Major EMS Systems Paper & Project For t.docx

Major
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1
NAME 1
Name
Lecture’s name
Course name
Date
Poverty and Its Impact on Children's Health
Introduction
Just by the word itself, poverty is seen as a very major disaster
and human crisis. Poverty in the economic terms is defined as
the state of economy whereby an individual cannot be able to
meet the basic needs of their family effectively as well as that
of their children. These needs include shelter that is housing,
food as well as clothing. Poverty causes so much harm and
damage on the lives of children, destroys life chances and
opportunities and damages the entire society as a whole.
Poverty is considered a major economic crisis that has affected
millions and millions of life’s all across the globe leading
people to live in a lot of human suffering as well as misery. The
effects of health on human life are very many and very broad.
However in this paper we are going to put our focus on the issue
of poverty, how it rates to the children and we will particularly
focus on how the poverty that children experience affects their
health status.
The prevalence of poverty among children is real and staring at
our faces in the communities that we live in. The prevalence of
poverty among the children is commonly referred to as child

poverty. Child poverty is defined as the state whereby the
amount of income cannot effectively meet the needs of a child
that their family makes. Children poverty can also be defined as
the situation where a child lives in a family whose income per
day is below the national poverty line which means that their
basic needs cannot be catered for. This issue is very saddening
manly because children do not choose in what kind of families
to be born it is one only considered as a social or a political
issue, child poverty is considered as an ethical issue since it can
be considered under social justice (Strelitz and Ruth, 10).
According to statistics that were carried out in the United
States, the rate of child poverty is seen to be rising very rapidly
over the years. “The statistics showed that in 1973 the
proportion of child poverty was at 14% and by 1995 the level of
child poverty had risen all the way up to 21%. Statistics also
showed that among the whole proportion of children, who are
poor, 15% of them are not only just poor but they are
chronically poor.” (Rita Paul-Sen Gupta, Margaret L de Wit,
and David McKeown, NCBI). By chronically poor, it means that
these children are living at almost the starvation rate. The main
contributor to child poverty is the level of income that a family
earns. Low-income families are the families that makeup the
highest proportion of children poverty rates. Low-quality
education or lack of education again being the main causes of
the low-income levels that these families experience. Over the
years, the level of poverty among families has one up, and this
only goes to show that the level of children poverty has also
been shooting upwards. Other causes of child poverty include
the presence of so many families that are being led by a single
parent, cases which have become almost common in our society
today.
The statistics presented above are indications of how serious the

issue of children poverty. However, as if not enough, children
poverty has been greatly linked to the health status and health
well-being of children. This has been confirmed by numerous
studies that have indicated that children from low-income
families are more prone to diseases as compared to their
counterparts who are born and brought up well up families.
There is no denying it that there is a very strong and extensive
link between poverty and the health of children. This means that
each and every single aspect that relates to health is usually
worse for the children living in low-income families as
compared to those who live in affluence. This is a very major
and serious public health issue since it not only unfair but also
very saddening that health differences between children of the
same age are very great just because of the differences in their
social status. For example, take an incidence of disease that is
equally prevalent in all social classes say for example fibrosis,
the child living in affluence has better chances of surviving than
the poor child just by the definition of the social status factor.
The more worrying thing is the fact the effects of child poverty
on health are not short term, but they will continue to affect
children even in their adult ages.
The following section will discuss the effects that children
poverty or social disadvantage has on various aspects of the
health of a child. The paper will synthesize the different effects
which could be physical emotional or even cognitive at different
stages of the child’s development.
The impacts of child poverty on the health of the children
Research conducted in Canada has indicated that the outcome
on health for poor children is way worse as compared to the
outcomes of health for those who live in affluence. The impacts
that poverty has on health include first Outcomes of pregnancy.

The outcome of pregnancy that is during birth acts as a major
indicator or pointer on to how the health of a child will be in
the future. Poor mothers are more likely to experience poor
outcomes out of the pregnancy as compared to the affluent
mothers. The most common poor pregnancy outcomes that the
poor experience includes low birth weights and poor health for
the mothers.
Low birth weight refers to the state where a baby is born with a
very low weight than they are expected to. Certain natural
reasons lead to this, and they include premature birth. However,
many cases of a mother delivering at the right time giving birth
to children who are way below the minimum weight that a child
ought to be born with. These instances are mainly prevalent
among poor mothers. This is mainly because these mothers
strain to get even their daily bread. This means that the mother
sometimes goes without feeding, feeds on too little or feeds on
unbalanced foods which affected the development of the child
in the womb in terms of gaining weight. The low birth weights
among poor mother may also be as a result of premature births
since most of them strain too much and are even forced to do
hard labor during their pregnancy period so as to be able to
survive which could lead premature births. Children born with
low birth weights face so may health complications and also the
risk of death especially during their firs days. Statistics have
shown that the children who are born with low birth weights
also show characteristics such as a higher and more rapid rate of
hospitalization, poor growth that is growth that is below the
normal growth rates, physical limitations that are related to
health, greater cases of childhood illnesses as well neurological
and developmental problems later on in the future (Strully,
Rehkopf, and Xuan, 535).
Due to poor feeding habits among poor mothers, they are highly
prone to complications when giving birth. This renders them
unable to take proper care of their newborn babies for example

through feeding them and increases the incidence of disease for
children as well as weakness which could lead to death.
Furthermore, due to the fact that poor mothers usually seek the
help of a midwife during delivery due to inability to pay the
expensive hospital bills, the mothers as well as the child lack
proper prenatal care which could lead to the above mentioned
complications during pregnancy and also poor postnatal care
which further increases the incidence of disease and health
complications in children. Complications that arise as a result
of low birth weights during birth have been proven to extend to
the adulthood years of a child, and this increasingly causes
health complication for the lifetime of the child.
The second impact of child poverty is mortality. Child mortality
in the world is at a very high level of 49.4% (Tamm, 45). The
rate of infant mortality in a country acts as a major indicator of
the health status of society. The poor populations are highly
characterized by a very high rate of infant mortality, and this
only goes to show that health of these poor children is very low.
The rate of child mortality is higher for poor families than in
the affluent families.
Children who are born in low-income families are at a higher
risk of dying during the first few years of their life as compared
to those in affluent families. This is because the children in the
poor families lack basic necessity in life, for example, enough
food or well-balanced diet which leads to conditions such as
malnutrition. Children at the early years of their life also
require very great and constant hospital care due to their high
level of vulnerability to environmental factors. Due to financial
constraints in the low-income families, this become impossible
most of the times, and this exposes children to greater diseases
incidence with no medical care or improper medical care, and
this is a cause of the high mortality rate. According to the
NCBI, the total rate of child mortality is 1000 children daily
and about 70% of these children come from poor families (Rita,

Margaret, and David).
Infant mortality is not the only type of mortality that is caused
by poverty and ill health. Perinatal mortality is another type of
mortality that is very prevalent among poor populations
whereby due to complications that are experienced by poor
mothers during delivery mainly due to delivery under poor
conditions or by inexperienced or unknowledgeable people, the
mother dies. The death of the mother during delivery can have
very great effects on the health of the newborn child which
could even lead to the death of the child. First, a mother breast
milk acts as the main source of food for a new born child and on
the incidence of death, the child may not have access to the
required feed during the first 6 months and this leads to
malnutrition and weakness among children which can cause
death or poor development of a child which carries through to
their adult years.
The third effect is Lack of education. Children who are born in
low-income families lack the opportunity to attend school right
from the first school level. This is mainly due to financial
constraints in the family. Such children lack access to the most
important form of education which is the basic education. Basic
education plays a very major part in a child’s life since children
acquire important knowledge about certain basics of life such as
hygiene. Lack of this education for the poor children leads them
to live very low-quality life, not in financial terms but general
hygiene terms. He lacks the knowledge of simple hygiene
practices such as washing of hands after visiting a toilet, and
this put them in more and more dangers of diseases such as
cholera, typhoid among many other that affect their overall
health conditions. Such basics may also not matter to their
parents since most of them are mainly uneducated and thus the
risk of disease incidence increases. Such cases are very rare for
the affluent children because they have the chance to receive
this knowledge from the basic school levels and also from their

parents.
Lack of education also makes children take up manual labor at a
very tender age with the aim of trying to help their parent and
also as a means of survival, and this does so much harm for
their bodies due to the strain caused. Girls from underdeveloped
countries especially in developing countries report to marriage
and giving birth at a very tender. Since their bodies are not
prepared for such tear at this age, they start to develop health
complication at their adolescence ages.
The forth and very serious impact is the Confluence of risks.
One of the main consequences of poverty is poor housing and
poor living environments. As a result, poor children suffer the
health risks as a result of the environments that they live in.
More than half of the poor population in a country usually lives
in very remote settlement mostly referred to as slums. These
settlements pose a lot of health risks to children due to the kind
of conditions that prevail in these areas.
First, the environments in these settlements are highly polluted
with dump sites as well as the dumpy area. These dirty
conditions act as a means of attracting pests and insects such as
mosquitos which cause diseases for example malaria among
children. These settlements areas characterized by a lot of
congestion a factor that increases the incidence of disease
because it makes the transmission of communicable diseases
even easier. They also lack proper sanitation leading to high
prevalence of diseases such as cholera and bilharzia among
children. Finally, children in such settlements also lack access
safe drinking water due to the immense dumping, and this
causes a high prevalence of water-borne diseases.
The final impact of child poverty is on the mental health of the
children. Mental health conditions of any individuals are mainly

