Revised and Approved by Maryland State Emergency Medical Services Board June 10, 2003 Mission, Vision, and Values



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Maryland
EMS
Plan
Approved by Maryland State

Emergency Medical Services Board

August 8, 1995
Revised and Approved by Maryland State

Emergency Medical Services Board

February 8, 2000



Revised and Approved by Maryland State

Emergency Medical Services Board

June 10, 2003
Mission, Vision, and Values
We seek to provide a model system of Emergency Medical Services (EMS). The overall goal of the Emergency Medical Services system is to reduce death and disability from injury and acute illness in Maryland. System components will be organized to include injury prevention, prehospital and hospital care, rehabilitation and reintegration of the patient as a productive member back into the community. In order to accomplish this, all involved organizations, agencies and individuals will work together cooperatively to ensure that services are integrated efficiently with other providers and are designed to maximize the benefit to the public. In doing so, we hold the following values without compromise:


  1. We will provide an environment that attracts and supports outstanding healthcare providers dedicated to achieving excellence in patient care, research, and education related to emergency medical services.




  1. We will promote a collaborative statewide approach to the effective organization and use of Emergency Medical Services providers (career and volunteer), facilities, equipment, and financial resources in the provision of emergency medical services, with service to the citizens of the State of Maryland as the overriding consideration of all efforts.




  1. We will provide leadership in issues related to clinical care, research, education, prevention, health-care policy, and system operations for each region, the state, and the nation.




  1. We will be far-sighted in planning, organizing, providing, and evaluating emergency medical services.




  1. We will sponsor a system that will be a model for others to study and emulate; a system that is recognized for quality, for respecting the dignity of patients and partners in the Emergency Medical Services community; for the cost-effective use of resources and for innovation.


Overall System Goals





  • Reduce death, disability and societal burden due to injury and acute illness for all persons in Maryland.




  • Initiate and participate in activities directed at preventing injury and acute illness.




  • Provide appropriate care and services in a timely and cost effective manner.




  • Maintain, enhance, and evaluate with a quality focus, the necessary resources to insure effective delivery of essential emergency medical services for all persons in the State of Maryland.



Component Goals and Objectives




  1. Human Resources



Goal:
Ensure qualified, knowledgeable, and skilled emergency medical services personnel are available to meet overall System goals.
Objectives:


  • Where consistent with Maryland Emergency Medical Services Plan, adopt national “blueprint” for all levels of prehospital certification, including intermediate, within an acceptable timeframe and ensure appropriate funding for the training and education of Emergency Medical Services providers of the state, to include equipment and technology necessary to ensure proper applications of state-of-the-art techniques and exploration of new teaching modalities.

  • Design and develop modular training programs based on the national “blueprint” for use throughout the state.

  • Evaluate the feasibility and effectiveness of distance education program development for Emergency Medical Services providers.

  • Provide a mechanism to allow current Cardiac Rescue Technicians to voluntarily attain national level intermediate or paramedic certification while allowing those desiring to maintain current Cardiac Rescue Technician certification or equivalent to do so.

  • Assure jurisdictional medical director’s authority to include Basic Life Support, for the purpose of protocols, scope of practice and Continuous Quality Management.

  • Encourage workers’ compensation coverage for all Emergency Medical Services providers.

  • Conduct regular needs assessments throughout the state to identify numbers and types of care providers and services needed, and develop appropriate strategies to address issues.

  • Encourage volunteerism by use of public service announcements; volunteer recognition program and other means.

  • Evaluate and supplement, if necessary, management and leadership training for Emergency Medical Services providers and their leaders.

  • Determine the appropriate integration of commercial and public sector emergency medical services providers and ensure a mechanism to achieve this level.

  • Encourage the training of hospital personnel in Emergency Medical Services practices and equipment enhancements.

  • Develop methods for Emergency Medical Services providers to perform their duties more safely.

  • Make provisions for the evaluation of Emergency Medical Services personnel training with a focus on skills retention.

  • Encourage greater utilization of hospital resources in prehospital education.

  • Encourage communication and cooperation between volunteer and career prehospital providers.

  • Provide timely access for public safety personnel to Critical Incident Stress Management (CISM) when necessary.


