1. CLINICAL
PERFORMANCE
(POSSIBLE 15 POINTS)
An ambulance system’s actual performance is
extremely difficult to evaluate, except on a diagnosis-specific and
case-by-case basis. Many systems handle certain kinds of cardiac cases very
well, but tend toward poorer performance when faced with serious trauma. Some
may do well with emergency childbirth, but not so well when dealing with
diabetic coma or insulin shock. Realizing these complexities, this scale
resorts to simplifying by determining whether clinically sound medical
protocols exist at all; whether on-board equipment, communication systems and
inventory control systems are compatible with sophisticated medical protocol;
and finally whether field crews are even potentially capable of clinically
excellent performance.
The rating scale favors systems where all field
crews are paramedic, and where each crew handles both emergency and
non-emergency work, since other types of systems result in a community served
by a combination of “elite” emergency crews and less capable so-called
non-emergency crews. The overall clinical performance capability of a fully
professionalized service system is obviously greater than that of a system
which is only partly professional.
Score
A. Select the sentence which most nearly
describes your community’s ambulance system.
__________
SCORE: 1A
* All ambulances in the
system (emergency and non-emergency) are capable of full paramedic performance
at all times.(score 10 points)
* Paramedic units are
dispatched to all emergencies; BLS units handle non-emergencies. (score 4 points)
* Paramedic units are
normally reserved for life threatening emergencies all other emergencies and
non-emergency
transports are normally handled by BLS
crews (Non-transporting paramedic teams assisted by BLS transport crews rate
the same).(Score 2 points)
B. Select the sentence which most clearly
describes your community’s ambulance system.
__________
SCORE: 1B
* Medical protocols are
current, clinically sophisticated, not unreasonably restrictive, and are
detailed and extensively documented. (Score 3 points)
* Medical protocols are; not
current, overly restrictive, vague or not well documented. (Score – subtract 2
points)
__________
SCORE: 1C
C. On-board equipment, medical communications
system, medical control, and inventory control systems are state-of-the art,
fully compatible with medical protocols in use, formal, and documented. (if true, add 2 points, if not, subtract 2 points)
YOUR TOTAL SCORE- SECTION 1: ___________
2. MEDICAL ACCOUNTABILITY (POSSIBLE 6 POINTS)
A critic might fairly comment that if a system has
no bonafide medical accountability, then by
definition it must be impossible to assess that same system’s clinical
performance, and to some extent that makes sense. On the other hand, a system
may be performing beautifully without being able to document the fact, and so I
have elected to separate the question of clinical performance from the question
of medical accountability.
Each of the characteristics listed below count one
additional point toward your system’s total score, if your system substantially
exhibits that feature. (If you are tempted to say something like, “we sort of
have that feature, but it’s more informal…” then you probably don’t have the
characteristics and should score your system zero on that feature.)
Give yourself one point if your system shows
strength in any of the following areas; zero points if it appears weak.
