Statewide Emergency Medical Services Strategic Plan (version 1.0)


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Statewide Emergency Medical Services Strategic Plan (version 1.0)

  1. 1. DRAFT Statewide Emergency Medical Services Strategic Plan (version 1.0) July 2010 – June 2012 Updated 9/4/2009 You may contact the EMS Advisory Council’s Strategic Visions Executive Committee at: Bureau of EMS Attn: Lisa Walker 4052 Bald Cypress Way, Bin C-18 (850) 245-4440 ext. 2733 Note: Table of Contents, Message from the Surgeon General, and Executive Summary to be inserted at a later date. statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 1 of 56
  2. 2. 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. statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 2 of 56
  3. 3. 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 Values Leadership: 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. statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 3 of 56
  4. 4. 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? statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 4 of 56
  5. 5. 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. urban o 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) statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 5 of 56
  6. 6. DRAFT • Wall time – see Access to Care paper (economic sustainability issue) Existing Goal 5: • EMSystem Steering Committee? o Discuss with Rhonda White o 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). statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 6 of 56
  7. 7. DRAFT Goal 1 Improve patient care and EMS systems through effective leadership and communication by EMSAC Goal Owner: EMS Advisory Council Note: ALL new Objectives Measure(s) Strategies Lead Resource Timeline 1.1 Amend the Successive Amend the EMSAC bylaws to support EMSAC bylaws to leadership Strategic Plan support Strategic Plan Officer’s leadership Assign goals to EMSAC subcommittees. These committees Each committee has serve as goal owners who are to report a tie in to SP status at each council meeting. # of strategic Encourage all EMSAC members and planning milestones constituency group presidents (or met 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 Strategic for the EMSAC. Visions Executive statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 7 of 56
  8. 8. DRAFT Committee 1.2 Improve the Measure Improve the relevancy and regularity of relevancy and dissemination of SP communication between the EMSAC regularity of through agencies and and the system communication hospital base between the EMSAC and the system 1.3 Conduct or host Assign EMSAC mentors to new leadership members. workshops for the EMSAC and provide Assign mentors to new members of an information on EMSAC subcommittee. leadership seminars, fellowship Disseminate leadership resources opportunities to the (articles, webinars, etc…) to EMSAC EMS system 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 EMSAC statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 8 of 56
  9. 9. DRAFT 1.5 May want to add In turn, a succession a succession planning objective for planning objective the EMS system for the EMSAC to should be identified. ensure that new Many have retired or chairs and new will retire. How is the members are system transferring already familiar with knowledge to new the SP or have leaders to reduce mentors in place. disruptions in patient care, etc…? 1.6 Serve as a Increase female and Provide paramedic “shadowing” and EMS June 2010 national model for minority paramedic mentorship opportunities for middle and Advisory paramedic representation by high school children. (Note: Polk Council recruitment of 15% by 2010. county has a high school program that females and may be a model) minorities to ensure that the paramedic Provide scholarship and training profession is information through high school representative of the guidance counselors. area served. Increase grant and scholarship Moved from existing opportunities available to minorities 3.12 per planning seeking paramedic careers. session. Promote focused recruitment initiatives and other outreach programs that encourage females and minorities to consider the paramedic profession. statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 9 of 56
  10. 10. 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 Committee Note: ALL New Objectives Measure(s) Strategies Lead Resource Timeline 2.1 Improve % of committee • Annual review to ensure effective Data Leadership members who fulfill bylaws/operation of subcommittee Committee effectiveness and their term • Mentoring/Develop Succession participation of Data % of committee Plan Committee members attending • Leadership Orientation each meeting • Committee Member Orientation (including conference calls) 2.2 Maintain • All Florida Data • Use the expertise of the Data Data EMS Data Unit On-going statewide standards Dictionary data Committee to Committee for data collection for elements defined review/define/maintain all data EMS incident level and accepted by elements in Florida Data Dictionary data EMS Advisory consistent with National mandatory Council requirements • Florida Data Dictionary maintained and consistent with National mandatory data collection requirements statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 10 of 56
