OHIO DEPARTMENT OF PUBLIC SAFETY Administration Bureau of Motor

OHIO DEPARTMENT OF PUBLIC SAFETY • • • • • • • • Administration Bureau of Motor Vehicles Emergency Management Agency Emergency Medical Services Division Office of Criminal Justice Services Ohio Homeland Security Ohio Investigative Unit Ohio State Highway Patrol Ted Strickland, Governor Nancy J. Dragani, Acting Director Richard N. Rucker Executive Director Emergency Medical Services 1970 West Broad Street P.O. Box 182073 Columbus, Ohio 43218-2073 (614) 466-9447 (800) 233-0785 www.ems.ohio.gov EQUIPMENT AVAILABLE OHIO EMS FOR CHILDREN MANNEQUIN GRANT 2006-07 GRANT APPLICATION The seven studies required by HB 138 (11/03) and a recent survey of Ohio emergency medical technicians and EMS coordinators (11/05) indicated that there are ongoing needs in pediatric continuing education in the State of Ohio. The Ohio Emergency Medical Services for Children (EMSC) Committee, a subcommittee of the Ohio EMS Board, is supporting opportunities for improvement in EMT training by making available a number of pediatric mannequins utilizing Ohio EMSC grant funding. Training mannequins have been purchased by Ohio EMSC and are proposed to be provided to approved EMS accredited training institutions and continuing education programs throughout Ohio. Enclosed in this packet is the EMSC Training Mannequin Grant Application. The mannequins provided by this grant will enable approved EMS accredited training institutions and continuing education programs to offer specific skills training in pediatric pre-hospital care. Following is key information about the grant application process. PLEASE NOTE: This grant is NOT for funding for purchase of training equipment. Equipment which has already been purchased is available. You may apply separately for each of the two mannequins available. PURPOSE: To improve emergency medical service in select Ohio regions by providing pediatric training mannequins through this grant, for the purpose of providing training approved for continuing education. ELIGIBLE APPLICANTS: All approved EMS accredited training institutions and continuing education programs as of January 1, 2007, are eligible for training mannequins. The applicant will be the lead agent responsible for implementation of the proposed plan, reporting, evaluation and maintenance regardless of other regional EMS partners. DEADLINE: The deadline for 2006-2007 applications is 5:00 PM, Wednesday, February 28, 2007. See “Instructions for Assembling the Application” below for details. APPLICATION AVAILABILITY: Applications are available to all eligible applicants on the EMS website at: http://www.ems.ohio.gov, then go to the EMSC section. AVAILABLE EQUIPMENT: There are a total of 80 training mannequins available for this grant period. See page 4 for details. Mannequins have been purchased with EMSC Partnership Grant funds (H33MC00136) provided by the Health Resources and Services Administration (HRSA). ALLOWABLE EXPENSES: No expenses are allowed for this equipment grant. Any and all associated cost for use, maintenance and repair of the allotted mannequins, as well as for any other activity related to this grant project, shall be borne by the recipient. PROJECT PERIOD: July 1, 2007 to June 30, 2009 Mission Statement “to save lives, reduce injuries and economic loss, to administer Ohio’s motor vehicle laws and to preserve the safety and well being of all citizens with the most cost-effective and service-oriented methods available.” Ohio Department of Public Safety Page 2 SELECTION CRITERIA: Applications will be reviewed by an objective review committee. Each committee member will complete a standardized review document which reflects the requirements stated in this packet. This committee may award grants conditionally, at which time the applicant must provide additional information by a specified date. Notification of grant award offers will be mailed to the contact address by June 30, 2007 and equipment will be delivered to recipients by September 30, 2007 unless recipients are otherwise notified. Competitive proposals for the grants must: • Provide a plan for training using the requested training mannequin for all levels of Ohio EMS certification. EMS continuing education credits must be offered to all trainees. All instruction must be conducted by an Ohio EMS instructor as defined in the Ohio Administrative Code Chapter 4765-18. • Include plans to publicize and offer appropriate regional training to first responders, EMT-B, intermediate, and paramedic levels utilizing the training mannequin. Training must be offered a minimum of three times a year for a two year period from July 1, 2007 to June 30, 2009. An estimated cost for training per participant must accompany the application and must be reasonable and affordable as determined by the EMSC Grants Review Workgroup. • Provide a general description of the type of training to be offered and the curriculum to be used. • Contain letters of support documenting any plans to collaborate with training partners and EMS agencies. A LETTER FROM YOUR INSTITUTION’S MEDICAL DIRECTOR, INDICATING HOW S/HE IS TO SUPERVISE MEDICAL CONTENT IN YOUR EDUCATIONAL PROGRAMS, IS REQUIRED. • Describe plans for evaluating the effectiveness of training