paramedics plus alameda appendices redacted_web_2of6

7/24/2019 Paramedics Plus Alameda Appendices Redacted_web_2of6

1/80


2/80122

Good

Good


3/80123

Good

Good


4/80124

Good

Good


5/80125

MISCELLANEOUS RESPONSE PERFORMANCE


6/80126

Good

Good


7/80127

Good

Good


8/80128


9/80129

LOST UNIT HOURS

Good

Good


10/80130


11/80131

EMD QUALITY ASSURANCE REVIEWS


12/80132


13/80133

95%


14/80134


15/80135

PATIENT CARE REPORTS

Good

Good


16/80136

QUALITY ASSURANCE REVIEWS


17/80137

995% Overall Protocol compliance was achieved


18/80138


19/80139

HOSPITAL CLOSURE/DIVERSION OCCURRENCES


20/80140

FIELD CLINICAL STUDIES

STROKE PATIENT COMPLIANCE

% of Suspected Hemorrhagic Strokes with OLMC Consult

Good

Good


21/80141

OTHER CLINICAL STUDIES

Good

Good


22/80142

CARDIAC ARREST SURVIVAL RESULTS

Good

Good


23/80143

Good

Good


24/80144

Good

Good


25/80145

Good


26/80146

CONTINUING EDUCATION COMPLIANCE

Good

Good


27/80147

FLEET / MATERIALS

Good


28/80148

SAFETY AND RISK

Good

Good


29/80149


30/80150

Good

Good


31/80151

Good


32/80152


33/80153


34/80154

EMPLOYEE FULL TIME EQUIVALENT HEADCOUNT


35/80155

There are currently 13 full-time paramedics, 9 part-time paramedic, 20 full-time EMTs, and 1part-time EMTs in the orientation pipeline.


36/80156


37/80157

OK CQI Report October 09

Clinical Quality Improvement Report

October 2009


38/80158

Clinical Quality Improvement

Executive Summary Report

October 2009

Introduction

The report that follows is a summary of the clinical CQI actions for the month of

September. For further detail into any, all, or areas not listed in the summary report,contact the EMSA Q.I. Hotline at (396-9299) or [email protected], leave your

questions, and return number. Someone from the Q.I. department will follow up withyou as soon as possible.

This report represents 100% of all electronic patient care reports for the month of

September. A portion of the PCRs are selected for manual review based on an apparentprotocol deviation. The PCRs are reviewed manually to determine if the deviation was

clinically indicated. There were a total of 470, or 4.3 % of the total PCRs that

were manually reviewed because of a possible protocol deviation and a total of 653priority one transports that were reviewed as well. In the system we had a total of 5386transports in the Eastern Division and 5554 in the Western Division for a total of 10940

total transports.

Paramedic Clinical Management

There was a 99% and 99% rate for correct assessment in the Eastern and Western

Divisions respectively and a 99% rate for correct management in Tulsa with a 99% ratein OKC

Protocol Utilization

The most frequent protocol deviations in the Eastern Division were SVT, Destination,

and Airway Management. In the Western Division they were Destination, Capnography,and ACS, and code Termination.

Procedure Report

The procedural report is based on 5386 transports in the Eastern Division and 5554

transports from the Western Division for a total of 10940 transports within the system.

The overall success rate for IV this month in the Eastern and Western Divisions were91% and 91% respectively.

There were a total of fifteen (15) IOs successfully placed in Eastern division and thirteen(13) successfully placed in the Western division by EMSA medics. There were three (3)

IO placed by TFD and six (6) placed by OCFD.


39/80159

Eastern Division Airway

Total # of Cases 40

% Successful 33 of 40 patients attempted or 83%

# of Oral and success rate 32 of 39 patients attempted or 82%

# Cardiac Arrest 24 of 30 patients attempted or 80%# Nasal and Success Rate 1 of 1 patients attempted or 100%

% Airway correctly Managed 100%

Of the seven (7) patients where oral/nasal intubation failed, four (4) had a combitube

placed and the other three (3) had their airway controlled using less invasive techniques.The reasons for the missed intubations are listed below:

Reason Number

Anatomical Difficulties 3

Clenched Teeth 1Fluid Obstruction 1

Gag Reflex 1

Traumatic Airway 1

Western Division Airway

Total # of Cases 53

% Successful 45 of 53 patients attempted or 85%

# of Oral and Success Rate 42 of 50 patients attempted or 84%

# Cardiac Arrest 34 of 38 patients attempted or 89%

# Nasal and Success Rate 3 of 3 patients attempted or 100%% Airway Correctly Managed 100%

Of the eight (8) patients where oral/nasal intubation failed, three (3) had a combitubeplaced; two (2) were intubated by fire and the other three (3) had their airway controlled

using less invasive techniques. The reasons for the missed intubations are listed below:

Reason Number

Anatomical Difficulties 3

Fluid Obstruction 1

Traumatic Airway 1Clenched Teeth 3

Eastern Western

< 60 sec 28/33 85% 40/45 89%

< 120 sec 29/33 88% 41/45 91%


40/80160

Total number of oral intubations performed by other agencies such as First Responders or

Physicians on scene, compared to the number of oral intubations performed by EMSAmedics.

Eastern Division: 7/8 (Success/Attempt) performed by TFD, 1/1 by JFD and 33 byEMSA medics. These numbers are taken from the EMSA PCRs.

Western Division: 15/18 (Success/Attempt) performed by OCFD, 2/2 by EFD, 0/1 for

WAFD, 1/1 by YFD and 45 by EMSA medics. These numbers aretaken from the EMSA PCRs.

Educational Activities:

The team meetings for the month of October were as listed below:

Eastern Division: Wilderness training with 186 participants.Western Division: ICS training with 183 participants.

Q.I. Hotline activity:

Received a call on the QI Hotline regarding the excellent job done by Sarah Woodringand Tony Goddard. The call came from Edmond Fire who wanted to report that the crew

was extremely compassionate and went the extra mile to make sure the patient got thebest care possible.


41/80161

Percentage of Patients Evaluated by Age Groups

Eastern Division Western Division

1.20%

2.51%3.84%

19.99%

40.53%

31.93%

Age Range Eastern

Division

65

1.40%

2.51%

3.86%

20.49%

37.98%

33.76%

Age Range

Western Division

65


42/80162

Priority One Trauma Returns:

Eastern Division:

40 (10% of trauma pts) total returned priority one to receiving Emergency Departments,

28(70%) met the Priority One Trauma criteria by documentation on the patient careform.

The destinations of the priority one-trauma case are as follows:

SFH 18(45%) SJMC 21(53%) HMC 1 (2%)

The one (1) P-1 patient taken to HMC was a burn patient.

Western Division:

67(11% of trauma pts) total returned priority one to receiving Emergency Departments,

57(85%) met Priority One Trauma criteria by documentation on the patient care form.

The destinations of the priority one-trauma cases are as follows:

OUMC 65 (97%) SAH 1 (2%) BMC 1 (2%)

The two (2) patients not taken to OU, one (1) burn went to BMC and one (1) MVC toSAH by patient choice after education by the medic.


43/80163

Eastern Division Priority II Total of 99 patients (25% of trauma pts).

Western Division Priority II Total of 101 patients (17% of trauma pts).


44/80164

Trauma Scene Times

Trauma scene times are comprised from trauma cases returned priority one to theappropriate Trauma center.

Eastern Division

The Eastern Divisions Trauma Scene Times are made up from 40 cases that met thecriteria. There were 20 cases of scene times greater than 10 minutes that have

extenuating circumstances that were excluded from this calculation. There were 5 casesof scene times greater than 10 minutes without documented extenuating circumstances.

Western Division

The Western Divisions Trauma Scene Times are made up from 67 cases that met the

criteria. There were 22 cases of scene times greater than 10 minutes that haveextenuating circumstances that were excluded from this calculation. There were 19 cases

of scene times greater than 10 minutes without documented extenuating circumstances.

11:13

10:56

12:58

16

:22

11:02

13:20

11:44

9:08

11:01

10:05

9:39

10:34

11:29

10:07

14:0

7

11:25

10:02

10:00

10:15

10:11

9:26

11:12

11:24

10:01

0:00

2:24

4:48

7:12

9:36

12:00

14:24

16:48

19:12

9:1

7

10:02

10:49

13:04

6:43

8:28

8:41

8:12

9:1

3

8:4

4

1

0:24

1

0:17

1

0:10

9:

40

8:18

10:50

1

0:30

9:24

9:

44

8:38

9:0

7

9:1

1

9:53

11:33

0:00

2:24

4:48

7:12

9:36

12:00

14:24


45/80165

Non-Transports after contact:

Eastern Division

There were 12 occurrences where the FOS was not contacted when indicated.Compliance to completed assessment was 99%. The medics that were non-compliantwere counseled individually.

