements often called clauses or articles •Collective bargaining creates the opportunity to negotiate how labor and employment processes are managed •It is a negotiation focused on solving problems and coming to reasonable agreements •When proposing contractual language, a few general rules should be followed: -Proposal should be written in clear, concise language, avoid long sentences, repetition, and lengthy paragraphs -Avoid using complicated legal terms and ambiguous wording, such as "in general," "whenever possible," and "except in emergencies" •When proposing contractual language, a few general rules should be followed: -Proposals should have documentation and examples to illustrate the problems -Ensure before a proposal goes forward that it is proofread and checked for accuracy

physician prerogative

•In situations that involve clinical performance and the delegated practice of a paramedic under the direction of the medical director, the physician may impose discipline that can result in a reduction in pay or a downgrade in or loss of certification •The physician has the right to eliminate, restrict, or suspend certifications or licensure under his or her delegated practice

interstate resource response plans

•In the wake of some of the major disasters in recent years, a concept of interstate resource agreements has developed and was invaluable in Louisiana during hurricane Katrina (2005) •These agreements, which are placed into statute with the participating states, allow for the movement of resources from one state to another •Although the NRP may have been activated already, these plans provide for access to resources that may not be available from the federal government •The ready acquisition of like or in-kind ambulances, fire apparatus, and law-enforcement officers can be achieved through such plans •Emergency Management Assistance Compact (EMAC) •Southern Regional Emergency Management Compact (SREMAC)

customer care

•In their article "StarCare" (JEMS, September 1991): -Mike Taigman and Thom Dick refer to the three C's of customer care: §Courtesy, competence, and customer sense

who sets the rates

•Individual agencies, states, and local jurisdictions set ambulance rates •Medicare and large insurance carriers (third-party payers) set reimbursement rates

discipline

•Inside the scope of practice of the physician medical director is the role in discipline •Medical directors are tasked to make certain EMS providers are delivering quality patient care •Medical directors as employees of the jurisdiction are given that responsibility; however, they have a limited capacity to recommend or administer discipline to employees •Case law has established that the practice of a paramedic or EMT can be limited under the license of the medical director -Hennepin County v. Hennepin County Association of Paramedics and Emergency Medical Technicians •When mistakes happen, the challenge of the medical director is to decide a course of action •Prior to any decision, it is imperative that the investigative process be completed •To help focus the investigative process, the physician must consider: -Whether or not, given the situation faced by the medics, the mistake is understandable -Whether or not the mistake at hand indicates a need for further training -Whether or not the mistake was simply an anomaly -Whether a specific medic or the entire service needs to be addressed about the mistake •Public employees are entitled to "due process" rights when faced with disciplinary charges that may affect their continued employment -Due process includes notification of the employee regarding the pending decision, a hearing in which the employee has the opportunity to present his or her side, and representation by legal counsel at a hearing if the employee so chooses •Many states have collective bargaining, and the union will be required to represent and protect the employee under the labor agreement •Terminations under such a system must be for cause

specialty care transport

•Inter-facility transports requiring level beyond the scope of paramedic care •A higher level of billing •May be billed under Medicare Part A, but: -Must have a physician-documented medical reason for the trip

interacting with the media

•Interacting with the media can intimidate and frustrate EMS managers •Media can be a useful leadership tool, if the managers do their homework •You are not in an adversarial relationship with the media •Media members are commonly professionals with a job to do, which is to inform the public without bias •Earn their confidence and they will seek you out for straight answers and fact-finding -"I don't know yet, but I will let you know" •Be proactive rather than position yourself in a reactive role

investigation kit

•Investigation kit should contain: -Compass -Accident forms -Graph paper -Mechanical pencils -Rulers -Tape -Digital camera

investigation kit

•Investigation kit should contain: -Compass -Accident forms -Graph paper -Mechanical pencils -Rulers -Tape -Digital camera •Colored cones and paint for marking •Photographs -Skid length -Road width -Area of impact -Gouges and scuffs -Debris field -Point of rest

employee satisfaction and retention

•It is expensive to recruit, train, and consistently employ an EMS provider •It is important to retain those employees once they are inside the organization •Employee turnover and satisfaction is a key performance indicator in an EMS organization •Retention is best accomplished by continued participation of employees in the operation of the EMS service •Length-of-service award programs have been a long-standing way of rewarding employees and an effective strategy for retention •Longevity pay -A monetary incentive that is commonly tied to length of service •Incentive plans -Vary and are often creative -Some agencies provide incentive pay to employees based on transports, completion of pre-hospital care reports, or total runs completed -Are often written into union contracts -An educational incentive plan is another way of rewarding and retaining employee's •Job enrichment -A planned program for enhancing job characteristics §Adds skills from the job classification above the employee's current position and leads to more training and autonomy §Involves redesigning jobs to increase the level of responsibility, authority, control, and challenge •Job enlargement -Involves adding more tasks at the employees, current level of operation -Requires some sort of monetary reward, and may have financial concerns defined in a union contract

vehicle maintenance

•It is important to establish a schedule for preventive maintenance •Preventive maintenance is a schedule of mechanical checks or changes designed to prevent critical failures in vital equipment •Preventive-maintenance schedules should be based on manufacturer recommendations, or schedules should be determined within the organization

descriptions and specifications

•Job description -A document that provides information about the task, duties, and responsibilities of the job -Has three key elements: a job title, job identification, and a job duties section •Job specification -A list of knowledge, skills, and abilities that an individual must have in order to succeed in the position

crew resource management and situational awareness

•Keeping people attentive to an event -Perceive -Observe -Recognize stress on personnel

developing PIER programs

•Key elements in the development: -Messages are consistent, easily understood, and disseminated on a regular basis §Symbols such as logos, art, and themes •Key elements in the development -Material should be of high quality and presented in an effective manner §Everything printed is a PR tool -Public messages should be sent using a variety of media §Radio, media, newspapers •Public service announcements

labor relations

•Landmark legal cases -The history of labor law in the United States can be traced back to the 1920s. -EMS managers and leaders most often will be operating with one of three unions: §The International Association of Firefighters (IAFF) §American Federation of State, County, and Municipal Workers (AFSME) §Teamsters Union •Labor acts -Railway Labor Act (1926) -Davis Bacon Act (1931) -Norris LaGuardia Act -Wagner Act §National Labor Relations Act

crew resource management teamwork

•Leadership and followership •Results in mutual respect •Common goal of providing the best patient care

psychological resources

•Liability issues related to an organization's personnel-making decisions or inappropriate actions has created a new focus in human resources management on using psychological screening tools •Organizations are using such tools to help them identify successful matches for positions in the organization

EMS budgets

•Line-item budget -Focuses on inputs -Specific items or services by division, department, and unit -Easy to balance -Often requires last-minute spending to empty accounts -Does not focus on results •Integrative budgeting system -Modification of line-item budget -Three computerized categories: §Personnel, operations, and capital outlays •Service-based budget -Focuses on outputs or specific services, not dollars -All aspects of a specific type of service -Calls processes "call centers" -Requires full costing or recording of both the direct and indirect costs •Activity-based cost system -Assigns costs to activities -Cost objects are based on the consumption of resources •Attribute-based cost system -Integrates cost with quality, function, and deployment -Provides means for examining performance in the EMS system and customer levels •Program-based budget -All costs are summarized for each program, rather than placed in broad categories -Links system costs with results -Limits most line items for lump sums to major objects in EMS operations •Performance-based budgeting -Develops workload and unit costs -Specified categories are personnel, maintenance, operations, and development -Commonly used for shared functions •Zero-based budgeting -Requires EMS to justify the existence of a budget for the program or item -Takes a significant amount of administrative time -Has lost popularity -Employed only when a city or department is facing budget shortfalls or there is an economic downturn

customer relations

•Little time is spent in learning about the need or means of providing for the personal and emotional needs of patients are the system's customers •A displeased customer will tell nine to ten people about an unhappy experience and even more people if the problem is serious •One in six of those unhappy customers will tell up to 30 people about poor service •The same customer will tell five people if a problem is handled adequately •One-third of the customers who experience service problems never register a compliant because it is not worth the effort

funding mechanisms

•Majority of local government budgets are funded by taxes -Property taxes, local income taxes, general sales taxes •Millage rate -Special taxes collected for fire and EMS -Defined as dollars per $1,000 of assessed value •Property taxes -Assessed value is typically 40% of the fair market value of the property •Sales taxes -Sometimes called gross-receipts tax -Tax on the total amount of the sale price of all sales •Impact fees -Assessments on new construction, new business, or activities as a one-time fee for infrastructure

