Okaloosa County BOCC — April 7, 2015 — NaCO Award CTP 2015

National Association of Counties 2015 Achievement Award Nomination Summary: Okaloosa County EMS Comprehensive Quality Assurance and Training Program ABSTRACT In 2013, the Okaloosa County Emergency Medical Services facing a crisis of medical mistakes and their consequences on the patients they affected and the credibility of the organization. Responders in the County EMS system relied on online training to maintain competency and quality assurance was based on less than objective performance measures and competence criteria. The resulting decline in medical competency was having an impact on patients and the department by virtue of liability claims. This situation prompted the County EMS Chief and Medical Directors to develop the Okaloosa County EMS Comprehensive Quality Assurance and Training Program. Local fire chiefs and hospital administrative personnel also participated in the effort. The plan fostered participation between local fire departments, hospitals, and EMS in the development and implementation of new quality standards, pre- hospital medical performance measures, resource and data sharing procedures, and a comprehensive training program that provided realistic classroom and skills lab training modules based on local treatment protocols rather than commercially available web-based programs. The result was objective and measurable improvement in all categories of clinical competency and a higher quality of care system wide. THE PROBLEM OR NEED FOR THE PROGRAM In 2013, Okaloosa County Emergency Medical Services was facing a crisis of competency in its pre-hospital medical staff. Medical mistakes were being made at an unacceptable rate and the consequences for the patients and the credibility of the organization were equally unacceptable. The crisis evolved within the context of free falling property values, substantially reduced tax revenues, and ultimately much smaller training and continuing education budgets. The statutorily mandated minimum clinical standard for medical staff was achieved by subscribing to a virtual training system that allowed employees to watch videos and take tests online while on duty rather than participate in classroom and laboratory sessions with real hands-on experience. The few classroom courses that were offered were commercially formatted programs that lacked the necessary flexibility needed by instructors to make adjustments based on the learning needs of the individual or group. These courses were at best one-size- fits-all nationalized programs that failed in important ways to support local medical direction or improve the deeper pathophysiological understanding necessary for the development of highly competent EMS medical care. These circumstances lead to lower levels of clinical competency in the medical staff, bad Page |1 patient outcomes, and ultimately resulted in litigation against the County. The County had an obligation to provide the highest level of pre-hospital care possible with available resources, and as such, EMS leadership saw this situation as an imperative to action. DESCRIPTION OF THE PROGRAM From October to December 2013, in recognition of the growing competency problem, EMS leadership worked internally and with external stakeholders, primarily ALS fire departments and hospital administrators, to develop a comprehensive EMS Quality Assurance (QA) and Training Plan that included all medical responders in Okaloosa County operating under Okaloosa EMS Medical Direction. At its completion, the plan focused on establishing an organized process that outlines control measures intended to facilitate the delivery of the highest possible patient care to the citizens of the community. The plan also provided a comprehensive protocol for establishing clinical benchmarks, monitoring quality, reviewing patient care procedures and implementing plans f