A. Our medical protocols are developed by the
same physician(s) who has responsibility for monitoring directly our system’s
street performance. (zero or one point)
________
SCORE: 2A
B. Medical audits are regularly (i.e. several
each week) conducted by an emergency
physician who is not affiliated with
or on the payroll of any ambulance provider organization. (zero
or 1 point)
________
SCORE: 2B
C. A widely known and convenient procedure
exists whereby any receiving facility physician, or
field medic can request that a formal physician-supervised audit be performed
relative to a given case, and such audit shall be performed. (zero or 1 point)
________
SCORE: 2C
D. At regular intervals, the physician(s)
responsible for medical monitoring and clinical quality control in our system
reviews multiple cases of a single problem-oriented or diagnosis-specific basis
in order to assess our system’s ability to deal effectively with specific
medical problems. (An EMS system is not “bad” or “good” in general—it may do
well with some types of emergencies, but not with others.) (zero
or 1 point)
________
SCORE: 2D
E. The findings and recommendations resulting
from our independent physician-supervised medical audits may call for change in
medical protocols, specific in-service training for individuals or the entire
organization, call for equipment additions or deletions or change, or may
require the suspension or termination or other restrictions on personnel, and
such findings are not merely advisory, but have the force of binding policy and
must be implemented. (If your physician oversight is not fully independent of
the provider organization(s), score this zero. Similarly, if medical audits are
not regularly performed by a physician expert in emergency medicine, or are
merely “paper audits” conducted without the mandatory presence of crew members
involved in the case, also score zero here.) (zero or
1 point)
__________
SCORE: 2D
F. Emergency physicians at the principal
receiving facilities in our area are not allowed to provide medical control
(via radio) to field personnel without first demonstrating knowledge of the EMS
system’s operating policies and procedures, radio protocols, medical protocols,
personnel capabilities, and on-board equipment and medical supplies. (zero or 1 point)
__________
SCORE: 2F
YOUR
TOTAL SCORE- SECTION ii:
__________
3. DISPATCHING and SYSTEM STATUS MANAGEMENT
(possible 15 points)
The scale favors systems with fully centralized and
complete control over the placement and movements of all ambulances in the
system at all times. The scale also favors systems where control center
personnel managing the system’s responses are both medically trained and
specifically trained in more sophisticated aspects of system status management,
that is, a system that is continuously controlled by a single group of
medically trained personnel, and which is controlled in a manner that allows
the system to continuously maintain and constantly re-establish the best
possible emergency response configuration at any point in time, given the
area’s demand patterns and given the level of emergency production capacity
remaining in the system at the moment.
Select the sentence in each group below which most
nearly describes your community’s ambulance system in all of the following
categories.
A. Span of Control: ________
SCORE: 3A
* All ambulance(s) operating
in the community, emergency and non-emergency, are exclusively controlled by a
single ambulance dispatch center. This control includes all vehicle movements
including dispatches, post assignments/reassignments, i.e. complete and direct
control over all ambulances. (Score 8 points)
* A single control center
receives nearly all emergency requests (e.g. a 911 center) and assigns those
requests to ambulances or multiple providers, but does not possess exclusive,
complete, and direct control over all movements of all ambulances. (Score 5
points)
* No single EMS control
center receives and manages nearly all emergency requests. The system is
characterized by multiple control points and multiple providers. (Score 0 points)
B. Quality of Dispatch
Personnel: ________
SCORE:; 3B
* Persons receiving
telephone requests and dispatching ambulances possess the verbal skills and
didactic knowledge of a field paramedic. They also have completed additional
training in System Status Management, disaster response management, and
clinically oriented telephone protocols. (Score 3 points)
* All persons receiving
telephone requests and managing system response are basic EMT’s
with little or no additional training in system status management, disaster
response management, and telephone protocols. (Score 2 points)
* Most emergency requests
are received by “911 complaint takers” or by other 911 communication center
personnel (e.g. police or fire dispatchers) who gather the information from the
caller, terminate the telephone conversation, and then “hand off” the request
to an “ambulance dispatcher” who is located either in the same facility or
elsewhere. (score 0 points)
* A regional EMS agency
receives most telephone requests, and “hands off” the calls to multiple
providers. (score 0 points)
* Any other configuration of
control not described in the list immediately above, or any configuration
wherein persons receiving telephone requests for ambulance services are not
basic EMT’s or paramedic trained. (Score 0 points)
C. System Status Management _________
SCORE: 3C
All ambulances in the community
(i.e. emergency and non-emergency) are continuously located and relocated, in
strict accordance with a detailed master plan so as to maintain the best
possible response capability at any given level of remaining ambulance
availability taking into consideration time of day, day of week, historical
demand patterns and demand fluctuations, traffic flow patterns and congestion,
special events and weather conditions, and other factors. Such system status
management plan also allocates quantities of ambulances to be in service by
time of day, day of week, and special event to adjust production capacity to
fit demand patterns and demand fluctuations. (Score 4 points)
* Emergency ambulances are
controlled as described above, but non-emergency ambulances are not. (Score 2
points)
* Our system makes some
effort to adjust both temporal and geographic ambulance distribution to match
remaining response capacity to estimated demand patterns, but not to the level
of sophistication described under the first description in this group. (Score 1
point)
* Ambulances are assigned to
their respective posts and generally remain at those same posts throughout a
shift, unless dispatched to a call or released for meals, repairs, shift
change, or occasionally provide back-up coverage for another unit or post at
dispatcher’s discretion. (Score 0 points)
* Ambulance posts and post
assignments are largely the result of historical accident, or a result of a
relatively static plan of vehicle placement, and only modest effort is made to control
vehicle placement on a “real time”, “even driven” basis to preserve the best
possible response capacity at any given level of remaining resources. (Score 0
points)
YOUR
TOTAL SCORE- SECTION III:
__________
4. ACCESS, FIRST RESPONDER AND CITIZEN CPR
(possible 15 points)
Highly organized and reliable citizen access methods
are favored, as are effective organized first responder programs and citizen
CPR programs.
