Special Task Force Report 05/16/1983 A
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EGON HILL
430 PUTTER POINT COURT
NAPLES, FLORIDA 33940
(813) 261-0569
May 16, 1983
Honorable Mary-Frances Kruse, Chairman
Board of County Commissioners
Collier County, Florida
Dear Commissioner Kruse:
Attached hereto is the report of the EMSAC Special Task Force,
constituted by the EMSAC Chairman in December 1981. It' s purpose was:
"To conduct an unbiased study of the Collier County
Emergency Medical Services and to determine if the
present services could be improved. "
The Task Force consisted of six members, three from EMSAC and
three from the public. The members were:
From EMSAC:
Chairman, Norris Ijams, Chief, Naples Fire Department
Hanns Ehrhardt, M.D.
J. C. Smelko
From the public:
Elizabeth Handley, R.N. , Ph.D. , Lt. Col . USAF Ret.
Sewall Pastor, M.D.
Carl Yaeger, J. D.
As EMSAC Chairman, I was an ex-officio member of the Task Force.
The undersigned wishes to extend his appreciation to the members
who diligently spent many hours in research and deliberation, who
travelled to Immokalee, rode the ambulances and interviewed a number
of persons who are knowledgeable in EMS procedures.
The undersigned wishes to extend his appreciateion to the staff
of Chief Norris Ijams and to Mrs. Doyle Smelko of the ABC Secretarial
Service who transcribed the tapes of the meetings and typed and
assembled the final report.
•
Honorable Mary-Frances Kruse May 16, 1983
Page two
It is hoped that the attached report will further the understanding
of EMS procedures and will help the Board of County Commissioners in
making decisions regarding the Collier County Emergency Medical Services,
if such are desired.
Respectfully submitted,
Chairman, Emergency Medical
Services Advisory Council
EH:abc
• Enclosure
EMS ADVISORY COUNCIL
Task Force Committee
May 1983
REPORT and RECOMMENDATIONS
The attached report and recommendations are the result
of many hours of research and study by the "Task Force
Committee. "
This committee was constituted by Mr. Egon Hill , Chair-
man of the Emergency Medical Service Advisory Council and
given the responsibility of conducting an unbiased study of
the Collier County Ambulance Service and to determine if the
present service could be improved. Recommendations were to
be made to the Board of County Commissioners , Collier County.
Initially, in order to obtain background information
from key personnel associated with Emergency Medical Ser-
vices , meetings were held with Mr. Dorrill , Director of
Public Safety; Mr. Greenfield , Director of EMS ; Mr . Norman ,
County Manager; Dr. Tober, Medical Director of EMS and Dr.
Zinn , Chief of the Emergency Department , Naples Community
Hospital . Discussions were also held with State officials
involved in EMS .
Additionally, we discussed with Mr. Yenawine , Chief
Executive Officer of Eastern Ambulance Service , Inc. , Syra-
cuse, New York , his report of a study he had conducted for
Collier County Ambulance Service.
Since many of the existing problems ( health and finan-
cial ) originate in the Immokalee area , members of the
Committee met with the Ambulance personnel during their
working hours and visited with Immokalee Clinic and law
enforcement personnel .
As Chairman of the Task Force , I wish to express my
appreciation to the members who unselfishly gave of their
time and professional expertise . Many hours of meetings ,
individual research and study went into this effort . It
would be impossible to overstate to the public , which will
ultimately be the beneficiary, the value of the contri -
butions of the Task Force members .
In conclusion , I would like to point out that each
member has a wealth of knowledge and experience for you to
draw upon . Each has expressed his/her willingness to dis-
cuss with the appropriate bodies our recommendations . If
more information is desired than is provided in this report,
each committee member will be glad to oblige .
RECOMMENDATIONS
I . MEDICAL MONITORING COMMITTEE
1 . Establish a Medical Monitoring Committee made up
of two or three volunteer physicians with emer-
gency service experience to audit reports of pre-
hospital services rendered. They should be retired
and not be affiliated with any ambulance provider
organization . Close and direct contact should be
maintained with the Medical Director.
2 . We strongly urge the use of the present telemetry
and telecommunication equipment to the fullest
extent possible. Technical improvements in the
present system are needed . This will accomplish
two things . It will keep the ambulance personnel
in contact with the Emergency Room physicians on
duty at the hospital and it will allow medical
decisions to be made by these physicians who would
be receiving information from units in the field.
It will also reduce the use of a "Protocol Book"
presently being used by EMS personnel . We feel
the extensive and complex "Protocol Book " goes
beyond the limits of the training EMS personnel
receive and the time available in emergency
situations .
Such considerable protocol detail creates a
standard of care if used alone . A deviation from
this standard of care could create unacceptable
legal liabilities . We strongly emphasize again
that all emergency room physicians should be
actively involved with telemetry and telecom-
munication.
II . 24-HOUR MEDICAL CLINIC IN IMMOKALEE
We recommend that a 24-hour clinic be established in
Immokalee, with financing of the clinic through the use
of present Federal Funds and by creation of a Municipal
Taxing District. We feel the taxing district would
have the effect of equalizing the cost burden of this ..
service. Currently, 29% of all Ambulance calls for the
County Services are from the Immokalee Area with a
collection rate of less than 15% . The present number
of transports to Naples Community Hospital would de-
crease. This would reduce the risks involved in
lengthy transports as well as the financial costs .
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III . FINANCIAL MONITORING COMMITTEE
We recommend that a Financial Monitoring Committee be
established with at least two volunteers familiar with
organization and finance who are not affiliated with
any ambulance provider organizations . They would
review all EMS expenditures and revenues and report
directly to the Board of County Commissioners .
The review and study of the Ambulance Budget brought to
light some problem areas . We suggest consolidation of
all Ambulance costs in one special budget , ( Personnel ,
Supplies , both Medical and routine , Maintenance , bill -
ing costs , etc. ) . Many duplications of similar items
should be consolidated in the budget. We found it very
difficult to establish a total cost of the system. We
want to bring to your attention that a significant part
of the overall cost of this system is directly related
to the substantial Fringe Benefit Package that all
County employees ( including EMS personnel ) receive .
We found that in some privately operated services ,
fringe benefit packages are much lower. We would
recommend caution in future negotiations of fringe
benefits . The benefit package for County employees
amounts to approximately 36% of base salaries .
IV. LIFE LINE CHARGES
We recommend that the Medical Director should advise
the billing office to charge Basic Life Support ( $25 . 00)
instead of Advanced Life Support ( $85 . 00 ) if an I . V.
was administered solely for the purpose of establishing
a lifeline and no other medication was given intraven-
ously ; a saving of $60 . 00 .
