EMS System Overview-A Call To Action

WISCONSIN
EMERGENCYMEDICALSERVICES
SYSTEMOVERVIEW;
ACALLTOACTION
Developedby
EMSStakeholders
September,2008
ApprovedbyEMSBoard08/2008
EMSSystemOverview;ACalltoAction
EXECUTIVESUMMARY
ThecurrentstateoftheEmergencyMedicalServices(EMS)SystemandTraumaCareSystem
areatriskofcatastrophicfailure.Thisdocumentdiscussestheissuesthroughastrengths,weaknesses,
opportunities,andthreats(SWOT)analysisofthesystem.Primarilythefollowingarethemainfindings:
StrengthsThesearegenerallycategorizedasthenumberofvolunteersthatprovidecare,the
dedicatedstakeholders/providers,variouscommitteesprovidingnetworkopportunities,adevelopinghospital
andtraumasystem,EMSeducationalsystem,progressivescopesofpracticeforalllevelofproviders,andthe
currentfundingassistanceinitiatives.
Weaknessesidentifiedasworkforceissues,lackofstablefundingtosupportdevelopmentand
structure,noincreaseinfundingassistancedollarssinceitsinception,poorcommunicationofinformation
throughtheEMSindustryaddingtoinadequaterepresentation,lackofDHS/DPHsupport,lackofregionalEMS
support,andthegeographyofserviceareas.
Opportunitiesapotentiallegislativecouncilstudy,buildingconsensusthroughstakeholderinitiatives
andconsortia,potentialrestructuringofthesystems,infrastructuretoeducateandpromoteEMS&Trauma,
developingEMS&Traumadatasystems.
Threatsincludeinconsistentandinaccuratemessagestothepublicandgovernmentleaders,Public
perception,otherspecialinterestgroups,strongethicsoftheworkforce,lackofstablefunding,open
administrativerules,DHS/DPHManagement,allofwhicharerepresentativeofafailingEMS&Trauma
infrastructure.
TheSWOTanalysisisfoundtobedirectlyassociatedwiththe2001NationalHighwayTransportation
SafetyAdministration(NHTSA).Specificallytheintroduction:2001Despitetheoutstandingprogressofthe
pastelevenyears,muchremainstobedone.Someofthebarrierstoprogressthatexistedelevenyearsago
arestillpresenttoday.Dedicatedpeoplethroughoutthestate,bothpaidandvolunteer,doingajobwith
littlerecognitionandinadequateresourceshavecreatedmonumentalachievements.Butevendedicationand
hardworkcancarryWisconsinonlysofar.Currently,resourcesarebeingcutandpersonnelandfinancial
supporttomaintainandcontinueimprovingtheEMSsysteminWisconsinhaveerodedtothepointthatthe
systemisindangerofcollapse.Evenwithahostofvolunteers,astable,continuingfundingsourcemustbe
2
obtainedfortheBureauofEMSandInjuryPreventionandpersonnelresourcesmustbeallocatedtomeetthe
demandforservicestothepublic,theEMSvolunteerandcareerpersonnelandotherEMSsystempartners.
ThepoliticalleadershipinWisconsinmustaddresstherealneedsfacingtheWisconsinEMSsystemand
ensurethatstablefundingmechanismsandpersonnelresourcesareavailabletomaintainagoodsystem
andmakeitevenbetter(NHTSA2001Report).
ThenbasedonthisNHTSAreportandtheSWOTanalysisthefollowingissuggestedbythestakeholders
asthekeyelementsnecessarytogetthesystemsbackontrack.Theyare:
1. RequesttheNationalHighwayTransportationSafetyAdministrationcompleteareassessment.
2. EstablishalegislativestudycommitteetoreviewtheEMSprogramandrecommendchangestothe
EMSBoardstructure.
3. BasedontheaboveprovideessentialfundingandstafffortheStateEMSSectiontosupporttheEMS&
Traumasystems.
4. IdentifyandchangeStateStatutesthatarerequiredtoprovideproperoversite.
5. InitiateneededsystemimprovementprojectsbasedonNHTSAReviewandstakeholderinput.
A. Datasystemdevelopment/integration
B. Qualityassuranceinitiatives
C. Recruitment&retention
D. Regionalization
6. Completeastrategicplanthatwillprovide1,3,5,and10yearprojectplanforsystemimprovement.
Theseideaswillthenbeplacedintoaninitiativetodevelopacontinuingstrategicplan.Anygoodbusiness
developsa1,3,5,and10yearstrategicplantoassurethatthebusinessismovinginthecorrectdirection.In
additionitgivesacheckandbalanceguidetoassurethebusinessstaysontrack.Thisdocumentisjustthe
beginningofaninitiativetoassurethatthestakeholdersareinvolvedindevelopingandmaintainahigh
qualityEMSandTraumasystem.
Contents
EXECUTIVESUMMARY...................................................................................................................................................2
MISSION..............................................................................................................................................................................5
VISION.................................................................................................................................................................................5
INTRODUCTIONANDPURPOSE..................................................................................................................................5
HISTORY.............................................................................................................................................................................6
STRENGTHS.....................................................................................................................................................................10
WEAKNESSES..................................................................................................................................................................12
THREATS..........................................................................................................................................................................16
OPPORTUNITIES............................................................................................................................................................18
VISIONOUTLOOK..........................................................................................................................................................20
RECOMMENDATIONS...................................................................................................................................................20
CONCLUSION...................................................................................................................................................................27
APPENDIXASTAKEHOLDERSLIST......................................................................................................................29
APPENDIXBCURRENTORGANIZATIONALCHART........................................................................................30
APPENDIXCPROPOSEDBUREAUORGANIZATIONALCHART....................................................................31
APPENDIXD1990NHTSAASSESSMENT.............................................................................................................32
APPENDIXE2001NHTSAREASSESSMENT........................................................................................................59
MISSION
ThemissionoftheWisconsinEmergencyMedicalServicesSectionistoensurethatthe
highestqualityandstandardsofprehospitalemergencymedicalcareisavailabletoall
citizensofandvisitorstoWisconsin.
VISION
Throughleadership,support,andregulation,theEMSSectionensuresthedevelopmentand
maintenanceofahighqualityEmergencyMedicalServicesdeliverysystemfortheStateof
Wisconsin.Itsprimaryfocusistoreducebothhumansufferingandeconomiclossfrom
prematuredeathanddisabilityresultingfromsuddenillnessorinjury.
INTRODUCTIONANDPURPOSE
TheWisconsinEmergencyMedicalServicesSectionhasbeenchargedwiththeresponsibilityof
developingandsustainingEmergencyMedicalServicesinWisconsinsince1968.Fromtheinception,itsstatus
withintheDepartmentofHealthandFamilyServices(DHS)(formerlytheDepartmentofHealthandSocial
Services)haschangedfromaSection(withintheDivisionofPublicHealthoftheDHS)toaBureauandbackto
itscurrentstatusasaSection.Duringthisperiod,theWisconsinEmergencyMedicalServicessystemhas
expandedtoincludemorethat430ambulanceservices,460firstrespondergroups,and24,000licensed
personnelandincludestheemergencymedicalservicesandtraumasystemprovidedthroughthehospitalsin
theState.SinceEmergencyMedicalServices(EMS)isanalliedhealthprofession,itcontinuestoevolveand
change.Sincethelate1970stheSectionhasdevelopedfivelevelsofprehospitalemergencymedical
providerseachwiththeirownadministrativerulesforoperation.Inaddition,ithasdevelopedastatewide
traumasystemtooptimizethetreatmentofpatientswithtraumaticinjuriesandprovideforpreventionof
suchinjuries.
Longgonearethedaysofdischargedmilitarymedicsdrivingtheambulance.Todaysprofessionals
havehundredsofhoursofeducationandtrainingtostandardsestablishedbytheEMSSection.Theyare
requiredtomaintainandexpandtheirknowledgeandskillsthroughenrollmentincontinuingeducationand
trainingclassesapprovedbytheEMSSectionandmaintaincertificationsandtheachievementofcurrent
competenciesasrequiredanddefinedbytheSectionforlicensing.Thiscontinuedtraininghelpstoassurethat
Wisconsincontinuestohavequalifiedandcompetentprovidersofprehospitalcare.
TheprimaryfocusoftheEMSSectionistheprovisionofcomprehensivehighqualityemergency
medicalservicestothecitizensandvisitorsoftheStateofWisconsin.Inordertoaccomplishthismission,
theSectionmustdevelopandsustainasolidandstableEMSSystemthatweldsallofthecomponentsintoa
functionalsystemthatcanmeetthedailyrequirementsandthosethatwillimpacttheStateduringdisasters
andcrisis.Thesecomponents,asidentifiedbyTheNationalHighwayTransportationSafetyAdministration
(NHTSA)are:RegulationandPolicy,ResourceManagement,ManpowerandTraining,Transportation,
Facilities,Communication,Evaluation,PublicInformationandEducation,MedicalDirection,andTrauma
Systems.
Thus,qualityassuranceanddevelopmentandmaintenanceofastateoftheartSYSTEMakeyfunction
oftheEMSSection.TheSectionmustassurethattheservicesprovidedareoptimalandinaccordancewith
nationalandstatebestpracticesandstandards.Thesechargesincludeassuranceofcompliancewith
administrativeruleandwithcurrentstandardsofemergencymedicalcare.
Beforeprovidinganindepthreviewofthecurrentsystemandmakingrecommendationsforfuture
progress,itisimportanttolookatthehistoryofWisconsinEMS.ThisiscrucialtounderstandinghowEMShas
arrivedatitscurrentcondition.Inadditionitwillassistindevelopingafunctionalsystemthatwillmeetthe
needsofWisconsin.
HISTORY
ThefollowingisageneraloverviewofkeyeventswithinthehistoryanddevelopmentofEMSin
Wisconsin.Itisnotanallinclusivechronology.ItonlycoversthemajoreventsandmilestonesforEMSin
Wisconsin.
Priorto1966
Priorto1966patientsweretreatedbyfirefighters,policeofficers,andlaypeoplewhopossessedlittle
scientificallybasedabilitiesforassessmentortreatmentofpatients.Generally,patientswererapidly
transportedtoahospitalwithoutreceivinganymedicalcareduringthetrip.Rapidtransportwasthe
treatmentoftheera.
1966Whitepaper
ThisisthebasisofmodernEMSintheUnitedStates.Thisdocumentoutlinedthetragedyoflossoflifefrom
automobilecrashes.Itelaboratedonthedeathanddisabilityfromlackofpropercareforthesickandinjured
peopleinthefield.
1968StatewideEMTtraining
Wisconsin,recognizingtheimpactoftheWhitePaper,beganeducationandtrainingofemergencymedical
technicians(EMTs).ThiswasinitiallydonebypersonnelemployedbyDHSS.Thisprocesswassupervisedby
theEMSExaminingCouncilappointedbythedepartment.
1973FederalEMSLegislation
ThecreationoftheNationalHighwayTransportationandSafetyAdministration(NHTSA)begantoprovide
financialresourcestotheStates.Thisprovidedtheseedmoneyfordevelopmentofanemergencymedical
servicessystemwithinWisconsin.ThiswasadministeredthroughFederalProject40/Blockgrants.Thisprocess
stipulatedthatapplicationswererequiredtomeeteachofthe15componentsofaneffectiveEMSsystem.
ThesecriteriaremainthefoundationoftodaysmodernEMSsystem.