activities. Areas of special focus include the following: • Special consideration will be given to programs with plans to offer training to rural areas as defined by the HRSA Office of Rural Health Policy’s eligibility for rural health grant programs (see http://ruralhealth.hrsa.gov/funding/eligibilitytestv2.asp). • Special consideration will be given to programs with plans for institutionalization of the project within the region. The Ohio EMSC Committee is looking for projects to make a long-term impact on pediatric patient care within a region. See section II for narrative content. REQUIRED REPORTING: • • Annual Report: July 1, 2008 Final Project Report: July 1, 2009 See Section VI for report content. Failure to submit a properly completed Annual Report electronically to the Ohio Division of EMS by July 1, 2008, may result in ineligibility for future participation in any future Ohio EMSC program. Failure to complete the proposed project in accordance with this application, as determined by the Ohio EMSC Committee, or failure to submit a properly completed Final Project Report electronically to the Ohio Division of EMS by July 1, 2009, may result in ineligibility for future participation in any future Ohio EMSC program. Thank you very much for your commitment to improve regional pediatric training opportunities. We look forward to receiving a grant application from your institution and working with you to improve pediatric pre-hospital care in Ohio. Ohio Department of Public Safety Page 3 INSTRUCTIONS FOR ASSEMBLING THE APPLICATION Using the checklist on the next page and the instructions below, send a complete application electronically to the following address by 5:00 PM, Wednesday, February 28, 2007. No faxed, mailed or hand-delivered applications will be accepted (see below for signed grant contract instructions). Send to: EMSC@dps.state.oh.us The information presented in the application, and your response to the review criteria, constitute the sole basis for evaluation of your request for funding. It is essential that your request and responses to the criteria be succinct, complete and easy to understand. Your proposal must be typewritten and include a response to each category in the application. Your proposal narrative must not exceed eight (8) pages. • To promote readability and consistency in organization, the Ohio Division of EMS has established specific conventions for the format of the application. Assemble the application per the Check-off List below. Acceptable files are Microsoft Word (.doc), WordPerfect (.wpd), or Adobe Acrobat (.pdf). Include a cover letter on your organization’s letterhead indicating the specific grant for which you are applying, followed by the Contact Information sheet, Project Narrative, Grant Contract (with original signature), Letters of Support, and any appendices. HARD COPY OF THE SIGNED GRANT CONTRACT MUST BE POSTMARKED BY THE SUBMISSION DATE (2/28/07) AND MAILED TO: EMS for Children Program/2007 Mannequin Grants Ohio Department of Public Safety Division of EMS P.O. Box 182073 Columbus, OH 43218-2073 • • • Letters of support and appendices may be scanned and sent electronically, or may accompany the hard copy of the signed grant contract, but must be postmarked by February 28, 2007. ANY SUPPORTING DOCUMENTS TO BE SENT BY MAIL MUST BE NOTED IN THE GRANT NARRATIVE. If you have any questions, contact Joe Stack at 1-800-233-0785 or through e-mail at jestack@dps.state.oh.us. • Ohio Department of Public Safety Page 4 TRAINING MANNEQUIN DETAILS Laerdal Nita Newborn (50 available): The Nita Newborn is a model of a 4 lb, 16" newborn female with realistic landmarks and articulation for vascular access procedures. • Nose and mouth openings allow placement of nasal cannulas, endotracheal tubes, nasotracheal tubes and feeding tubes • Standard venipuncture in various sites facilitating blood withdrawal, fluid infusion and heparinization • Median, basilic and axillary sites in both arms • Saphenous and popliteal veins in right leg • External jugular and temporal veins • Central catheter insertion, securing, dressing and maintenance • PICC line insertion, securing, dressing and maintenance • Umbilical catheterization Laerdal Pediatric Intubation Trainer (30 available): Anatomically accurate reproduction of a pediatric torso designed for teaching the differences in pediatric and adult anatomy for airway management procedures. • Anatomically accurate airway allows sizing and insertion of various airway adjuncts: o Oropharyngeal and nasopharyngeal airway insertion o Endotracheal tube insertion and securing • Bag-Valve-Mask ventilation • Tracheal suctioning • Manually generated carotid pulse • Closed chest compressions Ohio Department of Public Safety Page 5 (COMPLETE THIS SHEET AFTER YOU HAVE DONE THE REST OF THE APPLICATION) I. CONTACT INFORMATION Please list an organizational address (not home address). All correspondence concerning the grant will be mailed to the address listed below. All fields below are REQUIRED. Contact Person: Organization: Address: ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ Day Phone: E-mail: Mannequin Requested (circle/mark ONE): _______________________ FAX ________________________ ___________________________________________________ Nita Newborn