Baldridge criteria

•Malcolm Baldrige National Quality Award -A national award given to companies and businesses in recognition of their achievements in quality -The award is managed by the United States Department of Commerce's National Institute of Standards and Technology -Is given by the president of the United States

training and certification

•Managers overseeing fleet operations ideally need an associate's degree in management, automotive diesel technology, or a related field •Most require several years of hands-on experience in automotive maintenance and repair •A well-documented training program for your fleet-service people is a must if a vehicle is involved in an accident - law enforcement, lawyers, or regulatory agencies may examine your mechanics training records •Emergency Vehicle Technician Certification Commission -Certification is the minimum standard set in many states and is one of the most common ways for fire mechanics and emergency-vehicle technicians to demonstrate their qualifications to work on emergency vehicles •Other technicians and mechanics who service county and municipal fleets go on to achieve the highest EVT certification by taking both the EVTCC tests and seeking certification by the National Institute for Automotive Service Excellence (ASE) •Certificates demonstrate the skills and experience needed to perform high-quality maintenance and repair services; further, they instill confidence in the fleet's drivers and customers that the fleet operation is professionally run

funding sources

•Many sources of funding: -Public funds §Tax revenues •Sales taxes, property taxes, or impact fees §EMS operating levies §Municipal bonds •Many sources of funding: -Government reimbursements §Medicaid §Medicare §Military or government dependent care -Other §Grants, capitated agreements with HMOs, philanthropic donations, and civic group donations and subscription programs

marketing

•Marketing is closely linked with PIER strategies, networking, and customer service •Developing solid public support is essential for all EMS organizations •EMS leaders must devote time and planning to effectively market and promote their agency •Marketing plans should be founded upon customer needs and expectations with consideration to realistic budgets, operations, and resources •The most effective way to identify customer needs is through market research •Common market research tools include written and mailed surveys, telephone interviews, and focus groups •A classic marketing strategy is to segment the market: •Goals and objectives -Should be specific, measurable, attainable, and written in a clear and logical manner •Develop specific strategies and tactics to market the service -Determining which strategies will be most effective for different segments of customers -Which service products should be marketed to the different customer segments •Several questions may help in matching customers with market strategy and service: -What characteristics do all potential customers have? -What characteristics are shared by customers who are most likely to use the service? -What are the characteristics of each major segment of the actual and potential market? •Must be continually monitored and adjusted to keep pace with changing organizational goals and customer values

mediation

•Mediation -A process for resolving disputes with the aid of a neutral third party -The mediator's role involves assisting parties, privately and collectively, to identify the issues in dispute and to develop proposals to resolve the disputes -The mediator is not empowered to decide any disputes; accordingly, the mediator may meet privately and hold confidential and separate discussions with the parties -Mediation may be mandatory under the terms of certain laws or court rules, or may be voluntary by agreement of EMS agencies and their labor units -Voluntary arbitration may be undertaken when two parties agree in advance to submit any disputes to mediation §Such mediation clauses are common in agreements in which the parties seek to resolve their disputes in a manner that avoids hostility and preserves an ongoing relationship -Mediation agreements also may be made at the time a dispute arises -The mediator assists each party to determine the parties' genuine interests, and encourages each party to identify settlement proposals intended to address those interests -The mediator communicates settlement proposals to each party and helps each party determine how best to respond to a settlement proposal -In most cases, records or proceedings from mediation cannot be used in judicial or administrative processes

arbitration and mediation

•Mediation or facilitation occurs when labor and management cannot agree on a solution to a problem -Mediation §A process by which a neutral third party is brought in to find common ground between to the two groups -Arbitration §A decision-making process by a neutral third party §Binding arbitration is often a clause placed in the contract or provided under state labor law that indicates a decision made by an arbitrator is final and binding on both parties

medical incident review

•Medical directors assist in developing a process to identify potential issues with patient care •Must have a clear, consistent, formal process for investigating incidents and providing discipline or retraining, as needed •The procedure must be written in the agency's standard operating procedures as a policy •The procedure must include the EMS operations and administrative staff •All providers must sign a statement on day of hire that they have read and understand the policy, including potential disciplinary actions up to and including decertification •The procedure must delineate between minor and major infractions •All providers must sign a statement on hiring that they have read and understand the policy, including potential disciplinary actions up to and including decertification •The procedure must delineate between minor and major infractions •The procedure must clearly describe progressive disciplinary and due process actions that will be triggered by certain actions •The course of action must include grounds for and the process of immediately suspending a provider's privilege to practice •The process must provide written feedback for individual medics and may include retraining •The process must identify patterns of behavior that need individual or group retraining •The medical director or his or her designee must be involved in all incident reviews; the medical director must be involved in all reviews that may involve decertification •Records, protected from discovery if possible, must be maintained of all medical incident reviews regardless of the outcome •The process must provide written feedback for individual medics and may include retraining •The process must identify patterns of behavior that need individual or group retraining

the law

•Medical-legal issues have become more and more significant to EMS managers and leaders •Criminal law -Laws established by legislatures to indicate public wrongs or crimes against the state -The federal, state, county, or city government prosecutes these actions or pubic wrongs •Criminal law -Violations of criminal law can result in fines, imprisonment, probation, or restricted action. •Civil law -Private law that is established between two recognizable parties, which may include corporations, partnerships, quasi-government structures, or other public entities •Civil law -This type of law usually involves a plaintiff and defendant -Based on torts or contracts and usually involving acts done by one person against another in a negligent or willful manner, causing an injury or loss

communication litigation

•Medical-priority dispatch remains a common source of bad press and litigation for EMS agencies •Most often litigation is the result of a lack of professionalism, burnout, and dispatcher abandonment by not providing pre-arrivals or by hanging up on the caller

scheduled transfers

•Medically necessary = success in billing •Medical necessity is established when the patient's condition is such that transfer by any other means of transportation would endanger the health of the patient •Actual reason for the transfer by ambulance and exactly why the patient cannot ride in a car is required on run report

medicare abuses

•Medicare fraud has become rampant in the health-care industry •Qui tam -Lawsuit is conducted under the False Claims Act of the Federal Medicare law -It is an action brought by an informer under federal statute that establishes a penalty for the commission or omissions of a certain act and provides that the same shall be recoverable in a civil action -Part of the money paid as the penalty go to the individual who blows the whistle, the remainder of the monies will go to the state or other institutions

medically necessary

•Medicare only allows billing at the ALS level when medical necessity has been met -ALS assessment is provided -Information at time of dispatch meets ALS level

future medicare charges

•Medicare will become stricter •Expect to see: -Performance-based reimbursement §Will force EMS providers to provide care and complete transport based on medical necessity and evidence-based medicine -Evidence-based medicine §Interventions and actions that produce a positive outcome for the patient •Medicare Payment Advisory Committee -"Medpac" -May decide not to pay for the cost of the EMS to work an arrest knowing that evidence-based medicine indicates this will not have a favorable or positive outcome §Expect the same trend from third-party private insurance companies

billing for multiple patients

•Medicare will reimburse multiple patients in the following manner: -Two patients §Will reimburse 75% of base rate for each patient -Three or more patients §Will reimburse 60% of base rate for each patient

metropolitan medical response system

•Metropolitan Medical Response System (MMRS) Program, 1996 -Currently is funded by the United States Department of Homeland Security (DHS) -The primary focus of the MMRS Program is to develop or enhance existing emergency preparedness systems to effectively respond to a public-health crisis, especially a weapons of mass destruction (WMD) event -Through preparation and coordination, local law-enforcement, fire, hazmat, EMS, hospital, public health, and other first- response personnel plan to more effectively respond in the first 48 hours of a public- health crisis •When EMS is summoned to a technical rescue incident, the minimum qualifications require rescuers to be certified at the BLS level and have rescue awareness training •All personnel at the site need to understand that they must operate under an incident management system •Awareness-level training -Represents the minimum capabilities of responders who in the course of their duties could be called upon to respond to or be first on scene of a technical-rescue incident. -At this level the EMS manager and field crew are generally not considered rescuers but rather support personnel for the operations •Operational-level training -Is designed for responders who will have the capability of hazard recognition, equipment use, and techniques necessary to conduct a technical rescue •The Federal system for Urban Search and Rescue (USAR) -Relies on local fire and EMS organizations to organize into 60- to 72-person FEMA USAR teams -There are 28 teams stationed throughout the United States -These teams require federally mandated training and a specialized equipment list -Requests for FEMA teams must go through a chain of command