influenced by their social orientation among many other factors.
Studies have indicated that children from low-income families
have shown a lower level of physical development, intelligence
as well educational achievements. All these factors act as
reflections of the poor mental health of conditions of children
due to poor social interaction practices. Their mindset is very
negatively influenced by the conditions that they see around,
and they carry this mindset for the rest of their life (Abernathy,
Webster, and Vermeulen, 60). This is a very different form the
mentality of children from affluent families which are most
positive. Studies also showed that children from low-income
families are more likely to suffer greater emotional disorders
such as anxiety which is mainly caused by the stress and the
hardships that they have to go through growing up. In general
the social interactions, social set up as well as the poor
functioning of low-income families negatively affect the
cognitive development of a child and this brings about the great
difference that is recorded in academic performance compared
to the performance of the rich children (Tamm, 76).
Conclusion
Poverty is highly prevalent in most parts of the globe, and the
evidence above shows that it has a very great impact on the
health of children. Child poverty has recorded an increasing rate
despite the fact that poverty levels of certain countries such as
the United States are said to be going down, and this is mainly
because as the level goes down poverty is quantitatively
increasing in some poor areas. Without proper intervention
measures being put in place these children will continue to
suffer even in the future as a result of their childhood poverty
and may also carry forward the vicious cycle of poverty.
Governmental and economic interventions thus need to be put in
place as a measure of curbing child poverty and the discussed
measures that come with it.

Work Cited
Abernathy, Thomas, Webster, Greg, and Vermeulen, Marian.
The relationship between poverty and health among adolescents.
ProQuest Social Science Journals, 2002. Print.
Rita Paul-Sen Gupta, Margaret L de Wit, and David McKeown.
The impact of poverty on the current and future health status of
children. US National Library of Medicine. National Institutes
of Health, 2007, Print. Retrieved from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528796/
Strelitz, Jason, and Ruth Lister. Why money matters: family
income, poverty and children's lives. London: Save the
Children, 2008. Print.
Strully, Kate, Rehkopf, David and Xuan, Ziming. Effect of the
prenatal health of infant Health State earned income tax credits
and birth weight. American Sociological Review Journals, 2010.
Print.
Tamm, Marcus. The poverty of children in Germany and its
impact on children's health and educational outcomes. Bochum:
Univ.-Bibliothek, 2007. Print.
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Prepared by: Chief Stephen D. Paulsell
Boone County Fire Protection District/Missouri Task Force 1
June 2003
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WHAT IS AN URBAN SEARCH AND RESCUE TASK
FORCE?
The national Urban Search and Rescue (US&R) Response
System is managed by FEMA

within the Department of Homeland Security. Within the system
are 28 urban search and
rescue task forces, sponsored by local fire departments. They
are under contract with FEMA
and are made available for response to catastrophic events
involving the collapse of heavy
steel and concrete construction throughout the United States and
its territories. While most
local fire departments are capable of affecting search and rescue
in light to medium
construction collapse, search and rescue demands in heavy
construction (heavy steel and
concrete) require a particularly high level of expertise coupled
with very sophisticated and
expensive search, rescue and support equipment.
THE HISTORY
In the late 1980’s, following a series of severe earthquakes in
California, Mexico and other
locations throughout the world, FEMA determined that there
was a significant deficiency in
our nation’s ability to respond to structural collapses in heavy
steel and concrete
construction. Building on some limited capability that had
already been developed in
California and with two OFDA sponsored international teams in
Fairfax Co., Virginia and
Dade Co., Florida. FEMA developed the concept of an urban
search and rescue system, to be
sponsored by selected local fire departments and supported by
the federal government.
Initially, 25 fire departments from throughout the United States
were selected from
competition and the development of a national response system

began. Over the course of the
next few years, as the result of minimal funding, development
was slow but deliberate. The
sponsoring agencies at the local level provided personnel,
training and varying levels of
equipment within local financial constraints.
The emphasis behind the development of the system was rooted
in a response mentality
directed at natural disasters such as earthquakes and hurricanes.
With the advent of the
Oklahoma City bombing, the Urban Search and Rescue System
found itself at the forefront
of the federal government’s response to terrorism, as well.
Deployments of federal urban search and rescue assets are
initiated in response to an
unexpected disaster such as an earthquake or act on terrorism,
in anticipation of a disaster
such as a hurricane or as a precaution where intelligence has
identified an increased threat
risk such as the Olympics or Presidential Inaugural. The
following is a chronological record
of federal task force deployments:
3
RECORD OF TASK FORCE ACTIVATIONS *
Hurricane Andrew — 08/1992
Hurricane Iniki — 09/1992
Typhoon Brian — 10/1992
Hurricane Emily — 08/1993

Northridge Earthquake — 01/1994
Hurricane Emelia — 07/1994
Oklahoma City — 04/1995
Hurricane Luis — 09/1995
Hurricane Marilyn — 09/1995
Hurricane Opal — 10/1995
Atlanta Olympic Games — 07/1996
Hurricane Bertha — 07/1996
Hurricane Fran — 09/1996
Humberto Vidal — 11/1996
Presidential Inaugural — 01/1997
DeBruce Grain Elevator — 06/1998
Hurricane Bonnie — 08/1996
Hurricane Georges — 09/1998
NATO Summit — 04/1999
Hurricane Floyd — 09/1999
UN Millennium — 09/1999
Worchester fire — 12/1999
MOBEX 2000 — 11/2000
TOPOFF I — 05/2000
OPSAIL 2000 — 07/2000
Presidential Inaugural — 01/2001
WTC / Pentagon — 09/2001
SLC Olympic Games — 02/2002
Shuttle Columbia — 02/2003
*Most activations involved multiple task forces and IST
deployments.
While funding has continued to be minimal, the Federal Urban
Search and Rescue Response
System has become the most effective of its kind in the world
largely due to the
overwhelming commitment and dedication of the sponsoring
agencies and their personnel

who have committed thousands of hours in program
development, preparation and delivery
of training programs, the development of operating guidelines
and equipment research and
development. There is a great deal of pride of ownership within
the system on the part of the
participants in the local fire departments that sponsor FEMA’s
urban search and rescue
program.
4
TODAY’S TASK FORCES
Upon a federal deployment authorized by a Presidential disaster
declaration, an urban search
and rescue task force deploys 70 highly trained personnel and
four search dogs, certified to
federal standards by FEMA. The 70 personnel are rescue
specialists, logistics specialists,
communications specialists, trauma surgeons, emergency
physicians, structural engineers,
hazardous materials technicians, nurses, management personnel,
safety personnel, heavy
equipment operators, technical information specialists and
planning specialists. Each of these
disciplines requires special backgrounds in training and
experience and each discipline also
maintains its own training regime. Under agreement with
FEMA, each task force must be
staffed three deep in each one of the 70 positions to insure

around the clock availability of all
specialty positions. In other words, each task force maintains
roster strength of 210
specialists to insure that at any given time, 70 can be called
upon to respond. It should be
noted that these personnel are all in place at the local level
employed either by the local fire
department or in an aligned vocation. They are not on the
federal payroll until such time as
the President authorizes activation. System wide, there are in
excess of 5880 personnel
available to the federal government at no direct personnel cost
until such time as they are
needed. This is an incredible value and a very special and
unique partnership that exists
between 28 local fire departments and the federal government.
Additionally, this partnership
combines the quick-strike mentality of local fire departments
with the superb support system
of the Federal Response Plan.

