statewide emergency medical services strategic plan (version 1.0)

DRAFT

Statewide Emergency Medical Services Strategic Plan (version 1.0)

July 2010 – June 2012Updated 9/4/2009

You may contact the EMS Advisory Council’s Strategic Visions Executive Committee at:Bureau of EMS

Attn: Lisa Walker4052 Bald Cypress Way, Bin C-18

(850) 245-4440 ext. [email protected]

Note: Table of Contents, Message from the Surgeon General, and Executive Summary to be inserted at a later date.

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mailto:[email protected]

DRAFT About the Emergency Medical Services Advisory Council

The Emergency Medical Services Advisory Council (EMSAC) was created for the purpose of acting as the advisory body to the emergency medical services program. Pursuant to chapter 401.245, F.S. the duties of the council include, but are not limited to:

(a) Identifying and making recommendations to the department concerning the appropriateness of suggested changes to statutes and administrative rules.

(b) Acting as a clearinghouse for information specific to changes in the provision of emergency medical services and trauma care.

(c) Providing technical support to the department in the areas of emergency medical services and trauma systems design, required medical and rescue equipment, required drugs and dosages, medical treatment protocols, emergency preparedness, and emergency medical services personnel education and training requirements.

Note: the EMSAC also provides technical support in the area of emergency preparedness via the Disaster Response Committee, but is not reflected in chapter 401.245, F.S.

(d) Assisting in developing the emergency medical services portion of the department's annual legislative package.

(e) Providing a forum for discussing significant issues facing the emergency medical services and trauma care communities.

(f) Providing a forum for planning the continued development of the state's emergency medical services system through the joint production of the emergency medical services state plan.

(g) Assisting the department in developing the emergency medical services quality management program.

(h) Assisting the department in setting program priorities.

(i) Providing feedback to the department on the administration and performance of the emergency medical services program.

(j) Providing technical support to the emergency medical services grants program.

(k) Assisting the department in emergency medical services public education.

EMSAC Mission: To facilitate, promote, and ensure the best prehospital emergency medical care to the residents and visitors of Florida.

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DRAFT EMSAC Vision:

A unified EMS system that provides evidence based prehospital care to the people of Florida and serves as the recognized leader in EMS response nationwide.

EMSAC ValuesLeadership: To achieve and maintain quality results, accountability, and outcomes through guidance, direction, encouragement, and reinforcement.

Customer Service & Satisfaction: To put the patient first – always!!!

Public Welfare & Safety: To dedicate ourselves to ensure services are available that benefit and protect the public.

Collaboration: To encourage active collaboration to solve problems, make decisions and achieve common goals.

Ethics: To ensure ethical behavior in all decisions, actions, and stakeholder interactions. (The EMS Advisory Council needs to develop a code of conduct or ethical principals. Examples to be provided.)

Quality Improvement: To use the most rigorous of scientific methods to support our policies and decision making.

Evidence-based Medicine: To research, identify and adopt evidence-based science and best practices shown to reduce mortality and morbidity.

Education: To continually educate the public, all EMS personnel, and motivate providers to work together in providing evidence based prehospital care.

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walkerly, 09/03/09,

This portion of the value statement doesn’t seem to fit in education – suggest moving to collaboration

DRAFT (insert information on the development process – session, goal owners facilitating, etc…)

Goal 1: Improve patient care and EMS systems through effective leadership and communication by the EMS Advisory Council.

Goal 2: Need a new goal statement that reflects data collection. Benchmarking will be moved to goal six to improve key EMS processes. Perhaps something that reflects “Improving EMS data collection and participation through advocacy, outreach, and improved accessibility to EMS incident-level data.”

Goal 3: Improve customer satisfaction through injury prevention, public education and knowledge of the EMS system. (customer as defined by the EMS agency) Suggestion: 3.4-3.6 may be able to be consolidated and may need to move to goal 9 if that goal statement is more aligned with the objectives. The goal statement for goal 3 may focus on injury prevention and public education, but customer satisfaction may be moved to goal 9 if that is more appropriate. Does customer satisfaction deal with patient safety, increasing access to care, etc…? Then you may want to move customer satisfaction to goal 9 and identify customers as patients, emergency departments, etc…

Goal 4: Improve EMS work-force safety, education, performance, and satisfaction. Note: workforce safety is now under goal 9.

Goal 5: Ensure economic sustainability of the EMS system. Note: There are objectives within other goals that have the Legislative Committee as the lead. Do those objectives need to move under this goal? This would require a rewrite of the goal statement to go beyond a focus on financial sustainability, but legislative issues.

Goal 6: Improve performance of key EMS processes through benchmarking and partnerships.

Goal 7: Assure the EMS system is prepared to respond to all hazard events in coordination with state plan

Goal 8: Maintain an accident-free environment and promote a culture of safe and appropriate utilization of Florida air assets.

Goal 9: Increase access to care by improving patient safety, responder safety, and the safety of general public.New goal with new objectives and some objectives moved from other goals because they tie to this goal statement. Does the customer satisfaction portion in goal 3 have to be moved here?

Goal 10: Need a goal statement that the following objectives related to radio communications and emergency medical dispatch can tie back to. If you complete these objectives what is your vision for an end result?

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DRAFT

Parking Lot Issues From the Strategic Planning Session (Tabled Items for Additional Consideration/Discussion (please refer to the 2008-2010 Florida EMS Strategic Plan when reviewing these items). Additional parking lot items may be embedded into the new goals and objectives listed in this draft (they will be in red or listed as notes from the session:

Existing Goal 1 (leadership and data): Craft new goal statement for new goal 1 – leadership, include measures. (Status: in development below) Gap: disconnect between EMSAC and constituency groups Set aggressive targets to obtain vision Benchmark nationally Gap: Improve Data Committee and EMRC relationship Don’t limit benchmark New data goal statement move benchmarking (EMRC) under improving key EMS processes (Status: benchmarking/EMRC moved to goal

six below; new goal statement for data goal 2 needed) See comments within the new goal 1 and new goal 2 below

Existing Goal 2: See comments within the new goal 3 below.

Existing Goal 3: Split goal and have education as its own goal. (Status: some items have been moved to the new safety goal 9; the goal statement will

have to change, and there are some legislative items that may need to be moved to the new goal 5 if that goal statement is changed to reflect economic sustainability and legislative issues; see new goal 4 below)

Create safety goal and move personnel and patient safety items into new goal. (Status: complete; see goal 9 below) Paramedic/EMT recertification survey:

o Breakdown by rural vs. urbano Combine all survey questions into 1 survey (Tracy Burger volunteered to assist)

Accreditation tied to future funding?

Existing Goal 4: Where are we feeling the pinch? How many patients are we transporting that are uninsured? (look at SWOT results that were provided at the planning session and

emailed prior to the session; if needed please contact the SVC Executive Committee for electronic copy) Need foundation before asking questions? Create understanding that it affects ALL of us. Sharing information Level of service DATA (identify problem areas) Wall time – see Access to Care paper (economic sustainability issue)Existing Goal 5:

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DRAFT EMSystem Steering Committee?

o Discuss with Rhonda Whiteo Fragmented use

Combine neurological with cardiovascular Measure quality of care; low acuity patients (specify type of acuity patients, such as, diabetics, etc…)

Existing Goal 6: Ensure Public Health and Medical Preparedness plan links to EMS plan. Encourage EMS stakeholders to volunteer to serve on the various target capability teams to ensure linkage and EMS concerns are

addressed which may lead to federal funding. Community Surge Capability Team currently has projects tied to the EMS strategic plan and are funded (i.e. develop statewide disaster

protocols with Medical Directors, PPE bags to EMS training centers, etc…). Uncertain if any of the projects by the other target capability teams tie to the plan (gap).

