ems fire chiefs handbook 2 Flashcards
______planning must focus on the unique services and added value the fire service brings to the community with emphasis on improved service that results in better outcomes
EMS strategic
.Identifiable measures, benchmarking to other similar services locally and nationally, and a clear handle on costs and budgeting are critical for _______
EMS strategic planning.
_____must have a thorough familiarity with medical billing, the Centers for Medicare and Medicaid Services (CMS) regulations and guidelines, and applicable state and regional requirements for medical insurance billing and reimbursement.
EMS officers
NFPA ____Standard for Automotive Ambulances will likely become the de facto reference for ambulance construction and design
NFPA 1917
Who is much more likely to give and receive mutual aid support on a routine basis than is fire suppression
EMS
A quality records management system provides two critical contributions to a fire-based EMS program: ___and _____
patient care reports and research.
Currently, which states in the United States has agreed to submit local EMS data to the National EMS Information System (NEMSIS; www. nemsis.org).
every state
The most efficient means of accomplishing the somewhat challenging feat of maintaining and indexing records of every patient contact is through implementation and use of an ________
electronic medical record (EMR).
Research initiatives and quality improvement (QI) studies are also best managed when patient care data is stored ______
electronically.
______can help gather more accurate information and should be investigated. It can also lead to higher billing collection rates.
Patient-side computer usage
Outcomes for certain critical medical emergencies such as choking and cardiac arrest are significantly impacted by the provision of _____
high quality emergency medical dispatch (EMD).
______in EMS is not just about preventing monetary losses; it is about preventing disability, loss of life, and/or irreparable fire department damage as a result of the provision of EMS response and patient care
Risk management
_____ involves direct hands-on patient care as well as indirect aspects of patient care, including the development of effective training programs and the selection of qualified personnel.
Risk management
The overall goal of risk management is to reduce the ____AND ____ of preventable adverse events that create losses.
frequency and severity
It should come as no surprise that the leading cause of EMS litigation, in fact nearly __% of claims made, involves operation of department motor vehicles.
58%
It should come as no surprise that the leading cause of EMS litigation, in fact nearly 58% of claims made, involves operation of department motor vehicles. This is followed by patient handling (%), medical management (%), response (_%), and equipment issues (__%).
28 patient handing
9 medical management
5 response
4 equipment issues
any time a department adds new EMS skills, procedures, or services (for example, interfacility critical transport or intubation using paralyzing medications), _____ should be reviewed
insurance policies
The first step in a comprehensive risk management program is_______
identifying the risks
any _____ event should trigger a thorough internal review for any failures or contributing factors
sentinel
____ events might include patient deaths during EMS care, medical equipment failures, vehicle crashes, injuries to EMS providers, complaints against providers, and other events deemed as significant by department administration.
Sentinel
Mitigation strategies can be designed and implemented after potential ______
risks and probabilities are known
Continued monitoring using ongoing data collection and analysis coupled with sentinel event review and analysis of adverse occurrences allows for adjustment of ________.
risk mitigation strategies
But where the ____ends is where pertinent information should begin.
obvious
___ involves meeting the needs and expectations of the customer based on a strategic quality plan, objectives, and performance indicators.
QI
___ is carried out by post-incident review and audits to determine compliance with performance indicators
QA
_____ include patients and their families, physicians, nurses, taxpayers, visitors to the area, and suppliers;
External customers
_____ are the employees of the organization
internal customers
the ultimate consumer is_____
the patient
Customer service is greatly dependent upon _____
bedside manner
The goal of every EMS system should be to continuously evaluate itself and constantly strive for____
performance improvement
If data analysis reveals that a fire department is meeting performance goals, What needs to happen next?
new goals should be set that encourage higher levels of performance
benefits of adopting a quality management process are many, including:
improved patient care, employee morale, patient satisfaction and outcomes, and decreased cost
In the United States, fire departments and EMS agencies using regulated medical devices are required to report equipment breakdowns, failures, and adverse effects to patients caused by a medical device to the_____
Food and Drug Administration (FDA; www.fda.gov/medwatch).
From a risk management perspective, there are two key areas of litigation involving EMS equipment:
lack of equipment and equipment failure
Equipment failure typically involves
defibrillators or automated external defibrillators (AEDs) and suction units. Dead batteries or malfunction of these units are the most common reasons for litigation.
The primary guidance documents for infection control are:
OSHA regulation 29 CFR 1910 and NFPA 1581: Standard on Fire Department Infection Control Program.
Claims arising from medical management represent ___% of EMS litigation, but often produce some of the most significant damage awards, especially when they involve airway management
9%
Medical management issues break down into four sub-categories: It should be no surprise that airway leads the list, and most common among these is
misplaced endotracheal tubes (tube placed in the esophagus instead of the trachea, resulting in air to the stomach instead of lungs, often with fatal conse quences
Procedural problems in EMS typically involve ______
involve spinal injuries, fractures, and protocol compliance
Key among claims for_____injuries is early recognition and appropriate treatment; most claims allege significant delay in recognition or providing treatment
spinal cord
______ is most often the contention when claims involve fractures.
Improper immobilization
Treatment and patient moving tactics are largely ____ that should be detected and remediated through supervisory activities or run reviews
educational issues
When an adverse outcome occurs related to a drug administered by EMS, it is most commonly related to administration of the _______
wrong dose of a medication or giving a drug by an incorrect route
_____, owning to their dangerous side effects, are more often involved in medication error claims and typically involve protocol violations .
Narcotics
Transport to the wrong or inappropriate facility leads claims for___% response and transport , followed by response errors (__%) and patient security (__%)
(52%)
44
4
More often, delayed response claims can be traced back to either the________being used in the 9-1-1 center (another reason for active involvement of fire depart ment and EMS officers in dispatch) or delayed response by EMS providers who either weren’t alerted of a call or failed to respond in a timely manner
dispatch process
______ accounts for a small percentage of claims against EMS services, but often with significant injuries sustained. These include situations where a patient falls during movement (often when allowed to ambulate instead of being carried), is injured in an ambulance crash as a result of not being properly secured to the stretcher, or jumps from a moving ambulance
failure to properly secure the patient
Fire-based EMS services must provide HIPAA-compliance training to all ________
newly hired members and at regular intervals thereafter
The greatest dangers, and most frequent cause for complaints pertaining to confidentiality, are when health information is inadvertently ______
shared outside of the fire department
Claims arising from the operation of ______are the most significant risk to any EMS service
motor vehicles
Nearly __% of drivers involved in ambulance crashes are considered high-risk drivers.
41 percent
Departments that routinely use EMD protocols to limit RLS responses have __ % fewer crashes with __% less severity when they do occur.
25%
39.6%
Next to claims arising from operation of motor vehicles, _____is the largest exposure for most EMS departments These claims typically include patient drops (35%), stretcher tips (30%), problems during patient movement (20%), and falls (15%).
patient handling
The root causes of these incidents tend to be improper selection and use of equipment, imbalance in strength and/or height of crews, improper evaluation of the physical hazards in the path of travel while moving the patient, and equipment failure (often due to improper maintenance) .
patient handling
_____are the leading cause of lost time from work for EMS providers
Back injuries. Musculoskeletal and spinal injuries
______ have proven to be beneficial in reducing back injuries. Ergonomic devices such as motorized stretcher lifts and vehicle chassis lowering lifts have demonstrably better results.
Fitness and educational programs
