Accreditation & EMS Research What’s In It For My EMS Agency?

1. Accreditation & EMS ResearchWhat’s In It For My EMS Agency? Kenneth J. Sternig Ms-EHS, BSN, EMTP Program Director Milwaukee County EMS

2. What Is The Biggest Resource Of Any EMS Agency? What Are Definitive Ways EMS Can /Should Validate Our Impact In Health Care? This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

3. Would You Seek Services From ….? • A physician who graduated from medical school without an accreditation ? • A hospital that did not receive accreditation? • Allied health providers who graduated from schools without accreditation? Why should we ask anything different from EMS education institutions??????? This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

4. What Can The Profession of EMS Do To Assure Our Profession & Professional Growth? Prove through scientific discovery that what we do has a positive impact on patients This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

5. Accreditation & Research Lecture Intent of presentation: Open discussion on how accreditation and research can have a positive impact on EMS agencies Goal: Expose participants the issues surrounding these topics This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

6. Accreditation • Definition: (accreditation assoc. for ambulatory health care) “Accreditation is a voluntary process through which an ambulatory health care organization is able to measure the quality of its services and performance against nationally recognized standards.” This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

7. Accreditation • Definition: (CoAEMSP) Accreditation is an effort to assess the quality of institutions, programs and services, measuring them against agreed-upon standards and thereby assuring that they meet those standards. This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

8. Accreditation • What does accreditation mean for an EMS organization? • Addresses risk management issues • Employers know the quality of their applicants • Allows EMS agencies to be part of the quality education process through field training This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

9. Accreditations In EMS • Local • Nevada, Kansas City, Louisiana • State (requirement for licensure) • Missouri, Texas, Iowa, North Carolina • Does not replace State’s responsibilities related to certifying EMS education institutions • Federal • NREMT requirement This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

10. Accreditations In EMS • Organizations: • CAAS (Commission on Accreditation of Ambulance Services) • CPSE (Center for Public Safety Excellence) • CFAI (Commission on Fire Accreditation International) • CoAEMSP (Committee on Accreditation of Educational Programs for the EMS Professions) • CECBEMS (Continuing Education Coordinating Board for Emergency Medical Services) This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

11. What Does Accreditation Do For An Organization? • Provides a level of quality in regards to staff • Helps to assure qualified candidates apply • Builds a foundation for high performance expectations • Further supports a corporate culture of providing quality care This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

12. So What’s The Big Need? • NREMT 2013 deadline • Why did the NREMT make this decision? • “Who is the NREMT to make this claim?” • NHTSA agenda for the future • EMS Education agenda for the future • Institute of Medicine (IOM) recommends a single accreditation agency This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

13. Accreditation For EMS Education • EMS education is one of the only allied health education specialties not to require accreditation • Will help stabilize EMS education as a respected educational experience This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

14. Accreditation Standards • Often written in general terms • Often comprehensive/yet flexible in meeting outcomes • Often invite feedback from participants regarding the ability to meet and appropriateness of the standards • Often create an interactive environment between accrediting agency and those seeking approval This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

15. Value of Accreditation • Requires heavy lifting on the front-end • Development and application of processes within an organization • Requires repeated drill-down within an organization • Interlinking of values, mission and product created helps to assure standards are met • Benefits are within the “process” work, NOT in the paper certificate This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

16. Impact of Accreditation on EMS Education Centers & Providers • Ownership of responsibilities • Identification of what staff “really does” • Positive moral booster • Creates an improvement of efficiencies • Generates a corporate culture of high quality production of outcomes This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

17. Impact of Accreditation on EMS Education Centers • Strengthens relationships with education stake holders • Clinical sites • Medical control involvement • Field training sites • Consortiums with degree granting institutions This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

18. Impact of Accreditation on EMS Education Centers • Can help force funding issues to obtain equipment/staff/building space etc • Accreditation will help WI EMS education institutions continue the work done between 1998-2000 to standardize EMS education in WI This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

