Table of Contents
Preface
Chapter 1: Government Structure and EMS
The Beginning of EMS
The History of Prehospital Emergency Medicine
Federal Initiatives
The EMS System
The EMS Agenda for the Future
Federal Government and EMS
Department of Transportation/National Highway Traffic Administration
Office of Domestic Preparedness
Health and Human Services
Federal Communications Commission
State Organizations and Activities
State Initiatives
State EMS Offices
County and Local Governments
Other Government Interactions
Professional Organizations
Management Organizations
Unions and Labor Groups
Trade and Advocacy Groups
Physicians Groups
Aeromedical Associations
Standards Setting Organizations
Accreditation Agencies with EMS Interest
Provider Associations
Lobby Organizations
Volunteers
Chapter 2: Strategic Planning for EMS
Benefits of Strategic Planning
Setting the Stage for Strategic Planning
Overview of a Strategic Plan
Balanced Scorecard
Contingency Model of Strategic Planning
Planning Processes
Clearly Defined Mission and Vision
Brainstorming
SWOT Analysis
How to Use a SWOT Analysis
Internal Characteristics: Strengths and Weaknesses
External Characteristics: Opportunities and Threats
Clearly Defined Goals and Objectives
Costing Out Planning Process
Economies of Scale
Work Load Indicators
Capital Expenses
Operating Expenses
Facility Cost
Capital Equipment Cost
Personnel Cost
Problem Research Techniques
Who Is Involved with the Problem or Budget Item?
Project and Program Management
Tools for Strategic Planning
Critical Path Method
PERT
Strategic Plan as a Living Document
Business Plan
Strategic Quality Planning at the State of Regional Level
State and Regional Vision
Strategic Quality Planning Structure
Chapter 3: Manager to Leader
Origins of Management
The Role of Management
Values Statements
Culture
Managing Power
Management Defined
Basic Management Skills
Management Processes
Employee Needs, What Employees Want
Increase Supervisor/Subordinate Communication
Foster a Supportive Work Environment
Delegate Tasks When Appropriate
Institute Sound Performance Appraisal and Coaching Programs
Motivation and Building Teams
Foundations of Motivation
Team Building and Participation
Leadership
What is the Same? What is Different?
Leadership Defined
Establishing Vision for the Organization
Leadership Styles
Competency
Communication
Managing E-mail
Communicating with People
Conflict Resolution
Ethics and the Leader
Succession Planning
Coaching
Mentoring
Leadership Failures
Why EMS Leadership Fails and Why EMS Teams Fail
Chapter 4: Injury Prevention and EMS
Introduction to Injury Prevention
History of Injury Prevention
Injury Prevention Programs
Databases and Injury Prevention
Science of Injury Prevention
Public Health Model
Epidemiological Model
Haddon Matrix
Access, Interpret, Use, and Present Injury Data
Framing an Injury Problem
Finding Data to Define the Injury Problem
Federal Cost Tracking
Interventions
The Spectrum of Prevention
Putting It to Action
Injury Prevention Leadership
Implementing These Strategies at the Community Level
Funding Strategies
Collaborative Approaches
Best Practices in Injury Prevention
Safe Communities
The EPIC Medics Story A Local Paramedic Initiative
Frisco Fire Safety Town Project
Seattle Bike Helmet Program
Resources
Evaluating Injury Prevention Programs
Time to Implement
Chapter 5: Marketing and Customer Service
Introduction to Customer Service
Customer Relations
EMS Service Benchmarking
Public Information, Education, and Relations (PIER)
The Importance of Public Education
Applying a Fire Protection Model to Injury Prevention
Interacting with the Media
Handling a Crisis
Media Mitigation
Types of Media Available to EMS
Life Safety Education Program
Community Relations and Citizenry
Image Building Programs
Branding
Citizen Relations
Celebrate with the Community
Planning Special Events
Marketing
Developing a Marketing Plan
Assessing Customers
Resolving Customer Complaints
Complaint Databases
Internal Customer Service Programs
Creating and Environment of Sharing and Helping
Chapter 6: Risk Management and Safety
Defining Risk Management
Risk Management Process
Identifying Risks
Identifying and Measuring Risk
Near Miss Reporting Systems
Methods of Managing Risk
Analysis of System Failure
Conducting an Investigation
Documentation
Successful Programs
Crew Resource Management
EMS Near-Miss Program
Psychological Applications
FDA Equipment Failure and Medication Reactions
Infection Control
Laws, Standards, and Regulations
Guidelines for Responding to Infectious Disease Exposures
OSHA Standards for Occupational Injuries and Illness
What is an Occupational Disease?
