EMS Captain Test Study Guide 2024 PDF

EMS Captain test study guide 2024 EMS Supervisor book Ch. 1- Dynamics of EMS Leadership and Organizational structure ​ EMS Officers must stay informed within this continuously changing landscape and must remain well positioned to make any necessary adjustments. ​ The goal for every ORGANIZA...

EMS Captain test study guide 2024 EMS Supervisor book Ch. 1- Dynamics of EMS Leadership and Organizational structure ​ EMS Officers must stay informed within this continuously changing landscape and must remain well positioned to make any necessary adjustments. ​ The goal for every ORGANIZATIONAL LEADER and the members of an EMS organization must be to EMBRACE A BUSINESS CULTURE MINDSET that will MAXIMIZE POSITIVE ORGANIZATIONAL OUTCOMES, both operationally and administratively. LEVELS OF EMS OFFICERS- Supervising EMS officer- (Entry level) Primary responsibility is supervising EMS personnel in the field. May entail pt care, QA/QI, EMS training, discipline, completing supervisory reports. Managing EMS officer- Commonly held by a (Mid level) EMS officer who manages the ems division or bureau. May manage or lead functional work groups, analyzing and monitoring the budget, developing strategic objectives, collective bargaining negotiations, performance benchmarks, support CQI, hospital consortia as well. Executive EMS officer- (Top level leadership)- manages the entire organization typically through a director or CEO position. -As “SUPERVISING OFFICER LEVEL” may hold the rank of (EMS lieutenant, EMS Captain, EMS district supervisor, EMS Battalion supervisor/ EMS Supervisor. -As “MANAGING EMS OFFICER LEVEL” may hold the rank of (EMS division chief, EMS Bureau chief, FIre/EMS chief, CEO, Commander or director of the organization. ULTIMATE GOAL OF ANY EMS OFFICER is to be a good MANAGERIAL LEADER.!! Understanding the big picture Once promoted to an EMS officer the primary focus is to ensure the organization and not just your division is moving in the right direction and achieving positive outcomes. A new EMS officer must review the “VERTICAL SNAPSHOT” of the organization to become familiar with its makeup. The snapshot includes an organizational chart of divisions within the organization, and assists in the EMS officer getting to know the division leaders, personnel, process workflow, layout of the EMS buildings and location. This will help you understand the big picture of how the organization conducts business on a daily basis. -Managers sometimes make the mistake of coming into an organization or division and IMMEDIATELY MAKING CHANGES and getting so involved in day to day processes (MICROMANAGING) which causes them to overlook the people who run these processes. The big picture will be easier to understand if you are promoted from within. FIVE BUSINESS PRIORITIES- 1.​ PEOPLE- Most important asset including customers and members A good officer must realize they cannot do it all alone and must depend on a GOOD TEAM. 2.​ STRATEGIC OBJECTIVES- improving current/future services, developing plans, monitoring competitors, developing CQI, ensuring the most qualified people are in the right positions. This is where you put together an organizational roadmap. It is important to implement a VISION, MISSION, GOALS,PERFORMANCE MEASURES and OBJECTIVES to set your organization on the right track. 3.​ FINANCIAL MANAGEMENT OBJECTIVES- understanding the divisions budget, how much money is available, forecasting and HAVING A PLAN 4.​ LEARNING OBJECTIVES- making sure your team is well informed and knowledgeable, supporting team members as they learn to grow within the organization. Create a learning environment, encourage your team to learn and grow and be more proficient at their duties. It is CRITICAL that your employees remain focused and knowledgeable within their field of expertise. 5.​ CULTURE OF QUALITY-analyzing and improving performance outcomes. Setting benchmarks, seeking out ways to exceed customer expectations. Methodologies that focus on quality improvement; TOTAL QUALITY MANAGEMENT (TQM), CONTINUOUS QUALITY IMPROVEMENT (CQI) and LEAN SIX SIGMA. SIX SIGMA- quality management program which focuses on identifying variations (CHANGES FROM NORM) -method of improving processes, ensuring a continuous analysis of processes, keeping customers happy, identifying variations in processes. -Six Sigma quality initiatives use the (DMAIC) methodology ​ - DEFINE the project that you would like to address ​ - MEASURE the current situation ​ - ANALYZE the current process so that you can identify the defects. ​ - IMPROVE the current process. ​ - CONTROL the process to ensure that you maintain the level of efficiency and effectiveness with the processes at hand. Organizational spokes- Components that SUPPORT, ADD VALUE, and KEEP THE ORGANIZATION MOVING IN THE RIGHT PATH. Organizational spokes can be operational or administrative. OR micro or macro level. -Ex. Finance sections, training section, fleet section, operation section, logistic section, dispatch section, information system section, human resource section. -It is up to the EMS OFFICER to assess, implement and support organizational spokes that add value to the organization. -2 organizational spokes that will directly impact your ability to make decisions related to equipment availability. -Capital improvement plan - Efficient organizational purchasing process. -Performance - Performance metrics and Benchmarks are organizational spokes that provide baseline performance information. Organizational culture -A set of norms, beliefs and attitudes that have permeated an organization. ​ Organizations beliefs may be.. 1.​ Formal- Directed by senior management 2.​ Informal- Displayed by senior employees Culture within an organization typically arise from a set of NORMS and VALUES. ​ Norms- attitudes and behaviors that the organization and individuals see as normal ​ Value- Ideas that reflect what the organization or individuals believe are right or wrong. Equipped for business -First review the organization’s big picture. -Make sure the 5 BP’s are clearly defined for all members and continuously monitored. -Organization equipped for business is about operational components, leadership behaviors and organizational culture. EMS Officers should make changes to the organizational CULTURE SLOWLY. -Make sure your team’s goals align with the goals of the organization. -Most commonly people resist change simply because they FEAR the UNKNOWN. It may be harder for one in a new leadership role to create change. However, it only takes ONE person to initiate change that other may follow. -Be patient, humble, listen and treat others as you would like to be treated. -One of the greatest challenges is “stepping into a new role surrounded by senior management and be able to execute duties as your predecessor.” -5 Business Priorities (People, Strategic objectives, Financial management objectives, Learning objectives, and Culture of quality) -Implementing quality improvement program will ensure the WORK be done adds VALUE to the organization. -Organizational spokes are (operational or administrative sections, processes, culture or anything else within an organization that is responsible for supporting the overall mission. -Establishing good communication among all members of your team will help BREAK down BARRIERS and perhaps begin to new culture. -BIG Picture- The overall structure, composition and direction of an organization. Chapter 2 Managerial Leadership -Management is a science, Leadership is an art -The ultimate goal for a newly promoted individual is to become an effective and efficient MANAGERIAL LEADER. -Management primarily deals with the processes and Leardership is ALL about the people. -As a new ems officer you will be managing processes, systems and people. ​ -A PROCESS is a set of steps or actions to achieve an end-result. ​ -A SYSTEM is a group of interrelated components working together to ensure a specific outcome. -Certain important directives must remain accessible in the future. Ie; SOP’s, SOG’s, bulletins, general orders, memos. -Overall monitoring of a budget MUST be ongoing, not just addressed during the budget workshop. Creating a quality management system is a necessity. ​ A quality management system is the means by which you (perhaps your team) review specific core processes to ensure that the services delivered are meeting or exceeding the benchmarks set within the organization. Creating performance improvement metrics ​ This will set benchmarks and analyze results which will allow you to see how well your division is delivering quality services and what needs to be improved. Purchasing equipment ​ -Familiar with organizational purchase processes ​ -vendors ​ - obtain purchase quotes ​ -apply for grants ​ -Partnership with another EMS agency to offset expenditures When attempting to establish or evaluate a set goal the EMS officer should consider the SMART mnemonic. (SPECIFIC, MEASUREABLE, ACHIEVABLE, RELEVANT and TIME-BOUND) ​ Specific- The goal needs to be specific and not ambigious. Team needs to know what is to be accomplished. ​ Measurable- If the process cannot be measured than how will you know how effective the process is..? ​ Achievable- The processes need to constantly be monitored to determine whether they are achievable or not. ​ Relevant- Are the processes specific and leading to a relevant core value or mission. ​ Time- Set target dates for project completion. The team must know what is expected and how much TIME they have. Good leadership traits 1.​ Promise only what you can deliver.’ 2.​ Be honest 3.​ When things go wrong, before placing blame, REMEMBER “YOU ARE IN CHARGE” 4.​ Give a gift for no reason. 5.​ Be accessible to your team and a good listener. 6.​ Autonomy is critical-MICROMANAGING is a killer 7.​ Do not wait for change- Make it happen. 8.​ Be an example 9.​ Be humble 10.​Loyal 11.​Give CLEAR direction 12.​Develop people -HOW to succeed as a manager Management is fulfilling day to day operations; Leadership is gaining the needed support from your team to ensure that operational demands are addressed effectively. Scope Creed- members move away from the intended goal of the project and into other areas that do NOT add value to the project. -UNDERSTANDING the leadership role Leaders must be PASSIONATE about the role they are working with team members while keeping the mission, vision and values of the organization in mind. The FIRST 5 of the 5BP’s is always “PEOPLE” -One of the first things to consider taking the role of EMS Officer is “Organizational behavior” ​ Organizational behavior- How people behave within an organization, which in turn is a direct reflection of the organizational culture. ​ Organizational culture- What makes an organization function the way it does. LEADERship styles Directive leader- Creates a dependent relationship with subordinates who carry out the orders. This leader gives clear directions and objectives and how to carry them out. ​ This type of manager may be looked at as a “MICROMANAGER” Coaching leader- Focuses on guiding the team, challenging them and taking them to the next level. This works well when your team want to continue to learn and grow. ​ -Focus on motivation, learning and trust. ​ ​ This type of leadership will not work if the team will NOT accept the “Coach” personally. ​ ​ -This leader may also come across as a micro manager. REGARDLESS of your intentions as a leader, how you carry yourself is how others will PERCEIVE you. Consensus leader- Seeks agreement without hurting subordinates FEELINGS. This leader relies on group consensus when making decisions, making sure all team members have an opportunity to be a part of