NFPA 1581 consensus standard

•Minimum requirements for infection-control practices within emergency services •Must have a written policy statement -Defining mission •Firefighter protective gear •Other legislation -Presumptive legislation

background checks

•More and more cases of falsified or embellished resumes are making their way into EMS services •EMS places employees in a person's home during a vulnerable time, and it is important that a law-enforcement agency checks applicants for criminal backgrounds and character •It is important to confirm that the employee holds a valid certificate or license from the regulatory authority or the originating jurisdiction •Simply requiring photo copies of certifications opens an agency up to falsified credentials •The number of falsified college degrees and degrees awarded from nonaccredited institutions is also on the rise •The Internet has become a frequent source of degrees that are purchased or awarded from organizations that do not meet educational standards

physician involvement

•Most EMS managers will have little direct contact with the system medical director •In communities like Austin, Texas, and Boston, Massachusetts, a physician actively involved and personally accountable with knowledge of each paramedic, is still an exception more than the rule •Generally, any questions or formal recommendations from EMS managers regarding specific medical policy, procedures, or clinical changes should go to the medical director via the system chain of command •Routine questions regarding clinical procedures, standing orders, protocols, or patient care may be handled on a more informal basis directly with the medical director's office or during any regularly scheduled meeting with the medical director •The medical director's direct input into the certification-recertification of EMS personnel in some states acts as a gatekeeper for the medical-practice act •The physician medical director or county medical director approves individuals to be able to work in a specific area •The medical director must ensure the appropriateness of initial qualifications of personnel involved in patient care and emergency medical dispatch •EMS system must provide a medical director with the necessary resources (personnel, vehicles, and equipment) and authority to accomplish his or her assigned medical responsibilities •Clinical supervision also requires an effective quality improvement process for system improvement and patient care •Ensure the medical director has access and subscribes to the EMS research •A mechanism and budget should be in place to ensure that the EMS medical director maintains up-to-date knowledge •EMS agencies should budget and provide malpractice insurance for the physician

mutual aid agreements

•Most organizations have mutual-aid or automatic-aid agreements with neighboring communities •These plans also identify specific authorities with regard to command, compensation, and liabilities •Automatic aid is sent by the dispatch center without a command officer's input and is done on a pre arranged matrix •These agreements specify that another agency will help and, in return, the other agency can expect help when necessary; or in some cases, there is state wide mutual aid that eliminates the need to have to renew signed agreements on an annual basis •Even with the best intentions, without detailed operational plans, execution of such agreements can be destroyed by personal interpretations or local politics and can have disastrous effects •Many parts of the country have only informal, "handshake" agreements •Some communities have signed agreements, but frequently there is little beyond the signatures that separate them from informal agreements, since many do not contain detailed plans, protocols, or training exercises to support their integration into an operational process

quality in EMS

•Most people in EMS come to work with the philosophy to do the best job possible •In most cases they never see results or are never given the feedback on their performance •Lack of feedback on performance creates apathy •Quality-improvement activities are essential to keep the workforce motivated, provide excellence in patient care, and reduce the risk to the organization •There are two key themes to keep in perspective when managing EMS quality-improvement activities: do the right thing, and do the right thing well •EMS quality-improvement activities need to be effective with regard to the tests, procedures, treatments, and services that are provided

ALS level 2

•Must include the administration of at least three intravenous medications or the performance of at least one of the following skills: -Manual defibrillation/cardioversion, endotracheal intubation, central venous line placement, cardiac pacing, chest decompression, a surgical airway, an intraosseous line

requirements for reporting

•Name, date, time, and location of incident •Identification of possible pathogen •Description of the tasks being performed when exposure occurred •Source of transmission •Portal of entry •Personal protective equipment used

medical malpractice

•Negligence -When an EMS worker has a duty to act -This is created within the jurisdiction the EMS agency responds to or is chartered to operate in -A breach of that duty occur when the worker does not observe a patient-care or operational standard, and that breach causes an injury •Negligence -To be considered negligence, that injury must have been linked to the actions or lack of actions by EMS workers •Malfeasance -When an EMS worker performs an act that violates a standard of care or a law •Nonfeasance -When an EMS worker fails to act, often called an act of omission •Contributory negligence -When the patient is said to have done something that contributed to his or her injury or death •Comparative negligence -Requires each agency, person, or participant that the claimant or plaintiff has filed on to pay for injuries or damages in the same proportion as his or her part in responsibility for the injury

HMO contracting

•Negotiated fees for service should actually represent costs •Can limit payment delays with good contract language •Definitions should be clear •Establish prompt payment rules and enforce them •Payment options •Capitated contract -Annual lump sum payment to the provider to cover an estimated number of patients under their plan -If EMS can provide service at a cost less than what it is paid, the agency can generate a surplus -If costs rise above capitated amount, the agency experiences a loss •Disease management coordinators

OSHA standards for occupational injuries and illness

•Occupational diseases: -Contracted through the course of a person performing his or her work •Infectious diseases: -Results from the invasion of the body by bacteria, virus, fungi, or parasites •Communicable diseases -Spreads from one person to another •Occupational injury -Cut, fracture, sprain, amputation from a work-related accident •Occupational illness -Any abnormal condition or disorder caused by exposure to environmental factors associated with employment §Inhalation, absorption, ingestion, direct contact with toxic substances

occupational injuries and illness

•Occupational injury -Cut, fracture, sprain, amputation from a work-related accident •Occupational illness -Any abnormal condition or disorder caused by exposure to environmental factors associated with employment §Inhalation, absorption, ingestion, direct contact with toxic substances

patient parking

•Occurs when a patient is prevented from being transferred from the ambulance gurney to a hospital bed or gurney •Occurs when hospital personnel believe that they are not responsible for the patient •EMTLA states that a patient is presented to the hospital when the patient is on hospital property or within 250 feet of the hospital, including the parking lot •A hospital that does not provide an initial screening exam and stabilizing treatment is in violation of the EMTLA law

risk value analysis

•Once risk is evaluated, a score is generated between 0 and 100 •Risk management should focus on high risk/low frequency and high risk/high frequency

interviews

•Oral board or interview questions should be prepared from job descriptions before you start interviewing -Questions focusing on job duties and the applicant's skills and experience §Tell me about your experience in EMS or public safety. §How much experience did you have in public safety or EMS? §How do you typically go about organizing your workday? §Have any of your jobs required strong leadership skills? •Tell the applicant about job — the duties, hours, pay range, benefits, and career opportunities •Get into the applicant's work history and relevant experience •Avoid discussing sex, religion, or politics in a social setting •Avoid focusing on an applicant's age, ethnicity, birthplace, or marital and family status

paramedic intercept

•Paramedic services provided by non-transporting entity •Limitations: -Billing agency must bill all recipients of service regardless of Medicare status -Area must be a rural service area -Must be certified as an ALS service

specific areas of risk

•Patient refusals -The no-transport call -Question of "informed refusal" -Risk management may concentrate on: §Improving assessment skills §Dealing with the complexities of consent issues •Endotracheal intubations -Failure to confirm tube placement -Improper placement -Risk management may concentrate on: §Researching success rates and identify the criteria for success §Provide frequent education and skills labs §Having supervisors respond on all cardiac arrests to observe and assist

specific areas of risk management in ems care

how to process a system failure

•Perform preparatory work •Collect data •Summarize results •Calculate loss •Determine "significant few" •Validate results •Issue a report

how to process system failure

•Perform preparatory work •Collect data •Summarize results •Calculate loss •Determine "significant few" •Validate results •Issue a report

building a performance apprsial

•Performance appraisals are built on well -crafted job descriptions or a function assessment that describes work and the personal requirements of a particular job •Knowledge, skills, and abilities (KSA) that an employee needs to be successful in the job •Basic steps to an effective performance-appraisal process: -The first step is to review the legal requirements -Qualitative and quantitative attributes should be used to evaluate performance -It is illegal to pass your judgment on personal characteristics •Identify performance-based, job-relevant EMS criteria jointly with medical direction, labor, and management -Aspects of members' performance that are measured during the process -Performance standards used to evaluate members' knowledge, skills, abilities, motivations, and behaviors •Continually review performance standards and revise as necessary to improve the quality and validity of the measures •This is an ongoing process and should be included in the strategic-planning cycles

performance appraisal and incentives

•Performance appraisals often lay the groundwork for a promotion or salary increase for an employee •Should attempt to motivate a less-than-optimally performing employee who has the potential to achieve greater things in the organization •Can lay the groundwork for progressive discipline or dismissal of an otherwise unacceptable worker •The most important function of the performance appraisal is to take an inventory of a person's skills and abilities that the organization can use in new assignments •Can have significant impacts on the organization's training and employee development programs •This makes the delivery of a performance appraisal the EMS manager's most important tool for helping an employee develop to maximize his or her potential •The key to good employee evaluation is to evaluate performance and not the person •The goal of a performance appraisal is to improve the quality of the work and the individual employees involved with that work

interviews

•Phone calls from media sources should be returned promptly •Coaching a paramedic or EMT through an interview can save the agency and the employee from embarrassing remarks •Ideally, a reporter will forward a prepared set of questions in advance to provide the interviewee time to formulate reasonable and intelligent answers •Avoid interviews in your office, dress professionally, stick to the facts or prepared written statements •Keep to the point and be brief; however, a simple yes-or-no answer does not suffice -Don't be afraid to say, "I don't know" or "I will have to check the facts and report back," and do not say "no comment" •Health Insurance Portability and Accountability Act (HIPAA) privacy regulations do not allow for personal medical information to be released without patient consent •Provide general condition and generic information about the patient(s), then refer the news agency to the nursing supervisor for further detail

celebrate with the community

•Plan, organize, and host special events, anniversaries, and other organizational observances -EMS Week is a perfect opportunity for a community celebration focusing on local EMS -Identify particular social needs of the community, and develop specific programs to meet those needs §Home for the Holidays

