Policy: - IEMSA



Policy:

1. Scheduled duty

• Scheduled ECP’s will be compensated at an hourly rate set forth by the ______________

2. Crew Meetings and mandatory training special assignments

• Crew meetings will be paid at an hourly rate.

• Mandatory training will be paid at an hourly rate.

3. CPR or educational classes

• Those who instruct or assist in the instruction of the public in medical related education, sponsored by the department will be reimbursed hourly. In order to be reimbursed the ECP must submit the appropriate number of hours on the special pay sheet.

4. Pre-hospital education/continuing education

• The following guidelines are enacted to assure an equitable distribution of educational funds to all Emergency Care Providers.

• The ___________________must first approve any training desired by an ECP. The ECP, as soon as possible, but in no case less than three (3) weeks prior to the training event, must submit a Travel/Training request form to________________; payment of registration late fees will be the responsibility of the ECP.

• The ________________________will review the request to assure that the training meets departmental criteria as defined later in this policy. The _______________will then make their recommendation ____________for final review and determination. Once the determination has been made the ECP will be informed and registration completed if indicated.

• If the ECP does not successfully complete or pass the training requested, the ECP will reimburse all costs to the Department.

• The ECP will be responsible for reimbursement of costs for unattended classes/conferences in which they were enrolled and fees paid by the department.

5. Education

• While the ________may pay for continuing education and associated expenses, ECP’s will not be paid an hourly wage for the time in this training if it is required to renew your State EMS Certification.

6. Meeting and Educational Activities

• If ECP’s are scheduled by a Supervisor to attend any meeting or educational activities during or after normal work hours, they will be paid their normal hourly wage including overtime or compensatory time depending on the circumstances.

7. Continuing Education

• If an ECP wishes to attend a continuing education event or conference, he or she must have attended a minimum of 75% of the provided in-house training in the proceeding 12 months.

He or she must complete and submit a travel/training request in the manner described above. Training may be approved if it falls within the following criteria.

• Certification Level: EMT-B

➢ Education – Maximum of two EMS training events per fiscal year in the ________________________area.

➢ Travel Expenses – No travel expenses will be allowed

• Certification Level: EMT-I

➢ Education – Maximum of three EMS training events per fiscal year. Plus re-certification of Prehospital Trauma Life Support.

➢ Travel Expenses – Travel expenses will be considered for no more than one out-of-town event annually.

• Certification Level: EMT-P / PS

➢ Education - Maximum of four EMS training events per fiscal year. Plus recertification of Prehospital Life Support, Advanced Cardiac Life Support, Pediatric Advanced Life Support and Advanced Medical Life Support.

➢ Travel expenses will be considered for no more than two out-of-town events annually.

8. All other miscellaneous training requests will be submitted as defined above and will be evaluated on a case-by-case basis.

Purpose:

To provide guidelines for the reporting, investigation and resolution of complaints received against the department as well as provide feedback to those parties involved.

Reporting of Complaints

1. Complaints directed towards the department whether received in written or verbal format shall immediately be made aware to ___________________. The circumstances of the complaint should be outlined on a departmental incident report form and contain the following information:

➢ Name of the complainant if appropriate

➢ Names of employee(s) involved in the incident

➢ Nature of the problem

➢ Date, time and who received the complaint

2. Depending on the seriousness of the complaint, the appropriate superiors within the department should be notified by the receiving supervisor.

3. The reporting and investigation of complaints will be consistent with the Departments Problem Solving Process

Investigation of Complaints

1. Following the receipt of a complaint and any associated documentation, a member __________________________will themselves, or a staff member they appoint, conduct an investigation of the incident.

Resolution of the Complaint

1. Following the investigation of the complaint, the investigating party shall provide resolution to the involved parties.

Feedback

1. Once a resolution to the complaint has been formulated, appropriate feedback shall be given to all parties involved. Feedback made to the party making the complaint shall be prompt in nature.

2. Feedback and disciplinary actions made to staff shall be consistent with the departments progressive discipline policy.

Complaint Documentation / Tracking

1. Incidents reports outlining complaints shall be maintained in accordance to the records maintenance policy.

2. Documentation of complaints and any disciplinary actions shall be noted in personnel files of those parties involved in a manner consistent with the departments progressive discipline policy.

