Management of EMS 1 CHAPTER Government Structure and

Management of EMS 1 CHAPTER Government Structure and EMS

Learning Objectives 1. 1 Identify six key historical events and key figures that have impacted the progress of emergency medical services (EMS), then discuss their collective influence. 1. 2 Identify four key federal, state, and local legislative events that have formed the emergency medical services, and then discuss their collective influence. Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Learning Objectives (Cont. ) 1. 3 Identify federal, state, and local EMS system components and discuss their interrelationship. 1. 4 Identify the components of an EMS system. 1. 5 Explain the various National Highway Traffic Safety Administration EMS agendas for EMS, related topic. Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Learning Objectives (Cont. ) 1. 6 Identify the various trade organizations that support EMS activities. Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

The Beginning of EMS • History of prehospital emergency medicine – Crusades – Napoleonic Wars – Union Army, 1862 – Doctor “house calls” – World War II – Korean War – Vietnam War Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

The Beginning of EMS (Cont. ) James O. Page often remarked that it does not matter who the provider is, just as long as he is doing a good job. To ensure that the next generation of providers van do the best job possible, today’s managers and leaders must continue to improve the system based not only on its history but also with a vision of the future. FIGURE 1. 1 James O. Page (1936 -2004), the "Father of Modern EMS. " (Tom Page / Tom Page Photography) Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

The White Paper 1966 • Accidental Death and Disability: The Neglected Disease of Modern Society – National Academy of Sciences (NAS) § Long-range effects of quality emergency medical care on mortality § Concluded: • Average response time exceeded 40 minutes • Crews were inadequately equipped and trained • Americans had a greater chance of surviving in the combat zones of Korea or Vietnam than on the nation’s highways Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

The White Paper Summary of the Recommendations of the White Paper. Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

National Highway Traffic Safety Administration • Created in 1966 by Congress • First federal standards in EMS • Highway Safety Act of 1966 – Developed specifications for training, equipment requirements, and design of the emergency vehicle itself – Funds communications and education for EMS Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Federal Initiatives • Emergency Medical Services Systems Act of 1973 – Designated federal funding – Developed the first set of DOT national curriculums for EMTs and paramedics – Funded Department of Health, Education, and Welfare – Identified 15 components of an EMS system Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Components of an EMS System Original Components of an EMS System (1973). Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

The EMS Agenda for the Future 1996 • Department of Transportation and the National Highway Traffic Safety Administration • More of a community-based approach to EMS Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

The EMS Agenda for the Future • 14 attributes for EMS systems: – – – – Integration of health-care services EMS research Legislation and regulation System finance Human resources Medical direction Education systems Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

The EMS Agenda for the Future (Cont. ) • 14 attributes for EMS systems (cont. ) – – – – Public education Prevention Public access Communication systems Clinical care Information systems Evaluation Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

The EMS Agenda for the Future (Cont. ) • The effectiveness of EMS will be measured by the impact it has on the movement of the patient through the health-care system Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Integration of EMS and the Health-Care System • Key partnerships with EMS – Hospitals § Receiving facilities, medical control, education resource – Fire departments, rescue squads, law enforcement § First responders, specialized resources Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Integration of EMS and Health-Care System (Cont. ) • Key partnerships with EMS – Regional, state, and national EMS organizations § Funding, advocacy, education, lobbying efforts § ASTM, NFPA Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Functions of an EMS System • System organization and management – Authority to direct, develop, and allocate resources • Medical direction – Offline and online or direct – Protocols § Direct transport, treatment, and triage decisions Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Functions of an EMS System (Cont. ) • Communication systems – Interagency, mutual aid, disaster communication • Public education – Prevention, system access, system education, citizen CPR and first aid • Quality improvement – Ongoing review of performance of all systems Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Star of Life • National EMS symbol • Six-barreld cross represents – Six system functions: § § § Detection Reporting Response On-scene care Care in transit Transfer to definitive care FIGURE 1. 4 Star of Life Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Star of Life (Cont. ) • Staff in the center – Represents medicine and healing FIGURE 1. 4 Star of Life Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

The End of Federal Funding • Mid-1980 s • EMS programs slashed or eliminated • Systems became dependent on state and local funding – Differences in systems today • Lack of comprehensive 911 coverage Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

The Impact of Television on EMS • Emergency, Rescue 911 – Raised awareness and expectations – Public demand for high-quality EMS • Integration of EMS services Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Federal Government and EMS • Department of Homeland Security – Safe, Accountable, Flexible, Efficient Transportation Equity Act § Federal Interagency Committee on EMS • Federal oversight committee for EMS • Congressional mandate to report to congress yearly – National EMS credentialing system – Federal Emergency Management Agency (FEMA) – National Fire Academy Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

