EMS sect test 3

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

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 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

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

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

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)

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

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

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

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

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.

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

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

behavior warning signs

chapter 6 slide 143

types of workplace

chapter 7 slide 141

management activities to reduce workplace violence

chapter 7 slide 142

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

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

management eliminate barriers

Eliminate barrier Communication Situational awareness Decision making Teamwork

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

360 degree evaluations

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

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

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)

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

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

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

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

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

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?

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 five 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

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

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)

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

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

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

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

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

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

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

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

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

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

decision making skills

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

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."

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

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

Gordon graham

•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

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

investigation kit

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

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

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

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

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

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

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

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 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

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

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

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

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

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

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

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

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

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?

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

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

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

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

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

OSHA reporting requirements

•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

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

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

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

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

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

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

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

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

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

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