Select the sentence in the following categories which
most nearly describes your community’s ambulances system.
A. Access: ________
SCORE: 4A
* All telephone requests (both emergency
and non-emergency) for ambulance service terminate at a single EMS control center. These may
enter via 911, a well-publicized standard number, or by combination of these.
If 911 is employed, the “complaint taker”, immediately upon discovering that
the request is ambulance related, hands off the caller to the EMS control
center personnel who speak directly with the callers, non-emergency requests
employ a separate number--- not 911. (Score 5 points)
* All emergency requests are
handled as described immediately above, but non-emergency requests terminate
elsewhere. However, persons receiving non-emergency requests follow strict
protocols for referring calls likely to involve emergency conditions to the EMS Control Center and are monitored and
regulated to insure compliance. (Score 3 points)
* Emergency calls are
handled as described under the first sentence in this group and there is no regulation
or significant monitoring of calls received by non-emergency providers. (Score
2 points)
* There exists in our
community multiple telephone numbers for accessing emergency ambulance service.
(Even if 911 is present in your community, give your system zero points if more
than 10% of emergency ambulance requests enter the system via a telephone
number which is not 911 and which does not terminate in the EMS control center
which would handle a 911 request. (Score 0 points)
B. First Responder: _________
SCORE: 4B
* Our community has a formal
police and/or fire department first responder program capable of placing a
trained first responder team on the scene of 90% of all life-threatening
emergencies within a maximum 4-minute time limit after receipt of request at
the EMS control center. The decision to employ a first responder is made by a
medically trained EMS dispatcher, using physician approved telephone protocols, and who is
in direct communication with the person requesting service. The first responder
team is trained and equipped at essentially the basic EMT level, but need not
be EMT certified, and has had additional paramedic-assist training to better
participate in highly organized multiple crew ALS team procedures. Some
integrated/first responder in-service training is routine and first response
team members do participate, when requested, in medical audits of cases in
which they were involved. The EMS data system is capable of capturing and documenting
arrival times of both ambulance and first response teams as well. (Score 5
points)
* Our community does have a
police and/or fire first responder program which is employed on nearly all
life-threatening ambulance calls, but which lacks the formality or performance
capabilities described immediately above in one or more significant ways.
(Score 3 points)
* Our community either has
no such police or fire first responder program, or the program we do have is
significantly deficient, when compared with the first sentence in this group,
in more than a few ways. (Score 0 points)
C. CPR: __________
SCORE: 4C
* Our community currently
has---not on paper but in fact—a functioning CPR training and annual
recertification program which has achieved and currently maintains CPR
certification for not less than 20% of our community’s adult population, or our
community has in place a CPR training program which, at present levels of
participation, will achieve the 20% bare minimum adult level within two years.
(Score 5 points)
* Our community has a CPR training program that we all
like very much and are very proud of, but we haven’t achieved the 20% minimum
adult level, and at present levels of participation, we don’t know when we
might. (Score 0 points)
* Our community has some really involved people with some
impressive credentials and financial contribution, and we have or are
developing a CPR training program or plan which will knock everyone’s eyes out
some day. (Score 0 points)
* We don’t have any CPR program and there is no plan for
one. (Score 0 points)
YOUR
TOTAL SCORE – SECTION IV
__________
5. DISASTER CAPABILITY (possible 8 points)
Keeping in mind that we are discussing the disaster
capability of the prehospital EMS system only, the scale favors
those communities whose day-to-day field operations are so effective and so
flexible that they are designed to function with little change in a disaster
situation. Similarly, the scale favors systems which have the capability of
focusing large forces of advanced life support production capability upon a
disaster event without resorting to exotic or elaborate plans and procedures
which are not tested on a routine (i.e. daily or weekly) basis. A system’s
ultimate disaster capability is more difficult to predict and probably requires
the judgment of more experienced evaluators than other areas of the scale.
