DC Fire and Emergency Medical Services: EMS Task Force Rec 3 Details

Status		Action Item	Progress
	a	The Medical Director shall implement, no later than December 31, 2008, a comprehensive training and educational program for emergency medical technicians and paramedics. The program shall include new employee orientation, periodic classroom and internet-based continuing training, case review and peer learning opportunities, simulation exercises and field-based training. The Department shall pursue partnerships with medical education institutions to enhance training and clinical practice and increase the internal training capacity of the Department. The training program may include Department and external trainers under contract, as deemed appropriate by the Medical Director.	A comprehensive revision of the Department's training and education programs is underway under the leadership of the Department's medical director, Dr. James J. Augustine. Projects underway include establishment of a university-based paramedic training program, clinical training agreements with local medical facilities, the hiring of dedicated EMS faculty positions at the DC Fire & EMS Training Academy, usage of contract-based personnel for delivery of specific training modules, upgrade of simulation laboratories and ALS training facilities, and revision of the continuing medical education curriculum content and schedule. Recently completed tasks include the hiring of an experienced EMS educator faculty member in May 2009, and the procurement of an Internet-based Learning Management System for on-line delivery of training and education.
	b	The Medical Director shall establish, no later than November 20, 2007, procedures to certify the operational competency of medical providers at all levels of training within the Department. This may include, but is not limited to, (i) demonstration of compassionate and professional service to patients; (ii) successful execution of key clinical competencies in the field; and (iii) completion of a minimum number of hours or medical calls under provisional status.	The Department has established a requirement that all providers be evaluated on an annual basis. The Department has created and revised evaluation instruments to support field evaluation and quality assurance.*
	c	The Medical Director shall establish, no later than November 20, 2007, a process to evaluate current employees for proficiency at their respective levels of clinical privileges. This evaluation and certification process shall be completed not later than December 31, 2008. Effective December 31, 2008, response to medical calls may be provided only by Department apparatus with at least one field-certified provider as described above.	On November 16, 2007, the Department established a new annual field evaluation process for all EMS providers. The first complete cycle of annual field evaluation for the Operations Division (1,776 personnel) was completed on March 10, 2009. 1,624 personnel demonstrated satisfactory levels of proficiency at their respective levels of clinical privileges. 152 personnel assigned to the Operations Division were unavailable to be evaluated due to extended sick leave status, military leave, detail to other divisions, or other reasons. Personnel unavailable to be evaluated are scheduled for field evaluations upon their return to full-duty status in the Operations Division. The Department is compliant with the directive that response to medical calls must be provided by apparatus with at least one field-certified provider as described above. The annual field evaluation requirement is now institutionalized as the primary responsibility of the expanded EMS supervisory cadre. Compliance with the evaluation requirements is monitored closely by the DFC Operations and the responsible Battalion Management Teams. Approximately 211 EMS providers are assigned to other divisions with primary responsibilities that are administrative or do not involve the direct delivery of EMS, such as the Fire Prevention Division. These personnel currently receive biannual proficiency evaluation through the recertification process at the Training Division. The Department is exploring options for expanding the annual evaluation requirement to this population.
	d	(Part 1) Effective immediately, the Medical Director shall oversee the clinical performance evaluation of all personnel with medical certification at least once a year. In addition to any other disciplinary basis (see sub-recommendation (k) below), based on the results of the annual performance evaluation, personnel may be approved for continued duty, assigned to supplemental training, placed on provisional EMS status, or temporarily or permanently relieved of their EMS proficiency status.	Evaluation process has been implemented.* Expansion of evaluation personnel (company training specialists, & field supervisors) and associated equipment is needed to ensure that the 12/2008 deadline is met for evaluation of entire workforce.
	d	(Part 2) The Department shall also provide enhanced field supervision as ongoing quality assurance for all personnel.	(Note, this recommendation is supported by recommendation 2c.) Responsibility for enhanced role in quality assurance has been given to EMS Field Supervisors: all providers will now receive annual evaluation.