the decision making progress. ​ This leader may appear INDECISIVE and always seeking group input before making a decision. Affiliative leader- Has an empathetic relationship with employees. They work to establish cohesion and harmony among team members. ​ This leader may overlook troubling situations affecting an employee or entire group. Expert leaders- Believe knowledge is power and that being RIGHT and efficient is more important than establishing a relationship with the team. ​ This leader is knowledgeable in the responsibilities assigned to them. ​ ​ Such leadership can lead to employee frustration and lost opportunities for team member inputs. Charismatic leader- Gathers followers by having a charming personality. They can highly engage an audience. ​ ​ The focus is about their presence, personal goals and perception by the audience. Situational leader- Puts themselves in a leadership role during challenging situations. ​ This leadership style is the MOST IMPORTANT leadership style because it emphasizes the leader’s ability to lead during challenging situations. Servant leader- Is available for the team members and puts their needs first. Their priority is helping the team members SUCCEED. They keep the team moving in the right direction. ​ -More of a support role NOT recommended for quick decision making. Autocratic leader- Does not seek input from team members. This member always has the last word. ​ This form of leadership may be beneficial, but it can be demoralizing and lead to team member frustration and underperformance. Participative leader- Works cooperatively with team members to get tasks completed. They get everyone involved working together. They engage employees and improve morale. Transformational leader- Goes to the very core of the organizational culture of the employees. -They play a critical role if the organization needs a REBOOT. ​ Most useful when a NEW DIRECTION is desired. Laissez-faire leader- Non authoritative and offers minimal guidance. Allows the team to work independently and at their own pace. ​ Poor outcomes may result due to the LACK OF supervision. Southwest Airlines- has been one of the most successful airline companies and MUCH of its success comes from its employees. Establishing 5BP’s as a managerial leader 1. Meet with your team and get to know them. 2. Listen to what they have to say “Very important” 3.DO NOT make changes (Unless clearly warranted) Strategic Objectives -Set a direction with a plan ​ The plan should center the organization’s strengths, weaknesses, opportunities and threats (SWOT). Strengths and weaknesses are INTERNAL ​ Opportunities and threats are EXTERNAL Vision statement- Identifies where you want the section, division or organization to ne in the future. ​ -It serves as the COMPASS of the organization. Mission statement- Identifies what you are doing now as an organization. Goals- Are set TARGETS -Learning objectives These may consist of a formal education, speciality classes, seminars, etc. ​ ​ Regardless of what title you have, anyone has the power to initiate change. ​ ​ If employees feel empowered and believe they have a say within the department they will support the MISSION. Your goal is to create a positive learning environment, promote learning and surround yourself with the most talented group of individuals possible. -Culture of Quality You must have a good or service that is consistently measured and evaluated. For this you must have performance metrics and benchmarks set in place. -80/20 RULE ALso known as the Pareto Principle and the Law of Vital few, is a rule that all leaders must keep in mind. -It states that for 20% of something results in 80% of outcome. Ie; 80% of EMS complaints involve 20% of the response. When analyzing operations LOOK for that 20% that is creating 80% of the poor outcome and DO NOT get bogged down with every issue. -Time Management ​ Give yourself 1-2 hours a day for yourself. This is time to get work done. Make attempts to avoid meeting on MONDAY morning or on FRIDAYS. -Mondays= busiest -Fridays= Use friday to tie up any loose ends from the week and prep for the next monday. Advantage of being promoted from within is the familiarity of the system, culture and people. Advantage of joining an organization is the ability to provide a NEW perspective to the organization. -Chapter 3 Building the Team One of the most important things you will do as an officer and leader is to ensure the employees understand what is expected of them. ​ All jobs must have a clearly defined job description. ​ HR is a great resource for guidance. Evaluating applications ​ Job ad will typically be posted for 1-2 weeks. It may available to internal and external candidates. Once all the applications are in FIRST thing to do is PRIORITIZE. ​ Determine which candidates are QUALIFIED for the position. SECOND, consider making 2 batches of applications. 1.​ Applicants who meet the requirements 2.​ Applicants who excced the requirements Interviewing candidates ​ Check with HR to see if a template needs to be followed for scoring. ​ When conducting the interview you should make every attempt to have AT LEAST TWO interviewers besides yourself present. ​ Interview questions may be JOB specific or SCENARIO based or both. ​ Prior to interview introduce yourself and interviewers to the candidate and give a little history. Leading the team- -Establish a Plan ​ The newly promoted EMS officer must first establish CLEAR direction, Expectations and distinct PLAN. -Management Components 1.​ Coach and mentor the team 2.​ Empower the team (Avoid micromanaging at all costs). 3.​ Have confidence in the team.  4.​ Collaborate and communicate with the team. 5.​ Be available for the team (be a managerial leader) -No matter where you are on the leadership ladder, the same rule applies: You and the organization will NOT be successful without excellent support from the PEOPLE. -YOUR team is a clear reflection of your expectations as an EMS officer. - First step for the mentor and mentee is to develop a relationship where both acknowledge that being candid with each other is TOP priority and feedback is encouraged. -Second is to develop a plan that will establish a foundation for guidance for the mentee -Third is when you agree to be a mentor , make sure that you are truly committed to help as long as the mentee needs it. -Fourth, being a mentor means that you must be a role model. -Fifth, the relationship is ALL about the mentee. -As a coach you may need to mix things up to keep the employees interested and engaged -Empower the team ​ Avoid MICROMANAGING at all costs. ​ ​ -This can be demoralizing and lead to frustration and underemployment. -Let the team know What is expected of them, Provide them the tools to get the job done, be AVAILABLE in case they need you, TURN them loose and let them soar. -Sharing outcomes and results= this shows the team members something tangible that they help build = creates ownership. -TO empower your employees FIRST establish a rapport with your team, Listen to their concerns. -Steps that an EMS officer may take to empower a team to carry out day to day operations. 1.​ Keep the team informed 2.​ Promote constant communication 3.​ Once your team members understands, LEAVE them alone. 4.​ Treat your employees with respect. 5.​ Give recognitions when earned 6.​ If your team is meeting its full potential, see what you can do to take them to the NEXT level. -Instill confidence  -​ If a team member makes a mistake DO NOT tear them down, take time to support them. Take the opportunity to let the member know how they can improve, but point out the positives and build from there. -​ Confidence is gained through action -Promoting collaboration, you are bringing a diverse group of team members together to achieve a desired outcome. -Be available for the team ​ -To answer questions, work through problems, demonstrate to the team you are their for them. Let them know if you are out of the office for an extended period of time. ​ -Make it a point to meet with team members individually. -Negative attitudes, “It all starts and ends with you”. ​ Avoid negative attitudes 1. Pointing the finger 2. That’s not my job 3. I don’t have time 4. I’m a great leader and that’s why we succeed. 5. I don’t want to do this job anymore Commitment to a team ​ As a new managerial leader, establishing a healthy relationship with your team members should be one of your FIRST priorities. -Start by showing respect, listening, and providing feedback, eliminating noise, knowing your team, and rolling up your sleeves. Always show respect to those with whom you speak. Listen to what the other person is telling you and provide feedback. ​ -When providing negative feedback, it will be your responsibility to work with the team member and give them every opportunity to get back on track. Eliminate noise- background noise, construction, Noise can also come in participant’s “EMOTIONS and BIASES”. -Open communications ​ -Make sure everyone understands what you are saying and always encourage the team members to ask questions, -Rolling up your sleeves ​ -Being in the trenches with your team members allow you to observe their work- together as individuals and provide feedback about their performance. This will make any feedback you may have, good or bad, easier to accept on their part. -Meetings ​ -Reason for the meeting ​ -Create an agenda and share with the team prior to the meeting. ​ -Announce speaking time limits ​ -Keep the meeting short ​ -Make sure everyone had the opportunity to speak ​ -If meeting goes beyond the scheduled time, take breaks. -HIGH probability after “15 minutes” you spend speaking with your team, they will stop listening and think about what they are going to do on the weekend. Conflict resolution -ROOT cause, matter really boils down to at least TWO parties disagreeing. ​ - Make very attempt to negotiate a win- win resolution. ​ -Interview key personnel separately (Initially) with a neutral party. ​ -Listen to both parties ​ -Encourage both side to be open and candid ​ -Find a positive point in each side ​ -Ask how to find common ground ​ -How to resolve conflict? From both parties Profile assessment tools ​ DISC Profile assessment tool ​ -The DISC profile assessment tool uses FOUR dimensions- ​ ​ 1.Dominance -takes action, desires power and authority, accepts challenges, makes quick decisions ​ ​ 2. Influence -Who strives to be a leader, influences and persuades others, coach/counselor ​ ​ 3. Steadiness - Senior member, predictable, good listener, enjoys helping others ​ ​ 4. Conscientiousness - focus on key details, check for accuracy, desires to ask WHY? -This is to describe the EMPLOYEE’s behavioral pattern. Myers-Briggs Type Indicator (MBTI) Emotional Intelligence Appraisal Clifton Strength Finder Manager is part of the conflict -​ Seek a neutral party to help -​ Mediator must not have ties to either party -​ Both on the same team Working with HR ​ -Once a selection is made the new employee will meet with HR rep and complete the following. ​ ​ -Compensation and benefits ​ ​ - Tax info ​ ​ - Retirement info ​ ​ - Professional certs ​ ​ - Background check ​ ​ Union and contract relationship ​ Create labor agreement and negotiations -​ Wages -​ Staffing profile -​ Drug testing -​ Cert requirements -​ Discipline -​ Grievances -​ ADA, probation Management rights- Management has the right to make management decisions outside of the negotiated union contract (to meet the needs of the organization, only in extreme operational circumstances.) ​ -This can only happen if there is an immediate need or potential negative impact to the organization Grievances -Once a grievance has been issued by a union member, the goal is to have both parties present -Come to an agreement without having to escalate -Cannot agree it will go to “Mediation”.