1973:Chapter321
Thislegislationprovidedforthelicensingofambulanceprovidersandindividuals.ItfurthercreatedtheEMS
Section/ExaminingCouncil.Thedutiesweretoissuelicensesandprovideexaminationdutiesforpeople
receivingtraining.ThisalsoprovidedtheopportunityforthefirstparamedicsystemsinMadisonand
Milwaukee.
1975&1977
FederalFundingundertheProject40BlockGrantwasreceivedtohelpfundtheEMSSection.In1979,the
federalfundingwasnotrenewed.SincetheStatehadlittleinvestmentintheEMSSystem,thislossresulted
inaprogressivedeclineofpersonnelfromtheEMSSectionandlefttheSectionunabletomeetitsmandated
responsibilities.ThisresultedinaparochialeffectonEMSwhichmeantthateachEMSServicehadtofendfor
itselfthroughgenerationofoperationalfundsthroughcommunityevents.Thisremainedinplaceuntil1992.
1989
ThepassageofAct102FundingAssistanceProgramprovides$2.2million/yearfortrainingeffortsand
ambulanceserviceimprovements.
1990
NHTSAwasaskedtoevaluateEMSinWisconsin.Theymademanyrecommendationsthatwereevaluatedand
somewereactedupon(seeNHTSA1990Assessment).But,thereremainedmanyrecommendationsthat
neededtobeimplementedtofurtherdevelopandmaintainanoptimalEMSsystem.TheNHTSATechnical
AdvisoryTeamreportemphasizedthatthekeytothesuccessfuldeliveryofEMSinWisconsinwastotheneed
toidentifyaSTABLEfundingsourcetosupportdevelopmentandmaintenanceofessentialactivities.
1991
Act238waspassedwhichprovidedfortheFirstRespondercertificationlevel.Thisallowedagreaternumber
oftrainedpersonnelwithbasicmedicalskillstorespondinruralareasaheadofthehighertrainedpersonnel
ontheambulances.
1992
Inresponsetothe1990NTHSAreview,aLegislativeCouncilStudyCommittee(Riser,Robson[Chairs])was
createdtoexaminetheproblemswithEMSinWisconsin,anddraftnewlegislationtoassistinsystem
development.
1993
TheStudyCommitteerecommendednewlegislation:Acts16and25providedforaStateMedicalDirectorto
overseemedicaltreatmentwithinthestateandcreatedtheGovernorappointedEMSBoard.ThisBoardwas
tobeappointedonthebasisofindividualexpertiseinthefieldofEMSandwastoprovideexpertadviceon
issuestotheEMSSection.ThelegislationalsorequiredtheBoardtodevelopandsubmit11reportsto
Legislature.Thereportsareasfollows:
WisconsinAct251(1993)ReportsfromBoardtoLegislature
1.Regionalization(12/31/94;06/30/95)
2.DataCollectionandAnalysis(6/30/95)
3.DispatcherCertification/Licensing(12/31/95)
4.MandatoryEVOCTraining(12/31/95)
5.TrainingandContinuingEducation(12/31/95)
6.Funding(12/31/95)
7.StateEMSPlan(12/31/95)
8.EMSBoardAdvisorytoDOTandWTCS(1995?)
9.MedDirectorsMandatedforBasic&FirstResponderServices(1995?)
10.StatewideTraumaSystem(1995?)
11.UseofHospitalCategorizationLists(1995?)
Aftermorethanthreeyearsofwork,thereportswerecompletedonschedule.Unfortunatelythese
reportswereneversentbythedepartmenttothelegislature.
1998
TheEMSSectioniselevatedtoBureaustatus.
2001
NHTSATechnicalAdvisoryTeam(TAT)wasaskedtodoaReEvaluationofEMSinWisconsinincomparisonto
the1990evaluation.Againthereweremanyrecommendations(seeNHTSA2001Reassessment).Theoverall
sentimentexpressedintheReportwasanythingthatdidnotrequiremoneytocompletewasfinished.
However,theoverwhelmingrecommendationwasagainasolidfundingsourceneededtosupportthe
activitiesoftheEMSsystem.
8
2004
ThiswasasignificantyearinthehistoryofWisconsinEMS.ThiswastheyearthatDHSwasreorganizedand
whathadbecometheBureauofEMSwasslatedtobedissolvedandbecomeabsorbedwithintheOfficeof
Operations.AftertheEMScommunityvoicedtheirconcernsthebureauremainedintactbutwasreducedtoa
sectionandplacedintheBureauofLocalHealthSupportandEMS.
20062008Current
TodayEMSinWisconsinissignificantlybehindotherstatesofsimilararea,population,andgeographical
makeup.TheSectionhasgonefrom11peoplein2005toacurrentstaffof8people.TheSectionisunableto
assurequalitystandardsandproperlyassistservicesinmeetingtheburdenofstatuteandrule.Withoutthe
abilitytomonitorandassistservicestheEMSsystemisprovidingaquestionablelevelofquality.Complaints
areincreasingandinitiativesthathavebeenstartedseveralyearsagohavebeenstalledbecauseofthelackof
resourcesavailable.ThisfailureoftheSectionisdirectlyrelatedtocrumblingoftheEMSinfrastructure.
METHODOLOGY
Theinformationinthisdocumentrepresentsinputfromthreeseparatemeetingsheldoveraoneyear
period.InJanuaryof2007astrategicplanningsessionwasheldwiththeEMSBoardasappointedbythe
Governor.TheprocessusedatthatmeetingwastoevaluatetheStrengths,Weaknesses,Opportunitiesand
ThreatsfacingtheDHSEMSsection.Thisprocess,calledaSWOTanalysis,providesaneffectivewayto
evaluatebothnegativeandpositiveissuesfacingaprojectorbusinessarea.
ThereweretwoadditionalSWOTevaluationsessionsheldtoensurethatallstakeholderswereableto
participateintheprocess.OnMarch4th,theEMSSectionheldtwostakeholdermeetingsatwhichtheEMS
Board,StateTraumaAdvisoryCouncil,andalltheirsubcommitteesparticipatedaswellasotheragenciesand
organizationsidentifiedasEMSstakeholders.ThesewerethefinalSWOTsessionsusedtowardscompleting
thisplan(AcompletelistofthestakeholdersandthegroupstheyrepresentarelistedinappendixA).This
documentanditsanalysisisbasedonthesemeetings,EMSSectionmeetings,discussionsattheEMSBoard
Meetings,EMSBoardPlanningmeetings,andincludesofficialandcasualdiscussionswithvariousEMSleaders
andstakeholders.
ThedevelopmentofahighqualityEMSsystemisverycomplicated.Whatispresentedhereisthebest
evaluationoftheissuesandgeneralrecommendationsmadeinconjunctionwiththeEMScommunity.Thisis
9
notanisolatedinternaldocumentbutacollaborativeeffortinthebestinterestofWisconsinEmergency
MedicalServicesandTraumaSystem.ThefollowingispresentedoutofordertothenormalSWOTstructure
byplacingweaknessesandthreatstogethertoprovideanaturalprogressionintoopportunitiesandthenfinal
recommendationstoimprovethesystems.Onewillalsoobservethatseveralissuesspanintomultiple
categories.Thisisnotunusualincomplexsystemsandsupportstheneedforcontinueddevelopmentand
maintenanceofasolidemergencycaresysteminWisconsin.
STRENGTHS
Aswithallorganizations,itisimportanttoidentifythebestattributestoshowthatallisnotasbadas
itmayappear.Thisalsoprovidesaspringboardtousethestrengthstopromoteandfacilitatechange.Though
theEMSSectionispartofastategovernmentalstructure,acceptedbusinessconceptscanbeappropriately
applied.InthissectionthestakeholdersidentifythekeystrengthsoftheEMS&Traumasystems.Theyare
generallycategorizedasthenumberofvolunteersthatprovidecare,thededicatedstakeholders/providers,
variouscommitteesprovidingnetworkopportunities,adevelopinghospitalandtraumasystem,EMS
educationalsystem,definedandprogressivescopesofpracticeforalllevelofproviders,andthecurrent
fundingassistanceinitiatives.
Volunteers
WisconsinhasenjoyedalonghistoryofadedicatedEMS&Traumaworkforce.Almost60%oftheEMS
workforceisconsideredvolunteer.Menandwomengiveoftheirtimeandresources,oftentimestosignificant
personalsacrifice,tohelptheircommunities.Theyaregenerallynotcompensatedfortheireffortsandprovide
vitalhealthservicestoareasthatcouldnotsupportfulltimecoverage.Fortunatelythisdedicationhas
supportedlocalEMSandTraumainitiativesandbeenthecornerstoneofEMSinWisconsin.
Boards
InadditiontothevolunteersthatprovidecaretothecitizensandvisitorsofWisconsin,thereisagroup
ofdedicatedprofessionalsthatrepresenttheirorganizationstohelppromoteandstrengthenthesystems.
ThesestakeholdersandgroupsarespecificallylistedinAppendixAandwereintegralindevelopingthis
document.TheyrepresenttheirorganizationsthroughtheparticipationprimarilythroughtheStateEMS
BoardappointedbytheGovernorrepresentingtheEMSsystemandTheStateTraumaAdvisoryCouncil
appointedbytheSecretaryofHealthandFamilyServicesrepresentingthetraumasystem.
10
Thesetwoboardshavemanydiversifiedsubcommitteesthatareabletoaddressissuesthatfacethe
EMS&Traumasystems.TheyreporttotheEMSsectionandprovidecriticalinformationandfeedbackineffort
toassistindevelopingfunctionalandeffectivecaresystems.Theseboardshavededicatedpeoplethathave
madetheseworkingboards.Themembersrolluptheirsleevesandassistingettingissuesresolvedand
aidindevelopmentofelementsthatarecriticaltoprotectingthecitizensandvisitorsofWisconsin.
Itisbecauseoftheseboardsthattherehasbeenasignificantamountofworkengagingstakeholdersin
systemsdevelopment.TheWisconsinHospitalAssociationisoneofmanykeyorganizationstolobbyand
providesupportfortraumaandEMSactivities.Astronghealthcaresystemfacilitateseffectivequalitycare
fromonsetofinjuryorillnessthroughdischargefromcare.EMSprovidestheprehospitaltraumaand
medicalcarewhichisdefinitivelytreatedwithinthehospitalsystemandrehabilitationfacilities.Significant
progresshasbeenmadetodevelopinganeffectivehospitalcaresystemthatsupportstraumaactivitiesand
reducingmortalityanddisability.ThisdefinitivecaresystemprovidessolidsupportforactivitiesforTrauma
andEMS.
TrainingCenters
Inthesamesupportroletothesystemasawholearethetraininginstitutionsthatprovideeducation
fortheprovidersandindividuals.TheWisconsinTechnicalCollegeSystem(WTCS)isthebackboneoftraining
foremergencymedicaltechniciansandotheralliedhealthcareprofessionals.Thereare26EMStraining
centersthatservethestate;16ofwhichareWisconsinTechnicalCollegesandprovide95%ofinitialtraining.
Therearethreeprivatecentersthatofferinitialparamedictrainingandtheremaindersofthecentersprovide
inhouserefreshertraining.ItisthistietotheWTCSthatallowsforcosteffectiveandaccessibletrainingfor
theEMS&Traumaworkforce.
ThepartnershipbetweentheEMSSectionandtheWTCSismutuallybeneficialandstrong.The
WisconsinTechnicalCollegeEMSTrainingCenterAdvisoryCouncilprovidesthevoiceforEMStraining.In
collaborationwithalltrainingcenterstheyprovideexpertadviceoneducationalstandardsandproceduresto
boththeWTCSandthedepartment.ThisallowstheEMSsectiontocontinuetoassureconsistentquality
trainingforEMSproviders.
