Recommendations Specific for Livingston County

1. Enhancement of the EMS Chiefs and Captains Committee with sub-committees designated to develop, implement, and monitor plans as needed for issues specific to Livingston County Emergency Medical Services.

2. Leadership Training for the managers and future managers specific for:

• Community Relations and Marketing Plan development.
• Development of promotional materials (i.e.- flyers, brochures, news releases, newsletters etc).
• People management Training (i.e. - Listening skills, Interest based bargaining, etc).
• Fund raising.
• Mutual-aide contract development.
• Rapid recertification program information and presentation for groups.

3. Provide developed menu of generic programs for use by the departments;

• Standard Operating Procedures.
• Quality Management Programs.
• Listing of Media contacts (i.e. Radio, TV, Newspapers, publications, etc).
• Listing of Physicians and other health care professionals willing to provide Continued Medical Education for specific medical topics.
• Training Course listings for the training year with applications and directions for a Service/Department who would like to host a course.
• New member orientation checklists.
• Exit interview forms.
• Skill Maintenance sheets.

4. Increase Quality Management efforts with:

• Formal feedback between ALS and BLS. This would offer BLS the Quality Improvement process they will benefit from in today's environment. Sharing of resources would not only enhance the process, but also increase efficiency, by decreasing redundancy of multiple similar operations. The utilization of the Regional office quality reviews through Dr. Davis will decrease the data collection manpower required.
• BLS and ALS continuing education programs should be co-joined whenever practical to ensure close coordination and evaluation of care.
• Detailed written reports should be provided to the Medical Director on a monthly basis. This could enhance "best-practice" programs for all Services in Livingston County.

5. Enhanced 911 System will continue to reduce response problems, which have occurred in the past. Emergency Medical Dispatch (EMD) would be beneficial to the providers allowing:

• Uniform incident information gathering.
• A resource to aid providers in finding a location or obtaining clarification of the medical concern. Dispatch information during response allows for readiness of responders and can reduce the anxiety of the caller.
• Justifiable response in conjunction with the Alpha - Bravo - Charlie - Delta criteria.
• Medical Direction and Quality reviews should be part of the day to day operation of the 911 center.

6. A pre determined multi level mass casualty incident (MCI) plan needs to be developed to ensure the pre-determined response to a specific area. Inventories of patient care items from each service would assist to get the right items to the scene of the incident. Deputy ES Coordinator(s) should be designated to provide assistance with MCI Incident Command.

7. The utilization of Deputy EMS Coordinators to assist the current EMS coordinator at major scenes with oversight by the Office of Emergency Preparedness would ensure resources and support for the providers during an incident. This could improve the relationship of Fire and EMS agencies. The current EMS Coordinator needs to explore methods to validate the concerns of the EMS Advisory Board.

8. Encourage Services to incorporate involvement of community leaders. A position on the Board of Directors of the service ensures a balance of community and service needs.

9. Computer enhanced information sharing should be included in strategic planning. The addition of e-mail, information networks and product information can provide useful information and decrease hours of research when reviewing the purchase of new equipment and best practice benchmarking.

10. Efforts to place Automatic Defibrillators in strategic areas should continue. Consideration of CFR training should be offered with these units. Training and grant programs from the Department of Health, American Red Cross and insurance companies can be utilized to promote these programs. Local EMS services should be included in the publicity and can assist with personnel updates and equipment maintenance for the unit locations.

11. All care providers should be trained and promote the prevention approach to emergency care. The use of trained technicians in other than emergency situations offers health systems an efficiency and community recognition not yet realized. Additionally, this area provides the volunteer with a new, highly visible, area of recognition.

12. The survey of the Chief/Captains indicated funding issues are future concerns. Efforts are necessary now to understand new regulations from Medicare, insurance companies, HMO's and other third party payers. The most viable alternative funding source to fund EMS services is "user fees," both fee for service and capitated contracts with third party payers. Managed care organizations and health care facilities will be reluctant to depend on free, but potentially unreliable, ambulance service providers. Patient populations will require prompt reliable service and may create a disincentive to make donations supporting local services that are unable to respond timely. These are good reasons to collect and evaluate performance data like response times and new methods to assure future funding.

13. The development of Volunteer Recruitment, Retention, Incentives, Training and Follow-up Programs are essential for the health and longevity of all the agencies in the survey. Each of these areas are further explained in the text.

14. The development of agency to agency mutual aid contracts needs to be explored. Sharing staffing, covering adjacent districts, or employment of paid staff may become necessary as volunteer staff diminishes and is unable to provide timely service. Each service needs to review response time data regularly to determine their individual trends and needs.