292 calls were canceled by TPD, of those 252(86%) were after EMSA was on scene.

86 calls were canceled by TFD, of those 49(57%) were after EMSA was on scene.

Western Division

There were 8 occurrences where the FOS was not contacted when indicated. Complianceto completed assessment was 99%. The medics that were non-compliant were counseledindividually.

337 calls were canceled by OCPD, of those 208(62%) were after EMSA was on scene.203 calls were canceled by OCFD, of those 125(62%) were after EMSA was on scene.

14% 1

7%

13%

13%

14%

15%

15%

15%

14%

14%

14% 1

7%

17%

16%

15%

16%

16%

17%

17%

16%

16%

16%

15%

14%

0%

2%

4%

6%

8%

10%

12%14%

16%

18%

Series1

10%

10%

9%

9%

10%

9%

11%

11%

11%

11%

11%

11%

11%

10%

10%

11%

11%

11%

10%

11%

12%

12%

12%

11%

0%

2%

4%

6%

8%

10%

12%

14%

Series1


46/80166


47/80167

Eastern Division No Haul %

TRUE

##### S

pecialCause(s

)Detected

ChartType:Custom

DatabaseColumn

1

LastCenterValue

0.268

A.1BeyondControlLimit

E.2of3Beyond2Sigma

LastDataValue

0.25

B.9OnOneSideofAverag

e

F.4of5Beyond1Sigma

SigmaforLimits

0.01102

C.6TrendingUporDown

G.15Within1Sigma

BaseforLimits

AverageMR

D.14AlternatingUp&Dow

n

H.8Outside1Sigma

X.ExcludedorMissingData

AE

F

E

A

G

G

G

A

EF

0.2

0.2

2

0.2

4

0.2

6

0.2

80.3

0.3

2

0.3

4

0.3

6

0.3

80.4

March

JuneSeptember

December

March

June

September

December

March

June

September

December

March

June

September

December

MarchJune

September

December

March

June

September

December

March

June

September

SpecialCauseFlag

Period

Eastern

DivisionNoHaul%

12/4/2009

BPChart3M


48/80168


49/80169

Personnel Injuries


50/80170


51/80171

Viehicle Contact Report


52/80172


53/80173

OKC Off Late Shifts

SpecialCause(s

)Detected

ChartType:

Custom

DatabaseColumn

1

CurrentAverage

49.725

A.1B

eyondControlLimit

E.2of3Beyond2Sigma

CurrentMedian

46.5

B.9O

nOneSideofAverage

F.4of5Beyond1Sigma

SigmaforLimits

9.336901876

C.6T

rendingUporDown

G.15Within1Sigma

BaseforLimits

AverageMR

D.14

AlternatingUp&Down

H.8Outside1Sigma

p(notrend)=0.000


A

E

020

40

60

80

100

wk11-11

wk12-8

wk1-6

wk2-3

wk3-3

wk3-31

wk4-28

wk5-26

wk6-23

wk7-21

wk8-18

wk9-15

wk10-13

wk11-10

wk12-08

wk1-5

wk2-2

wk3-1

wk3-29

wk4-26

wk5-24

wk6-21

wk7-19

wk8-16wk9-13

wk10-11

wk11-8

wk12-6

wk1-3-09

wk1-31

wk2-28

wk3-28

wk4-25

wk5-23

wk6-20

wk7-18

wk8-15

wk9-12

wk10-10

wk11-7

SpecialCause

Flag

#ofshiftsofflateinpayperiod

Period

OKCOffLateShifts

1/14/2010


54/80174


55/80175

Transports by Priority

Western Division MonthCalls Transports Patients No Haul %

Priority 1 2233 1939 1939 13% Special Event U

Priority 2 4628 3185 3185 31% Scheduled UH 19137.25

Priority 3 427 418 418 2% Adjustments 631.65

Priority 4 2 1 1 50% Actual UH 18505.6

Totals 7290 5543 5543 24% Lost UH 1350.06

Effective UH 17155.54

5110 17621 0.29

Projected TX 5543 Projected UH 18506 Projected UHU 0.30

5543 18506 0.30

433 885 0.01

Projected vs. Budge 433 Projected vs. Budge 885 Projected vs. Budge 0.01

Effective UHU 0.32

Eastern DivisionCalls Transports Patients No Haul %


Priority 2 4262 2803 2803 34% Scheduled UH 14558.75



Totals 7182 5370 5370 25% Lost UH 1021.2


5332 15682 0.34


5370 14035.73 0.38

38 -1647 0.04

Projected vs. Budge 38 Projected vs. Budge -1647 Projected vs. Budge 0.04

Effective UHU 0.41

Summary DataCalls Transports Transports No Haul %


Priority 2 8890 5988 5988 33% Scheduled UH 33696



Totals 14472 10913 10913 25% Lost UH 2371.26


10442 33303 0.31


10913 32541 0.34

471 -762 0.02

Projected vs. Budge 471 Projected vs. Budge -762 Projected vs. Budge 0.02

Effective UHU 0.36

Budget Summary By Priority

Budget Actual Projected To Budget Budget Actual Projected To Budget

Priority 1 1695 1939 1939 244 Priority 1 1514 1721 1721 207

Priority 2 2999 3185 3185 186 Priority 2 2896 2803 2803 -93

Priority 3 414 418 418 4 Priority 3 903 821 821 -82

Priority 4 2 1 1 -1 Priority 4 19 25 25 6

Totals 5110 5543 5543 433 Totals 5332 5370 5370 38

Budget TX Actual TX Projected To Budget Budget* Actual Variance

Priority 1 3209 3660 3660 451 East 57746 56053 -1693

Priority 2 5895 5988 5988 93 West 56094 57253 1159

Priority 3 1317 1239 1239 -78 Combined 113840 113306 -534

Priority 4 21 26 26 5

Totals 10442 10913 10913 471 *based on full month budget figur

October

Budgeted TX Budgeted UH Budget UHU

Actual TX Actual UH Actual UHU

Actual vs. Budget Actual vs. Budget Actual vs. Budget



Actual vs. Budget

Actual vs. Budget Actual vs. Budget Actual vs. Budget



Actual vs. Budget Actual vs. Budget

Western Division Eastern Division

Information through October 31

Combined Fiscal Year To Date


56/80176


57/80177

Western - Late Sign On/Crew Late

SpecialCause(s)Detected

ChartType:

Custom

D

atabaseColumn

1

LastCenterValue

0.378


E.2of3Beyond2Sigma

LastDataValue

0.44861111


e

F.4of5Beyond1Sigma

SigmaforLimits

0.1757

C.6TrendingUporDown

G.15Within1Sig

ma

BaseforLimits

AverageMR


n

H.8Outside1Sig

ma


D

D

A

0:00:00

12:00:00

24:00:00

36:00:00

wk11-17

wk12-29

wk2-9

wk3-22

wk5-3

wk6-14

wk7-26

wk9-6

wk10-18

wk11-29

wk1-10

wk2-21

wk4-4

wk5-16

wk6-27

wk8-8

wk9-19

wk10-31

SpecialCauseFlag

LostHours

Period

WesternDivisionLostUHU-LateSignOn

/CrewLate

11/13/2009

BPChart3M


58/80178


59/80179

Key Performance Data

2010 01 07

January 7, 2010

Compliance: Week

Compliance: MTD : QTD 91.5% 91.5% 90.5% 90.5%

Exceptions + or - : MTD : QTD 5.4 5.4 1.4 1.5

Effective UHU: WK : MTD 0.291 0.291 0.423 0.423

Budgeted Effective UHU : Trans/Day 0.320 180.2 0.405 182.6

Trans/ Day Actual / plan : N 92% 165.6 96% 174.7

Shifts Produced / Plan Week

Shifts produced Week : Plan 91.8 88.0 64.6 68.0

Medics (N / Plan) : N 107% 94 84% 57

EMTs (N / Plan) : N 103% 90.5 121% 82

Produced / Scheduled UH (WK : MTD) 102% 102% 90% 90%

Lost Unit Hours WK : MTD 1.4% 1.4% 0.9% 0.9%

Payroll Data: Special Pays:

XOT : PT Hours 669.9 759.5 464.8 983.5

% Fleet OOS : Critical Failures 6% 0 14% 3

Vehicle contacts

% Next Acad Filled Medic : EMT 0% 0% 10% 0%

Actual: Medic EMT 0 0 1 0

Plan: Medic EMT 6 10 10 5

Date next Acad Medic : EMT

Open shifts coming week Medic : EMT 5 10 15 2

Call outs past week

OKC Tulsa

91.5% 90.5%

104% 95%

325$ 10,006$

0 2

March February

21 14


60/80180


61/80181

Western Late Start Mechanical

SpecialCause(s

)Detected

ChartType:Custom

DatabaseColumn

1

LastCenterValue

0.07


E.2of3Beyond2Sigma

LastDataValue

0.01319444


e

F.4of5Beyond1Sigma

SigmaforLimits

0.05810

C.6TrendingUporDown

G.15Within1Sigma

BaseforLimits

AverageMR


n

H.8Outside1Sigma


G

G

G

A

F

A

0:00:00

4:48:00

9:36:00

14:24:00

19:12:00

wk11-17

wk12-29

wk2-9

wk3-22

wk5-3

wk6-14

wk7-26

wk9-6

wk10-18

wk11-29

wk1-10

wk2-21

wk4-4

wk5-16

wk6-27

wk8-8

wk9-19

wk10-31

SpecialCauseFlag

LostHours

Period

WesternDivisionLostUHU-LateStartMechanical

11/13/2009

BPChart3M


62/80182


63/80183

Appendix 10 Sunstar Sterling Application 2009


64/80184

Table of Contents

Glossary of Terms and Abbreviations Page G1

Organizational Profile..Page i

Category 1.0: Leadership. Page 1

1.1 Senior Leadership. Page 1

1.2 Governance and Social Responsibilities.. Page 5

Category 2.0: Strategic Planning Page 8

2.1 Strategic Development.. Page 8

2.2 Strategic Deployment Page 10

Category 3.0: Focus on Patient, Other Customers, and Markets Page 13

3.1 Patient, Other Customer, and Health Care Market Knowledge.. Page 13

3.2 Patient and Other Customer Relationships and Satisfaction... Page 15

Category 4.0: Measurement, Analysis, and Knowledge Management Page 18

4.1 Measurement, Analysis, and Improvement of Organizational Performance.. Page 18

4.2 Management of Information, Information Technology, and Knowledge Page 21

Category 5.0: Workforce Focus.. Page 24

5.1 Workforce Engagement Page 24

5.2 Workforce Environment.. Page 28

Category 6.0: Process Management Page 32

6.1 Work Systems Design... Page 32

6.2 Work Process Management and Improvement. Page 35

Category 7.0: Results Page 37

7.1 Health Care Outcomes. Page 37

7.2 Patient and Other Customer-Focused Outcomes.. Page 39

7.3 Financial and Market Outcomes. Page 42

7.4 Workforce- Focused Outcomes Page 43

7.5 Process Effectiveness Outcomes.. Page 45

7.6 Leadership Outcomes... Page 49


65/80185

GLOSSARY OF TERMS ANDABBREVIATIONS

AAA. American Ambulance Association-TheAmerican Ambulance Association represents am-bulance services across the United States that par-ticipate in serving more than 75% of the U.S. popu-lation with emergency and nonemergency careand medical transportation services. The AAA was

formed in response to the need for improvementsin medical transportation and emergency medicalservices.

AAR. After Action Review-A meeting developedto critique an event or incident to identify suc-cesses and area.

ACE. Accredited Center of Excellence-A 3-yearaccreditation by the National Academy of Emer-gency Dispatch based on 20 indicators of perform-ance for improvement.

ACLS. Advanced Cardiac Life Support- Certifi-cation required for paramedics

ACSI. American Customer Satisfaction Index-Used for comparative data.

Administration and Support Staff- Includes allnon-certified personnel in areas other than directlyrelated to patient care (office personnel, mechan-ics, and materials personnel)

Ad Valorem Tax- A tax based on the value of realestate which used to fund the EMS first responders

(fire department operations).

AHA. American Heart Association-is a non profitorganization in the United States that fosters ap-propriate cardiac care in an effort to reduce disabil-ity and deaths caused by cardiovascular diseaseand stroke.

ALS. Advanced Life Support.

Alternate-Employee who has been trained andcertified for a specialty position but only work thatposition on an as needed basis (CCT, SSC, MHT).

Ambulance Service Agreement-Agreement be-tween the Pinellas County Authority and Paramed-ics Plus to be the sole provider of ambulances ser-vices in Pinellas County. The term of the agree-ment is five years with possible two 3-year exten-sions.

Ambulance User Fees- Fees that are charged topatients (or insurers) who use the ambulance ser-vices, which are typically reimbursed by the pa-tients insurer. These fees fund the ambulance

provider contract costs.

AQUA-AQUA Quality Improvement Software auto-mates the entire emergency dispatch case reviewprocess. It assists the dispatcher with many taskssuch as data entry, compliance scoring, record keep-ing, reporting and more. It helps ensure that emer-gencydispatchers in your agency are providing quality ser-

vice in compliance with all standards established bythe National Academies of Emergency Dispatch. Itpinpoints specific training needs and liability risks,and helps you document continuous improvementefforts. In today's world, public safety agencies sim-ply must have a defendable quality improvement pro-gram to help protect them from liability lawsuits.AQUA is a powerful tool that helps the dispatchermeet this need with minimal commitments of timeand personnel.

Assistant Supervisor- An employee who has beenselected through an interview process and trained to

perform the role of a supervisor. Assistant supervi-sors work their regular shifts in the field and fill in forsupervisors when the need arises.

Auth. Authority-Refers to the Pinellas County EMSAuthority

BCC. Board of County Commissioners

BLS. Basic Life Support-Certification required forEMTs and paramedics.

BTLS. Basic Trauma Life Support- Certification

required of paramedics.

CAAS. Commission on Accreditation of Ambu-lance Services- A 3-year accreditation establishedto encourage and promote quality patient care inAmerica's medical transportation system. Accredita-tion signifies that the service has met the "gold stan-dard" determined by the ambulance industry to beessential in a modern emergency medical servicesprovider. These standards often exceed those estab-lished by state or local regulation.

CAD. Computer Aided Dispatch.- The software

utilized to receive requests for service and to assignthose requests to available resources.

Call-Taker-System Status Controller/Dispatcherwhos primary duty is to answer the phones including9-1-1 calls.

CAMTS. Commission on Accreditation of MedicalTransport Systems- The Commission on Accredita-tion of Medical Transport Systems is dedicated toimproving the quality of patient care and safety of thetransport environment for services providing ro-

Glossary of Terms and Abbreviations - Page G1


66/80186

torwing, fixed wing and ground transport systems.

Capnography-is the monitoring of the concentrationor partial pressure of carbon dioxide (CO2) in the res-piratory gases. It is used in our system to assist inassessing respiratory patients and confirming en-dotracheal intubation tube placement.

CCT. Critical Care Transport.

CDE. Continuing Dispatch Education- Classesrequired for dispatchers to maintain their certification.

Clinical Staff- Includes all certified personnel (EMTsand Paramedics) who are involved in the care of ourpatients.

CME. Continuing Medical Education Classesheld monthly through the St Petersburg College thatall licensed personnel must attend. Credits for theseclasses count towards re-certifications.

CME Steering Committee- Committee that meetsmonthly to determine the educational offerings to theEMS providers in the county.

COO. Chief Operating Officer.

CPI. Consumer Price Index.

CPR. Cardiopulmonary Resuscitation.

Crew-Refers to an ambulance crew usually consist-ing of a paramedic and EMT.

CSFs. Critical Success Factors-People, Quality,Responsible Financially, and Service.

Daily Performance Analysis Graph-A graph usedin the PULSE meetings that reviews the last daysperformance. It layers actual call volume for eachhour of the day, number of ambulances that weredeployed, duration of bed delays, and emergencyresponse time compliance that was achieved in eachhour of the day.

Dispatch Services- 9-1-1 calls that are triaged asmedical calls by the Pinellas County 9-1-1 dispatch

center are transferred to the Sunstar Paramedicscommunications center to provide pre-arrival instruc-tions to callers and dispatch the closest ambulanceusing Computer Aided Dispatch (CAD) and GPS.Non-emergency transport requests are received di-rectly to the Sunstar Paramedics communicationcenter.800 MHz Radio System- Each ambulance isequipped with an on-board radio and two portableradios that allow communication between dispatch,other EMS agencies, and area hospitals.

EMS Services-Ambulances are deployed through-out the county using a flexible ambulance deploy-ment model called System Status Management(SSM). This model ensures that the correct numberof ambulances are in the right location at the righttime when they are needed. By accurately predictingwhen and where ambulances will be needed, we areable to exceed contract response time requirementsand optimize our financial performance (Figure P.1-

2). Response to the callers location is either emer-gency (lights and siren) or non-emergency in a cus-tomized ambulance staffed with a paramedic and anEmergency Medical Technician (EMT).

DOC. Director of Communications.