5
Below is an organizational chart of a task force during a
deployment, which delineates lines
of responsibility and control. It reflects duplicity in each of the
specialist positions. Task
forces are capable of around the clock operations by splitting
the task force into two 35-
member teams, which work in 12-hour increments.
A task force, upon deployment, is equipped to operate in a self-
sustaining mode for 72 hours.
Following 72 hours, within the Federal Response Plan, the
Department of Defense and U.S.
Forest Service is tasked with replenishing supplies to the task
force. For the first 72 hours,
these task forces come, not only with their technical search and
rescue equipment, but they
come with tents, sleeping bags, food, water, toilet facilities,
medicine and all other support
supplies and equipment necessary to function in an austere
disaster environment while not
creating additional support demands on the community that has
been impacted by a disaster.
The search and rescue equipment contained within the task
force consists of fiber-optic
cameras, seismic listening devices, concrete cutting chain saws,
heavy lifting capability, a
complete communications system, a complete weapons of mass
destruction protection unit, a
structural engineering unit and a complete emergency medical

unit. The equipment cache is
now in excess of 100,000 lbs. and requires three tractor-trailers
to transport the massive
equipment and logistical support cache. The total equipment
cache, inclusive of personal
equipment and weapons of mass destruction capability (to be
explained in more detail later)
is $3.25M.
Safety Officer (2)
Technical Search
Specialist (2)
Canine Search
Specialist (2)
Canine Search
Specialist (2)
Search Team
Search Team Mgr (2)
Heavy Rigging/Equip
Specialist (2)
Rescue Squad #4
1 Officer/5 Specialists
Rescue Squad #3
1 Officer/ 5 Specialists
Rescue Squad #2
Rescue Squad #1

Rescue Team
Rescue Team Mgr (2)
Haz Mat Specialist (4)
Haz Mat Specialist (4)
Haz Mat Team
Haz Mat Team Mgr (2)
Medical Specialist (2)
Medical Specialist (2)
Medical Team
Medical Team Mgr (2)
Communications
Specialist (2)
Logistics Specialist (4)
Logistics Team
Logistics Team Mgr (2)
Technical Information
Specialist (2)
Structural Specialist (2)
Plans Team
Planning Officer (2)
Task Force Leader

Assistant Task Force Leader
6
In addition to the 28 task forces, 3 Incident Support Teams
(ISTs) are maintained. These are
management teams similar to overhead teams deployed by the
U.S. Forest Service on major
wildfire campaigns. ISTs provide on-site coordination of
multiple task forces (there were 8
initially deployed to the World Trade Center and 4 to the
Pentagon) and also provide
interface and coordination with the local emergency resources
and local command structure.
They also initiate resupply and special resource needs. ISTs are
comprised of personnel from
within the task force system specially trained in respective
positions.
IST ORGANIZATION STRUCTURE
[Shading denotes IST-A response]

IST Safety
Officer
IST Liaison
Officer
IST Branch
Director
US&R
Task Force(s)
IST Division /
Group Supervisor
IST Operations
Section Chief
IST Situation
Unit Leader
IST Resource
Unit Leader
IST Documentation
Unit Leader
IST Demobilization
Unit Leader
IST Structures
Specialist
IST Geographic Info
System Specialist

IST US&R
Specialist
IST Planning
Section Chief
IST Communications
Unit Leader
IST Veterinary
Specialist
IST M edical
Unit Leader
IST Supply
Unit Leader
IST POA/M ob
Center Spclst
IST Transportation
Unit Leader
IST Facilities
Unit Leader
IST Logistics
Section Chief
IST Time
Unit Leader
IST Procurement
Unit Leader

IST Compensation /
Claims Unit Leader
IST Cost
Unit Leader
IST Administrative
Specialist
IST Finance/Admin
Section Chief
IST Leader
IST ESF-9
Leader
7
FUNDING
The funding history for such an expansive and critical program
has been drastically deficient
since its inception. The program has been funded through the
FEMA Disaster Relief Fund
(Fund Code 6). This is a discretionary fund managed by FEMA
Administration. Staff
salaries have been funded through FEMA Fund Code 9. The
US&R program has never
received a line item allocation.

Even in the early years, the equipment cache, alone, was valued
at just under $1.5M per task
force. Training expenses, maintenance expenses and personnel
expenses (Fair Labor
Standards Act applies) require the local sponsoring agencies
spend significant dollars to meet
the short falls created by inadequate federal funding.
Much of the equipment, over the years, has been acquired under
the Robert T. Stafford Act
during disasters when FEMA was in a position to authorize
additional equipment acquisition.
In 1987, two additional task forces were added to the program
to expand the system’s
capability in the central region of the United States and in 1999
an additional central region
task force was added, as well. When the task forces were added
in 1997, additional funding
was provided to quickly bring them to the same capacity as the
pre-existing 25 task forces.
This funding remained in Fund Code 6 after 1997, bringing
annual task force grants to
$150,000 per year per task force.
*Funding History
1990 $422,133
1991 $2,257,009
1992 $494,735
1993 $1,068,514 [NOTE: All figures do not include mission
response costs]
1994 $1,030,000
1995 $1,829,694
1996 $4,069,473

1997 $3,968,200
1998 $6,438,000 TFs began receiving $150,000 in grant
funding this year
1999 $6,438,000
2000 $6,438,000
2001 $10,238,000 (included original $3,800,000 for first
WMD TFs)
2002 $6,438,000
02/03 WMD $32,400,000 (supplemental — with $740,000 to
each TF grant)
2003 $6,400,000
2003 $60,000,000 (supplemental — with $800,00 to each TF
grant)
*Funding inclusive of FEMA US&R system support and task
force grants
It should be noted that, over the years, the fire departments that
sponsor these task forces
have made significant contributions in staff time, training time,
equipment and maintenance,
program administration and equipment acquisition. With
current and forecasted funding
shortfalls, it is becoming increasingly more difficult for local
governments to compensate for
federal funding shortfalls. Concrete cutting chainsaws valued at
$24,000 and fiber optic
cameras valued at $22,000 are not acquisitions normally found
in routine fire department
8
operations. Likewise, the overtime required (Federal Fair Labor
Standards Act-FSLA) for

specialized training is a budgetary impact that is becoming more
difficult for local
government to absorb.
TASK FORCE GRANT HISTORY
Year of Award
TASK FORCE FY
1991
FY
1992 FY 1993
FY
1994
FY
1995 FY 1996 FY 1997 FY 1998 FY 1999 FY 2000
Phoenix Fire Dept. $50,000 $10,000 $15,000 $0 $25,000
$32,000 $76,500 $80,000 $83,740 $150,000
Los Angeles City Fire Dept. $85,427 $10,000 $28,656 $0
$25,000 $45,500 $95,750 $80,000 $83,740 $150,000
Los Angeles County Fire Dept. $87,554 $10,000 $28,656 $0
$25,000 $32,000 $95,750 $80,000 $83,740 $150,000
Menlo Park Fire Dept. $100,000 $10,000 $28,656 $0 $25,000
$32,000 $95,750 $80,000 $83,740 $150,000
Oakland Fire Dept. $97,150 $10,000 $28,656 $0 $25,000
$45,500 $95,750 $80,000 $83,740 $150,000
Orange County Fire Dept. $100,000 $10,000 $28,656 $0
$25,000 $32,000 $95,750 $80,000 $83,740 $150,000
Riverside Fire Dept. $94,674 $10,000 $28,656 $0 $25,000
$45,500 $95,750 $80,000 $83,740 $150,000
Sacramento Fire Dept. $49,490 $10,000 $28,656 $0 $25,000

$32,000 $95,750 $80,000 $83,740 $150,000
San Diego Fire Dept. $95,942 $10,000 $28,656 $0 $25,000
$45,500 $95,750 $80,000 $83,740 $150,000
West Metro Fire Protect. Dist. $65,500 $10,000 $15,000 $0
$25,000 $100,000 $127,500 $80,000 $83,740 $150,000
Metro-Dade Fire Dept. $100,000 $10,000 $15,000 $0 $25,000
$32,000 $76,500 $80,000 $83,740 $150,000
City of Miami Fire Dept. $0 $0 $0 $0 $25,000 $0 $76,500
$80,000 $83,740 $150,000
Marion County Fire Dept. $45,000 $10,000 $15,000 $0 $25,000
$32,000 $76,500 $80,000 $83,740 $150,000
Montgomery County Fire Dept. $92,980 $10,000 $25,000 $0
$25,000 $32,000 $76,500 $80,000 $83,740 $150,000
City of Beverly $0 $10,000 $45,000 $0 $25,000 $32,000
$115,000 $80,000 $83,740 $150,000
Boone County Fire Protect. Dist. $0 $0 $0 $0 $0 $0 $500,000
$250,000 $83,740 $150,000
City of Lincoln $34,765 $10,000 $15,000 $0 $25,000 $32,000
$76,500 $80,000 $83,740 $150,000
Clark, County $75,000 $10,000 $15,000 $0 $25,000 $100,000
$115,000 $80,000 $83,740 $150,000
State of New Mexico $45,000 $10,000 $15,000 $0 $25,000
$100,000 $127,500 $80,000 $83,740 $150,000
NYC Fire, Police, EMS $100,000 $10,000 $25,000 $0 $25,000
$32,000 $76,500 $80,000 $83,740 $150,000
Jefferson County, OH $0 $10,000 $25,000 $0 $25,000 $0 0 $0
$0 $0
Miami Valley Fire/EMS
Alliance $0 $0 $0 $0 $0 $0 $500,000 $250,000 $83,740
$150,000