lawsuit progression

•Pre litigation phase -EMS manager makes initial contact with insurance companies or the agency's legal staff and risk-management department •Discovery phase -Requires bringing together all the information together, both good and bad -Requires EMS managers and the employees involved to assist the legal team -During discovery EMS personnel are usually questioned by the victim's attorney in a deposition or a written interrogative •In some states a medical malpractice case must first attempt to go through an alternative dispute-resolution system •If attempt at alternative dispute resolution fails, then the case usually goes to trial

types of media available to ems

•Press releases should come from one source and facts double-checked •Press releases should be distributed at every press conference and be on official letterhead -Double spaced, limited to one page, with a contact name and phone number •Press releases should cover the "who," "what," "when," "where," "why," and "how" surrounding an event

preventative maintenance

•Preventive maintenance (PM) -Prevent a malfunction or failure, not just correct it after it occurs -Should also be a key component of managing vehicle recalls; vehicle warranties also help to prevent unnecessary costs to the EMS agency -Equipment and vehicle manufacturers normally provide routine maintenance and inspection recommendations for their products •Preventive maintenance (PM) -These recommendations should be used as the basis for developing the system's routine maintenance requirements and PM schedule -Individual team members should be accountable for performing and documenting routine inspections, cleaning, and maintenance, using standardized checklists as part of regular shift changes •Preventive maintenance (PM) -Using a standardized checklist makes the task easier and helps to avoid overlooking any requirements

preventive practices

•Preventive measures can include: -Pre-employment screening, identifying problem situations and risk factors, and security preparation and training of EMS managers and leaders -Pre-employment screening that identifies and screens out potentially violent people before hiring is an obvious means of preventing workplace violence •Preventive measures can include: -Pre-employment screening practices must be consistent with privacy protections and antidiscrimination laws -As an applicant is examined, certain red flags, such as a history of drug or alcohol abuse, past conflicts (especially if violence was involved) with coworkers, or past convictions for violent crimes, should exclude a candidate from employment •Preventive measures can include: -Other red flags can include a defensive, hostile attitude; a history of frequent job changes; and a tendency to blame others for problems

confidentiality issues

•Privacy must be maintained •Confidentiality issues: -Who will own the records? -Who is authorized to see them? -Where and how will they be stored? -If computerized, are they really secured?

grievance procedures and discipline

•Progressive discipline -A process for dealing with job-related behavior that does not meet expected and communicated performance standards -Assist the employee to understand that a performance problem or opportunity for improvement exists -Features increasingly formal efforts to provide feedback to the employee so he or she can correct the problem -Not intended as a punishment for an employee, but to assist the employee to overcome performance problems and satisfy job expectations -Is most successful when it assists an individual to become an effectively performing member of the organization •It is important that EMS managers understand the concept of due process in discipline •Employees have the right to be informed of the accusation, to receive promptly a copy of the complaint, and to have access to relevant material to be introduced in order to guarantee the ability to prepare a defense •Employees have the right to be assisted without prejudice by an advisor who may be an attorney or union official •Employees may be compelled to testify against themselves •If an employee chooses to testify, a negative inference may be drawn from any person's failure to respond to relevant questions in a judicial proceeding •A violation of these rights can result in litigation and constitute a gross procedural error in many union contracts and establish grounds for appeal

discipline

•Progressive discipline -Involves an increasing level of severity for actions that violate the organization's rules, standard operating procedures, or standards of conduct -In most progressive discipline systems, the procedures are divided into formal and informal processes: §In the informal process, typically coaching and counseling occurs that is not placed in the formal system of discipline and the documentation is kept with the immediate supervisor §Coaching and counseling is applied in progressive discipline when it is a training or performance issues that is not serious but not in line with given work standards

occupational exposures and pre exposure

•Proper vaccinations and protective equipment •Vaccinations -HBV, chicken pox, measles, mumps, rubella, and annual flu vaccine -Hepatitis A, pneumonia •Titers

occupational exposures pre exposure

•Proper vaccinations and protective equipment •Vaccinations -HBV, chicken pox, measles, mumps, rubella, and annual flu vaccine -Hepatitis A, pneumonia •Titers

the importance of public information

•Providing members of the public with necessary safety information actually serves three goals: -Public service, making our job easier and sometimes safer, and marketing •Educating the public about the value of EMS allows us to serve the public better while furthering the mission of this public service •Public opinion often can be the determining factor in budget and contracting issues

public information, education and relations

•Public relations is a continuous affair •It must be a priority for EMS system managers, supervisors, and responders because it impacts all levels within the system •PIER determines how the system is perceived as a public service entity and, at budget time, if it is worth the cost •Present a good public image while offering tours for school children, conducting community blood-pressure screenings, or making sure the appearance of a paramedic unit or ambulance throughout a shift presents a positive, professional image of the service •Clean uniforms and outwardly caring behavior •Public image of EMS is largely based upon news-media coverage •The media can assist in enhancing the public image of EMS by making time or space available upon request for public- service announcements, press releases, or messages about EMS

history of quality management

•Quality improvement -Sum of all activities undertaken to continuously examine and improve products and services -Activities are prospective, concurrent, and retrospective, depending when they are conducted relative to an event -Tools include tests, databases, infield observations, chart review, customer service surveys, and checkout sheets •Scientific management - Fredrick Taylor §Author of The Principles of Scientific Management (1911) •A formal look at the motivations of work that would result in improved efficiency •Frank and Lillian Gilbreth -Improved upon scientific management by studying human motivations at work and the psychological aspects of work •Elton Mayo -Studied the efficiency of work and its relationship to working conditions -The Hawthorne studies §Focused more attention on understanding individuals, attitudes, and groups and less on organizational structure and efficiency of the work §Concluded that the knowledge of being observed causes alterations in behavior •W. Edwards Deming -Applied quality processes to modern manufacturing -Began working in Japan in 1950 and was instrumental in building the Japanese industry into an economic world power Problems in a production process are due to flaws in the design of the system, as opposed to being rooted in the motivation or professional commitment of the workforce •W. Edwards Deming -Quality is maintained and improved when leaders, managers, and the workforce understand and commit to constant customer satisfaction through continuous quality improvement •If Deming's principles were applied to the prehospital area, EMS would focus on quality patient care and appropriate use of resources •The EMS system would be focused on system quality and productivity, not revenue •Two other modern quality-improvement methods, supported by the Joint Accreditation Committee on Hospital Organizations, provide a background for EMS-related quality-improvement or quality-assurance activities -Philip Crosby §Organizations should redesign operations to encourage doing the job right the first time §Challenged organizations to think of how processes could be redesigned to reduce errors and to reach a goal of zero defects -Ernst and Young •DR. Joseph M. Juran -Revolutionized the Japanese philosophy on quality management -Juran's work incorporates the human aspect of quality management, which is referred to as total quality management (TQM) -Top management involvement -The need for widespread training in quality •QI program must reflect the strong interdependency among all of the operations within an organization's production processes •Juran advocated a quality trilogy that included quality planning, quality control, and quality improvement •Quality planning -The process of understanding what the customer needs -Designing all aspects of a system that is able to reliably meet those needs •Quality control -Is used to constantly monitor performance for compliance with the original design standards -If performance falls short of the standard, plans are put into action to deal quickly with the problem •Quality Improvement (QI) -Occurs when new, previously unobtainable levels of performance are achieved -Requires the continuous comparison of the system to itself using performance measures

physician providing quality leadership

•Quality management is probably the most important task a medical director performs •Medical directors have the responsibility and often legal liability to ensure that all care provided under their authority is of the best quality possible •Quality management is the tool that makes this possible •This is typically done in a routine report review by EMS agency's leadership •The EMS chief, filed supervisor, or a designated QI coordinator should maintain statistics on medical practice -Scene times, number of attempted IVs and intubations, number of completed IVs and intubations, number of cardiac arrests managed •Collected data should be analyzed by the physician medical director to determine necessary areas of improvement for the entire service

calculating unit hour utilization

•Queuing theory -Study of waiting lines and the consequences of these lines -Excellent method for determining how many EMS units are needed to handle calls -Can estimate how busy EMS units are, probability of a call, waiting time, number of units needed to satisfy operations •Measurement of workload for EMS agencies •Developed from queuing theory •Used to determine the line between too few ambulances and putting an ambulance on every corner •Must know the number of EMS calls and amount of time a crew spends on an ambulance call •U:UH ratio

medicare rates

•Rates increase based on the CPI-urban percentage increase •Nonemergency transports require a physician certification statement (PCS) to bill Medicare -Signed by a physician; if not available, then a nurse, physician assistant, or nurse practitioner may sign

online medical control

•Real-time (via radio or telephone) direction of prehospital providers in the delivery of emergency medical care •Differs from off-line medical control, which refers to administrative and protocol control exercised by a medical director or committee of physicians and EMS providers •Requires the presence of on-line physicians who are involved in the design and implementation of the system, participate routinely in on-line direction of care, are well-acquainted with EMS personnel, and are involved in EMS medical audits and quality-assurance programs •Three general models of on-line physician direction have been developed: -Hospital-based direction §Provided by radio or telephone communication from a hospital-based physician who is usually located in an ED §Most common model •Three general models of on-line physician direction have been developed: -Mobile medical direction §Less well-known, but has several advantages §Emergency physicians provide medical direction on a rotating basis to field teams through portable radios and telephones, allowing for the medical management of the EMS system through a consortium of hospitals or physician groups •Three general models of on-line physician direction have been developed: -In-field §Physician is present at the scene of an incident

psychological applications

•Recognition-prime-decision-making (RPDM) -Draws on past experiences •Emotional intelligence (EI) -Looks at how to control emotions to recognize triggers and avoid a negative response