Pediatric Intubation Trainer CHECK-OFF LIST Your application should contain the following: _____ Cover Letter on your organization’s letterhead _____ Contact Information and Check-Off List (this page) _____ Project Narrative: Includes Participants & Project Description. Please type your responses, double spaced, with 1-inch margins on all sides and respond to the questions in the order that they are listed (should not exceed 8 pages) _____ Contract/Assurances: Completed electronic version without signature AND with original authorizing signature, mailed as noted above _____ Letters of Support: From medical director (REQUIRED), training partners, collaborators and/or potential participant agencies _____ Appendices: Additional supporting information (Optional) SEND A COMPLETE APPLICATION ELECTRONICALLY TO THE ADDRESS ON PAGE 3, BY 5:00 PM, WEDNESDAY, FEBRUARY 28, 2007. NO FAXED, MAILED OR HAND-DELIVERED APPLICATIONS WILL BE ACCEPTED. Ohio Department of Public Safety Page 6 II. PROJECT NARRATIVE Your narrative should be typewritten, double-spaced, with one-inch margins on all sides, and respond to each of the following questions in the order that they are listed. Responses should be labeled (e.g. 1A, 2B, etc.) so that they correspond with the questions. Your proposal narrative must not exceed eight (8) pages. 1. PARTICIPANTS: A. Identify the participant organizations in your project, including their history of providing EMS continuing education. Who will provide the training, where will the training be held, who will grant continuing education credits? How will training be made accessible to interested parties? Who will be responsible for the care and maintenance of the training mannequin? How you will maintain the quality of the training program if various individuals are involved? B. How will your medical director oversee the medical components of the training offered? C. Who will be the recipients of the training, and how will you notify/recruit your target audience? How will you prioritize who can take the training if demand exceeds availability? 2. PROJECT DESCRIPTION: A. Choose one training mannequin (i.e., Nita Newborn or Pediatric Intubation Trainer). How will training with this mannequin help improve pediatric pre-hospital skills in your region of Ohio? B. Describe the methodology associated with your proposal. Describe strategies/activities that will be used and how they will be implemented. Include a brief description of the type of training to be offered, any curricula to be used, class size and how many trainings will be planned. C. Describe future project plans; what is the plan to continue or expand this project after the grant period has ended. This should include: 1) brief description of plan; 2) specific agencies or programs involved in continuation plan; and 3) other potential sources of support or plans for future funding. D. Describe how you will evaluate the effectiveness of the program. State how you will measure that your project achieved its objectives. E. List any supporting documents which can not be sent electronically and which will accompany the signed agreement. Ohio Department of Public Safety Page 7 III. CONTRACT/ASSURANCES EMERGENCY MEDICAL SERVICES EMS BOARD TRAINING MANNEQUIN GRANT CONTRACT Agreement And Assurances Between The EMS Organization Mentioned Below And The Ohio Department of Public Safety, Division of Emergency Medical Services 1. Organization Name 2. Federal Tax I.D. Number 3. Address 4. Telephone ( ) County 5. City State Zip 6. 7. Authorizing Official 8. Telephone ( ) 9. Contact Person 10. Telephone ( ) I ATTEST THAT I AM THE DULY AUTHORIZED OFFICER FOR THE ORGANIZATION LISTED ABOVE, AND THAT ALL INFORMATION CONTAINED IN THIS APPLICATION AND AGREEMENT IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I HEREBY ACKNOWLEDGE THAT I AM BOUND BY THE TERMS AND CONDITIONS OF THIS GRANT APPLICATION AND AGREEMENT IF EQUIPMENT IS AWARDED. Authorizing Official Signature: Witnessed or Notarized By Signature: Executive Director, Division of Emergency Medical Services Ohio Department of Public Safety Signature: Witnessed or Notarized By Signature: Date Date / Date / / Equipment Awarded / Date / / / / OHIO DEPARTMENT OF PUBLIC SAFETY ADMINISTRATIVE USE ONLY THIS PAGE MUST BE SIGNED AND MAILED TO THE ADDRESS LISTED IN THE INSTRUCTIONS, POSTMARKED NO LATER THAN WEDNESDAY, FEBRUARY 28, 2007. PLEASE INCLUDE THIS COMPLETED FORM, WITHOUT SIGNATURE, WITH YOUR ELECTRONIC APPLICATION. Ohio Department of Public Safety Page 8 AGREEMENT This Agreement (hereinafter referred to as “the Agreement”) is made by and between the Ohio Department of Public Safety, Division of Emergency Medical Services, (hereinafter referred to as "the Division,") on behalf of the State Board of Emergency Medical Services (hereinafter referred to as “the Board”), and the above mentioned organization presently located at the above mentioned address, (hereinafter referred to as "the Contractor,"), and is subject to the terms and conditions set forth herein. WHEREAS, the Division has indicated a desire to improve emergency medical services in Ohio by providing resources to assist organizations in providing EMS continuing education training utilizing training mannequins, and the Contractor has indicated a