ACCREDITATION & EMS RESEARCH WHAT’S IN IT FOR MY EMS AGENCY? Kenneth J. Sternig Ms-EHS, BSN, EMTP Program Director Milwaukee County EMS

ACCREDITATION & EMS RESEARCHWHAT’S IN IT FOR MY EMS AGENCY?

Kenneth J. Sternig

Ms-EHS, BSN, EMTP

Program Director

Milwaukee County EMS

What Is The Biggest Resource Of Any EMS Agency?

What Are Definitive Ways EMS Can /Should Validate Our Impact In Health Care?

This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.2

Would You Seek Services From ….?

3

A physician who graduated from medical school without an accreditation ?

A hospital that did not receive accreditation?

Allied health providers who graduated from schools without accreditation?

Why should we ask anything different from EMS education institutions???????

This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this presentation without the expressed permission is prohibited.

What Can The Profession of EMS Do To Assure Our

Profession & Professional Growth?

4


Prove through scientific discovery that what we do has a positive impact on patients

Accreditation & Research Lecture

5

Intent of presentation: Open discussion on how accreditation and research can have a positive impact on EMS agencies

Goal: Expose participants the issues surrounding these topics


Accreditation6

Definition: (accreditation assoc. for ambulatory health care)

“Accreditation is a voluntary process through which an ambulatory health care organization is able to measure the quality of its services and performance against nationally recognized standards.”


Accreditation7

Definition: (CoAEMSP) Accreditation is an effort to assess the

quality ofinstitutions, programs and services,

measuringthem against agreed-upon standards and

thereby assuring that they meet those standards.


Accreditation8

What does accreditation mean for an EMS organization? Addresses risk management issues Employers know the quality of their

applicants Allows EMS agencies to be part of the

quality education process through field training


Accreditations In EMS9

Local Nevada, Kansas City, Louisiana

State (requirement for licensure) Missouri, Texas, Iowa, North Carolina Does not replace State’s responsibilities

related to certifying EMS education institutions

Federal NREMT requirement


Accreditations In EMS10

Organizations: CAAS (Commission on Accreditation of

Ambulance Services) CPSE (Center for Public Safety Excellence)

– CFAI (Commission on Fire Accreditation International)

CoAEMSP (Committee on Accreditation of Educational Programs for the EMS Professions)

CECBEMS (Continuing Education Coordinating Board for Emergency Medical Services)


What Does Accreditation Do For An Organization?

11

Provides a level of quality in regards to staff

Helps to assure qualified candidates apply

Builds a foundation for high performance expectations

Further supports a corporate culture of providing quality care


So What’s The Big Need?12

NREMT 2013 deadline Why did the NREMT make this decision? “Who is the NREMT to make this claim?” NHTSA agenda for the future EMS Education agenda for the future Institute of Medicine (IOM) recommends

a single accreditation agency


Accreditation For EMS Education

13

EMS education is one of the only allied health education specialties not to require accreditation

Will help stabilize EMS education as a respected educational experience


Accreditation Standards14

Often written in general terms Often comprehensive/yet flexible in

meeting outcomes Often invite feedback from participants

regarding the ability to meet and appropriateness of the standards

Often create an interactive environment between accrediting agency and those seeking approval


Value of Accreditation15

• Requires heavy lifting on the front-end• Development and application of processes

within an organization• Requires repeated drill-down within an

organization• Interlinking of values, mission and product

created helps to assure standards are met• Benefits are within the “process” work, NOT

in the paper certificate


Impact of Accreditation on EMS Education Centers & Providers16

Ownership of responsibilities Identification of what staff “really does” Positive moral booster Creates an improvement of efficiencies Generates a corporate culture of high

quality production of outcomes


Impact of Accreditation on EMS Education Centers

17

Strengthens relationships with education stake holders Clinical sites Medical control involvement Field training sites Consortiums with degree granting

institutions


Impact of Accreditation on EMS Education Centers

18

Can help force funding issues to obtain equipment/staff/building space etc

Accreditation will help WI EMS education institutions continue the work done between 1998-2000 to standardize EMS education in WI


Impact of Accreditation on EMS Providers

19

Helps to assure quality of education institutions where students receive their education

Credentialed accreditation agencies help assure standards for accreditation (no accreditation mills) Minimizes Mom-n-Pop EMS education

centers Raises the bar regarding the quality of EMS

education centers


CoAEMSP20

Parent organization: The Commission on Accreditation of Allied Health Education Programs (CAAHEP)

Committee on Accreditation of Educational Programs for the EMS Professions (CoAEMSP)


Members of CoAEMSP21 • American Academy of Pediatrics (AAP)

• American College of Cardiology (ACC)• American College of Emergency Physicians (ACEP)• American College of Osteopathic Emergency Physicians

(ACOEP)• American College of Surgeons (ACS)• American Society of Anesthesiologists (ASA)• Commission on Accreditation of Allied Health Educ.