  11. 11. DRAFT 2.3 Provide # regional • Work closely with remaining Data Education/Training advocacy and educational/training agencies to ensure smooth Committee Subcommittee outreach for opportunities transition; implement lessons Data Unit statewide data provided learned from startup collection • Use the expertise of the Data Committee for the education/training curriculum and delivery Achieve 70% % of agencies participation in participating statewide data collection system Improve access to Data mart Collaborate with DOH IS to create data EMS Data DOH IS EMS incident level warehouse/data mart solution Unit data for evaluation and benchmarking activities Link EMSTARS # linked data sets Establish relationship to share data EMS Data Data Committee incident-level data between agencies Unit DOH IS with other state data Establish technical environment to DOH Trauma for outcome house shared data ACHA assessments Utilize expertise of Data Committee to Identify data linkage requirements for linking incident level data for outcome assessments statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 11 of 56
  12. 12. 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 Committee 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… statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 12 of 56
  13. 13. Objectives Measure(s) Strategies Lead Resource Timeline 3.1 Provide injury Existing New strategies: PIER EMSC prevention measure(s): (S) Identify funding sources, DOT programs to public Increase by 5% the # resources and partnerships Motorcycle Safety DRAFT of educational (S) Look at alternative distribution Coalition programs provided to mechanisms Florida Injury Status – hard to the public through Prevention Advisory measure, need to EMS/fire agencies Existing strategies: Council resurvey, Partner Office of Injury w/Trauma/DOT for Identify Injury Prevention Prevention stats Note: (M) Look at programs and opportunities for final data to the general public by making determine them available to any agency in Comment from percentages the state. colored paper from otherwise leave as is strategic planning Provide public injury session: Reduce prevention/educational programs injuries and directed towards the top 5 injuries improve customer in Florida by working with EMS satisfaction through agencies to start or expand injury injury prevention, prevention programs in their public education, areas. Act as a resource for and knowledge of injury prevention programs the EMS system. throughout Florida. Data Source: Office of Injury Isn’t the ultimate Prevention goal to reduce injuries? (top 5 Identify number of classes and injuries) number of attendees Existing Existing strategies: PIER Access to Care measure(s): Work with the Office of Injury DOT Prevention and the Injury Motorcycle Safety Reduce the # of Prevention Advisory Council to Coalition hospital ED visits identify # of hospital ED visits Florida Injury caused by injuries caused by injuries and partner Prevention Advisory Data Source: AHCA with them to promote educational Council Top 5 injuries: falls, programs Office of Injury motor Prevention vehicle/pedestrian, bicycle safety, drowning/water safety, fire/burns Add motorcycle crashes to link to MSSP??? 3.2 Increase EMS Existing New strategies: Quality Medical Care systems utilizing measure(s): (S) Update the customer service Managers Committee statewide-emergency-medical-services-strategic-plan-version-104405.doc customer survey Increase the number tool related to new definition of Page 13 of 56 tool of EMS providers customer utilizing a customer Status: Quality satisfaction survey Existing strategies:
  14. 14. DRAFT statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 14 of 56
  15. 15. 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 Timeline 4.1 Define and adopt Existing New Strategies or Resources EMS Florida Association of into rule the measure(s): Needed: Education EMS Educators minimum standard Need legislative committee to adopt Committee for curricula to be % meeting scope of minimum standards into rule Legislative used for critical care/ practice Define the minimum standards for Committee specialty care requirements curricula. provider courses in Providers FL Existing Strategies: Establish state model that is aligned Note: with critical care/specialty care guidelines completed; awaiting Seek statutory authority for regulating further direction training requirements. Establish rule and train providers/personnel in requirements of rule. Establish monitoring process. 4.2 Remove current need sponsorship in New Strategies: Legislative EMS Education statutory requirement both House and Need legislative committee to delete Committee Committee of 2-hour HIV/AIDS Senate reference to FS 401 from FS 381.034 while keeping total Florida Association of number of Greg R would be willing to take forward, EMS Educators recertification hours find sponsor, ? Change HIV to at 32 Infectious Disease/Bloodborne Pathogens Status: Not Existing strategies: complete; does this Seek statutory change. need to be removed because it may not meet the SMART criteria? Or does the timeline have to exceed 2 years to statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 15 of 56