desire to improve emergency medical services in this area and has expressed a need for assistance to accomplish these goals; and WHEREAS, the Contractor represents that it is capable of performing the activities listed in the Agreement; and WHEREAS, the Division desires the Contractor to perform such activities in order to fulfill the above listed needs. NOW, Therefore, it is agreed that the Contractor shall perform the following activities for the Division, in exchange for training equipment, in accordance with the following terms and conditions: I. Scope of Work The Contractor agrees to secure training as outlined in its grant application, which is incorporated by reference as part of this Agreement. The Division is responsible only for providing equipment as indicated in the grant application packet. Any and all associated cost for use, maintenance and repair of the provided equipment, as well as for any other activity related to this grant project, shall be borne by the Contractor. The Contractor understands that training mannequins will be issued in accordance with this grant application packet. The Contractor is required to submit an Annual Report to the Division as indicated in the grant application packet. The Contractor must also submit a properly completed Final Project Report to the Division by July 1, 2009: failure to complete the proposed project to the satisfaction of the EMS Board may require the return of equipment provided under this grant to the Division of EMS and may result in ineligibility status for participation in any future Ohio EMSC program. II. Contractor Responsibilities For the purpose of this Agreement, the Contractor acknowledges that all rules as promulgated by the Board shall be followed, including those in Chapter 4765-5 of the Ohio Administrative Code. III. Department Liaison For the purpose of this Agreement, the Contractor shall report, accept direction from, and make inquires to the Executive Director of the Division of EMS, or the Executive Director’s designee. IV. Conditions The Contractor agrees that equipment made available by the Division of EMS for the proposed project will be used to increase and not to supplant federal, state, or local funds otherwise available. V. Compensation The Division, on behalf of the Board, agrees to provide the Contractor the equipment requested in its grant application if approved by the Board. No funding is provided through this grant. VI. Period of Performance This Agreement shall be binding and effective from the execution date through June 30, 2009. VII. Reports All required reports must be submitted in accordance with the grant application, along with all required documentation, and sent to: EMSC@dps.state.oh.us. Any nonelectronic supporting material, and the signed copy of this agreement, must be postmarked or hand-delivered by the date listed in the grant application to: EMS for Children Program/2007 Mannequin Grants, Ohio Department of Public Safety, Division of EMS, P.O. Box 182073, Columbus, OH 43218-2073. VIII. Modification of Work The Division and the Contractor may propose changes in the scope of this Agreement; however, any such changes shall be mutually agreed upon by the Division and the Contractor and be incorporated by written addendum, properly executed, to this Agreement. IX. Equal Opportunity During the performance of this Agreement, the Contractor, for itself, its assignees, and successors in interest, agrees to comply with the requirements of R.C. 125.111. The Contractor asserts that no person shall, on the grounds of race, color, religion, creed, national origin, ancestry, sex, handicap, or age, be excluded from participation under the benefits of this Agreement, or be otherwise subjected to any form of discrimination under this Agreement. X. Sanction for Noncompliance In the event of the Contractor's noncompliance with any provisions of this Agreement, the Division shall impose such contract sanctions as it may determine to be appropriate and may employ any legal or equitable remedies available to it, including, but not limited to: A. Requiring additional reporting until the Contractor complies; B. Imposing ineligibility status upon the Contractor for participation in any future EMSC program; and/or C. Canceling, terminating, or suspending the Agreement in whole or in part. Ohio Department of Public Safety Page 9 XI. Inspection of Work The Division or its designee(s), and the State of Ohio, shall be accorded proper facilities for review and inspection of the work thereunder and shall at all times have access to the premises which includes the classroom, storage areas and any other areas used to conduct the project under this Agreement. The Division or its designee(s) may perform announced or unannounced inspections of the project operation. XII. Protection for Contracting Authority Any and all of the employees of the Contractor, while engaged in the performance of any work or services required by the Division under this Agreement, shall be considered employees of the Contractor only and not the Division, and any and all claims that may arise under the Workers’ Compensation Act on behalf of said employees while so engaged, shall be the sole obligation and responsibility of the Contractor. Any and all