OHSA reporting requirement

•Record needle-stick and sharps injuries involving contamination by another person's blood or other potentially infectious materials •Establish a procedure for employees to report injuries and illnesses, and for telling employees how to report •Guarantee employees access to OSHA 301 forms •Protect employee's privacy •Routinely update the forms and save them for five years

OSHA reporting requirements

the ems workforce

•Recruiting, selecting, and retention of employees will be one of the most challenging aspects of managing or leading an EMS agency •Number of people choosing EMS as a career or profession is declining •The National Registry of EMTs reported that 19 states saw a decrease in the number of paramedics and EMTs taking the National Registry exams •Longitudinal EMT Attributes and Demographics Study (LEADS) -Demographics of EMS workers -Work activities, working conditions, and job satisfaction •Future of Emergency Medical Care in the United States -"Emergency Medical Services at the Crossroads" -An Institute of Medicine study -The EMS component of the study is "EMS at the Crossroads"

balanced budget act of 1997

•Reformulated the ambulance fee structure through negotiated rulemaking conducted by: -Industry stakeholders who negotiate the regulations specifying how ambulance services are reimbursed under Medicare

ems interaction within the health care system

•Regulatory agencies tend to have many hats to wear and are often given marching orders by the political leadership of the day -Continual changes as political agendas and administrations change •For emergency-service organizations, this can appear to be inconsistency •Good relations with people will always produce better results

infection control officer

•Responsible for maintaining records •Liaison -Department physician, health and safety officer, infection-control representative at health-care facilities, regulatory agencies •Maintaining compliance •Investigate incidents with followups •"Designated infection control officer" program

financial requirements and billing

•Revenue recovery is important •Ambulance rates and billing should be balanced -Cost of delivering EMS, collection of revenues, and non-service related monies coming into the organization •Rarely will rates reflect the cost of providing services

summary

•Risk management and safety operations go hand in hand •The nature of EMS places personnel in hazardous environments •Responsibility of every EMS manager to conduct reviews and ongoing assessment of risk management and safety principles •Risk management and safety require quality policies, training, and management

risk management

•Risk management in EMS: -Preventing monetary losses -Preventing disability -Preventing loss of life -Preventing irreparable business damage •Risk management in EMS involves: -Direct, "hands-on" patient care -Indirect aspects of patient care, such as development of effective training programs and selection of qualified personnel •Risk management has five strategies: -Eliminate the risk -Avoid the risk -Acquire insurance -Pool financial resources -Transfer the risk

identifying risks

•Risk management is proactive •It identifies: -Root cause of loss -Proximate cause -Causal factors

EMS safety

•Safety education should be part of any- risk management program •Required OSHA training for EMS workers -Hazard communication, emergency plan, lock out tag out, respiratory, access to medical records, portable fire extinguishers, ergonomics and equipment, hazardous waste and spills, hearing protection

ems safety

mileage

•Services can charge for a loaded mileage, which starts at point of pick up •Currently rate of $5.47 per loaded mile but goes up annually •Zip code must be documented on each claim •Loaded miles only

ems infection control equipment

•Single-use medical gloves •Fluid-resistant clothing •Pocket masks and/or NIOSH-approved respirators •Splash-resistant eyewear and face-protective devices •Respiratory-assist devices •Approved sharps containers •Leak proof bags

infection control equipment

physician organizations for EMS

•Society for Academic Emergency Medicine •The National Association of EMS Physicians •American College of Emergency Physicians •American Heart Association •American Stroke Association •EMS Section of the International Association of Fire Chiefs EMS •Advocates for EMS •National Association of EMTs

state emergency operation plan

•Stafford Act -States are encouraged to engage in emergency planning and are provided funding to augment the state's planning efforts -Each state has an EOP for the deployment of state resources and to guide coordination activities with the NRP -Many of these plans closely resemble the NRP in organizational concept and through the use of an emergency support function (ESF) structure -A properly developed plan also will have sufficient flexibility to allow it to be applied modularly to any emergency or disaster in which the state is called upon for assistance •The state accesses resources from the federal government through the request for activation of the NRP •In order to obtain federal activation, the state must demonstrate that the disaster or emergency exceeds its abilities to respond to the incident, even though the state EOP has been activated •This concept of demonstrating need also applies to the local jurisdiction's ability to access the state EOP •Once local fire and EMS officials have determined that the incident exceeds their capabilities to respond, those local agencies contact city or county officials to request activation of the local EOP by declaring a local state of emergency and, subsequently, by activation of the state's EOP

SCHIP

•State Children's Health Insurance Program -Established in 1997, as part of the Balanced Budget Act -Allowed states to provide health insurance for children

complaint information process

•Take a report and separate crew for individual responses •Interview witnesses •Gather physical evidence •Run background and criminal history checks •Intelligence information/information sharing •Interview suspect

disparate impact

•The "80% rule" says that a selection rate for any race, sex, or ethnic group that is less than four-fifths or 80% of the rate for the group with the highest rate will generally be regarded...as evidence of adverse impact.

federal legislation and ems

•The EMS manager and leadership should be aware of current legal statutes that affect the delivery of EMS or affect the EMS system -Emergency Medical Treatment and Active Labor Act (EMTLA) §This section of federal law was taken from an amendment to the Consolidated Omnibus Budget Reconciliation Act (COBRA) -Emergency Medical Treatment and Active Labor Act (EMTLA) §Covers any emergency medical condition and is designed to prevent unequal treatment of patients in need of emergency care §Applies to every hospital and every patient §Requires that any individual who comes to a hospital be given a medical screening exam by qualified personnel, stabilized, and transferred to an appropriate facility if necessary §The hospital must maintain transfer records for up to five years

ambulance types classes configurations

•The Federal standard uses three ambulance types, with further divisions into classes and floor configuration -Type I conventional truck, with cab chassis and a modular ambulance body §Type I ambulance can have an additional-duty (AD) unit when modified for neonatal, critical-care transports, and rescue or fire suppression package •The Federal standard uses three ambulance types, with further divisions into classes and floor configuration -Type I conventional truck, with cab chassis and a modular ambulance body §This is often referred to as a "medium duty" rescue in the fire service; The vehicle types are divided into class I or class II, representing two-wheeled and four-wheel drive, respectively •The Federal standard uses three ambulance types, with further divisions into classes and floor configuration -The Type II is a standard van with an integral cab-body ambulance §A type III ambulance is a cutaway van, cab-chassis with integrated modular ambulance body •The Federal standard uses three ambulance types, with further divisions into classes and floor configuration -The type III ambulance can also have a classification of additional duty (AD) §It is recommended in the federal standard that ALS ambulances be either type I or type II §Type I and III ambulances also have two standard configurations in the federal specification: "A" for ALS and "B" for BLS

first amendment rights

•The First Amendment protects freedom of speech, religion, and association •These are not unlimited rights, and only speech on matters of pubic concern is protected •If a public employee's speech is purely job related, it is not entitled to First Amendment protection •Legal counsel should be consulted before taking any disciplinary action against outspoken employees

jcaho

•The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) -Sets standards for health-care organizations -When a health-care organization seeks accreditation, it demonstrates commitment to giving safe, high-quality health care and to continually working to improve that care -Many of the CAHO principles have been applied to EMS, and it is a natural migration for CAHO standards to find their way from a physician medical director to an EMS agency

local emergency planning committee

•The Superfund Amendments and Reauthorization Act of 1986 (SARA) Title III, or the Emergency Planning and Community Right-to-Know Act •Requires governors of every state to establish a state emergency response commission (SERC) and to designate local emergency-planning committees (LEPC's) •The purpose of this law was to require emergency-planning efforts at the state and local levels, and to increase the public's awareness of hazardous chemicals within their communities •Depending on the state, the LEPC can be designated as the entire state, a portion of the state, or any county or other geographical designation