11
ScopeofPractice
TheeducationalsupportfromtheWTCShashelpedtokeepWisconsinattheforefrontofEMSand
traumacare.ThecitizensandvisitorsofWisconsinarefortunatetohaveavailablesomeofthemost
progressiveandaggressivetreatmentsintheUnitedStates.Thisisatthecreditofthevariousstakeholders
andadvisorygroupsthathavetakentheapproachofifitcanbedonesimply,provideabenefit,andnot
makethepatientworse,itshouldbedone.InWisconsinwehaveascopeofpracticethatspecifieswhat
skills,equipment,andmedicationsareallowedtobeusedorperformedwithintheirleveloflicensure.The
philosophyabovewithstrongmedicaldirectionhasallowedawidescopeofpracticethatprovidesaccessto
treatmentsatalllevelsthataregenerallyreservedforhigherlevelprovidersinmostotherstates.
Withtheseaggressivetreatmentsandgenerousscopeofpractice,theStateofWisconsinhasprovided
someinfrastructuresupport.In1989thelegislaturepassedafundingassistanceinitiativethathashelpedto
supportthedevelopmentofEMSsystems.Theprovisionis2.2milliondollarsthatistobesharedamongall
providersof911service.Thismoneyismarkedforeducationandserviceinfrastructuresupportfornew
equipmentandambulances.Theaverageservicereceivesabout$4,000ayearfromthisaidsprogram.
Summary
Asonecansee,theEMSandTraumasystemshavemanystrengths.Theyhavebeendevelopedwith
dedicatedprofessionalsandvolunteers.Supporthasbeenshownthroughthevariousstakeholdergroupsto
developastrongEMS,Hospital,andTraumasystemforsupport.Theeducationalsystemhasprovidedsupport
fortheprogressiveandeffectivescopeofpractice.Finallythestakeholdersweresuccessfulintryingto
providecontinuedsupportthroughtheaidsappropriationtoambulanceservices.Thishasallbeencompleted
withthemainfocusbeingtoprovideeffectivequalitycaretothecitizensandvisitorstotheStateof
Wisconsin.
WEAKNESSES
Asmentionedearlierstrengthsarealwaysbalancedbyweaknesses.Thestakeholdershaveidentified
thefollowingassignificantbarrierstoaneffectivesystem.Theidentifiedweaknessesareworkforceissues,
lackofstablefundingtosupportdevelopmentandstructure,noincreaseinfundingassistancedollarssinceits
inception,poorcommunicationofinformationthroughtheEMSindustryaddingtoinadequate
representation,lackofDHS/DPHsupport,lackofregionalEMSsupport,andthegeographyofserviceareas.
12
EMSWorkforce
TheEMSworkforceishardtoidentifybecauseofthelackofdata.Basicallytheaverageworkerisin
theirmidtolatetwentiesandearnsanaveragesalaryofapproximately$25,000peryear.Themeanageofan
EMSworkertodayis40yearsofage.However,asstatedpreviouslythereisstrengthinthededicated
volunteerstoprovidevitalservices.However,thisisalsoatrueweaknessbecausetheworkforceisnot
consistentandreadilyavailabletohandlerequestsforservice.Thisisonlycompoundedbytheattitudeofwe
arejustvolunteers.Thepublicexpectsprofessionalandcompetentprovidersdeliveringtheircare.A
volunteerworkforcehassignificantchallengesthatitpresentstoassurethislevelofservice.Manyproviders
mustworkanormaljobandtheirtimeislimited.Thismeansthatavolunteerworkforceneedstobeatleast
twicethatofafulltimeservice.Thisaffordsadequatecoverageforserviceandtrainingandtheavailabilitiesof
thepersonnel.
Inregardstocompetencyitaffordslittletimetodothosetrainingandqualityassuranceactivitiesthat
arecriticaltoqualitycare.Typically,astrainingandcompetencyverificationisincreasedtomeetcurrent
standards,thevolunteersfindtheincreasesunmanageable.Thistypicallyleadstothecommentofweare
justvolunteers.Unfortunatelythepublicdoesnotmakethatdistinctionwhentheyneedanambulance.Their
expectation,andright,istohaveaqualifiedlicensedEMTarrivewithstateoftheartequipment.Thelevelof
accountabilityisthesameregardlessofhowtheserviceoperatesallEMTsarelicensedtothesame
standardsandrequirethesamecredentialingandmaintenanceofskills;paidorvolunteerthereshouldbeno
differenceinthequalityofcarethatisbeingprovided.Thisjustbuildsacaseforconsolidationofservicesto
betterfacilitatecoordinationofactivitiesandaccountability.Thereareareasthatwillneverbevoidof
volunteerismandthisismorethanappropriate.Howevertheweaknessistheabilityofmaintainingthe
providerslevelofcompetency;notintheoperation.
Anotherissueisthatmanyofthesevolunteersarededicatedtotheircommunitiesandtheprofession.
Thismayseemcontrarytotheabovestatement,buttheywilldoeverythingwithintheirpowertomakeevery
callforservice.Iftheyarelowonpeople,funding,equipment,education,theywillalwaysrespondinthebest
waytheycan.Itisnotwithintheirpersonalitiestorefuseacallorallowonetogounanswered.Thisis
detrimentaltothembecausetheyworkonshoestringbudgetsandlessthanoptimalequipmentandallow
theirgoverningbodiestoassumethattheywillalwaysbetheretoanswerthecallandtheywill!Other
professions,whentheyaretreatedunjustly,willjuststopworking.Theseprofessionalswilladapttoanything
13
thatisthrownatthembecausetheyaretrainedtoreactinthismanner.Thissignificantlyaffectstheabilityto
bargain.WhenaskedHowarethingsgoing?Theyrespondwithfinebecausetheyhaveadaptedtothefact
thatthingsare,andalwayswillbe,thewaytheyare.
Funding
ThededicationoftheprovidershashadanegativeinfluencetofundinginitiativesforEMSandthe
Traumasystem;theydothejobregardlessofthebarriersthatareplacedbeforethem.Manyfunding
initiativeshavebeentriedveryunsuccessfully(1992,1993,&2001).Inthisageofreducedbudgetsand
shrinkingfiscalsupport,thetimemaynotberightforseekingastablefunding.However,iftheprevious
attemptswouldnothavefailedtheproblemwouldalreadyberesolved.Thebottomlineisthatthesystemwill
failifstablefundingisnotfound.Therehavebeennosignificantimprovementstothesystemsbecause
fundingisneededtoperformessentialfunctions.
Servicesandindividualsarebeginningtoseetheconsequencesofthisenvironment.Therehasbeen
delayedresponsetoinquiries,licenseissuance,andresponsestophonecallsandemails.Therehasbeenlittle
supportforthetraumasystemandtheWARDSprojectwhichhascausedthestakeholderstobecome
concerned.Theofficeisunabletoprotectthepublicbecausetherearenotadequateresourcestoinvestigate
complaintsanddositevisits.Thislackofstablefundinghasalsocausedtraveltobesignificantlyreduced
whichcompoundstheeffectsoftheseissuesandpreventstheSectionfrommaintainingtheintegrityofthe
systemandenforcingtheadministrativerulesandstatutes.
Anothersignificantweakness,thatwouldappeartobeastrength,isthefundingassistanceprogram.In
1989(almost20yearsago)thelegislatureapproved$2.2Millionasaidforambulanceservices.Thepurposeof
themoneywastohelpprovidefundingfortrainingandnewequipment.Theaveragecheckisaround
$4000.00perservice.ThismoneydoesnotgofarconsideringthecostoftraininganewEMTrunsabout
$1000.00andtheaveragecostofarefreshercourseisabout$75.00.Ashealthcarecostshaveincreasedand
reimbursementsfrominsurancedecrease,thismoneyhasmeantmoretoservicesbutnotgoneasfar.There
hasbeennoadjustmenttothismoneyinover19years.Thisisasignificantbarriertohelpingservicesmeet
theincreasingcostsofoperatingandtrainingproviders.
14
Communication
Manyoftheweaknessesstemfromasimpleproblemthatplaguesmanyindustriesandthisis
communication.Asalludedtoabove,whenaquestionisaskedofaservicebytheirlegislators,thededication
oftheprovidersallowthemtostatethatallisfine.Thisisacrucialflawinthecommunicationsystemwithin
theEMSindustry.Withouttheproperflowofinformationfromtheindustrytothoselegislatorschanges
cannotbemade.Thelocalservicewillrespondregardlessofanythingelsethatisoccurring.Thekeyto
facilitatinganychangeistheimprovementofcommunicationbetweenallstakeholdersintheindustryalong
withthepublicandtheirpolicymakers.
Communicationhasalsobeenabarrierwhenlookingatsupportfromwithinthedepartmentofhealth
services.Accordingtothestakeholders(manyofthempreviousemployeesofthedepartment),the
departmenttraditionallyhasnotbeenafriendtotheEMSandTraumasystems.Manyofthereportsdueto
thelegislaturewereheldbackbythedepartment,manyrequestsforfundingwereneversupportedorsent
forward,andtypicallytheirrolehasbeenreactiveratherthanproactiveinhelpingmeettheneedsof
supportingthesesystems.
ThislackofsupportwasveryclearwhentheEMSsectionandgovernorappointedboardspentthree
yearsworkingonaninitiativetoregionalizeEMS.Theplanwastoplaceonestaffmemberintoeachpublic
healthregionaloffice.ThisindividualwouldworkfortheEMSsectionbutbethelocalcontacttoassistwith
regionalissues.Thebenefitsofthisplanweremanybutneversupportedbythedepartment.Thisisoneof
manyprojectsthatshowedthedepartmentdidnotconsiderEMSapriority.
GeographicDifferentiation
FinallyasignificantweaknessisthediversegeographythatWisconsinhaswithinitsbordersandthe
variedmethodsandsystemsthatneedtofunctionforaneffectivesystem.Thegeographyismoreofa
significantbarrierthanweaknessbutitdoesaffectthedevelopmentofanintegratedTraumaandEMS
system.Whatworksinoneareamaynotrelatetoanother.Distancefromthehospital,distancefromthe
nearestadvancedlifesupportsquad(ALS),aswellasthedistancetohigherleveldefinitivecarecan,attimes,
beasignificantissue.Thisisonlycompoundedbythedistancetotrainingopportunities.Someserviceshave
totraveloveranhourjusttogettotheirlocaltechnicalcollege.SomeareevenclosertoMinnesota,Michigan,
Iowa,orIllinoisresourcesthanthoseinWisconsin.Thisisabarriertowardsstandardizationofservicedelivery
15
andwillrequireauniquesolutiontohelpdeveloplocal(orregional)systemsthatcanpartnerandjoin
resourcestoprovideforeffectiveservice.
Itmakessensethatifalocationismilesawayfromahospitalthatahighlevelofcareshouldbe
available.Unfortunately,ourveryruralareaswithtransporttimesof3060minutesaregenerallycoverwith
EMTsandnotparamedics.Theresourcesoftraining,people,anddollarspreventtheruralareasfromhaving
highlevel&qualityprovidersavailable.Everycitizenandvisitorinthisstatedeservestohaveaccesstothe
essentialcaretheyrequireandprovidingaccessinruralareashassignificantchallengestobeovercome.