A. Application of day-to-day working systems of
control and coordination.
________
SCORE: 5A
* If the communications,
dispatch, and control systems which function normally on a day-to-day basis are
capable of effecting and coordinating a system-wide response to a single
disaster without change in personnel, equipment, or operating protocol, add 4
points.
* If much of the system’s
routine control network must change to effect a switch
to “disaster mode,” give your system a zero on this criterion.
* Use your judgment to rate
your system if it falls somewhere in between these extremes, as most do. (zero to 4 points)
B. Normally working produc-tion capacity and
reserve capacity:
__________
SCORE: 5B
Again, judgment must be
employed to assess this criterion. An all paramedic system (both emergency and
non-emergency) with high response time performance on a day-to-day basis
obviously has the ultimate normal working production capacity for immediate
disaster response, as well as having the best reserve production capacity for
an extended mass-disaster, since off-duty crews are fully ALS capable as well.
At the other extreme are multiple provider BLS systems employing many crews who
rarely perform under life-threatening emergency circumstances.
(zero to 2 points)
C. Disaster
site communi-cations, supply systems, and support services:
__________
SCORE: 5C
Considerable attention was
given to these issues in the article on the Hyatt Regency disaster, jems,Vol.6,No.9, September 1981. This is essentially a binary
criterion—i.e. either you have it set up or you don’t. (Score zero to 1 point)
D. Integration of communi-cations, equipment, and procedure with
neighboring providers:
__________
SCORE: 5D
Again, either plans have
been made throughout the region to effect fully integrated communications among
neighboring providers, and to insure that, where possible and practical,
on-board equipment is compatible or that crews have been cross-trained in the
use of each other’s equipment, or these steps have not
been taken. Federally sponsored regional EMS groups have all worked to
establish such regional coordination, and a few have been effective. Having a
plan to provide such coordination in disaster situations, and being able to
actually pull it off are two different things. Experience-based judgment alone
can distinguish between the two. (zero to 1 point)
YOUR
TOTAL SCORE- SECTION V:
__________
6. PERSONNEL MANAGEMENT PRACTICES (possible 10
points)
The scale favors heavily those systems which
recognize that the caliber of field personnel and control center personnel is
extremely important to system performance. Smart, well-trained, creative and
resourceful personnel have been known to make some really poor systems perform
pretty well, at least for a while. Similarly, there are probably no system
designs that can squeeze consistent high performance out of low caliber
personnel. The scale looks at and categorizes recruitment methods, initial
screening of employees, the interview process, and system reputation. The
highly inbred “first-guy-off-the-street” systems suffer on the scale, whereas
systems that actively recruit the best in the industry are favored.
Select the sentence in each of the following
categories which most clearly describes your community’s ambulance system.