  1. Communication and Information System Management



Goals:
Provide a system that meets the needs of each jurisdiction, that rapidly and reliably transmits, organizes, stores, and retrieves the information needed to provide optimal patient care and systems management.
Provide reliable statewide system on-line medical communication for consultation and medical direction.
Objectives:


  • Continue to implement plan to provide statewide EMRC capability.

  • Implement the new Uniform Pre-Hospital Emergency Medical Services Data Elements standard (format and vocabulary) on a statewide basis.

  • Identify methods of improving data collection in the field to include reliability, consistency, speed and integration with the patient’s medical record. To the extent possible, work to integrate Emergency Medical Services data with other existing and planned databases (e.g.: police, traffic crash, Geographical Information System, etc.).

  • Ensure patient confidentiality at all levels of data access/transfer and meet HIPPA regulations.

  • Develop methods of making Emergency Medical Services data available to all provider agencies and decision makers on a timely basis and in a standardized format while maintaining patient confidentiality and addressing discoverability concerns.

  • Encourage compliance with Maryland regulations in the use of the Maryland Ambulance Information System (MAIS).

  • Develop a consolidated communications and information management plan for the state in conjunction with other Maryland public service agencies and with the assistance of outside expertise in communications and information technology.

  • Evaluate current communications systems in light of new technologies and cost; and, if determined to be appropriate, develop strategies to upgrade the systems

  • Assure a standardized approach to data collection via collaboration with the Healthcare Access and Cost Commission.

  • Standardize the Maryland Ambulance Information System (MAIS) documentation and training.

  • Encourage the establishment of a mechanism to collect data in a near real time basis for patient management, patient care improvement, and system management (EMAIS).

  • Ensure that quality emergency medical dispatch services are available statewide through a coordinated program of licensing, quality improvement, and Emergency Medical Dispatcher education.

  • Work to improve public safety communication and interoperability.

  • Develop a plan for the distribution and maintenance of state-purchased medical and communication equipment.

  • Continue to improve the mechanism for disseminating to providers the aggregate results and analysis of the information they have provided in a timely manner.


  1. Transportation



Goal:
Ensure that Emergency Medical Services personnel and equipment are delivered to the scene in a safe, cost effective, and timely manner; and, as necessary, patients are transported at an appropriate level of care to and between appropriate facilities.
Objectives:


  • Identify best practices at the local level for improved/increase in EMS resources.

  • Monitor the number and geographic distribution of Emergency Medical Services vehicles including air transport services.

  • Establish and encourage compliance with minimum equipment and safety standards for each Emergency Medical Services vehicle type.

  • Monitor the cost effectiveness of the Emergency Medical Services transportation system.

  • Monitor the impact of managed care/health reform on the transport of patients and quality of care.

  • Ensure that aeromedical resources are used in the most effective and efficient manner.


  1. Receiving Facilities



Goal:
Ensure that patients are being received in a timely manner to appropriate medical facilities that are maximally prepared to manage illness or injury.
Objectives:


  • Consider role of stroke and AMI specialty centers.

  • Facilitate collaboration and encourage cooperation among hospital emergency departments and providers.

  • Monitor appropriateness of geographic coverage and capabilities of existing emergency care facilities.

  • Monitor and evaluate the impact of hospital re-route on the Emergency Medical Services system; establish mechanisms to reduce the incidence and impact of hospital re-routing.

  • Examine the effect of health care reform on bed capacity.

  • Establish a process to enable all hospitals to participate in Maryland’s system of trauma and specialty care.

  • Develop a plan to appropriately manage the disposition of priority three patients.

  • Develop and implement objective standards for the designation/de-designation of specialty care centers when medically appropriate. Implement re-designation process on a 5-year cycle.

  • Monitor the adequacy of existing rehabilitative services.

  • Ensure the continuation of Maryland’s unique trauma/specialty care system, especially under healthcare reform and the expansion of managed care.

  • Monitor the compliance of providers and facilities with current designation standards.


  1. Law Enforcement and Other Public Service Agencies



Goal:
Encourage the effective integration of public safety personnel and resources in both the day-to-day and disaster functions of the emergency medical services system.
Objectives:


  • Encourage and support recertification of First Responder training for all public safety personnel.