vehicle and equipment failures

•The annual critical vehicular failure (CVF) rate, or the average frequency at which something fails, should be calculated •This is done by identifying a specific mileage or operating-hour benchmarks for the entire fleet -A common benchmark is the number of incidents for the fleet every 100,000 miles, 1,000 engine hours, or 100,000 engine hours •Mileage and hour benchmarks work well, since wear and tear on equipment is based on use and not calendar days •Common areas to plan for in preventive maintenance are replacement of items such as tires, batteries, belts, fluids, brakes, and any other parts determined to need replacement on a scheduled or regular basis •A common rate of failure in public-safety or ambulance fleets suggest that out-of-service incidents occur at a rate of 0.87 vehicle failures per 100,000 fleet operating miles •A vehicle failure above this rate in pubic safety may indicate a vehicle should be taken out of service with a problem identified in a vehicle checkout •When performing a critical failure rate, the automotive industry tends to use three parameters for each failure - severity, occurrence, and detection - and gives each one a score between 1(not critical) and 10 (extremely critical) •Safety-analysis guidelines propose a scoring scheme along the following lines: -Severity: The hazards associated with each failure should be categorized into 10 different levels ranging from 1 (least severe) to 10 (most severe) based on safety and impact on the operation -Occurrence: Is the number of events and the probability of random failures in a given mileage benchmark or a specific number of hours of engine use; the occurrence of random faults should ideally be scored objectively using a percentage per certain hours or mileage -Detection: A meaningful interpretation of this number is a measure of the degree to which preventative systems and vehicle checkouts can be detected; it should be made up of the probability expressed in a percentage

fleet management and equipment

•The delivery of EMS services cannot be accomplished without technologically sophisticated medical equipment and state-of-the-art emergency vehicles •A number of factors must be considered in order to establish the cost of operating an EMS system -Direct services are the services provided to the public §This includes patient-care activities, public-education programs, preventive-maintenance programs, and special events •A number of factors must be considered in order to establish the cost of operating an EMS system -Functional services are those provided to the agency within and can include such services as yearly physicals, EAP, training, uniforms, office support, and utilities •A number of factors must be considered in order to establish the cost of operating an EMS system -An EMS manager must identify all the services provided by the organization as the first step in identifying and costing out each key aspect of the operation •Fleet administration requires EMS managers to supply vehicles and services to support fire and EMS activities •These services cover a wide range of job tasks -Logistics chief officer or front-line supervisor •An EMS manager must consider replacement policies, contracting and government bidding standards, whether to purchase or lease apparatus and equipment, and replacement criteria •A contingency plan should be put in place to provide reserve equipment or equipment on loan during planned and preventive maintenance •In the event that there is equipment failure, a procedure should be put in place for using reserve equipment, such as borrowing an ambulance or cardiac monitor from a neighboring department or perhaps a local vendor who will loan you a demo unit if your reserve unit is unavailable or you need additional resources

federal mutual aid initiatives

•The federal government has developed two projects that will help EMS service's ability to support the national response plan and implement concepts presented in the National Incident Management System •This initiative was authorized under Homeland Security Presidential Directive (HSPD-5) •The initiative will provide the nation with the highest capability to rapidly and easily exchange disaster resources during times of need •National Fire Service Interstate Mutual Aid System (IMAS) -The goal is to support the creation of formalized, comprehensive, and exercised intrastate mutual-aid plans. •Mutual Aid System Task Force (MASTF) -The goal is to bring a fire-service perspective to recommendations to improve the sharing of resources across state lines

applications

•The first phase of any selection process is an application process •Applications need to be constructed to meet legal requirements •It is permissible to ask if the applicant has any disabilities that would prevent him or her from satisfactorily performing the job

specification process

•The first step in purchasing or leasing equipment is to create a procurement process for your agency, whether for a new ambulance or a cardiac monitor •Defining the specifications for the vehicle or equipment is really one small part of the process •More ownership and pride in the equipment when employees have input into the design and construction •Vendors normally provide a set of specifications and place in those specifications conditions or statements designed to exclude other vendors •Rarely is that set of specifications designed to a performance standard -In many cases, the vendors reserve the right to substitute or change the specifications •It is important to use the request for proposal (RFP) process and include key performance criteria and penalties if the equipment fails to meet those standards •Similar to construction contracts, bid specifications can include monetary penalties for late delivery or for not meeting performance criteria •When purchasing equipment, EMS managers ask for several different requests for proposals or contracts used by other agencies for purchases, and employ a committee to review the content and use the best of the content to create a custom request for proposal

protocols

•The medical director must establish a set of protocols that defines the overall system design •These protocols must address and identify the scope and involvement of prehospital providers, the role of on-line medical control, and the mechanism for quality assurance •Protocols are generally written in two types of formats: -Descriptive protocols §Written as a narrative, describe a condition or situation, and usually contain educational material -Algorithmic protocol §A series of logical steps based on recognized or objective facts or conditions and does not have educational components •Treatment protocols -Define the scope of prehospital interventions -Establish uniform quality of care and become the basis for the design of training, continuing education, and refresher training programs for prehospital providers -Form the basis for on-going monitoring of the system and for quality assurance •The practice of medicine is dynamic; therefore, treatment protocols must be reviewed on an annual or bi-annual basis •Whenever major changes are made in treatment protocols, appropriate in-service or continuing-education training is necessary •Standing orders -More specific than treatment protocols -Included in a protocol when delay in treatment might have a harmful effect or outcome -Are quite specific and define those prehospital interventions that are authorized by an EMS system without on-line, real-time medical control -Standing orders should be standardized throughout the system to ensure uniformity and prevent confusion •Communication protocols -Define the method and timing of communications with on-line medical control -Closely related to standing orders in that they might define those situations where on-line voice communication is not necessary -As this is a medical decision, they must be established by the medical director, ideally in consultation with a medical advisory committee•Destination protocols -Protocols that define the appropriate receiving facility for a patient with any given medical condition -Involves bypassing closer, nondesignated facilities -The most controversial, attracting the most attention in the course of their development •Destination protocols -Determining the appropriate receiving facility clearly involves medical decisions and must be established through off-line medical direction -Ideally accomplished through an advisory committee of physicians from various specialties §Hospital representatives should be included in the development of these protocols •Special protocols -Developed to address special circumstances that might be encountered within the EMS system §When to terminate cardiopulmonary resuscitation §Whether or not to transport a patient against his or her will §When a physician is on the scene

protocols

•The medical director must provide treatment and triage protocols •Treatment protocols are standards of practice for an EMS system and apply to all parties of the system •Standing orders are used to guide members when direct medical control is not established or available •Triage protocols provide patient-destination policy (point-of-entry plan) or designate a facility for transport •Treatment protocols prevent medical-control facilities from usurping patient-destination decisions

national response plan assumptions

•The national response plan (NRP) -Assumes a disaster or emergency, such as an earthquake or act of terrorism, may occur with little or no warning at a time of day that produces maximum casualties -The plan also deals with other types of disasters, such as a hurricanes, that could result in a large number of casualties and cause widespread damage, and with the consequences of any event in which federal response assistance under the authorities of the Stafford Act is required -In all cases, the plan assumes that the response capability of an affected state will be overwhelmed •The planning function of operations -Immediately following a major disaster or emergency requiring federal response, primary agencies, when directed by FEMA, will take actions to identify requirements, and mobilize and deploy resources to the affected area to assist the state in its lifesaving and life‑protecting response efforts •Agencies have been grouped together under 15 emergency support functions (ESFs) to facilitate response assistance to the state •Requests for assistance will be channeled from local jurisdictions through the designated state agencies for action •Federal response assistance will be provided by an ESF to the state, or, at the state's request, directly to an affected local jurisdiction •A principal federal official (PFO) will be appointed by the president to coordinate the federal activities in each declared state •The PFO will work with the state coordination officer (SCO) to identify overall requirements, including unmet needs and evolving support requirements, and coordinate these requirements with the ESFs •The PFO also will coordinate public information, congressional liaison, community liaison, outreach, and donations activities, and will facilitate the provision of information and reports to appropriate users •The PFO may appoint a federal coordination officer (FCO) to head a regional interagency emergency response team (ERT), composed of ESF representatives and other support staff •The ERT provides initial response coordination with the affected state at the state EOC or other designated state facility and supports the FCO and ESF operations in the field •The PFO will coordinate response activities with the ESF representatives on the ERT to ensure that federal resources are made available to meet the requirements identified by the state •A national interagency emergency support team (EST) will operate at the Department of Homeland Security, FEMA headquarters, to provide support for the PFO and the ERT •The catastrophic disaster response group (CDRG) will operate at the national level to provide guidance and policy direction on response coordination and operational issues arising from PFO and ESF response activities •The CDRG also is supported by the EST and will operate from FEMA headquarters •Activities under the plan will be organized at various levels to provide partial response and recovery (using selected ESFs) or to provide full response and recovery (using all ESFs)

national level response structure

•The national‑level response structure is composed of the following specific elements: -Catastrophic disaster response group -Emergency support team -Agency operational centers •In addition to supporting EST activities at the FEMA EICC headquarters, departments and agencies will conduct national-level response activities at their own EOCs

written exams

•The objective format using a true/false, multiple choice, matching, or fill-in-the-blanks question is the traditional format for a written exam •Most commercial testbanks are validated and save time and effort •Be sure to make the question(s) very clear •Short answers also gives the EMS agency a chance to evaluate a writing style, legibility and grammar skills to see if that applicant can complete a prehospital report