Purpose:

This policy provides a definition of a medical record, identifies confidential information, and outlines what information may be released and to whom it may be released.

Definition:

1. A medical record is hereby defined as:

• Personal information on the patient, including: name of the patient, date of birth; sex; marital status; occupation; other items of identification and next of kin or other contact person.

• Financial data on the patient, including: name of patient’s employer; health insurance information; and other information to assist in billing.

• Medical data on the patient, including physical examinations; medical history; treatment administered; progress reports; physician’s orders; clinical laboratory records; radiological reports; consultation reports; anesthesia reports; operation records; consent forms; and discharge summaries.

Policy:

1. Information regarding the patient's personal information or medical data will not be given out to anyone not directly involved in the patients care or those involved in quality assurance. A copy of the Patient Care Report will be left with the hospital or faxed in a timely manner to the emergency department once the report is complete.

2. Disclosure of Medical Records to Patients

• Ownership of Records

• All original medical records generated by the department shall be recognized as the property of _____________________________Emergency Medical Services. Any original documents should not leave the Department.

3. Release of Medical Records to Patient

• The patient may have a legitimate interest in the information contained in their medical records. A copy of medical records may be released to the patient when he/she presents in person to the EMS Administrative office, during normal business hours, signs a release and presents valid photo identification such as a drivers license or pass port.

• Written Release:

➢ A release of any information in a patient’s record requires a release in the form of a written authorization.

➢ The written authorization should contain, at a minimum, the following:

➢ A request for release of the records;

➢ the date;

➢ the patient’s signature;

➢ the portion of the record authorized to be released; and

➢ the identification of the party to receive the records.

• Release of Records Relating to Minor Patients

➢ Release of any record which may disclose any of the following conditions shall be conditioned upon legal approval by the _________________:

← Pregnancy;

← AIDS/HIV infection;

← Sexually transmitted diseases;

← Substance abuse.

← Request for Minor Records: A request for access to or release of a minor patient’s records should be made by a patient’s parent or legal guardian.

← Denial of Request: Instances where the request might not be honored include: (a) pregnancy; (b) AIDS/HIV infection; (c) sexually transmitted diseases; and (d) substance abuse.

• Release of Deceased Patient’s Medical Records

➢ Any release signed by the patient prior to his/her death becomes null and void at the time of the patient’s death.

➢ The executor or administrator of the estate should execute a release of information for a decedent’s records. (The executor may be an individual other than the deceased patient's spouse.)

➢ If no estate has been opened, the ______________________________should be consulted prior to the release of any information.

4. Disclosure of Medical Records to Third Parties

• The Department shall strictly comply with the provisions of Chapter 22, Code of Iowa, Examination of Public Records (Open Records), and shall keep confidential any medical records of the condition, diagnosis, care or treatment of a patient or former patient, and any report which identifies a person infected with a reportable disease.

• Prohibition on Disclosure Without Consent of Patient

➢ General Prohibition: Medical records will not be disclosed to a third party without prior written consent of the patient or other statutory authorization.

5. Disclosure of Medical Records Without Patient’s Consent

• Child Abuse: Under the state’s child abuse law, ECPs who, in the scope of their employment responsibilities, examine, attend, counsel or treat a child under 12 years of age, and reasonably believe a child has suffered abuse, shall report said suspected ;child abuse within 24 hours. (Section 232.60, Code of Iowa)

• Dependent Adult Abuse: Similar to the state law on child abuse, state statute requires immediate reporting of suspected dependent adult abuse by emergency care providers. (Section 235B.3, Code of Iowa)

• Criminal Investigation: Law enforcement personnel may obtain a copy of the ambulance report once they have established the necessity of having access to the report in terms of the state’s interest in well founded criminal charges and the fair administration of criminal justice. A subpoena shall be necessary for the release of any patient care information used for criminal investigation.

6. Handling of patient care reports

• Care should be taken to prevent the visibility of patient care reports that are in the process of being completed or are awaiting delivery to the billing specialist. Incomplete reports should be stored using the following guidelines:

➢ Incomplete reports in an EMS unit should be kept in a clipboard, cabinet or other secure location within the EMS unit.

➢ Incomplete reports in crew and station areas should be placed in a drawer or secure office. Paperwork should be placed face-down and out of plain view when placed in an area subject to potential visitors.