  • Encourage and support AED acquisition/training for all Law enforcement personnel.

  • Encourage cooperation and collaboration among public safety provider personnel.


  1. Inter-Facility Patient Transfer



Goal:
Provide and assure adherence to guidelines for initiating and coordinating the timely transfer of patients with an appropriate level of medical care between facilities.

Objectives:





  • Establish standards for the appropriate level of personnel and equipment required for the transfer of patients between facilities and make such standards available to bordering states (and federal hospitals/facilities)

  • Develop the appropriate scope of practice for caregivers in the inter-facility transport environment and develop training programs as necessary for Specialty Care Transports.

  • Ensure that aeromedical resources are used in the most effective and efficient manner.



  1. Public Information, Education and Relations (PIER)


Goal:
Increase public awareness of the role of Emergency Medical Services, the appropriate means to access and utilize the system, and effective ways to prevent injury and acute illness.
Objectives:


  • Enhance relationships with all media to enhance accurate coverage of Emergency Medical Services issues and activities.

  • Develop a campaign to educate the public about the organization, role and importance of Emergency Medical Services in their community.

  • Establish public, private and community relationships to promote support for Emergency Medical Services and for injury and illness prevention activities.

  • Provide basic media training to regional and local Emergency Medical Services agencies to enhance the flow of information to our customers through local media.

  • Utilize technologies for dissemination of public information and educational materials (e.g.: training, satellites, cable/computers)

  • Identify and address public information and education priorities through use of relevant data.

  • Establish monitoring and evaluation tools for public information and education activities to ensure all materials and activities reach their intended audience and accomplish their intended goals.


  1. Medical Response to Disaster



Goal:
Minimize death, suffering and long-term medical effects from disasters and other mass casualty events through planning, development, implementation and coordination of the medical response.
Objectives:


  • Improve disaster/resource information exchange between/among EMS providers and hospitals.

  • Support the Maryland Emergency Management Agency (MEMA) in completing a comprehensive all-hazards disaster vulnerability analysis.

  • Complete and maintain a jurisdiction-by-jurisdiction and state disaster medical response plan.

  • Based on results of vulnerability analysis, conduct appropriate disaster medical response exercises in each region periodically.

  • Develop and implement a plan for medical response to Weapons of Mass Destruction (WMD) events.


  1. Mutual Aid



Goal:
Enhance the timely availability of emergency medical resources when local resources prove temporarily insufficient.
Objectives:


  • Review existing and develop model mutual aid agreements that include immunity and liability protection.

  • With the concurrence of the involved local jurisdictions, facilitate agreements based on current and anticipated needs and in conjunction with disaster plans.

  • Support efforts to secure adequate funding for mutual aid.

  • Involve hospitals in Mutual Aid planning.

  • Review the existing interstate continuity of care agreements and update as necessary.

  • Ensure that personnel and services providing mutual aid have appropriate immunity and liability protection.



  1. Medical Direction



Goal:
Ensure that emergency medical care is rendered in a manner consistent with standards of quality medical practice via the involvement of physicians with appropriate knowledge and experience in the delivery of emergency care.
Objectives:


  • Address the special needs of our growing geriatric population.

  • Establish and clarify the lines of authority, responsibility and accountability, and qualifications, including job descriptions and, as appropriate, contracts and reimbursement arrangements, for medical directors and others involved in medical control.

  • Increase the involvement of the medical director in the design, implementation, management and provision of emergency medical care, according to the overall plan.

  • Develop guidelines and ensure training for Emergency Medical Services medical directors.

  • Mandate training and certification programs for base stations and personnel who elect to exercise base station medical control, with appropriate standards.

  • Ensure adequate Base Station Medical Control credentials for all physicians, emergency departments and specialty referral centers receiving and/or managing care of patients transported by being trained to use and understand the Maryland Emergency Medical Services System.

  • Develop and implement a standardized hospital consultation format.

  • Enhance the quality of on-line and off-line medical direction for all operational Emergency Medical Services programs.

  • Ensure that base-station quality improvement programs evaluate the quality and clarity of on-line medical direction.