A. Recruitment Methods. ________
SCORE: 6A
When a job position becomes
available in our system, the employer(s) seeks and attracts the best possible
person for that job by utilizing recruitment and screening procedures generally
as follows:
* A continuous national
advertising program insures a steady incoming flow of applications, and the
advertising is concentrated to impact in American communities which enjoy
ambulance service of the highest reputation. (Score 4 points)
* A continuous recruitment
program is in place with nationwide advertising, but no real effort is made to
attract applicant’s from the most respected ambulance
systems. (Score 3 points)
* A continuous recruitment
program exists, but it concentrates on applicants from within our regional
area, and very few of our new personnel have experience in remote metropolitan
ambulance systems of high reputation. (Score 2 points)
* Our recruitment is
intermittent and most of our new hires are graduates of one or two local
training programs, and if they have previous experience, it is usually with a
neighboring provider organization, and as a result, our EMS system is somewhat
“inbred.” (Score 1 point)
* We have no formal
recruitment program, so when a position opens up, “word gets out” and someone’s
friend, relative, or classmate is usually hired as soon as possible to avoid
too much overtime pay to cover the unfilled vacancy. (Score 0 points)
B. Initial Screening: __________
SCORE: 6B
* After a good number of
qualified applications have been received, a professionally oriented, fair, and
reasonably objective process is used to narrow down the applications to the
most qualified applicants for interviews. References and work histories are
thoroughly checked out before interviews are held. (Score 2 points)
* The “boss” looks over the
applications and interviews whoever the boss likes best, but 3 or 4 people are
normally interviewed for each job and references and work histories are usually
thoroughly checked. (score 1 point)
* Sometimes only 1 or 2
applications are received before the boss interviews and selects, and the boss
checks out whatever he
thinks is necessary. (Score 0 points)
* The “boss” says he can
tell mostly by the look in their eye, and he will hire whoever he wants to
hire, even if only one application has been considered, if that’s what he feels
like doing. (Score 0 points)
C. Interview Process: __________
SCORE: 6C
* After thorough checking
and screening of applicants, a minimum of 2 or 3 applicants are interviewed by
a review team whose collective decision is final, or whose advice concerning
selection is given to “the boss,” who normally but always accepts the judgment
of the team. (Score 2 points)
* Applicants “tour the
facility,” chatting with several people, and before deciding, “the boss”
usually asks for opinions. (Score 1point)
* The boss usually talks to
people before he hires them. (Score 0 points)
D. System Reputation: __________
SCORE: 6D
* Our system is widely known
and respected as a high performance ambulance organization that demands
excellence from its personnel and gets it.a place
where only the most qualified people are employed and where peer group pressure
demands professional conduct, clinical excellence, and skill maintenance. This
reputation is deliberately employed to attract and retain the best, and to
deliberately discourage applications from others. (Score 2 points)
* We think our organization
is pretty good, but our excellence is not widely known or recognized, and so
our reputation doesn’t play much of a role in recruiting and retaining good
people. (Score 0 points)
* Frankly, our EMS system isn’t all that
great, but we tell applicants with good credentials that we need them to help
us do better. (Score 0 points)
* Our EMS system really isn’t as bad
as a lot of people think it is, and if you think it is that bad, maybe you
should work somewhere else. (Score 0 points)
YOUR
TOTAL SCORE- SECTION VI __________
7. STABILITY, RELIABILITY, and FAIL SAFES (zero
to 7 points)
Here again we have an area that requires expert
judgment to evaluate. Many systems appear to be stable and reliable, only to
prove extremely vulnerable to a shift in majority leadership on the City
Council. Some systems are heavily dependent upon the leadership of a single
individual, upon hand-to-mouth financing from the local tax resources of a
single unit of government, or are entirely dependent upon the financial
stability and integrity of the present owners of a single private ambulance
organization. An additional one point each can be given to the system which
displays significant strength in the following areas:
Give yourself one point if your system shows
strength in any of the following areas; zero points if it appears weak.
A.
Financial strength, soundness of business practices, rainy-day financial
reserves, and system net worth, the debt to equity ratio of the system, and
general insulation from local politics. (zero or 1
point)
________
SCORE: 7A
B.
Soundness of hardware financing and replacement practices, favoring those
systems which employ heavily funded depreciation programs, or some equally
sound commercial financing mechanism backed up by a solid cash management
program. (zero or 1 point)
__________
SCORE: 7B
C.
Performance security in the form of performance bonds or similar security,
equipment ownership in the public sector or protective lease arrangements, and
a variety of devices to insure uninterrupted field performance even during an
emergency changeover from one operator to another or from one type of system to
another. (zero or 1 point)
__________
SCORE: 7C
D.
Insurance against fraud and mismanagement, such as a well-managed company being
sold out to owners of questionable character, ability, or intent. (zero or 1 point)
__________
SCORE: 7D
E.