selection

•The process of selection is one of the most important tasks and EMS leader or manager can be involved with •Reliability -The degree to which interviews, tests, and selection procedures yield comparable data over the period of time -EMS managers need to be able to consistently rate the interviewees exactly the way they have previously -Likewise, a written test should yield the same results every time it is administered •Validity -Refers to what a test measures and how well it measures it -The extent to which data from the selection process predict the job performance -Required by the EEOC -There are several types of validity: §Criterion-related validity §Concurrent validity §Predictive validity §Content validity §Construct validity

motivating the generations

•The silent or "greatest generation" chooses formality over informality, often calling EMS managers and leaders by titles and sur names -They communicate face-to-face or on a regular telephone, rather than by electronic forms of communication, such as e-mail or text messaging -Often ask for things to be explained logically •Boomers are goal-oriented and take steps to achieve those goals -Boomers state objectives in people- centered terms, and believe actions reflect effort -They respond to inspirational speeches and function well in most team-centered activities -Boomers see widespread recognition from newsletters or press releases as an incentive •Xers need a leadership style that does not micromanage -Xers can be told what needs to get done and when, and will operate with very little instruction -They are great at multitasking -Provide frequent feedback, keep the work environment fun, and ask for their opinions and reactions -Free time or additional time off is the best motivator •Generation Y must be constantly challenged with continuous learning and building skills -Know their personal goals, and try to match up tasks with those goals -They respond best to coaching and upbeat messages through informal routes of communication

ethics and conduct

•The word "moral" refers to is the ability to distinguish right from wrong •The word "ethics" refers to the rules of society, religion, and organizations that help to define behavior as right, good, and proper •Morals and ethics are taught and developed from birth to adulthood •Ethical decisions are most often made from one of five different perspectives: -Utilitarian approach makes an ethical decision based on what is most efficient -Rights approach seeks to maximize the employee's rights and see a decision's purpose as a benefit to the employee -Fairness or justice seeks to make a decision that distributes benefits equal based on the law -Common-good approach seeks to do the most for the most people, and in making this decision an individual may receive a less-than-favorable personal outcome personally -Virtue approach is inspired by supreme respect for the individual and a moral message

hippa

•There are penalties for violating the confidential information of patients -The financial costs are divided among civil and criminal penalties -The civil penalties are $100 per violation and up to $25,000 per person, per year, for each violation -Criminal penalties can be assessed up to $50,000 and 1 year in prison -Penalties increase up to $100,000 and 5 years in prison for obtaining past medical history under false pretenses -An agency or individual can be fined up to $250,000 and given 10 years in prison for obtaining and disclosing past medical history with the intent to sell or use the information for commercial or personal gain or malicious harm •Administrative Simplification Compliance Act, 2001 -Mandated that new Medicare claims and billing had to be conducted electronically after October 16, 2003 -This was in response to HIPAA requiring electronic filing •Privacy officer -May be the EMS chief officer or an EMS supervisor -If there is no EMS officer, this responsibility must fall on the fire chief or agency executive to ensure compliance with the rules, or the agency could forfeit the right to bill Medicare

selecting and hiring a medical director

•There will be various individuals or groups of individuals who will be charged by law or tradition with the selection of the medical director •This authority should be familiar with the qualifications of medical directors as specified by the American College of Emergency Physicians (ACEP) •The selection committee should seek out the advice of key medical leaders within the community •The physician medical director should go through a normal hiring process •The medical director should be actively involved with the EMS system, familiar with EMS, and have an unrestricted license to practice locally •The medical director should have the support of local emergency physicians, local and state medical societies, and hospital associations and their representatives •A medical director should be board certified in emergency medicine and emergency medical services •Likely to have completed an emergency medicine residency •It is preferable to have a physician who has actually been in an ambulance and has the motivation to seek out field experiences •Needs an understanding of labor relations, incident command, and disaster preparedness •The selection of an EMS medical director should include evaluating the residency training program and/or fellowship programs where the physician trained

regional resource response plans

•These plans identify the method of mobilization, organization, and operation well in advance of the need •Plans identify financial considerations in advance, rather than at the time of need •Resource response plans are based heavily on the concepts of incident management •An agency requiring a specific resource contacts a lead organization (many times the state EOC) and places a request for a specific resource, task force, or strike team •This lead agency then determines the closest available source of the needed items from the membership of the plan and contacts one or more organizations to assemble what is needed •The requesting member can specify a unique resource at the time of the request •Could include EMS task forces, disaster medical assistance team, or an urban search and rescue team •Responding units should have a means of common communication between units capable of working outside their home jurisdictions -Known as interoperability

legal issues in human resources

•Title VII of the Civil Rights Act of 1964 -Prohibits discrimination against a person seeking employment based on the applicant's race, color, religion, sex, or national origin -Prohibits discrimination in hiring, promotion, salaries, benefits, training, treatment of pregnancy, and other conditions of employment on the basis of race, color, religion, national origin, or sex -Protections are offered regardless of the citizenship status of the applicant or employee -Most employment discrimination charges are filed under Title VII •The Civil Rights Act of 1991 -Makes clear that intentional discrimination occurs when race, color, sex, religion, or national origin is a motivating factor in an employment decision, even if there are other, nondiscriminatory reasons for the decision -Limit on the monetary damages for victims of intentional discrimination under Title VII, the Americans with Disabilities Act, and the Rehabilitation Act •Americans with Disabilities Act -Prohibits discrimination against job seekers with physical or mental disabilities and is for those with a record of disability •Pregnancy Discrimination Act -An amendment to Title VII that prohibits sex discrimination on the basis of pregnancy, childbirth, or related medical conditions •Uniform Services Employment and Reemployment Rights Act -Prohibits discrimination by employers against past or present job applicants who may be called to or volunteer for military service -Employees have the right to be reemployed in the civilian jobs they left -If the employees are discharged with a less-than-honorable discharge, the benefits of USERRA can be denied -Employees must be restored to a job and benefits they would have attained in the time they were absent due to military service -The employer cannot deny the employee initial employment, reemployment, retention in employment, promotion, or any benefit of employment -This includes health insurance and employers are obligated to continue the employees' and their dependents' health-care coverage for up to 24 months •The Age Discrimination Act 1967 -Protects those over the age of 40 -It is important that EMS managers hold employees to job standards and treat the more experienced workers with dignity •Immigration Reform and Control Act -Protects against discrimination based on citizenship -Does not cover those in the country illegally -With the shortages-health-care professionals in the United States, allied-health professional have been coming from other countries -EMS professionals with valid work permits and green cards have protection under the Immigration Reform and Control Act •Family Medical Leave Act -Entitles a person up to 12 weeks of unpaid leave for the care of new child or family member in a 12-month period -Coverage includes both adopted and biological children and immediate family members -The employee does not lose rank or pay while on leave •Volunteer Firefighter and EMS Personnel Job Protection Act -Prevents an employer from terminating, demoting, or discriminating against an employee absent from a job for up to 14 days a year while serving as a volunteer emergency responder •Fair Labor Standards Act -Controls the working hours and the payment for comp time or overtime of nonexempt employees -Established minimum wage, and created a 40-hour workweek standard -Includes record-keeping requirements -In 1963, mandated equal pay for equal work -In 1966, amended to cover quasi-public employees in hospitals, schools, nursing homes, and transit firms -In 1985, amended to allow compensatory time or additional time off instead of cash payment for overtime §Maximum accrual of 480 hours §Compensatory time must be agreed upon between the agency and the labor unit, and employees must be able to use any compensatory time awarded to them -In 1986, established rules and policies for local government this included compensatory time, rules for public-safety employees, recordkeeping, dual employment, and volunteers •Employee that holds an executive, administrative, or technical position can be exempt from regulations under FLSA -An executive position is one in which the person's primary duty consists of management of the organization, directs the work of two or more, and has the authority to hire and fire employees -An administrative position is one in which an employee performs work directly related to management policies or general operations; performs general supervision and does not devote more than 20% of time to other duties -A professional position exemption requires knowledge of an advanced type in a field of science in which the work is intellectual and creative in nature; Also applies to teaching •Public-safety employees are regulated under section 7K of 29 CFR Section 553.201 -Public service personnel have a regulated work periods. §Cannot be less than 7 days or more than 28 days §A work period is not the same as a pay period, and FLSA also defines a tour of duty as the period of time an employee is considered to be on duty for determining compensable hours §Tours of duty include regular shifts, special assignments, and any activities beyond scheduled time to complete assignments, yet exempts shift swaps §Stipulates that fire and EMS employers keep payroll records, certificates, agreements, collective-bargaining agreements, and employee contracts for three years §Compensable hours include all hours less than 24 hours and any hours over 24 hours: sleep and meal time may be excluded if expressed in an agreement between the agency and the labor unit or employee §The exemption under the 7K rule depends on the 80/20 rule, which says that no more than 20% of an employee's work otherwise covered under a 7 K exemption may be spent on non-exempt work