  1. Evaluation and Quality Management



Goal:
Enhance the effectiveness of emergency medical care and services through continuous quality improvement.
Objectives:

  • Continue a program for training Emergency Medical Services managers at all levels with the principles and methods of outcomes measurement and performance improvement.

  • Enhance the performance improvement model based on near real-time data collection that can be utilized throughout the Emergency Medical Services System.

  • Continually assess Emergency Medical Services system performance using both process and outcome measures and report appropriate findings to all components of the Maryland Emergency Medical Services System (see MFR publication).

  • Encourage the use of patient outcomes and system performance information in resource allocation decision making by all components of the Maryland Emergency Medical Services System. Especially with regards to our sudden cardiac arrest population.

  • Support customer service satisfaction survey instruments for use by all components of the Maryland Emergency Medical Services System.

  • Encourage the incorporation of performance improvement activities in all components of the Maryland Emergency Medical Services system.

  • Promote the development of a system-wide culture that rewards individual and organizational contributions, innovation and commitment to achieving excellence in patient care and supporting services.

  • Evaluate the service of Base Stations at the jurisdictional level through use of quality indicators.

  • Evaluate the effectiveness of medical interventions by the lay public.


  1. Research/Analysis



Goal:
Promote, support and conduct coordinated quality research to reduce death and disability from injury and acute illness.
Objectives:


  • Encourage cooperation and collaboration among Emergency Medical Services researchers in Maryland and nationwide and between Emergency Medical Services researchers and others working to achieve the goal.

  • Encourage and support Emergency Medical Services outcomes analysis necessary for the system’s quality initiatives.

  • Develop and implement a research agenda including policies and procedures for the distribution of research funds.

  • Provide assistance to ensure sound study design and adherence to appropriate regulations.

  • Develop and implement a methodology for tracking, compiling and reporting research activities and outcomes.

  • Encourage all providers within the state to participate in Emergency Medical Services research activities.

  • Ensure that new technologies and therapeutic approaches are scientifically and rapidly evaluated prior to or at the initiation of their use.

  • Define and institute the process for review and approval of prehospital research and protection of human subjects.

  • Assure patient/provider confidentiality.


  1. Finance



Goal:
Secure adequate levels of continuous and stable funding to meet the objectives and goals established in the Emergency Medical Services Plan and Emergency Medical Services related legislation.
Objectives:


  • Ensure long term viability of EMS Fund.

  • Address issues related to trauma center funding for physician reimbursement and uncompensated care.

  • Develop funding plan for helicopter replacement.

  • Develop methodologies for associating financial resources with approved operational objectives.

  • Publish and disseminate an annual Emergency Medical Services system financial report.

  • Review the cost effectiveness of Emergency Medical Services expenditures periodically and report the finding to the Emergency Medical Services Board.

  • Survey the operating and capital costs and the revenue streams associated with prehospital Emergency Medical Services provision throughout the state.

  • Work proactively to establish equitable reimbursement for emergency care.

  • Maintain a rolling five-year operating and equipment budgeting system for all state supported Emergency Medical Services operations fund expenditures.

  • Ensure appropriate funding to implement and operate governmentally mandated programs.

  • Promote Federal funding of EMS domestic preparedness and infrastructure.



  1. Emergency Medical Services Systems Management



Goal:
Further develop and sustain a system of planning, implementing and managing the complex, multi-agency structure required to achieve the goals of the Emergency Medical Services Plan, assuring continuity and excellence through leadership and consensus building.
Objectives:


  • Improve networking capabilities within regions.

  • Continue to provide public notice and access to Emergency Medical Services deliberations.

  • Continue to provide Emergency Medical Services management education within the state.

  • Continue to provide Emergency Medical Services ombudsman function in concert with local jurisdictions.

  • Review, evaluate and update statewide Emergency Medical Services Plan on a five-year planning cycle.

  • Maintain a database of system resources.

  • Seek to ensure that managed care initiatives are consistent with the goals of the Emergency Medical Services Plan.

  • Enhance the quality of care and maintain system stability and integrity through defined Emergency Medical Services operational programs and regions.

  • Support the role of the Jurisdictional Advisory Committee (JAC) and the Commercial Ambulance Services Advisory Committee (CASAC).



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