Summary
TheweaknessesaresignificantastheyrelatetothesurvivaloftheTraumaandEMSsystem.Oneofthe
greateststrengthsisthevolunteersandthewaytheyoperateonashoestringbudget.Clearlythisisalsoa
weaknesswhenitisappliedtotheoverallviewofthesystems.Tightlyrelatedisthelackoffundingsupport
theyandthesystemreceive.Thisiscompoundedbythelackofcommunicationbetweenthepublic,the
legislator,andtheEMS&Traumacommunities.
THREATS
Threatsarethosethings,thatifgounchanged,willcauseanimminentfailureofthesystems.Typically
thereisadirecttiebetweenthreatsandweaknessesandwithinEMS&Traumathisisnodifferent.Threatsto
thesystemsincludeinconsistentandinaccuratemessagestothepublicandgovernmentleaders,Public
perception,otherspecialinterestgroups,strongethicsoftheworkforce,lackofstablefunding,open
administrativerules,DHS/DPHManagement,allofwhicharerepresentativeofafailingEMS&Trauma
infrastructure.
LackofunitedEMS&TraumaSystemVoice
Asnotedearlier,therehavebeenseveralattemptsatfundingandchangingthewayEMSandTrauma
aremanaged.Someoftheseinitiativesweresuccessfulandothersfailedtomeetexpectations.Thishasbeen
commonlyreferredtoasafailuretocommunicate.Thisreallyspeakstotwoitems;inconsistentmessagesand
thespecialinterestsofothergroups.Earlieritwasstatedthatcommunicationbetweenthestakeholderswas
lackingorganizationandclarity.ThisthreatenstheabilityofaunifiedvoiceforEMS&Trauma.Itisonly
furtherweakenedbytheattacksofotherspecialinterestgroupsastheyforcetheirmessagetothepolicy
16
makersandkeepdownthemessageofEMS&Trauma.ThistrulyhasgivenamixedmessagethatEMS&
Traumahavenoconsolidationandareworkingtowardscommongoals.
LackofPublicAwareness
Thecitizensandvisitorshavebeenlulledintoafalsesenseofsecuritywhereambulanceserviceis
concerned.Manyneverusetheservicebutarehappytoknowitistherewhentheyneeditorisit?EMSis
commonlyseenasacommunityservicethatisprovidedbythemunicipalityeitherdirectlyorthrougha
servicecontract.Manydontthinkaboutituntiltheyneedtheservice.Then,whenitisnottotheexpected
standardtheycriticizeandcomplainbutareunwillingtosupportafundingrequesttomakeitbetter.This
doesnothappeninallinstancesbutisthefrequentresponse.Peopledonotunderstandnorcanfathoma
timewhentheyneedthislifesavingserviceanditdoesnotarrive.Howeverthetimemaycomesoonerthan
anyonecanimagine.
StrongEthics
ThisthreatisevenperpetuatedbythelackofactionorunderstandingoftheEMTsinthefield.Asthey
sacrificetonotjeopardizelifeorlimbtheyshowadedicationthatinstillsconfidenceinthepublicandthe
communityleaders.Themessageis;nomatterhowbaditgetstheywillbetheretoserve.Thisthreatensand
underminesthemessagethatthesystemisfailingandifhelpdoesnotcometoEMS&Traumasoon,therewill
benohelpforthoseinneed.
InadequateFunding
Unfortunately,aswithmanyotherprogramsinWisconsin,thesystemneedsfundingtosurviveand
assurealastingqualityEMS&Traumasystem.Thiswouldnotbeacriticalissueifthoseinpowerduringthe
lastattemptswouldhavebeenreceptiveandfoundtheneededfunding.Instead,thesystemisonthevergeof
failureandnowafundingsourceisneededtofixthesystem,soitcancontinuetomeettheneedsofthe
State.
Asmuchasfundingisneeded,theadministrativerulesandstatuteneedtoberevised.HFS110113are
currentlyopenforrevision.Theproblemisthatwhiletheyareopentherecouldbechangesmadethatare
unintended.Asmentionedbefore,somespecialinterestgroupsmayhaveanopportunitytofindsomeissues
orconcernsthatwillhurtthesystemratherthanhelp.Thisisalwaysaverydifficultprocesstoassuretherules
17
aredevelopedfairly,andtocorrecttheconcernsthathavedeveloped.Apoorlywrittenruleorrequirement
couldhurtthesystemmorethantheintenttohelp.
OffurtherconcernotherthantherulesisthesupportoftheDepartmentofHealthServices.As
mentionedearliertherehasbeenahistoryoflackofsupport.ThereasonsorintentofnotassistingEMS&
Traumaisirrelevantinthisdiscussion.Thefactsarethatinthepastpromisesweremadeandnotfulfilled.
Manyhoursofvolunteerworkwascompletedandnotforwarded.ThisisnottosaythatDHSisunwillingat
thistimetosupportEMSandTraumaactivities,butitdoesbegthequestionastothetrueamountofsupport
thatwillbeaffordedtoEMS&Traumafromthedepartment.
Summary
Thisgeneraloverviewofthethreatsissimplythat,anoverviewofthosethingsthatwillbeanegative
forcetoovercomeingoingforward.Ifcommunicationbetweenthesystempartners,workforce,policymakers
andpublicarenotalltiedtogetherinuniformity,nothingwillchange.EMSworkersmustcomeforwardwitha
voiceandshowthattheirdedicationistheonlyglueholdingthesystemstogetherbecausetheinfrastructure
isbeingthreatenedbylackoffundingandattacksofpolicy,regulation,andpotentialspecialinterests.
OPPORTUNITIES
Opportunitydoesaboundregardlessofthethreatsandweaknessestothesystems.Focusingonthese
willhelptofacilitateaforwardvisionandthedevelopmentofstrongersystems.Thestakeholdersidentified
opportunitiesforapotentiallegislativecouncilstudy,buildingconsensusthroughstakeholderinitiativesand
consortia,infrastructuretoeducateandpromoteEMS&Trauma,developingEMS&Traumadatasystems.
LegislativeStudyCouncil
OneofthegreatestpossibilitiesthatthestakeholderssawwasforalegislativestudycouncilforEMS&
Trauma.In1992thestudycouncilwassuccessfulinallowingupdatedlegislationandidentifyingweaklinksin
thesystem.Theyattemptedtofixtheproblemsbuttheballwasdropped.However,eventhoughthere
wereissues,thestakeholdersfeelthatthiswassuccessfulandisagainrequiredtoreviewtheprogressand
gainanotherspotlightonTraumaandEMS.Thisisthebestplacetostarttogetaclearunderstandingofthe
issuesbyputtinginplaceguidelinesthatthelegislativestudycouncilsuggestsandshouldhelptocorrectand
18
rebuildtheTraumaandEMSSystems.Inadditionitwillprovidemorepublicinformationtohelpincrease
awarenessoftheissues.
StakeholderInitiatives
Anotherpartnershipisthestakeholderinitiativesthathavehelpedtodevelopthisdocument.Though
broughttogetherwhenDHSwasreorganized,thisgroupwasreactivatedinthesetryingtimes.The
memberslistedintheappendixarecommittedtoworkingtogethertostrengthenthesystemsthroughtheir
groups,andascommunicationcanbecomestandardized,andworkcollaborativelytoeffectchange.EMSand
traumaareeithercriticalpiecesofbiggersystemsorhandinhandpartnersoftheseorganizations.This
forumcangiveEMS&Traumaalargervoiceandgreaterexposuretomanydifferentpolicymakers.
EducationalInfrastructure
Thisisthebasisoftheeducationalinfrastructurethatcanbeusedtopromotetheimportanceofthese
systemstothehealthandwelfareofboththecitizensandvisitorsofWisconsin.Thetrainingcentersand
partneringorganizationshavethemeanstoproduceeducationalmaterialsabouttheneedsandissuesfor
EMS&Trauma.Thiscanprovideawidenetofinformationalresourcestoeducateeveryoneofthesecritical
problems.ThisisbeingboostedbytheEMSBoardsrecentinitiativetocreateaspeakersgroupandpublishan
electronicnewslettertobetterdisseminateinformationtoall.
DataSystems
OneofthemostimportantresourcesbeingdevelopedforeducationisthedatasystemsofbothEMS
andTrauma.InthelastthreeyearsbothTraumaandEMShavedevelopeddatasystemsthathavethe
potentialtoshowthebenefitsofthesystemandidentifyperformancetrends.Thisvitalinformationwillonly
helptosupportinitiativesandprovideasnapshotoftheservicesbeingprovided.Dataisthecornerstoneof
scientificstudyandusedtoprovidebetter,factbasedinterventionstoincreasethehealthandwelfareofthe
public.
Summary
Itwillbetheintegrationandexploitingoftheseopportunitiesthatshouldhelptorebuildthefailing
EMS&Traumasystemsandassureasolidinfrastructure.Buildingconsensusbetweenstakeholderswillonly
19
helptofacilitatealegislativestudycounciltohelpbringfocusontothecrisis.Byleveragingthenewdata
systemsandusingtheeducationalinfrastructurethesystemcanbelookingatpotentialbrighterdays.
VISIONOUTLOOK
ThevisionoftheEMSSectionthroughleadership,support,andregulation,mustensurethe
developmentandmaintenanceofahighqualityEmergencyMedicalServicesdeliverysystem.Theprimary
focusmustbereductioninboththehumansufferingandeconomiclossfromprematuredeathanddisability
resultingfromsuddenillnessorinjury.Itiswiththisinmindthattheforwardvisionisbased.
Tomeettheexpectationofthevisionitisnecessarythattherebeaproperlytrainedandcapablestaff.
ItistheplanoftheSectiontofullydevelopafunctionalstructureofessentialpositionstofacilitatethe
fulfillmentofthemissionandvision.ThisvisioncannotbeobtainedwithoutidentifyingSTABLEfundingfor
bothpeopleandprograms.ItisthehopeoftheSectiontofinallymeettheexpectationsandcriteriaidentified
intheNHTSAreviews.
RECOMMENDATIONS
AchievingthevisionoftheSectionwillnotbeaneasytask.Thereisnosimplewayorsinglestepthat
canbetaken.Itisamultifacetedissuethatwillrequireseveralinitiativesandincludemanypeopleand
organizations.Presentedinthissectionarestrategiesthatcoulddirectactivities,andworkingtogether,begin
toresolvetheissuesforEMSinthisstate.
In2006,theInstituteonMedicinepublisheditsdocumentEmergencyMedicalServices:AtThe
Crossroads(IOMReport).Thefollowingisanexcerptfromthisreportthatemphasizestheproblemthatisvery
realtoWisconsin:
Emergencycarehasmadeimportantadvancesinrecentdecades:emergency911servicenow
linksvirtuallyallillandinjuredAmericanstoimmediatemedicalresponse;organizedtraumasystems
transportpatientstoadvanced,lifesavingcarewithinminutes;andadvancesinresuscitationandlife
savingproceduresyieldoutcomesunheardofjusttwodecadesago.Yetjustunderthesurface,a
growingnationalcrisisinemergencycareisbrewing.Emergencydepartments(EDs)arefrequently
overloaded,withpatientssometimeslininghallwaysandwaitinghoursandevendaystobeadmitted
toinpatientbeds.Ambulancediversion,inwhichovercrowdedEDsclosetheirdoorstoincoming
ambulances,hasbecomeacommon,evendailyprobleminmanycities.Patientswithseveretrauma
orillnessareoftenbroughttotheEDonlytofindthatthespecialistsneededtotreatthemare
unavailable.Thetransportofpatientstoavailableemergencycarefacilitiesisoftenfragmentedand
disorganized,andthequalityofemergencymedicalservices(EMS)ishighlyinconsistentfromone
20
town,city,orregiontothenext.Insomeareas,thesystemstaskofcaringforemergenciesis
compoundedbyanadditionaltask:providingnonemergentcareformanyofthe45millionuninsured
Americans.Furthermore,thesystemisillpreparedtohandlelargescaleemergencies,whethera
naturaldisaster,aninfluenzapandemic,oranactofterrorism.