= Third party attempts to resolve the dispute. -Hearing panel consists of : leadership members of the organization and a union representative. Disengaged team members -The disengaged employee will try to do as little as possible and is minimally committed to the organization and to completing his or her assigned work duties. ​ -Resist change ​ -make an effort to make things difficult ​ -Consider themselves as informal leaders. How did the member become disengaged? ​ ​ -When disengaged employees are identified: ​ ​ -Address the issue immediately and let the member know you are there to support them. Organizational silos- (functional working teams)- Groups of individuals within an organization who are assigned to work in specific division or department. -Productive or Unproductive? Coaching- Method of directing, instructing and training a person or group of people with the aim to achieve some goal or develop specific skills. Due process- The opportunity for an individual to know the charges and have evidence considered prior to disciplinary action. Mentoring- Developmental relationship between an more experienced person (mentor) and less experienced person (mentee). -Chapter 4 Communications The majority of your time will be interacting and engaging in conversations. ​ You must not just convey a message, the information must be CLEAR and CONCISE, and the sender of the message needs to make sure that the receiver understands it. -Communications basics ​ Sender- the person who is trying to communicate ​ Receiver- The person with whom the sender is trying to communicate with. ​ Message- WHAT the sender is trying to communicate. ​ Medium- The FORMAT which the sender is trying to communicate. ​ Encoding- HOW the sender FORMATS the message. ​ Decoding- How the receiver INTERPRETS the message. ​ Feedback- The response from the receiver to the sender based on the message received. ​ ​ This can be verbal, non-verbal, written or a combination of these. -Transitions are used to shift to other topics. This helps prevent confusion, clearly defines new topics and keeps the receiver engaged. -When you begin to communicate with your team you will most likely use a variety of communication methods; one on one, written memos and emails, meetings, briefings or perhaps question and answer sessions during presentations. -FACE to FACE communication should be considered FIRST choice. ​ This is typically preferred because the sender can see whether the receiver understands the message by observing the body language. -Medium of communication may be PHYSICAL or MECHANICAL. ​ -Physical the speaker can be seen; meeting or interview. ​ -Letter, email, memo, PCR. -Sender/receiver should actively participate, body language, eyes focused on each other, ignore the noise. -Informal conversations ​ MOST of an individual’s verbal communications are informal. ​ ​ Ie; more relaxed and conversational- Supervisor visiting a crew at a station. -If you are waiting for a text or phone call prior to the start of the meeting, let EVERYONE know that you may need to step away from the meeting for a few minutes. -Video/phone conferencing- similar to normal meetings but you will need a CODE for phone conferences and video, you may FREEZE or lose connection/sound. -Presentations Prepare thoroughly , relaxing during the event, keep the presentation SIMPLE. ​ EMS education, orientation for new hires, in service training. ​ -Know the material; be organized and do your homework. Deliver an ORGANIZED, CLEAR and CONCISE message. The GOAL is to capture the audience attention within (1-3 MINUTES). ​ ​ -Make it easy to follow - Avoid busy slides - Make sure slides colors are not distracting. -Combining images with text, try not to exceed 3 IMAGES per slide. -Keep font size no less than (30) points​ ​ -Know your audience; topic familiarity or new person -Become familiar with your surroundings; location of facility, time allotment, room conducive to learning. -Plan your time; How much TIME do you have. Depending on your content or presentation you will need (AT LEAST 30-60 seconds per slide.) And at least 15 minutes for Q/A after the presentation. -Crew Resource Management (CRM)- introduced during NASA air safety workshop ​ -A multidisciplinary management system with the primary goal of improving safety and efficiency by focusing on leadership, communication, situational awareness, teamwork, decision making, and use of all resources available to meet a goal. Written communication- A standard mode of communication, it may be the most CHALLENGING means of getting the intended message to the receiver. Memo or bulletin- Memo is used when a specific message is being sent to (members of the organization or between working units). A bulletin is used to post a specific message for for (ALL members of the organization). ​ Both used for internal communication between organizational members and are LESS formal than letters. Letters- Sending a message from one person on behalf of the organization to another PARTY OUTSIDE of the organization. Letters are a FORMAL way of communicating. -SOPS/SOGS ​ -SOPS =Documents containing a set of instructions to assist employees with the management of operation and administrative conditions. These serve a REFERENCE point when dealing with operational or administrative conditions and provide a STANDARD of operation across the organization. ​ -SOGS essentially provide GUIDANCE on how to address certain business activities and SOPS include the STEPS required to accomplish the activities. ​ SOGS can be in text format and consist of : ​ -Purpose- The reason for the SOG ​ -Guideline- guide for performing specific activities addressed. ​ -SOPS are typically more DETAILED and includes STEPS. -SOPS ​ -Purpose ​ -Policy ​ -Responsibility ​ -Procedure -Once these are created they need to be evaluated via dept head and at least once every 12-18 MONTHS. -Emails are the MOST widely used communication media today. ​ ​ When assigned a work station/computer avoid ​ ​ ​ -HIPPA information ​ ​ ​ -Non work related info ​ ​ ​ -Sending threatening emails/non-work related -Emails are PUBLIC RECORDS.. Organization’s Website ​ -the color BLUE reflects peacefulness and tranquility ​ -RED suggests and intense emotion or power ​ -BLACK represents authority ​ -YELLOW is cheerful ​ -White is innocence and trust -DO NOT write an email or social media post when you are upset or don’t know all the facts. -Employee reviews ​ As a manager you should not wait to compliment or advise an employee until their annual evaluation is due. -Verbally acknowledging an employee’s good performance is essential and should be done more ofter than once a year. -When working with a new hire the OFFICER should meet with the new employee at 30 day, 90 day and then as needed to monitor progress. -Positive or negative evaluations must be viewed as an OPPORTUNITY to show the employee you want to help him/her succeed within the organization. PIO’s- may also have other duties as a (community public safety liaison) ​ When creating a media release- keep it SIMPLE: Media wants to know the 5W’s, (WHO, WHAT, WHEN, WHERE, WHY) ​ Barriers to Effective communications 1.​ Personal barriers 2.​ Physical barriers 3.​ Process barriers 4.​ Semantic and language barriers Personal- originate with the person who is either attempting to convert a message or receiving the message. Physical- 2 categories NOISE and DISTORTION ​ Noise can be environmental in nature; construction, telephones, congregating employees, doors closing, etc. ​ Distortion- distance, climate too hot/cold. Process- Breakdown within the process of the communication system. It can be in either ort all of the communication process. (sending, receiving, encoding, medium, decoding, feedback.) Semantic/language - Poor grammar, use of technical or uncommon words, poor transitions. Is the sender/receiver speaking in a different language. ​ Semantics- LOL instead of “Laugh Out Loud” or using radio 10 codes. Chapter 5- Creating a Culture of Quality -Tangible and intangible items must be QUALITY DRIVEN. ​ When providing EMS QUALITY must be embedded at the very core of service being provided. Quality- entails meeting or exceeding customer expectations by delivering goods or services consistently with minimal to no variation from the expected outcome. Quality Management Program benefits: ​ -improvements in organizational processes and systems ​ -Identify processes that do not add value ​ -Reduction of administrative and operational waste ​ - focus on exceeding customer expectations ​ -detecting underperforming processes ​ -comparing overlapping processes ​ -cost savings and promotion of lean environment -To introduce quality within an organization it must begin from the Top leaders. ​ Before implementing a quality initiative, the leadership team may establish a quality management team to ensure that all phases of the organizations new quality initiative have been addressed. ​ The success of a quality result-driven organization is directly related to the COMMITMENT by the organization’s leadership team and its team members in embracing the culture of quality. ​ First, the EMS officer must demonstrate his/her own commitment to the organization wide quality initiative. ​ Second- establishing a culture of quality is to send a CLEAR message. ​ Third- The total quality management approach must be an organization wide effort that obtains buy in from all team members. ​ Fourth- EMS officer must ensure that total quality approach is ongoing and not a one-time event. An effective quality management program will serve as the foundation and resource, which must be in place before tackling any project. Project charter- A document that is prepared by senior leadership or manager and contains information on how the project will be managed. Quality planning- Critical component of quality management that is used when preparing to work on a specific project. ​ -Following elements to consider: ​ ​ Description of the project improvement ​ ​ Baseline ​ ​ Who is the project manager ​ ​ Who are the participants ​ ​ Objectives ​ ​ Evaluation of QA/QC ​ ​ What tools are needed ​ ​ Operational/administrative resource needs ​ ​ Feedback FOUR of the 5BP’s are IMPACTED by implementation of a quality management program; People, Strategic objectives, Financial management objectives and Culture of quality. -individuals responsible for implementing quality management framework will need uninterrupted time. This may consist of 2 HOURS per week or a 3 DAY retreat. Quality Assurance- is a quality management activity that monitors (audits) organizational standards and detects any variation from the expected delivery of quality goods or service. ​ This is required to ensure that the quality objectives are met. Quality assurance is often confused with QUALITY CONTROL. ​ Quality assurance is an audit or an evaluation of a business activity. (PROCESS oriented, ensuring things are being done correctly) ​ Quality control is a specific activity within the quality management program. (PRODUCT ORIENTED, ensuring the desired outcomes occur. “This is a quality management activity that seeks to ensure necessary procedures are in place to support a QUALITY outcome. The KEY for every organization, however, is a continued COMMITMENT to quality management. CQI- Continuous Quality Improvement - an ongoing quality management activity pertaining to continuous process and or system improvements. ​ Focuses on the use of tools that will lead to improvements in the internal and external outputs. ​ (Six Sigma, ‘TQM’ total quality management) Continuous quality improvements tools ​ DMAIC ​ CTQ ​ Cause and effect (fishbone) diagrams ​ Process charts ​ Brainstorming Resistance to Change ​ Resistance often results from the employee’s UNCERTAINTY -Following steps to help success 1.