DOCS. Director of Clinical Services

DOHS. Director of Health and Safety

DOIT. Director of Information Technology

DOO. Director of Operations

DOSS. Director of Support Services

Dynamic Post Plan-The plan in which we use tostrategically position our ambulances throughout thecounty to respond to emergencies. These strategiclocations may change every hour of the day and dayof the week.

EE. Employee.

EKG. Electrocardiogram- Displays cardiac rhythm.

EMD. Emergency Medical Dispatch- A standard ofemergency call taking developed by the NationalAcademy of Emergency Dispatch.

EMS. Emergency Medical Services.

EMS Authority. The entity designated by the Boardof County Commissioners to oversee all EMS, firedepartment, Medical Control and Educational con-tracts.

EMT. Emergency Medical Technician.

Enhanced 9-1-1A system in the communicationcenter that displays the location of the calling party.

ePCR. Electronic Patient Care Report. Electronicdocumentation of patient care performed by para-medics in the field.

EVOC. Emergency Vehicle Operations Course.Amandatory training course all employees that oper-ate emergency vehicles must successfully completethat covers vehicle operation and safety.



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Field.Term used to reflect the environment whereEMTs and Paramedics work.

Fiscal Year- The timeframe in which we base ourstrategic planning process and reporting data, andalso coincides with our ambulance contract years;October 1 September 30.

FISH. Fresh Ideas Start Here.A process in whichemployees can offer suggestions or request im-provements by name or anonymously. All forms sub-mitted are reviewed in the Directors meeting weeklyand feedback is provided to the authors of eachform.

FTO. Field Training Officer-A designated em-ployee who newly hired employees are placed withto mentor and train for a specific amount of time. Allnew hires are provided with an itinerary and a checkoff sheet for skills and many other items such as poli-cies and procedures.

Gallop Organization-provides a variety of manage-ment consulting, human resources and statisticalresearch services.

GEMS. Geriatric Education for Emergency Medi-cal Services.

GPS. Global Positioning System.A system de-signed to designate the location of an object by atriangulation of a minimum of four satellites.

GSA. Governor Sterling Award.

Headcount Analysis-Analysis performed to deter-mine if the current number of clinical personnel aswell as the anticipated number of personnel in 3months and in 6 months will be enough to meet thepredicted call volume.

HPEMS. High Performance Emergency MedicalServices-The timely use of analytic models andtools in the planning and implementation of re-sources in an Emergency Medical Services (EMS)system to match supply with demand. The end goalof this model is to facilitate the effective and cost effi-cient allocation of resources.

HIPAA. Health Insurance Portability and Ac-countability Act.

IAEP. International Association of EMTs andParamedics.

ISERA- Deployment planner that analyzes targetstaffing levels and finds the most efficient allocationof shifts to match ambulance resources with call vol-ume demands.

ITLS. International Trauma Life Support-A certifi-cation required of paramedics.

JEMS. Journal of Emergency Medical Services.

Joint Labor Management Committee- The purposeof the Joint Labor-Management Committee is to en-courage the parties to collective bargaining disputesto agree directly on the terms of such agreements or

on a procedure to resolve these disputes. The Com-mittee makes every effort to achieve voluntary settle-ments and to encourage a constructive long-termrelationship between the parties. The Committeealso serves as forum for discussion of larger issues,unrelated to specific disputes, of mutual concern.

Leadership Meetings Quarterly meetings were theLT meet with the supervisors to discuss organiza-tional knowledge and performance.

LET. Leadership Effectiveness Training

LT. Leadership Team Includes the COO, directorsand managers.

MARVLIS. Mobile Area Routing and Vehicle Lo-cation Information System- A system used in dis-patch that utilizes historical call data to predict de-mand on an hour by hour basis.

MMA. Materials Management Assistant.

MMRS. Metropolitan Medical Response System.

MPDS. Medical Priority Dispatch-A set of proto-

cols used in the dispatch center by 9-1-1 call-takersto provide pre-arrival instructions while EMS unitsare responding to the call. The MPDS is in partbased on published standards by the National Asso-ciation of EMS Physicians, the American society forTesting and Materials, the American College ofEmergency Physicians, the U.S. Department ofTransportation, the National Institutes of Health, theAmerican Medical Association, and more than 20years of research, development, and filed testingthroughout the world. The protocol contains 34 ChiefComplaint Protocols, Case Entry and Exit informa-tion, call termination scripts, and additional verbatim

instruction protocols for automatic external defibrilla-tor support, CPR, childbirth assistance, airway andbreathing, and the Heimlich maneuver.

MVV. Mission, Vision, and Values.

NAED. National Association of Emergency Dis-patchers.

NAEMT. National Association of EmergencyMedical Technicians



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National Registry- Anational certification that es-tablishes uniform standards for training and exami-nation of personnel active in the delivery of emer-gency ambulance service.

Ninthbrain- Software program that provides on-linetraining, incident tracking, automated compliancealerts, database for certification renewals and vacci-nation records, and QI tools.

NIMS. National Incident Management Training-On February 28, 2003, President Bush issuedHomeland Security Presidential Directive-5. HSPD-5directed the Secretary of Homeland Security to de-velop and administer a National Incident Manage-ment System (NIMS). NIMS provides a consistentnationwide template to enable all government, pri-vate-sector, and nongovernmental organizations towork together during domestic incidents.

NOMAD-Computer and software used in the ambu-lance that includes mapping, call information, and

the ability to change unit status.

OLMC. On line Medical Control-A service providedby the Office of the Medical Director to provide in-stant contact with a doctor for pre-hospital patientconsultation. During these consultations, the on linedoctors approve specific procedures such as admini-stration of medication. OLMC also provides patientreports to receiving facilities depending on the pa-tients condition during the consult.

OMD. Office of the Medical Director- The con-tracted entity responsible for providing a Medical Di-

rector physician who oversees all of the clinical as-pects within the EMS system through a complete setof protocols called a Medical Operations Manual.

OSHA. Occupational Safety and Health Admini-stration

PALS Meeting-Paramedic Advanced Life Supportmeetings held monthly in which all EMS coordinatorsattend.

PALS. Pediatric Advanced Life Support.

Paramedic-A person trained and certified to provideemergency medical treatment.

PAT Program- Positive Action Taken- Method usedto provide employee recognition.

PBS. Patient Business Services- The departmentwhere patient care reports are reviewed for accuracyand completeness before going to the county billingdepartment for billing.

PCR. Patient Care Report.


PEPP. Pediatric Education for Pre-hospital Pro-viders.

Pinellas County EMS-The Pinellas County Emer-gency Medical Services (EMS) Authority was createdthrough a Special Act of the Legislature. Chapter 80-585, Laws of Florida, created the countywide EMSdistrict investing all powers in a seven member,elected board, empowered to oversee and regulate

all emergency medical service activities in theCounty. The Special Act was approved by a county-wide voter referendum in 1980. The Authority ownsthe trade-name Sunstar EMS, and holds the licensefor paramedic ambulance services in the county. Pi-nellas County's EMS Authority provides a "OneTier" (all units are advanced life support (ALS) -level; meaning all paramedic), "Dual Response" (twoparamedic units are sent to each 9-1-1 emergencycall) system. We are a "Public Utility Model (PUM)"EMS system. Pinellas County is the second largest,PUM in the nation.

PIP. Performance Improvement Plan

PM. Preventive Maintenance.

Preceptor-Employees who work with new employ-ees to provide coaching and mentoring during theirinitial orientation period.

ProQA- ProQA Dispatch Software integrates thepower of the National Academy Protocols with to-day's critical computer technologies. It helps emer-gency dispatchers move smoothly through Case En-try and Key Questioning. It assists dispatchers in

quickly determining the appropriate DeterminantCode for each case and clearly displays the re-sponse configuration specifically assigned to thecode by local agency authorities. ProQA then guidesdispatchers in providing all relevant Post-Dispatchand Pre-Arrival Instructions, as well as importantcase completion information.

PTCA. Percutaneous Transluminal Coronary An-gioplasty- One of the most common procedures foropening damaged or obstructed coronary arteries.

PTO. Paid Time Off. PTO are hours that can be util-

ized for pay when the employee is not at work on aregularly scheduled shift whether they are out sick oron a prescheduled vacation. PTO is accrued basedon longevity with the company.

PULSE. Performance Utilization, Late-call, Sys-tem Evaluation-A daily meeting in which future de-mand is evaluated and production is reviewed. Alsoin this meeting, requests for service that exceed ourcontractual obligation to the Authority due to humanerror are reviewed and employees are providedfeedback.


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Pulse Oximetry- a non-invasive method allowingthe monitoring of the oxygenation of a patient's he-moglobin.