Empire building inhibitors such as prohibitions against an oversight agency
becoming an operator of the system, a training organization taking on an
evaluative role in the system, or other tendencies of organizations to assume
functions and responsibilities which are inherently incompatible with those
already being carried out by that same organization. (zero or 1 point)
__________
SCORE: 7D
F.
Public relations efforts designed to help insulate the system from uninformed
and misguided press coverage, non-constructive and damaging attacks by
opportunistic local politicians, or other unfair criticisms which may damage
the system’s reputation, the morale of its personnel, or which may even result
in the demise of the system and its replacement by an inferior but better sold
system. (The better and more accountable
EMS systems are the most
visible and the most open to criticism, both deserved and unfair. Responding to thousands of emergencies each year, and under the
most adverse of conditions, while dealing with patients, families, and
bystanders who are upset and sometimes out of control, an EMS system
is, perhaps more than any other service organization, vulnerable to unfair yet
damaging attack. Effective public relations efforts designed to counter this unfortunate fact of EMS life are essential to
long-term system stability.) (zero or 1 point)
_________
SCORE: 7F
G.
Strike protection in some form is essential to system stability and reliability
especially when the labor force is organized.
Strike protection can be provided for in a variety of ways without
undermining the intent of fair labor practices, but there is not space here to
elaborate further on this complex area of system management. (zero or 1 point)
__________
SCORE: 7G
YOUR
TOTAL SCORE – SECTION VII: __________
8. PRICING POLICIES, BILLING, and COLLECTION
PRACTICES (possible 5 points)
The way an ambulance service system conducts itself
financially, especially its management of revenues, is itself a measure of its
service to the community. More than a few otherwise well-managed ambulance
services place an impossible burden upon senior citizens by failing to accept
assignment, where appropriate, and by failing to prepare Medicare claim forms
for routine mailing with statements to Medicare eligible clients where
assignment is not accepted. Pricing policies, billing, and collection
procedures which reduce local tax subsidies, which minimize patients’
out-of-pocket expenditures, maximize patients’ third-party recovery and which
make the patients’ claim filing simple and speedy….all add to the system’s
ability to serve the community. At the other extreme are systems which employ
token prices and billing efforts, thereby placing an unnecessary load upon the
local taxpayer, and systems which make little or no effort to maximize
third-party recovery or to assist patients in making third-party claims. The
community cannot escape the effects of less service oriented financial
management practices, and for that reason the EMS system and its management
cannot escape responsibility for this area of evaluation.
Obviously, in a multiple provider system, some
patients may experience highly effective and professional, yet quite humane
billing and collection practices, while other patients may experience the
opposite. Thus, it is entirely possible for a system to get a “mixed review” on
this area of service.
Like several other areas of this assessment, the
evaluator must have at least a solid basic understanding of the rate setting
and reimbursement world of an ambulance service health care provider
organization. (Keep in mind that ambulance services fall under Part B of
Medicare, while hospital services fall under Part A, and that these two
programs bear almost no resemblance to each other where rate setting and
reimbursement practices are concerned.)
Rate your system in terms of its general compliance with
the purposes of sound pricing policies, billing, and collection practices as
follows:
A. Pricing policies
should: (zero to 2 points)
__________
SCORE: 8A
* Maximize third party
recoveries while minimizing out-of-pocket expenditures, especially by insured
patients;
* Avoid cutting the throats
of providers sharing same geographic profile;
* Be capable of covering
full system costs, in the event of subsidy reductions;
* Discourage use of 911 or
other emergency access phone number for purposes of a non-emergency nature.
B. Billing and Collection
Practices should: (zero to 3 points)
__________
SCORE: 8B
* Provide easy maximum
third-party recovery for senior citizens;
* Insure that most
uncollectible write-offs are related to services delivered which were truly
medically necessary and provided to persons whose true financial situation is
such that payment of the ambulance bill would produce an unreasonable hardship.
In such cases, the billing and collection procedure should be capable of
identifying such conditions early in the billing/collection cycle, so that the
responsible party is not “badgered” extensively;
* Discourage abuse of the
ambulance service in cases where there is no reasonable medical necessity for
emergency or non-emergency ambulance use;
* Help educate the public,
politicians, and public as well as third-party payors as to the need for
extensive reform in the ambulance segment of America’s health care finance programs.