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DRAFT

Goal 1 Improve patient care and EMS systems through effective leadership and communication by EMSACGoal Owner: EMS Advisory Council

Note: ALL newObjectives Measure(s) Strategies Lead Resource Timeline

1.1 Amend the EMSAC bylaws to support Strategic Plan

Successive leadership

Officer’s leadership

Each committee has a tie in to SP

# of strategic planning milestones met

Amend the EMSAC bylaws to support Strategic Plan

Assign goals to EMSAC subcommittees. These committees serve as goal owners who are to report status at each council meeting.

Encourage all EMSAC members and constituency group presidents (or designated liaisons) to attend every Strategic Visions Meeting and conference calls to ensure plan is being deployed and to facilitate the dissemination of information.

Work with the Bureau of EMS to find ways for the EMSAC to implement the plan without violating Sunshine. (Can the EMSAC communicate via email and copy central contact at the bureau on issues related to the plan? How is the EMSAC able to get work done on the plan between meetings with Sunshine law?)

Identify resources needed to develop and implement the SP. How are these resources going to be acquired?

Develop strategic planning guidelines for the EMSAC.

Strategic Visions Executive

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DRAFT Committee

1.2 Improve the relevancy and regularity of communication between the EMSAC and the system

Measure dissemination of SP through agencies and hospital base

Improve the relevancy and regularity of communication between the EMSAC and the system

1.3 Conduct or host leadership workshops for the EMSAC and provide information on leadership seminars, fellowship opportunities to the EMS system

Assign EMSAC mentors to new members.

Assign mentors to new members of an EMSAC subcommittee.

Disseminate leadership resources (articles, webinars, etc…) to EMSAC members. This may include information on quality improvement, facilitating meetings, etc…

1.4 Identify the EMS direct customer base and strengthen the relationship by monitoring the achievement of the SP through the meetings held in conjunction with the EMSAC1.5 May want to add a succession planning objective for the EMSAC to ensure that new chairs and new members are already familiar with the SP or have mentors in place.

In turn, a succession planning objective for the EMS system should be identified. Many have retired or will retire. How is the system transferring knowledge to new leaders to reduce disruptions in patient care, etc…?

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DRAFT 1.6 Serve as a national model for paramedic recruitment of females and minorities to ensure that the paramedic profession is representative of the area served.

Moved from existing 3.12 per planning session.

Increase female and minority paramedic representation by 15% by 2010.

Provide paramedic “shadowing” and mentorship opportunities for middle and high school children. (Note: Polk county has a high school program that may be a model)

Provide scholarship and training information through high school guidance counselors.

Increase grant and scholarship opportunities available to minorities seeking paramedic careers.

Promote focused recruitment initiatives and other outreach programs that encourage females and minorities to consider the paramedic profession.

EMS Advisory Council

June 2010

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DRAFT

Goal 2: Need a new goal statement that reflects data collection. Benchmarking will be moved to goal six to improve key EMS processes. Perhaps something that reflects “Improving EMS data collection and participation through advocacy, outreach, and improved accessibility to EMS incident-level data.”

Goal Owner: Data CommitteeNote: ALL New

Objectives Measure(s) Strategies Lead Resource Timeline

2.1 Improve Leadership effectiveness and participation of Data Committee

% of committee members who fulfill their term% of committee members attending each meeting (including conference calls)

Annual review to ensure effective bylaws/operation of subcommittee

Mentoring/Develop Succession Plan

Leadership Orientation Committee Member Orientation

Data Committee

2.2 Maintain statewide standards for data collection for EMS incident level data

All Florida Data Dictionary data elements defined and accepted by EMS Advisory Council

Florida Data Dictionary maintained and consistent with National mandatory data collection requirements

Use the expertise of the Data Committee to review/define/maintain all data elements in Florida Data Dictionary consistent with National mandatory requirements

Data Committee

EMS Data Unit On-going

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DRAFT 2.3 Provide advocacy and outreach for statewide data collection

# regional educational/training opportunities provided

Work closely with remaining agencies to ensure smooth transition; implement lessons learned from startup

Use the expertise of the Data Committee for the education/training curriculum and delivery

Data Committee

Education/Training Subcommittee

Data Unit

Achieve 70% participation in statewide data collection system

% of agencies participating

Improve access to EMS incident level data for evaluation and benchmarking activities

Data mart Collaborate with DOH IS to create data warehouse/data mart solution

EMS Data Unit

DOH IS

Link EMSTARS incident-level data with other state data for outcome assessments

# linked data sets Establish relationship to share data between agenciesEstablish technical environment to house shared dataUtilize expertise of Data Committee to Identify data linkage requirements for linking incident level data for outcome assessments

EMS Data Unit

Data CommitteeDOH IS

DOH TraumaACHA

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DRAFT

Goal 3: Improve customer satisfaction through injury prevention, public education and knowledge of the EMS system. (customer as defined by the EMS agency)Goal Owner: PIER CommitteeSuggestion: 3.4-3.6 may be able to be consolidated and may need to move to goal 9 if that goal statement is more aligned with the objectives. The goal statement for goal 3 may focus on injury prevention and public education, but customer satisfaction may be moved to goal 9 if that is more appropriate. Does customer satisfaction deal with patient safety, increasing access to care, etc…? Then you may want to move customer satisfaction to goal 9 and identify customers as patients, emergency departments, etc…

Objectives Measure(s) Strategies Lead Resource Timeline3.1 Provide injury prevention programs to public

Status – hard to measure, need to resurvey, Partner w/Trauma/DOT for stats

Comment from colored paper from strategic planning session: Reduce injuries and improve customer satisfaction through injury prevention, public education, and knowledge of the EMS system.

Isn’t the ultimate goal to reduce injuries? (top 5 injuries)

Existing measure(s):Increase by 5% the # of educational programs provided to the public through EMS/fire agencies

Note: (M) Look at final data to determine percentages otherwise leave as is

New strategies: (S) Identify funding sources, resources and partnerships(S) Look at alternative distribution mechanisms

Existing strategies:

Identify Injury Prevention programs and opportunities for the general public by making them available to any agency in the state.

Provide public injury prevention/educational programs directed towards the top 5 injuries in Florida by working with EMS agencies to start or expand injury prevention programs in their areas. Act as a resource for injury prevention programs throughout Florida.Data Source: Office of Injury Prevention

Identify number of classes and number of attendees

PIER EMSCDOTMotorcycle Safety CoalitionFlorida Injury Prevention Advisory CouncilOffice of Injury Prevention

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DRAFT

Existing measure(s):

Reduce the # of hospital ED visits caused by injuriesData Source: AHCATop 5 injuries: falls, motor vehicle/pedestrian, bicycle safety, drowning/water safety, fire/burns Add motorcycle crashes to link to MSSP???

Existing strategies:Work with the Office of Injury Prevention and the Injury Prevention Advisory Council to identify # of hospital ED visits caused by injuries and partner with them to promote educational programs

PIER Access to CareDOTMotorcycle Safety CoalitionFlorida Injury Prevention Advisory CouncilOffice of Injury Prevention

3.2 Increase EMS systems utilizing customer survey tool

Status: Quality Managers surveyed how many agencies utilizing tool, and followed up with those not using. Help to those needing tool template .recommend keeping for continued follow up – look at new definition of customer

Existing measure(s):Increase the number of EMS providers utilizing a customer satisfaction survey tool by 10%

Think about/maybe rewrite. Combine with 3.3?