PUM. Public Utility Model-An EMS system that isdesigned where the government not only regulatesand oversees system performance, but the ambu-lance service provider (contractor) is held account-able to meet or exceed performance requirements.

This can include termination of the provider contractand even fines being imposed. In Public Utility ModelEMS system design, the government is a"purchaser" of First Responder paramedic, and para-medic ambulance transport services through a com-petitive (bidding) process insuring that the most cost-effective provision of EMS services is guaranteed.

QAR. Quality Assurance Review-A review or in-vestigation of patient care issues that are brought toour attention.

Ride-a-longs. When administrative personnel such

as directors and managers ride with a crew for a shiftto provide opportunities for two-way communicationand see firsthand what field employees manage on adaily basis.

Road Safety.A system in each emergency vehiclein the Sunstar Paramedics fleet that monitors seat-belt usage, safe backing techniques and a vehicleoperator level or score which measures the opera-tors performance. The standard is five or higher on ascale of one to ten. This number is reached via aformula that measures the number of infractions perone hundred miles driven.

ROSC. Return of Spontaneous Circulation- Indi-cates when a patient regains a pulse.

Scorecard Meeting-Monthly meetings where themanagers and directors review department and or-ganization scorecard performance.

SPP. Strategic Planning Process.

Shift Bid. When demand patterns dramaticallychange or when unit hours being produced do notadequately cover the demand a shift bid will be held.

This is a process in which all employees must bid ona shift to work in a two-week rotation. Shifts areawarded based on seniority.

SQC. Sunstar Quality Council-A monthly meetingwhere the LT and some stakeholders gather togetherto report on the overall system performance. Keyperformance measures are reviewed at these meet-ings.

SSC. System Status Controller-Another name fordispatcher, this is a highly trained and certified em-ployee who works in the Communications Center.

SSM. System Status Management-The dynamicmethod of moving available resources to strategiclocations to cover the most demand based on thenumber of resources available.

STAR CARE- The acronym that our values are re-flected in. Safe, Team-based, Attentive to humanneeds, Respectful, Customer-accountable, Appropri-ate, Reasonable, and Ethical.

Stats Page-An automated page sent to designatedrecipients three times daily with our performance ineach call priority by percentage and number of trans-ports.

Sunstar Paramedics- The Pinellas County desig-nated name for the ambulance server provider.

Sup.- Abbreviation for Supervisor

S.W.A.T. Special Weapons and Tactics - A groupof highly trained Paramedics that work in conjunctionwith the Sheriffs Office to ensure deputy and poten-tial patient safety on high risk incidents.

SWOT. Strengths, Weakness, Opportunities, andThreats.

Talking Points. Pertinent items of information thatall members of the administrative staff communicateto the workforce. These talking points can include

but are not limited to safety, new equipment, proce-dures and process improvement.

UH. Unit Hour-A unit hour is defined as a one hourperiod of time when a fully staffed and fully stockedambulance can be assigned an emergency call.

UHU. Unit Hour Utilization-A number derived froma formula to determine and measure workload bydividing the number of transports by the number ofhours worked.

Utstein Template- Tool used for the measurement

of cardiac arrest survival.



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ORGANIZATIONPROFILE


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Sunstar Paramedics 2009 Florida Governors Sterling Award Application

Organizational ProfileIn October of 2004, the Pinellas County EMS Authorityfirst contracted with Paramedics Plus, a for-profit Lim-ited Liability Corporation (LLC), as the single providerof countywide paramedic ambulance services in Pinel-las County, Florida. Contractual requirements man-date Paramedics Plus to operate under the countytrade name of Sunstar Paramedics. The PinellasCounty Emergency Medical Services (EMS) is consid-

ered a Public Utility Model (PUM) which makes it dif-ferent from other EMS systems. The Pinellas Boardof County Commissioners (BCC) provides policy over-sight for all EMS related activities in Pinellas County,Florida. EMS services are contracted by both publicfire departments and a private ambulance company.

All are under performance-based agreements withPinellas County EMS Authority. The EMS system isfunded through two main sources, a countywide advalorem tax and ambulance user fees. The nineteenfire department first responder agencies are fundedthrough ad valorem taxing of all business and home-owners in Pinellas County. The single countywide am-bulance contractor does not receive any tax supportedrevenues, instead, is funded entirely from EMS userfees collected from approximately 90,000 patientstransported annually.

P.1a(1) Main Products and ServicesSunstar Paramedics is a 24/7 operation that serves280 square miles and a population of 945,000 withover 4 million visitors annually. The main products andservices of Sunstar Paramedics are: (1) Dispatch Ser-vices, and (2) Emergency Medical Services (EMS)Operations. Key process requirements and perform-ance measures for both are identified in Figure 6.1-1.In 2008 (fiscal year), Sunstar Paramedics responded

to 176,605 requests for ambulance service(approximately 73% 9-1-1 emergency and 27% non-emergency interfacility transports).

Dispatch Services: Citizens request our services ei-ther by dialing 9-1-1 for emergencies or a seven digittelephone number for non-emergency ambulancetransport services. Specially trained paramedicscalled System Status Controllers (SSCs) located in theSunstar dispatch center providepre-arrival instructionscustomized to the callers emergency, giving life sav-ing instructions even before the arrival of paramedics.Simultaneously while instructions are being provided,

the closest ambulance is located using ComputerAided Dispatch (CAD) and GPS, and then dispatchedusing the 800 MHz radio system.

EMS Operations:Ambulances are deployed through-out the county using a unique flexible ambulance de-ployment model called System Status Management(SSM). This model ensures that the appropriate num-ber of ambulances are in the right location at the righttime when they are needed based upon an on-goingsystematic analysis of historical EMS 9-1-1 call vol-ume. By predicting where ambulances will be needed,we are able to exceed contract response time require-

Figure P.1-1: Mission, Vision, Values, CSF

VISION

To be an organization that sets the standard for EMS by

providing extraordinary care and service to our customers

and community, continuously improving through innova-tion and technology, and being a great place to work.

MISSION

To provide compassionate quality care and service to our

community.

STAR CARE VALUES

Safe: Are my actions safe for me, for my colleagues,for other professionals and for the public?

Team-based: Are my actions taken with due regard forthe opinions and feelings of co-workers, including thosefrom other agencies?

Attentive to human needs: Do I treat my patients, cus-tomer or colleagues as a person? Do I tell them what to

expect in advance? Do I treat their family and/or relativeswith similar respect?

Respectful: Do I act towards my patients, colleagues,my customers, and the public with the kind of respectthat I want to receive my self?

Customer accountable: Can I look my patients andcustomers in the eye and say I did my very best foryou?

Appropriate: Is my care or work appropriate medi-cally, professionally, legally, and practically, considering

the circumstances I face?

Reasonable: Do my actions make sense? Would a col-league with similar experience make a comparable deci-

sion? Ethical: Are my actions fair and honest in every way?

ments (Figures 7.1-2, 3. 4)and are financially competi-tive (Figures 7.3-1, 2, 3, 4). Response to the callerslocation is either emergency (lights and siren) or non-emergency in a customized ambulance staffed with a

paramedic and an EMT.

Organizational Profile - Page i


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Critical Suc-

cess Factors(CSF)

CSFDescription

Key Performance Measures

PEOPLE

Highly Engaged,Caring, Skilled

andSafe Workforce

% Overall employee engagement (Fig. 7.4-1)

% Customers rate workforce compassionate & caring (Fig. 7.2-3)

Overall employee workforce safety index (Fig. 7.4-3)

% Clinical employees meeting CME Attendance Req. (Figure 7.4-4)

QUALITYQuality Care toOur Patients

% Overall EMD compliance (Fig. 7.1-1)

% Arrive emergencies within 10 minutes. (Fig 7.1-2)

% Arrive scheduled non-emergencies within 15 minutes (Fig 7.1-3)

% Arrive unscheduled non-emergencies within 60 minutes (Fig. 7.1-4)

% Cardiac arrest survival (Figure 7.1-5)

% Stemi patients going to correct facility (Fig. 7.1-7)

% Stroke alerts called appropriately (Fig. 7.1-8) % Trauma alert patients arrive hospital within golden hour (Fig. 7.1-9)

RESPONSIBLEFINANCIALLY

OptimizeFinancial

Performance

Cost per unit hour (Fig. 7.3-1)

Cost per capita (Fig. 7.3-2)

Cost per transport (Fig. 7.3-3)

% Change in annual cost per unit hour (Fig. 7.3-4)

Response time compliance fines (Fig. 7.3-5)

SERVICE

Exceed TheExpectations

of OurCustomers

% 9-1-1 customer satisfaction (Fig. 7.2-1)

% Non-emergency customer satisfaction (Fig. 7.2-9)

% EMS Authority key contract requirements met (Fig. 7.2-20)

Figure P.1-2: Organizational Scorecard, Critical Success Factors, and Measures

% Minority % Women

Pinellas County 17% 52%

Sunstar Paramedics 11% 25%

On emergency 9-1-1 calls, both a fire department unitand a Sunstar ambulance respond to the emergencyand work together to provide quality patient care onthe scene of the emergency. Sunstar Paramedicstransports the patient to the hospital and the fire de-partment is then available for another emergency call.On non-emergency interfacility transports, a Sunstarambulance is dispatched alone and provides treatmentand transport to the intended destination.