State of Pennsylvania $39,220 $10,000 $15,000 $0 $25,000
$100,000 $127,500 $80,000 $83,740 $150,000
Memphis/Shelby County EMA $97,750 $10,000 $15,000 $0
$25,000 $100,000 $127,500 $80,000 $83,740 $150,000
TEEX $0 $0 $0 $0 $0 $0 $0 $0 $0 $0
State of Utah $4,000 $10,000 $25,000 $0 $25,000 $100,000
$115,000 $80,000 $83,740 $150,000
Fairfax County Fire & Rescue $100,000 $10,000 $25,000 $0
$25,000 $32,000 $76,500 $80,000 $83,740 $150,000
Virginia Beach Fire Dept. $86,351 $10,000 $25,000 $0 $25,000
$32,000 $76,500 $80,000 $83,740 $150,000
Pierce/King Counties $100,000 $10,000 $15,000 $0 $25,000
$32,000 $76,500 $80,000 $83,740 $150,000
9
RECENT FUNDING EFFORTS – FY02 SUPP. & FY03
In response to the tragic events of September 11th, the Urban
Search and Rescue System were
activated and 8 task forces were immediately deployed to the
World Trade Center and 4 were
deployed to the Pentagon. After 10 days of operations, all task
forces were rotated and
replaced by additional task forces. The incredible value and

capability of the task forces
became well known throughout the country.
The events of September 11th also created a keen awareness of
our nation’s exposure to
terrorist attacks from conventional weapons and within the
evolving threat from weapons of
mass destruction. In February of 2002, the Senate
Appropriations Subcommittee on VA,
H.U.D and Independent Agencies heard testimony which spoke
to the value and challenges
of the urban search and rescue system and funding deficiencies
that had plagued the proper
development, maintenance and growth of the system for many
years. They also heard
concerns of the system’s inability to respond to structural
collapses in which weapons of
mass destruction were present (dirty bomb scenario).
As a result of these efforts, Congress authorized $32.4M in the
FY02 Supplemental Budget
to bring the 28 federal urban search and rescue task forces to a
weapons of mass destruction
level so that they could affect urban search and rescue functions
within a contaminated
environment. That evolution is presently in process as
equipment is being acquired and an
accelerated and aggressive training program is underway in all
28 task forces.
Additionally, in FY03, Congress authorized $60M to address the
following additional areas
that were also identified in February 2002. It should be pointed
out that the initial funding
proposal in FY03 (S2061) called for $160M. Following are
budget areas addressed by

Congress in recent FY02 Supp, FY03, current status and
remaining needs.
• Completion of Urban Search and Rescue Equipment Caches-
Prior to recent
funding increases, some of the 28 task forces had yet to be
equipped with the
complete equipment cache as specified by FEMA. Depending on
the deployment
history of the individual task forces (Stafford Act), equipment
acquisition has been
varied and inequitable. Funding was needed to insure that all 28
task forces were
operating with a complete equipment cache as identified by
FEMA.
As a result of the FY03 funding, the annual individual task
force grants will allow
task forces deficient in equipment to complete their response
cache. No further
funding in this regard is required.
• Weapons of Mass Destruction for the Task Forces – All
FEMA US&R task
forces must be capable of operating in an environment
contaminated by weapons of
mass destruction. With the increased threat of terrorism, the
potential for an attack
using a conventional device wrapped with a WMD material
(dirty bomb scenario) is
magnified. Task forces must be provided with chemical,
biological and nuclear
testing and protective equipment, coupled with thorough
training, to insure that they

can affect search and rescue in a contaminated environment.
10
As a result of the $32.4M allocated in FY02 Supplemental, an
aggressive equipment
acquisition and training program is presently underway and
should be complete by
Sept. 2003. No further initial funding is required however; as
will be discussed in a
following section on task force grants, maintenance of this
equipment cache, training
and medical assessment of task force personnel consistent with
federal law is very
costly and an annual recurring expense.
• Establish Second Equipment Cache for All Task Forces-
Following the events of
September 11, there was some interest in Congress regarding
expanding the number
of task forces (24 of the 28 task forces were used over a three
week period in
response to the events of Sept. 11). In response, concern was
expressed to Congress
from within the system that additional task forces would dilute
the ability of the
existing 28 to maintain proficiency due to increased lack of use.
As an alternative, it
was agreed by the system and Congress that the most efficient
expansion process,
from a financial and expediency standpoint, was to develop a

second equipment
cache for each of the existing 28 teams. Under the terms of
agreement with FEMA,
all task forces must be staffed 3-deep in each position to assure
constant availability.
In other words, each task force deploys 70 personnel and 140 do
not deploy. With
the addition of a second cache, each task force could field a
second task force using
personnel already trained and equipped with personal safety
gear, thus doubling
system capacity from 28 to 56 task forces without doubling the
expense.
A second equipment cache will also allow a task force to
maintain its rigid training
schedule without rendering its primary response cache out of
service. Presently, all
task force caches must be kept packaged to military standards
for immediate airlift.
Training programs cause the packaging system to be broken
down, slowing a
response to a disaster. Additionally, some task forces located in
major cities, since
September 11, are more reluctant to allow their task force to
leave their community
as their task force might be needed there in the event of a local
terrorist attack. The
second cache would insure availability of all task forces,
regardless of local threat
levels or perceptions.
Funding in FY03 will allow partial funding (approximately
30%) of the second
US&R caches. Below are costing calculations for the second
cache. Note, as agreed

to with Congress, that there is no additional costing for personal
protective
equipment as existing task force personnel already have it
assigned. It should also be
noted, as also agreed, there is no allowance for additional
training or administrative
expense for additional personnel as there would be if additional
teams were added.
The cost avoidance to the federal government is estimated at
$49M.
An additional $50M is needed to bring the second equipment
cache in each task
force up to the required level to insure duplicity in the system
and achieve the depth
of response initially desired by Congress.
11
2003 US&R Equipment Cache List Component Costs (in final
approval process)
Rescue Component $355,156
Medical Component $216,937
Technical Component $153,233
Communications Component $546,997
Logistics Component $1,593,166
Planning Component $518
WMD Component $550,000
CACHE TOTAL $2,021,719

As a result of duplicate cache acquisition, the system will
double in capacity without
incurring the following expenses:
Personal Gear $844,288
Training (initial) & Admin $500,000
Transportation $400,000
TOTAL SAVINGS $1,744288 X 28 = $48,840,064
• Annual Task Force Grants- Since FY00 and until FY02 and
FY03, task forces
have been receiving $150,000 annually from FEMA to operate,
maintain and train
these critical teams. In years prior to FY00, funding was much
less. This is very
inadequate. Current projections, based on local requirements,
indicate that the task
forces, to operate effectively, provide proper training and
management, replace and
maintain aging and worn equipment, take advantage of new
technology, properly
warehouse the equipment cache, develop effective training
environments and
conduct mobilization exercises and drills is $1.3M.
Much of the search, rescue and support equipment in the task
force cache is used in
highly demanding environments and/or has shelf lives. It is
estimated that 10% of
the cache warrants replacement each year and yet, with annual
grants of $150,000,

this has been unachievable. Additionally, task forces have not
been in a position to
take advantage of evolving technology and have been forced to
operate with radio
and computer technology over 12 years old.
Program staffing — $225,000 [75% funding for TF Program
Manager
and Cache Manager — $150,000 each
X 2 = $300,000 X 0.75 = $225,000]
Program management — $150,000
Program training — $200,000
Equipment acquisition — $200,000
Storage/maintenance — $300,000
Medical screening/physicals — $200,000
TOTAL $1,275,000
Inclusive within these calculations are accommodations to
support the weapons of
mass destruction capability. With the expansion of capability to
include weapons of
mass destruction operational capability, the annual operating
costs have increased
significantly. Over $550,000 worth of highly specialized WMD
equipment is being
12
added to each task force. Much of the environmental
monitoring and testing
equipment requires periodic calibration, chem-bio suits require

testing and periodic
replacement, training expenses are extremely high as chem-bio
suits in some cases
can not be reused and many of the pharmaceuticals must be
periodically replaced.
Additionally, OSHA requires that all personnel must receive
extensive annual
medical exams. It is estimated that maintenance and support for
the WMD
component, alone, is $187,000 annually per task force.
The FY03 budget, as presently programmed, will provide annual
grants of $800,000
for each task force. While a significant improvement over the
$150,000 of the past,
the grants will continue to fall short of true funding
requirements. An annual
allocation of $35M for task force grant is required to properly
support these units.
• Ground Transportation- Within the federal response plan,
Department of Defense
airlift assets have historically transported the federal
government’s urban search and
rescue task forces to the site of a catastrophic event. In recent
deployments,
specifically the World Trade Center and the Pentagon, it was
determined that in
many instances, particularly with the geographic spread of the
task forces, if task
forces were provided with dependable and appropriate ground
transportation assets,
task forces could be pre-loaded and could respond by road, in
most cases, quicker
(and cheaper) than they could respond by air. This is also

essential due to the
increasing unavailability of military airlift assets (airlift
requires 3-4 military C-130s
or C-141s) as a result of military downsizing and ongoing
military activities
overseas.
Funding provided in FY03 will insure that all 28 task forces
will have solid ground
transportation assets readily available as opposed to relying on
borrowed, leased or
surplus trucks upon activation. No further funding, in this
regard, is required
however; increased annual task force grants would provide
maintenance, insurance,
etc.
• Urban Search and Rescue System Support - The FEMA Urban
Search and Rescue
Division is tasked with support and coordination of the response
system. Funding
allocated from FY03 ($60M), Fund Code 6 and Fund Code 9
within FEMA’s annual
budget is $10M. With the additional funding provided in FY03,
support has been
enhanced (for one year) however; additional staff is needed to
insure timely
responsiveness to task force needs and system enhancement. To
adequately support
the system, an annual allocation of $10.5M is required.
• International Response – As we move to enhance our
homeland security, the

vulnerability of our facilities abroad and those of our allies will
increase. Presently,
two of the 28 task forces are equipped and maintain agreements
with the Office of
Foreign Disaster Assistance within the State Department to
respond outside the
United States. We do not believe this is adequate and steps
should be taken to
facilitate the overseas deployment of any of the task forces
should they be needed on
foreign soil.
13
This will involve the acquisition of additional logistical
supplies, provision of
passport acquisition, immunizations and an adjustment in the
State Department’s
philosophy regarding the need for additional teams for
international deployment.
This issue was addressed before the Senate in February 2002
however; no funding
was provided within the FY03 package due to limited funding
and domestic
priorities. The cost of this system enhancement is an initial
capital allocation of $5M
to acquire additional logistical support items and an annual
operating allocation of
$8.4M to maintain international immunizations, passports, etc.