V. VOLUNTEERS
We recommend recruiting volunteers with health services
backgrounds , as well as secretarial and clerical workers ,
to assist with the operation of EMS. Our research in-
dicates that our community has a wealth of talented
retired or semi -retired individuals with expertise in
health , financial , legal and managerial professions .
We further suggest that contact be made with the Harbor
City Volunteer Ambulance Squad , Inc . , 1131 South
Hickory Street , Melbourne , Florida 32901 . This
volunteer organization is providing outstanding pre-
hospital service at cost to the user.
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VI . HELICOPTER
We recommend that EMS use the helicopter for appro-
priate emergency purposes only. Our studies show that
the helicopter has been used for non-emergency ser-
vices . We feel that stricter control over use of the
helicopter should be instituted.
VII . SUPPLIES
We recommend purchase of all vehicle supplies , etc . ,
and all items costing over $100 . 00 be made through
Central Purchasing .
For purchasing drugs and items of a medical nature , if
Central Purchasing cannot accommodate these needs , a
purchasing procedure to obtain the lowest prices should
be instituted. After completion of the new building ,
bulk purchasing should be considered , which can result
in substantial savings .
VIII . 24-HOUR SHIFT (56 hour work week )
After thorough investigation , the committee realizes
that in an Emergency Service running four or five trips
daily, per crew, 24-hour shifts (24-hours on-48-hours
off) are adequate for the present time. Should the
service become busier, a change to a 12-hour shift may
be advisable .
IX. PRIVATE VERSUS PUBLIC AMBULANCE SERVICE
In our review and study of the Collier County Ambulance
Service, one of the major subjects was Private versus
Public Ambulance Service. Several points need to be
highlighted :
1. We recommend that a special committee be estab-
lished to study this sensitive subject and report
the results to the County Commissioners for their
consideration . This committee should consist of
five members ; three from the public sector ; (one
physician , one accountant, one attorney) one
member of the Board of County Commissioners and
one member associated with the Emergency Medical
Services .
2 . There are successfully run private ambulance
companies in operation today which give a very
high level of service at a lesser cost than public
service.
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These companies are under strict contract and are
publicly accountable . This contract is monitored
daily by a public administrator under stringent
guidelines .
3 ) We feel that there has been a psychological wall
created by the recent experience involving American
Ambulance and the County Government. The remark
most often overheard was , "We don ' t want to go
through that again . " This subject should be
approached with an open mind so as not to lock out
a viable option available to the Commissioners .
X. No Consensus of Opinions Could be Achieved on this Para-
graph
Exceeding the speed limit and associated
driving by ambulances rarely will favorably influence
the outcome of a patient ' s condition , and may cause
accidents resulting in needless injury or death . A
well -trained paramedic or EMT will have his patient
well stabilized and will not need excessive speed .
Ambulance drivers should be cautioned to observe
traffic laws .
XI . MEASURING YOUR SYSTEM
We found the attachment #1 , "Measuring Your System , " to
be of value to us as a study group and would suggest
the use of the Standards of Excellence in the future
for evaluation purposes . (See attachment #1 )
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CONCLUDING STATEMENT
After considerable indepth study and discussion , this
Task Force is pleased to conclude that the Collier County
Emergency Medical Services , in its present form , is de-
livering a very high level of pre-hospital emergency medical
care to the citizens of Collier County . EMS ambulance
patients usually arrive at the emergency room of Naples
Community Hospital well stablized and having received ex-
cellent basic medical care before and during transportation
to the hospital . Although we give Collier County Emergency
Medical Services excellent grades for its overall emergency
medical performance , we have pointed out several areas in
which potential problems may exist and we sincerely hope
that these suggestions and recommendations will receive the
careful attention that we strongly feel they deserve .
Our studies and recommendations were based on the
premise that efficient and effective medical care should be
given the highest priority, but we have not overlooked the
fact that this service should be as cost-effective as pos-
sible without compromising the excellence of the medical
care . It is to this end that we have included several items
designed to encourage investigation of possible means of
reducing the present high cost of the Collier County Emer-
gency Medical Services .
As a final word , the members of this committee wish to
say that we have thoroughly enjoyed this challenging and
stimulating task which we feel is so closely related to the
health and well being of the entire population of Collier
County. Each of us will be happy to serve in any way in the
future . We thank you for this opportunity to serve our
community.
Chairman, Norris Ijams, Chief, Naples Fire Dept.
Elizabeth Handley, Ph.D. , R.N.
Hanns Ehrhardt, M.D.
Sewall Pastor, M.D.
Carl Yaeger, J.D.
Mr. J. C. Smelko
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,� • Jack Stout's Ten Standards of Excellence
-I - %' Measuring Your System '
exists, yet no individual or organza-
Jack Stout has long been Involved in designing and implementing EMS systems. With tion is at fault,you can be certain that
his company, the Fourth Party, he was the majo force In implementing the Public Utility the organizational structure itself i6.
Model concept for providing prehospital care in 1 Asa,Oklahoma,Little Rock,Arkansas, seriously flawed. In many EMS sysh.
Kansas City, Missouri, and most recently, Ft 't Wayne, Indiana. He has lectured tems today, it is entirely possible to
nationally on the topic of the Public Utility Model tind EMS system design,and will be a have each element of the systemper-i
regular columnist for jams beginning this spring. 's latest article in jem 3 was an account forming its task admirably well,while
of the Hyatt Regency Hotel disaster in Kansas( ty,which he witnessed. the overall system performance fails
The following article is based on a presents on he made at the November 1982 miserably. In such cases, there is rid.
meeting in New Orleans of the A,,lerican Ambt ,nce Association. point in looking for someone or some
organization to blame. Instead, the
system itself must be restructured and
ome months ago I had the Vhen I was later asked to present reorganized so that accountability,
pleasure of visiting the Syracuse, . out's Standards of Excellence" at exists for every important aspect of:
New.York operations of Eastern th November 1982 New Orleans meet- system performance. • • i
Ambulance.Eastern's Chief Executive . in of the American A,nbulance Assn- How to Use This Rating System •r
Officer, Marty Yenawine, had invited ci. ion, I decided to put some real � y
me to go salmon fishing, but the of in into analyzing i°ty own thought It depends upon your purpose. I1
weather turned sour, bitter cold and pr .cesses,and the result is this modest you are simply interested in checking.
blowing snow, so Marty asked me to at• mpt to apply numb or•s and scores to out your prehospital EMS system ta(
look over Eastern's operations with a a I ocess of judgment that is,in tru t h, gain a better personal understanding of
critical eye. During my stay in fit ,00 complex for thi:kind ofsimpli- how things are going, then there is;
Syracuse,I talked with people working fie. tion. Even so, a i I review the nothing wrong with using Stout's Stan-'•
in all aspects of Eastern's business and co l ents of this article, I find that the dards yourself.