  16. 16. 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 monitor for recert New strategies: Legislative EMS Education Education for requirement changes Need legislative committee to pursue Committee Committee recertification must through NHTSA rule change include course topics Add education representative on Florida Association of from the seven areas Legislative Committee (private & public) EMS Educators defined in the NHTSA Continuing Existing strategies: Education guidelines. Seek rule change. (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? 4.4 Establish Existing Existing strategies: Dispatch FAMA guidelines for measure(s): Review national guidelines and identify Work Group emergency medical Compare to national funding sources. ASTNA services dispatch standards. training for ground Note: Voluntary going toward and air mandatory cert; bring in all dispatch; remain in this goal statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 16 of 56
  17. 17. DRAFT 4.5 Measure and Existing Existing strategies: Fire Chiefs Providers Identify Opportunities measure(s): Implement process to identify and EMLRC to Improve % overall satisfaction resolve potential areas of statewide MQA EMT/paramedic EMT/paramedic dissatisfaction satisfaction Survey EMTs and Paramedics (work Note: Customer as with the EMLRC) employee; survey % Turnover rate Fire Chiefs Quality Managers has been completed (thanks to MQA's help during recertification); #EMTs/# Fire Chiefs Quality Managers review data to Paramedics identify opportunities for next step. Cory Providers has results. post on SVC page??? 4.6 All Florida New measure(s): New strategies: EMS Florida Association of Does this approved EMS Number of training Education Committee will be contacting Education EMS Educators need to move training programs, as centers who obtain all EMS training centers not currently Committee into the defined in FAC National EMS accredited by CoAEMSP and ask if they Legislative 2010-2012 (64E-2.001), will be Education intend to become accredited, and if so, Committee plan or will it nationally accredited accreditation how can we assist them in the process. be complete in accordance with by June the NTHSA - EMS 15 training 2010? Education Agenda programs not for the Future by accred (4 public/11 Existing strategies: 2010. private) represent Bureau of EMS will monitor for 10% not COAMPS compliance during inspections. Note: Modify to Existing Florida Association of EMS Educators "National EMS measure(s): partnering with DOE and DOH to Education Program promote this type of accreditation) Accreditation" per the Measure the number EMS Education of schools that are Research the language of the previous Agenda for the accredited by rule that was deleted which required Future CoAMPS or other CoAMPS accreditation agency that meets the EMS Education for the future statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 17 of 56
  18. 18. DRAFT guidelines. 4.7 Increase % staffing at EMS New Strategies: FAREMS PIER paramedic and EMT agencies in rural FAREMS – two surveys, staffing percentage counties recruitment/retention video aimed at Education Committee at EMS agencies younger, ?next Cory survey to break out located in rural rural vs. urban vs. specialty groups Florida Association of counties Promote recruitment and retention EMS Educators video (EMS Week, Florida Channel, EMS newsletter, etc…)??? Providers 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 statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 18 of 56
  19. 19. DRAFT ALL New: 4.8 Adopt survey results • Survey providers through provider levels from FLEMSCOMM National Scope of identify financial • Follow Up with those that don’t Practice Model. implications of not respond adopting all levels • Identify provider levels to be adopted - currently EMT/PM. NHTSA Question Advanced EMT? Transition/Refresher Need for EMR (first responder) Criteria • 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) statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 19 of 56