14
FUNDING SUMMARY - NEED
Domestic Response
One Time Expenditure – For the completion of second
equipment caches to be used for
domestic response: $50M
Annual Recurring Expense – For annual task force grants and
System Support (FEMA) for
domestic response: $45.5M
International Response*
One Time Expenditure – For upgrade of response caches for
international response: $5M
Annual Recurring Expense – For task force and personnel
expenses: $8.4M
*This may be a State Department (OFDA) issue.
PROPOSED FY04 FUNDING (OMB)

This year, in the FY04 budget process, OMB has sent forward a
budget recommendation for
the Urban Search and Rescue Program of $6.4M to Congress.
This translates into annual
grants to the task forces of, again, $150,000 per year per task
force and no improvement in
the support offered from FEMA Headquarters. While the $60M
allocation in FY03 is
providing task forces with badly needed enhancements to the
program, original budget
language contained in S2061, sponsored by Senator Christopher
Bond of Missouri, was for
$160M. Clearly, we continue to fall short of our required
funding levels to maintain and
enhance the system.
15
LEGISLATIVE NEEDS
National Urban Search & Rescue Response System Act of 2003:
Protecting the Nation’s Urban Search & Rescue Personnel
Background
In 1989, FEMA created the National Urban Search & Rescue
Response System1 (National
System) to provide assistance in the event of a Presidential
Declaration of Disaster or

Emergency. This assistance includes locating, extracting and
providing on-site medical
treatment to victims trapped in collapsed structures.
The National System relies on the expertise of local fire
department and emergency response
personnel (System Members), who are trained and organized
into Urban Search and Rescue
(US&R) “Task Forces.” Upon activation by the Department of
Homeland Security, System
Members perform search and rescue operations, such as
collapsed structure search and rescue
operations, incident management, and other emergency
operational activities. Because the
National System utilizes local emergency personnel employed
by local governments for
relatively short-term assignments, System Members serve as
temporary federal resources.
A fundamental principle of the National System is that the local
fire department and
emergency personnel are concurrently employed by DHS and
the Task Force sponsor, which
prevents the workers from suffering a break in their service to
their usual employer when
acting as temporary federal resources. The local fire
department and emergency personnel
receive pay and benefits from their usual employers, and their
usual employer is then
reimbursed by DHS for their time.
The Problem
The creation of the National System, while directed by Congress
in the Earthquake Hazards
Reduction Act of 1989, was never specifically authorized by
either that Act, or FEMA’s

authorizing statute, the Stafford Act. As a result, important
protections – primarily workers’
compensation and tort and professional liability coverage –
remain ambiguous.2 Without
these protections, System Members, and the State and local
governments who sponsor their
federal service, could face crushing financial liability in the
event of a line-of-duty injury or
death, or a lawsuit. These workers, called upon to respond
immediately to disasters and
emergencies in communities across the country, could find
themselves without Federal
workers’ compensation and tort liability protections.
The
Solution
The National Urban Search & Rescue Response System Act of
2003 (proposed)
By specifically authorizing and describing the National System
by amending the Stafford Act,
the proposed bill would ensure that System Members are
afforded federal workers’
compensation and tort liability protections, and sponsors of
US&R Task Forces are shielded
from crushing financial liability.

1 FEMA established the National System under authorities
provided by the Stafford Act, and this
authority has now been transferred to the Department of
Homeland Security (DHS).
2 Specifically, coverage under the Federal Employees’
Compensation Act, 5 U.S.C.§§ 8101 et seq.
(“FECA”) and the Federal Tort Claims Act, 28 U.S.C.§§ 2671 et
seq.
THE ACCREDITATION COUNCIL OF TRINIDAD AND
TOBAGO
(ACTT)

Level 3, Building B
ALGICO Plaza
91-93 St Vincent St, Port of Spain
Trinidad and Tobago, West Indies
TEL: 623-2500/8620
FAX: 624-5711
REPORT ON GAP ANALYSIS
CONDUCTED ON
THE APPLICATION FOR REGISTRATION
SUBMITTED BY

EMERGENCY TRAINING INSTITUTE OF
TRINIDAD AND TOBAGO
rev 3
2
Institution: Emergency Training Institute of Trinidad and
Tobago (ETITT)
Date: 30th October, 2008
The Nature of the gap analysis review and the conclusion:
A gap analysis is conducted on the application for registration
submitted by the institution. The

purpose of this review is to determine whether the institution
has presented sufficient evidence to
satisfy the criteria and standards for registration. If the desk-
top review reveals that sufficient
evidence has been presented, an on-site visit is conducted and
then a recommendation as to whether
registered status should be granted is made to the Board of
ACTT. The decision by the Board to
grant or not grant registered status to an institution is based on
the outcome of the gap analysis
AND the results of the on-site visit. Institutions that meet the
criteria for registration will be placed
on a register kept by the ministry responsible for post secondary
and tertiary education.
Analysis and Conclusion

___ Sufficient narrative, documentation or other supporting
evidence have been provided to show
that the requirements for this standard have been met.
___ Additional narrative, documentation or other supporting
evidence are needed to satisfy the
requirements of the standard.
___ The narrative, documentation or other supporting evidence
submitted show that the
requirements for this standard have not been met.
rev 3

3
Background
The Emergency Training Institute of Trinidad and Tobago
(ETITT) is a newly founded emergency
training and education organisation established in 2004. The
company has over 30 years of
Emergency Medical Services (EMS) and related experience
amongst its Directors. ETITT’s
philosophy is to work with its clients and customers in
planning, developing, implementing and
monitoring its training programmes.
To date, the institution has trained over four hundred personnel
as Emergency Medical Technicians
(EMTs) – Basic. Many are employed with public and private
ambulance services and over three
hundred are certified by the National Registry of EMT, the USA
testing and certifying body of EMS
professionals.

rev 3
4
A post secondary or tertiary institution seeking registration with
ACTT must
meet the requirements of these standards and criteria for
registration.
Criterion 1.0 Legal, Policy and Regulatory Requirements
Criterion Statement: The institution’s activities comply with
legal, policy and regulatory
requirements
Standard 1.1: The institution has been established as a legal
entity.

Comments ( ):
Sufficient narrative, documentation or other supporting
Additional narrative, documentation or other supporting
FINDINGS:
The Emergency Training Institute of Trinidad and Tobago
(ETITT) has submitted:

1. a narrative which states:
a. it has been established as a legal entity. It is in full
compliance with the legal
regulations that govern such institutions
b. the Certificate of Registration, number BN77-112, dated 12th
May, 2004 is attached
2. its Certificate of Registration, bearing the name Emergency
Training Institute of Trinidad
and Tobago, from the Registrar General’s Office dated 12st
May, 2004, with Certificate No.
BN77-112 and Computer ID No. 4109622 (Appendix 1-A)
rev 3
5

Standard 1.2: The institution demonstrates the ownership of,
and
responsibility for, assuring access to the learning facilities that
support and facilitate the learning expected of its students.
Comments ( ):

FINDINGS:
ETITT has submitted:
a. the current layout of the facility ensures that the institution
supports and facilitates
the learning expected of its students
b. it guarantees that the infrastructure provides for adequate
ventilation, lighting,
comfort and space allocations
c. an evacuation plan for each type of emergency has been
developed and is located in
the HS&E Manual
d. the fire evacuation plan and a copy of the floor plan is
located on the walls
throughout the facility

e. the evacuation plans are reviewed with all students at the
beginning of each
programme
2. its Fire Evacuation Plan and Facility Layout (Appendix 1-C)
3. its Health, Safety and Environment (HS&E) Policy Manual
(Appendix 4-A) outlines:
a. General Emergency Planning and Evacuation – section 1-7.1
b. Severe Weather – section 1-7.2
c. Bomb Threat – section 1-7.3
d. Earthquakes – section III
Follow-up required:
ETITT should submit evidence which includes but may not be
limited to evidence of ownership of
the premises which it occupies.
ACTT’s evaluators will verify the adequacy of occupant
comfort, lighting and ventilation in
ensuring health and safety.