	e	(Part 1) The Medical Director shall establish, no later than December 31, 2007, a clearly documented chain of patient care with clear evaluation and treatment documented by each provider as follows: The first arriving provider (Fire-based or EMS) should document the situation as well as patient evaluation and treatment; A formal process for "giving report" and transferring care to the next provider should be conducted; this process should be repeated as patient care is transferred until full transfer to emergency department staff or other appropriate final patient destination staff; Documentation requirements should include: (1) all evaluation and treatment, (2) all providers, (3) all care transfers, and (4) documentation of arrival at the receiving facility as well as who and when the transfer to receiving facility personnel occurred;	Clearly documented chain of patient care was accomplished in September 2006 with full implementation of the FEMS Form 902EMS* (First Responder Report). Next steps are to evolve Form 902EMS into an electronic form and link it to the electronic patient care reporting application.
	e	(Part 2) Online medical direction to FEMS personnel shall be provided only by licensed physicians who are adequately trained and are designated as qualified by the Medical Director. Online medical direction shall be subject to the QI process.	The Department, in collaboration with the directors of the local emergency departments, is developing a reengineering of the online medical control process such that each facility will be responsible for providing medical control to patient’s en-route to its facility utilizing personnel who have been trained and evaluated in a standardized manner.
	f	The Chief, no later than December 31, 2007, shall design and implement an annual program to recognize and publicly reward employees for EMS performance that demonstrates exceptional compassion, professionalism, and clinical competence.	On May 23, 2007, DC Fire & EMS combined the annual EMS awards ceremony with the annual valor awards ceremony* to demonstrate the value that it places on outstanding EMS performance*: For the 2008 awards , DC Fire & EMS continued to improve and increase the emphasis placed on EMS during the annual awards ceremony.
	g	The Chief shall periodically conduct confidential, anonymous surveys of Department employees (both single-role and dual-role) regarding their attitudes, concerns, and opinions relating to the Department's provision of emergency medical services. The first survey shall be completed no later than December 31, 2007.	The first confidential employee survey was distributed by the Office of the City Administrator on December 7, 2007: to all 1,787 operational FEMS employees. The overall participation rate was just under 44%, with 781 invitees responding. The results are being collated and will be used both to inform follow-up questions and as a baseline for further periodic surveys of the workforce. The Complete survey results, as well as supporting material and analysis, are available by following this link. EMS Survey Results
	h	(Part 1) The Medical Director shall, no later than December 31, 2008, take the following steps to develop a performance evaluation and quality control/quality assurance: establish a FEMS peer review program that promotes a culture of excellence;	Peer review enabling legislation became effective on 4/15/08. The Department currently utilizes peer-review on an ad-hoc basis, and is establishing a structured peer-review program as a component of its overall medical quality management efforts.
	h	(Part 2) The Medical Director shall, no later than December 31, 2008, work with other jurisdictions and the federal government to regionalize system management.	The District submitted a grant proposal to improve integration of the National Capital Region’s (NCR) pre-hospital information systems. This proposal was endorsed by the Homeland Security Senior Policy Group and Chief Administrative Officers of the NCR and is being funded through the federal Urban Area Security Initiative (UASI) program. This initiative will support the integration of the existing systems and the identification of needs for new systems where such do not already exist.
	h	(Part 3) The Medical Director shall, no later than December 31, 2008, issue customer satisfaction surveys, internal and external, that focus on EMS service.	An EMS-focused customer survey is now mailed to all identifiable patients transported and/or treated by DC Fire & EMS. The Department also provides the ability for the public to report customer satisfaction online through its agency website. For the most recent sample period (August to October 2008), 923 customer survey responses were received, and 72% of respondents indicated that they were "very satisfied" with the EMS service they received, and 20% indicated they were "satisfied," an overall satisfaction rating of 92%. 4% were neutral; 3% could not answer; 2% were "dissatisfied" and 1% were "very dissatisfied."