ThiscrisisismultifacetedandimpactseveryaspectofemergencycarefromprehospitalEMS
tohospitalbasedemergencyandtraumacare.TheAmericanpublicplacesitsfaithintheabilityof
theemergencycaresystemtorespondappropriatelywheneverandwhereveraseriousillnessor
injuryoccurs.Butwhilethepublicislargelyunawareofthecrisis,itisrealandgrowing(IOMReport,
2006,p.xi).
ThiscriticaldocumentisbeingusedinEMSsystemsacrossthecountrytodirectactivitiesforimprovement
andultimatelysavelives.ThefocusoftheIOMreportistodescribethedevelopmentofEMSoverthelast
fourdecadesandthefragmentedsystemthatexiststoday.Itexploresarangeofissuesthataffectthedelivery
ofprehospitalEMS,includingcommunicationssystems;coordinationoftheregionalflowofpatientsto
hospitalsandtraumacenters;reimbursementofEMSservices;nationaltrainingandcredentialingstandards;
innovationsintriage,treatment,andtransport;integrationofallcomponentsofEMSintodisaster
preparedness,planning,andresponseactions;andthelackofclinicalevidencetosupportmuchofthecare
thatisdelivered(IOMReport,2006,p.xi).Asonecansee,ithitsattheheartofsomeverysimilarissueshere
inWisconsin.
Asaprefacetothefollowingrecommendationsofthisdocumentitisimportanttobringthehistoryof
theNationalHighwayTransportationSafetyAdministration(NHTSA)assessmentsintodiscussion.Copiesof
thesecompleteassessmentdocumentscanbefoundinappendixD&E.Twoassessmentswerecompleted,
onein1990andareassessmentin2001.Thesedocuments,inconjunctionwiththeIOMreport,provideasolid
foundationforthedirectionofEMSandTraumainWisconsin.Whatfollowsaretheintroductoryparagraphs
ofthe1990and2001NHTSAreviewdocuments.Oneshouldnotetheconsistentthemes:
1990TheresponsibilityforbothvehicularandonboardmedicalequipmentstandardslieswiththeWisconsin
DepartmentofTransportation.Thisresponsibilityisbeingfulfilledwithoutappropriatemedicalinvolvementor
oversight.
AhospitalcategorizationprocessisinplacebutWisconsinhasnoenablinglegislationwhichestablishestraumacare
systemsincludingthedesignationoftraumacenters.
Authorityexiststoregulatebasicandadvancedcareambulanceservices.However,duetolackoffundingandstaff
withintheEMSSection,nostandardshavebeenestablishedformanyprogramsandenforcement/complaint
investigationislimitedinmostprograms.Specifically,therearenorequirementsforbasicambulanceservicesto
21
haveaphysicianmedicaldirector.Inaddition,establishedstandardsareinadequateforair(rotorcraftandfixed
wing)services,andtherearenowatercraftstandardsestablished.
TheEMSSectionhasmandatorydatacollectionrequirementswhicharelargelyunenforcedduetolackoffunding
andstaff.
AsaresultofthepassageofAct102,thereisanadvisorycommitteewhichonlyprovidesadviceonthedistribution
ofAct102funds.ThereisnostatewideEMScommitteetoprovideadviceonEMSsystemsandmedicalissues.
Act102willprovideessentialfundingforEMSservicesthroughouttheState,butitfailstoprovideadequate
fundingtotheStateEMSSectionfortheadministrationofrequiredandnecessaryprograms.
TheStateEMSSectiondoesnotassessanyfeestodefraythecostsofadministeringthelicensureandcertification
programs.Thereisnoenablinglegislationfortheassessmentoffinesfornoncompliancewithlicensingor
certificationrequirements.
EnactlegislationforlicensureofEmergencyMedicalServicesDispatchers
Enactlegislationforthelicensureofemergencyvehicleoperations.
Establishauthoritytoassessfinesfornoncompliancewithlicensureandcertificationrequirements.
AssessalicensurefeeforallEMSproviderstodefraytheadministrativecostsassociatedwiththe
licensureprogram.
EstablishcomprehensiveregulationandenforcementofairandwaterEMSservices.
ProvideadequatestatefundingtosupporttheneededEMSSectionpersonnelandactivities.
2001Despitetheoutstandingprogressofthepastelevenyears,muchremainstobedone.Someofthe
barrierstoprogressthatexistedelevenyearsagoarestillpresenttoday.Dedicatedpeoplethroughout
thestate,bothpaidandvolunteer,doingajobwithlittlerecognitionandinadequateresourceshave
createdmonumentalachievements.ButevendedicationandhardworkcancarryWisconsinonlysofar.
Currently,resourcesarebeingcutandpersonnelandfinancialsupporttomaintainandcontinue
improvingtheEMSsysteminWisconsinhaveerodedtothepointthatthesystemisindangerof
collapse.Evenwithahostofvolunteers,astable,continuingfundingsourcemustbeobtainedforthe
BureauofEMSandInjuryPreventionandpersonnelresourcesmustbeallocatedtomeetthedemandfor
servicestothepublic,theEMSvolunteerandcareerpersonnelandotherEMSsystempartners.The
politicalleadershipinWisconsinmustaddresstherealneedsfacingtheWisconsinEMSsystemand
ensurethatstablefundingmechanismsandpersonnelresourcesareavailabletomaintainagood
systemandmakeitevenbetter.
Thesetwodocumentscomplementeachotherinthefactthatthesystemisindisarrayandthecommon
themeisthelackofsupportbothfinancialandpolitical.Theforwardfocusofthisplanisnotbasedintheneed
22
forfunding;itisbasedintheneedforchangetoprotectlives.ThemissionoftheWisconsinEmergency
MedicalServicesSectionistoensurethatthehighestqualityandstandardsofprehospitalemergency
medicalcareisavailabletoallcitizensofandvisitorstoWisconsin.Thisistheonlygoalofthisplan.
TheRecommendedstepswiththestakeholdersassistanceare:
1. RequesttheNationalHighwayTransportationSafetyAdministrationcompleteareassessment.
2. EstablishalegislativestudycommitteetoreviewtheEMSprogramandrecommendchangestothe
EMSBoardstructure.
3. BasedontheaboveprovideadequatefundingandstafffortheStateEMSSectiontosupporttheEMS
&Traumasystems.
4. IdentifyandchangeStateStatutesthatarerequiredtoprovideproperoversite.
5. InitiateneededsystemimprovementprojectsbasedonNHTSAReviewandstakeholderinput.
a. Datasystemdevelopment/integration
b. Qualityassuranceinitiatives
c. Recruitment&retention
d. Regionalization
6. Completeastrategicplanthatwillprovide1,3,5,and10yearprojectplanforsystemimprovement.
Theaboveitemsseemverystraightforwardbutaremultifacetedintheirimplementationandconsideration.
Asthefirstitemindicates,itwillbenecessarytohaveNHTSAcometoWisconsintocompleteareassessment.
ThepurposeistovalidatetheassumptionsthathavebeenregardingthestateofEMS&Trauma.Someofthe
stakeholdersbelievethattheassessmentwillshowthatWisconsinhasfallenbacktomanyoftheelements
thatwerenotpresentduringthefirstassessment.
Theassessmentisalsothebestplacetostartandbuildmomentumforimprovement.Theoutcome
fromthepreviousreviewsdidprovideformanychangesthatbenefitedthesystems.Howevertherewasno
increaseinfunding,noprovisionforsustainability,andnofollowthroughontherecommendationstothe
legislature.ItwillbecriticaltohavethistaskcompletedtoaccuratelyshowthecurrentstatusoftheEMS&
Traumasystems.
Aftertheassessmentiscompleted,itshouldprovideaspringboardforaLegislativeCouncilStudy
CommitteetoreviewtheEMSprogram.Thelasttimethiswasdonetheworkhadmixedresults.The
recommendationsfromtheNationalHighwayTransportationSafetyAdministration(NHTSA)thatdidnot
23
requirefundingwereimplemented.Addingstaffandothersuggestionsthatrequiredfundingwerenot
addressed.TheDepartmentofHealthandFamilyServiceshashesitationwithaddingstaffandfindingfinancial
support.Themainreasonisthenumberofstudiesthathavebeencompletedwithlittleornoactionorfollow
up.However,thestakeholder,representingtheEMScommunity,findsitverynecessary.Itisimportantto
thesegroupsthatlightbeshedontheseneglectedindustriesEMSandTrauma.Manycitizensandpolicy
makersautomaticallyassumethattheyarepartofthefireservicebut54%oftheservicesarenotaffiliated
withtheseagencies.
ThoughtherearemanyissuesforreviewintheLegislativeCouncilStudyCommitteethemajor
discussionneedstobefocusedonfundingtheEMS&Traumasystemsandprovidingforproperstaffingofthe
EMSSectiontofulfillitsroleofqualityassuranceandsystemintegrity.Itwouldbethestakeholdersdesire
thatthecommitteewouldlookatotherstatesmodelsforrevenueandoperationalsubsidies.Theseprovide
forsomeverycreativeandnonintrusivefundingschemes.Somestatesuseanexpandeduserandlicensefee
model,finesandpenalties,vehicletaxes,insurancepremiumtax,andonestateofficereceives2%ofallfines
andforfeitureschargedthroughthecourtsystem.Thoughthisparticulardiscussionisonfunding,itmustbe
rememberedthattosupporttheSectionondoingsitesurveys,qualityassuranceinitiativesandaidingservices
withrecruitment&retentioninitiatives,itwilltakefinancialsecurity.
InconjunctionwiththeLegislativeCouncilStudyCommittee,itishopedthatlightwouldbeshedon
theEMSboardappointments.AccordingtotheGovernorswebsite;
Theboardshallconsistof11votingmembers,appointedfor3yearterms,whohaveaninterestandexpertisein
emergencymedicalservicesissues,whorepresentthevariousgeographicalareasofthestateandwhoinclude
representativesofthevarioustypesofemergencymedicalservicesproviders.Inadditiontothe11voting
members,thesecretaryofhealthandfamilyservices,thesecretaryoftransportation,thedirectorofthe
technicalcollegesystemboardandthestatemedicaldirectorforemergencymedicalservicesortheirdesignees
shallserveasnonvotingmembersoftheboard.
CurrentlytheboardconsistsofrepresentativemembersoftheEMScommunitythatdonotfulfillthis
mandate.ThereisgeographicrepresentationbutmanyviewsofEMS&Traumahavebeenneglected.There
arenomembersoftheboardfromthenorthernportionofthestate.Thereisnovolunteer,individualEMT,air
medical,lawenforcement,military,ortraumarepresentativesontheBoard.Itwouldbetherecommendation
thatthemembershipbemadeofsubjectmatterexpertsfromtheEMScommunitythataregeographically
diverse.ThiswouldvalidatetheirpresenceontheBoardaswellasprovideexpertinsighttotheworkthatis
beingdone.ItwillalsohelptomaketheBoardmoreeffectiveandfocusedontheworkthatwillneedtobe
24
completed.Thisisnotinconflictwiththeappointmentguidelinesbutneedstobeenforcedtoassureequal
representation.