P.1a (2) Organizational CultureAnnually, through a systematic Strategic PlanningProcess (SPP) (Figure 2.1-1), we review and modifyas necessary, our vision, mission, values, Critical Suc-cess Factors (CSFs), measures, goals, and key actionplans. Our mission and vision are accomplishedthrough our four CSFs (Figure P.1-2), capitalizing onour core competencies (agility, data analysis, and opti-mize use of resources), and frequently monitoring keyperformance measures within the organizational(Figure 2.2-2), department (on site), and employeescorecards (on site). These methods enable us to fo-cus on creating and balancing values for our key cus-

tomers and partners. In our vision, we define as anorganization that sets the standard for EMS as per-formance on the key measures aligned to the organ-izational scorecard CSFs (Figure 2.2-1) that is in thetop 25 percentile of EMS organizations and is compa-rable to organizations who have been identified as rolemodels through the Baldrige and the Florida SterlingQuality Award.

P.1a (3) Workforce ProfileSunstar Paramedics has 516 employees which aresegmented into two key groups: (1) Clinical 428 em-

ployees (83%) and (2)Administration and Support91 employees (18%). Of our clinical employees, 57%are paramedics, 42% are EMTs and 1% are nurses.How staff ethnic diversity compares to that of PinellasCounty is shown below.

Key requirements and expectations for both employeegroups are based upon the extensive research studyconducted by the Gallup Organization involving 80,000managers and employees. The Gallup study showedthat companies that reflected positive responses to thequestions listed below had higher employee engage-ment (Figure 7.4-1)and were more productive(Figures 7.1-2, 3, 4). Key workforce requirements in-clude:

Do I know what is expected of me at work? (Fig. 7.4-2)

Do I have the right materials and equipment I needto do my work right? (Fig. 7.4-2)

Sunstar Paramedics is a safe place to work. (Fig.7.4-2)

At work, do I have the opportunity to do what I dobest every day? (Fig. 7.4-2)

In the last seven days have I received recognition orpraise for doing good work. (Fig. 7.4-2)

My supervisor or someone at work seems to careabout me as a person. (Fig. 7.4-2)

There is someone at work who encourages my de-velopment. (Fig. 7.4-2)

Organizational Profile - Page ii


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Organizational Profile - Page iii

The mission / purpose of Sunstar Paramedics (toprovide compassionate quality care and service toour community) makes me feel my job is important.(Figure 7.4-2)

My co-workers are committed to doing quality work.(Figure 7.4-2)

In the last year, I have had the opportunity at work tolearn and grow. (Figure 7.4-2)

In October of 2004, when Paramedic Plus wasawarded the contract, we inherited a workforce thatwas represented by a single bargaining unit, the Inter-national Association of Emergency Medical Techni-cians (EMTs) and Paramedics. They represent all

paramedics, EMTs, Materials Management Assistants(MMAs), and fleet mechanics, for a total of 464 em-ployees, or about 89% of the workforce. Eighteen per-cent of this bargaining unit pays dues monthly.

Sunstar Paramedics offers a variety of benefits includ-ing sign-on and retention bonuses, paramedic trainingreimbursement, medical, dental and vision insuranceplans, short and long-term disability insurance, match-

ing 401(k), paid holidays, vacation and sick pay, andbereavement leave. Key health and safety require-ments include Florida Workers Compensation andOSHA regulations (Figure P.1-3).

P.1a (4) Facilities, Technologies, EquipmentFacilities

Sunstar Headquarters A 55,000 sq. ft. PinellasCounty owned facility. Ninety percent of all employees(clinical and administrative) aredeployed from this facility. Itincludes: an ambulance fleetmaintenance facility, medicalsupply warehouse, state of the

art dispatch center, four baydeployment areas, and admin-istrative offices.

South County Hub A 1,200sq. ft. facility. Seven percent ofour employees are deployedfrom this facility in St. Peters-burg.Technologies

Computer Aided Dispatch(CAD) Computer Softwaresystem assists dispatch per-sonnel handling and prioritizing

requests for ambulance ser-vice. Enhanced 911 will sendthe location of the call to theCAD system and display theaddress on to the dispatcher.The system allows the dis-patcher to see the location ofthe ambulance and track theirresponse route.

MARVLIS Mobile AreaRouting & Vehicle Location In-formation System designed to

save time by getting the right resources to the rightlocation at the right time.

NOMAD Computer and software used in the am-bulance that includes mapping, call information, andthe ability to change unit status.

EPCR / Computers Patient care documentation isperformed electronically using Zoll Tablet PCR soft-ware and Panasonic Tough-Book laptops.

ISERA Deployment planner analyzes staffing lev-

els and finds the most efficient allocation of shifts tomatch resources with call volume.

ROAD SAFETY Ambulances equipped with datarecorder to monitor how staff drives on a second tosecond basis. Monitors speed and aggressive drivingand gives an audible warning.

Pro-QA A quality improvement software that auto-mates the entire emergency dispatch case reviewprocess to ensure that emergency dispatchers areproviding quality service in compliance with all stan-dards established by the National Academies of Emer-gency Dispatch.

AQUA Dispatch software that helps dispatchers

move smoothly through case entry and key question-ing and assists dispatchers in quickly determining thelevel of response mode.

Equipment

AmbulanceWe have 64 Type III AEV/Ford E450sto respond to and transport patients. Each ambulanceis equipped with a light system designed to give 360degree visibility in concert with high output sirens.

Key Regulatory Areas Key Measures

Contractual Obligations

Pinellas County EMS

Contract

% Arrive emergencies within 10 minutes (Fig.7.1-2)

% Arrive scheduled non-emergencies within 15minutes (Fig. 7.1-3)

% Arrive unscheduled non-emergencies within60 minutes (Fig. 7.1-4)

% PCR proper billing information (Fig. 7.1-10)

% EMS Authority contract req. met (Fig. 7.2-20)

Occupational Reg.

Florida Workers CompLaws

OSHA

% Workers compensation cases reported < 24hours (Fig. 7.6-1)

% OSHA 300 reported less 7 days (Fig. 7.6-2)

# Substantiated EEOC complaints (Fig. 7.6-4)

Accreditations

CAAS ACE

AHA Training Facility

CAMTS (CCT Unit)

Maintain CAAS accreditation (Fig. 7.6-4)

Maintain ACE accreditation (Fig. 7.6-4) Maintain AHA training facility accreditation

(Fig. 7.6-4)

Maintain CAMTS accreditation (Fig. 7.6-4)

Certifications

County EMT, Para-medic & RN Cert.

CME requirements

% Clinical employees meeting CME atten-dance requirements (Fig. 7.4-4)

% Dispatchers meeting CDE requirements(Figure 7.4-6)

Medical Privacy

HIPAA Patient Privacy Number of substantiated HIPAA violations (Fig.