	h	(Part 4) The Medical Director shall, no later than December 31, 2008, improve response time evaluation that has a goal of measuring time to patient's side.	The Department is utilizing the Electronic Patient Care Reporting (ePCR) system to gain additional information on the time of arrival to patient’s side, as well as the time of performance of clinical interventions. These efforts are ongoing and the Department will continue to explore the use of technology to create more accurate time stamps for key clinical events in the response time continuum.
	h	(Part 5) The Medical Director shall, no later than December 31, 2008, measure and analyze patient outcome.	FEMS is working with area hospitals to establish data-sharing agreements so that patient outcomes can be better tracked.* In addition, the Department is now participating the CARES (Cardiac Arrest Registry to Enhance Survival) Program, a collaborative effort of the Centers for Disease Control and Prevention (CDC), the American Heart Association (AHA) and the Emory University Department of Emergency Medicine, Section of Prehospital and Disaster Medicine. The CARES program is a model national registry that will enable us to accurately measure our progress in the treatment of Out of Hospital Cardiac Arrest, as well provide comparative analysis of our performance as benchmarked to other national and international EMS systems
	h	(Part 6) The Medical Director shall, no later than December 31, 2008, improve complaint tracking by FEMS.	New investigation protocol and complaint tracking system have been developed.
	i	(Part 1) The Chief shall, no later than December 31, 2007, establish hiring preferences for candidates with degrees from recognized accredited higher education institutions and relevant certifications or skills.	FEMS has established hiring preferences and a streamlined hiring process for certified paramedics and is actively recruiting them.
	i	(Part 2) The Chief shall, no later than December 31, 2007, subject to collective bargaining agreements, establish promotional preferences for employees with degrees from recognized accredited higher education institutions and relevant certifications or skills.	The Fire/EMS Chief has submitted proposals to establish promotional preferences for employees with degrees from recognized accredited higher education institutions and relevant certifications or skills to the collective bargaining units. Implementation of these proposals is subject to the collective bargaining process.
	j	(Part 1) The Chief shall require, effective with the next contract: All personnel to maintain or acquire EMS certifications in order to be retained as employees of the Department after December 31, 2010.	Negotiations underway with collective bargaining units.
	j	(Part 2) The Chief shall require, effective with the next contract: All candidates for promotion to the rank of Sergeant or higher to have served as a field-certified EMS provider, according to criteria established by the Medical Director that requires a minimum cumulative number of patient contacts, assessments and treatments.	Negotiations underway with collective bargaining units.
	k	(Part 1) The Chief shall, no later than December 31, 2008, establish an Internal Affairs Unit.	Internal Affairs Unit has been established.*
	k	(Part 2) The Chief shall, no later than December 31, 2008, establish a table of penalties and disciplinary timelines for operational employees. Penalties for employee misconduct should be swift, fair and appropriate.	Revised table of penalties has been finalized; formal adoption is pending completion of the collective bargaining process.
	k	(Part 3) The Chief shall, no later than December 31, 2008, establish online records and tracking for Quality Assurance/Quality Control.	The Department has moved its EMS complaint tracking database online and also provides the ability for the public to report concerns and complaints online through its agency website.
	l	The District Attorney General, in consultation with the Chief of the Department, shall submit to the Chair of the DC Council Committee on Public Safety and the Judiciary, no later than November 20, 2007, recommendations to strengthen the Department's ability to terminate Department employees for medical malfeasance and misconduct.	Letter submitted on 11/19/07.*
	m	The FEMS Chief, Dr. Barbera and Mr. Halliday shall complete a plan to monitor implementation and performance measures relating to the recommendations of the Task Force that includes input, process and output metrics. Progress on implementation and performance shall be monitored through ongoing CapStat sessions to which all members of the Task Force shall be invited, including sessions in April and October of 2008 that will specifically address the implementation and performance monitoring plan.	The Implementation and Performance Measures Plan* was completed February 20, 2008.