19. Impact of Accreditation on EMS Providers • Helps to assure quality of education institutions where students receive their education • Credentialed accreditation agencies help assure standards for accreditation (no accreditation mills) • Minimizes Mom-n-Pop EMS education centers • Raises the bar regarding the quality of EMS education centers This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

20. CoAEMSP • Parent organization: The Commission on Accreditation of Allied Health Education Programs (CAAHEP) • Committee on Accreditation of Educational Programs for the EMS Professions (CoAEMSP) This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

21. Members of CoAEMSP •   American Academy of Pediatrics (AAP) •       American College of Cardiology (ACC) •       American College of Emergency Physicians (ACEP) •       American College of Osteopathic Emergency Physicians (ACOEP) •       American College of Surgeons (ACS) •       American Society of Anesthesiologists (ASA) •       Commission on Accreditation of Allied Health Educ. Programs (CAAHEP) •        National Association of EMS Educators (NAEMSE) •        National Association of EMS Physicians (NAEMSP) •        National Association of EMT’s (NAEMT) •        National Association of State EMS Officials (NASEMSO) •        National Registry of EMT’s (NREMT) This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

22. What DoesCoAEMSP Accreditation Address ? • Goals & Objectives of educ. Programs • Methods of monitoring goals, curriculum, customer satisfaction • Surveys/feedback from customers/clinical sites/ employers • Course: • Skills labs, didactic, clinical, field evaluations • Agreements with stakeholders (clinical, field EMS services) This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

23. What DoesCoAEMSP Accreditation Address ? • CV of director, teaching and medical control staff • Methodologies for teaching and evaluating • Competencies obtained during clinical & field training • Staff ID strengths and weakness of program & plans • Lesson plans for didactic, skills labs, clinical and field training • Consortium agreements This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

24. C0AEMSP Mission Statement The mission of the CoAEMSP, under the auspices of CAAHEP, is to continuously improve the quality of EMS education through accreditation and recognition services for the full range of EMS professions. This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

25. Wisconsin EMS Education Institutions & Accreditation • EMS Education Institutions met with CoAEMSP executive director • Some EMS educ. centers shared their progress/plans • Strategic plans stated for completion of self-study packets • On WTCS/ EMS Education Institutions quarterly meeting agenda This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

26. Negative Impact of Accreditation • Staff time to prepare: • Self-study • Site visit • Costs of accreditation and renewal This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

27. What Concerns / Comments Do You Have Regarding EMS Education Accreditation ?????? This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

28. EMS Research Impact on EMS Agencies This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

29. Validation of EMS as a Profession? • How does EMS validate itself as a profession? • What can EMS do to be further accepted as a respected partner in allied health? • How does EMS demonstrate that the care it provides makes a difference in a patient’s outcome? • What can EMS do to further strengthen its relationship with hospital partners? This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

30. EMS Needs To Become Further Involved In Research It Is Simple ……. This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

31. How Can Research Assist EMS? • Research will help: • Address issues critical to EMS • Expand the scope of practice for EMS providers • Prove to funding sources; local, state, federal, private and third party, that care in the out-of-hospital setting affects patient outcomes • Elevate EMS as a profession • What health care profession is not involved in research? This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

32. Policy Statement by Consortium of U.S. Metropolitan Municipalities’ EMS Medical Directors “Evidence-based clinical measures of EMS system performance have been few in number, largely due to the limited quantity and quality of research committed to the prehospital arena. “

33. Impact of EMS Research • Best Practices (May 2008) • Need to research current popular EMS interventions • Unsubstantiated by scientific evidence • Research will help define EMS benchmarks • Research will create high-quality evidence based decisions to guide EMS practices This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

34. Research Challenges For EMS Agencies • Increased workload • Learning new content (perceived experts) • Integrating content into CE curriculums • Outside researchers taking advantage you • Unrealistic time tables for rolling out research • EMS agency/ staff buy-in This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