New strategies: (S) Update the customer service tool related to new definition of customer

Existing strategies:

Quality Managers will develop a customer satisfaction tool.Create a customer service template for agencies to use.

How will this template be distributed? Will a survey be done to see how many are using this template? How will agencies make suggestions for improvement to the template? Will statewide customer satisfaction rates be shared and through what mechanism (EMS newsletter, flemscomm, etc…)?

Quality Managers

Medical Care Committee

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DRAFT 3.3 Implement a process to identify potential areas of statewide customer dissatisfaction(example: pain management)Address this through EMRC? Goal 6? Customer satisfaction is in this goal statement and not goal 6. Objectives need to tie back to the goal statement they are under.

Existing measure(s):Measure the # and type of complaints regarding quality of care (example: medical care, professional demeanor)

Generated through med directors and sent back to them, hard to get feedback on this – cannot get data to measure this

Existing strategies:Identify top 5 customer complaints

Quality Managers will develop a customer satisfaction tool for providers

Quality Managers Group

ProvidersFire ChiefsMedical DirectorsPIERASTNA

3.4 Identify, Research and Publish the current Pre-Hospital Best Practices to all EMS providers within the state.

TBD

Comment from colored paper at strategic planning session: Look at existing white paper from Access to Care (recently published)

1) Identify top 3 issues affecting access to care (that EMS can affect)

2) How to measure baseline

3) Objectives to improve and

-publish a current paper or add addendum to our current paper -produce media products to go to all statewide EMS providers

Comment from colored paper at strategic planning session: Can be accomplished, we don’t have to list every best practice out there, but we could “share” some good solid best practices that most aren’t already utilizing.

Comment from colored paper at strategic planning session: Target programs that are established and are evidenced

Access to Care FHAPIERMedical Directors

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walkerly, 09/03/09,

Please see comment in red above about 3.4-3.6

DRAFT plan to remeasure in a predetermined time in interval (example: EMS to ED hand off time)

based.

Comment from colored paper at strategic planning session:

Evidence based Best practices Outcome based

Injury prevention programs

3.5 Identify and partner with Hospitals and other health care providers to reduce the number of ED visits.

Should this objective be changed to reduce ED overcrowding and move the partnering under strategies?

TBD

Comment from colored paper at strategic planning session: It seems counter-intuitive to our mission in EMS to maintain an objective of “reducing the # of ED visits.” I would either delete this object or re-word this.

-health fairs

Suggestion from Amy Paratore:I want to make sure that the issue of ED overcrowding as well as the issue of Baker Acts and psychiatric emergenciesin our EDs across the state (lack of places to send BA52s to)

Comment from colored paper at strategic planning session: “Partners” should not be limited to hospitals and healthcare providers. DOT for example could be a partner in their safety (proactive) efforts. Look at this more globally. (don’t get tunnel vision )

Comment from colored paper at strategic planning session: Let’s educate the public about ED use instead of “reducing visits.” EDs are our safety net. The public should not be afraid to use them.

Access to Care FHAPIERMedical DirectorsEmergency Nurses Association

3.6 Educate all players on Access to Care.

TBD -Statewide PSA's -Private Doctors offices

Access to Care FHAPIERMedical Directors

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walkerly, 09/03/09,

Please see comment in red about 3.4-3.6.

walkerly, 09/03/09,

Please see comment in red above about 3.4-3.6

DRAFT

-Nursing Homes -Continue with Hospital education

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DRAFT

Goal 4: Improve EMS work-force safety, education, performance, and satisfaction. Note: workforce safety is now under goal 9.Goal Owner: Education Committee

Objectives Measures Strategies Lead Resource Timeline4.1 Define and adopt into rule the minimum standard for curricula to be used for critical care/specialty care provider courses in FL

Note: guidelines completed; awaiting further direction


% meeting scope of practice requirements

New Strategies or Resources Needed:Need legislative committee to adopt minimum standards into ruleDefine the minimum standards for curricula.

Existing Strategies:Establish state model that is aligned with critical care/specialty care

Seek statutory authority for regulating training requirements.

Establish rule and train providers/personnel in requirements of rule.

Establish monitoring process.

EMS Education Committee

Florida Association of EMS Educators

Legislative Committee

Providers

4.2 Remove current statutory requirement of 2-hour HIV/AIDS while keeping total number of recertification hours at 32

Status: Not complete; does this need to be removed because it may not meet the SMART criteria? Or does the timeline have to exceed 2 years to

need sponsorship in both House and Senate

New Strategies:Need legislative committee to delete reference to FS 401 from FS 381.034

Greg R would be willing to take forward, find sponsor, ? Change HIV to Infectious Disease/Bloodborne PathogensExisting strategies:Seek statutory change.




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walkerly, 02/12/08,

Keeping the number of training hours 32 toallow for flexibility address special needs that arise such as peds, trauma, etc…

DRAFT complete? Do legislative issues need to be moved under the legislative committee’s goal and reword the goal statement to beyond financial sustainability?4.3 Continuing Education for recertification must include course topics from the seven areas defined in the NHTSA Continuing Education guidelines. (See Appendix A for table)

Status: Not complete; do legislative issues need to be moved under the legislative committee’s goal and reword the goal statement to beyond financial sustainability?

monitor for recert requirement changes through NHTSA

New strategies:Need legislative committee to pursue rule changeAdd education representative on Legislative Committee (private & public)

Existing strategies:Seek rule change.




4.4 Establish guidelines for emergency medical services dispatch training for ground and air

Existing measure(s):Compare to national standards.

Existing strategies:Review national guidelines and identify funding sources.

Note: Voluntary going toward mandatory cert; bring in all dispatch; remain in this goal

Dispatch Work Group

FAMA

ASTNA

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DRAFT 4.5 Measure and Identify Opportunities to Improve EMT/paramedic satisfaction

Note: Customer as employee; survey has been completed (thanks to MQA's help during recertification); review data to identify opportunities for next step. Cory has results. post on SVC page???

Existing measure(s):% overall satisfaction

Existing strategies:Implement process to identify and resolve potential areas of statewide EMT/paramedic dissatisfaction

Survey EMTs and Paramedics (work with the EMLRC)

Fire Chiefs ProvidersEMLRCMQA

% Turnover rate Fire Chiefs Quality Managers

#EMTs/# Paramedics

Fire Chiefs Quality Managers

Providers

4.6 All Florida approved EMS training programs, as defined in FAC (64E-2.001), will be nationally accredited in accordance with the NTHSA - EMS Education Agenda for the Future by 2010.

Note: Modify to "National EMS Education Program Accreditation" per the EMS Education Agenda for the Future

New measure(s):Number of training centers who obtain National EMS Education accreditation

15 training programs not accred (4 public/11 private) represent 10% not COAMPS


Measure the number of schools that are accredited by CoAMPS or other agency that meets the EMS Education for the future

New strategies:Education Committee will be contacting all EMS training centers not currently accredited by CoAEMSP and ask if they intend to become accredited, and if so, how can we assist them in the process.

Existing strategies:Bureau of EMS will monitor for compliance during inspections.

Florida Association of EMS Educators partnering with DOE and DOH to promote this type of accreditation)

Research the language of the previous rule that was deleted which required CoAMPS accreditation




Does this need to move into the 2010-2012 plan or will it be complete by June 2010?

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DRAFT guidelines.

4.7 Increase paramedic and EMT staffing percentage at EMS agencies located in rural counties

% staffing at EMS agencies in rural counties

New Strategies:FAREMS – two surveys, recruitment/retention video aimed at younger, ?next Cory survey to break out rural vs. urban vs. specialty groupsPromote recruitment and retention video (EMS Week, Florida Channel, EMS newsletter, etc…)???