AstheLegislativeCouncilStudyCommitteepreparesitsreportandrecommendations,itishopedthat
thiswillprovidetheneededattentiontocausediscussionsonhowtoimprovethesystems.Thiswillmost
likelyrelatetoafundinginitiativetobeintroducedtothehouseandsenate.Itisatthispointthatitwillbe
necessarytohavethestakeholdersvoicetheirconcernsandsupportfortheinitiativethatwillbeproposed.
ThiswillallowforproperstaffingoftheSectiontofacilitateaqualitycaresystemthattightlyintegrates
practicebasedmedicinetohighqualitystandards.
ThepreviousNHTSAreviewsbothsupporttheneedforfundingtoincreaseandsupportsystem
integrity.Initiativeslikequalityassurance,sitevisits,timelyinvestigationsofcomplaints,analysisofdata,
developmentoftechnicalassistancetosupportvolunteerservices(whichincludesaregionalpresencefrom
theEMSSection),andmoretimelyambulanceinspections,arejustsomeofthenecessaryelementthat
requirestaffingincreases.Thereareservicesusingunauthorizedequipmentandmedicationsandhaveno
fearofbeingcaughtbecausetherearenotenoughpeopletoassurecompliance.Servicesaredoingasthey
pleasewithoutanyconsequencesandthisisthreateningthesafetyandlivesofthosebeingtreatedand
transported.Thisiswhythesystemisatacriticalcrossroad,thereismuchtooverseeandlittleresourcesto
assurecompliance.
StaffingandessentialservicesarebetterillustratedintheorganizationalchartlocatedinappendixE.
Onecanseethatthereisaneedforinvestigators,educationaloversight,programsupport,servicesupport,
anddataanalystsjusttonameafew.Thetraumasystemissignificantlyimpairedbecauseitcurrentlydoesnot
haveatraumacoordinator,itneedsastatetraumaregistrarforthedatasystem,aswellasanadditional
supportstafftomaintainallofthecurrentresponsibilitiesandinitiatives.Thisisessentialinassuringsystem
survivalandpreservingpreciouslives.
Iftheproperpeoplecanbeputintoplacetorightthesystems,therewillmostlikelybeaneedfor
changestostatutes.Thepurposewillbetoallowforsystemchangestobetterfacilitatequalitymanagement
andassureproperoversightandsupport.BetterdefiningtherolesoftheEMSBoardandtheStateTrauma
AdvisoryCouncil,alongwithcleaningupvaguelanguagewillbethefocusofthestatutechanges.Thiswillbe
doneinconjunctionwiththeEMSandTraumaboards,thestakeholders,andbasedontherecommendations
fromthedepartmentandtheLegislativeCouncilStudyCommittee.Thedepartmenthasalreadyidentified
manystatutechangesthatarerequiredtobetterclarifytherequirementsforoperatingwithintheEMS&
Traumasystems.
25
Asthestepsoftheabovearecompleted:theNHTSAreview,LegislativeCouncilStudyCommittee,
securingsolidfundingandbuildingafunctionalSectionstaff,revisingstatutestosupportthechangeprogress,
itwillnaturallyfallintotheneedtoaddresskeyconcernsthatareidentifiedthroughtheseprocesses.Someof
thesehavebeenpreviouslyidentifiedasdatasystemdevelopmentandintegration,qualityassurance
initiatives,recruitmentandretention,andregionalization.Theseconcernswillmostlikelybesupportedwith
findingsbytheLegislativeCouncilStudyCommitteebutarecurrentissuesthatneedtoberesolved.
Asdiscussedearlierinthisdocumentqualityassuranceisanintegralfunctionthatisnotbeconducted
duetolackofstaff.Theabilitytofollowuponcomplaintsandinvestigationsisseverelyhinderedbythelack
ofresourcesandfunding.Also,complicatingthisisthattherearecurrentlynopenaltiesinplace,andnoaction
thatcanbetaken,togettheoffendersattentionshortoflicensesuspension.Whenthisaffectsaservicethis
optionisnotinthebestinterestofthecommunityandthepeopletheyserve.
TosomeextenttherehasbeensomeworkonqualityassurancethroughtheEMSboardbutithasbeen
focusedonprovidingtoolsfortheservicestodevelopqualityassuranceprograms.Thesecanbemanagedif
thedatasystemsarefurtherdevelopedandintegrated.InJanuary2008theWisconsinAmbulanceRunData
System(WARDS)wasmademandatoryforallservices.Therehasbeenlittleworktoassurecomplianceand
increasedataqualitysincethatdate.Thisagainisduetolackofdedicatedresourcestothisproject.However
thisisaverycriticalprojectthathasfarreachingimplications.Thisis,andwillbe,thebackboneofthequality
assuranceinitiativeforEMSandTrauma.
Thetraumaregistryhasbeeninplacesince2005andhasatightfittotheWARDSsysteminthatit
couldbepossibletocaptureinjurytodischargeinformationthroughthesesystems.Themainproblemisthat
thecurrenttraumaregistrylackstheneededpersonneltomonitorandfullydevelopthesystem,letalonethe
integrationofthedata.TheseareallcriticalcomponentsthatneedtobeaddressedifWisconsinistobeable
toassurequalitycareisavailabletoall.
Theintegrationanddevelopmentofdataisintegraltoassuringthatrecruitmentandretentionof
personnelareproperlyaddressed.Thecurrentlicensingsystemdoesnotallowforeasycollectionorretrieval
ofworkforcedata.Inorderforanyinitiativesinthisareatobesuccessful,itisnecessarytoidentifytrendsand
toobtainanaccuratepictureofthecurrentworkforce.TheSectioniscurrentlylookingatanewlicensing
systemthatwillallowforeasycollectionanddataminingtobetterviewthedemographicsofthesystems
workforce.Thisneedstocontinueasahighpriorityinitiativetoassistinidentifyingrecruitmentandretention
activities.
26
ThefinalprojectthatculminatesinalloftheseinitiativesisthatofaregionalmodelforEMS.The
traumasystemcurrentlyusesaregionalizationapproachtoitsfunction.SincetheEMSboarddidapproach
thissituationmanyyearsago,itmakessenseatthistimetobuildthismodelwiththeexistingTraumadesign.
ThismayenhancebothsystemsbyhavingqualifiedpeopletofilltheEMSandTraumacoordinatorrole.This
couldbeseamlesslyintegratedintopublichealth,EMS,andTraumabyusingthefacilitiesoftheregional
publichealthoffices.ThiswoulddomuchtoimproveandintegratepublichealthinitiativeswithEMSand
TraumaandcreatebetterservicetothecitizensandvisitorstoWisconsin.
Theseinitiativesneedimmediatedevelopmenttoassurethatthesystemsdonotfail.Dataintegration
anddevelopmentleadstoqualityassuranceofsystemactivities.Itfurtherhelpstodevelopabetterpictureof
theworkforceandsupportthedevelopmentofregionalization.Theseactivitiesshouldreallybefocusedinthe
projectplanfordevelopmentthroughthenexttenyears.
Thisiswherethisstrategicplanbecomescriticaltothesurvivalofthesystems.Ifallofthesestepsare
developed,theywillbecriticalpiecestothedevelopmentofadetailedplanfortheEMS&Traumasystems.
Wherethisdocumentisaroadmaptoneededimprovements,therewillneedtobeadetailedmapof
activitieswithgoalsandobjectives.Theaboveactivities,inconjunctionwithallinterestedparties,shouldbein
abetterpositiontodevelopadetailedstrategicplanthatwilltakeEMSandTraumafarintothefuture.Plans
for1,3,5,and10yearsshouldbeintegratedintothestateEMSplanthatissenttothelegislatureasrequired
bystatute.Thiswillassistinproperdisseminationofinformationandkeepprogressontrack.
CONCLUSION
WisconsinEMSandTraumahashadalongandbumpyroadtoitspresentstate.Therehavebeenmany
upsanddownsasmodernEMShasdeveloped.Thosethatprecededdidtheirbesttodirecttheprofessionand
theSectionpositively.Unfortunately,theworkhashadverymixedresults.Thishasbroughtthesystemtoits
presentstate.Asoutlinedinthisdocument,therearemanyopportunitiesthatcanbepursued.However,
thesemustbedonewithcarebecausethreatsabound.
TheEMSSectioniscurrentlyseeingmajorproductivitydecreaseasresourcesdwindle.Thereisalack
ofqualifiedpeopleapplyingforopenpositions.Manyfactorscancontributetothisbutthemainfactorseems
tobejobsecurity.Qualifiedpeoplearenotinterestedintakingajobwheretherehavebeenmanycutsand
continuedissuesaboutfunding.Aspeopleleaveitistakinglongertogetthemreplaced.Whentimecomesto
facilitatefillingpositionsthereareadditionalhurdlesthatpreventthehiring,mainly,theredirectingofthe
moneythatwassavedduringthevacancy.
TheEMSandTraumacommunityisrealizingthattheyareonceagainatacrossroadsandthismaybe
thefinalopportunitytoresolvetheissuesthathavebeenplaguingtheEMSindustryforyears.Lackof
27
movementontheissueswithinthisdocumentwillmostlikelyresultinEMS,Trauma,andtheirstakeholders,
beginningeffortstolobbyforsweepingchanges.Theproblemwiththisapproachisthattherewillnotbeany
controloverwhathappenswiththeissuesandhowtheyareresolved.ItisimportantthattheEMSsection
createtheplanandusethestakeholderstodirecttheaction.Thiswillcreateavestedpartnershipthatcanbe
grownintoaffectingaresponsivequalityEMSsysteminthestateofWisconsin.
28
APPENDIXASTAKEHOLDERSLIST
County Rescue Services

EMS for Children
Froedtert Hospital
Gunderson Luthern Medical Center
Gunderson Luthern Medical Center
Marshfield Clinic
Medical College of WI
Milwaukee Fire Department
Northeastern Wisconsin Regional Trauma Committee
Northeastern Wisconsin Technical College
Physician Advisory Committee
Professional Ambulance Association of WI
Professional Fire Fighters of WI
Professional Fire Fighters of WI
Southeastern Regional Trauma Advisory Committee
State Trauma Advsiory Council
State Trauma Advsiory Council
Steven Point Fire Depatment
University of WI Hospital and Clinics
UW American Family Childrens Hospital
West Allis Fire Department
WI Department of Transportation
WI EMS Advisory Board
WI Hospital Association
WI Medical Society
WI Office of Rural Health
WI State Firefighters Association
WI Technical College System
WI Towns Association
Wisconsin EMS Association
Wisconsin EMS Association
Madigan
Brazelton
Bertelson
D'Huyvetter
Patel, MD
Szlabick, MD
Cady, MD
Murawski
Lintz
Lintz
Cady, MD
Fredrickson
Haase
Hefter
Ramerez
D'Huyvetter
Szlabick, MD
Kujawa
Sears
Cline
Cisler
Brazelton
Bane
Hagen
Lintz
Brazelton
Bane
Haase
Johnson, MD
Aldrich
Fellenz
Fredrickson
Murawsky
Teesch
Bazan
Grapentine
White
Stormen
Severson
Stadelman
Hunjadi
Meeker
29
Mark
Tom
Annette
Cecile
Nirav
Randy
Charles
Gloria
Cal
Cal
Charles
Mark
Troy
Alan
Robert
Cecile
Randy
Tracy
Lynne
Joseph
Adrianne
Tom
Steve
Don
Cal
Tom
Steve
Troy
Ken
Tracy
Brenda
Mark
Gloria
Travis
Bill
Mark
Char
Jim
Annette
Richard
Don
Richard
APPENDIXBCURRENTORGANIZATIONALCHART
30
EMSSysteemOverview;A
ACalltoAction
n
APPEND
DIXCPR
ROPOSEDB
BUREAUOR
RGANIZATTIONALCH
HART
Bureau
Director
Bureau
Office
Manager
Chief
Program
Assistant
Trau
uma
Coordiinator
Traauma
Asssistant
Data
D
Coordinator
Trauma
Registrar
Prrogram
Asssistant
EMS
Training
Program
Coordinator
Co
oordinator
EM
Responder
Coordinator
Licensing
Coordinator
Commun
nicatio
nsCoordiinator
Re
egional
Prrogram
Coo
ordinator
Investigator
North
Central
Coordinatorr
Lake
or
Superio
Coordinattor
WARDS
Co
oordinator
EMT
Coordinator
Investigator
NorthEast
Coordinatorr
FoxValleey
Coordinator
EMSS
Co
oordinator
AEMT
Coordinator
Licensiing
Specialist
SouthEaast
Coordinaator
Paramedic
Coordinator
Licensiing
Specialist
North/
Northwest
Coordinatorr
Southwest
Coordinatorr
WestCen
ntral
Coordinaator
EMSfor
Children
South
Central
Coordinatorr
DNR
Coordinator
31
StateMedical
Dirrector
Section
APPENDIXD1990NHTSAASSESSMENT
32
STATEOFWISCONSIN
ANASSESSMENT
OF
November1315,1990
NationalHighwayTraffic
SafetyAdministration
TechnicalAssistanceTeam
CarlR.Boyd,MD
JohnL.Chew
ArthurHarman
KarlaHolmes,RN
DonaldE.Kerns
WilliamF.Rutherford,MD
33
BACKGROUND
Injuryistheleadingcauseofdeathforpersonsintheagegroup1through44.Eachyearnearly40,000peoplelosetheir
livesonournation'sroads,andapproximately70percentofthosefatalitiesoccuronruralhighways.TheNational
HighwayTrafficSafetyAdministration(NHTSA)ischargedwithreducingaccidentalinjuryonthenation'shighways.
