EMS Task Force Recommendations
Title: Recommendation 3a
Action Item:
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.
Progress:
The Department is engaged in an ongoing comprehensive revision and improvement of its EMS training and education programs. A major milestone has been the procurement and implementation of an electronic Learning Management System (LMS) for management of training records and distributive delivery of training and education.
The Department has completed several revisions of its Advanced Life Support (ALS) and Basic Life Support (BLS) refresher and continuing education curriculums, most recently in 2012.
In 2009, all ALS providers successfully completed comprehensive education, training and testing on recognition and treatment of acute coronary syndromes (ACS) and ST segment elevation myocardial infarction (STEMI).
Current EMS training initiatives underway include Department-wide training and testing on the new 2012 EMS Medical Protocols, and maintenance of certification of all ALS providers in Pediatric Advanced Life Support (PALS) and Advanced Life Support (ACLS).
The Department plans to resume internal paramedic training, subject to funding availability and accreditation by the Committee on Accreditation of Educational programs for the Emergency Services Professions. (CoAEMSP). The Department has invested in four realistic Patient Simulators: an Adult SIMMAN 3G, a Sim Baby, a SimJr. (child) and a SimMom (obstetrical).
Status: Complete
Title: Recommendation 3b
Action Item:
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.
Progress:
Status: Complete
Title: Recommendation 3c
Action Item:
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.
Progress:
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 by the DFC Operations and the responsible Battalion Management Teams.
Personnel currently receive biannual proficiency evaluation through the recertification process at the Training Division.
Status: Complete
Title: Recommendation 3d (Part 1)
Action Item:
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.
Progress:
All ALS providers have received 8 hours of education and evaluation for the 2012 EMS protocols at the Training Academy.
The Deputy Medical Director once hired, will be assigned to the Training Academy and shall implement a plan to better accomplish this goal in 2013.
Policy, procedures and documentation for the remedial education process have been revised and improved.
Status: Complete
Title: Recommendation 3d (Part 2)
Action Item:
The Department shall also provide enhanced field supervision as ongoing quality assurance for all personnel.
Progress:
(Note, this recommendation is supported by recommendation 2c.)
Responsibility for enhanced role in quality assurance has been given to EMS Field Supervisors.
Status: Complete
Title: Recommendation 3e (Part 1)
Action Item:
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;
Progress:
Clearly documented chain of patient care was accomplished in September 2006 with full implementation of the FEMS Form 902EMS* (First Responder Report).
All assessment and patient care currently is documented on the Department’s Electronic Health record (ePCR). All units dispatched to a call are required to document their participation on the scene. First Responders may forward their ePCR to the transporting unit. All reports are archived by incident number and are available for review. The ePCR is currently compliant with established NEMSIS guidelines.
In 2013 plans to include Fire National Fire Incident Reporting System (NFIRS) data fields will allow such data to be used for NFIRS reporting.
Status: Complete
Title: Recommendation 3e (Part 2)
Action Item:
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.
Progress:
The Department, in collaboration with the directors of the local emergency departments, has re-engineered the online medical control process such that each receiving facility is now responsible for providing medical control to patients en-route to its facility. Protocol revisions allow for most emergency care to be delivered with standing orders.
Status: Complete
Title: Recommendation 3f
Action Item: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 to demonstrate its value. DC Fire & EMS continued to improve and increase the emphasis placed on EMS during the annual awards ceremony. 2010 and 2011 awards were conferred in an awards ceremony in May 2012.
Status: Complete
Title: Recommendation 3g
Action Item:
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.
Progress:
The first confidential employee survey was distributed by the Office of the City Administrator to all 1,787 operational FEMS employees. The overall participation rate was just under 44%, with 781 invitees responding. The results will be used both to inform follow-up questions and as a baseline for further periodic surveys of the workforce.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.
Status: Complete
Title: Recommendation 3h (Part 1)
Action Item:
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;
Progress:
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.
Status: Complete
Title: Recommendation 3h (Part 2)
Action Item:
The Medical Director shall, no later than December 31, 2008, work with other jurisdictions and the federal government to regionalize system management.
Progress:
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. DCFEMS has participated in numerous UASI Grants for EMS Equipment and Training as well as participated in regional Trauma Care Committees.
Status: Complete
Title: Recommendation 3h (Part 3)
Action Item:
The Medical Director shall, no later than December 31, 2008, issue customer satisfaction surveys, internal and external, that focus on EMS service.
Progress:
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 through its agency website.
For FY 2012, overall patient satisfaction rate was 91%.
Status: Complete
Title: Recommendation 3h (Part 4)
Action Item:
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.
Progress:
The Department is utilizing multiple data streams and has very detailed metrics for response time, committed time, and patient drop time. Such information is being used to enhance performance.
Status: Complete
Title: Recommendation 3h (Part 5)
Action Item:
The Medical Director shall, no later than December 31, 2008, measure and analyze patient outcome.
Progress:
The Department is now participating in the 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 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.
We also Participate in District STEMI, Stroke and Trauma Patient Care Quality Assurance registries.
Status: Complete
Title: Recommendation 3h (Part 6)
Action Item: The Medical Director shall, no later than December 31, 2008, improve complaint tracking by FEMS.
Progress: Investigation protocol and complaint tracking system have been developed.
Status: Complete
Title: Recommendation 3i (Part 1)
Action Item: 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.
Progress: FEMS has established hiring preferences and a process for hiring that takes Education, Certification and Skills into consideration.
Status: Complete
Title: Recommendation 3i (Part 2)
Action Item: 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.
Progress: Implementation of promotional preferences is subject to the collective bargaining process.
Status: Incomplete
Title: Recommendation 3j (Part 1)
Action Item: 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.
Progress: Negotiations underway with collective bargaining units.
Status: Incomplete
Title: Recommendation 3j (Part 2)
Action Item: 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.
Progress: Negotiations underway with collective bargaining units.
Status: Incomplete
Title: Recommendation 3k (Part 1)
Action Item: The Chief shall, no later than December 31, 2008, establish an Internal Affairs Unit.
Progress:
Status: Complete
Title: Recommendation 3k (Part 2)
Action Item: 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.
Progress: Revised table of penalties has been finalized; formal adoption is pending completion of the collective bargaining process.
Status: Complete
Title: Recommendation 3k (Part 3)
Action Item: The Chief shall, no later than December 31, 2008, establish online records and tracking for Quality Assurance/Quality Control.
Progress: 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.
Status: Complete
Title: Recommendation 3l
Action Item: 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.
Progress:
Status: Complete
Title: Recommendation 3m
Action Item: 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.
Progress: The plan was completed February 20, 2008.
Status: Complete