7. Audit Procedures

• Patient care records which are audited are reviewed solely for QA/QI purposes. The exchange of information regarding a patient’s care should be held in strict confidentiality in accordance with HIPAA standards.

• All reports submitted for audit will be marked appropriately by staff.

8. Fees

• An administrative fee of $10.00 will be assessed for all report copies provided by this department.

• No fee will be charged for duplication of records for criminal investigations or abuse cases.

Purpose:

This policy outlines the __________________________EMS disciplinary procedures.

Policy:

1. The department follows the Progressive Discipline Policy as outlined in policy ________________of the ________________Guide to Personnel Policies and Procedures.

Purpose:

Outline the initial and ongoing training requirements for staff operation of department ambulances.

Policy:

Driving Orientation

1. Staff participating in the orientation process shall drive under the direct supervision of a Field Training Medic during both emergent and non-emergent driving. Orientees who have not obtained their CEVO certification shall not be allowed to drive emergently.

2. As part of the orientation process, all ECP’s shall obtain the CEVO certification and be observed and remediated by department staff during their field training period.

3. Following completion of the orientation period and satisfactory completion of orientation testing an ECP shall be allowed to drive without observation.

Annual Driver Training

1. As part of their employment requirements, all ECP’s shall possess at a minimum a valid Iowa Motor Vehicle Operators License.

2. In order to maintain their driving privileges, all ECP’s shall participate annually in a driving competency course, obtaining a satisfactory score.

Remedial Driver Training

1. Any driver deemed in need of further driver training by administrative staff will be immediately revoked of their driving privileges.

2. Any driver failing to obtain a satisfactory score, following three attempts, during annual competency testing will be immediately revoked of their driving privileges.

3. Any driver who is revoked of their driving privileges shall by remediated by __________________. Following remediation the staff member will then be allowed two further attempts at a satisfactory score on the driving competency course.

4. Staff members failing the driving competency course following remediation will be considered for termination.

Purpose:

The purpose of this SOG is to provide guidelines for making SOG and protocol manuals available to departmental staff.

Policy:

Availability of Manuals

Updated manual of departmental policies and patient care protocols will be available to all staff member. Manuals should be available in the EMS administrative offices, patient care area of ambulances as well as EMS crew office areas.

Distribution of Manuals

Due to the frequency of changes and additions to departmental procedures and patient care, manuals will not be distributed to staff on an individual basis.

An updated version of departmental SOG’s and Protocols should be made available to staff members through the department’s_________________________.

Purpose:

This policy provides guidelines for the orientation and training of new ECPs

Policy:

1. New ECPs will be assigned to a field Training Medic (FTM) once they are officially hired by the_____________________________. Once assigned to the FTM, ECPs will be issued an orientation manual and complete the orientation process as listed below.

• The ECP will schedule their first shift with their FTM. During this shift the ECP will be informed on the orientation process and expectations.

• The ECP will meet with _______________________________to complete required training such as Blood Borne Pathogens, fit testing and provide other pertinent documentation as requested.

• The FTM will coordinate the new ECPs orientation schedule

• The ECP will be allowed to schedule orientation time at their discretion.

• Field Evaluators will fill out an evaluation form following each orientation shift and forward it to the assigned FTM. The FTM will monitor the evaluation forms and will place emphasis on identified weak areas.

• Field orientation time will continue until the training manual has been completed. At this point, a meeting will be set up between the FTM, The Deputy Chief of QA / Education and Assistant Chief to evaluate the new ECPs performance and readiness to complete the final practical and written testing.

• The Deputy Chief of QA / Education will administer a written and practical test dependant on the ECPs level of certification. The written test will need to be completed with a score of 80% or better. The practical exam will be pass/fail.

• If the ECP does not pass this testing, they will not be allowed to see the test, but will be re-mediated by ____________________in areas of concern and then allowed to retest at a later date.

➢ If the ECP fails for a second time, ________________________________and The __________________________will develop a remedial orientation process.

➢ If the ECP fails the written and practical testing for a third time, the may be dismissed at __________________discretion.

• Successful completion of the testing results in the status of Provisional ECP. The ECP will be placed on the schedule and function in the capacity of the second crew member.

➢ The ECP will function in a Provisional status for six months following their orientation process.