services, including those of employees, materials, and any other procurement made by the Contractor for the work done under this Agreement are solely the financial responsibility of the Contractor. The Division reserves the right to protect itself against all suits and disputes pertaining to any nonpayment of any procurement made by the Contractor and to take whatever legal action that may be necessary to make recovery. XIII. Termination of Contract Either party may terminate this Agreement for any reason by giving the other party thirty (30) days written notice. Upon termination, all data results, reports, and other material developed by the Contractor will become the property of the Division. All Division equipment, materials, and/or supplies provided to the Contractor for use under this Agreement must be returned to the Division within thirty (30) days of said written notice. XIV. The terms and provisions of this Agreement are to be interpreted in accordance with the applicable laws of the State of Ohio. XV. Ohio Elections Law The Independent Contractor affirms that, as applicable to it, no part listed in R.C. 3517.13 (I) or (J) (including an individual, partner, shareholder, or business trust), nor the spouse of such party, has made, as an individual, within the two previous calendar years, one or more contributions totaling in excess of one thousand dollars ($1,000.00) to the Governor or to the Governor’s campaign committee, consistent with the restrictions under R.C. 3517.13 (I) and (J). XVI. Drug-Free Work Place The Contractor agrees to comply with the drug-free workplace policy as set forth in Ohio Administrative Code 123:1-76 and Ohio Executive Order 1999-02T. Ohio Department of Public Safety Page 10 IV. LETTERS OF SUPPORT Attach letters of support for the project from individuals, physicians, or member agencies or organizations describing their role and involvement in the project. These letters should come from relevant agencies that have a role in the project. A LETTER FROM YOUR INSTITUTION’S MEDICAL DIRECTOR, INDICATING HOW S/HE IS TO SUPERVISE MEDICAL CONTENT IN YOUR EDUCATIONAL PROGRAMS, IS REQUIRED. Letters of support may be scanned and sent electronically, or may accompany the hard copy of the signed grant contract, but must be postmarked by February 28, 2007. V. APPENDICES (Optional) Attach any additional information which may help describe your project. This information should not duplicate information provided under the Project Narrative, but should be new information or should add detail not included above. This section is optional. Appendices may be scanned and sent electronically, or may accompany the hard copy of the signed grant contract, but must be postmarked by February 28, 2007. Ohio Department of Public Safety Page 11 VI. REPORTING 1. Annual Report ♦ ♦ ♦ Annual Report due: July 1, 2008 Limit to 5 pages each report (not including attachments), double spaced, with 1-inch margins on all sides and respond to the questions in the order that they are listed Report should be sent electronically to EMSC@dps.state.oh.us by the due date; file formats should match the grant application requirements (i.e., .doc, .wpd, .pdf) 1. Provide an activity report that lists progress-to-date for your project objectives. A. Describe any events/activities that have occurred by the completion date of the report and provide a calendar of upcoming events. (Receipt of training mannequin, trainings completed, number of participants, etc.) B. Describe any successes or failures you have had in collaborating with the partners named in your proposal C. Attach copies of resource materials used in your project which can be sent electronically 2. Discuss any problems or delays encountered in completing your proposal. 3. Explain and justify any changes in project objectives, activities, schedule, or location from your original proposal. 2. Final Project Report ♦ ♦ ♦ Due July 1, 2009 Limit to 8 pages (not including attachments), double spaced, with 1-inch margins on all sides and respond to the questions in the order that they are listed Report should be sent electronically to EMSC@dps.state.oh.us by the due date; file formats should match the grant application requirements (i.e., .doc, .wpd, .pdf) Please respond to the following: 1. Who was involved in the planning and implementation of your proposal, and how were they involved? What agencies, organizations, and individuals helped your project and what was their role? 2. Describe the participants and attendance. How many trainings did you conduct during the award period? Provide the number of trainees for each training offered, and a summary of your participant survey/evaluation results. 3. How did you get the word out about your project? Attach any flyers, announcements, or newspaper articles that were used to advertise your project to the community which can be sent electronically. 4. Were there any observable changes among the participants as a result of your project? (For example: does your evaluation of techniques indicate increased knowledge or does EMS Incident Reporting data reflect an increase in proficiency). 5. Were activities conducted as planned; if not, what was changed? (Please review your intended objectives/evaluation plans from your original proposal.)