field operations.Eastern's people were. va ous criteria are, in fact,those that If you disagree with the way I have;;
unusually relaxed, open, and offered re: ly matter.Other things matter too, weighted the various criteria, reassigns;
their own observations and construe- bu not as much. And while I might your own weights. For personal use„;
five criticisms in a casual and relaxed qu 'ble with myself concerning how I Stout's Standards are a good way top
manner.Obviously, Eastern is a corn- hit .distributed scoring points among raise issues that otherwise may be over,1
pany where it is okay,even encouraged the various criteria, I have to admit looked. However, if you use Stout's!,
for an employee to identify a problem th, this evaluative in,trument comes Standards to rate your own system,oil
in plain English so that solutions can am,,ally close to describing how I look not try to compare the score you gcrvet
be pursued. at. lid evaluate the performance capa- your system with the score someone
Weeks later,Marty was still squeez- bili ies of modern prehospital EMS else gave another system. Intersystetp:
ila.fr a consulting out of me by trying sys, .ms,regardless of type or desig't. comparisons require that the same
to'g it:me to talk more about my"find- ( aution: "Stout's Standards of independent, objective, and expert,
iiigs'' ever beer. In the course of his Excellence" are intended to evaluate evaluator rate both systems being
efforts, he observed that I apparently the ,erformance of an entire prehos- compared. . 4
employ a fairly elaborate,though per- pita EMS system—not an ambulai ice You can use Stout's Standards
haps informal,set of criteria for evalu- corn pany, not an EMS Department, strictly as an internal assessment tool td
ati a prehospital care system. I said not t fire department EMS operation, do"before"and"after"comparison
that as probably true, but I assured not my single component of an EIS of the same system.Your scores maybe)
Marty that my way of looking at pre- system. In far too many American way off compared to scores for other;
hospital care systems would bear no communities, there is no single orga- systems, but the relative comparil
resemblance to the federal govern- nii.ation that is responsible for all son of the same system, "before'.,
molt's`"Fifteen Components." (The aspects of EMS system performance. and "after," should be reasonab4
way you look at a problem has a lot to Such communities can expect to find valid as a measure of improvement dr..
do-with your ultimate ability to solve very low scores on several criteria while deterioration, provided the same
that problem, and I have always felt • scoring very high on other criteria. person or organization perform ' ,.
that the federal "Fifteen Mandatory When a serious performance problem both assessments.
.Components,"as a way of looking at While metropolitan or large regional
an EMS System, did almost as much EMS systems stand the best chance
damage to our industry as the federal by Jack L. Stout scoring high, Stout's Standards
money did good.) and should be used to evaluate cur
111 IANI IARY 1 W4 lens •
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EMS systems as well. Rural EMS a system were entirely free to its u•ers third-party payors,or even the heirs.
systems, even fully regionalized sys- and to the taxpayers. Complica ted
tems, can rarely achieve the response recoveries, premature death, and Summary of Criteria
time performance or clinical excellence astronomically expensive long-tcrni Stout's Standards of Excellence
of a highly organized metropolitan sys- disabilities are the by-products of poor employ ten general criteria of system
tern, simply because the low popula- prehospital care EMS performance.At performance, several with multiple
tion density, poor economy of scale, any price, these consequences are no subcriteria,witha possible score of 100
and relatively low frequency of life- bargain to the consumer,taxpayer,the points for the"nearly perfect"system.
threatening emergency cases work _
against high-performance system
development in rural areas. On the Summary Scoresheet
other hand, many of these barriers to
rural EMS development can and have Stout's Standards of Excellence
been overcome by more aggressive
regionalization of production,finance, Name of Prehospital EMS System:
and operational control. Therefore,
Stout's Standards can be applied to the Organization Performing Assessment:
rural EMS system, sometimes as a
means of demonstrating the true costs, Supervisor in Charge:
in terms of lost performance,of main-
taining a hodgepodge of tiny but nearly Dates of Assessment: From To
autonomous municipal, county, and
even township based operations. On
the other hand, the more effectively
organized rural systems can use Stout's Possible Group
Standards to demonstrate their ability Score Score
to approach some of the best known
urban EMS systems on all but a few 1. Clinical Performance 15
criteria. 2. Medical Accountability 6
A Warning About Efficiency 3. Dispatching and System Status
Stout's Standards, objectively and Management 15
expertly applied, can give you a pretty 4. Access, First Responder and
clear idea as to your system's perfor- Citizen CPR 15
mance capabilities. But Stout's Stan-
dards tell you nothing about your b. Disaster Capability 8
system's efficiency. As Alan Jameson 6. Personnel Management Practices 10
is fond of saying, "An idiot with
enough money and enough time can 7. Stability, Reliability and
produce performance." (The federal Fail Safes 7
EMS grants programs demonstrated 8. Pricing Policies, Billing and
that such is not always the case.)In this Collection Practices 5
writer's opinion, questions of per-
formance are more important,because 9. Response Time Performance , 15
the nature of this industry's work is 10. Public Accountability 4
critical.But performance at any price is
certainly not the answer,and perhaps a TOTAL SCORE 100
sequel entitled "Stout's Standards of
Efficiency"may be in order someday.