NHTSAhasdeterminedthatItcanbestuseitslimitedresourcesNitseffortsarefocusedonassistingStateswiththe
developmentofintegratedemergencymedicalservicesprogramsthatincludecomprehensivesystemsoftraumacare.
Toaccomplishthisgoal,NHTSAhasdevelopedaTechnicalAssistanceTeamapproachthatpermitsStatestoutilize
highwaysafetyfundstosupportthetechnicalevaluationofexistingandproposedemergencymedicalservices
programs.NHTSAservesasafacilitatorbyassemblingateamoftechnicalexpertswhohavedemonstratedexpertisein
emergencymedicalservicesdevelopmentandimplementation.Theseexpertshavedemonstratedleadershipand
expertisethroughinvolvementinnationalorganizationscommittedtotheimprovementofemergencymedicalservices
throughoutthecountry.SelectiontotheTechnicalAssistanceTeam(TAT)isalsobasedonexperienceinspecialareas
identifiedbytherequestingstate.Examplesofspecializedexpertiseincludeexperienceinthedevelopmentoflegislative
proposals,datagatheringsystems,andtraumasystems.Experienceinsimilargeographicanddemographicsituations,
suchasrural,mountainousareas,coupledwithknowledgeinprovidingemergencymedicalservicesinurban
populationsisessential.
TheWisconsinDepartmentofTransportation,OfficeofTransportationSafety,inconcertwiththeWisconsin
DepartmentofHealthandSocialServices,DivisionofHealth,EmergencyMedicalServicesSectionrequestedthe
assistanceofNHTSA.NHTSAagreedtoutilizeitstechnicalassistanceprogramtoprovideatechnicalevaluationofthe
WisconsinstatewideEMSProgram.NHTSAdevelopedaformatwherebytheEmergencyMedicalServicesSectionand
OfficeofTransportationprovidedcomprehensivebriefingsontheEMSsystembasedonanoutlinedevelopedbythe
TechnicalAssistanceTeam.
TheTechnicalAssistanceTeamassembledinMadison,WisconsinonNovember13through15,1990.Forthefirstday
andahalf,over40presentersrepresentingvariouscomponentsoftheEMSsystemintheStateofWisconsinprovided
indepthbriefingsonemergencymedicalservicesandtraumacareinWisconsin.RepresentativesofNativeAmericans
discussedproblemsuniquetoEMSintheirareas.Topicsforreviewanddiscussionincluded:
GeneralEmergencyMedicalServicesOverviewSystemComponentsof:
RegulationandPolicy
PublicInformationandEducation
ResourceManagement
MedicalDirection
ManpowerandTraining
TraumaSystems
Transportation
Facilities
Communication
Evaluation
34
TheforumofpresentationanddiscussionallowedtheTechnicalAssistanceTeamtheopportunitytoaskquestions
regardingtheemergencymedicalservicessystem,clarifyanyissuesidentifiedinthebriefingmaterialsprovidedearlier,
anddevelopaclearunderstandingofhowemergencymedicalservicesfunctionthroughoutWisconsin.Theteamspent
considerabletimewitheachpresentersothatRcouldreviewthestatusforeachtopic.
FollowingthebriefingsbypresentersfromtheWisconsinDepartmentofHealthandSocialServicesandDepartmentof
Transportation,publicandprivatesectorproviders,membersofthemedicalcommunity,andstatelegislatures,the
TechnicalAssistanceTeamsequesteredtoevaluatethecurrentEMSsystemaspresentedandtodevelopasetof
recommendationsforsystemimprovements.
Thestatementsmadeinthisreportarebasedontheinputreceived.Preestablishedstandardsandthecombined
experienceoftheteammemberswereappliedtotheinformationgathered.Allteammembersagreewiththe
recommendationsaspresented.
Whenreviewingthisreport,pleasenotetheareasinbolditalicsrepresentpriorityareasidentifiedbytheTechnical
AssistanceTeam.
ACKNOWLEDGMENTS
TheTechnicalAssistanceTeamwouldliketoacknowledgetheWisconsinDepartmentofHealthandSocialServices,
DivisionofHealth,EmergencyMedicalServicesSectionandtheWisconsinDepartmentofTransportation,Officeof
TransportationSafetyfortheirsupportinconductingthisassessment.
TheTeamwouldliketothankallthepresentersforbeingcandidandopenregardingthestatusofemergencymedical
servicesinWisconsin.Eachpresenterwasresponsivetothequestions;posedbytheTechnicalAssistanceTeamwhich
aidedthereviewersintheirevaluation.
SpecialrecognitionshouldbemaderegardingtheextraordinaryeffortstakenbyTerryMoen,InterimChief,Emergency
MedicalServicesSectionandstaff,MichaelFrench,formerChief,EmergencyMedicalServicesSection,andthebriefing
participantsfortheirwellpreparedandforthrightpresentations.Inaddition,theteamapplaudsthewellorganized,
comprehensivebriefingpackagessenttotheteammembersinpreparationfortheassessment.Specialthanksalsoto
TimGalbraith,OfficeManager,andSusanKavulich,EmergencyMedicalServicesProgramManager,Wisconsin
DepartmentofTransportationforprovidingassistancetotheTechnicalAssistanceTeam.
WisconsinEmergencyMedicalServices(EMS)
TheTechnicalAssistanceTeamreviewedtenessentialcomponentsofanEMSsystemForeachcomponentreviewed,the
TechnicalAssistanceTeamidentifiedkeyEMSissueorstandards,assessedthestatus,andmaderecommendationsfor
necessarychanges
35
A.REGULATIONANDPOLICY
Standard
Toprovideaquality,effectivesystemofemergencymedicalcare,eachEMSsystemmusthaveinplacecomprehensive
enablinglegislationwithprovisionforaleadEMSagency,aswellasafundingmechanism,regulations,andoperational
policiesandprocedures.
Status
WisconsinhasaseriesofenablingstatutesrelatingtothevariousaspectsofanEmergencyMedicalServicessystem.
Unfortunately,theresponsibilityofenforcementoftheEMSstatuteslieswithmanydifferentstateagencies.Noagency
functionsastheleadEMSagency.Thefragmentationbetweenagencieshasledtotheineffectiveuseofstate
resourcesandthefailuretocompletestatutoryrequirements.
Wisconsin'sstatutesrequiretheDepartmentofHealthandSocialServices(DHSS)toprovideadministrativeand
technicalassistancetoEMSprograms.Inaddition,DHSSisrequiredtocoordinatetheactivitiesofagenciesand
organizationsprovidingEMStraining,assistinthedevelopmentofEMStraining,assessemergencymedicalresources
andservices,andassisthospitalsinplanningforappropriateandefficienthandlingofthecriticallyillandinjured.
TheresponsibilityforbothvehicularandonboardmedicalequipmentstandardslieswiththeWisconsinDepartmentof
Transportation.Thisresponsibilityisbeingfulfilledwithoutappropriatemedicalinvolvementoroversight.
AhospitalcategorizationprocessisinplacebutWisconsinhasnoenablinglegislationwhichestablishestraumacare
systemsincludingthedesignationoftraumacenters.
Authorityexiststoregulatebasicandadvancedcareambulanceservices.However,duetolackoffundingandstaff
withintheEMSSection,nostandardshavebeenestablishedformanyprogramsandenforcement/complaint
investigationislimitedinmostprograms.Specifically,therearenorequirementsforbasicambulanceservicestohavea
physicianmedicaldirector.Inaddition,establishedstandardsareinadequateforair(rotorcraftandfixedwing)services,
andtherearenowatercraftstandardsestablished.
WisconsinhasestablishedFirstRespondertrainingbasedupontheU.S.DepartmentofTransportation'sstandardized
curriculum.However,theStatehasnolicensureorcontinuingeducationrequirements,andtheskillsusedbyFirst
Respondersvaryaccordingtolocation.Therearenofirstresponse"(nontransport)servicelicensurerequirementsand
FirstRespondersarenotpermittedtoutilizeautomateddefibrillators.
Wisconsinhasenablinglegislationpermittingtheestablishmentof911systems.Thelegislationprovidesanassessment
of25centspertelephonelinetodefrayoperationalcostofthe911system.Inruralareas,thislowfeedoesnotcover
thecostsofthe911systemanddoesnotaddresstheissueofstartupcosts.
TheEMSSectionhasmandatorydatacollectionrequirementswhicharelargelyunenforcedduetolackoffundingand
staff.
36
AsaresultofthepassageofAct102,thereisanadvisorycommitteewhichonlyprovidesadviceonthedistributionof
Act102funds.ThereisnostatewideEMScommitteetoprovideadviceonEMSsystemsandmedicalissues.
Act102willprovideessentialfundingforEMSservicesthroughouttheState,butitfailstoprovideadequatefundingto
theStateEMSSectionfortheadministrationofrequiredandnecessaryprograms.
TheStateEMSSectiondoesnotassessanyfeestodefraythecostsofadministeringthelicensureandcertification
programs.Thereisnoenablinglegislationfortheassessmentoffinesfornoncompliancewithlicensingorcertification
requirements.
Recommendations
ProvideadequatestatefundingtosupporttheneededEMSSectionpersonnelandactivities.
EnactlegislationwhichspecificallydesignatestheEMSSectionastheleadStateEMSagencyandwhichtransfers
regulatoryauthorityforEMSprogramstotheEMSSection.
EstablishthelegalauthorityforaStateEMSMedicalDirectortosupervisethemedicalaspectsofthestatewide
program.
EnactlegislationwhichwouldestablishanappropriatelyconstitutedEMSadvisorycommittee.