NFPA 1581 Consensus Standard
State or Local Legislation that Protects Workers
Building an Infection Control Program
Components of the Plan
Infection Control Officer
Infection Control Training
Equipment Needs
Decontamination Areas
Occupational Exposures
Pre-exposure
The chain of Infection
Modes of Transmission
Defining an Exposure
Reporting Exposures
Documenting Exposures
Post Exposure
Occupational Exposures
Reporting Requirements
What are the Privacy Issues?
Components of an Infection Control Program
EMS Safety
Safety Education
Why Safety?
Top Five Injuries for EMS Workers
Back Injuries
Exposure to Infectious Diseases
Injuries Sustained on Highway Operations or Scenes
Vehicle Crashes Responding to Code 3, Lights and Siren
Assaults on EMS
Chapter 7: EMS Human Resources Management
The EMS Workforce
Human Resources Activities for Staffing
Generational Bridges
Motivation Tools for Different Generations
Job Analysis and Design
Methods of Assessing Job Standards
Job Descriptions and Specifications
The DACUM Process
Recruiting
Disparate Impact
The Griggs Decision
Selection
Applications
Written Exams
Physical Abilities Test
Interviews
Psychological Resources
Academic Predictors for Health Care Workers
Assessment Center Process
Meyers Briggs
Background Checks
Medical Exams
Drug Testing
Employee Satisfaction and Retention
Legal Issues in Human Resources
Discrimination
Fair Labor Standards
Collective Bargaining
What are Mandatory Subjects of Bargaining?
Grievance Procedures and Discipline
Conflict Resolution
Fact Finding/Non-binding Arbitration
Mediation
Performance Appraisal and Incentives
Building a Performance Appraisal
Conducting Appraisals
Problems Affecting the Performance Appraisal Process
Rating Errors
Performance Appraisal Process Errors
360 Degree Evaluations
Sexual Harassment
Ethics and Conduct
Employee Safety
Workplace Violence
Preventive Practices
Identifying Problem Situations and Risk Factors of Current Employees
Employee Assistance Programs
Chapter 8: Management of EMS Education
EMS Education and the Manager
History of EMS Education
The Future Framework of EMS Education
National EMS Framework and Practice Blueprint
EMS Education Agenda for the Future
National EMS Core Content
EMS Scope of Practice
National EMS Education Standards
National EMS Program Accreditation
National EMS Certification
Paramedic Education Program Accreditation
Current Curriculums
Pre EMS
National Standard Curriculums
1998 Paramedic Training
EMS Instructor Education
Emergency Vehicle Operations Course
Inservice Training
Refresher Training
EMT Intermediate Recertification
Paramedic Recertification
Continuing Education
Continuing Education Programs
Pediatric Education
Trauma Continuing Education
Medical Continuing Education
Accredited Education
Design of EMS Training
Active Learning
Creative Ideas for EMS Training
Distributive Learning
Management Efforts toward EMS Education
Evaluation of Training
Maintaining EMS Education Records
Attending Committee Meeting
Maintaining Clinical and Teaching Experience
Psychomotor Education
Skills Performance
Preceptor Programs
Training to the Affective Domain
Affective Domain
Core Values Training
ICARE Program
Leadership Training Programs
Not-for-Profit Leadership Training
Federal Leadership Training
Other EMS Leadership Training Programs
Academic EMS Management Programs
Chapter 9: Financial Management
Financial Requirements and Billing
Marginal Costing
Medicare
Medicare Part B
Scheduled Transfers
Future Medicare Changes
Billing Third Party Payees
HMO Contracting
Financial Policy
Budgets
EMS Budgets
Economies of Scale
Costing Out Service
Cost Per Response
Calculating Unit Hours
Calculating Unit Hour Utilization
Benchmarks of Unit Hour Utilization
Seasonal Variations
Estimating Delays for Ambulance Service