7.6-4)

Figure P.1-3 Regulatory Environment



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Organization Communication Methods Key Requirements

KeySuppliers

Zoll - Computer Aided Dispatch(CAD) software, Electronic Pa-tient Care Reporting

Physio Control - Supplies car-diac monitors

Bound Tree Disposable medi-cal supplies

MARVLIS- Ambulance deploy-ment

Priority Dispatch - Pre-arrivalinstructions

Service agreements

User group meetings

Weekly visits

Conference calls

Regular meetings

Email

Telephone

CAD system up time (Fig.7.5-16)

Cardiac monitor mainte-nance on schedule (time)(Fig. 7.5-18)

Zoll Software updates onschedule (time) (Fig. 7.5-19)

KeyPartners

Local Fire Departments - Col-laboration providing direct pa-tient care

Medical Director Office - Es-tablishes clinical protocols andgrants clinical privileges

Local Hospitals - Provides clini-cal outcome data

Saint Petersburg College -Continuing Medical Education(CME)

Monthly Fire Chief meet-ing

Equipment committee

Monthly PALS meeting

Monthly SQC meetings

RN Managers meeting

CME Steering Committee

Figure P.1-4 Key Customer Groups, Requirementsand Expectations

Figure P.1-5: Key Suppliers, Partners, Communication Methods and Requirements

EmergencyPatients124,064(73%)

Arrive quickly (Fig. 7.2-2)

Compassion and caring (Fig. 7.2-3)

Knowledgeable & competent (Fig.7.2-4)

Tell me & my family what you aredoing and listen to my answers(Fig. 7.2-5)

Polite and respectful (Fig. 7.2-6)

Professionalism (Fig. 7.2-7)

Overall quality of care (Fig. 7.2-8)

Non-

EmergencyPatients34,970(27%)

Arrive on-time (Fig. 7.2-10)

Knowledgeable (Fig. 7.2-11)

Courteous and kind (Fig. 7.2-12)

Gentle and careful lifting me (Fig.7.2-13)

Talk with me & listen to my needs(Fig. 7.2-14)

Professionalism (Fig. 7.2-15)

Helpful and caring (Fig. 7.2-16)

Make me comfortable (Fig. 7.2-17)

Overall quality of care (Fig. 7.2-18)

EMSAuthority

% EMS Authority key contract re-quirements met (Fig. 7.2-20)

KeyCustomers

Key CustomerRequirements & Expectations

Organizational Profile - Page iv

LP12 EKG Monitors Electrocardiogram monitorsare capable of EKG, cardiac pacing, defibrillation,pulse oximetry, capnography, and non-invasive bloodpressure monitoring.

800 MHz Radios Each ambulance is equippedwith an on-board radio and two portable radios thatallow communication between dispatch, other EMSagencies, and area hospitals.

Power StretchersEvery ambulance has a

stretcher that uses a hydraulic power system capableof lifting patient loads of up to 750 lbs.

P.1a (5) Regulatory EnvironmentSunstar Paramedics complies with local, state, andfederal regulations and accreditations requirements.Figure P.1-3 outlines our key regulatory areas andassociated performance measures.

P.1b Organizational RelationshipsP.1b (1) Organizational structure and governancesystems:The Pinellas County EMS Authority was createdthrough a special act of the Florida Legislature after

approval of a countywide voter referendum in 1980.The governing body of the Authority is the Board ofCounty Commissioners of Pinellas County. This sevenmember elected board is empowered to oversee andregulate all Emergency Medical Service activities inthe county. Pinellas County purchases EMS servicesand is not a direct provider of patient care. It contractswith 19 local fire departments for paramedic first re-sponder services and with a single ambulance pro-vider. The EMS Authority controls all funding, sets therates, bills, and collects user fees. Paramedics Plus isowned by a not-for-profit hospital group, East TexasMedical Center (ETMC), located in Tyler, Texas. The

Chief Operating Officer (COO) of Pinellas County op-erations reports to the President of Paramedics Plus.

P.1b (2) Key Customer and Stakeholder Groups


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Figure P.1-4 outlines Sunstar Paramedics three keycustomer groups and their key requirements and ex-pectations.

P.1b (3),(4) Key Suppliers, Partners, Collaborators,and DistributorsSunstar Paramedics key suppliers, partners, commu-nications methods, and key requirements are listed inFigure P.1-5.

P.2a Competitive EnvironmentP.2a(1) Competitive PositionThe current contract for Paramedics Plus expires inOctober 2009 with two possible 3-year extensions.Because of tax reform legislation and decreasing prop-erty values, there is a funding gap of about 15 millionfrom the ad velorum revenue side which funds the 19fire department first responders for FY2010. A commit-tee has been established to evaluate the current sys-tem design and make recommendations to reducecost. The fire departments have requested to takeover transporting 9-1-1 patients and off set their costsby shifting user fees from Sunstar Paramedics to theindividual fire department contractors.

P.2a(2) Principal Factors That Determine SuccessThe principal factors that determine our success aremeeting our ambulance contract requirements andcapitalizing on our advantages listed in Figure P.2-1.

P.2a(3) Comparative and Competitive DataKey sources of comparative and competitive data fromwithin our industry include other local and nationalEMS providers, the International City/County Manage-ment Association, Journal of Emergency Medical Ser-vices annual multi-city survey, and National Academyof Emergency Dispatch. Key sources of comparativedata outside our industry include Baldrige and FloridaSterling award winning organizations, National Bureauof Labor and Statistics, and American Customer Satis-faction Index (ACSI). Limitations in obtaining data in-clude lack of common data definitions and differencesin community demographics and contractual require-ments.

P.2b Strategic ContextSunstar Paramedics performs a SWOT analysis annu-ally to update our strategic challenges and our strate-gic advantages. Figure P.2-1 outlines our key busi-

ness, operational, human resource, and sustainabilitystrategic challenges and advantages.

P.2c Performance Improvement SystemProcesses, initiatives and tools used to drive perform-ance improvement include:

The organizational, department, and employeescorecards the use of key performance measuresthat are aligned to the four CSF to track performanceagainst goals/targets.

In 2006, an annual Baldrige organizational assess-ment was implemented. The results are used as inputsinto the strategic planning process.

Plan-Do-Check-Act (Figure P.2-2) is Sunstar Para-medics Performance Improvement System. All of thedirectors, managers and supervisors have been intro-duced to the six-step approach to problem solving ei-ther through Six Sigma Yellow Belt training or in-houseclasses.

Performance data and results are systematically ag-gregated and reviewed through our performance man-agement system described in 4.1.

Daily reviews of system performance through

PULSE meetings (4.1b-1) and daily stats pages pro-vide us with rapid improvement cycles and increasedagility.

Results and learning are shared through several inter-nal and external meetings as listed in Figure 1.1-2 andthrough our communication methods listed in Figures1.1-1 and 5.1-1.

Challenges Advantages

Business &Operations

1. Meeting contractual obligation withincreased population growth and callvolume.2. Hospital bed delays.

1. Our core competencies (agility, data analy-sis, optimize use of resources).2. Deployment of System Status Management.

HumanResource

3. National and regional paramedicshortage.4. Communicating with clinical mobileworkforce.

3. Ability to match call volume demand withflexible workforce scheduling.

OrganizationalSustainability

5. Contract expires in October 2009.6. County committee evaluating transportalternatives by the fire department.

4. Services provided at no cost to taxpayers.Totally funded by user fees.5. Positive relationships with key stakeholders.

Figure P.2-1: Key Challenges and Advantages

Figure P.2-2: Performance Improvement Model

Organizational Profile - Page v


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LEADERSHIP


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Category 1: Leadership1.1 Senior LeadersSunstar Paramedics is led by a Chief Operating Offi-cer (COO), six directors and four managers whomake up the Leadership Team (LT). Reporting di-rectly to the COO is the Director of Operations, Di-rector of Clinical Services, Director of Support Ser-vices, Director of Health and Safety, Director ofCommunications, and Director of Information Tech-

nology.

1.1a(1) Sunstar Paramedics values are reflected inSTAR CARE (Figure P.1-1). The LT reviews/setsthe organizations vision and values during step 1:Input (Environmental scan, SWOT analysis, voice ofthe customer), step 2: Analyze (Analyze inputs, pri-oritize challenges, review benchmarks), and step 3:Set direction (Review mission, vision and values) ofthe annual Strategic Planning Process (SPP) (Figure2.1-1). Additional systematic approaches include areview of ambulance contract requirements and anyamendments, past performance for each Critical

Success Factor (CSF) measure, and progress to-wards short and longer-term goals for each (Figure2.2-1); input from key customers (Figure P.1-4) andpartners (Figure P.1-5) such as the Pinellas CountyAuthority executive staff and Office of the MedicalDirector (OMD), customer satisfaction results(Figures 7.2-1 to 20); employee engagement results(Figures 7.4-1, 2), benchmarking best practiceswithin and outside our industry, legislative and regu-latory requirements, industry trends, and communitydemographics.

1.1a(1) The LT systematically deploys our vision

and values to the workforce, key suppliers andpartners, and customers through organizational,department, and employee scorecards. In 2007 theLT developed an organizational scorecard aligningour mission, vision, values, CSFs, measures, goals,and action plans in an easy to read one page docu-ment. In 2008, this was further deployed and inte-grated throughout the organization with the develop-

WORKFORCE

P.1a(3)

SUPPLIERS / PARTNERS

Figure P.1-5

CUSTOMERS

Figure P.1-4

Organizational, de-

partment, employeescorecards

Monthly newsletters

Bi-weekly scoopnewsletter

Bulletin boards

Face to face manda-tory employee meet-ings

Sunstar vision cards

Employee orientation

Critical Success

Factors (CSF) Performance

evaluations

Weekly directorsmeeting

Open door policy

Code of conduct

Strategic plans

Role modeling

Pulse meeting

Stats pages

Contract agreements

Personal contact Regular meetings

Email

Website

Conferences and tradeshows

Satisfaction Surveys

Email Website

Monthly report to county

Community meetings

Community involvement

Annual report

Monthly Sunstar QualityCouncil (SQC) Meeting

Figure 1.1-1 Methods to Communicate and Deploy Vision and Values

Category 1 Leadership - Page 1


ment of four department scorecards. Additionalmethods are listed in Figure 1.1-1.