  20. 20. 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 Committee Notes from discussion at planning session: Is this related to the killed legislation? Relies on data of a proprietary nature – revenue industry EMSTARS can capture, but elected not to collect EMS can control the treat and release, low acuity – how do we Manage these? Not being reimbursed? Pertinent during pandemic EMS 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 these Non-transport issues: ALS fire who don’t charge – need to be broken out Best 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 foundation Look at tourism revenue? Look at TDC (Tourist Development Council) Currently not a provision for the safety of the tourist NonALS, Non-transport independent of system Not affiliated with providers who are essentially first response EMS – Potential bureau income stream/revenue Statue sponsor, etc for First Responders What is relevant – what is our baseline – immediate goal/objective Suggested objectives – Baseline/survey Move employee satisfaction to this goal Identify the leads who are most applicable to the objective How does the EMS manager respond to legislative/reduction Of revenue sources, economic shifts? Respond to revenue streams Outside of the billing system, look for resources and partnerships EMR funds – electronic transfer of records between agencies Resources, grants, grant writers, creative best practices, finance solutions statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 20 of 56
  21. 21. 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 Timeline 5.1 Measure and % calls reimbursed Advocate for non-transport Providers Fire Chiefs Unknown as improve % of reimbursement. to whether it reimbursable calls FAA can be Explore non-traditional transport options collected. (chase car with PA/ARNP) FAMA 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 % billed charges New Strategies: FAA Fire Chiefs improve % of billed collected Best practice to share; identify charges collected countermeasures to offset - ? survey to Providers self report Existing Strategies: FAMA Benchmarking to identify best practices 5.3 Measure and Cost per capita New Strategies: Providers Fire Chiefs improve the cost per Best practice to share capita for EMS Existing Strategies: FAA Benchmarking to identify best practices statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 21 of 56
  22. 22. 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 %/# of non- Statewide survey regarding current non- Fire Chiefs Providers Unknown as additional revenue billed/non-transport transport billing practices to whether streams for non- responses statewide FAMA can collect. transport services See note in ASTNA 5.1 %/# of agencies with non-transport billing procedures in place Suggestion from Partner with other agencies to provide colored note: transport and healthcare services for these populations. 5.5 Identify uninsured Identify funding sources populations throughout the state. statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 22 of 56
  23. 23. DRAFT Suggestion from Partner with injury prevention, EMS, colored note NHTSA, etc… 5.6 Identify Should this be under goal 3??? Or is it opportunities to more of a focus on financial implications provide public when EMS is not properly utilized? education regarding the utilization of EMS Suggestion from Best practice (Coop supply purchases) colored note: 5.7 Identify cost saving measures to offset EMS expenses Suggestion from Hundreds of millions of dollars are colored note: collected through TDC taxes. Are there revenue There is no provision of funding for streams that can be safety programs. (money goes to realized through: marketing, infrastructure, convention centers development, etc…) • Marketing of the EMS system Legislate % for safety services • United Way campaign • Foundations (private) • % of fees for courses taught statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 23 of 56
  24. 24. DRAFT • Federal stimulus money statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 24 of 56
  25. 25. DRAFT Goal 6: Improve performance of key EMS processes through benchmarking and partnerships. Goal Owner: Medical Care Committee Notes 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 data Uniform trauma transport protocol for geriatrics Diversion – Med Care to Access to Care (New) Process performance improvement opportunities Data sharing/Reorganizing the measurements (sub objectives) Broad latitude – but constituency groups need to hold Med Care Committee Responsible for addressing topics that need addressed. Flexibility without Distraction. Bring back burner topics forward – generate agenda for Med Care Committee. 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 Timeline statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 25 of 56
  26. 26. DRAFT 6.1 Measure and % of Primary PSAPs Notes from planning session: Dispatch Providers Identify utilizing a nationally Amber Lee Foundation, survey from Group Opportunities for recognized Dispatch Group 66% return, data being FAMA improvement of Emergency Medical evaluated dispatch system Dispatch System effectiveness (EMD) Existing Strategies: Establish baseline and benchmark to Notes: (a PSAP identify best practices. would be counted as a YES if the Primary Promote use of EMD system Quality PSAP transfers EMS Improvement processes calls to a secondary PSAP that utilizes an Promote ongoing continuing education EMD system. of Emergency Medical Dispatchers Currently Priority Medical Dispatch, Complete survey of PSAPs (Note Powerphone and already in progress- Jim Lanier has APCO are nationally detail) recognized) Promote involvement of EMS Medical Note: Continue as is Directors in EMD. Medical Directors per planning session Promote utilization of NAACS standards by all communications centers that handle air medical transport statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 26 of 56