Managing Unit Hours
Determining Number of Personnel
Subsidy Price Tradeoff
Funding Mechanisms
Ambulance Membership Programs
Non Transport MVA Reimbursement
First Responder Fees
Future Reimbursement Issues
Billing Service
Foundation, Associations, and Non-profit Structures
Financial Reports
Chapter 10: Medical Practice
Medical Leadership
Medical Authority
The Role of the Agency Medical Director
Physician Organizations for EMS
Physician Involvement
Support of Medical Directors
The Medical Director’s Role in 911 Communication Center
Relations with the Medical Director
Discipline
Online and Off-line Medical Control
Protocols
Protocol Development
On-line Medical Control
On-line System Design
Offline Medical Direction
Interrelations
Affiliation and Ethical Constraints
Physician Providing Quality Leadership
Other Sources of Information
Medical Incident Review
Situations Requiring Immediate Involvement
Unrecognized Esophageal Intubation
Inappropriate Medical Care and Inappropriate Withholding of Medical Care
Substance Abuse among Medics
Chapter 11: Fleet Management
Fleet Management and Equipment
Fleet Management
Verifying and Maintaining Check List
Ambulance Specifications
Ambulance Types, Classes, and Configurations
Specification Processes
Procurement Process
Ethical Considerations and Bidders
RFP Construction
Scoring and Evaluating Bids
Vehicle Inspections
Training and In-Service
Monitoring Cost in Fleets
Vehicle Costs
Cost Tracking Software
Calculating Unit Hour Cost
Cost Per Mile
Medical Equipment
Vehicle Maintenance
Vehicle/Equipment Failures
Planned Maintenance
Preventive Maintenance
Corrective Maintenance
Replacement Considerations
Feedback
Training and Certification
Accident Reports
Facilities
Chapter 12: Career Development and Staff Focus
The Need for Professional Development
Professional Development
IAFC Officer Development Handbook
The National Highway Safety and Traffic Administration and the Baldridge Criteria
Malcolm Baldridge and Professional Development
Education Opportunities
Collegiate Education
EMS Model Curriculum
University Programs
Skills Acquisition
Competencies
Job Experience and Rotations
Personal Skills
Key Concepts
Entering a New Position
Stabilize Personal Issues
Liaison Activities
Internal Customers
Government Relations
Community
National Outreach
The Personal Career Path Plan
Mentoring
Finding a Mentor
Mentorship Experiences
Community Relationships and Citizenry
Professionalism
Succession Plans
How Succession Planning Helps
Succession Planning
Why Do People Often Put Off Succession Planning?
Chapter 13: EMS Quality Management
Quality in EMS: A Necessity
History of Quality Improvement in EMS
Total Quality Management (TQM)
Six Sigma
EMS Quality Improvement
Justifying Quality Improvement
Comprehensive Quality Management
Implementing Quality Improvement Programs
Building a Successful Program
Service Audit
Establishing Goals
Identify and Develop Standards of Care
Objectives and Performance Indicators
IAFF Performance Indicators
State EMS Performance Indicators
Benchmarking
Cardiac Arrest Outcomes
Sentinel Events
Develop CQI Programs/Processes
Quality Assurance
QI Process Steps
Expanding Knowledge
Full Integration and Monitoring
Baldridge Criteria
JCAHO Accreditation
Human Resource Needs
Provider Feedback and Access
Linking Results to Education
Discipline
What Causes QI Efforts to Fail?
QI and the Law
Chapter 14: Incident Management
History of Incident Management for Emergency Medical Services
Background
The History of the Incident Command System
Variations on the Theme
National Incident Management System
Types of Command Teams
Elements of an Effective Incident Management System
Business Management Techniques Applied to Incident Management
Factors that Affect Incident Management
What is NIMS ICS?