​ Be transparent and explain what the quality program will entail 2.​ Seek input from the members of the organization 3.​ Explain any training that will be required and promote an environment of learning (training is a lifelong process) 4.​ Demonstrate a commitment to quality 5.​ Celebrate the teams success with any completions of projects. Total Quality Leaders -W Edwards Deming= Deming’s 14 Principles marked the beginning of the TQM movement (Quality Guru) -Walter Shewart = Conceived the Plan-Do-Check-Act (PDCA) -Juran = Managing quality consists of quality planning, quality control and quality improvement AKA (Juran Trilogy) -Kaoru Ishikawa= Father of japanese quality control efforts (Company Wide Quality Control) “CWQC” -Armand Feigenbaum= Total Quality Control (TQC) -Philip Crosby= Do It Right the First Time (DRIFT) -Frederick Taylor= Workplace experiments to find ways to maximize efficiency (Taylorism) Total Quality Management (TQM) -Meet and exceed customer expectations by eliminating variations within the organizations Total Quality is a commitment to creating culture of quality across all levels of the organization, ensuring that the goods and services meet or exceed customer expectations and that continuous improvement is at the center of every quality initiative. Six Sigma- quality management program “focuses on achieving near-perfect outcomes.” Lean quality program- is based on the Toyota Production System (TPS). Lean and Six Sigma complement each other. ​ -Lean focuses on eliminating waste. ​ -Six Sigma by comparison focuses on identifying the variation (root cause) within the process and improving outcomes. ​ These work well together because an organization should ideally make a concentrated effort both to prevent waste (LEAN) and to deliver an error free product or service. (Six Sigma) -Six Sigma was adopted by GE general electric by CEO Jack Welch. ​ Within 2 years of implementation this increased $700 million dollars in corporate benefits. -ISO 9000 ISO is organization comprising members form different countries that publish standards to ensure goods and products are safe, reliable and meet specific quality levels. ​ ISO 9000- Quality Management ​ ISO 14000- Environmental Management ​ ISO 22000- Food Safety Management ​ ISO 31000- Risk Management ​ ISO 9001- Quality management program requirements ​ ISO 9004- Quality management programs for efficient and effective ​ ISO 19011- Guidelines for internal and external audits of quality management programs. -1987 US Congress passed a bill signed by President Reagan reacognizing organizations that demonstrated performance excellence. -Baldridge National Quality Award criteria serves as a framework for the foundation of performance excellence. ​ -7 categories 1.​ Leadership 2.​ Strategic planning 3.​ Customer market focus 4.​ Measurement analysis and knowledge management 5.​ Workforce focus 6.​ Operations focus 7.​ Business results ​ ​ These can be divided into THREE sections; (Leadership, system foundation and results process.) Quality tools for continuous improvement ​ ​ -DMAIC is Six Sigma methodology tool that can help identify a process or system that should be improved. ​ This stands for “Define, measure, analyze, improve and control” This can give the team a roadmap to ensure everyone stays on track. -Define= EMS officer clearly defines set goals and objectives under their responsibility. This is done by reviewing KPI “Keep Performance Indicators.” -Measure= Metrics are set to evaluate performance outcomes. Each measure must be specifically defined to what and how it must be measured to maintain consistency. -Analyze= Gathers all data that suggest the presence of a problem and begins to uncover the root cause of the variation in the desired outcome. -Improve= The officer removes the root cause of the underperformance by either implementing a new process, correcting the current process or eliminating it. -Control= Officer monitors the new process to ensure that the root cause of the problem has been removed. Critical to Quality Tree (CTQ) tree- Used to identify the critical components for achieving a desired outcome. (VSM) Value Stream Mapping- technique used to illustrate steps in a process or system and that can be extremely beneficial for an officer to track the flow of EMS activities. -Process Flow Chart- This chart includes the start and finish points within a process and the tasks that make up the process. -Cause and Effect (Fishbone) Diagram- You can use this tool to move backward from the ultimate effect and determine which causes and effects in different areas help lead to the ultimate effect/problem.​ -Process Flow Chart symbols 1.​ Oval- indicates the start and end of a process. 2.​ Rectangle- indicates an activity (instructions or process step) 3.​ Diamond- indicates a decision point. 4.​ Arrow- indicates the direction of the process flow. 5.​ Half Oval- indicates a delay in process 6.​ Rectangle with wavy base- indicates document flow through a system 7.​ Cylinder- represents a data file. PDCA Plan Do Check Act- AKA (Deming cyle, Shewarts cycle or PDSA “Plan Do Study Act” ​ -Used to control and manage continuous improvement. ​ ​ Plan- design or redesign a business process to meet or exceed goals ​ Do- Execute the Plan ​ Check- Determine how well the plan is working by measuring its performance. ​ Act- Support the plan if it is successful. If changes are required the cycle starts over. Benchmarking- comparing your business processes, practices and metrics to those of the organizations that are industry leaders. ​ Competitive benchmarking- How well is your organization is performing compared to your competition. ​ ​ Functional benchmarking- Focuses on the product or service provided by the organization. ​ Internal benchmarking- Compares internal units (divisions) of the organization to those of the industry leaders. ​ Strategic benchmarking- form of benchmarking observes the practices, processes, products and services of industry leaders not necessarily within the same industry. Allows for leaders to look outside their industry and learn from other best practice organizations. The goal for the EMS officer when working with performance measures, benchmarking, quality management, continuous improvement objectives and exceeding customer expectations is to align the organization’s RESOURCES to meet the OPERATIONAL and ADMINISTRATIVE demands and achieve the desired service delivery outcomes. Balance Scorecard -Is a management tool that focuses on aligning key business practices and processes with the VISION, MISSION and STRATEGY of the organization. ​ Created by Drs. Robert Kaplan and David Norton as a performance measurement framework and assesses the organization from FOUR perspectives. 1.​ Learning and Growth perspective- Makes sure employees are learning and growing with the organization. 2.​ Business process perspective- Implement metrics to monitor performance and continuously monitor and benchmark practices. 3.​ Customer perspective- Survey your customers 4.​ Financial perspective- Every organization must be fiscally healthy. -Performance measures are usually stored and displayed in a spreadsheet or project management software system described as a COCKPIT or DASHBOARD. Statistical terms Mean- The sum values divided by the number of values; AVERAGE. Mode- The value that occurs MOST often. Median- The MIDPOINT in a series of values. “Data must be placed in ascending order and then the number in the middle is selected. Range- The difference between the highest and lowest numbers in a set of values. Trend- A movement of a series of data points in a specific direction over time. ​ -Six Sigma methodology- SIX or more points continuously increasing or decreasing from the median and in the same direction indicate a TREND. Variation- A value or data point that differs from the mean. Standard deviation- Amount of variation or distance from the mean. -VARIANCE is the squared difference from the mean. -Charts- Control Limit Chart- A chart with an upper and lower limit specifications that pertain to a process or system. Scatter Plot- A graph in which individual data points are plotted in TWO dimensions to show their relationship. Histogram-A group of vertical bar graphs illustrating data points and the frequency Pie Chart- A circular graph divided into sections containing specific data assigned to each section. Pareto Chart- A graphical bar view, where bars are in descending order, representing the greatest issues affecting the organization. -Standard deviation is AKA Sigma… ​ DPMO- Defects Per Million Opportunities. -Chapter 6 Customer Service The MOST important factor in an organization’s success is satisfied customers. -TWO types of customers 1.​ External customers- traditional customers to whom your organization provides goods or services; they are outside of the organization, do NOT work for the organization. 2.​ Internal customers- Work for the organization and depend on your support to ensure that they have the necessary tools to better serve the external customers. A customer service plan is commonly created either by an employee project TEAM with customer service experience or a LEADERSHIP team. The FIRST step in creating a customer service plan is to determine who will be responsible for overseeing the process and ensuring that a customer service plan is created. ​ Categorize customers as primary, secondary and tertiary rankings ​ -Primary = patient who is an external customers ​ -Secondary = patients husband/wife ​ -Tertiary = Neighbor -SWOT Analysis (Strengths, Weaknesses, Opportunities and Threats) -When attempting to define customer segments, the ems officer must gather DATA to determine customer characteristics. Internal customers- Those within an organization to whom you provide services. Creating a Customer-Centric Culture ​ Book of “Creating Magic” Author: Lee Cockerell, Executive of Walt Disney. ​ Adopting a CUSTOMER-CENTRIC ATTITUDE within a public safety organization is critical. ​ ​ -You take car of your customers they will take care of you when it comes to Ie. (voting, taxes, budgets, city support.) ​ Customer service problems tend to arise when organizational members who interact with customers DO NOT clearly understand what is expected of them. Ensure Quality Customer Service by HIRING THE RIGHT PEOPLE. ​ -Consider the following questions: 1.​ Is the candidate Qualified for the position 2.​ Could the candidate grow within the organization.  3.​ Does the candidate have the required customer service experience for the position? 4.​ Attempt to get at least 3 references Organizational “Brand”- built on the value, perception and feel of a product or service after a customer experience. -A brand requires at least TWO key FACTORS: A product or service and an evaluator. Outlining a process for quality customer service -​ Establish a central location for customer issues. -​ Specifiy a functional unit to address customer issues. -​ Put the plan into writing Ie: SOG’s, new hire orientation, Protocols Evaluating the Customer Service Plan ​ “Place yourself in the customer’s shoes and go through the organization’s customer service system” ​ Surveys are good tools for capturing customer feedback and measuring your organizations ability to meet patient expectations. Before submitting any survey to customers, answer the following questions: ​ -What will the organization gain by investing in surveys. ​ -Will the data be accurate ​ -Will the Sample of collected surveys be large enough for statistical analysis ​ -What type of medium will be used to gather data. ​ -What will the organization do once the data is analyzed. First-surveys must NOT be complicated. Second- Questions must center on the service provided to the customer and must consider the demographics. Third- Avoid creating surveys that are too LONG. ‘No longer than 5 MINUTES’ Fourth- Customers may choose not to complete a survey because it adds no value to them personally. Providing feedback to TEAM Members ​ -Strategic Communication Plan ​ ​ 5 critical target areas: 1.