In any case,efficiency is directly related
to performance; since an expensive Additional comments and observations:
system may still be efficient if it per-
forms extremely well, while an inex-
pensive system may be a bad deal,
financially,if it performs more poorly
than its equally inexpensive counter-
part. In short,how your system scores _
on Stout's Standards of Excellence tells
you nothing about whether your - --
system is a "good deal"financially. _
Exception: Any system that scores
poorly probably creates more costs
than it could possibly save even if such
jams JANUARY 1983 86
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V-;; 1 . Stout's Standards of Excellence(continued) ,,:
1. Clinical Performance(possible 15 points) physician(s) who has responsibility for monitoring
directly our system's street performance.(zero or 1 point)
•
An ambulance system's actual clinical performance is extremely SCORE:2A
difficult to evaluate,except on a diagnosis-specific and case-by-case B. Medical audits are regularly(i.e.several each week) ,
basis.Many systems handle certain kinds of cardiac cases very well, conducted by an emergency physician who is not affil-
but tend toward poorer performance when faced with serious iated with or on the payroll of any ambulance provider
trauma.Some may do well with emergency childbirth,but not so organization.(zero or 1 point) SCORE:2B
well when dealing with diabetic coma or insulin shock. Realizing C. A widely known and convenient procedure exists
these complexities,this scale resorts to simplifying by determining whereby any receiving facility physician, patient's
whether clinically sound medical protocols exist at all;whether on- personal physician, or field medic can request that a •
board equipment,communication systems,and inventory control formal physician-supervised audit be performed relative
systems are compatible with sophisticated medical protocol; and to a given case,and such audit shall be performed.(zero
finally whether field crews are even potentially capable of clinically or 1 point)
excellent performance. WORE:2C
The rating scale favors systems where all field crews are D. At regular intervals,the physicians)responsible for
paramedic,and where each crew handles both emergency and non- medical monitoring and clinical quality control in our •
emergency work,since other types of systems result in a community system reviews multiple cases of a single problem-
served by a combination of "elite" emergency crews and less or anted or diagnosis-specific basis in order to assess our -
capable so-called non-emergency crews. The overall clinical per- system's ability to deal effectively with specific medical
formance capability of a fully professionalized service system is problems.(An EMS system is not"bad"or"good"In
obviously greater than that of a system which is only partly general— it may do well with some types of emer- •
professional. gencies,but not with others.)(zero or 1 point)
Score scoRE:2D
E. The findings and recommendations resulting from
A. Select the sentence which most nearly describes our independent physician-supervised medical audits
your community's ambulance system. may call for change in medical protocols, specific in
SCORE:1 A se-vice training for individuals or the entire organization,
• All ambulances in the system(emergency and non- caul for equipment additions or deletions or change,or
emergency are capable of full paramedic performance may require the suspension or termination or other
at all times.(Score 10 points) restrictions on personnel, and such findings are not
• Paramedic units are dispatched to all emergencies; merely advisory,but have the force of binding policy and • •
BLS units handle non-emergencies.(Score 4 points) must be implemented.(If your physician oversight is not
fully independent of the provider organization(s),•score •
• Paramedic units are normally reserved for life- this zero. Similarly. if medical audits are not regularly
threatening emergencies; all other emergencies and performed by a physician expert in emergency medicine,
non-emergency transports are normally handled by BLS or are merely "paper audits" conducted without the
crews(Non-transporting paramedic teams assisted by mandatory presence of crew members involved in the
BLS transport crews rate the same).(Score 2 points) case.also score zero here.)(zercor 1 point)
score 2E
B. Select the sentence which most nearly describes F. Emergency physicians at the principal receiving
your community's ambulance system ___- tacillties in our area are not allowed to provide medical `
.,.,ORE' 1B control(via radio)to field personnel without first demon-
• Medical protocols are current, clinically sophist{- strafing knowledge of the EMS system's operating
cated. not unreasonably restrictive, and are detailed policies and procedures.radio protocols,medical pro-
and extensively documented.(Score 3 points) tricots,personnel capabilities,and on-board equipment
• Medical protocols are:not current,overly restrictive, and medical supplies.(zero or 1 point) SCORE:2F
vague or not well documented. (Score —SU8I RACr 2 •
points) YOUR TOTAL SCORE—SECTION n.
C. On-board equipment, medical communications
system.medical control,and inventory control systems 3. Dispatching and System Status Manage.
are state-of-the art, fully compatible with medical ment(possible 15 points)
protocols in use,formal,and documented.(II true,ADD 2
points,it not,SUBTRACT 2 points) The scale favors systems with fully centralized and complete control
;CORC 1C over the placement and movements of all ambulances in the system
at all times. The scale also favors systems where control center
.YOUR TOTAL SCORE—SECTION t personnel managing the system's responses are both medically
trained and specifically trained in more sophisticated aspects-of
2. Medical Accountability (possible 6 points system status management, that is, a system that is continuously
controlled by a single group of medically trained personnel,and•
A critic might fairly comment that if a system has no Iionafide which is controlled in a manner that allows the system to
medical accountability,then by definition it must be impossible to continuously maintain and constantly re-establish the best possible
assess that same system's clinical performance,and to solute extent emergency response configuration at any point in time,given the
that makes sense.On the other hand,a system may be per forming area's demand patterns and given the level of emergency production
beautifully without being able to document the fact,and so I have capacity remaining in the system at the moment.
elected to separate the quesiton of clinical performance I rom the
question of medical accountability. '
• Select the sentence in each group below which most ' • .
. Each of the characteristics listed below count one addit Iona)point nearly describes your community's ambulance system in
toward your system's total score, if your system sub.:rantially all of the following categories.
exhibits that feature.(If you are tempted to say something Ii ke,"we ! -�Control: '
sort of have that feature, but it's more informal ..." then you scot :3A
probably don't have the characteristic and should score your system • All ambulance(s)operating in the community,emer-
zero on that feature.) gency and non-emergency,are excluslvelycontrolled by
Give yourself one point if your system shows strength in a single ambulance dispatch center.This control includes
any of the following areas;zero points if it appears weak. all vehicle movements including dispatches,post assign-
A. Our medical protocols are developed by the same mentslreassignments, i.e.complete and direct control
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II JANUARY 1983 jams
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over all ambulances.(Score 8 points) ing resr‘onse capacity to estimated demand patterns,but
not to the level of sophistication described under the first
• All emergency requests are managed by a single
ant)
facility, and all emergency ambulances are under the description in this group.(Score 1 p
exclusive complete and direct control of this single dis- • Amt dances are assigned to their respective posts
patch facility. Non-emergency ambulances are con- • and generally remain at those same posts throughout a
trolled by others.(Score 5 points) shift,ur less dispatched to a call or released for meals,
repairs shift change, or occasionally provide back-up
• A single control center receives nearly all emergency
coverai,e for another unit or post at dispatcher's discre-
requests(e.g.a 911 center)and assigns those requests to lion (S,ore 0 points)
ambulances or multiple providers.but does not possess
exclusive,complete,and direct control over all move- • Amt 4ance posts and post assignments are largely
ments of all ambulances.(Score 3 points) the re_.,lit of historical accident,or a result of a relatively •
static plan of vehicle placement,and only modest effort is
• No single EMS control center receives and manages made to control vehicle placement on a "real time,"
nearly all emergency requests. The system is charac- "even driven" basis to preserve the best possible
terized by multiple control points and multiple providers. response capacity at any given level of remaining
(Score 0 points) resources.(Score 0 points)
B. Quality of Dispatch Personnel: -- YOUR TOTAL SCORE—SECTION III.
SCOW 3B
• Persons receiving telephone requests and dispatch-
ing ambulances possess the verbal skills and didactic
knowledge of a field paramedic. They also have com- 4. Access,First Responder and Citizen CPR
plated additional training in System Status Management, (possible 5 points)
disaster response management.and clinically oriented (p
telephone protocols.(Score 3 points) Highly organized and reliable citizen access methods are favored,as
• All persons receiving telephone requests and manag- are el fective organized first responder programs and citizen CPR
trig system response are basic EMT's with additional ptoft'tmc.
dispatcher training In system status management,dis
aster response management,and telephone protocols. Select the sentence in the following categories which
(Score 2 points) most nearly describes your community's ambulances
syste•n.