rev 3
6
Criterion 2.0 Governance and Administration
Criterion Statement: The corporate governance body and
management actively show its
commitment to achieving the development and continual
improvement of the Quality Management System.
Standard 2.1: Institution has a governance structure.
Comments ( ):

FINDINGS:
a. the institute is managed by two (2) Directors – the
International Relations Director
and the Training & Education Director
b. the Human Resources (HR), Administration & Information
Technology (Admin &

IT) and Health, Safety and Environment (HS&E) Coordinators
report to the
International Relations Director, while the Program Medical
Director, Course
Coordinator and Quality Assurance (QA) Coordinator report to
the Training and
Education Director
c. the distribution of authority, responsibilities and
relationships is clearly defined in
the organisation’s Quality Manual
2. its Quality Manual (Appendix 2-A), section 2.3 outlines the
authority and responsibilities
for:
a. Directors
b. International Relations Director
c. Training & Education Director
d. HR Coordinator
e. Admin & IT Coordinator
f. HS&E Coordinator
g. Program Medical Director
h. Course Coordinator/Primary Instructor

i. QA Coordinator
j. Accountant
rev 3
7
Follow-up required:
limited to:
1. a clearer narrative which explains:
a. the working and reporting relationships between the Board
and the administration
b. the relationship between the Board and any external
stakeholder body or interest
group to which the Board is accountable

2. the highlighted sections of its policies and procedures for the
Board of Directors (e.g. bye-
laws) that give the Board authority to (among other things):
a. establish and review basic policies
b. ensure the financial integrity of the institution
c. meet regularly
d. gain access to the information necessary for sound
judgements
rev 3
8
Standard 2.2: Institution has a documented Vision Statement.
Comments ( ):

FINDINGS:
a. it has ensured that the vision statement has been established
and is consistent with its
philosophy

b. the vision is communicated to stakeholders and will be
reviewed annually for
suitability and effectiveness
c. the vision statement is located in the Quality Manual (ETITT-
01) Section 1.1
d. the Procedure for Quality Management (ETITT-02) section
5.3 defines the review of
the vision statement as being annually or as determined by top
management
2. its Quality Manual (ETITT-01) (Appendix 2-A) which states
its vision statement:
“To be the leader in the provision of quality EMS and Medical
Disaster educational
programme both locally and regionally.”

rev 3
9
Standard 2.3: Institution has a documented Mission Statement.
Comments ( ):

FINDINGS:
a. the institution ensured that the mission statement has been
established and is
consistent with its philosophy
b. the mission is communicated to stakeholders and will be
reviewed annually for
suitability and effectiveness
c. the mission statement is located in the Quality Manual
(ETITT-01) Section 1.1
d. the Procedure for Quality Management (ETITT-02) section
5.3 defines the review of
the mission statement as being annually or as determined by top
management
2. its Quality Manual (ETITT-01) (Appendix 2-A) which states
its mission statement:

“The Emergency Training Institute of Trinidad and Tobago is
committed to serving
in a leadership role in the enhancement of comprehensive EMS
related and disaster
medical training and educational programmes. We will ensure
the provision of
quality, affordable and professional programmes through our
commitment to
accountability, quality improvement, collaboration and
cooperation among
providers.”
rev 3
10
Standard 2.4: Institution has an approved current Organisational
Structure

with supporting text that clearly identifies the role and
responsibilities of all personnel.
Comments ( ):
FINDINGS:

a. it has an approved and current organisational chart that
reflects roles and key
responsibilities
b. the organisational chart is located in the Quality Manual
(ETITT-01) section 2.2
c. job descriptions have been defined for all key personnel
identified on the
organisational chart. It is maintained by the HR Coordinator
and/or Director
International Relations in the respective employee files
2. its approved Organisation Chart dated 15th August, 2005
(page 12, Appendix 2.A)
3. the authority and responsibilities for the following personnel
in the Quality Manual, section
2.3 (Appendix 2-A):
a. Director - section 2.3.1
b. International Relations Director – section 2.3.2

c. Training & Education Director – section 2.3.3
d. HR Coordinator – section 2.3.4
e. Admin & IT Coordinator – section 2.3.5
f. HS&E Coordinator – section 2.3.6
g. Program Medical Director – section 2.3.7
h. Course Coordinator/ Primary Instructor – section 2.3.8
i. QA Coordinator – section 2.3.9
j. Accountant – section 2.3.10
rev 3
11
Criterion 3.0 Quality Management System
Criterion Statement: The institution has a well-planned Quality
Management System

that is in keeping with its vision, mission, policies, processes,
organisational structure, responsibilities and resources, in order
to
assure the quality of educational outcomes.
Standard 3.1: Institution has a documented Quality Policy.
Comments ( ):

FINDINGS:
a. it has developed a Quality Policy that is appropriate to its
vision and mission
statements
b. the Quality Policy is communicated to stakeholders and will
be reviewed annually
for suitability and effectiveness
c. it is located in the Quality Manual (ETITT-01)
2. its approved quality policy dated 15th August, 2005
(Appendix 3-A)

rev 3
12
Standard 3.2: Appropriate personnel have been assigned the
duty of
establishing, implementing and maintaining the institution’s
Quality Management System (QMS).
Comments ( ):

FINDINGS:
a. the Training and Education Director has the authority and
responsibility for the
implementation, effectiveness and continuous improvement of
the QMS
b. the QA Coordinator has the day to day responsibility for the
QMS and functions as
the Management Representative
2. its Quality Management System Structure (Appendix 3-D)
Follow-up required:

limited to the résumé and job
descriptions for personnel assigned the duty of establishing,
implementing and maintaining the
QMS.
rev 3
13
Standard 3.3: Institution has documented student policies to
ensure that
quality services are delivered to them.
Comments ( ):

FINDINGS:
a. a Students’ Policy Manual has been developed which defines
the numerous policies
governing the students

b. an Equity and Diversity Policy has been developed and
implemented to ensure that
there is no discrimination of applicants and students
2. its Students’ Policy Manual (Appendix 3-E) outlines various
policies, such as:
a. Student Admissions and Registration – page 4
b. Student Rights and Responsibilities – page 10
c. Equity and Diversity Policy – page 12
d. Harassment and/or Discrimination – page 30
e. Student Discipline – page 50
f. Student Appeal – page 53
rev 3
14

Criterion 4.0 Resource Management
Criterion Statement: The resources essential to the institution’s
operational activities
are identified and available.
Standard 4.1: Institution has established and documented
policies and/or
procedures relating to the management of its resources.
Comments ( ):

FINDINGS:
a. the institution has developed and implemented a Policy
Manual for Health, Safety
and Environment (HS&E), a Procedure for Human Resources
Development, a
Procedure for Infrastructure Maintenance and a Financial Policy
b. the HS&E Policy Manual (ETITT-13) provides direction to
members for the
maintenance of safety awareness in programmes and within the
institute facilities

c. the Procedure for Human Resources Development (ETITT-08)
has been developed
and implemented to manage the human resources of the
institution. The procedure
defines the selection, training and evaluation of employees
d. the Procedure for Infrastructure Maintenance (ETITT-10) has
been developed and
implemented to govern the planning and recording of building
infrastructure and
includes all maintenance activities, predictive and preventative
and the general
maintenance and enhancement of the physical learning
environment to meet the
needs of key stakeholders
e. the Financial Policy (ETITT-09) defines the controls of cash,
income, treasury
management, payments, purchasing and payroll
2. its HS&E Policy Manual (Appendix 4-A)
3. its Procedure for Human Resources Development (Appendix
4-B)
4. its Procedure for Infrastructure Maintenance (Appendix 4-C)
5. its Financial Policy Manual (Appendix 4-D)

rev 3
15
Standard 4.2: Members of staff are competent on the basis of
appropriate
education, skills and work experience to perform their teaching
functions as they relate to quality programme delivery in the
institution.
Comments ( ):

FINDINGS:
a. employees’ files have been created and include the relevant
job descriptions,
academic qualifications and records
b. files are maintained by the HR Coordinator and/or the
Director International

Relations
2. curriculum vitae for three primary instructors (Appendix B of
additional evidence):
a. Karla Reid
b. George Fitzgerald Hazel
c. Brent Murphy
Follow-up required:
limited to:
1. a clearer narrative explaining how members of the teaching
staff are competent on the basis
of appropriate education, skill and work experience to perform
their teaching functions, such
as level of qualification and experience required
2. a table of all lecturers indicating their name, position,
programme teaching, highest level of
qualification and relevant work experience

ACTT’s evaluators will review all résumés and job description
for the teaching staff during the site
visit.
rev 3
16
Standard 4.3: Institution has established and documented a
procedure for
maintaining its infrastructure.
Comments ( ):

FINDINGS:
1. a narrative which states that a Procedure for Infrastructure
Maintenance has been developed
and implemented to govern the planning and recording of
infrastructure maintenance
2. its Procedure for Infrastructure Maintenance (Appendix 4-C)

rev 3
17
Standard 4.4: Institution offers reliable access to student and/or
guidance
counseling services, whenever needed.
Comments ( ):