35. Challenge of Defining Roles & Expectations • What will be the roles of the research team? • Who is responsible for what? • Content preparation: • Will research team develop content? • Will EMS or education staff develop content? • Does content need to be approved? • Follow up of EMTPs who miss educ. content This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

36. EMS Agency Challenges • Educating agency administrators need to participate in a research project • Defining for agency administrators what your role as a research project will be • Addressing the perception of “using my agency to do your work” • “What does my EMS agency get out of this?” • Developing a partnership with EMS researchers This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

37. EMS Agency Involvement In Research Committees • Drill down to assure proper content is developed to assure EMS providers are properly educated on: • study protocols • psychomotor skills • cognitive content • Stay “in the loop” regarding study planning • Advocate for your time table is necessary • Be aware of being taken advantage of • Preach your agenda This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

38. EMS Provider Challenges • “WHY should we participate ?” • Achieving buy-in • More work = More pay????? • Bargaining unit issues • Learning a “temporary” change in scope of practice • Extra equipment (contract issue?) This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

39. EMS Provider Support • Willingness to participate • Willingness to improve patient care • See research as a hindrance Vs help • Negative mob mentality • Need to see beyond struggle that research takes away from Pt. care This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

40. What Are The Barriers ? • Buy-in by EMS agency and providers • Budget issues (increased work load) • Time table for research project • Direct dollar benefit to EMS agency Vs general fund? • Knowledge of study content • Researchers wants / needs Vs use of solid education theories This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

41. Rolling Out Research Study Education • Award education hours for “Study” education • NREMT topic hours • Integrate education for study into as many refresher classes and CEs as possible • Timing of rollout of study education • Training/education need to schedule far in advance • Study need to be flexible and put off rollout pending IRB and government approvals • Detain planning of rollout sessions This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

42. Milwaukee County EMS & Medical College of Wisconsin Our Experiences With Recent Research Projects

43. How To Achieve Buy-In • Start small and work big • Award hrs for study content • Stay true to the vision • Push when appropriate • Integrate education about research into refresher classes • NIH human participant certification This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

44. Public Access Defibrillation (PAD) Trial • Prospective, randomized, multi-center • 1000 public locations • 24 cities in the US and Canada • Funded by NIH, AHA, Industry • Volunteer, non-medical responders • Randomized: CPR Vs CPR and AED This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

45. PAD Trial: Milwaukee • 34 public locations throughout Milwaukee and surrounding suburbs • 17: CPR only • 17: CPR and AED • Fitness clubs, banks, shopping malls, outlet stores, country clubs, food stores, hotels • Trained ~1000 volunteer laypersons

46. Conclusions • Trained volunteer laypersons can use automated external defibrillators safely and effectively in a variety of public locations • In public locations, CPR and AED use by trained laypersons doubled survival rate to hospital discharge • Neurological outcome in survivors was excellent This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

47. ITD Study • Use of an ITD during CPR in patients with out-of-hospital cardiac arrest: • Significantly increased systolic blood pressure • More than doubled short-term survival for patients with PEA • This represents the first effective treatment to increase acute resuscitation rates for cardiac arrest patients with PEA. This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

48. Resuscitation Outcomes Consortium • Alabama Resuscitation Center • Dallas, TX • Iowa City, IA • Milwaukee, WI • Pittsburgh, PA • Portland, OR • Ottawa/OPALS/B.C. • San Diego, CA • Seattle/King County, WA • Toronto, ON

49. Hypertonic Saline Trial • 250cc hypertonic saline • Administered to penetrating shock patients and isolated head injury • Study placed on hold after 14 months This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

50. ROC Primed • Analyze early VS late: • Evaluating whether immediate defibrillation or delaying defibrillation is better • Use of redesigned ITD valve • BLS and ALS 911 fire based EMS providers are Currently enrolling patients This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.