1.1a(1) The LTs personal actions reflect a com-mitment to the organizations values through ac-tive participation in setting and deployment of STARCAREvalues throughout the organization and par-ticipation in an annual badge ceremony where allmembers of the LT agree to support our values. Ad-

ditional approaches and deployment methods in-clude participating in the SPP, creation and deploy-ment of department and employee scorecards, per-sonal involvement in daily PULSEand monthlyScorecard and SQC Meetings,role modeling STARCAREvalues in their daily behavior, sending person-alized thank you notes to employees, personally pre-senting employee recognition awards, actively par-ticipating in community events, and using customersatisfaction and employee engagement survey re-sults.

1.1a(2) Ethical behavior is one of the STAR CARE

values (Figure P.1-1). Senior leaders personallypromote an organizational environment that fos-ters, requires, and results in legal and ethical be-haviorby establishing policies, procedures, and fre-quent monitoring of organizational performance at alllevels. Sunstar Paramedics has professional conductand human resource policies that reflect our corevalues and are reviewed bi-annually. These policesare reviewed with new employees during orientation.Additional approaches and deployment methods in-clude: Starting in 2007 all employees receive annualethics training and in 2008 required employees toannually sign a document signifying their commit-

ment to our codes of conduct (Figure 7.6-5). Mem-bers of the LT write a monthly newsletter article onlegal and ethical behavior, department heads deploySTAR CARE within each area they are responsiblefor, and hold their staff accountable through immedi-ate termination of employees who violate legal andethical behavior. In 2007, an ethics hotline was im-plemented to encourage the anonymous reporting of


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Figure 1.1-2 Performance Review System

Category 1 Leadership - Page 2


legal or ethical behavior policies (Figure 7.6-4).

1.1a(3) The LT creates a sustainable organizationby continually ensuring our performance of key proc-esses meet or exceed theAmbulance Service

Agreement Contract requirements, accomplishingour CSFs, and capitalizing on our core competencies(agility, optimize use of resources, and data analy-sis). This will ensure we remain the provider of am-bulance transport services in Pinellas County, Flor-

Freq. Meeting Attendees Purpose

3 x Day Status Pages /

STATS

COO, LT, Sup, Auth,

OMD

Real time status of daily performance; contractual re-

quirements

Daily PULSE COO, LT, Sup Daily performance, weekly schedule, late call

review

Daily Employee Inter-

actions

Sup/LT Emp. Engagement; coaching and feedback

Weekly Directors COO, LT Review of departments; listening and learning; FISH

Form discussion

Q 3 wks Supervisors DOO, Sups, (DOC,

DOSS, DOCS)

Planning and deployment of SP; review of measures

Monthly Support COO, Admin EE Reinforce MVV; Listening and Learning; process im-provements

Monthly Super Support COO, LT, Admin EE Reinforce MVV; Listening and Learning; process im-provements

Monthly SQC COO, LT, OMD, Auth Review of Org. Scorecard measures

Monthly Scorecard COO, LT Review of organization and department scorecards andkey process and support process measures

Monthly Dept staff meet-ings

Dept head, EE Dept review of any department performance measuresand plans

Monthly PALS meetings COO, DOCS, DOSS,FD, OMD, Auth

Listening and Learning; obtain info for EnvironmentalScan; ID key partner req.

Monthly Operations andFire Chiefs

meetings

DOO, FD Listening and Learning; obtain info for Environmental

Scan; ID key partner req.

Monthly MMRS DOO, DOSS, Partners Listening and Learning; obtain info for EnvironmentalScan; ID key partner req.

Monthly EquipmentCommittee

DOCS, Ed train Mgr.,DOSS, EE, Auth, FD

Listening and Learning; obtain info for EnvironmentalScan; ID key partner and customer req.; discuss im-

provements

MonthlyMay-Oct

Strategic Plan-ning

COO, LT MVV, CSF, objectives, goals, measures, initiatives.

Monthly Union DOO, Ops Mgr., Un-

ion President

Planning; MVV; discuss key requirements

Bi-

monthly

Medical Control

Board

COO, DOCS, Partners Listening and Learning; obtain info for Environmental

Scan; ID key partner req.

Quarterly Headcount COO, LT, key staff Review of workforce staffing capacity and needs.

Quarterly Safety Commit-

tee

DOHS, DOSS, EE, Review of safety measures; Listening and Learning;

obtain info for Environmental Scan; ID key partner

requirements

Quarterly LeadershipMeetings

Directors, Mgr., Sups Planning; review of Org. Scorecard measures; Listen-ing and Learning

Quarterly ER Nurse Man-agers

COO, DOCS, Partners Listening and Learning; obtain info for EnvironmentalScan; ID key partner req.

Quarterly Med DispatchReview

DOC, OMD, Auth Listening and Learning; Input for Environmental Scan;ID key partner req.; Review/improve processes; re-

view EMD measures

CSF

Q

P,Q,S

P,Q

P,Q

P

P,Q

P,Q

P,Q,R,S

P,Q,R,S

P,Q

Q

Q

Q

Q

P,Q,R,S

P

Q

P

P

P,Q,R,S

Q

Q


80/80

Figure 1.1-2 Contd Performance Review System


ida. Additional approaches and deployment methodsinclude our annual SPP (Figure 2.1-1), PerformanceManagement System (Figure 4.1-2), PerformanceScorecard System (Figure 4.1-1), Daily Pulse meet-ings, monthly organizational and department Score-card meetings, regular meetings with our key part-ners (Figure 1.1-2), monthly SQC meetings, meetingand exceeding customer requirements, meeting keycontractual and process requirements (Figure 6.1-1),and disaster planning / Continuity of Operations

Planning.

Senior leaders create an environment for organ-izational performance improvement, accomplish-ment of our mission, strategic objectives, inno-vation, role-model performance, and organiza-tional agility through our annual SPP and deploy-ment of organizational, department, and employeescorecards (Performance Scorecard System (Figure4.1-1). Performance improvement and accom-plishment of our mission and strategic objec-tives begins with a systematic four-step Perform-ance Management System (Figure 4 1 2) which in

organizational goals within their area of responsibilitythrough input from customers and employees, reviewof performance measures, benchmarking, atten-dance at professional conferences and participationin user groups. Employees are encouraged to iden-tify and share innovative ideas through the FreshIdeas Start Here (FISH) program.

The LT creates an environment for role modelperformance leadership through our vision to be

an organization that sets the standard for EMS andthrough the establishment of measures, goals andaction plans that are aligned to each CSF. Goals areestablished through a review of national, state, andregional benchmarks, standards of care, contractrequirements, and past performance.Additionally ouraccreditations create a focus on role model perform-ance (CAAS, CAMTS, andACE) (Figure 7.6-4). Sun-star Paramedics was the second in the nation to ob-tain all three of these accreditations. Completion of aBaldrige and Sterling assessment in the past twoyears is another method to achieve role model per-formance

Freq. Meeting Attendees Purpose

Monthly

or PRN

Emergency Mgt.

Steering Commit-tee

COO, LT, Supervisors,

key personnel

To ensure preparedness, mgt. continuity of

operations, and recovery of disasters; AAR

Bi-Weekly

Corporate ZollConference Call

DOC, DOIT, Corp, Sup-plier

Discuss key req.; process improvements; shareMVV

AsNeeded

Materials Vendor DOSS, Suppliers Discuss key req.; process improvements; shareMVV

Bi-Annual Employee Per-formance Review

Sup, EE Employee scorecard measures; discuss keyrequirements; reinforce MVV

Quarterly CME Steering

Committee

SPC, Auth, OMD, Ed &

Training, FD

Listening and Learning; obtain info for Envi-

ronmental Scan; ID key partner req.

Quarterly Joint Labor Mgt. Union Rep, EE, Sup, Di-

rector

Listening and Learning; discuss key require-

ments; review MVV

Annual LT Performance

Review

COO, Director, Manager Planning; review employee performance

Annual Strategic Planning

meeting

COO, LT Set vision, values, CSF, measures and targets

to meet or exceed contractual requirements.

Quarterly Public Safety An-

swering Point

DOC, Auth, Supplier Listening and Learning; Input for Env. Scan;

ID key partner req.; Review/improve processes

CSF

QS

Q

Q

Q

PQS

PQ

P

PQS

P,Q,R,

S

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