• At the end of the six month Provisional period, the new ECP, ____________________________________________will meet to decide on official ECP status. If necessary the Provisional period may be extended.

2. Orientation period

• The ECP will be required to complete the orientation manual/process within a three month period from their hire date.

• Extensions to this time frame may be made with the approval of ___________________

Purpose:

This policy defines the equipment that will be issued to ECP’s.

Policy:

1. __________________________________EMS will provide the ECP the following equipment at the discression of the ______________________:

• Pager, radio and chargers if applicable

• Digital pager if applicable

• Building key fob or card

• Identification card/badge

• Drug cabinet fob if applicable

• Appropriate uniforms and accessories as outlined in Uniforms and Appearance policy.

• EMS protective gear

2. Equipment upon separation

• Upon separation from the department, all department -owned equipment will be turned in to the EMS office, and all issued keys returned.

Purpose:

To define methods for initiating or responding to media contacts.

Policy:

1. Release of Patient Information

• No member of __________________EMS will provide any confidential patient information to the media or any member of the public. Refer to the confidentiality policy for more detailed information.

• ECPs are allowed to release the following information to a confirmed media contact: time, date, location of the call, initial dispatch (medical alarm or trauma alarm.) and if the injuries were life-threatening or non life-threatening. Refer other media questions to the destination hospital’s public relations department. ECP’s may refer the media contact to__________________________.

➢ _________________ ________

➢ _________________ ________

➢ _________________ ________

➢ _________________ ________

➢ _________________ ________

• In the event of a death, refer inquiries to the _____________County Medical Examiner’s Office (____________; after-hours:______________). All questions from the general public should be referred to the destination hospital’s main phone line.

2. On-Scene Media (TV Crews and Newspaper)

• Protect the patient’s modesty and confidentiality.

• If the on-scene media interferes with patient care, have a patrol officer remove the individual(s).

3. Releasing Information to the News Media (News Releases, Public Service Announcements)

• News releases and public service announcements may be sent out with ______________ approval.

4. Obtaining Consent to Photograph, Record or Interview for promotional purposes

• Staff will explain the intended use of photographing, videotaping, voice recording or interviewing the subject prior to obtaining the image or recording for advertising or promotional purposes. This consent will remain on file while the image or recording is used.

• Images and recordings used for promotional purposes are the property of __________________ EMS.

5. Use of Public Information Officer (PIO)

• The _________________shall serve as the department’s primary PIO, others may be appointed at the discretion of___________________________.

6. Scene Photographs

• Photographs used for clinical purposes become a part of the patient’s medical record and are not covered under this consent

Purpose:

This policy will outline expectations and policy regarding meeting attendance

Policy:

1. Required Duty

• ECP’s will be allowed two (2) absences from monthly Crew meetings from January 1st to December 30th of each year. Each ECP will be responsible for ensuring that they don’t use their absences at the beginning of the year and not have any available for illness, vacation, etc. at the end of the year. Training meetings are at the individual ECP’s discretion, unless they are mandatory.

• The ECP’s absence will be excused if the following criteria applies

➢ The meeting conflict's with the ECP's primary job, which does not include secondary jobs

➢ The primary job is shift work and no other work scheduling options are available

➢ The death of an immediate family member as defined by the ____________ leave policy.

➢ The ECP is taking educational classes which lead to a degree or certification and the class is held during our meeting time

➢ The ECP is on military leave

➢ The ECP must notify _______________________of the conflict prior to the meeting.

➢ The ECP must attend the entire meeting to be counted as present

Purpose:

This policy will outline the guidelines regarding performance appraisals.

Provides guidance through the performance appraisal process

Policy:

1. All full-time and part-time employees will receive a Performance Progress Appraisal on a yearly basis.

2. The Performance Progress Appraisal will be performed by the appropriate supervisor, with input from other staff where appropriate.

• While all employees will receive input on improvement throughout the year, the yearly performance appraisal process will allow a set time to evaluate strengths, areas for improvement and for goal setting.

Purpose:

This policy outlines the expected conduct of ECP’s.

Policy:

1. Standard of Conduct

• All ECP’s whether on call or off, shall be governed by the ordinary and reasonable rules of conduct and behavior which are common standard for the profession. They shall not commit any act tending to bring reproach or discredit upon _________________Emergency Medical Services or the___________________________.