​ Clearly illustrate and explain the organization’s expectations and the reasons they are important to the organization.  2.​ Ensure the employees understand the leadership team’s expectations, make sure all questions have been addressed. 3.​ Give feedback to crews regarding patient care outcomes and seek feedback. 4.​ Make sure to deliver GOOD and BAD news personally to avoid rumors. 5.​ Monitor performance improvement after implementing the plan. Chapter 7- Strategic Planning -Strategy planning must be thorough and systematic with leadership support and buy-in. ​ Establish a mission and vision statement for the organization will be one of the FIRST priorities. Creating a strategy will be the FIRST step in establishing administrative and operational goals that maximize performance and align business resources to achieve improved service delivery outcomes. Strategy- defined as the art of devising or employing plans or stratagems to reach a goal. Strategic Plan- Organizational plan designed to clearly and concisely communicate how the organization will achieve its desired future goals. ​ -It is essentially an organizational roadmap that provides DIRECTION between the CURRENT administrative and operational state of the organization and where the organization’s leadership would like it to be in the FUTURE. Attempting to develop a plan without: considering multiple ideas, conducting a SWOT, seeking input from internal and external stakeholders, referencing 5 BP’s and clearly having a mission and vision will result in INEFFECTIVE organizational goals. -BAGS FLY FREE- Southwest airlines -Types of straegic plans -Organizational (corporate) strategic plan= If the strategic plan is to include performance improvement initiatives across all levels of the organization a.​ Focuses on evaluating current organizational activities , then establishing organization-wide administrative or operational goals. -Functional level strategic plan= EMS officer creating a strategy for a single functioning work group or division. a.​ Involves creating a strategy within a functional level work group that will contribute to attaining the organization’s vision. Strategic planning process broke down into FIVE parts: 1.​ Create a mission and vision statement 2.​ Conduct a SWOT analysis 3.​ Establish goals, objectives, strategy and tactics 4.​ Implement the plan 5.​ Routinely evaluate the plan FIRST THING, create a mission statement.. -Clearly state the purpose of the organization. ​ Strategy team must ask the following questions? -​ Why does the organizations exist? -​ How is the organization going to improve? -​ Which services is the business providing today? SWOT (Strengths, Weaknesses, Opportunities and Threats) Internal External ​ Strengths Opportunities ​ Weaknesses Threats -During brainstorming the strategy team must refer to the SWOT analysis and 5 BP’s to ensure the goals introduced support the core organizational priorities. Many goals may be suggested BUT the final list of goals should include FIVE to SEVEN. A time frame needs to be included to accomplish the goals. Usually between 12, 18 or 36 month period. When creating strategic objectives consider using KPI’s (KEY PERFORMANCE INDICATORS) ​ KPI- Specific performance measurement, used to measure specific outcomes for organization sustainability. -Consider using the SMART mnemonic when creating goals and objectives to ensure the goals and objectives message is clear: ​ Specific- Goal must be specific for everyone to understand it. ​ Measurable- Strategy team must be able to measure the progress of achieving the goal and determine whether the organizations is on target to accomplish the goal. ​ Achievable- Goal must not be so high that it is impossible to obtain. ​ Realistic- Goal must be realistic and pertinent towards the organization’s mission. ​ Time-bound- Must clearly establish deadlines, which then must be shared with participants. -Strategy and Tactics answer the question of HOW something will be done. ​ STRATEGY- is the approach you will take to accomplish the goal. ​ TACTICS- are the tools used to accomplish the goal. When creating a strategic plan, the strategy team may specify a number of goals that should be accomplished at the 1-3 or 5 YEAR mark. A strategic plan can have an actionable time span anywhere from 1,3 to 5 years goals must be set for completion at -6,-12,-18 or 36 month increments. -Without IMPLEMENTATION, the plan is not serving its purpose. -As an EMS Officer assigned to strategy team consider the following during evaluation of a plan. a.​ Key members are in their place and everyone understands his or her ROLE. b.​ Ask what is working and what is NOT. c.​ Must be ready to make necessary ADJUSTMENTS d.​ Ensure that the goals, once set in place to MOVE the organization FORWARD. -Chapter review ​ -Strategy planning must be thorough and systematic ​ -Strategic planning is an organizational plan designed to CLEARLY and CONCISELY communicate how the organization will achieve its future goals. Chapter 8- Managing a Crisis -Crisis management is part of every EMS officer’s responsibilities and effect FOUR of the 5BP’s. ​ PEOPLE ​ Strategic objectives ​ Financial management objectives ​ Culture of quality -As an EMS officer you will have to deal with INTERNAL and EXTERNAL risks and crises. ​ RISKS- are processes, systems, stakeholders and other business activities that may turn into CRISES if not monitored and managed properly. -Internal risk one that originates WITHIN the organization -External risk- one that originates OUTSIDE the organization. -As and EMS Officer DO NOT wait for a crisis to occur to begin preparing a crisis management plan Crisis types: Internal -​ New vendors with poor reputation -​ Opting out of extended warranties  -​ Priority dispatching errors -​ Non-essential equipment purchases -​ Reducing staffing -​ LODD -​ Injuries -​ Layoffs -​ Budget cuts -​ Healthcare reform, taxes, economy External -​ Market competition -​ Crew exposure to communicable diseases -​ Natural disaster/ terrorist attack -​ MCI -​ Ambulance accidents -​ PHI safety breach -Instilling a culture of PREPAREDNESS and ensuring all team members understand their role before a crisis happens is CRITICAL. ​ -It’s not a question of if a CRISIS will occur rather of WHEN.. Crisis with warning -Ie. Impending hurricane/tornado, volcanic eruption, winter storm, heavy rain, potential flooding, pandemic -Injury prevention and personnel safety are key components in preparing for- and potentially preventing a CRISIS. -Organizational leaders must conduct RISK ASSESSMENTS to ensure the safety of their personnel and those they serve. ​ To create a injury prevention and safety program the organizational leaders must FIRST conduct a WORKPLACE RISK ASSESSMENT. -Risk assessment steps: a.​ Review pre-existing injury prevention and safety plans b.​ Review specific injury prevention policy, procedures and forms currently in place. c.​ Collect data (recent inspections, injuries, worker’s comp claims, training type conducted) ​ -Leadership MUST maintain records of all injury and safety activities, including accident investigations. -For the injury prevention plan to be successful it must be CLEARLY written in an ACCESSIBLE format and supported by POLICIES and PROCEDURES. ​ -Components that must be part of an injury prevention and safety plan. a.​ Perform safety activities mandated by state/federal OSHA b.​ Meetings on regular basis for safety c.​ Conduct routine drills at least TWICE a YEAR d.​ Create an organizational hazard form specific to worksite, office and pre-hospital environments -Preventing injuries is an ONGOING EVENT -Creating a Crisis Management Plan ​ The content must be SIMPLE and STRAIGHTFORWARD enough for everyone to understand during a crisis and must be easily ACCESSIBLE for any team member to use. -Establish an ICS system -Share the plan with internal and external stakeholders -Ensure necessary resources are available -Ensure the plan is easy and has a simple flow process -Include the big picture of the organization and root cause of crisis -Assign an spokesperson to disseminate information about the crisis. -Include the organization’s expected outcomes when dealing with crisis’s -Include protocols for PIA and CISD -Prepare for a crisis before it occurs. -Determine who will be involved in managing the crisis and make sure the team members know their responsibilities. It often takes a REAL crisis to occur for an organization to realize it is not adequately prepared to manage a crisis. -NIMS (National Incident Management System) a.​ Provides a standardized framework for managing an incident. b.​ NIMS is integrated with the NRP (National Response Plan) c.​ Assists responders in preparing and managing crisis situations at the local, state and national levels. d.​ Used as a foundation for developing a coordinated and organized approach. e.​ PRIMARY goal in using NIMS is to ensure EMS and public safety organizations implement a standard ICS (Incident Command System) -ICS: existed before NIMS was created, having originated after a series of California wildfires in the 1970’s. -NIMS: was introduced by the federal government after the 9/11 terrorist attacks allowing for effective coordination, interoperability, communication and collaboration with multijurisdictional crisis events. -When there are at least TWO commanding officers from different organizations working together and sharing command authority as ONE command center, this is referred to as UNIFIED COMMAND. ​ Incident Commander IC- IC is the one position that must be implemented immediately and MUST not be terminated until the crisis is resolved. ​ Public Information Officer PIO- PIO is responsible for disseminating information about the incident to the news media, community, incident personnel. ​ ​ Safety Officer SO- Responsible for the safety of on scene personnel. ​ Operations Section Chief OSC- Responsible for the operational management of the crisis and development of the strategy and tactics used to mitigate the crisis. ​ Logistics Section Chief LSC- Responsible for providing the necessary resources to assist in mitigating the crisis. ​ Planning Section Chief PSC- Responsible for capturing and analyzing scene data, which are then used to plan the response to the crisis event. The PSC also prepares the WRITES the IAP for adoption by the IC. Finance/admin Section Chief FSC- Financial or administrative duties that must be handled during the incident. -First ICP= Incident Command Post/ EOC= Emergency Operations Center where leadership can conform to determine the best management plan to mitigate the crisis. -IAP may be updated EVERY 8,12, or 24 hours. ​ Contains information necessary to management of the scene including: a.​ Incident name b.​ Date/Time c.​ Weather d.​ Participating units e.​ Operational Sections f.​ Operational Objectives g.​ Strategy and Tactics h.​ Situational Awareness Updates i.​ Logistical Plans j.​ Medical Plans k.​ Temperature Managing the Crisis ​ Management of a Crisis should follow the basic STEPS: 1.​ Avoid the crisis 2.​ Confirm the crisis 3.