YOUR
TOTAL SCORE – SECTION VIII:
___________
9. RESPONSE TIME PERFORMANCE (possible 15
points)
Stout’s Standards deal with a system’s response time
performance by looking separately at response times to life-threatening
emergencies, non-life-threatening emergencies, non-emergency calls, and at
response time performance distribution among the various neighborhoods or
districts of the service area. This scale deliberately avoids reference to
“average response times,” since an impressive-sounding average may well be
achieved at the expense of life-threatening excessive response times to a
sizable percentage of patients in more difficult-to-serve areas. (There is not
space here to go into such matters as response time definition, adjustments for
no-hauls and turn-arounds, or validation of response time reporting, but these
issues should be dealt with in depth in any serious application of the scale.
Additionally, a system incapable of documenting its performance relative to
this scale is simply incapable of being evaluated on this criterion, and no
attempt should be made to guess at what may be happening in the field.)
Select the sentence which most nearly describes your
community’s ambulance system in all of the following categories. (Note: this rating assumes
presence of medically trained dispatch and medically sound telephone protocols
for presumptively defining a life-threatening emergency. If these conditions
are not met, utilize your emergency response times for all emergency requests,
both life-threatening and non-life-threatening emergencies, for both Categories
A and B below.)
A. Life-threatening
Emergencies: __________
SCORE: 9A
(Note: If your system is all
BLS assign zero points to this category)
* For less than 10% of all
presumptively defined life-threatening emergency requests, the system fails to
place paramedic ambulance on life-threatening scene within 8 minutes or less
after call received. (Score 9 points)
* For between 10 and 15% of
all presumptively defined lie-threatening emergency requests, the system fails
to place paramedic ambulance on life-threatening scene within 8 minutes or less
after call received. (Score 7 points)
* For between 15 and 20% of
all presumptively defined life-threatening emergency requests, the system fails
to place paramedic ambulance on life-threatening scene within 8 minutes or less
after call received. (Score 7 points)
* For between 20 and 30% of
all presumptively defined life-threatening emergency requests, the system fails
to place paramedic ambulance on life-threatening scene within 8 minutes or less
after call received. (Score 2 points)
* For more than 30% of all
presumptively defined life-threatening emergency requests, the system fails to
place paramedic ambulance on life-threatening scene within 8 minutes or less
after call received. (Score 0 points)
B. Non-life-threatening
Emergencies:
_________
SCORE : 9B
* Ambulance response time
(paramedic or other) is under 12 minutes or longer on more than 10% but less
than 20% of all non-life-threatening emergency calls. (Score 4 points)
* Ambulance response time
(paramedic or other) is 12 minutes or longer on 20% or more of all
non-life-threatening calls. (Score 1 point)
C. Non-emergency calls: _________
SCORE: 9C
* Ambulance response to
non-emergency transport requests are reasonably prompt (i.e. within 20 to 30
minutes) for unscheduled requests, except under unusual system overload
conditions which occur rarely (i.e. not more than 2 or 3 periods lasting less
than 1 or 2 hours weekly) and previously scheduled transports are almost never
delayed. When delayed non-emergency response does occur, the requesting party
is contacted immediately, and explanation is given and a revised ETA is offered
and adhered to. (Score 1 point)
* The description
immediately above does not characterize non-emergency service in our community.
(Score—subtract 2 points)
D. Geographic Performance
__________
SCORE: 9D
* Response time performance
is approximately, but not precisely equal amongst the various neighborhoods,
quadrants, sectors, or districts of our community. (Score 1 point)
* Certain parts or
neighborhoods of our community usually enjoy good response times, while other
areas in our community experience chronically poorer response time performance.
(Score—subtract 2 points)
YOUR TOTAL SCORE – SECTION IX: ___________
10. PUBLIC ACCOUNTABILITY (possible 4 points)
Sophisticated prehospital
care EMS is becoming increasingly
complex and specialized. By default or by design, the type of EMS system serving your
community is mostly determined by the action or inaction of local
government—more specifically, local elected officials. Public accountability is
necessary both to protect the public from a bad EMS system, and to protect a good EMS system from unfair
criticism and possible misguided intervention by semi-informed public officials
or even representatives of the press.