Programs (CAAHEP)• National Association of EMS Educators (NAEMSE)• National Association of EMS Physicians (NAEMSP)• National Association of EMT’s (NAEMT)• National Association of State EMS Officials (NASEMSO)• National Registry of EMT’s (NREMT)


What DoesCoAEMSP Accreditation Address ? 22

Goals & Objectives of educ. Programs Methods of monitoring goals, curriculum,

customer satisfaction Surveys/feedback from customers/clinical

sites/ employers Course:

Skills labs, didactic, clinical, field evaluations Agreements with stakeholders (clinical, field

EMS services)


What DoesCoAEMSP Accreditation Address ? 23

CV of director, teaching and medical control staff

Methodologies for teaching and evaluating Competencies obtained during clinical & field

training Staff ID strengths and weakness of program &

plans Lesson plans for didactic, skills labs, clinical

and field training Consortium agreements


C0AEMSP MISSION STATEMENT

The mission of the CoAEMSP, under the auspices of CAAHEP, is to continuously improve the quality of EMS education through accreditation and recognition

services for the full range of EMS professions.


Wisconsin EMS Education Institutions & Accreditation25

EMS Education Institutions met with CoAEMSP executive director

Some EMS educ. centers shared their progress/plans

Strategic plans stated for completion of self-study packets

On WTCS/ EMS Education Institutions quarterly meeting agenda


Negative Impact of Accreditation

26

Staff time to prepare: Self-study Site visit

Costs of accreditation and renewal


What Concerns / Comments Do You Have Regarding EMS

Education Accreditation ??????

27


EMS RESEARCH

Impact on EMS Agencies


Validation of EMS as a Profession? 29

How does EMS validate itself as a profession?

What can EMS do to be further accepted as a respected partner in allied health?

How does EMS demonstrate that the care it provides makes a difference in a patient’s outcome?

What can EMS do to further strengthen its relationship with hospital partners?


EMS Needs To Become Further Involved In Research

30


It Is Simple …….

How Can Research Assist EMS?

31

Research will help: Address issues critical to EMS Expand the scope of practice for EMS

providers Prove to funding sources; local, state,

federal, private and third party, that care in the out-of-hospital setting affects patient outcomes

Elevate EMS as a profession What health care profession is not involved in

research?This presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this

presentation without the expressed permission is prohibited.

“Evidence-based clinical measures of EMS system performance have been few in number, largely due to the limited quantity and quality of research committed to the prehospital arena. “

Policy Statement by Consortium of U.S. Metropolitan Municipalities’ EMS Medical

Directors

32

Impact of EMS Research33

Best Practices (May 2008) Need to research current popular EMS

interventions Unsubstantiated by scientific evidence

Research will help define EMS benchmarks

Research will create high-quality evidence based decisions to guide EMS practices


Research Challenges For EMS Agencies

34

Increased workload Learning new content (perceived experts) Integrating content into CE curriculums Outside researchers taking advantage you Unrealistic time tables for rolling out

research EMS agency/ staff buy-in


Challenge of Defining Roles & Expectations

35

What will be the roles of the research team?

Who is responsible for what? Content preparation:

Will research team develop content? Will EMS or education staff develop content? Does content need to be approved?

Follow up of EMTPs who miss educ. content


EMS Agency Challenges

36

Educating agency administrators need to participate in a research project

Defining for agency administrators what your role as a research project will be

Addressing the perception of “using my agency to do your work”

“What does my EMS agency get out of this?”

Developing a partnership with EMS researchers


EMS Agency Involvement In Research Committees

37

Drill down to assure proper content is developed to assure EMS providers are properly educated on: study protocols psychomotor skills cognitive content

Stay “in the loop” regarding study planning

Advocate for your time table is necessary Be aware of being taken advantage of Preach your agenda


EMS Provider Challenges38

“WHY should we participate ?” Achieving buy-in More work = More pay????? Bargaining unit issues Learning a “temporary” change in scope

of practice Extra equipment (contract issue?)


EMS Provider Support39

Willingness to participate Willingness to improve patient care See research as a hindrance Vs help Negative mob mentality Need to see beyond struggle that

research takes away from Pt. care


What Are The Barriers ?40

Buy-in by EMS agency and providers Budget issues (increased work load) Time table for research project Direct dollar benefit to EMS agency Vs

general fund? Knowledge of study content Researchers wants / needs Vs use of

solid education theories


Rolling Out Research Study Education

41

Award education hours for “Study” education

NREMT topic hours Integrate education for study into as many

refresher classes and CEs as possible Timing of rollout of study education

Training/education need to schedule far in advance

Study need to be flexible and put off rollout pending IRB and government approvals

Detain planning of rollout sessionsThis presentation is property of Mil. Co. EMS Education Center. Any reproduction or use of this

presentation without the expressed permission is prohibited.