2. Obedience to Laws and orders

• All ECP’s of the department shall obey all laws of the United States of America, the state of Iowa, all ordinances and regulations of ______________________Counties and the______________________, Iowa. This includes all lawful orders of the courts, the provisions of these rules and all written directives of the department.

3. Obedience to orders of the Management Staff

• All ECP’s shall comply with all lawful orders of the Management Staff

4. Respect between ECP’s

• All ECP’s in the department shall treat those in the department of either superior or lesser rank or authority, whether full-time or part-time with the respect due to fellow ECP’s.

5. Derogatory remarks or act by ECP’s

• ECP’s shall not perform any acts or make any statement, oral, or written, for publication or otherwise, which tend to bring the department or it employees into disrepute, ridicule, or which destructively criticizes the department or its employees or which tend to disrupt or impair the performance of the duties and obligations of employees in the department; or which tend to interfere with or subvert the reasonable supervision of proper discipline of ECP’s in the department.

6. Courtesy and Customer Service

• ECP’s shall be courteous and civil to the public and one another.

• ECP’s shall be orderly, attentive, and respectful and shall exercise patience and discretion in the performance of their duties.

7. Cause of disciplinary action

• Employees shall be subject to disciplinary action for acts of misconduct.

• Failure of an ECP, either willfully or through negligence or incompetence, to perform the duties of his/her certification or assignment may be considered sufficient cause for discharge, or other disciplinary action.

• The progressive disciplinary action shall proceeded in the following order:

➢ Oral

➢ Written informal

➢ Formal written

8. Patient Confidentiality

All employees __________________EMS will abide by the staff policy regarding confidentiality.

Purpose:

To provide guidelines for scheduling and vacation requests.

Policy:

1. Scheduling will be completed by the __________________and will meet or exceed the following guidelines:

• Two (2) certified ECP’s with at least one (1) being certified at an EMT-Paramedic Specialist level and one (1) being certified at an EMT-B level.

• Station assignments based on the posted schedule will be created and posted to the department by the _________________________. Assignments should be posted far enough in advance so as to allow staff adequate time to prepare for their scheduled duty.

2. Availability

• All part-time ECP’s shall be available for a minimum of twenty-four (___) hours of work per month.

• Part-time ECP’s shall turn in their schedule of availability for the upcoming month to the _________________on or before the twentieth (___) of each month. Schedules of availability should be made available on the In-House Availability form located in the crew quarters.

• Failure to comply may result in not being scheduled or being scheduled at a time chosen by_______________________.

• If not available for a scheduled shift, the ECP shall find coverage that meets minimum state scheduling requirements.

3. Requests for time off

• Full-time ECP’s requesting time off should complete a vacation request form and turn it in to the _______________by the twentieth (__) of the month prior to the request. The _________________will consider requests after this date if appropriate coverage is obtained by the ECP.

• Every effort will be made to honor requests for time off; however, approval is not guaranteed.

• Factors considered when a scheduling conflict arises will include, seniority, when request was received, availability of vacation, sick or comp time, and reason for request.

• Requests for time off made less than ninety (__) days in advance will be made on a first-come-first-serve basis.

• Request for time off made greater that ninety (__) days in advance will be made on the basis of seniority. Seniority shall be determined by the hire dates for full and ¾ time staff.

4. Requests for Trading Shifts

• Requests within the month will be handled by the_______________. Any paperwork related to time off or vacation should be filled out and turned into ____________as well.

• Requests for trades made for months following the active schedule will be approved by the _________________and changes to the schedule will be made appropriately.

Purpose:

This policy details the _____________________EMS position on tobacco use.

Policy:

1. Tobacco use is inconsistent with a professional image for the department as well as good personal health habits. Therefore, tobacco use, whether “smokeless” (chew or dip) or smoked (cigarettes or cigars) is prohibited except in designated areas located outside of __________ facilities.

2. The ________________or his/her designee will designate an approved smoking area outside each _________________facility. Tobacco users are responsible for cleaning up all materials. Cigarette butts are to be properly disposed of and not left on the ground or pavement.

3. Tobacco use is strictly prohibited:

• Inside any Department facility

• Inside any Department vehicle

• Anytime while at any emergency scene whether before, during, or after the emergency.

• Anytime on duty or in uniform and visible to the public.

Purpose:

This policy provides guidance as to the use of intoxicants and medications as related to their work obligations.