​ Implement the crisis management plan 4.​ Contain the crisis 5.​ Resolve the crisis 6.​ Conduct a Post Crisis Analysis -Avoiding a Crisis- Make it a point to conduct CRISIS REVIEW AUDITS- inspections of the organization’s current operational risks, processes, systems, weaknesses and threats. -Confirming the Crisis- Important because it provides the (Go/No go) decision making point for the implementation of the crisis management plan. Implementing a Crisis Management Plan- a.​ Ensure safety of all personnel b.​ Account for all personnel c.​ Determine the immediate impact zone d.​ Attempt to determine the ROOT cause of the crisis e.​ Ensure resources are requested immediately f.​ Prepare to deploy crisis management goals g.​ Establish ICS as necessary h.​ Brief the PIO i.​ Determine how the organization will communicate within stakeholders j.​ If crisis is a result of organization’s action be upfront and transparent with those affected. k.​ Provide support for personnel l.​ Take control of show a command presence. Be collaborative with team members to find a resolution. Conduct a Post-Crisis Analysis ​ After a Large incident and After Action Report must be completed, usually created by the crisis management team. ​ -This report MUST answer (What happened?, What went right?, What went wrong? And What can be improved upon?) RPD (Recognition Primed Decision making)-being able to provide a solution or taking action to a problem during a stressful period by essentially using PAST EXPERIENCES, identifiable PATTERNS that were present in PREVIOUS situations or intuitions. Classic Decision Making Process- Where the individual thoroughly assesses the situation by weighing the pros and cons of different strategies and discusses the approach with other leadership members prior to making a decision. Chapter 9- Budgeting Many EMS organizations have a budget office staffed with employees who are well versed in Generally Accepted Accounting Principles (GAAP), budgeting and billing collections. -As an EMS manager, you are most likely to create an OPERATIONAL and CAPITAL budget. Budget preparations require you to forecast revenues and expenses, ensure that those align with the budget and monitor daily activities to ensure they align with the budget. ​ ​ Financial Management Plan- Conveys the Big Picture of the organization’s strategic and financial goals and can be useful when deciding what to include in the organization’s budget. ​ -Financial Management Objectives= are specific to activities that involve monetary transactions. -Organizational leaders will most likely be responsible for FORECASTING the organization’s overall financial position based on the organization’s current financial, operational and economic conditions. ​ -EMS officer may be responsible for budgeting key items that fall under his/her responsibility (e.g., capital improvement, replacement of major equipment, maintenance of regular equipment and supplies, employee training, intro of new services and payroll.) When FORECASTING and obtaining a historical picture, it is best to use at least 3 TO 5 YEARS worth of DATA in your evaluation. A demand analysis may also help you creating a budget, or even if your trying to strengthen your organizational financial position. -​ Demand Analysis= Involves researching the amounts that customers are willing to pay for service, the number of units they are willing to purchase, and other factors that provide information regarding how customers perceive a product or service. Being an organizational leader entails NEVER losing sight of the organization’s CORE MISSION AND PURPOSE. The Budgetary Process ​ To ensure the organizations stays within budget it must ROUTINELY evaluate it’s budget activities. ​ ​ “Fiscal year” or BUDGET YEAR- used to describe the year for which a budget is meant to be used. (The fiscal year is NOT required to match the calendar year) ​ ​ ​ Depending on the organization size, the budget preparation phase can range from 4-6 MONTHS or longer.  Basic steps in the Budgetary process: 1.​ Identification of the organization’s (Unit’s) needs and required resources 2.​ Budget request preparation 3.​ Review and approval of the budget request 4.​ Adoption of the approved budget 5.​ Administration of the approved budget Top- Down or Bottom-up Approach -Top-down= Leadership team provides financial management objectives and other budgetary parameters to the managers, giving managers a firm standing point but also provides LITTLE room for adjustments based on manager’s research. -Bottom-Up= Managers have more flexibility in pursuing the financial management objectives that will best meet their unit’s strategic goals. Budget worksheet- Itemized list of EXPENSES (e.g., employee salaries and benefits, billing services, fleet services, station maintenance, training, administrative supplies, medical supplies, support services. ​ Itemized list of REVENUE sources (e.g., Fixed costs- expenses that must be paid independent of output changes. (rent, leased equipment, loans) Variable costs- Dependent on output.. (e.g., gasoline, utilities, office supplies) If output increases so will the costs. Once the budget has been prepared, it must be reviewed and approved by the organization or individual’s in charge of the Master Budget. Budget presentation key items to include: a.​ Presentation structure b.​ Trends and issues c.​ Operating revenue summary d.​ Non-operating revenue summary e.​ Operating expenditure summary f.​ Non-operating expenditure summary g.​ Position summary h.​ Capital improvement plan i.​ Service level impacts j.​ Summary Many organizations use 1 YEAR budgets, some use 3-5 year budgets Budget Variance- Differences between a budgeted amount and the actual amount. ​ This variance can either be positive or negative. Types of Budgets Operational budgets- includes all the basic expenses an organization requires to remain operational, such as station utilities and rent, salaries and benefits. This is presented as a LINE-ITEM BUDGET- which clearly separates each budget activity by description and funding account. This is commonly a static budget, meaning it CANNOT be changed during the budget year, and typically has a life span of ONE year. General fund- Dollars contributed to the department from the controlling government entity (city/county). This can be a catch all account for items that do not have their own, more specific, account. Special revenue fund- An account established by the government, to collect proceeds that will be used for a specific project. Debt service fund- Account used to pay principle and interest on general long-term debt Capital project fund- Account to cover major capital acquisitions or construction Internal service fund- Account to cover services provided to other departments within the government. CAPITAL BUDGET- Unlike an operational budget, includes only outlays for capital purchases such as equipment, EMS stations, ambulance units, and is included within the master budget. MASTER BUDGET- Is where all budgetary activities for the entire organization are represented. -​ Includes all revenue and expenses for the entire organization. STATIC or FIXED budgets- Budgets CANNOT change, the funds earmarked for one item cannot be used for something different. These static budgets are used for a ONE-YEAR budget cycle. (Ie. OPERATIONAL BUDGETS) Flexible budgets- Expenses are adjusted as a result of variance between actual budget output and revenue. Zero-based budget- This type of budget does not include roll-over amounts from the previous budget cycle, so it always starts with a ZERO balance. Incremental budget- Leadership team uses data (actuals) from the previous year and makes minor adjustments to create the upcoming year’s budget. Incremental and Zero-based budget activities can be used to create and OPERATIONAL BUDGET GOAL of every financial management plan is to minimize EXPENSES and maximize REVENUES. Salaries and benefits SALARIES and BENEFITS will probably be the organization’s GREATEST expense. New hire- Hiring and training a new employee are only one of the additional expenses. The added expense of replacing an employee are often termed COST OF TURNOVER. ​ ​ -To hire a pre-hospital provider ranges from $15,000-$25,000 not including salary. ​ -Another rule of thumb is that it costs 25% of the annual salary to replace the lost employee. Incentives and bonuses can incur significant expenses but also improve employee morale. Insurance and Benefits- Can cost $10,000 or more per employee. FICA- Both employee and employers are required to make contributions to FEDERAL INSURANCE CONTRIBUTIONS ACT tax. Overtime- Significant contributor ti the organization’s bottom line. Managers should make sure this is kept to a minimum. Retirement- Employer contributions to a 401K, sickleave pay out, bonuses, Personal leave. Fleet services ​ -A 3 year historical analysis of preventative maintenance, oil, fuel, windshield wiper and tire cost provide key info and enable managers to budget replacement units appropriately. ​ -Reserve number of ambulances should be calculated based in deployment, maintenance schedules and contingency factors. Threshold set for backup units may be HALF the number of front-line units. (30 front-line units and 15 back up units) Older units beyond the 50% backup/frontline ratio can be disposed of. Medical Supplies ​ -Consider implementing a RESEARCH and DEVELOPMENT committee compromising field providers and managers. a.​ Evaluate medical equipment and supplies before purchasing. b.​ Allows buy in from other team members. For any EMS organization, supplies and equipment will be an ongoing expense that must be managed effectively. Training ​ -Employees must be well trained to provide patient care regardless of training medium it will be EXPENSIVE. ​ -You must weigh the cost of training and the value it brings to the organization. Capital replacement and Capital improvement ​ CAPITAL ITEMS- those items that cost more than a specific limit set by the organization. (e.g., $500-$750) and have a life expectancy greater than 1 YEAR. (e.g., ambulances, station renovations, cardiac monitors) ​ -Asset management team that maintains a list of ALL capital items; this team can help budget for capital related expenses. Support services ​ Dispatch center operations, personnel uniforms, PPE, storing of operational and administrative items, office supplies, toilet paper and cleaning supplies. Unfunded mandates ​ -Mandates are statutes or regulations imposed by FEDERAL, STATE or LOCAL GOVERNMENT. When they are not funded through government allocations, they pose a significant challenge for manager overseeing the budget. (e.g., health insurance, retirement plans, medical equipment and salaries) Central Supply Location ​ -This may prevent ambulances and supply delivery from having to travel great distances. ​ -This may add to increase fuel costs due to ambulances having to travel to resupply and be away from their response area. ​ Central supply distribution- Crews can have supplies delivered to their stations and not put a strain on the system. Medical transport Fees and Reimbursment ​ EMS organizations receive MORE REVENUE from the medical transport fees than from any other source. ​ Required billing information a.​ Name b.​ SSN c.​ Insurance info d.​ Treatment modalities e.​ Medicare info f.