• All persons receiving telephone requests and manag-
ing system response are basic EMT's with little or no addi- A. Access:
tional training In system status management, disaster . All telephone requests (both emergency and non- SCORE:4A
response management,and telephone protocols.(Score
1 point) amen rency)for ambulance service terminate at a single
• ' EMS i:ontrol center. These may enter via 911,a well-
• Most emergency requests are received by"911 corn- publicized standard number,or by combination of these.
plaint takers"or by other 911 communication center per- • If 911 is employed,the"complaint taker,"immediately
sonnet(e.g. police or fire dispatchers)who gather the upon discovering that the request is ambulance related,
information from the caller,terminate the telephone con- hand' off the caller to the EMS control center personnel
versation,and then"hand off'the request to an"ambu- who speak directly with the callers, non-emergency •
lance dispatcher"who is located either in the same facility requests employ a separate number—not 911.(Score 5
•or elsewhere.(Score 0 points) point) .
• A'regional EMS agency receives most telephone • All emergency requests are handled as described
requests.and"hands off"the calls to multiple providers. immediately above,but non-emergency requests fermi-
(Score 0 points) nate elsewhere. However, persons receiving non-
.
• Any other configuration of control not described in the emergency requests follow strict protocols for referring
list immediately above,or any configuration wherein per- calls likely to involve emergency conditions to the EMS
sons receiving telephone requests for ambulance Com 1 ol Center and are monitored and regulated to insure
services are not basic EMT's or paramedic trained. compliance (Score 3 points)
(Score 0 points) • Emergency calls are handled as described under the •
first sentence in this group and there is no regulation or
C. System Status Management: ____ significant monitoring of calls received by non-
SCOPI 3C emergency providers.(Score 2 points)
• All ambulances in the community(ce.emergency and -'"
non-emergency)are continuously located and relocated,
• 1 here exists in our community multiple telephone
In strict accordance with a detailed master plan so as to numbers for accessing emergency ambulance service.
maintain the best possible response capability at any (Even if 911 is present in your community, give your
given level of remaining ambulance availability taking into system zero points if more than 10% of emergency
consideration time of day,day of week,historical demand ambulance requests enter the system via a telephone
patterns and demand fluctuations,traffic flow patterns number which is not 91 t and which does not terminate in
and congestion,special events and weather conditions, • the EMS control center which would handle a 911
and other factors.Such system status management plan request.(Score 0 points)
also allocates quantities of ambulances to be in service by
B. First Responder:
time of day,day of week and special event to adjust pro- SCORE:48
duction capacity to fit demand patterns and demand Iluc- • Our community has a formal police and/or fire depart-
tuations.(Score 4 points) ment first responder program capable of placing a trained
• Emergency ambulances are controlled as described first responder team on the scene of 90% of all life
Above,but non-emergency ambulances are not.(Score 2 threatening emergencies within a maximum 4-minute -
)oints)
time limit after receipt of request at the EMS control
center.The decision to employ a first responder is made
r Our system makes some effort to adjust both temporal by,i medically trained EMS dispatcher,using physician
nd geographic ambulance distribution to match remain- approved telephone protocols,and who is in direct com-
lemS IANt IARY 1981 87
I
��1 Did 1 Stout's Standards of Excellence(continued) {
•
munication with the person requesting service.The first change to effect a switch to"disaster mode."give your „
responder team is trained and equipped at essentially the system-a zero on this criterion. •1.:.
basic EMT level,but need not be EMT certified,and has • Use your judgment to rate your system if it falls some-.. •
had additional paramedic-assist training to better partici where in between these extremes,as most do.(zero to 4 ,
pate in highly organized multiple crew ALS team pro- points) .",,
cedures. Some integrated/first responder in-service • ,
•
training is routine and first response team members do '
participate,when requested,in medical audits of cases in B. Normally working production capacity and
which they were involved.The EMS data system is cap- reserve capacity: scone:5B
able of capturing and documenting arrival times of both Again,judgment must be employed to assess this cri-
ambulance and first response teams as well.(Score 5 tenon. An all paramedic system(both emergency and .
points) non emergency)with high response time performance
• Our community does have a police and/or fire first on allay-today basis obviously has the ultimate normal
responder program which is employed on nearly all life- working production capacity for immediate disaster
threatening ambulance calls, but which lacks the for response,as well as having the best reserve production
mality or performance capabilities described immedi- capacity for an extended mass disaster,since off duty
ately above in one or more significant ways. (Score 3 crews are fully ALS capable as well,At the other extreme
points) are multiple provider BLS systems employing many
crews who rarely perform under life-threatening enter- . ,,•
• Our community either has no such police or fire first gency circumstances.(zero to?points)
responder program,or the program we do have is signi-
ficantly deficient,when compared with the first sentence C. Disaster site communications, supply sys- .
In this group,in more than a few ways.(Score 0 points) toms,and support services:
Considerable attention was given to these issues in the scoff
C. 0 article on the Hyatt Regency disaster,jams.Vol.6,No.9, '
• Our community currently has—not on paper but Intact SCORE.4C September 1981.This is essentially a binary criterion-
-a functioning CPR training and annual recertification i.e.either you have it set up or you don't.(zero to 1 point)
•
program which has achieved and currently maintains
CPR certification for not less than 20% of our D. integration of communications, equipment, :,.r.
community's adult population,or our community has in and procedure with neighboring providers:
place a CPR training program which,at present levels of 7 scow:5D
participation,will achieve the 20%bare minimum adult Again, either plans have been made throughout the • • •.
level within two years.(Score 5 points) region to effect fully integrated communications among _ ,
neighboring providers,and to insure that,where possible
• Our community has a CPR training program that we all and practical,on-board equipment is compatible or that •
like very much and are very proud of,but we haven't crews have been cross-trained in the use of each other's
achieved the 20% minimum adult level,and at present equipment:or these steps have nbt been taken.Federally .
• levels of participation,we don't know when we might. sponsored regional EMS groups have all worked to
•
(Score 0 points) establish such regional coordination, and a few have
• Our community has some really Involved people with been effectivn.Having a plan to provide such coordina-
some Impressive credentials and financial contribution, off In disaster o different rent thing and being able to actually pull It
and we have or are developing a CPR training program or off ere two different things.en th once-based judgment •
plan which will knock everyone's eyes out some day. alone can distinguish between the two.(zero to 1 point)
(Score 0 points)
YOUR TOTAL SCORE—SECTION V
• We don't have any CPR program and there is no plan
for one (Score 0 points) - '"
YOUR TOTAL SCORE—SECTION N: _ 6. Personnel Management Practices
(possible 10 points) '
• The scale favoi:s heavily those systems which recognize that the
5. Disaster Capability (possible 8 points) caliber of field personnel and control center personnel is extremely
important tosystemperformance.Smart,well-trained,creative and .'