  27. 27. DRAFT 6.2 Measure and % of calls with Establish baseline and benchmark to Dispatch Providers Identify appropriate response identify best practices. Group Opportunities for prioritization by Fire Chiefs improvement in the dispatch **Can only Notes from session: Continue area of EMS be measured if an Measure – currently collecting data – Access to Care response time (from agency provides need to interpret and identify areas of 911 call to patient EMD QA…consider improvement. contact). changing to: adopt Dispatch feedback – data difficult to a standardized collect; Not applicable emergent vs. non model for call emergent, may be proprietary nature, types: non life measurements not standard, threat, potential life EMSTARS has data on times threat, life threat, Looking for a benchmark to compare immediate life best practice threat, etc. In addition, cellular calls vs. landlines, etc will need to be considered for call processing implications % of calls meeting Establish baseline and benchmark to Dispatch Providers response time identify best practices. Group targets**needs to be Fire Chiefs based on adopted standardized call *Add EMSTARS? priority models as Jim L in 5.1 statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 27 of 56
  28. 28. DRAFT 6.3 Changes to All data elements Establish uniform definition of “EMS- Data Trauma Committee EMSTARS Data needed to capture hospital turnaround time” Committee Dictionary and EMS off load and FENA Disaster Response diversion times Establish uniform definition of hospital is Tracking System to accepted by the EMS on “Diversion” status Medical Directors be able to capture Advisory Council. EMS off load and Notes from session: Off load is Access to Care diversion times. 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. Promote an Utilize Data Committee and Disaster Disaster Access to Care?? Emergency System Committee expertise and knowledge to Committee Status (ESS) Internet develop requirements based process on a statewide basis 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 partnership Make into own objective - # counties utilizing system More than 75% trauma systems utilizing system statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 28 of 56
  29. 29. DRAFT 6.4 Measure and 6.4.1 Cardiac: New Strategies: Quality Medical Directors Identify % ROSC return of Review of data to identify opportunities Managers Opportunities for spontaneous for improvement American Heart improvement circulation in the Association effectiveness of on- prehospital Systemized care of STEMI/Stroke site EMS treatment environment EMRC Develop concept for establishment of % of time 12 lead Office of Cardiovascular EKG was captured (statute) on a patient with chest pain Notes from planning session: AHA moving packet for cardiac care – mtg % of EMS agencies 8/20 Orlando w/stakeholders that obtain 12 lead Current intent not to move forward EKG on chest pain w/legislation patients per protocol QMgr/MedDir took lead – couldn’t measure before but now mechanism w/ EMSTAR % of time aspirin was Need Office of Cardiovascular given to patients with (funding?) chest pain Data Committee has established STEMI definition, working on cardiac Look at accrediting agencies Determine 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. Identify mechanisms for benchmarking utilizing EMSTARS and expertise of the EMRC to identify best practices. statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 29 of 56
  30. 30. DRAFT 6.5 Measure and % of patients refusing Benchmarking to identify best practices. Quality Providers Identify opportunities transport Managers Fire Chiefs for improvement for appropriate transport destination. % of victims meeting Identify mechanisms for benchmarking Trauma Notes from trauma alert criteria utilizing EMSTARS and expertise of the Committee planning session: transported to trauma EMRC to identify best practices Issues will be kept center as starting points – defer to new objective of patient safety??? % of acute Identify mechanisms for benchmarking Quality Medical Directors myocardial infarction utilizing EMSTARS and expertise of the Managers patients field triaged EMRC to identify best practices AHA to interventional cardiac cath capable facility % of acute stroke Identify mechanisms for benchmarking Quality Medical Directors June 2010 patients within utilizing EMSTARS and expertise of the Managers statutory timeframe EMRC to identify best practices AHA transported to a stroke center 6.6: Develop a % of EMS agencies Notes from planning session: 100% EMRC Quality Managers June 2010 standardized QI/QA utilizing QI/QA under 401 – EMRC is developing a template for use by procedure template for this Medical Directors all EMS provider agencies in Do 3.2 and 3.3 need to be merged with conjunction with the this objective? state plan 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 ( 6.7 Prioritize and # of targets Use the expertise of The statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 30 of 56