​ Service level provided (BLS, ALS 1, or ALS 2) FOUR parties may be billed by the ems organization: Medicare, Medicaid, Commercial insurance and Self-pay customers. Reimbursement rate for self-pay is very LOW. Compliance ​ -Ensure that the organization is compliant and up to date with the billing requirements. ​ ​ The organization must assign someone within the organization to ensure compliance. This individual must receive necessary training requirements and be of HIGH RANKING authority. -Donations provide a source of revenue (e.g., equipment or monetary donations) -Community education may generate revenue (e.g., CPR classes, first-aid classes) -Strategic Partnership ​ AUTOMATIC-AID AGREEMENTS with other ems providers. Compensation for these agreements may be MONETARY or EXCHANGE OF SERVICES that benefits EACH department. -Subscriptions are revenue generating similar to insurance payments. -MIH-CP (Mobile-Integrated Healthcare Community Paramedicine) ​ Funding source for the program must be necessary ​ -For this funding to occur legislative changes need to occur to recognize these services as reimbursable. -Property Taxes ​ Government entities receive monies from tax dollars to help support operational budgets. ​ -AD VALOREM TAXES= property taxes based on the value of real-estate or personal property. ​ ​ These taxes are calculated by using the millage rate= Tax rate PER $1000 of taxable value. This rate is set by the local government officials. -EMS Response Contracts ​ Response for city, township, county, etc. This contract may be with either Private or County EMS providers. ​ ​ The process of establishing a contract for ems delivery starts with a (RFP) Request for Proposal. ​ ​ An EMS response contract typically includes a statement regarding cancellation of contract by either service which may require a 30 DAY notice. Grants ​ -May cover 100% or stipulate 80/20 or 50/50 arrangement. City pays some and the grant covers the rest. ​ Many grants are offered through STATE and FEDERAL GOVERNMENT. ​ ​ -Requirements may be set in place. Ie. (Update on project outcomes at the 1 year mark post implementation, Detailed report provided to grant officials VERIFYING purchase has occurred and the funds have been USED as required.) Capital Items ​ -The buyer MOST likely will be required to obtain THREE PRICE QUOTES. If two are obtainable a letter specifying why only two were obtained. Or if only one company sells an Item.. ​ -Preferred vendor MAY NOT require a quote due to being previously approved. Request For Proposal (RFP) ​ -A solicitation document on behalf of the organization. ​ ​ Requesting a bidding process for a purchase of significant value. ​ ​ =Process entails completing an application that includes the specs of the product or service the organization is seeking to purchase. (e.g., New station, EPCR software, Station alerting system) ​ ​ -Establish RFP committee with preferably an ODD number of members to prevent tie during a vote.. ​ -Town or city will have to approve then RFP will be proposed to all potential vendors to bid on the RFP. -THIS is designed to ENSURE purchases meet the required specifications and the organization’s purchase process remains FAIR AND TRANSPARENT. Purchase Orders ​ -Issued by organization’s purchasing department. ​ ​ CHANGE order request- (dept specific form that identifies the reason for the changes.) ​ -Every organization will have an EXPENSE THRESHOLD that will require approval from CEO. Emergency Purchasing Process ​ -Emergency purchase orders are to be used only when an item is needed to prevent IMMINENT THREAT to LIFE or PROPERTY or disruption of ESSENTIAL SERVICES. ​ -Allows for documentation to occur after the purchase of supplies or contractual services to prevent delays in obtaining the items. ​ -Authorization: may require the approval of the CEO. ​ -Procedure: When an emergency exists, a requisition (purchasing authorization form) with an explanation of the nature of the emergency must be submitted electronically or via fax. -Request: During non-business hours, holidays, weekends, etc ​ If the amount required exceeds the limit on the purchase cards, a SENIOR-LEVEL OFFICER must make the necessary arrangements to complete the purchases by working with the vendor. Material Requisitions -Are documents used to notify the purchasing department of goods or services needed to conduct business. ​ These should answer the following questions: a.​ Who needs the items being requested for purchase? b.​ What is being requested for purchase? c.​ Where will the goods or services be delivered? ​ ​ -May include the following information a.​ Date of request b.​ Department or Requester name c.​ Required delivery date d.​ Location e.​ Vendor info f.​ Funding info g.​ Description and specifications h.​ Quantity of Units i.​ Unit price j.​ Justification for request k.​ Approval signature Voucher ​ -Internal document used to obtain the necessary approvals prior to authorization of a specific transaction. ​ (e.g., EMS recertification training, HR vouchers for new hire physicals) ​ ​ Before implementing a FORMAL agreement needs to be in place between both parties.. Credit ​ -If an organization overpaid a vendor this creates CREDIT. A reimbursement may be obtained or the organization may use this as CREDIT. Credit Cards- Purchasing card provided to authorized individuals allowed to make business purchases. -​ Predetermined spending limit -​ Organization’s name -​ Tax Exempt? Make sure no taxes are applied, SAVE receipts. Cash- Petty cash used for necessary purchases below a set dollar amount, no purchase order required. ​ Make sure to get a receipt to keep track of purchase and report it to finance. Unit Hour Utilization (UHU) ​ -Helps determine the efficiency of their EMS response. Analyzing the UHU can identify which ambulance units are under-utilized, moderately utilized, or performing at the maximum utilization. Steps to determine organization’s utilization rates: a.​ Take the number of activities completed by the unit (e.g., 10 calls) b.​ Take the number of hours the unit was in service for the shift (e.g., 24 hours) c.​ Divide the number of activities by the hours in service (e.g., 10 calls / 24 = 0.4) Higher the number the greater the efficiency. OPTIMAL UTILIZATION (0.55 to 0.45) AVERAGE UTILIZATION (0.35 to 0.45) POOR UTILIZATION (0.15 to 0.01) ​ ​ -This is all influenced by response REQUIREMENTS, response AREAS, TRANSPORT times, hospital TURN AROUND times. ​ GFD Policies Policy 301- Emergency Response Purpose of the policy is to ensure a safe and appropriate response to emergencies white maintaining safety for department members and the public. Any call for service or assistance involving fire, explosion or violent rupture; human rescue, entrapment, hazmat, illness/injury, acts of terrorism, etc. -Fire personnel dispatched to an emergency shall proceed immediately and continuously operate sirens and sound alarm - In operating an authorized emergency vehicle while responding to, but not returning from a call, fire alarm the operator may.. A. Park or stand B. Proceed past a red or stop sign/signal after slowing necessary for safe operation. C. Exceed and maximum speed limit, except as provided by any local rule or ordinance specifically regulating that emergency vehicle, as long as the operator does not endanger life or property. D. Disregard a regulation governing the direction of movement or turning in a specified direction. -Responding with lights and sirens does not relieve personnel of the duty to continue to drive with due regard for safety of all persons nor does it relieve the operator of the consequences of reckless disregard for the safety of others. -The use of any other warning equipment without a RED LIGHT and SIREN does not provide any exemption from texas law. A fire department emergency vehicle shall NOT overtake another emergency vehicle that is traveling in the same direction unless the driver of the lead vehicle has indicated the other vehicle may pass. The trailing vehicle may also contact the lead vehicle for permission to pass. -When feasible, emergency vehicles should pass to the left of traffic. - Motorists are directed to A.​ Yield the right away  B.​ Immediately drive to a position parallel to and as close as possible to the right hand size of the roadway CLEAR of any intersection. C.​ STOP and remain standing until Fire/EMS has passed. -When opposing the direction of traffic ‘SHALL NOT EXCEED A SPEED THAT IS SAFE AND PRUDENT’. -Travel against normal directions of traffic on one way streets shall be limited to SHORT DISTANCES WITH EXTREME CAUTION. Emergency vehicle operators should reduce speed and should come to a complete STOP at all blind intersection streets or intersections with a Red light, stop sign, flashing red light. They also should come to a complete stop whenever they reasonably believe they cannot account for traffic approaching lanes or when vehicles have not yielded the right of way. Driver shall never exceed the speed that is SAFE and PRUDENT, based on weather and road conditions, design capabilities of the vehicle. The posted speed limit may be exceeded only when the required warning devices are in use and road and weather conditions are favorable. The SPEED limit (Prima Facie)”Posted” may be exceeded if the driver does not endanger life or property. Water tenders, vehicles pulling trailers/boats SHALL NOT respond in emergency mode. Policy 306- Response time standards Purpose- to establish turnout, travel and response time goals and objectives for emergency incidents. Committed time- Time elapsed between receipt of dispatch until the unit is placed back in service and available for the next emergency. Dispatch processing time- Time elapsed between the receipt of the telephone call and the dispatch of emergency units. Response time- Time elapsed between dispatch center receiving the notification of the alarm and the arrival of the first emergency response unit. Turnout time- time elapsed between the emergency notification of firefighters and when the emergency unit begins travel. Total response time first arriving- Time from 911 notification to the arrival of the first unit. Total response time ERF arriving.- Time from the 911 notification and the total number of effective response units arrive. Performance objectives 306.3 Response times should be measured at 90% of fractal time and reported against standards of cover document. A.​ ONE minute or less for dispatching times. B.​ TWO minutes or less for turnout times for all incident types. C.​ LESS than 6 MINUTES (URBAN) 8 MINUTES (RURAL) travel time for the arrival of the first unit. D.​ LESS than 8 MINUTES (URBAN) 11 MINUTES (RURAL travel time of the ERF Policy 500- Patient care reports Purpose- establish requirements for documentation of patient responses and related document distribution, storage and disclosure. -Provides the department with a PCR of the incident for risk management and legal purposes -Provides a receiving facility or base hospital EPCR for EVERY patient. -Provides DATA for the fire department -Provides data for annual run response summary DSHS/Trauma data collection PCR shall be completed for every patient response -A run is a resulting action from a call for assistance where an EMS provider is dispatched/responds/provides care or transports a person. This includes releases from scene, field pronunciation, IFT or MCI. -PCR must be completed within 180 MINUTES, exceptions must be approved by the company officer and the PCR MUST be completed by the end of the shift. ALS assessment/treatment performed- An ALS provider is responsible for completing the form. The ALS provider may “DELEGATE” the duty to a BLS provider but the ALS provider must review the documentation for accuracy and co-sign the form. GFD QM committee - monitors the process of EMS documentation for quality management. Data will be audited ON A MONTHLY BASIS. -When an error is found upon reviewing EPCR the provider will be notified for correction and will have up to 7 SEVEN DAYS to make the correction -An administrator SHALL NOT make any clinical corrections but shall notify the providers of the changes that need to be made. -CORRECTIONS OR ADDENDUMS a.