ems fire chiefs handbook 2

Question 1

______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

Answer 1

EMS strategic

Question 2

.Identifiable measures, benchmarking to other similar services locally and nationally, and a clear handle on costs and budgeting are critical for _______

Answer 2

EMS strategic planning.

Question 3

_____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.

Answer 3

EMS officers

Question 4

NFPA ____Standard for Automotive Ambulances will likely become the de facto reference for ambulance construction and design

Answer 4

NFPA 1917

Question 5

Who is much more likely to give and receive mutual aid support on a routine basis than is fire suppression

Answer 5

EMS

Question 6

A quality records management system provides two critical contributions to a fire-based EMS program: ___and _____

Answer 6

patient care reports and research.

Question 7

Currently, which states in the United States has agreed to submit local EMS data to the National EMS Information System (NEMSIS; www. nemsis.org).

Answer 7

every state

Question 8

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 ________

Answer 8

electronic medical record (EMR).

Question 9

Research initiatives and quality improvement (QI) studies are also best managed when patient care data is stored ______

Answer 9

electronically.

Question 10

______can help gather more accurate information and should be investigated. It can also lead to higher billing collection rates.

Answer 10

Patient-side computer usage

Question 11

Outcomes for certain critical medical emergencies such as choking and cardiac arrest are significantly impacted by the provision of _____

Answer 11

high quality emergency medical dispatch (EMD).

Question 12

______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

Answer 12

Risk management

Question 13

_____ 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.

Answer 13

Risk management

Question 14

The overall goal of risk management is to reduce the ____AND ____ of preventable adverse events that create losses.

Answer 14

frequency and severity

Question 15

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.

Answer 15

58%

Question 16

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 (__%).

Answer 16

28 patient handing
9 medical management
5 response
4 equipment issues

Question 17

any time a department adds new EMS skills, procedures, or services (for example, interfacility critical transport or intubation using paralyzing medica­tions), _____ should be reviewed

Answer 17

insurance policies

Question 18

The first step in a comprehensive risk management program is_______

Answer 18

identifying the risks

Question 19

any _____ event should trigger a thorough internal review for any failures or contributing factors

Answer 19

sentinel

Question 20

____ 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.

Answer 20

Sentinel

Question 21

Mitigation strategies can be designed and implemented after potential ______

Answer 21

risks and probabilities are known

Question 22

Continued monitoring using ongoing data collection and analysis coupled with sentinel event review and analysis of adverse occur­rences allows for adjustment of ________.

Answer 22

risk mitigation strategies

Question 23

But where the ____ends is where pertinent information should begin.

Answer 23

obvious

Question 24

___ involves meeting the needs and expectations of the customer based on a strategic quality plan, objectives, and performance indicators.

Answer 24

QI

Question 25

___ is carried out by post-incident review and audits to determine compliance with performance indicators

Answer 25

QA

Question 26

_____ include patients and their families, physicians, nurses, taxpayers, visitors to the area, and suppliers;

Answer 26

External customers

Question 27

_____ are the employees of the organization

Answer 27

internal customers

Question 28

the ultimate consumer is_____

Answer 28

the patient

Question 29

Customer service is greatly dependent upon _____

Answer 29

bedside manner

Question 30

The goal of every EMS system should be to continuously evaluate itself and constantly strive for____

Answer 30

performance improvement

Question 31

If data analysis reveals that a fire department is meeting performance goals, What needs to happen next?

Answer 31

new goals should be set that encourage higher levels of performance

Question 32

benefits of adopting a quality management process are many, including:

Answer 32

improved patient care, employee morale, patient satisfaction and outcomes, and decreased cost

Question 33

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_____

Answer 33

Food and Drug Administration (FDA; www.fda.gov/medwatch).

Question 34

From a risk management perspective, there are two key areas of litigation involving EMS equipment:

Answer 34

lack of equipment and equipment failure

Question 35

Equipment failure typically involves

Answer 35

defibrillators or automated external defibrillators (AEDs) and suction units. Dead batteries or malfunction of these units are the most common reasons for litigation.

Question 36

The primary guidance documents for infection control are:

Answer 36

OSHA regula­tion 29 CFR 1910 and NFPA 1581: Standard on Fire Department Infection Control Program.

Question 37

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

Answer 37

9%

Question 38

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

Answer 38

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

Question 39

Procedural problems in EMS typically involve ______

Answer 39

involve spinal injuries, fractures, and protocol compliance

Question 40

Key among claims for_____injuries is early recognition and appropriate treatment; most claims allege significant delay in recognition or providing treatment

Answer 40

spinal cord

Question 41

______ is most often the contention when claims involve fractures.

Answer 41

Improper immobilization

Question 42

Treatment and patient moving tactics are largely ____ that should be detected and remedi­ated through supervisory activities or run reviews

Answer 42

educational issues

Question 43

When an adverse outcome occurs related to a drug administered by EMS, it is most commonly related to administration of the _______

Answer 43

wrong dose of a medication or giving a drug by an incorrect route

Question 44

_____, owning to their dangerous side effects, are more often involved in medication error claims and typically involve protocol violations .

Answer 44

Narcotics

Question 45

Transport to the wrong or inappropriate facility leads claims for___% response and transport , followed by response errors (__%) and patient security (__%)

Answer 45

(52%)
44
4

Question 46

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

Answer 46

dispatch process

Question 47

______ 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

Answer 47

failure to properly secure the patient

Question 48

Fire-based EMS services must provide HIPAA-compliance training to all ________

Answer 48

newly hired members and at regular intervals thereafter

Question 49

The greatest dangers, and most frequent cause for complaints pertaining to confidentiality, are when health information is inadvertently ______

Answer 49

shared outside of the fire department

Question 50

Claims arising from the operation of ______are the most significant risk to any EMS service

Answer 50

motor vehicles

Question 51

Nearly __% of drivers involved in ambulance crashes are considered high-risk drivers.

Answer 51

41 percent

Question 52

Departments that routinely use EMD protocols to limit RLS responses have __ % fewer crashes with __% less severity when they do occur.

Answer 52

25%

39.6%

Question 53

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%).

Answer 53

patient handling

Question 54

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) .

Answer 54

patient handling

Question 55

_____are the leading cause of lost time from work for EMS providers

Answer 55

Back injuries. Musculoskeletal and spinal injuries

Question 56

______ 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.

Answer 56

Fitness and educa­tional programs