“The rates are exorbitant ...Response time was
terrible….The crew was rude to the Mayor’s mother-in-law…..The private provider
makes excessive profit…..The city subsidy is outrageous…..The fire department
could do it cheaper….A private company could do it cheaper….A fired employee
exposes the truth….Consultant blasts EMS system…..” and so forth. The public
must know the truth, and the system itself, especially if it is a good one,
needs the protection of fully informed, expert, and independent oversight.
Again, evaluating a system’s mechanisms for
achieving public accountability requires experience and judgment. Score your
system zero through 4 points depending upon which of the descriptions below
most nearly describes your situation.
A. In our system, the agency
of local government responsible for all EMS activities is itself a
provider of EMS services. (For example, a city wherein EMS is operated by a fire
department or third city department, and no other agency is funded or staffed
to oversee operations.) (Score 0 points)
___________
SCORE: 10A
B. In our state, ambulance
providers are licensed by a Department of State Government, and our community
relies heavily upon the state agency, regularly referring inquiries and
complaints to the state agency, and the state agency normally conducts a prompt
and complete inquiry into the matter and issues an official statement of
findings. (score 1 point)
___________
SCORE: 10B
C. Our system is monitored
by one or more part or full time employees of local government who work in a
department which is not also a provider of ambulance services. These officials
regularly inspect ambulance equipment, assist in the performance of
physician-supervised medical audits, and with the help of qualified accounting
personnel or hired accounting firms, make recommendations concerning subsidy
requests, rate reviews and approval, and billing and collection practices of
provider organizations. (Score 2 points)
___________
SCORE: 10C
D. Our community has an EMS
council (regional or local) made up of provider representatives, hospital
representatives, and other interested individuals who meet regularly in meetings
open to the public to discuss issues effecting the EMS system. When a problem
is reported, this group looks into the matter and makes a recommendation.
(Score 2 points)
___________
SCORE: 10D
E. In our system, all
questions related to clinical performance are handled by a legally authorized,
funded, staffed, and provider-independent physician-controlled organization
charged with the authority and responsibility to prescribe medical standards,
oversee compliance, and institute mandatory corrective action when necessary.
Physicians expert in and knowledgeable of emergency medicine and of care being
rendered by our system control this organization, in addition, the financial
management of our system is overseen by a separate group of individuals who are
also informed and expert, as well as provider-independent, as regards matters
of organization and finance. This group is controlled by representatives of the
local business community who possess the kind of expertise necessary to make
sound financial judgments in a complex financial environment, and who have no
personal financial interests in the EMS system. This financial
oversight organization has the power to require certified audits and financial
statements of provider organizations; establish or review and approve all
billing and collection policies; perform reviews and make recommendations to
local government concerning the proper balance among quality of service, fees,
and local tax subsidies; and where appropriate, reviews and approves the
qualifications of potential provider organizations based upon the findings
related to organizational reputation, integrity, character of owners and key
personnel, and financial stability. Furthermore, the data system used to
evaluate response time performance is provider-independent, except for
collection of primary data, and is subjected to periodic spot checks for
accuracy and truthfulness. Finally, our system imposes severe financial
penalties upon individuals or organizations found guilty of willful
falsification of information for the purpose of enhancing the apparent
performance of the system or organization, and our monitoring systems are so
designed to eventually uncover any repeated fraud of that type. In short,
system performance is assessed and documented, both medically and financially,
by qualified individuals and organizations other than the providers themselves
or their employees. Elected officials, the press, and the general public can
rest assured that the system is continuously monitored by qualified and effective
people, and that complaints are dealt with promptly and fairly, and that the
findings from complaint inquiries can be trusted, even if the issues involved
are too complex for easy interpretation by the public at large. Similarly,
providers and field personnel are almost never required to defend themselves
against unfair criticism, as these independent and objective oversight
organizations serve to