​ Clearly and permanently identify the amendment or correction as such b.​ Indicate the date and author of the correction c.​ NOT delete but clearly identify all original content. d.​ PCR shall NOT be copied, redistributed without prior knowledge or consent of GFD OPS CHIEF and MEDICAL DIRECTOR. -All CQI related to EMS records must be communicated through IMAGETREND messaging tool and NOT through any unsecured platform. -Notice must be provided to DSHS of any changes to physical location of PCR. Policy 503- Advance Health Care Directives Purpose- Policy identifies the circumstances and types of documents required for department EMS members to withhold or withdraw resuscitative or life-sustaining measures based on Texas law and OOH-DNR regulations. ​ -Nothing in this policy should be interpreted to limit EMS members from relieving an AIRWAY OBSTRUCTION. -Advanced directive- is the instruction to withhold or withdraw life saving measures in the event of terminal or irreversible conditions AKA (OOH-DNR Order) ATTORNEY IN FACT- A person granted legal authority in a written document to act for another in health matters. -Person may wear and DNR identification around (neck or wrist) as prescribed by Texas law. - OOH-DNR- legally binding document signed by attending physician that directs authorized representative and healthcare providers acting out of hospital to not initiate/continue…. a.​ CPR b.​ Advanced airway c.​ Artificial ventilation d.​ Defib e.​ Pacing This DOES NOT mean withholding medical care for comfort measures, alleviate pain or provide water/nutrition. Palliative care- total care of patients who are not responsive to curative treatment, this is designed to achieve the highest quality of life possible. Proxy- Person designated the authorization by a directive executed or issued in accordance with Texas law to make treatment decisions for another person that is incompetent or otherwise mentally/physically incapable of communication. ALL ems providers shall honor OOH-DNR when.. a.​ Identified OOH-DNR approved device or documentation b.​ Physically seen the OOH-DNR form from facility c.​ EMS members CAN accept OOH-DNR orders/devices that have been executed within another state if there is no reasonable question to the authenticity of the order. d.​ EMS members may not withhold CPR or life sustaining treatment if the person is known to be PREGNANT. e.​ An OOH-DNR shall be DISREGARDED if the pt requests (resuscitative measures) f.​ When EMS honors a DNR it shall be documented within the PCR including the circumstances surrounding the situation. ONLINE MED CONTROL notification ​ If any question concerning validity of OOH-DNR ​ DNR not complete or signed ​ Anytime EMS has concerns or requires assistance. All OOH-DNR patients in CARDIAC ARREST shall NOT be transported. EMS shall contact Law enforcement to report death and should provide grief support. OOH-DNR patients refusing transport- EMS should make reasonable efforts to preserve the patient's PRIVACY, DIGNITY and COMFORT prior to leaving the scene. If an OOH-DNR patient is transported to a hospital the following apply; 1.​ Valid OOH-DNR shall be honored during transport 2.​ OOH-DNR shall accompany the patient 3.​ The “Attorney in fact” should accompany the patient to the hospital if necessary. Policy 505- Controlled Substance Accountability Purpose- Establish procedures for the supply, accountability of controlled substances administered via the City of Georgetown. Controlled Substance- A drug, substance or immediate precursor listed in any schedule of federal controlled substance act. Policy- It is the policy of GFD to ensure availability of the proper medications for emergencies and comply with all applicable local, state and federal regulations STORAGE AND INVENTORY- To prevent the unauthorized access of controlled substances during an incident, the controlled substances must either be in direct possession of a PARAMEDIC, STATION OFFICER or LOCKED in a SECURED AREA. The LOGISTICS CAPTAIN will determine the locking mechanism to be utilized on vehicles that contain controlled substances. These should be secured in the locked mechanism any time the unit is parked and unattended. All personnel shall follow procedure unless permission to deviate is obtained from OPERATIONS CHIEF or MEDICAL DIRECTOR. a.​ All controlled substances are to be secured by department members in the designated locking mechanisms provided by the department. b.​ At each shift change incoming and outgoing paramedic/station officer shall, IN EACH OTHERS PRESENCE, INSPECT the quantities, the INTEGRITY of the vials, the EXPIRATION dates, VIAL NUMBER of the controlled substance inventories. EACH paramedic or station officer shall attest to the quantity available by electronically signing and entering their PIN with FULL NAME on OPIQ daily report. At no time shall an individual enter the name, pin or signature on BEHALF of ANOTHER PERSON. c.​ If any discrepancies are found, every attempt shall be made to reconcile the missing medications. If the discrepancy cannot be corrected immediate notification shall be made to the COMPANY OFFICER, BATTALION CHIEF, OPERATIONS CHIEF, LOGISTICS COORDINATOR. The logistics coordinator shall be responsible for completion and submission of the online DEA form 106, report of theft or loss of controlled substances d.​ Unit is dispatched prior to inventory being completed; the reconciliation should be completed as soon as possible. If the outgoing paramedic has already left, ONE on duty PARAMEDIC and the COMPANY OFFICER from the on duty shift may conduct inventory and reconciliation process. e.​ If a PARAMEDIC works 2 consecutive shifts on the same unit. The inventory shall be performed by the paramedic and witnessed and verified by another paramedic, company officer, or on-duty shift member assigned to the station. f.​ A controlled substance daily report shall be maintained within OPIQ at all times. These records are available for random inspection and review by the LOGISTICS COORDINATOR, BATTALION CHIEF and or local,state, federal, regulatory representatives. g.​ When a controlled substance daily report is completed on THE LAST DAY OF THE MONTH, a company officer and logistics coordinator shall review for completeness and sign the bottom of the record. The logistic coordinator shall maintain a photo copy and corresponding controlled substances disposition records FOR ONE YEAR. h.​ A copy of this report shall remain in electronic form within the OPIQ program FOREVER.. Standard controlled substance inventory a.​ The standard complement of controlled substances shall be established via MEDICAL DIRECTOR or AUTHORIZED DESIGNEE. b.​ Any modifications shall be justified and approved via MEDICAL DIRECTOR or AUTHORIZED DESIGNEE.  c.​ Only PARAMEDICS, STATION OFFICERS and LOGISTIC COORDINATORS are authorized to remove controlled substances from the automated storage, retrieval unit or controlled substances vault. A witness (paramedic, EMT or authorized member) is required.. When removing controlled substances personnel shall record (Patient’s first/last name, sex, DOB, Unit ID #, PCR # and Incident #). d.​ When a controlled substance is received it must immediately be secured and locked in the locking mechanism of the unit. Only PARAMEDICS shall administer controlled substances. Each time the substance is administered to the patient the drug DOSE and administration ROUTE shall be documented for DSHS guidelines. ​ In addition in OPIQ controlled substances disposition and restock record this information shall be documented. 1.​ Date of administration 2.​ Incident number 3.​ PCR number 4.​ Patient first/last name 5.​ Drug dose administered 6.​ Printed first/last name of paramedic administering followed with signature 7.​ Date and source of medication resupply. If a paramedic transfers care to a transporting paramedic prior to the administration of the entire dosage, any remaining controlled substance shall NOT be provided to the transporting paramedic. Controlled substance supply and resupply a.​ LOGISTICS COORDINATOR shall submit a DEA Form 222 to the designated department supplier to order controlled substances. b.​ Upon receipt of controlled substances the LOGISTICS COORDINATOR or DESIGNATED PARAMEDIC shall inventory to ensure type and quantity match and correspond w/ DEA Form 222. c.​ LOGISTICS COORDINATOR or DESIGNATED PARAMEDIC will immediately secure the controlled substances within the vault or automated storage. d.​ LOGISTICS COORDINATOR or DESIGNATED PARAMEDIC will inventory vault/automated storage WEEKLY to make sure files match with electronic files. The record of this inventory is to be PRINTED and maintained for a minimum of 2 YEARS. e.​ Any inventory discrepancies shall immediately be brought to BATTALION CHIEF, OPERATIONS CHIEF, MEDICAL DIRECTOR and a DEA Form 106 “Report or Theft or loss of Controlled Substances shall be completed and submitted. Unit Resupply A transporting unit may resupply on scene units with controlled substances via electronic OPIQ narcotics transfer.  Transporting unit or other department unit is responsible for restocking from departments automated storage and retrieval unit. ​ -This can occur any time it is operationally appropriate. Resupply from a NON-DEPARTMENT UNIT is NOT Authorized. Accounting for exp/damaged controlled substances -Note the expiration date/damage, date of replacement and source of restock on the department controlled substance restock record. - Place exp/damaged drug in MEDFLATS BOX and label type of drug,dose, unit identifier and name of paramedic who returned and date. Put in medflats, return the drug box and return to the designated supplier. Accountability LOGISTICS COORDINATOR SHOULD: a.​ Review the controlled substance daily reports and disposition/restock records monthly for completeness, compliance, consistency and comparison signatures. b.​ Create, complete and maintain and annually update the dept signature log. c.​ Randomly inspect controlled substance daily reports, disposition and restock records on units d.​ Ensure copies of daily reports, disposition and restock records are maintained and record retention for MINIMUM OF 2 YEARS. e.​ Notify the responsible BATTALION CHIEF of any deviation from this policy. Policy 509- EMS Quality Management Program Purpose: QM is the sum of all activities undertaken to assess and improve the products and services provided throughout the EMS system. Because the goal of Quality Management is overall system review and quality management can exist through CONSTANT MONITORING of performance, members of the department have been designated QM program participants. They are responsible for monthly reviews of EMS performance that meets the needs of GFD, hospitals and DSHS rules/regulations. Policy establishes GFD EMS QM program as required by DSHS Prospective evaluation- Review of various system components, policies and procedures Concurrent Evaluation- a.​ Direct field observation  b.​ Feedback from receiving facilities of GFD members EPCR reviews- dispatch management of call, field documentation EPCR, completeness, appropriate pt assessment, treatment, etc. 100% HIGH RISK ENCOUNTERS a.​ Resp Cardiac arrests b.​ Multi-system trauma c.​ Specialized ALS procedures (RSI, Cric, AEROMED) d.​ Transfer of care by ALS to BLS personnel e.​ Patient refusals f.​ treat/transport of minors g.​ Field terminations h.​ Use of Special equipment (LUCAS, AED, IV pumps, Vents) i.​ Controlled substance medication usage j.​ STEMI-STROKE ALERTS QM Meetings Medical director or designe