Notes: ?are boats rescue – at license “permitted boats” didn’t increase fees but gives us how many boats – list not complete

possibility of one survey to be completed with questions needed from multiple objectives

Existing Strategies:Develop youth recruitment initiative throughout rural counties

Create mentoring program among rural EMS agency management/directors

Enhance existing recruitment and retention technical assistance/feedback network for rural EMS management

Maintain EMT and paramedic scholarship availability for workers committed to living/working in rural counties

FAREMS PIER

Education Committee


Providers

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DRAFT ALL New: 4.8 Adopt provider levels from National Scope of Practice Model.

survey results

identify financial implications of not adopting all levels

NHTSA Transition/Refresher Criteria

Survey providers through FLEMSCOMM

Follow Up with those that don’t respond

Identify provider levels to be adopted - currently EMT/PM. Question Advanced EMT? Need for EMR (first responder)

Legislative Committee adopt provider levels

Adjust DOE Curriculum frameworks to match new scope of practice levels

partnership with DOE representative

in accordance with EMS Agenda for the Future, adopt national test for each approved provider level

partnership with MQA/Certification

Define a statewide transition process from NSC to Education Standards for each approved level of provider - GAP analysis template information on transitioning from old to new curriculum - look on SVC page for link (partner with BEMS)

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DRAFT

Goal 5: To ensure economic sustainability of the EMS system. Note: There are objectives within other goals that have the Legislative Committee as the lead. Do those objectives need to move under this goal? This would require a rewrite of the goal statement to go beyond a focus on financial sustainability, but legislative issues. Goal owner needs to be sure it has buy-in from all the leads and resources identified (ensure they take responsibility to complete objective assigned) OR replace leads identified.Goal Owner: Legislative CommitteeNotes from discussion at planning session:Is this related to the killed legislation?Relies on data of a proprietary nature – revenue industryEMSTARS can capture, but elected not to collectEMS can control the treat and release, low acuity – how do we Manage these? Not being reimbursed? Pertinent during pandemicEMS Discharge instructions?Increase in physician shortage – how will it effect ED/EMS?Look at % of uninsured patients – look at nonproprietary objectives? Annual EMS survey regarding future direction – system monetary Look at ways to eliminate waste/reduce expense dollars and share best practices on theseNon-transport issues: ALS fire who don’t charge – need to be broken outBest practice – look at purchase of supplies (co-op) – better prices?

How does the EMS/EMSAC obtain or allocate resources to support the Accomplishment of its plan?Look at partners to obtain funding/resources/etc There is no EMS tax exempt type of foundationLook at tourism revenue? Look at TDC (Tourist Development Council)Currently not a provision for the safety of the tourist

NonALS, Non-transport independent of systemNot affiliated with providers who are essentially first response EMS –Potential bureau income stream/revenueStatue sponsor, etc for First RespondersWhat is relevant – what is our baseline – immediate goal/objective

Suggested objectives – Baseline/surveyMove employee satisfaction to this goalIdentify the leads who are most applicable to the objective

How does the EMS manager respond to legislative/reductionOf revenue sources, economic shifts? Respond to revenue streams Outside of the billing system, look for resources and partnershipsEMR funds – electronic transfer of records between agenciesResources, grants, grant writers, creative best practices, finance solutions

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DRAFT Available on website (grants page of bureau website shows type of grant projects distributed over the past few years and providers may use the agency that was funded as a source for best practice). Practices to reduce expense; be careful.What do you do to ensure the financial sustainability of EMS system?

Comment from colored paper note at strategic planning session: What relationship does EMSAC have with district medical examiners? Are they reporting causes of death to EMS?

Objective Measure(s) Strategy (ies) Lead Resource Timeline5.1 Measure and improve % of reimbursable calls

% calls reimbursed Advocate for non-transport reimbursement.

Explore non-traditional transport options (chase car with PA/ARNP)

Providers Fire Chiefs

FAA

FAMA

Unknown as to whether it can be collected.

Note: All groups need to think about what kind of data they need to measure their objectives and identify a source. If there no source can be found it may not be SMART.

5.2 Measure and improve % of billed charges collected

% billed charges collected

New Strategies:Best practice to share; identify countermeasures to offset - ? survey to self reportExisting Strategies:Benchmarking to identify best practices

FAA Fire Chiefs

Providers

FAMA

5.3 Measure and improve the cost per capita for EMS

Cost per capita New Strategies:Best practice to shareExisting Strategies:Benchmarking to identify best practices


FAA

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DRAFT

Comment from colored paper at strategic planning session: Partner with DOT Strategic Highway Safety Plan Goal 6.3.Incorporate emergency response data into the overall problem definition process.Improve coordination with, and awareness of, emergency services.Increase access to and the security of crash scenes (secondary crash prevention).

Should part of this suggestion be moved to goal 9 regarding personnel safety? Or should it be combined with other access to care objectives that may need to move to goal 9.

5.4 Increase additional revenue streams for non-transport services

%/# of non-billed/non-transport responses statewide

Statewide survey regarding current non-transport billing practices

Fire Chiefs Providers

FAMA

ASTNA

Unknown as to whether can collect. See note in 5.1

%/# of agencies with non-transport billing procedures in place

Suggestion from colored note:

5.5 Identify uninsured populations throughout the state.

Partner with other agencies to provide transport and healthcare services for these populations.

Identify funding sources

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DRAFT

Suggestion from colored note

5.6 Identify opportunities to provide public education regarding the utilization of EMS

Partner with injury prevention, EMS, NHTSA, etc…

Should this be under goal 3??? Or is it more of a focus on financial implications when EMS is not properly utilized?


5.7 Identify cost saving measures to offset EMS expenses

Best practice (Coop supply purchases)


Are there revenue streams that can be realized through:

Marketing of the EMS system

United Way campaign

Foundations (private)

% of fees for courses taught

Federal stimulus money

Hundreds of millions of dollars are collected through TDC taxes.

There is no provision of funding for safety programs. (money goes to marketing, infrastructure, convention centers development, etc…)

Legislate % for safety services

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DRAFT

Goal 6: Improve performance of key EMS processes through benchmarking and partnerships.Goal Owner: Medical Care CommitteeNotes from discussion at planning session as to revising objective to include overall process:5.4 (replace 5.4 and 5.5) Develop a process to measure and monitor (Med Care Committee, EMSTARS, Data Committee, EMRC ) key performance indicators (pediatric, cardiovascular, geriatrics, etc) – issue of non-EMSTAR dataUniform trauma transport protocol for geriatricsDiversion – Med Care to Access to Care

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DRAFT (New) Process performance improvement opportunities

Data sharing/Reorganizing the measurements (sub objectives)

Broad latitude – but constituency groups need to hold Med Care CommitteeResponsible for addressing topics that need addressed. Flexibility withoutDistraction. Bring back burner topics forward – generate agenda for Med CareCommittee. Dr. Meurer implementing new process for Medical Care Committee to monitor the status of objectives in strategic plan for this goal.

Objectives Measure(s) Strategies Lead Resource Timeline6.1 Measure and Identify Opportunities for improvement of dispatch system effectiveness

% of Primary PSAPs utilizing a nationally recognized Emergency Medical Dispatch System (EMD)

Notes: (a PSAP would be counted as a YES if the Primary PSAP transfers EMS calls to a secondary PSAP that utilizes an EMD system. Currently Priority Medical Dispatch, Powerphone and APCO are nationally recognized)

Note: Continue as is per planning session

Notes from planning session: Amber Lee Foundation, survey from Dispatch Group 66% return, data being evaluated

Existing Strategies:Establish baseline and benchmark to identify best practices.