Keeping in mind that we are discussing the disaster capability of the resourceful personnel have been known to make some really poor
prehospital EMS system only,the scale favors those communities systems perform pretty well,at least for awhile.Similarly,there are
whose day-to-day field operations are so effective and so flexible probably no system designs that can squeeze consistent high perfor..
that they are designed to function with little change in a disaster situ- mane out of low caliber personnel.The scale looks at and.cate-
ation.Similarly,the scale favors systems which have the capability gorizes recruitment methods, initial screening of employees, the
of focusing large forces of advanced life support production interview process,and system reputation.The highly inbred"first- .,
capability upon a disaster event without resorting to exotic or eta- guy-off-the-street" systems suffer on the scale, whereas systems
borate plans and procedures which are not tested on a routine(i.e. that actively recruit the best,in the industry are favored.
daily or weekly) basis. A system's ultimate disaster capability is
more difficult to predict and probably requires the judgment of Select the sentence in each of the following categories
more experienced evaluators than other areas of the scale. which most nearly describes yotu community's ambu-
lance system. ,
A. Application of day-to-day working systems of A. Recruitment Methods.
•
control and coordination. soon:SCORE:5A When a job position becomes available in our system,the
• If the communications,dispatch,and control systems employers)seeks and attracts the best possible person
which function normally on a day-to-day basis are cap for that job by utilizing recruitment and screening pro-
able of effecting and coordinating a system-wide
response to a single disaster without change in person- cedures generally as follows:
net,equipment,or operating protocol,ADD 4 points. • A continuous national advertising program insures a
•
• If much of the system's routine control network must steady incoming flow of applications,and the advertising '
:I
118 JANUARY 1983 jams
._ .. ,
\fiNi , — 1. . t
_r
is concentrated to impact in American communities lence is not widely known or recognized. and so our
reputation doesn't play much of a role in recruiting and
which enjoy ambulance service of the highest reputation retaining good people.(Score 0 points)
(Score 4 points) • Frankly,our EMS system isn't all that great,but we tell
• continuous recruitment program Ia in place with applicants with good credentials that we need them to
nati onwide advertising,but no real effort i8r>hade to attract help us do better.(Score 0 points)
applicant's from the most respected ambulance sys- • Our EMS system really isn't as bad as a lot of people
tams.(Score 3 points)
m
think it is.and it you think it is that badd, aybe you shou ld
• A continuous recruitment program exists,but it con- work somewhere else.(Score t points)
m
centrates on applicants from within our regional area,and
very few of our new personnel have experience in remote
YOUR TOTAL SCORE—SECTION v
metropolitan ambulance systems of high reputation.
(Score 2 points)
• Our recruitment is intermittent and most of our new 7. Stability,Reliability,and Fall Safes
hires are graduates of one or two local training programs,
and it they have previous experience,It is usually with a (zero to 7 points)
neighboring provider organization,and as a result,our Here again we have an area that requires expert judgment to eval-
EMS system Is somewhat"inbred."(Score 1 point) uate.Many systems appear to be stable and reliable,only to prove
• We have no formal recruitment program,so when a extremely vulnerable to a shift in majority leadership on the City
Council.Some systems are heavily dependent upon the leadership
position opens or classmate" gets ally and someone's of a single individual,upon hand-to-mouth financing from the local
Mend,ref o v,id too m h ois vertime usually hired as soon as tax resources of a single unit of government,or are entirely depen-
unfilled ao avoid too much overtime pay to cover the - dent upon-the financial stability and integrity of the present owners •
unfilled vacancy.(Score 0 points) of a single private ambulance organization.An additional one point
_ each can be given to the system which displays significant strength in
/, Initial Screening: SCORE:6B. - the following areas:
• Atter a good number of qualified applications have point it our system shows strength in
t y
been received,objective a professionally recesIs s oriented,used trow and rea- Give yourself one poany of the following areas;zero points If it appears weak.
aonably objec process Is used to narrow down the
applications to the most qualified applicants for inter-
A. Financial strength,soundness of business practices, •
views. References and work histories are thoroughly rainy-day financial reserves,and system net worth,the
checked out before interviews are held.(Score 2 points) debt to equity ratio of the system.and general insulation
from local politics.(zero or 1 point) SCORE 7A
• The"boss"looks over the applications and interviews 6 Soundness of hardware financing and replacement
normally the pew dkes best, but 3 or references people and practices.favoring those systems which employ heavily
w r k his i riesvie us for thor job y c ecd.(Sc and funded depreciation programs,or some equally sound
work histories are usually thoroughly checked.(Score 1
point) commercial financing mechanism backed up by a solid
a'Sometimes only 1 or 2 applications are received
cash management program.(zero or 1 point) —sconu 78
before the boss interviews and selects, and the boss C, Performance security in the form of performance
.checks out whatever he thinks is necessary (Score 0 bonds or similar security, equipment ownership in the •
points) public sector or protective lease arrangements,and a
variety of devices to insure uninterrupted field perfor-
• e.a "boss"says he can r he mostly by the look in their. mance even during an emergency changeover from one
one,and is will hire been considered,n wants,if hire,seven if what he operator to another or from one type of system to another.
one application has been consideretl,it that's what he (zero or 1 pond SCORE 7C
feels like doing_(Score 0 points)
D. Insurance against fraud and mismanagement,such
C. 1Merview Process. n sold out tp owners of
SCORE 6C as swell-managed company being
• Atter thorough checking and screening of applicants,a questionable character,ability,Or intent.(zero or 1 point) SCORE 7D
minimum of 2 or 3 applicants we interviewed by a review E. Empire building inhibitors Such as prohibitions
team whose collective decision is final,or whose advice against an oversight agency becoming an operator of the
concerning selection is given to"the boss,"who normally system,a training organization taking on an evaluative
but not always accepts the judgment of the team.(Score 2 role in the system,or other tendencies of organizations to
points) assume functions and responsibilities which are inher- y
sally incompatible with those already being carried out by •
p Ape,andts before the ing,"t," chatting with several - that same organization.(zero or 1 point) c� 7E
people,and before deciding,"the boss"usually asks for
opinions.(Score 1 point) F. Public relations efforts designed to help insulate the
• The boss usually talks to people before he hires them. system from uninformed and misguided press coverage.
non-constructive and damaging attacks by opportunistic
(Score 0 points) local politians, or other unfair criticisms which may
__ _ damage the system's reputation;the morale of its person-
D. System Reputation: scoRr. 6D nel.or which may even result in the demise of the system
• Our system is widely known and respected as a high and its replacement by an inferior but better sold system.