  31. 31. DRAFT begin setting established the Emergency Emergency performance % of targets met Medical Review Medical improvement targets Committee to identify Review based on the patient outcome and Committee established service delivery benchmarks and components for utilizing EMSTARS uniform measurement; data also, use the data, publish the data, while still protecting the data 6.8 Conduct # of service Use the expertise of The benchmarking delivery or patient the Emergency Emergency activities care components Medical Review Medical to establish measured and Committee to identify Review statewide benchmarked patient care and Committee measurements for system delivery patient care and components for service delivery uniform measurement; also, use the data, publish the data, while still protecting the data 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 required to be certified first responders (ARC, etc…). EMSAC has ground and air covered, we need statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 31 of 56
  32. 32. DRAFT 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? statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 32 of 56
  33. 33. DRAFT GOAL 7: Assure the EMS System is prepared to respond to all hazard events in coordination with state disaster plans Goal Owner: Disaster Committee Put together in 2008 – patterned after PHP and Target Capabilities Survey to identify gaps in Disaster Preparedness, and book has been modified to this document Recommend for 2010 Plan Objectives Measure(s) Strategies Lead Resource Timeline 7.1: Ensure all __% of EMS Compare current standards in Florida Disaster Health and Medical 12/31/09 emergency medical providers train their Statute, Rule, Florida Fire Chiefs State Committee Co-Chairs services personnel staff annually on local Emergency Response Plan, National (Paramedics, EMTs, and regional disaster Fire Protection Association, Florida Trauma Committee Nurses and plans. OSHA, county emergency response dispatchers) are plans and Catastrophic Health Incident Office of Public knowledgeable about __% of agencies that Response Plans. Develop standards Health Preparedness local agency and include the local, that apply to fire EMS, Non-Fire EMS regional disaster regional and state and Air Medical EMS providers. Office of Emergency plans. disaster response Operations Gap – need to plans as part of educate staff to plans orientation Amend Florida Research and develop enabling Bureau of PHMP, OEO, 7.2 Enable EMS Statutes to enable language. EMS Disaster Committee providers to transport EMS providers to Should this & Community Surge patients to AMTS’s transport patients to be the Committee during times of AMTSs during times Legislative local/regional of local/regional Committee? disaster conditions. disasters. Work with Med Directors for alternate Destination site Legislatively. Address “disaster conditions” verbiage Hospital alternate triage would be included but need to statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 33 of 56
  34. 34. DRAFT be inspected as part of the process. FHA partner Look at role of telemedicine 7.3. Ensure ___% EMS agency Ensure plans, training and exercises Disaster EMSC, PIER, 12/31/12 emergency medical plans that specifically address At-Risk Populations. Committee PHMP Community services plans and address each Surge Committee, related documents identified At-Risk “Training” verbiage is vague; more Office of Trauma include consideration Populations specific (also 6.1) Medical Directors for At-Risk Populations __% of EMS providers train their 1. Pediatrics staff annually on their 2. Neonatal local At-Risk 3. Pregnant Population Plans. women ____% EMS agency 4. Elderly exercises that include 5. Disabled at-risk populations 6. Low/limited literacy 7. Public companions or service animals 8. Special medical needs statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 34 of 56
  35. 35. DRAFT 7.4: Ensure all __% of EMS Compare current standards in Florida Disaster Bureau of EMS, 12/31/12 emergency pre- providers train their Statute, Rule, Florida Fire Chiefs State Committee FFCA, PHMP hospital health care staff annually on Emergency Response Plan, National Responder Health & providers ( including Level “C” PPE. local Fire Protection Association, Florida Safety Committee but not limited to and regional disaster OSHA, county emergency response Paramedics, EMTs, plans. plans and Catastrophic Health Incident Nurses and Response Plans. Develop standards dispatchers) are __% of EMS that apply to fire EMS, Non-Fire EMS knowledgeable about providers train their and Air Medical EMS providers. Level “C” PPE and staff annually on Nerve Agent Nerve Agent Identify statewide standards to acquire, Antidotes. antidotes. inventory, store and disseminate and maintain protective equipment and (apply to others) 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? statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 35 of 56