1. Intoxicants

• No ECP under the influence of alcohol or a controlled substance, shall report for duty or meetings under any circumstances unless, he/she has first given this information to and has been ordered to respond by_________________. No ECP shall use or consume alcohol or a controlled substance, while working a scheduled shift.

• No ECP, off duty in any part of uniform dress, shall drink alcoholic beverages, or use a controlled substance, in public view or in a place accessible to the public, nor shall any ECP off duty in uniform purchase any alcoholic beverage, or wear any part of his/her uniform for social reasons into any establishment which functions solely as a bar or tavern.

• No ECP while off duty shall drink an alcoholic beverage, or use a controlled substance, to an extent that renders him/her unfit to report for his/her next scheduled tour of duty or which results in a commission of an obnoxious or offensive act, which might bring discredit upon the department. No alcohol shall be consumed within eight (8) hours of starting a shift.

• No ECP shall report to duty and not be able to perform normally due to the effects of alcohol consumption or a controlled substance prior to their shift. Poor attitude, tiredness, feeling ill and slow mental decision making ability due to the effects of alcohol will not be tolerated.

2. Medications

• No ECP shall report to duty under the influence of medication which impairs their mental ability, decision-making or driving whether prescriptions or non-prescriptions.

Purpose:

This policy defines the vital information ECP’s shall disclose to ________________________EMS.

Policy:

1. A report of any change of address or telephone number shall be made in writing to ______________within one week of the change. All ECP’s are required to have on file a current address and phone number in order to be eligible for EMS response.

2. Any ECP who has disciplinary action taken against their EMS certification, driving license, or other license or certificate, which may relate to their EMS duties, will immediately notify a member of the administrative staff in writing. In no case will the ECP respond to any calls until said notification has been made and authorization to respond received from the Chief.

3. Any ECP who has a medical condition, which may impact their ability to function on a physical or mental capacity, will notify __________________________immediately.

4. The arrest of any ECP shall be reported immediately to a member of the administrative staff.

Purpose:

To ensure that clinical and response quality is maintained

Policy:

___________________________EMS will have in place a CQI program to monitor both clinical and response quality.

Required elements of the CQI program shall at a minimum include:

Run Audits

A peer review / run audits will be performed on 100% of calls responded to be the department. The run reports and the care administered during a shift will be reviewed by the _____________reporting for duty the next day. Runs will be audited using the “Pre-Hospital Chart Audit” form. Crews will note any deviations from established protocol as well as any concerns they should have regarding the call for service.

Following the initial peer review, all calls will be reviewed by the________________________________. If needed or indicated, calls will be forwarded to the Medical Director for further comment.

The Medical Director for ________________________Emergency Medical Services designates the following to positions as designees in the EMS Quality Assurance/Improvement areas of Medical Audits (Run Reports) and/or Skills Maintenance (Logs/Training).

• ____________________

• ____________________

• ____________________

• ____________________

Run audit sheets for calls that demonstrate exemplary care or care in which redirection was provided by peers, administrative staff or medical direction will be maintained on file for future reference.

Random Audits

In addition to the calls for service forwarded to the Medical Director by the ________________, the Medical Director will reserve the right and is encourage to perform random audits on any call for service to ensure quality of care and documentation.

Clinical Indicators

At a minimum the following clinical indicators will be regularly assessed for compliance within established thresholds:

• Timely, accurate patient assessment: Vital signs acquired within 10 minutes of patient contact.

• Timely medical intervention: As appropriate for patient

• Care provided is done in accordance with established protocols

• IV success rate 70% for each employee

• Intubation success rate 80% for each employee

• Trauma scene time < 15 minutes

• Medical scene time < 20 minutes

• Clinical documentation quality: Performed within departmental documentation guidelines

• 12 lead ECG prior to treatment and within 15 minutes of patient contact

Response Indicators

• Code 1 < 10 minutes

• Code 2 or 3 < 8 minutes

• Call received to dispatch < 2 minutes

• Dispatch to en route: Day < 1 minute, Night < 2 minutes

• Arrival times 90% of calls in 8 minutes and 59 seconds or less for code 2 & 3 responses.

• Arrival times 90% of calls in 9 minutes and 59 seconds or less for code 1 responses.