performance ambulance organization that demands (The better and more accountable EMS systems are the
excellence from its personnel and gets it . a place most visible and the most open to criticism, both
'where only the most qualified people are employed and dese'ved and unfair.Responding to thousands of.emer-
where peer group pressure demands professional con- gencies each year,and under the most adverse of condi-
duct, clinical excellence, and skill maintenance. This tions, while dealing with patients, tamities, and by-
standers who are upset and sometimes out of control,an
reputation is deliberately employed to attract and retain EMS system is,perhaps more than any other service
the best,and to deliberately discourage applications from organization,vulnerable to unfair yet damaging attack.
others (Score 2 pants)
• We think our organization is pretty good,but our excel-
Effective public relations efforts designed to counter this
- jams JANUARY 1983 $9
•
i
. 44
( - v 1 T Stout's Standards of Excellence(continued)
s ' 11 .-
sx
unfortunate fact of EMS life are essential to long-term • Discourage abuse of the ambulance service in cases •
system stability.))(zero or t point) __ where there is no reasonable medical necessity for emer-
ScoRE 7F gency or non-emergency ambulance use.
G. St,•ce orotection in some form is essential to system • Help educate the public,politicians,and public as well
stacrrrty and reliability especia ly wher"e labor force is
,>i.a'zed.Strike protection can be pm,.ded fix in a van i as thud-party pal or:as to the need for extensrvit reform
z'h " .�ayS Wdhretl unrinn nu unit IhN irdpn)of I,w 1.11.01
❑r iha anibilianrr- :ailment of AnieriCis hUAlth care ``-
finance programs
,, ..:hers,but it r.not space Ilere to elaborate further
x this complex area of system rn,ul.f.;'•rrugnl (minor 1 rpuR TO AL SO JRE--SECTION vm:
mint, .kite 7t, --'---,'
•
vOVF TOTAL SCORE—SECT ION Vii .-__-_ 9. Response Time Performance (possible
points) f
Stout's Standards deal with a system's response time performable A
8. Pricing Policies, Billing and Collection by looking separately at response times to life-threatening out-
Practices (possible 5 points) gencies, non-life-threatening emergencies, non-emergency alb,
The way an ambulance service system conducts itself financially, and at response time performance distribution among the vans=.
neighborhoods or districts of the service area.This scale deliberaitdy
especially its management of revenues, is itself a measure of its avoids reference to"average response times,"since an impressive- r
service to the community.More than a few otherwise well managed sounding average may well be achieved at the expense of life- y
ambulance services place an impossible burden upon senior citizens threatening excessive response times to a sizeable percentage at
by failing to accept assignment,where appropriate,and b)failing to patients in more difficult-to-serve areas.(There is not space
prepare Medicare claim forms for routine mailing with statements go into such matters as response time definition,adjustments far
to Medicare eligible clients where assignment is not .Iccepted.• no-hauls and turn-arounds,or validation of response time repot- '
Pricing policies, billing, and collection procedures which reduce ing, but these issues should be dealt with in depth in any serioas
local tax subsidies, which minimize patients' out-of-pocket application of the scale.Additionally,a system incapable of doco-
expenditures, maximize patients'third-party recovery,and which meriting its performance relative to this scale is simply incapable of
make the patients'claim filing simple and speedy... all odd to the being evaluated on this criterion,and no attempt should be made to •
system's ability to serve the community.At the other extreme are guess at what may be happening in the field.)
systems which employ token prices and billing efforts, thereby
placing an unnecessary load upon the local taxpayer,and systems Select the sentence which most nearly describes your
which make little or no effort to maximize third-party recovery or to community's ambulance system in all of the following
assist patients in making third-party claims.The community cannot categories.(Note.this rating assumes presence of medi-
escape the effects of less service oriented financial management cally trained dispatch and medically sound telephone
practices,and for that reason the EMS system and its management protocols for presumptively defining a life-threatening
cannot escape responsibility for this area of evaluation. emergency.If these conditions are not met,utilize your
Obviously, in a multiple provider system, some patients may emergency response times for all emergency requests,
experience highly effective and professional, yet quite humane both lice-threatening and non-life-threatening •m•r-
billing and collection practices,while other patients may experience genies,for both Categories A and B,below.)
the opposite.Thus,it is entirely possible for a system to get ti"mixed
review"on this area of service. A. Lite-threatening Emergencies:
Like several other areas of this assessment,the evaluator must (Note:If your system Is all BLS,assign zero points to this SCORE 9A
have at least a solid basic understanding of the rate setting aid reim- category)
bursement world of an ambulance service health care provider • For less than 10% of all presumptively defined lite-
organization.(Keep in mind that ambulance services fall under Part threatening emergency requests, the system falls to
B of Medicare,while hospital services fall under Part A,and that place paramedic ambulance on life-threatening scene
these two programs bear almost no resemblance to each other where within 8 minutes or less after call received. (Score 9
rate setting and reimbursement practices are concerned.) points)
Rate your system in terms of its general compliance with the pur- -
poses of sound pricing policies,billing,and collection practices as • For between 10 and 15%of all presumptively defined
follows: life-threatening emergency requests,the system fails to
place paramedic ambulance on life-threatening scene
A. Pricing policies should:(zero to 2 points) . _ within 8 minutes or less after call received. (Score 7
• Maximize third party recoveries while minimizing out- s ORE 8A points)
of-pocket expenditures,especially by insured patients; • For between 15 and 20%of all presumptively defined
• Avoid cutting the throats of providers snaring same life-threatening emergency requests,the system fails to --i'
geographic profile; place paramedic ambulance on life-threatening scene
• Be capable of covering full system costs,in the event within 8 minutes or less after call received. (Score 4 -
of subs'dy reductions: . points)
• Discourage use of 911 or other emergency access • For between 20 and 30%of all presumptively defined
phone number for purposes of a non-emergency nature. life-threatening emergency requests,the system fails to
place paramedic ambulance on life-threatening scene
B. Billing and Collection Practices should:(zero within 8 minutes or less after call received. (Score 2
to 3 points) _ - points)
• Provide easy maximum third-party recovery for senior s-IRE 8B • For more than 30% of all presumptively defined life-
citizens. threatening emergency requests. the system fails to
• Insure that most uncoilectible writeoffs are related to piece paramedic ambulance on life-threatening scene
services delivered which were truly medically necessary within 8 minutes or less after call received. (Scots 0
and provided to persons whose true financial situation is points)
such that payment of the ambulance bill would produce B. Non-life-threatening Emergencies:
an unreasonable hardship.In such cases.the billing and SCOREt 98
collection procedure should be capable of identifying • Ambulance response time (paramedic or other) is
such conditions early in the billinglcollection cycle,so under 12 minutes on 90% or more of all non-life-
that the responsible party is not"badgered"extensively; threatening emergency calls.(Score 4 points)
90 JANUARY 1983 !mss
���j elf
t F_.