  36. 36. DRAFT 7.5: Ensure all __% of EMS Compare current standards in Florida Disaster Bureau of EMS, 12/31/12 emergency medical providers train their Statute, Rule, Florida Fire Chiefs State Committee FFCA, PHMP services personnel staff annually on Emergency Response Plan, National Responder Health & (EMS agencies, CBRNE detection Fire Protection Association, Florida Safety Committee Paramedics, EMTs) systems, notification, OSHA, county emergency response Medical Directors are knowledgeable verification & plans and Catastrophic Health Incident about CBRNE response procedures. Response Plans. Develop standards detection systems, that apply to fire EMS, Non-Fire EMS Note: Melia Jenkins notification, and Air Medical EMS providers. and Lisa Walker are verification, reporting co-project managers systems, all discipline on this funded project plans and protocols, for the Community and their respective Surge Capability roles and Team. May want to responsibilities in the add deliverables system. identified in that project plan to the strategies for this objective. statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 36 of 56
  37. 37. DRAFT 7.6 Develop State Wide Disaster Develop Statewide Disaster Medical EMS Medical Disaster Committee, June 2012 processes for EMS & Pan Flu Protocols and Pan Flu Protocols. Directors EMS Constituency, medical direction are written and Office of Trauma support of disasters, approved by FL Formulate implementation strategies mass casualty, and Assoc. of EMS Med large infectious Directors Note: Lisa Walker is the project disease emergencies manager for the Community Surge at the State, Regional project to “develop statewide disaster and Local level protocols”. Currently, the project is funded through the PHMP grants for Statewide protocol to meetings with the medical directors to work under in times develop the protocols. Next grant cycle of disaster – it will be proposed to develop a web utilization, training, based system (similar to ICS online clarification of training) to ensure all providers are existing process trained in the protocols. The web based How to make the system would track who is trained. protocol operational 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 Ensure EMS Providers receive the EMS Medical Agencies who have Disaster Medical Protocols Directors been trained in statewide disaster protocol statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 37 of 56
  38. 38. DRAFT 7.7 Develop medical ___% of Local EOC’s Compare current standards in Florida Medical Disaster Committee, June 2012 direction support to has a process in and FEMA Region IV State partners. Directors Bureau of EMS, EMS local Emergency place to access Local Providers, Office of Operations Center EMS Medical Director Robust process at state level, without Emergency (EOCs). or EMS Medical uniformity Operations, local Director designee for Need experts, familiar with disaster Emergency consultation during medicine, need formal process in place Managers, Health & activations May be available to a regional EOC Medical Co-Chairs 7.8 Capture disaster 100% of EMS Review NEMSIS data base for disaster Data Bureau of EMS, response data. Providers that response data that is currently not being Committee Disaster Committee, participate in collected. Consider adding disaster Medical Directors, EMSTARS report response data fields to EMSTARS. EMS Constituency disaster response data 7.9 Align with Disaster Committee Determine gaps that exist between Community Disaster Committee Community Surge & PHMP Community PHMP Community Surge Committee Surge Objectives Surge Committee Objectives and Disaster Committee Committee Objectives are Objectives. aligned. statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 38 of 56
  39. 39. DRAFT ____% of the 7.10 Identify facility counties have Align survey efforts with local EMS Public Health Disaster Committee, and plan for identified and Providers, Public Health Preparedness, Preparednes Office of Emergency implementation of at planned for the the Office of Emergency Operations s Operations, local least one Alternate implementation of an and DOH Regional Emergency EMS Providers, DOH Medical Treatment Alternate Medical Response Advisors. Regional Emergency Site in each county Treatment Site. Response Advisors, that can be used to Governor declared event vs. more local Disaster Committee help mitigate incident – how to handle and local Emergency community surge Office PHP – Terry Schenk Managers. during disasters. Medical Directors Hospitals (look at DOH is ESF 8 at the state level placing hospitals in several of these) statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 39 of 56
  40. 40. 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… statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 40 of 56
