Fire Service EMS Responsibilities What you don’t know can hurt you! Sabina Imrie, BC, EMS Manager Mike Giannini, BC, Emergency Medical Officer Marin County Fire Department 1 Livermore Pleasanton Fire Department and Why are you here? Minneapolis Fire Chief accused of harassment By Amy Forliti The Associated Press MINNEAPOLIS, Minn. Objectives • Understand the organizational structure of EMS at all levels • Review the regulations and laws that govern EMS • Discuss challenges facing an EMS Manager • Understand the importance of CQI • Recognize how education is the KEY to improvement (Video) BE RESPONSIBLE ! California EMS Organization Emergency Medical Services Authority (EMSA) Local Emergency Medical Services Agency (LEMSA) Local EMS Providers (Fire and Private) EMS Within Your Agency The people….. •Line Personnel •Leader •Medical Director •CQI Coordinator •Committees •Support Staff A Whole New Definition of Support Staff EMS Within Your Agency The tasks….. • • • • • Coordination (IC) Budget Vendor Management Equipment / Supplies Contracts – Paramedic & EMT Training Programs – Hospitals – Ambulance companies – Medical Director – CQI Coordinator – LEMSA – Maintenance agreements EMS Within Your Agency More tasks….. • • • • • • CQI Staff Reports Narcotic Management Infection Control Training ePCR Management EMS Within Your Agency More tasks…..(continued) • • • • • • Hospital Liaison Operations Liaison Meetings Grant Management Policy Development Recruitment EMS Within Your Agency What about these tasks….. • • • • • • • • • CPR Instruction Public Education CERT Disaster Preparedness Public Access Defib Injury Prevention Health and Wellness CISD Rehab Should they be in EMS ? What about Leadership? Regulations and Laws The Case of the Missing Report The Facts: An elderly woman places a call to the fire station to have the firefighters help her husband back to bed. Crews have been to the house many times in the past for this very same reason. The Case of the Missing Report More Facts: They arrive on scene and help the individual back to bed. They take a BP and run a strip to make sure there are no underlying problems. Everything looks good and they head back to the station. The Case of the Missing Report More Interesting Facts: On the way back to the station, they respond to a fatal accident with multiple patients. FAST FORWARD SIX MONTHS The Case of the Missing Report Wife files claim for wrongful death Argues transport was indicated Agency reviews their records for the incident GUESS WHAT ??? The Case of the Missing Report The agency has no record of being at the residence that day. Personnel have no recollection of being there. The Case of the Missing Report • • • • • • No dispatch record No station log entry No PCR No field notes No hospital contact No recollection of the event The Case of the Missing Report The agency attorney says: “WE WEREN’T THERE” Outcome • • • • How did this end? Could this happen within your agency? Importance of documentation Must have policies in place to insure ALL calls for service are documented. What you need to know….. • • • • • • • • Local Policies and Procedures Infection Control Narcotic Management (and disposal) OSHA Reporting (EMS) CPR Requirements Billing Practices HIPAA Other laws Local Policies and Procedures • • • • • • • Applicable To All Line Personnel Review Frequently Tie to Regular Training Pocket Protocol Books Post in Conspicuous Places Place on Website Lots of Access! Infection Control • • • • • • • Ever Changing Stay Current Rapid HIV Testing Understand the Role of the D.O. Blood Test for TB Must Provide Certain Vaccinations THIS IS THE LAW! Narcotic Management • • • • • • Required Documentation Form 222 Waste Management Clear Policies Drug agency probing fire department’s missing morphine Limited Access California - The federal Drug How would you Enforcement Administration is probing the theft of morphine carried on a fire track loss? department engine after several vials of the narcotic painkiller were discovered with broken seals. OSHA Reporting • • • • • Mandatory Reporting (Chapter 3.2, SC 2, A3 §342) EMS Incidents “Serious Injury” “Immediate Telephone Report” Include specific information CPR Requirements • California Law requires firefighters, peace officers and lifeguards to be trained in CPR • What about your Deputy, Division or Administrative Chiefs? Billing Practices Billing Practices • • • • Use an expert Be aware of your rights Accurate documentation Quick turn-around HIPAA • • • • • Provides for Confidentiality Are you a “Covered Entity” Notice of Privacy Practices What about non-transports? Don’t forget about “Best Practices” Regulations and Laws They’re Your Responsibility! http://osfm.fire.ca.gov/FFLaws.html EMS Challenges • Time Management • Regulation and Policy Change – Licensure – Certification – Infection Control • Technology – PDAs, Cell Phones, GPS, Cameras, Video, Websites, ePCR, Computers etc. • • • • • • Budgets Minimal Support Staff Medical = EMS ???? Succession Planning Meeting Public Expectations Ever-Changing Medical Landscape (Pan-Flu) CQI It’s All About COMMUNICATION! Old School CQI Case Study – A paramedic within your agency fails to give a proper medication to a patient. The doctor in the ED immediately calls you. You react and immediately call the medic. You tell him that he screwed up and a letter is going in his file. End of discussion. NEW School CQI Case Study – A paramedic within your agency fails to give a proper medication to a patient. The doctor in the ED immediately calls you. You gather the facts and determine that a system issue caused the medic to fail. You address the system issue. Is CQI Really Necessary ? • Most issues reflect flaw in “system” • Not Individual performance • Education is the KEY to improve performance • Repeat the message – Drive it home • CQI for suppression activities ? – We do it now, not formal. Examples? Education is KEY • • • • • • • • Regular Training Programs PHTLS, PALS Policy Updates Infrequently Used Skills Case Review Incident Critique CE Requirements College Course Work / Degree Positive Feedback • You Must Do This! • Remember how you felt the last time someone patted you on the back? (maybe not) • You may have forgotten how well that motivates someone • Homework What is your Mission? Questions?