Promote use of EMD system Quality Improvement processes

Promote ongoing continuing education of Emergency Medical Dispatchers

Complete survey of PSAPs (Note already in progress- Jim Lanier has detail)

Promote involvement of EMS Medical Directors in EMD.

Promote utilization of NAACS standards by all communications centers that handle air medical transport

Dispatch Group

Providers

FAMA

Medical Directors

6.2 Measure and Identify Opportunities for

% of calls with appropriate response prioritization by

Establish baseline and benchmark to identify best practices.

Dispatch Group

Providers

Fire Chiefs

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DRAFT improvement in the area of EMS response time (from 911 call to patient contact).

dispatch **Can only be measured if an agency provides EMD QA…consider changing to: adopt a standardized model for call types: non life threat, potential life threat, life threat, immediate life threat, etc. In addition, cellular calls vs. landlines, etc will need to be considered for call processing implications

Notes from session: Continue Measure – currently collecting data – need to interpret and identify areas of improvement.Dispatch feedback – data difficult to collect; Not applicable emergent vs. non emergent, may be proprietary nature, measurements not standard, EMSTARS has data on timesLooking for a benchmark to compare best practice

Access to Care

% of calls meeting response time targets**needs to be based on adopted standardized call priority models as in 5.1

Establish baseline and benchmark to identify best practices.

Dispatch Group

Providers

Fire Chiefs

*Add EMSTARS? Jim L

6.3 Changes to EMSTARS Data Dictionary and Disaster Response Tracking System to be able to capture EMS off load and diversion times.

All data elements needed to capture EMS off load and diversion times accepted by the EMS Advisory Council.

Establish uniform definition of “EMS- hospital turnaround time”

Establish uniform definition of hospital is on “Diversion” status

Notes from session: Off load is captured, diversion definition is not; Trauma quarterly monitors diversions for trauma centers – look at annually. Need to standardize diversion times – refer to Access to Care white paper.

Data Committee

Trauma Committee

FENA

Medical Directors

Access to Care

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DRAFT Promote an Emergency System Status (ESS) Internet based process on a statewide basis

Utilize Data Committee and Disaster Committee expertise and knowledge to develop requirements

Notes from planning session – EMSystem. What is statewide buy in by EMS and hospitals? Challenge – input of data into web based system and keeping updated. Statewide coordination through PHP in early stages with steering committee. Flexible county by county may not be advantage by taking away standardized information. Data committee very involved in linkage – strategy to ensure that partnershipMake into own objective - # counties utilizing systemMore than 75% trauma systems utilizing system

Disaster Committee

Access to Care??

6.4 Measure and Identify Opportunities for improvement effectiveness of on-site EMS treatment

6.4.1 Cardiac:% ROSC return of spontaneous circulation in the prehospital environment

% of time 12 lead EKG was captured on a patient with chest pain

% of EMS agencies that obtain 12 lead EKG on chest pain patients per protocol

% of time aspirin was given to patients with

New Strategies:Review of data to identify opportunities for improvement

Systemized care of STEMI/Stroke

Develop concept for establishment of Office of Cardiovascular(statute)

Notes from planning session: AHA moving packet for cardiac care – mtg 8/20 Orlando w/stakeholdersCurrent intent not to move forward w/legislationQMgr/MedDir took lead – couldn’t measure before but now mechanism w/EMSTARNeed Office of Cardiovascular (funding?)

Quality Managers

Medical Directors

American Heart Association

EMRC

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DRAFT chest pain Data Committee has established STEMI

definition, working on cardiacLook at accrediting agenciesDetermine mortality rate

Existing Strategies:Use UTSTEIN template reporting style

Establish uniform definitions of STEMI alert and cardiac alert

Identify mechanisms for benchmarking utilizing EMSTARS and expertise of the EMRC to identify best practices.



6.4.2 Stroke:% of time a Stroke Alert was initiated based upon a stroke assessment tool per protocol


Notes from planning session: monitorEMSTARS/EMRC/Medical Care Committee

Quality Managers (is this the same see notes at left; are those resources or one of them is lead?

Medical Directors

AHA’s Florida Stroke Systems Workgroup

Note: CDC is conducting a study on how states are implementing their respective stroke acts or policies. Please

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DRAFT contact Lisa Walker for more information if needed.

6.4.3 Trauma: Identify average time on scene for Trauma Alert patients.

Identify mechanisms for benchmarking utilizing EMSTARS and expertise of the EMRC to identify best practices.monitorEMSTARS/EMRC/Medical Care Committee

Trauma Committee(is this the same see notes at left; are those resources or one of them is lead?

Medical Directors

6.4.4 Pediatric:% of Certified EMS providers trained in a pediatric emergency care course

% of EMS agencies with pediatric specific treatment protocols

Work with Division of Medical QA to develop method of capturing this information during recertification

Work with Providers in determining best practice protocol

EMSC FNPTNA

Medical Directors

6.4.5 Airway management: % Recognition of proper placement of endotracheal tube placement as documented by end- tidal CAPNOGRAPHY

% of patients in which endotracheal intubation is attempted and is not successfully completed

% of patient in which

Define attempted intubation



Quality Managers

Medical Directors

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walkerly, 09/03/09,

Pediatric and adult?

DRAFT an alternative advanced airway device is used other than endotracheal intubation.

6.5 Measure and Identify opportunities for improvement for appropriate transport destination.

Notes from planning session:Issues will be kept as starting points – defer to new objective of patient safety???

% of patients refusing transport

Benchmarking to identify best practices. Quality Managers

ProvidersFire Chiefs

% of victims meeting trauma alert criteria transported to trauma center

Identify mechanisms for benchmarking utilizing EMSTARS and expertise of the EMRC to identify best practices

Trauma Committee

% of acute myocardial infarction patients field triaged to interventional cardiac cath capable facility


Quality Managers

Medical Directors

AHA

% of acute stroke patients within statutory timeframe transported to a stroke center


Quality Managers

Medical Directors

AHA

June 2010

6.6: Develop a standardized QI/QA template for use by all EMS provider agencies in conjunction with the state plan

% of EMS agencies utilizing QI/QA procedure

Notes from planning session: 100% under 401 – EMRC is developing a template for this

Do 3.2 and 3.3 need to be merged with this objective?How will this template be distributed? Will a survey be done to see how many

EMRC Quality Managers

Medical Directors

June 2010

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DRAFT are using this template? How will agencies make suggestions for improvement to the template? Will statewide customer satisfaction rates be shared and through what mechanism (

6.7 Prioritize and begin settingperformanceimprovement targetsbased on theestablishedbenchmarks andutilizing EMSTARSdata

# of targetsestablished% of targets met

Use the expertise ofthe EmergencyMedical ReviewCommittee to identifypatient outcome andservice deliverycomponents foruniform measurement;also, use the data,publish the data, whilestill protecting the data

The EmergencyMedical ReviewCommittee

6.8 Conductbenchmarking activitiesto establish statewidemeasurements forpatient care andservice delivery

# of servicedelivery or patientcare componentsmeasured andbenchmarked

Use the expertise ofthe EmergencyMedical ReviewCommittee to identifypatient care andsystem deliverycomponents foruniform measurement;also, use the data,publish the data, whilestill protecting the data

The EmergencyMedical ReviewCommittee

Comment from colored paper from strategic planning session: Is there a way to immediately integrate “lifeguards” in the plan as part of EMS? Many life guards are state licensed EMTs. All lifeguards are

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DRAFT required to be certified first responders (ARC, etc…). EMSAC has ground and air covered, we need water covered. It’s not what you’re called…It’s what you do!

