Recommendations Specific for Steuben County

1. Develop a support plan for countywide enhanced 911 center. 

2. Provide training for current dispatchers in Emergency Medical Dispatch providing:

• Alpha - Beta - Charlie - Delta Dispatch criteria.
• Ability to instruct the caller to assist with the emergency.
• High quality information for the providers about the emergency.
• Caller available for directions.

3. Develop training sights closer to the EMS students in Steuben County to maximize enrollment and attendance.

4. Create a career EMS Coordinators position to assist all services and provide a legislative link to County government. Oversight by the current Office of Emergency Management to maximize resources is advisable. 

5. Organize a County EMS Advisory Board with legislative representation. Each EMS service would have representative with the EMS Coordinator responsible for administrative support.

6. Provide leadership training for the managers and future managers specific for:

• Community Marketing 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-aid contract development.
• Rapid recertification program information and presentation for groups.
• Quality management.
• Performance and evaluation tools.
• Meaningful recognition.

7. Develop a "Steuben County EMS Newsletter." Include a guest article each month from a Service/Department. 

8. Provide generic programs for use by the departments with:

• 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.

9. Increase Quality Management efforts through:

• Formal feedback from Hospitals and ALS agencies to BLS services. 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 utilization of the Hospital's patient "outcomes, diagnosis, and improved methods of pre hospital care."
• Develop program of Regional "focused studies" to determine opportunities for improvement and identification of "system" difficulties.
• BLS and ALS continued 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(s) on a monthly basis. This could enhance "best-practice" programs for all Services in Steuben County.

10. 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 in getting the right items to the scene. EMS Coordinator or Disaster Services Coordinator should be available to assist with MCI Incident Command.

11. Services should incorporate community leaders on their Board of Directors to ensure a balance of service and community needs. The link to the community provides information about concerns before they escalate into major problems.

12. Computer enhanced information sharing should be included in service 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.

13. Semi-annual Rural Health Community Services meetings should be held to share information, national trends, and gain feedback on programs specific for Rural Health. These meetings need to be supplemented with a monthly newsletter to inform EMS members of current activities.

14. Efforts to place Automatic Defibrillators in strategic areas should continue. Consideration for CFR training should be offered with these units. This can be publicized as a "risk reduction" for industrial users. Training and grant support from the Department of Health, American Red Cross and insurance companies can be utilized to promote and enhanced these programs. Local EMS services should be included in the publicity and can assist with personnel updates and equipment maintenance for the unit locations. 

15. All care providers should be trained and promote the preventative 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. 

16. Funding options for services should be researched. Rural Health Community Services should publish new Medicare and third party payer regulations, as they become available. The Chiefs/Captains survey indicates funding issues are future concerns. 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 service that are unable to respond timely.

17. The development of a Volunteer Programs including:

• Recruitment
• Retention
• Incentives
• Training
• Follow-up

All are essential to the health and longevity of all the agencies in the survey area. These areas are further explained in the text.

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