•'Ambulance response time(paramedic or other)is 12 C. Our system is monitored by one or more part or fufl-
•mInutesorlongeronmorethan10%butlessthan20%of time employees of local government who work in a
departmer t which is not also a provider of ambulance
Op neMife threatening emergency calls.(Score 1 point) services These officials regularly inspect ambulance
mnutes Ambulance response time(paramedic or other)is 12 equipmer ,i•, assist in the performance of physician-
minutes Of longer on 20% or more of all non-life- supervise j medical audits,and with the help of qualified
•threatening calls.(Score 0 points) accountin l personnel or hired accounting firms,make
recommendations concerning subsidy requests, rate
C.'Hon-emergency calls: reviews at•d approval,and billing and collection practices
SCORE 9C provider organizations.(Score 2 points) -------
e Ambulance response to non-emergency transport of p scot*:1
.requests are reasonably prompt (i.e. within 20 to 30 p, Our community has an EMS council(regional or local)
minutes) for unscheduled requests, except under made up of provider representatives, hospital repre-
lmusuel system overload conditions which occur rarely made iv p•, and other interested individuals who meet
�.e.not more than 2 re or 3 periods lasting less than 1 or 2 regularly in meetings open to the public to discuss issues•'tours almost weekly)and previously delayed scheduled non-emergency effecting the EMS system.When a problem is reported.
�rtp St nedor delayed.c occur,the requesting delayed non Is cot y this grout looks into the matter and makes a recommen-
lesponse does occur,the requesting party Is contacted dation.(';:ore 2 points) SCORE:t OD
immediately,and explanation is given and a revised ETA
'tottered and adhered to.(Score f pang E. In stir system, all quesitons related to clinical
* The description immediately above does not charac- performance are handled by a legally authorized,funded,
't to non-emergency service In our community.(Score staffed. and provider-independent physiclancontrOl ed
i, Subtract 2 points) • organizai on charged with the authority and responsibility
,. to presu be medical standards, oversee compliance,
D.•Geographic Performance scoRE 90 and instit its mandatory corrective action when neces-
• Response time performance is approximately,but not sary.Physicians expert in and knowledgeable of emer-
-precisely equal amongst the various neighborhoods, gency medicine and of care being rendered by our
quadrants,sectors,or districts of our community.(Score system r untrol this organization.In addition,the financial
manager nent of our system Is Overseen by a separate•
1 pU of our community group of ndividuals who are also Informed and expert,as
f Certain parts or neighborhoods o well as provider-Independent, as regards matters of
*ally enjoy good response times,while other areas in organization and finance. This group is controlled by
er community experience chronically poorer response representatives of the local.business community who
time performance (Score—Subtract 2 points) possess the kind of expertise necessary to make sound
•,t, financial judgments in a complex financial environment,
YQI. TOTAL SCORE—SECTION IX and who have no personal financial interests In the EMS
u`�+• system This financial oversight organization has the
power to require certified audits and financial statements
of provider organizations: establish or review and
10. Public Accountability(possible 4 points) approve• all billing and collection policies; perform
Sophisticated prehospital care EMS is becoming increasingly reviews. and make recommendations to local govern
Complex and specialized.By default or by design,the type of EMS review!.
concerning the proper balance among quality of
system serving your community is mostly determined by the action service. fees, and local tax subsidies; and where
pr.inaction of local government—more specifically,t local tele the service.
appropriate,reviews and approves the qualifications of
officials, Public accountability is necessary ' potential provider organizations based upon the findings
public from a bad EMS system,and to protect a good EMS system er of
:tom unfair criticism and possible misguided intervention by semi- owners and.key personnel, and financial related to organizational reputation,integrity,character
stability.
tnormed public officials or even representatives of the press. Furthermore,the data system used to evaluate response
.r-;"The rates are exorbitant.... Response time was terrible.... time performance Is provider-independent, except for
:`ite crew was rude to the Mayor's mother-in-law'... The private time performance
of primary data,and is subjected to periodic
aaovider makes excessive..
rede artme profit.,.• The•city subsidy is out- spot checks for accuracy and truthfulness.Ftrkpfly,our
ageous..,,.could,do cheaper..could do it cheaper.••.p private- system imposes severe financial penalties upon Indivi-
fued employee exposes the
:totnpany soul stilt it cheaper A duals or organizations found guilty of wilful falsification o
ttntlt., Consultant blasts EMS system••-•land forth.The information for the purpose of enhancing the apparent
bile must.know the truth,and the system itself,especially if it is a performance et the system or organization, and our
. one, needs the protection of fully informed, expert, and monitoring systems are so designed to eventually
;::.%Again,evaluating loversight.ai a public uncover any repeated fraud Of that type.in short,system
Again,evaluating a system's mechanisms for achieving p performance is assessed and documented, both y
accountability requires experience and judgment. Score your medically and financially, by qualified individuals and
vystem zero through 4 points depending upon which of the descrip- organizations other than the providers themselves or •
t.'flans below most nearly describes your situation• their employees. Elected officials, the press, and the
1• general public can rest assured that the system is con-
�A. M our system, the agency of local government
tinuously monitored by qualified and effective people,
:responsible for all EMS activities is itself a provider of EMS and that complaints are dealt with promptly and fairly,and •
•serafies.(For example,a city wherein EMS is operated that the findings from complaint inquireis can be trusted,
agency department or third city department,and no other even if the issues involved are too complex for easy
'agency is funded or•staffed to oversee operations.) .. _ interpretation by the public at large.Similarly,providers
Score Opants) SCORE 10A and field personnel are almost never required to defend
i., • themselves 'against unfair criticism, as these
',Si In our state,ambulance providers are licensed by a themselentando instvunfair criorganizationsherse
eerheant o(p State Government,and our community to insulate this complex and somewhat delicate industry
fie6eS heavily upon the state agency,regularly referring from unfair attack.(Score 4 points) WORE:t0E
*wines and complaints tothestate agency,and the state
'`;J,gency normally conducts a prompt and complete •
.inquiry Into the matter and Issues an official statement of SCORE 10B YOUR TOTAL SCORE—SECTION K.
1lndings.(Spore 1 point)
)ems JANUARY 1983 91
L"
i"."55.17N4,4
L° c* E Cuit."F flG
/t ji7
735 EIGH FH STREET,SOUTH NAPLES, FLORIDA 33940
DEPARTMENT OF FIRE
May 31, 1983
Dear Task Force Committee Member:
Hope this finds you well and having a good summer.
Thought you might be interested in the two ( 2 )
news articles, and for sure, I want you to know the
)L7
Committee ' s feelings.
See you ail later,
t / S?)
Norris
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