MILWAUKEE COUNTY EMS & MEDICAL COLLEGE OF WISCONSIN

Our Experiences With

Recent Research Projects

How To Achieve Buy-In43

Start small and work big Award hrs for study content Stay true to the vision Push when appropriate Integrate education about research into

refresher classes NIH human participant certification


44

Public Access Defibrillation (PAD) Trial

Prospective, randomized, multi-center 1000 public locations 24 cities in the US and Canada Funded by NIH, AHA, Industry Volunteer, non-medical responders Randomized: CPR Vs CPR and AED


PAD Trial: Milwaukee

45

34 public locations throughout Milwaukee and surrounding suburbs 17: CPR only 17: CPR and AED

Fitness clubs, banks, shopping malls, outlet stores, country clubs, food stores, hotels

Trained ~1000 volunteer laypersons

Conclusions46

Trained volunteer laypersons can use automated external defibrillators safely and effectively in a variety of public locations

In public locations, CPR and AED use by trained laypersons doubled survival rate to hospital discharge

Neurological outcome in survivors was excellent


ITD Study47

Use of an ITD during CPR in patients with out-of-hospital cardiac arrest: Significantly increased systolic blood pressure More than doubled short-term survival for

patients with PEA This represents the first effective

treatment to increase acute resuscitation rates for cardiac arrest patients with PEA.


48

RResuscitation OOutcomes CConsortium

• Alabama Resuscitation Center

• Dallas, TX

• Iowa City, IA

• Milwaukee, WI

• Pittsburgh, PA

• Portland, OR

• Ottawa/OPALS/B.C.

• San Diego, CA

• Seattle/King County, WA

• Toronto, ON

Hypertonic Saline Trial49

250cc hypertonic saline Administered to penetrating shock

patients and isolated head injury Study placed on hold after 14 months


ROC Primed50

Analyze early VS late: Evaluating whether immediate defibrillation

or delaying defibrillation is better Use of redesigned ITD valve BLS and ALS 911 fire based EMS

providers are Currently enrolling patients


Tufts UniversityImmediate Trail Study

51

Administration of a IV cocktail Glucose, Insulin and Potassium (GIK)

> 2 yrs of education rollout and delays by NIH

Scope if possible enrolled subjects limited r/t lack of hospital participation

Study suspended


52

Neurological Emergencies Treatment Trials The NETT network consists of 11 regional

Hubs,

53

The mission of the Neurologic Emergencies Treatment Trials (NETT) network is to improve outcomes of patients with acute neurologic problems through innovative translational research focused on the emergent phase of patient care.

Vision: NETT will engage clinicians and providers at the front lines of emergency care to conduct large, clinical trials.


NETT Collaboration54

Emergency Medical Services Community Hospitals Cross Disciplinary

Emergency Medicine Neuro-Critical Care Neurology/Neurosurgery Trauma Surgery Pediatrics


55

EMS Pain Management Study

• Three year projected funded by EMS-C

• Proposal being developed for a second EMS-C grant through PECARN

• Educational CDs will be available


PECARN56

Pediatric Emergency Care Applied Research Network

Primary focus was in-hospital research Last year developed an EMS branch to

the network Actively seeking participation from EMS

providers


Milwaukee County EMS Education Center Experiences

57

?? Too many projects at one time Education staff staying up to date Complicated content developed by

researchers Frustration by EMTPs Nationals and international impact (+) Paradigm shift by EMTPs regarding

research


Get Involved Early In The Planning Process

58

Key Recommendation


Challenges We Have Faced59

Delays in start of studies after education has been rolled out

Challenges by bargaining units Increased number of EMTPs to be

educated NIH / FDA delays


How Did We Go About Addressing These Challenges

60

Redesigned education modules and offered remedial education

Had the study investigator pay overtime to EMTPs for increased education requirements

Addressed “studies” as being within scope of practice and will improve Pt care

Increased number of skills labs and tutorials when rolling out educational content

Provide scheduled updates r/t study progress


Methods Implemented To Roll Out EMS Research Education

61

Face to face CE conferences On-Campus refresher classes DL modules In-house follow up by research team Remedial education when study is delayed Web site resources Field ride time when study begins


Suggestions62

Address “EMS Agenda For The Future”& research

Make “research” part of the EMTP curriculum and review it as part of CEs

NIH Human Participants Certification Make sure “Education” is a line item in

research proposals Provide input into the development of a

research proposal Integrate time spent on research projects

into EMS curriculums as much as possible


But What Your EMS Agency Can Do For Research


Ask Not

What

Research

Can Do For

Your EMS

AgencyASK WHAT

RESEARCH

CAN DO FOR

EMS

RESEARCH

What If? 64

A wide number of EMS agencies became involved in research?

A large consortium of EMS agencies and medical schools, hospitals was created in Wisconsin?

Wisconsin becomes know as a leader in EMS research?


Interested In Getting Involved In EMS Research????

65

Contact major medical schools Contact EMS education institutions Contact major emergency medical

equipment vendors NIH State EMS agencies


Questions?????66

Kenneth J. SternigMS-EHS, BS, EMTPProgram Director

[email protected]

414-257-6492

Accreditation & EMS ResearchWhat’s In It For My EMS Agency?

Documents

ACCREDITATION & EMS RESEARCH WHAT’S IN IT FOR MY EMS AGENCY? Kenneth J. Sternig Ms-EHS, BSN, EMTP Program Director Milwaukee County EMS