FINDINGS:
a. career counseling is provided by instructors and Directors of
the institution and
psychological support service is outsourced from the Franklyn
Dolly and Associates
b. it is in the process of developing a web-based distributive
learning which will afford

students the opportunity to have access to learning materials
and courses off site
c. its Students’ Policy Manual had been developed which
defines the numerous policies
governing the students
2. its Student Policy Manual (Appendix 3-E)
3. its Guidance and Counseling Services Policy (Attachment C
of additional evidence)
Follow-up required:
limited to:
1. a formal agreement between the institution and Franklyn
Dolly and Associates
2. access to Health Care Services

rev 3
18
Standard 4.5: Physical resources are relevant and sufficient to
meet the
institution’s needs.
Comments ( ):

FINDINGS:
1. a narrative which states that physical resources include three
spacious air conditioned
classrooms equipped with multi-media, a storage room for
medical equipment and supplies
for training, a reception area, an administrative office,
kitchenette and washroom facilities
2. its Floor Plan (Attachment D of additional evidence)
Follow-up required:

TCC should submit evidence which includes but may not be
limited to:
1. a clearer narrative explaining how the institution meets the
requirements of this standard
2. the relevancy and sufficiency of its physical resources in
meeting its needs
rev 3
19
Standard 4.6:
Management of the institution plans, makes available and
controls the financial resources which are necessary for

achieving the institution’s objectives.
Comments ( ):
FINDINGS:

a. the financial resources are controlled through the policies
developed in the Financial
Policy Manual
b. the procedure for purchasing is documented in the Financial
Policy Manual
2. its Financial Policy Manual (Appendix 4-D) which gives
details:
a. Cash Controls
b. Income
c. Treasury Management
d. Payments
e. Purchasing
f. Payroll
g. Property, Plant and Equipment
h. Password Controls and Security
i. Back Ups
j. General Safety
k. Steps to Follow in a Robbery
3. its Financial Statements as of 30th November, 2007 and
Proposed Budget 2008 (Appendix 4-

E)
rev 3
20
Criterion 5.0 Teaching-Learning Process
Criterion Statement: The institution has a plan for the various
stages in its teaching-
learning process.
Standard 5.1: Institution has established and documented an
overall Quality
Plan for its teaching-learning process.

Comments ( ):
FINDINGS:
a. it currently offers multiple continuous education courses and

two certificate
programmes in the area of pre-hospital professions with the
intention of increasing
the offering to four in 2008
b. current programmes – Medical First Responder and
Emergency Medical Technician
– Basic. The curriculums used are from the United States of
America Department of
Transportation (DOT) National Standard Curriculum
c. upon successful completion graduates receive certification
from Creighton
University EMS Education
d. in selecting which programmes and courses to deliver,
management first determines
that there is a need for the programme
e. it has a procedure for programme development which details
the initial programme
design, development and approval process;
verification/validation of new or revised
programmes and curriculum delivery plan

f. the Annual Program Review Document is completed for each
programme by the
Course Coordinator and evaluates:
i. programme planning and institutional effectiveness
ii. curriculum and instructional objectives
iii. personnel
iv. student demographics
v. student satisfaction
vi. instructional material and supplies
rev 3
21
vii. facilities and equipment
g. the Standard Course/Programme Syllabus Form and Standard
Programme
Specification provide a standard format for developing

course/programme syllabus
and programme specifications document
h. in addition to the annual review, programmes and courses are
continuously
monitored for progress. Records of the status of the delivery
are kept by the Course
Coordinator on the Daily Synopsis Form
2. its Procedure for Comprehensive Program Development and
Revision (ETITT-15
(Appendix 5-A)
3. its Annual Program Review Document (ETITT-15-03)
(Appendix 5-B)
4. its Standard Course/Program Syllabus Form (ETITT-15-04)
(Appendix 5-C)
5. its Standard Program Specifications (ETITT-15-01)
(Appendix 5-D)
6. its Daily Synopsis Form (ETITT 15-02) (Appendix 5-E)
Follow-up required:

limited to:
1. the formal agreement with Creighton University EMS
Education.
2. its procedure for programme monitoring
rev 3
22
Standard 5.2: Curricula have been designed and developed to
enable students
to achieve the intended learning outcomes.

Comments ( ):
The narrative, documentation or other supporting evidence
FINDINGS:
a. it follows the US National Standard Curriculum which

includes a comprehensive
instructional guide to delivering all aspects of the programme
b. the curriculum delivery plan for the Emergency Medical
Technician – Basic and
Medical First Responder can be found on the following
websites:
i. EMT Basic:
www.nhtsa.dot.gov/people/injury/ems/pub/emthnsc.pdf
ii. Medical First Responder:
www.nhtsa.dot.gov/people/injury/ems/pub/frnsc.pdf
c. guided by the US National Standard Qualification and an
understanding of the local
requirements, programme specifications and a course syllabus
were developed for
the Medical First Responder and EMT-Basic programme
2. currents programmes are:
a. Certificate in Medical First Responder
b. Certificate in Emergency Medical Technician – Basic
3. the Medical First Responder Program Specifications and

Syllabus (Appendix 5-F)
4. the Emergency Medical Technician – Basic Program
Specifications and Syllabus (Appendix
5-G)
5. programme specifications (Attachment A of additional
evidence) for:
a. Emergency Medical Technician – Intermediate
b. Emergency Medical Technician – Paramedic
These programmes are in the final planning stages and are
expected to be implemented in
early 2009.
http://www.nhtsa.dot.gov/people/injury/ems/pub/emthnsc.pdf
http://www.nhtsa.dot.gov/people/injury/ems/pub/frnsc.pdf
rev 3

23
Please be advised that as stated under section 29 sub-section (1)
of Act No. 16 of 2004 as
amended by Act No. 10 of 2008, ‘institutions lawfully
performing their functions in
Trinidad and Tobago at the commencement of this Act shall, for
the period of five years
thereafter, be deemed to be authorised to continue to perform
such functions, provided that
no such institution shall advertise or offer to the public any new
courses or programmes
without the prior approval of the Council.’
rev 3
24

policies for the
teaching-learning process.
Comments ( ):

FINDINGS:
a. its Students’ Policy Manual has been developed which
defines the numerous policies
governing the teaching learning process
b. student orientation sessions generally provide students with a
broad range of
information on the institute, the programmes, what is expected
from students and the
various services provided
2. its Students’ Policy Manual (ETITT-11) (Appendix 3-E)
gives details on the following:
a. Student Admission and Registration
b. Students Rights and Responsibilities
c. Change of Personal Information
d. Equity and Diversity Policy
e. Academic Progress
f. Intellectual Property

g. Establishing, Implementing and Monitoring Agreements for
Accommodating
Learners with Disability
h. Harassment and/or Discrimination
i. Class Dress and Required Uniform Policy
j. Student Attendance
k. Leave of Absence
l. Smoking Policy
m. Alcohol and Dangerous Substances Policy
n. Parking Policy
o. Pregnancy Policy
p. Class Cancellation Policy
q. Code of Conduct for Learners
r. Student Misconduct
s. Student Discipline
rev 3
25

t. Student Appeal
u. Readmission and Reinstatement
v. Grade Reporting
w. Disclosure of Educational Records
x. Record of Request for Disclosure of Educational Records
y. Correction of Educational Records
z. Payment Policy for (Individuals) Diploma/Certificate
Program
aa. Payment Policy for (Companies) Diploma/Certificate
Program
bb. Payment Policy for Short Term/Continuing Education
Courses
rev 3
26
Criterion 6.0 Review

Criterion Statement: The institution’s management reviews the
Quality Management
System at planned intervals to ensure that it is suitable,
adequate
and effective. Records of the review are kept.
Standard 6.1: Institution’s management has established a
process for collecting
appropriate information.
Comments ( ):

FINDINGS:
a. within the institution, an internal auditing system has been
developed and
implemented which reviews the internal quality procedures and
policies for
conformance and areas of improvement
b. the Procedure for Internal Audits defines the schedule,
conducting, reporting and
close out of internal audits
c. internal audits are planned to determined whether operating
activities conforms to

the requirements of the institution’s QMS and whether the QMS
has been effectively
implemented and is being maintained
d. the internal audits are conducted at least once each year
e. for each audit, a trained auditor will be selected and shall be
a person who is
independent of the activity being audited
f. findings will be discussed with the auditee and agreed upon
2. its Procedure for Internal Auditing (ETITT-06) (Appendix 6-
A)
rev 3
27

Standard 6.2: Institution has reliable methods for monitoring
and measuring
stakeholder satisfaction.
Comments ( ):
FINDINGS:

a. at the end of each programme, each student is required to
complete the EMS
Education Program Student Feedback Form which seeks
information on the course,
examination and instructors
b. similarly at the end of each programme, once applicable, a
Stakeholders’ Feedback
Survey is sent to the relevant organisation that requested the
training
c. both surveys are defined in the Procedure for Measuring
Stakeholders’ Satisfaction
2. its Student Feedback Survey (ETITT-07-01) (Appendix 6-C)
3. its Stakeholders Feedback Survey (ETITT-07-03) (Appendix
6-D)
4. its Procedure for Measuring Stakeholders’ Satisfaction
(ETITT-07) defines both surveys