Adherence to Protocols

• Any ECP who is found consistently not adhering to protocols will be counseled and remediated by _______________________________and/or Service Medical Director

• Continual failure to adhere to protocols will result in the initiation of the progressive discipline policy

Dispatch QA/QI Audit Process

As part of the general audit process, the dispatch process will also be monitored. The ________________________will monitor all EMS requests for service for a “call received to dispatch” time that is less-than 2 minutes.

All calls with a “call received to dispatch” time greater-than two minutes will be reviewed. This process will include but not be limited to:

• Reviewing dispatch data for time entry errors on the part of EMS crew members.

• Requesting recorded dispatch tapes.

• Interviewing parties involved.

On a regular basis, the ___________________________will meet with representatives from the dispatch center to review requests for service that failed to meet the two minute “call received to dispatch” goal. It will be the purpose of this group to address issues that may arise and propose procedural changes and / or provide education to EMS crew members or dispatchers to remedy problems or improve dispatch times.

Educational Audit Reviews

During the course of the year, __________________________will gather patient care reports to be used for educational review and the advancement of departmental care. These reports should be reviewed with the assistance of the Medical Director during a department training session.

Employee Counseling and Remediation

Employees found to be below minimums in clinical indicators or displaying a consistent pattern of not meeting response guidelines as well as failing to meet other CQI initiative in the pre-hospital chart audit process will be counseled on the process and given further education and remediation if deemed needed by___________________________________.

Reporting CQI Data

Clinical Indicator Data

Data regarding clinical indicators will be reviewed on a quarterly basis. Each employee will be provided with a report of their performance related to the clinical indicators. Employees with skills or practices not meeting the established thresholds will be notified and if needed remediation will be given.

A summary report of clinical performance will be provided to the departments, management staff and the Medical Director.

Response Indicator Data

Data regarding response indicators will be reviewed on a monthly basis. The ______________in charge shall be responsible for reporting this data. Calls not meeting the response goal of 7 minutes and 59 seconds will be reviewed for cause and entered into the exception data base.

Fractile response reports containing calls not meeting the response goal and monthly response percentage totals will be given to the _______________________for review. In addition, the ________________________-will be provided with an exception report displaying responses not meeting the departmental goal and citing determined reasons for the failure.

Purpose:

This policy provides a means to assure the skills of ECP’s remain at a high level and to assure protocols are being followed.

Policy:

Ongoing Training

Continuing Medical Education Requirements

To remain an active member and/or an employee ________________Emergency Medical Services, each individual shall maintain as a minimum the following:

• Appropriate continuing education hours and required topics necessary to renew their EMS certification.

• Maintain a current CPR card according to current American Heart Association or American Red Cross standards (including 1 & 2 person adult/child CPR, infant CPR, adult, child obstructed airway and barrier device).

• EMT-Paramedic, EMT-Paramedic Specialist and Registered Nurse must also maintain a current ACLS card.

• Meet or exceed the minimum skills requirements for the position held on a quarterly basis, the necessary skills training session as required by Section 131.4 – (4) in, Code of Iowa

• Maintain on file a copy of all current certification cards applicable to their level of certification.

• Documentation of emergency driving and use of the communications equipment.

Minimum Skills Requirements

Because the field of Emergency Medical Services is continually changing, and certain skills required of an emergency care provider are used infrequently. The following skills must be performed on a call or simulated and documentation maintained by the Training Officer.

EMT-B

• Medical Patient Assessment – Biannually

• Trauma Patient Assessment – Biannually

• Patient Immobilization – Quarterly

• Hare/Sager Application – Biannually

• Combitube( – Quarterly

• Glucometer operations – Quarterly

• ECG Monitor Placement – Quarterly

• Written protocol test – Monthly

• Driving skills review / evaluation - Annually

EMT-I

• All skills required of an EMT-B

• Intravenous Cannulation – Minimum of 10 successful per quarter with a success rate greater-than 70%

Paramedic/Paramedic Specialist/RN

• All skills required of the EMT-I

• Medicated Airway management/review (Iowa Paramedic excluded) – 1 per quarter

• Endotracheal Intubation – Minimum of 3 successful per quarter with a success rate greater-than 80%.