ICS Management Characteristics
ICS Command Staff
Unified Command
General Staff
Area Command
Divisions and Groups
NIMS ICS Applied to EMS Incidents
Air Operations at EMS Incidents
Designate Landing Zones (LZs)
Helispot Manager
Helibase Manager
The Difference between NIMS ICS and FIRESCOPE/NIIMS ICS
ICS as Taught by the Department of Homeland Security
Available NIMS ICS Training
The Future of NIMS ICS Training
Mass Casualty Terminology
Resource Allocation
Pre-Planning Special Events
Incident Action Plans
Meet with Involved Agencies
Chapter 15: Interagency Relations and Operations
Interagency Communication and Cooperation
Interface with External Agencies
EMS Interaction within the Healthcare System
Competing Emergency Service Interests
Tiered or Dual-response Agencies
EMS Interaction with Home Health
Single Command with Assisting Agencies
Hazardous Materials Response
Unified Command and Area Command
EMS “All-Hazard” Approach
Plan Components
Resource Acquisition
Mutual-Aid Agreements
Local Emergency Planning Committee Plans
Regional Resource Response Plans
State Emergency Operation Plan
Interstate Resource Response Plans
Federal Mutual Aid Initiatives
Automated Resource Management Systems (ARMS)
National Credentialing System
Disaster Condition
National Response Plan Assumptions
The Plans Concept of Operations
Organization of Efforts
National-level Response Structure
Regional-level Response Structure
Regional Operations Center
Emergency Response Team
Disaster Medical Assistance Team (DMAT)
Metropolitan Medical Response System
Chapter 16: Data Collection and EMS Research
The Outcome and Research Challenge
EMS and Research Agenda
EMS Reports and Collection Techniques
Integrated Information Management Systems
Domains of EMS Research
Types of Research
Research Methodologies
Data Tools
Central Tendency
Uses for Measures of Central Tendency
Measures of Dispersion
Data Entry and Data Quality
Data Collection Tools and Trends
Longitudinal Data
The National Data Collection Efforts
Uniform Data Set
Hospital Collection of EMS Data
Federal Coordination of Health Care Research
National EMS Information System
EMS Outcomes Project
Trauma Registry
Motor Vehicle Crash Data
Cardiac Arrest Data
Airway Data
Special Project Data
Managing GIS Systems
Automatic Vehicle Locators
Research Outcomes
Literature Reviews
Research Tools and Techniques
Multi-voting
Types of Voting
Run Chart
Histogram
Bar Charts
Pie Charts
Cause and Effect Diagram
Flowcharts
Pareto Diagram
Ethics and Research
Chapter 17: Legal and Labor Relations
The Law
Legal Applications
Federal Legislation and EMS
UMC Quick Core Stuff
Ambulance Diversion
Privacy Law
Lawsuit Progression
State Laws
Antitrust
Right to Provide Service
Immunity from Liability
Fair Labor Standards
Labor Relations
Landmark Legal Cases
Collective Bargaining
Arbitration and Mediation
Discipline
Due Process and EMS Performance
Garrity Rule
Physician Prerogative
EMS Pay Differentials
Legal Trends in EMS
Civil Rights
First Amendment Rights
Communication Litigation
Vehicle Accidents
Medical Malpractice
Ethics in EMS
Ethical Decision Making
Chapter 18: EMS Management of Communication Centers
History of Emergency Medical Dispatch
Types of Centers
Certification Standards
Accreditation
Role of Communication Centers
Components of the Communication System
Diversity and Disability
Management of Communication Centers
Selection and Evaluation
Case Law
System Status Management
Quality Improvement Processes
Continuing Dispatch Education (CDE)
Additional Training
Case Study: Phoenix Fire
Radios
Security
Communication Unit Leader Position
Communication System in Disaster Mode
The Future of the Communication Center
Chapter 19: EMS Special Operations
Importance of Special Operations
Emergency Medical Services Organization’s Components During Routine and Special Operations
Emergency Medical Services Preplanning
Managing EMS Special Operations
EMS All-Hazards Approach
Mass Gatherings
Pre-event planning matrix
Event Public Health and EMS Surveys
All-Hazards Approach Influences
Plan Components
Mutual-Aid Agreements
Disaster Condition
Level of Care
Main Concerns in Planning Medical Care
Logistics
Medical Access to Venue
Medical Requirements
Medical Teams
Mobile Teams
Medical Aid Stations
Site Hospital
Medical Equipment
Documentation
Ambulance Vehicles
Other Medical Considerations
Legal Issues
Site
Contingency Plans
General Considerations
Mass Gathering and Crush Load
EMS Operations at Mass Gathering Events
Mass Care and Special Needs Populations
Basic Red Cross Organization
Shelter Operations
Minimizing Emergency Medical Services System Burdens
Assignment of EMS Resources to Shelters
EMS Special Teams
Tactical Emergency Medical Support
Bike Teams and Alternative Response Programs
Protective Operations
Causes of Assassinations
Tactics to Counter Assassination Methods
Organization of Protective Details
Security for the Protectee in Residence
The Command Post
The Safe Haven
Security Perimeters at an Office
Hotel Security
EMS Protection Levels
Direct Contact with the President or VIP
A Final Note Concerning Diplomats
Helicopter Teams
Medical Support of Hazardous Materials Operations
USAR and Technical Rescue
Structural Collapse
Glossary