  41. 41. 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 Room Look at resources in geographic area Look at tool for air medical resources Partner with Education Committee Look outside the box for management of patient – what are the Patient’s best interests? Objectives Measure(s) Strategies Lead Resource Timeline 8.1 Develop • % of air medical • Establish baseline and identify best • Florida • Air & Surface statewide criteria for providers that practices AeroMedi Transport Nurses appropriate air asset have established • Define appropriate air asset cal Association utilization(prehospital criteria for utilization Associati (ASTNA) and interfacility appropriate air • Promote use of a utilization review on • Florida EMS transfers). asset utilization process. (FAMA) Pilots Association • % of air medical • Educate requestors (EMS, • Florida Neonatal providers that hospitals) on risks associated with & Pediatric have an helicopter shopping. Transport established • Develop a repository of centralized Network utilization review information re capability/ availability Association process. to ensure appropriate use of (FNPTNA) • Statewide specialty providers. • EMS Medical measures Directors developed. • Florida Fire Chiefs’ Association (FFCA) • EMS Providers • Florida Committee on Trauma (FCOT) • Association of Air Medical Services (AAMS) • American College of Surgeons statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 41 of 56
  42. 42. DRAFT (ACS) • National EMS Physicians • Air Medical Physician Association (AMPA) 8.2 Improve air • # of air medical • Florida • Air & Surface medical communication • Develop and implement a AeroMedi Transport Nurses communications and centers that quality improvement process for cal Association dispatch procedures perform duties air medical communication Associati (ASTNA) for communication other than air centers. on • Florida EMS centers, flight crew, medical flight- • Promote formalized flight (FAMA) Pilots Association hospitals, and EMS related duties. following and dispatch • Florida Neonatal providers • # of air medical procedures including up-to-date & Pediatric communication weather per the National Transport centers with Transportation Safety Board Network established (NTSB) recommendations Association helipad • Identify, research, and (FNPTNA) communication implement the use of • Technical procedures technological services to Advisory Panel (TAP) • # of air medical improve information sharing. • Bureau of EMS communication • Identify and adopt initial centers with an • EMS Providers minimum criteria for air medical established communication specialists • Florida Fire Chiefs’ quality • Establish Bureau of EMS Association improvement support for inspections process • EMS process and compliance with the Florida Communications • # of air medical Communications Plan Engineer communication centers that are • National utilizing Association of Air technology for Medical Communication information Speciaists EMS statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 42 of 56
  43. 43. DRAFT sharing • # of air medical communication centers that utilize aviation- based technology for flight management • # of Florida receiving facilities and EMS providers that are Providers non-compliant • Florida Hospital with state Med8 Association requirements • Emergency • # of Florida air Dispatch medical providers Workgroup that are non- compliant with state Air Secondary requirements • # of air medical communication centers that have established continuing educational requirements 8.3 Improve air • # of programs • Establish baseline and benchmark • Florida • Air & Surface medical crew that have to identify best practices AeroMedi Transport Nurses resource established air • Assess operational education and cal Association management and medical crew training needs of flight programs Associati (ASTNA) education resource • Identify current risk assessment on • Florida EMS management as tools for air medical providers (FAMA) Pilots Association part of both the • Establish standardized minimum (FLEMSPA) initial orientation initial safety core competencies for • Florida Neonatal process and all personnel involved in air medical & Pediatric annual training Transport statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 43 of 56
  44. 44. DRAFT requirements • # of programs using a risk Network assessment tool Association for flight crew (FNPTNA) • # of • EMS Providers programs/provide • Fire Chiefs rs that have a • EMS Advisory dedicated transport Council’s operational Education education • Develop and adopt recommended Committee committee or safety continuing education for all • Association of Air training personnel involved in air medical transport Medical Services coordinator (AAMS) • # of programs • Establish operational awareness training for ground crews involved in • Commission on that have initial transport (safety, landing zone, Accreditation of training approach, etc…) Medical requirements that Transport include 4 hours of • Establish a minimum one day Services safety training annual air medical safety summit (CAMTS) and 4 hours of flight specific • Florida Neonatal training & Pediatric • # of air medical Transport Network programs with an Association operational (FNPTN) awareness course statewide-emergency-medical-services-strategic-plan-version-104405.doc Page 44 of 56