(Appendix 6-E)
rev 3
28
methods for
monitoring student learning outcomes.
Comments ( ):

FINDINGS:
a. assessment is an ongoing process aimed at understanding and
improving student
learning
b. assessment methods and schedules are implemented

according to the demands of a
particular programme or course
c. student assessment and progress are recorded and regularly
reviewed
d. skills assessments sheets for all practical components are
distributed to students
during orientation
e. in order to successfully complete the programme
requirements students will be
required to demonstrate competence in all practical skills
f. all assessment records must be maintained, used and disposed
of in accordance with
the procedures and guideline of ETITT-03. All official records
must be retained for
seven (7) years, after which time the records will be archived in
a format that is free
from deterioration
2. its Practical Assessment Sheets for Cardiac Arrest
Management and Patient
Assessment/Management – Trauma (Appendix 6-H)

3. its Procedure for the Control of Quality Management System
Documentation (Appendix 6-I)
Follow-up required:
limited to its procedure for the
control of assessment records.
rev 3
29
Criterion 7.0 Continuous Improvement

Criterion Statement: The institution continually reviews its
Quality Management
System.
Standard 7.1: Institution has documented a process to address
all activities
that do not comply with established criteria and standards for
registration.
Comments ( ):

FINDINGS:
a. inputs to the management review meeting shall include, but is
not limited to the
following: results of audits, customer feedback, process
performance, product
conformity, status of preventive and corrective actions, follow-
up actions from
previous management review changes that could affect the QMS
and
recommendations for improvement
b. output of the management review meeting shall include, but
is not limited to the
following: improvement of the effectiveness of the QMS and its

processes,
improvement of product related to customer requirements and
resource needs
c. the Procedure for Corrective and Preventative Action has
been developed and
implemented to handle the identification and processing of
detected or potential non
compliances or problems arising in the institution’s operations
d. corrective action is taken to eliminate the cause of a detected
non-conformity or
other undesirable situation
e. processing of corrective and preventive actions is handled by
the Training &
Education Director and/or Management Representative
f. the detected or potential non-conformities are reported on the
CPAR Form and close-
out monitored on the CPAR log
2. its Procedure for Corrective and Preventative Action
(ETITT-04 (Appendix 7-B)

rev 3
30
Follow-up required:
limited to its procedure to avoid
potential problems.
rev 3
31

SUMMARY OF FINDINGS
Comment No. of standards with evidence
falling into this category
evidence have been provided to show that the requirements for
this standard have been met
13
evidence are needed to satisfy the requirements of the standard
9
submitted show that the requirements for this standard have not

been met
0
rev 3
32
GENERAL FINDINGS:
The application for registration submitted by ETITT was
aligned to the seven criteria for
registration. The submission for registration was well organised
and evidence in the appendices
was accurately cross-referenced.
Sufficient narratives and supporting evidence were submitted

for thirteen standards. However, for
nine standards additional narrative, documentation and
supporting evidence are required to satisfy
the requirements of the particular standard. These standards
being 1.2; 2.1; 3.2; 4.2; 4.4; 4.5; 5.1;
6.3 and 7.1.
E N D O F Y E A R R E P O R T
2 0 1 3 E MS S TA T I S T I C S
C O U N C I L B L U F F S F I R E & R E S C U E

2
2 0 1 3 E M S S T A T I S T I C S
C O U N C I L B L U F F S F I R E & R E S C U E
OV E RV I E W
This is an overview of the medical services statistics and
quality medical care that the citizens of
Council Bluffs receive on a daily basis from the men and
women of the Council Bluffs Fire
Department. The Emergency Medical Services (EMS) system in
Council Bluffs is dedicated to
increasing survival and reducing disability from out-of-hospital
emergencies by providing the highest
quality patient care in the pre-hospital setting.
Once again we would like to thank both Mercy Hospital and
Jennie Edmundson Hospital for
their continued support of our EMS System, their education,
guidance, pharmacy, patient follow up
and feedback they continue to offer us on a daily basis. Thank-
you to our medical directors, Dr.

Chris Elliott and Dr. Tom Masters for their medical direction.
Patient outcome feedback has been
outstanding and allows providers timely feedback which results
in improved patient care.
During 2013 the Council Bluffs Fire Department responded to
7,745 (-1.3%) responses for fire
and EMS. Of those requests 6,187 (+0.5%) were EMS related or
80% (+2%).
12 Lead’s continue to play an important role in identifying
STEMI patients and helping to reduce
time the patient arrives to the cath lab. In 2013 we performed
and transmitted 513 field EKG’s and
identified 24 STEMI patients with an average time from 911
call to fax of 15 min.
R U N S TA T I S T I C S
emergency medical assistance and
4,171 (-1.4%) patients were transported to the hospital for
continued care. The remaining

responses were for fire suppression, hazmat, alarm activation,
and other non EMS related
responses.
per day and 11.6 transports per
day. This response average was unchanged from the previous
year average.
previous year. We have
increased in volume by 36.6% over the past 10 years.
and-
by for events around the city
including Mid-America Center, CB stadium for HS football and
IWCC football games.
42 (21%-) times.
- 2,380(36.6%) / M2 –
2,159(33%) / M1 – 1,964(30%)
-1,566(37%) / M1 –

1,339(32%) / M2 -1,319(31%)
3
2013 TRANSPORT DESTINATIONS
TRANSPORT TIMES AVERAGES
(MINIUTES)
DESTINATION PATIENTS
PERCENT
7:08 Jennie Edmundson 1,612 38%
7:08 Mercy Hospital 2,557 60%

7:55 Creighton Medical Center 32 0.7%
11:35 University Of Nebraska Med Center 37 0.9%
2013 SKILLS AND PROCEDURES
A dramatic improvement of intubation success rates were
continued in 2013. ET
Intubation success rates improved from 88% to 93%. This may
be contributed to the
addition of Glyde Scope Fiber Optic airway equipment.
A CO2 monitor was used in 98% of all intubated patients which
is an umprovement
from 91%. Esophageal Bulb was used in 89% of all intubated
patients. Documentation that
the emergency room physician confirmed tube placement was
documented in 91% of all
charts. Our goal for 2011 was to have 100% compliance with
our airway confirmation
protocol by using the EID bulb, CO2 monitor, and having the
ER physician confirm
placement on arrival to the ER. We had no unrecognized
misplaced intubations in 2013.

2013 MEDIC UNIT SCENE TIME AVERAGE OF 9:62
MINUTES
Individual Scene Time Ave: M1-10:19, M2-9:35, M3-9:34
A L S P RO C E D U R E S TA T I S T I C S
43% OF OUR PATIENTS TRANSPORTED REQUIRED ALS
INTERVENTIONS
73 DIABETIC PATIENTS RECEIVED ALS CARE AND
REFUSED TRANSPORT

4
ALS PROCEDURES PROVIDED
PROCEDURE COUNT SUCCESS RATE
IV PLACEMENT 1,616
75%
FIELD INTUBATION 54/58
93%
CHEST DECOMP 4
NA
DEFIBRILLATION 73 NA

CPAP 26 NA
12 LEAD EKG 513 NA
INTRAOSSEOUS PEDI 2 100%
INTRAOSSEOUS
ADULT
39
95%
EXTERNAL PACING 3 NA
KING AIRWAY 5 100%
CARDIOVERSION 1 100%
MOST COMMON MEDICATIONS ADMINISTERED
MEDICATION TIMES

USED
MEDICATION TIMES
USED
ALBUTEROL 116 VERSED 56
ASPRIN 258 OXYGEN 789
ATROPINE 13 BENEDRYL 10
D50 128 GLUCAGON 12
DUO-NEB 214 GLUCOSE PASTE 12
EPI 1:10,000 121 ADENOCARD 5
MORPHINE 55 AMIODARONE 20
NITRO 317 NARCAN 50
ZOFRAN 145 FENTANYL 167

5
CARDIAC ARREST STATISTICS
The following statistics show the changes that have been made
in the system the past few years
are improving the survival rates in Council Bluffs.
During 2013 there were 50 patients in cardiac arrest. Using the
Utsteine template which counts
only the victims who were in V-Fib or V-Tach on arrival of
EMS, and defining a ‘Save” as a patient
who walked out of the hospital without neurological deficits, we
can estimate the departments save
rate to compare nationally.
The Department had 17 patients that fit into this formula of V-
Fib/V-Tach and “had a chance to
be saved”. Of these cardiac arrests 8 patients walked out of the

hospital and can be counted as
“Cardiac Arrest Saves”.
THE NATIONAL AVERAGE IS 6-10%
THE COUNCIL BLUFFS FIRE DEPARTMENT
SAVE RATE FOR 2013 WAS 47%
Most common initial rhythms in cardiac arrests:
– 36% / PEA – 30% / VF/VT – 34%

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