National Fire Academy • Located in Emmitsburg, Maryland • Focuses on EMS management, EMS special operations, EMS safety and incident command Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

National EMS Credentialing System • Credentials EMS workers from across state lines • Documents minimum qualifications, certifications, training, and education • Designed to allow EMS providers to be plugged into the national incident management system Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Health and Human Services • Department of Health and Human Services – Contributes to national EMS activities Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Health and Human Services (Cont. ) • Centers for Disease Control (CDC) – Injury prevention programs, surveillance, maintains WISQAR, database – Education on infectious disease, promotes standards for bloodborne pathogens – Maintains Strategic National Stockpile Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Health and Human Services (Cont. ) • Center for Medicare/Medicaid Services – Sets reimbursement schedules, standards for billing, privacy regulations, works with Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Health and Human Services (Cont. ) • Health Resources and Services Administration – Level of pediatric care and education of EMS providers § EMS for children Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Health and Human Services (Cont. ) • Federal Office of Rural Health Care Policy – Rural EMS Agenda for the Future – Provides funding for rural EMS associations – Rural EMS and Trauma Technical Assistance Center § Radio equipment, support facilities, information technology Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Federal Communications Commission • FCC has long history of helping EMS – Telemetry units, field radios, base-station frequencies, 911, E 911 – Creating cell phone technologies – Wireless Telecommunications Bureau § Oversees the development of public safety radio systems § Wireless frequencies for paperless systems Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Department of Commerce • Manages national quality award – Malcolm Baldrige Award • The Baldrige national quality program – Public-private partnership to improve the performance of national organizations – Award presented by the president of the United States – Categories of health care, small business, manufacturing, and education Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Malcolm Baldrige Award • Criteria for performance – Leadership – Strategic planning – Focus on patients, other customers, and markets – Measurement, analysis, and knowledge management – Staff focus – Process management – Organization performance results Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

State Organizations Activities • U. S. Department of Health and Human Services – Robert Wood Johnson Foundation § Provided $15 million dollars for 44 EMS projects in 32 states – Wedworth-Townsend Act § Governor Ronald Reagan § “Mobile intensive care paramedics” Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

State EMS Offices • Funnel federal funds to EMS agencies • Located within the state department of health, or department of public safety Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

State EMS Offices (Cont. ) • State directors advise state legislatures on: – Medical practice – Certification requirements – Educational standards – Funding appropriations Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

State EMS Offices • State fire marshall office – Provides equipment, training on ICS, and other training Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

County and Local Governments • Provide oversight and accountability to the public • Oversee health-related activities • Local health departments – Oversee many large metropolitan EMS services Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Medical Authority • Grants certification recertification, and decertifies prehospital personnel • Grants privileges • Establishes, implements, revises, and authorizes medical protocols, policies, and procedures • Establishes destination criteria • Ensures competency of personnel • Establishes training levels Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Structure of Local EMS Providers • Single-role organization • Multiple-role organization • Fire-based – Cross-trained/dual role • Third service – Private enterprise, corporate – Has public oversight Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Professional Organizations • International Association of Fire Chiefs (IAFC) • International Association of Fire Fighters (IAFF) • International City/County Management Association (ICMA) • American Federation of State, County, and Municipal Employees (AFSCME) Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Other Groups American Red Cross American Heart Association American Stroke Association American Ambulance Association American College of Emergency Physicians • National Association of EMS Physicians • American College of Surgeons • • • Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Other Groups (Cont. ) • Association of Air Medical Services • Air Medical Physician Association • American Society for Testing and Materials • National Fire Protection Association Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Accreditation Agencies • Commission on Accreditation of Allied Health Education Programs – Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions • Commission on Accreditation of Ambulance Services Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Provider Associations National Association of EMS Educators Emergency Nurses Association International Tactical EMS Association National Association of Emergency Medical Technicians • National Registry of EMT’s • • Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Volunteers • National Volunteer Fire Council – 49 state firefighter organizations Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458

Summary • Responsibility to manage an EMS system requires an understanding of a larger picture involving outside agencies and government sources • Research, standards, regulation, and education emanate from many outside sources; EMS personnel should utilize these resources to ensure life long learning Bruce E. Evans • Jeff T. Dyar — Management of EMS Copyright © 2010 by Pearson Education, Inc. Upper Saddle River, NJ 07458