Should lifeguard initiatives be moved to goal 9 patient safety? What are some objectives, measures, strategies, etc…for lifeguards?

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GOAL 7: Assure the EMS System is prepared to respond to all hazard events in coordination with state disaster plansGoal Owner: Disaster Committee

Put together in 2008 – patterned after PHP and Target CapabilitiesSurvey to identify gaps in Disaster Preparedness, and book has been modified to this documentRecommend for 2010 Plan

Objectives Measure(s) Strategies Lead Resource Timeline7.1: Ensure all emergency medical services personnel (Paramedics, EMTs, Nurses and dispatchers) are knowledgeable about local agency and regional disaster plans. Gap – need to educate staff to plans

__% of EMS providers train their staff annually on local and regional disaster plans.

__% of agencies that include the local, regional and state disaster response plans as part of orientation

Compare current standards in Florida Statute, Rule, Florida Fire Chiefs State Emergency Response Plan, National Fire Protection Association, Florida OSHA, county emergency response plans and Catastrophic Health Incident Response Plans. Develop standards that apply to fire EMS, Non-Fire EMS and Air Medical EMS providers.

Disaster Committee

Health and Medical Co-Chairs

Trauma Committee

Office of Public Health Preparedness

Office of Emergency Operations

12/31/09

7.2 Enable EMS providers to transport patients to AMTS’s during times of local/regional disaster conditions.

Work with Med Directors for alternateDestination site Legislatively.Address “disaster conditions” verbiageHospital alternate triage would be included but need to

Amend Florida Statutes to enable EMS providers to transport patients to AMTSs during times of local/regional disasters.

Research and develop enabling language.

Bureau of EMSShould this be the Legislative Committee?

PHMP, OEO, Disaster Committee & Community Surge Committee

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DRAFT be inspected as part of the process. FHA partnerLook at role of telemedicine

7.3. Ensure emergency medical services plans and related documents include consideration for At-Risk Populations

1. Pediatrics2. Neonatal3. Pregnant

women4. Elderly5. Disabled6. Low/limited

literacy7. Public

companions or service animals

8. Special medical needs

___% EMS agency plans that specifically address each identified At-Risk Populations

__% of EMS providers train their staff annually on their local At-Risk Population Plans.

____% EMS agency exercises that include at-risk populations

Ensure plans, training and exercises address At-Risk Populations.

“Training” verbiage is vague; more specific (also 6.1)

Disaster Committee

EMSC, PIER, PHMP Community Surge Committee, Office of TraumaMedical Directors

12/31/12

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DRAFT 7.4: Ensure all emergency pre-hospital health care providers ( including but not limited to Paramedics, EMTs, Nurses and dispatchers) are knowledgeable about Level “C” PPE and Nerve Agent Antidotes.

(apply to others)

__% of EMS providers train their staff annually on Level “C” PPE. local and regional disaster plans.

__% of EMS providers train their staff annually on Nerve Agent antidotes.


Identify statewide standards to acquire, inventory, store and disseminate and maintain protective equipment and prophylaxis/antidotes.

Note: Melia Jenkins and Roy Pippin are co-project managers on the PHMP funded project for the Community Surge Team titled “PPE bags to EMS training centers” This project may need to be added to the strategies. In the 2008-2010 plan there is a measure “% of EMS training programs that have implemented CBRNE training in their programs.” Will this project help with this measure?

Disaster Committee

Bureau of EMS, FFCA, PHMP Responder Health & Safety Committee

12/31/12

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DRAFT 7.5: Ensure all emergency medical services personnel (EMS agencies, Paramedics, EMTs) are knowledgeable about CBRNE detection systems, notification, verification, reporting systems, all discipline plans and protocols, and their respective roles and responsibilities in the system.

__% of EMS providers train their staff annually on CBRNE detection systems, notification, verification & response procedures.


Disaster Committee

Bureau of EMS, FFCA, PHMP Responder Health & Safety CommitteeMedical Directors

Note: Melia Jenkins and Lisa Walker are co-project managers on this funded project for the Community Surge Capability Team. May want to add deliverables identified in that project plan to the strategies for this objective.

12/31/12

7.6 Develop processes for EMS medical direction support of disasters, mass casualty, and large infectious disease emergencies at the State, Regional and Local level

State Wide Disaster & Pan Flu Protocols are written and approved by FL Assoc. of EMS Med Directors

Develop Statewide Disaster Medical and Pan Flu Protocols.

Formulate implementation strategies

Note: Lisa Walker is the project manager for the Community Surge project to “develop statewide disaster protocols”. Currently, the project is

EMS Medical Directors

Disaster Committee, EMS Constituency, Office of Trauma

June 2012

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Statewide protocol to work under in times of disaster – utilization, training, clarification of existing processHow to make the protocol operational

funded through the PHMP grants for meetings with the medical directors to develop the protocols. Next grant cycle it will be proposed to develop a web based system (similar to ICS online training) to ensure all providers are trained in the protocols. The web based system would track who is trained. These may need to be added to strategies. May want to review the project plan (i.e. solution development template) and see if any of the deliverables listed can be used as strategies.

% of EMS Provider Agencies who have been trained in statewide disaster protocol

Ensure EMS Providers receive the Disaster Medical Protocols


7.7 Develop medical direction support to local Emergency Operations Center (EOCs).

___% of Local EOC’s has a process in place to access Local EMS Medical Director or EMS Medical Director designee for consultation during activations

Compare current standards in Florida and FEMA Region IV State partners.

Robust process at state level, without uniformityNeed experts, familiar with disaster medicine, need formal process in placeMay be available to a regional EOC

Medical Directors

Disaster Committee, Bureau of EMS, EMS Providers, Office of Emergency Operations, local Emergency Managers, Health & Medical Co-Chairs

June 2012

7.8 Capture disaster response data.

100% of EMS Providers that participate in EMSTARS report disaster response

Review NEMSIS data base for disaster response data that is currently not being collected. Consider adding disaster response data fields to EMSTARS.

Data Committee

Bureau of EMS, Disaster Committee, Medical Directors, EMS Constituency

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DRAFT data

7.9 Align with Community Surge Objectives

Disaster Committee & PHMP Community Surge Committee Objectives are aligned.

Determine gaps that exist between PHMP Community Surge Committee Objectives and Disaster Committee Objectives.

Community Surge Committee

Disaster Committee

7.10 Identify facility and plan for implementation of at least one Alternate Medical Treatment Site in each county that can be used to help mitigate community surge during disasters.

____% of the counties have identified and planned for the implementation of an Alternate Medical Treatment Site.

Align survey efforts with local EMS Providers, Public Health Preparedness, the Office of Emergency Operations and DOH Regional Emergency Response Advisors.

Governor declared event vs. more local incident – how to handleOffice PHP – Terry Schenk

DOH is ESF 8 at the state level

Public Health Preparedness

Disaster Committee, Office of Emergency Operations, local EMS Providers, DOH Regional Emergency Response Advisors, Disaster Committee and local Emergency Managers.Medical DirectorsHospitals (look at placing hospitals in several of these)

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DRAFT Comment from colored paper from the strategic planning session:Can we integrate lifeguard/EMT and lifeguard/1st responders into disaster preparedness?Benefits: Pool of state

licensed EMTs Use for aquatic

rescue Use to staff

shelters Use for traffic

control, etc…

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DRAFT

GOAL 8: Maintain an accident-free environment and promote a culture of safe and appropriate utilization of Florida air assets.Goal Owner: Access to Care Committee (Karen Chamberlain)Notes from planning session:Develop physio parameters for flight – look at actual times from call to RoomLook at resources in geographic areaLook at tool for air medical resourcesPartner with Education CommitteeLook outside the box for management of patient – what are the Patient’s best interests?