• Needle Chest Decompression – Biannually

• Needle Cricothyrotomy – Biannually

• Intraosseous Infusion – Biannually

• ACLS / Mega-Code Review – Biannually

• 12 lead ECG interpretation (Iowa Paramedic excluded) - Biannually

Skills Maintenance & Records

The ________________________________will be responsible for the recording of skills performed by each employee and informing each employee when a deficiency exists in their skills maintenance requirements.

Skills performed within the department will be tracked through patient care reporting software.

Skills performed at places of employment other that ______________EMS will be recorded in the “Outside Skills Documentation” binder made available in the__________________. It will be the responsibility of individual staff members to maintain records of outside skill documentation within this binder. Formal verification of these skills must be available upon request of administrative staff.

Any skills performed during skills labs or other informal sessions will be documented by completing a “skills checklist”, complete with witnesses signature, and submitting it to the _______________________.

In the month proceeding the last month of the quarter, the _______________________will inform employees when a deficiency exists in their skills maintenance requirements. Each employee will have until the end of the quarter to ensure that the deficient skills are completed. Should an employee fail to complete their required skills, the skills compliance disciplinary process will be initiated.

The Medical Director reserves the right to audit any service run report and/or individual’s skills log or compliance with QA skills directive at any time and hereby direct those acting as designees to bring to attention, at the earliest possible convenience of significant departure from written protocol and/or standard medical practice (for the individual’s and/or service’s level of certification).

Quarterly Skills Training

Skills labs will be held on a quarterly basis, generally within the last month of each quarter. During such sessions the equipment needed to perform minimum skills requirements will be made available.

Skills Maintenance Compliance

Decision Tree

Yes No

Purpose:

Provides guidelines for the orientation and training of new ECP’s.

Policy:

1. New ECP’s will be assigned to a Field Training Medic (FTM) once they are officially hired by_________________________. Once assigned to the FTM, ECP’s will be issued an orientation manual and complete the orientation process as outlined below.

• The ECP will schedule their first shift with their FTM. During this shift the ECP will be informed on the orientation process and expectation.

• The ECP will meet with the ____________________________to complete required training such as blood borne pathogens, fit testing and provide other pertinent documentation as requested.

• The FTM will coordinate the new ECP’s orientation schedule.

• The ECP will be allowed to schedule orientation time at their discretion.

• Field Evaluators will fill out an evaluation form following each orientation shift and forward it to the assigned FTM. The FTM will monitor the evaluations forms and will place emphasis on identified weak areas.

• Field orientation time will continue until the training manual has been completed. At this point, a meeting will be set up between the FTM, _________________and ____________________to evaluate the new ECP’s performance and readiness to complete the final practical and written testing.

• The _________________________________will administer a written and practical test dependant on the ECP’s level of certification. The written test will need to be completed with a score of 80% or better. The practical exam will be pass/fail. If the ECP does not pass this testing, they will not be allowed to see the test, but will be remediated by the ________________________________in areas of concern and then allowed to re-test at a later date.

✓ If the ECP fails for a second time, the FTM, ______________and _____________________will develop a remedial orientation process.

✓ If the ECP fails the written and / or practical testing for a third time, they may be dismissed at the ______________________discretion.

• Successful completion of the testing results in the status of Provisional ECP. The ECP will be placed on the schedule and function in the capacity of the second crew member.

✓ The ECP will function in a provision status for six months following their orientation process.

• At the end of the six month provisional period, the new ECP, ___________________, and the ___________________will meet to decide on an official ECP status. If necessary the provisional period may be extended.

2. The ECP will be required to complete the orientation manual/process within a three month period from their date of hire.

• Extensions to this time frame may be made with the approval of the Senior Command Staff.

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_________________ completes quarterly review of skills and completes a skills record. This should be completed by the end of month in February, May, August & November.

____________________notifies employee’s Lieutenant and formal disciplinary process is initiated.

Process Complete

Skill deficiencies completed prior to end of quarter?

Employee is notified in writing of pending skill deficiencies that will need to be completed by the end of the quarter.

Warning issued to employee, both verbally and electronically that they have 15 calendar days from the date of their notification to complete their deficient skills.

If deficiencies are not completed within the 60 days following the initial notification of skill deficiencies, the employee shall be terminated.

Process Complete

Formal written warning issued through_________________. Employee is suspended from all EMS operations until deficiencies are completed.

Skill deficiencies completed prior to end of 15 day period?

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