total quality management

•Total Quality Management (TQM) -A management system that focuses on continuously improving performance at every level of function, focusing on customer satisfaction -An EMS operation using TQM involves both leadership and employees -Assumes that most problems result from the inability of the system to perform, rather than the individual's inability to perform -In an EMS system, TQM requires three elements: §EMS managers and leaders must have an absolute commitment from the top §It must be easy to identify measurable and accurate indicators of quality §There must be involvement in the quality- improvement process by EMTs, paramedics, and support personnel in all quality-improvement methods

calculating unit hours

•Total cost per unit is a measure of the total cost of providing coverage during a given accounting period divided by the total number of unit hours of coverage during the same accounting period •Can be used to identify whether or not unit-hour costs are excessive given the quality of care being delivered •Top-heavy administration, high wages, poor economies of scale, overtime pay can drive up unit-hour cost •When you have excessive unit-hour costs with poor response times, consideration should be given to moving vehicles or adding units •Vehicle operating costs

infection control training

•Training to include: -Proper use of PPE -SOP's for safe work practices -Cleaning and decontamination -Disposal of contaminates -Exposure management -Medical followup

tiered or dual response agencies

•Turf issues also exist within organizations at the interdepartmental, opposing shift, and dual-response levels •A common place for disagreements is in combination career-and-volunteer agencies •A reasonable approach to improving this situation will involve having each group define its contribution to the whole mission and a facilitation of the contributions each group makes to the community •A basic understanding of teamwork and the expectations of the agency that everyone will "play well together" helps and must be delivered by the leaders of the organization •Of course, the leaders then need to walk the talk of getting along and using accepted behavior

situations requiring immediate involvement of the medical director

•Unrecognized esophageal intubation -A high-risk event that almost always has a bad outcome and forces a serious look at the actions of the person, system, and procedures •Inappropriate medical care -Patients are dropped from the ambulance stretcher -Patients are injured during the application of restraints -EMS crews fail to recognize a serious medical problem or refuse to transport a sick or injured patient •Substance abuse among medics -Requires action by the chain of command and medical director -The EMS agency must have personnel policies and procedures to address this situation -The medical director is responsible for appropriate use of all narcotic medications purchased by the EMS service under the drug enforcement agency (DEA) number of the medical director

sexual harassment

•Unwelcome sexual advances, requests for sexual favors, or other verbal or physical conduct of a sexual nature •A majority of sexual-harassment complaints are brought by one coworker against another •To be considered unlawful sexual harassment, the harassing coworker's conduct must be unwelcome and interfere with the employee's work performance; it may include: -Visual harassment: posters, magazines, calendars, etc. -Verbal harassment or abuse: repeated requests for dates, lewd comments, sexually explicit jokes, whistling, etc. -Written harassment: love poems, letters, graffiti, etc. -Offensive gestures -Subtle pressure for sexual activities -Unnecessary touching, patting, pinching, or kissing -Leering or ogling -Brushing up against another's body -Promise of promotions, favorable performance evaluations or grades, etc., in return for sexual favors -Demanding sexual favors accompanied by implied or overt threats to a person's job, promotion, performance evaluation, grade, etc. -Physical assault, rape •Develop a policy to address sexual harassment •Notify all employees and students that sexual harassment is a violation of law and intolerable in either the educational or employment setting •State that sexual harassment is a form of misconduct and sanctions will be enforced against individuals engaging in sexual harassment and against supervisory, administrative, or managerial personnel who knowingly allow such behavior to continue •Policy should also include a procedure for the following: -Making a complaint of sexual harassment -To whom complaints are to be made -In what form the complaint should be filed -How the sponsor/employer will investigate the complaint -A subsequent review to determine if harassment has stopped •In addition to filing a complaint, even in agencies that do not have policies, individuals are entitled to seek relief by filing a complaint with: -State Division of Human Rights -Federal Equal Employment Opportunity Commission -U.S. Labor Department's Office of Civil Rights •Policy should be widely distributed to all employees •It should be included in all new-employee and student orientations, and publicized within the workplace or educational setting •All employers developing polices should conduct appropriate training to instruct and sensitize all employees to the policy

vehicle costs

•Vehicle costing starts with the initial cost of the vehicle -The purchase price, taxes, warranty, and delivery charges are the initial cost of the vehicle •The cost of maintenance, repairs, and non-warranted parts is recorded and feed into the cost for EMS vehicles •It is important that a job card be filled out for any repair or maintenance on the vehicle and it should include the vehicle number, odometer reading, hours and cost of labor, and any miscellaneous expenses around the event, for example, towing •Fuel cost for each vehicle needs to be tracked •Overhead cost such as support personnel, office, cell phone, and filing or computerized applications to operate the system should be included as a portion of the expenses

RFP Construction

•Vendors should be qualified by the committee or the EMS manager overseeing the process •A stable operational history, solid customer support, FDA approval, and up-to-date technology are important in a profile of a vendor •Most companies should support your product for its life cycle -Seven years for vehicles and eight years for medical equipment •An EMS manager should contact the vendor's most recent customers and at least three other customers who have used their product for several years

internal customer service programs

•We forget to -take care of our own- •Make every attempt as EMS managers to recognize and reward exceptional service •Internal customer service results in employee satisfaction, employee loyalty, and employee retention

marginal costing

•What is the marginal cost of the ambulance transport? -The cost of providing the transport divided by the transport volume = marginal cost per transport •Revenues collected -Can provide additional monies to enhance other EMS services -All revenues are needed for the delivery of the services

training and inservice

•When a new vehicle arrives, EMS personnel should receive appropriate education and training •This should also include how the vehicle is to be checked out and maintained according to manufacturer's specifications •EVOC and CEVO are two programs designed to help train EMS personnel to operate emergency vehicles •Crashes are a common cause of litigation and risk for an EMS agency •Emergency-vehicle collisions are often serious, and some court cases have resulted in criminal charges being levied against EMS workers involved in them

vehicle inspections

•When accepting delivery of an ambulance, a series of procedures is recommended -A source inspection should be completed by EMS management or leadership prior to shipment from the manufacturer and should include workmanship, quality conformance, and a first-production inspection -First-production inspections ensure the manufacturer is conforming to the standards -This should be done at the manufacturing plant, and the cost of getting EMS managers to the factory should be borne by the manufacturer -A destination examination also should include a check of all ambulance controls, electrical systems and devices, door, windows, cabinets, and accessories, as well as a road test at highway speeds, a brake test, and a test for rattles and squeaks -Road test of new vehicles involves driving a total of 150 miles, with 75 miles of that on highways at a speed of 70 mph; 30 miles on city streets at 30 mph, 15 miles on gravel or dirt roads at 35 mph, and 5 miles on cross-county operations that are muddy or open field areas -A water spray test subjects the vehicle to a water spray at 25 psi for 15 minutes in order to look for any evidence of a leak -system should be pressurized to 150 psi with dry air or nitrogen and be able to hold that pressure for four hours -Have a checklist prepared in advance that details the tests and inspection points to be completed before acceptance of the vehicle -If a vehicle fails any of these tests and the vendor cannot fix the vehicle after a reasonable number of attempts, the EMS leadership should have the option to terminate the contract

interagency communications

•Whenever one system or agency comes up against another, there is a potential for challenges •Problems can range from basic interpersonal communications to more difficult inter professional issues, such as turf control, differences in procedures, differences in rank structure, or competition for funding •When interfacing with another system or agency, the goal of EMS members must be to avoid problems or adapt to the situation to achieve a cooperative working interface •The key issue is to ensure delivery of the best patient care possible •EMS managers are involved with rules, regulations, and other influences generated by external agencies and impacting upon their organization and personnel •Managers must know the extent of involvement and whether the particular agency has regulatory power over their operations •The best practice is to comply with applicable rules and regulations •If a situation arises that makes compliance difficult, the manager must work to achieve compliance or a reasonable solution to the problem •Failure to comply with applicable rules and regulations can cause administrative nightmares, preclude effective delivery of certain health-care services, and, in extreme cases, result in litigation and/or shut down the entire EMS system

workplace violence

•Workplace violence is becoming more prevalent in the EMS and public safety •Employers have a legal and ethical obligation to promote a work environment free from threats and violence •Workplace violence is any violent act, including physical assaults and threats of assault, directed toward persons at work or on duty •Civil rights laws require employers to protect employees against various forms of harassment, including threats or violence •In addition, employers may face civil liability after a workplace violence incident •Components of a workplace-violence prevention program can include: -A statement of the employer's no threats-or-violence policy and complementary policies such as those regulating harassment and drug and alcohol use -A physical security survey and assessment of the premises -Procedures for addressing threats and threatening behavior -Designation and training an incident- response team -Access to outside resources, such as threat-assessment professionals -Training of different management and employee groups -Crisis-response measures -Consistent enforcement of behavioral standards, including effective disciplinary procedures

Management of EMS full, EMS Incident Management (NIMS), Management of EMS Education, EMS: Terrorism & Disaster Managment, Management of EMS Chapter 1, Management of EMS Chapter 2, EMS 315 test 2, Management of EMS Chapter 1, EMS Management Mid-Term,...

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