Objectives Measure(s) Strategies Lead Resource Timeline8.1 Develop statewide criteria for appropriate air asset utilization(prehospital and interfacility transfers).

% of air medical providers that have established criteria for appropriate air asset utilization

% of air medical providers that have an established utilization review process.

Statewide measures developed.

Establish baseline and identify best practices

Define appropriate air asset utilization

Promote use of a utilization review process.

Educate requestors (EMS, hospitals) on risks associated with helicopter shopping.

Develop a repository of centralized information re capability/ availability to ensure appropriate use of specialty providers.

Florida AeroMedical Association (FAMA)

Air & Surface Transport Nurses Association (ASTNA)

Florida EMS Pilots Association

Florida Neonatal & Pediatric Transport Network Association (FNPTNA)


Florida Fire Chiefs’ Association (FFCA)

EMS Providers Florida

Committee on Trauma (FCOT)

Association of Air Medical Services (AAMS)

American College of Surgeons (ACS)

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DRAFT National EMS

Physicians Air Medical

Physician Association (AMPA)

8.2 Improve air medical communications and dispatch procedures for communication centers, flight crew, hospitals, and EMS providers

# of air medical communication centers that perform duties other than air medical flight-related duties.

# of air medical communication centers with established helipad communication procedures

# of air medical communication centers with an established quality improvement process

# of air medical communication centers that are utilizing technology for information sharing

# of air medical communication centers that utilize aviation-based technology

Develop and implement a

quality improvement process for air medical communication centers.

Promote formalized flight following and dispatch procedures including up-to-date weather per the National Transportation Safety Board (NTSB) recommendations

Identify, research, and implement the use of technological services to improve information sharing.

Identify and adopt initial minimum criteria for air medical communication specialists

Establish Bureau of EMS support for inspections process and compliance with the Florida Communications Plan





Technical Advisory Panel (TAP)

Bureau of EMS EMS Providers Florida Fire

Chiefs’ Association

EMS Communications Engineer

National Association of Air Medical Communication Speciaists EMS Providers

Florida Hospital Association

Emergency Dispatch Workgroup

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DRAFT

for flight management

# of Florida receiving facilities and EMS providers that are non-compliant with state Med8 requirements

# of Florida air medical providers that are non-compliant with state Air Secondary requirements

# of air medical communication centers that have established continuing educational requirements

8.3 Improve air medical crew resource management and education

# of programs that have established air medical crew resource management as part of both the initial orientation process and annual training requirements

# of programs using a risk assessment tool for flight crew

# of

Establish baseline and benchmark to identify best practices

Assess operational education and training needs of flight programs

Identify current risk assessment tools for air medical providers

Establish standardized minimum initial safety core competencies for all personnel involved in air medical transport

Develop and adopt recommended safety continuing education for all personnel involved in air medical transport

Establish operational awareness training for ground crews involved in



Florida EMS Pilots Association (FLEMSPA)


EMS Providers Fire Chiefs EMS Advisory

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DRAFT programs/providers that have a dedicated operational education committee or training coordinator

# of programs that have initial training requirements that include 4 hours of safety training and 4 hours of flight specific training

# of air medical programs with an operational awareness course

transport (safety, landing zone, approach, etc…)

Establish a minimum one day annual air medical safety summit

Council’s Education Committee

Association of Air Medical Services (AAMS)

Commission on Accreditation of Medical Transport Services (CAMTS)

Florida Neonatal & Pediatric Transport Network Association (FNPTN)

8.4 Improve use of air asset technology to enhance safety

# of air medical aircraft with terrain awareness and warning systems (TAWS) and radar altimeters

# of air medical providers utilizing night vision goggles (NVGS)

# of air medical programs utilizing satellite based flight following systems

# of air medical

Promote training for safe operations and Inadvertent Instrument Meteorological Conditions (IIMC) procedures

Promote compliance with Federal Aviation Administration (FAA)and National Transportation Safety Board (NTSB) safety recommendations

Promote compliance with the commercial/ instrument standards set by the Federal Aviation Administration (FAA)

Promote personal safety through Nomex flight suits and safety helmets

Promote Federal Aviation




Federal Aviation Administration (FAA)

National Transportation Safety Board (NTSB)

International Helicopter Safety

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DRAFT providers that have established inadvertent instrument meteorological conditions (IIMC) procedures and training

# of air medical programs that require Nomex flight suits and helmets

# of air medical providers actively utilizing night vision goggles (NVGs)

Administration best practicesTeam (IHST)

8.5 Adopt initial and continuing educational training requirements for aircrew of licensed air providers(attach document as an appendix)

Moved from 3.2 of the current plan. Is this still relevant? If so, do legislative issues need to be moved under the legislative committee’s goal and reword the goal statement to beyond financial sustainability? Does the Legislative

2 hours of altitude physiology course and aircraft safety/ emergencies for refresher training.

Identify statutory authority to develop a rule proposal to submit to the Bureau of EMS; or seek statutory change..


FAMA

FNPTNA

ASTNA

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DRAFT Committee need to include a representative from the air industry.

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DRAFT

GOAL 9: Increase access to care by improving patient safety, responder safety, and the safety of general public.Goal Owner: Access to Care Committee (Mike Patterson)New goal with new objectives and some objectives moved from other goals because they tie to this goal statement. Does the customer satisfaction portion in goal 3 have to be moved here?

Objectives Measure(s) Strategies Lead Resource Timeline

9.1 Determine Medication Error rate in Florida’s EMS Systems

(What type of data is needed and do you have a data source?)

Locate funding and resources to initiate a study of medication error rate in Florida EMS Systems

Fund and execute a study of EMS medication error rate and identify 3-5 of the most serious or frequent errors in Florida as a baseline. During next planning cycle, determine strategy to mitigate errors and institute plan for mitigation

Medical Care Committee

State EMS Medical Director

9.2 Quantify EMS vehicle collision rate in Florida in a measurable way;

Goal: Reduce rate by 10% by 2012

Work with Florida DOT to fund project to study EMS vehicle collision rate and a mitigation plan to reduce rate by 10% by the end of 2012

State EMS Medical Director

Florida DOT

9.3 Improve safety of staff from increasing violence in emergency departments (from psychiatric patients, trauma patients,and irate patients/families).

Emergency Nurses Association

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DRAFT Suggested by Amy Paratore

9.4 Reduce the number of on-the-job injuries or serious infectious illnesses in the EMS population

Moved from 3.4 of current plan.

What is the data source? Do you have a baseline developed from current plan so you can measure improvements in this new plan?


# of injuries Identify process to track all injuries/serious infectious illnesses


PIER# of infectious diseases

Identify process to track all injuries/serious infectious illnesses

Providers Legislative Committee

# workers’ compensation days

Identify process to track all injuries/serious infectious illnesses

Providers

# educational programs on injury prevention (vs. # of attendees???)

Identify/provide educational programs on injury prevention/infectious disease

PIER Access to Care

9.10 Improve EMS transport safety

Moved from 3.10 of current plan. Does it need to be merged with 9.2 above (the ground only portion)?

% EMS emergency aircraft meeting FAA air-worthiness requirements (target – 100%)

Analyze data to identify improvement opportunities.

ASTNA Pilots Association

FAMA

FNPTNA

Does this need to be removed or moved to air medical goal?

#EMS vehicle crashes

Analyze data and identify improvement opportunities.

EMS Providers

Objective Safety(Dr. Nadine Levick)

Department of Highway Safety and Motor Vehicles (Bill Ham)

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DRAFT

New Resources:National EMS Advisory Council’s Committee on Ambulance Crashes (or personnel safety). Dr. Jeff Lindsey is chair of this committee and should have data

# air and ground calls in which pediatric patients were transported in approved child restraints

Note: a comment was made at the session to change this word

Utilize Data Committee in determining mode of transport; comparison of agencies with approved devices

EMSC FNPTNA

ASTNA

FAMA

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GOAL 10: Need a goal statement that the following objectives related to radio communications and emergency medical dispatch can tie back to. If you complete these objectives what is your vision for an end result? Goal Owner: Access to Care Committee (Mike Patterson and Todd Mechler)

Objectives Measure(s) Strategies Lead Resource Timeline10.1 Improve EMS radio communications between transports and receiving hospitals

Determine % of primary systems using UHF vs. 800 MHz vs. other.

Determine % of MED 8 capable agencies.

Improve inspection procedures by AHCA for hospitals

Revise, vet and release new version of Volume I of the EMS Communications Plan

Todd Mechler and the Communications Committee

10.2 Improve agency access to training and education

Create and update regularly a list of approved radio makes/models for EMS communications

Operational radio/system use

Compliance/ statutory requirements

Purpose/intent of system design

Jim Lanier and the Communications Committee

10.3 Improve agency access to federal and state funding

Improve grant awareness

Improve grant submission process

Communications Committee

10.4 Improve interoperable communications capabilities

Determine % of agencies capable of communicating with other public safety radio systems

Determine requirements to improve I/O communications statewide

Todd Mechler and the Communications Committee

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10.5 Improve Air Medical Communications

Between transports and receiving facilities

Between transports and dispatch

Note: Does this conflict with the air medical goal (see goal 8 above)? Duplication of efforts?

David Duke and the Communications Committee

10.6 Improve capability to communicate during disasters

Between EMS agencies in non-home areas

Between EMS agencies and non-standard dispatch centers

Between EMS agencies and other public safety agencies

Jeff Palmer and the Communications Committee

Disaster Response Committee

10.7 Emergency Medical Dispatch

Actively participate in dispatcher certification legislation initiative

Provide a point of resource to assist agencies with EMD best practices

Review and evaluate EMSTARS data points relative to dispatch and work with the data committee to fine tune

Jim Lanier and the Communications Committee

10.8 Preparation for the Future

Improve awareness about future trends in public safety radio manufacturing

Improve awareness about future trends in public safety radio policy (FCC)

Jeff Palmer and the Communications Committee

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Addendum A – See objective 4.4Modules for Continuing Education topics with suggested hours

PREPARATORY: 3-5Suggested topics include: EMS Systems/The Roles and Responsibilities of the Paramedic, TheWell-Being of the Paramedic, Illness and Injury Prevention, Medical / Legal Issues, Ethics, GeneralPrinciples of Pathophysiology, Pharmacology, Venous Access and Medication Administration,Therapeutic Communications, Life Span Development

AIRWAY MANAGEMENT AND VENTILATION: 3-5Suggested topics include: Airway Management and Ventilation

PATIENT ASSESSMENT: 2-4Suggested topics include: History Taking, Techniques of Physical Examination, PatientAssessment, Clinical Decision Making, Communications, Documentation

TRAUMA: 3-4Suggested topics include: Trauma Systems/Mechanism of Injury, Hemorrhage and Shock, SoftTissue Trauma, Burns, Head and Facial Trauma, Spinal Trauma, Thoracic Trauma, AbdominalTrauma, Musculoskeletal Trauma

MEDICAL: 9-12Suggested topics include: Pulmonary, Cardiology, Neurology, Endocrinology, Allergies andAnaphylaxis, Gastroenterology, Renal/Urology, Toxicology, Hematology, Environmental Conditions,Infectious and Communicable Diseases, Behavioral and Psychiatric Disorders, Gynecology,Obstetrics

SPECIAL CONSIDERATIONS: 3-4Suggested topics include: Neonatology, Pediatrics, Geriatrics, Abuse and Assault, Patients withSpecial Challenges, Acute Interventions for the Chronic Care Patient

OPERATIONS: 1-2Suggested topics include: Ambulance Operations, Medical Incident Command, RescueAwareness and Operations, Hazardous Materials Incidents, Crime Scene AwarenessTOTAL 24-36

Appendix B - List of EMS Advisory Council Members to be insertedAppendix C – List of EMS Constituency Groups to be inserted

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DRAFT

Strengths, Weaknesses, Opportunities, and Threats (SWOT) Analysis Results for 2008-2010 plan; some of this may still apply, but please refer to the new SWOT analysis for the 2010-2012. The latest SWOT was provided at the planning session and via email prior to the session. Please contact the SVC Executive Committee if you need the latest SWOT results. (This will not be included in the final version of the plan. This is only for reference as we finalize the goals and objectives)Strategic Advantages:

Leader in EMS Leadership # of educational programs Access to quality services part of Surgeon General’s Strategic Priorities and Governor’s Healthcare Policy. Injury prevention programs Sterling Council of Florida Model National recognized leaders in their field State EMS Grant Program Working EMS Advisory Council Equipment Funding for areas with high vulnerability Constituency group system (voice) Advanced statewide EMS, Trauma, and disaster preparedness system Access to Domestic Security funding Experience in natural disasters and plan implementation Good education

o Training centerso Agencies

Incident level data collection system that works Medical Directors that were EMTs and Paramedics Active Medical Directors Trauma Registry Interagency Communication Legislative influence

Strategic Challenges: Funding Communication (field and leadership) Underserved high-risk populations (children, elderly, homeless) Preparedness equipment – need training for workforce; not available to students Lack of public education on EMS (and 911) Geographic challenges

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DRAFT Preparedness – high risk targets Statutes – hinders change Inconsistency in trauma center alerts (interpretations) Lack of understanding by hospitals re EMS (over expectations) Constituency groups – educate, recruit, lack of movement Disconnect between hospitals and MES (patient flow, through put, wait time, parking, lack of specialty services in hospitals) PIP insurance coverage Specialty centers – lack of access Rapidly expanding population – diversity Loss of national program accreditation for EMS education Geographic disparities around state (example: air ambulances) Public service vs. business model Rotor wing COPCN challenge Federal mandates (some unfunded) – tied to $ Balance state autonomy with partnering with federal and other states Variability in quality of medical directors; lack of minimum standards – standards that are too low Nursing homes – different rules – tie up ambulances, overburden hospitals, billing challenges Trauma – review registry guidelines by age Lack of EMS patient outcome data from hospitals on a timely basis Disparity in relationship between EMS and hospitals statewide (some good, some not so good) Legislative influence (can get in the way of good policy making) Data improving but still a challenge Maintaining Florida’s national leadership Maintaining strong system leaders Gaps in statewide programs (rural counties, geographical lack of personnel, access to training, lack of full-time medical director) Develop future EMS leaders (mentoring) Golden hour (EMS-Trauma) – access to trauma centers Using successful templates/tools in other areas (benchmarking, measurement) QA/QI – understanding difference, tied to discipline vs. improvement Lack of science-based research culture/foundation – like Trauma; legislation prohibits Class I research – impacts positive changes (i.e.

backboards) Need unbiased, objective body to evaluate data/set benchmarks Lack of crew safety in rigs Evaluate appropriateness of interfacility transports

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statewide emergency medical services strategic plan (version 1.0)

Health & Medicine