Enactcomprehensivetraumasystemlegislationincluding,butnotlimitedto,designationoftraumacenters,
evaluationandverificationoftraumasystems,andestablishmentoftriageandtransfercriteria/protocols.
Enactlegislationforuniformmandatorydatacollection.
Revisethecurrent911legislationtopermitthecollectionofahigherfeetopayforthestartupandmaintenanceof
the911system.
EnactlegislationforlicensureofFirstResponders,theregulationoffirstresponse(nontransport)servicesandto
ensurelimitedornocostfortraining.
EnactlegislationforcertificationofFirstResponderDefibrillation.
EnactlegislationforlicensureofEmergencyMedicalServicesDispatchers
Enactlegislationforthelicensureofemergencyvehicleoperations.
37
Establishauthoritytoassessfinesfornoncompliancewithlicensureandcertificationrequirements.
AssessalicensurefeeforallEMSproviderstodefraytheadministrativecostsassociatedwiththelicensureprogram.
EstablishcomprehensiveregulationandenforcementofairandwaterEMSservices.
Establishauthorityfortheregulationofinterhospitaltransfers.
B.RESOURCEMANAGEMENT
Standard
Theprovisionofcentralizedcoordinationtoidentifyandcategorizetheresourcesnecessaryforoverallsystem
implementationandoperationisessentialtoaneffectiveEMSsystem.Thisisrequiredtomaintainacoordinated
responseandappropriateresourceutilizationthroughouttheState.Itisessentialthatvictimsofmedicalortraumatic
emergencieshaveequalaccesstobasicemergencycare,includingthetriageandtransportofallvictimsby
appropriatelycertifiedpersonnel(ataminimum,trainedtotheEMTBasiclevel)inalicensedandequippedambulance
toafacilitythatisappropriatelyequippedandstaffed,andreadytoadministertotheneedsofthepatient.
Status
TheStateEmergencyMedicalServicesprogramlacksadequatephysiciandirectionandsupervision.Theauthorization
andresponsibilityfortheoverallStateEMSsystemissignificantlyfragmentedamonganumberofcompetingfactions.
StaffingoftheStateEMSSectionisgrosslyinadequate,andthislackofpersonnelprecludesfulfillmentofmandated
responsibilitiesdirectlyrelatedtohighqualitypatientcare.
PlansarebeingdiscussedtoconsolidatetheBureauofCommunityHealthandPreventionwiththeBureauof
EnvironmentalHealth,inwhichtheEMSSectioncurrentlyresides,forcingtheEMSSectiontooperateatanevenlower
functionallevelwithintheoverallstructureoftheWisconsinDepartmentofHealthandSocialServices.TheEMS
programlacksadequatevisibilityandsupporttoenableittofunctionproperlyinassuringcompliancewithminimum
standardsofemergencypatientcareandneededEMSprogramimprovements.
ThereisnoappropriatelyconstitutedadvisorycommitteetoassisttheDepartmentintheongoingestablishmentof
administrativerulesandpoliciesforstatewideEMSactivities.
ThereisnocomprehensivestatewideplanforEMSdevelopment.
38
Recommendations
Centralizeauthorityandresponsibilityforprogramregulation,management,development,andthecoordination
andadministrationofEMSgrantprogramswithintheStateEMSSection.TheStateEMSSectionshouldbe
restructuredtoreflectamoreappropriatedegreeofimportanceinprotectingthehealthandsafetyofthepublic
Provideadequate,ongoing,statefundingsupportforEMSprogramactivities,e.g.,centralandregionalstaffing,
traumacaresystemdevelopmentcommunications,andtraining.
AppointaphysicianwithextensiveknowledgeandexperienceinEMStoserveastheStateEMSMedicalDirector.
HeorsheshouldbeappointedbytheDepartmentofHealthandSocialServicesandprovideoverallsupervisionof
themedicalaspectsofthestatewideEMSprogram.
DevelopacomprehensiveStateEMSplan.
EstablishaStateEMSAdvisoryCommitteewithmembershiprepresentingphysicians,prehospitalpersonnel,
emergencynurses,EMSprovidergroupsandassociations,participatingfacilities,governmentalsponsors,and
consumers.ItspurposeshouldbetoadvisetheDepartrnentofHealthandSocialServicesontheestablishmentof
EMSpoliciesandadministrativerules.
StateEMSSectionstaffingshouldbeincreasedorestablishedatstateandregionalEMSsystemlevelstoaddress
identifiedneedsinsuchareasas:
StateEMSmedicaldirection
Traumacaresystemsdevelopment
Inspectionandlicensure
Investigation
Datacollectionandevaluation
Pubicinformationandeducation
Communications
Comprehensiveplanning
Training
39
RegionalizecoordinationofEMSsystemcomponents,underthedirectionoftheStateEMSSection.
C.MANPOWERANDTRAINING
Standard
EMSpersonnelcanperformtheirmissiononlyNadequatelytrainedandavailableinsufficientnumbersthroughoutthe
State.EachprehospitaltrainingprogramshoulduseastandardizedcurriculumforeachlevelofEMTpersonnel.Inan
effectiveEMSsystem,trainingprogramsareroutinelymonitored,instructorsmustmeetcertainrequirements,andthe
curriculumisstandardizedthroughouttheState.Inaddition,thestateagencymustprovideacomprehensiveplanfor
stableandconsistentEMStrainingprogramswitheffectivelocalandregionalsupport.
Status
TheEMSsysteminWisconsinconsistsofthreelicensedlevelsandthreecertificationlevelsofprehospitalproviders
frombasicEMTtoparamedic.Thelicensurelevelsinclude:EMTBasic(120hours),EMTIntermediate(100hours),and
EMTParamedic(750hours).Certificationlevelsinclude:EMTEpinephrine,andEMTD(Auto5hoursandManual20
hours).Therearecurrently12,500EMTBasics,3,500EMTDs,750EMTIntermediates,and700EMTParamedics.
AllEMTBasiccoursesareapprovedandconductedbytheWisconsinBoardofVocational,Technical,andAdultEducation
(VTAE)system.Thereisnostandardizedcourseevaluationorqualityassuranceprograminplace.Coursesareconducted
onan"honor"basisunlesscomplaintsarereceived.Allcoursesareevaluatedbythestudents.Ifnonegativecomments
arereceived,followupwithcoursecoordinatorsandinstructorsisnotdone.
AlladvancedlevelcoursesarereviewedandapprovedbytheStateEMSSection.
BasicEMTinstructorsarerequiredtobecertifiedpriortoinstructinganycourses.Thereisnostandardfortrainingof
instructors,nostandardforrecertifyinginstructors,andnorequirementforcontinuingteachingtoremaincertified.
80%ofthelicensedEMSservicesintheStatearevolunteers.
FirstRespondersarenotregulatedorlicensedintheState,
Thereisnomandateforstandardizedtrainingandlicensureofemergencymedicaldispatchersandemergencyvehicle
operators.
EMTBasiccoursesareavailabletoallareasoftheStateifclasssizeislargeenough.Thirtystudentsareneededbefore
trainingcanbegin,whichisabarriertotraininginruralareas.Specialtycourses(BTLS,ACLS,ATLS,EMSC,PALS,
HazardousMaterials,CISD)areavailableintheStatewithnoongoingfundingsource.
ThereportedEMTattritionrateishigh,
40
Recommendations
MandateallauthoritytoregulatecoursesbevestedwiththeStateEMSSection.
DevelopandimplementacourseevaluationandqualityassuranceprogramforallcoursesatalllevelsDistribute
summariesofevaluationstocoursecoordinatorsandinstructors.
ImplementstandardizedinstructortrainingutilizingDOTInstructorcurriculum.Theprogramshouldinclude
standardizedrecertificationrequirementsandshouldrequireteachingexperienceduringcertificationperiods.
Developandimplementstandardizedtraining,licensure,andcertificationofFirstResponders,FirstResponder
Defibrillation,EmergencyMedicalDispatchers,andemergencyvehicleoperators.
TheStateEMSSectionshouldmovetowardmandatoryaccreditationbytheAmericanMedicalAssociationJoint
ReviewCommittee(AMA/JRC)forparamedictrainingprograms.
Developaprocess/mechanismtopresentsmallgroupswithlow/nocosttraininginruralareas.
FosterpublicinformationandeducationdevelopmentthroughouttheEMSsystem,continuingtoutilizeWEMTA
personnelandresources.TopicstobeincludedinthesePI&Eprogramsshouldincluderecruitmentandretention.
D.TRANSPORTATION
Standard
Safe,reliableambulancetransportationisacriticalcomponentofaneffectiveEMSsystem.Mostpatientscanbe
effectivelytransportedinagroundambulancestaffedbyqualifiedemergencymedicalpersonnel.Otherpatientswith
moreseriousinjuriesorillnesses,particularlyinremoteareas,requirerapidtransportationprovidedbyrotorcraftor
fixedwingairmedicalservices.Routine,standardizedmethodsforinspectionandlicensingofallemergencymedical
transportvehiclesisessentialtomainaconstantstateofreadinessthroughouttheState.
Status
Thereare941groundambulances,8rotorcraft,7fixedwingaircraft,and450serviceslicensedintheState.Allground
vehiclesareinspectedannually.
Thelicensingandinspectionprocessforgroundambulancesiscurrentlybeingaccomplishedutilizingtwoseparatestate
offices.TheStateEMSSectionreceivestheapplication,reviewsitforcompletion,thenforwardsittotheinspection
officerintheWisconsinDepartmentofTransportation(WDOT)office.Whentheinspectionhasbeensuccessfully
41
completed,theapplicationisreturnedtotheStateEMSSection,andlicenseisissued.Thisprocessleadstodelaysofup
to6monthsinlicensingandplanapprovalforambulanceservices.
RequiredequipmentingroundambulancesisdefinedandmandatedbytheWDOTwithnomandatoryinputfromthe
StateEMSSection.Inspectionofmedicalequipment(e.g.defibrillators,suctiondevices)isperformedbytheWDOT.
AllgroundambulancesatthebasiclevelarestaffedbyonelicensedEMT,RN,MD,orPA.Thesecondindividualmust
meetaminimumofCPRcertificationandcompletionofAmericanRedCrossFirstAidtraining.Allparamedicservices
mustbestaffedbynolessthantwolicensedparamedics.
Thereisnoongoingassurancethatfixedwingaircraft(airtaxi)meetminimumstatutoryrequirements.
Emergencyvehicleoperatortrainingisavailabletosomeservicesbutisnotmandated.
42
Recommendations
LicensingandinspectionofambulancevehiclesisaregulatoryfunctionoftheStateEMSSectionandshouldbe
centralizedwithinthatoffice.Theauthorityshouldincludetheestablishmentofequipmentrequirements,
Investigationsofcomplaints,disciplinaryactions,andassessmentoffines.Theindividualschargedwithinspection
shouldhaveathoroughknowledgeofequipmentuse.
Regulationsshouldapplytoalllevelsortypesofvehicles(e.g.ground,airorwater)usedinpublictransportation
ofthesickandinjured.
Requireemergencyvehicleoperatortraining.Thetrainingshouldbemadereadilyavailabletoallservices
regardlessoflocation(urban/rural).
MinimumbasicambulancestaffingshouldbetwolicensedEMTs.
Ambulanceequipmentrequirementsshouldbeuniformforalllicensedservicesandshouldtakeintoconsideration
specialtyneeds,(pediatricequipment).
E.FACILITIES
Standard
Itisimperativethattheseriouslyillpatentbedeliveredinatimelymannertotheclosestappropriatefacility.This
determinationneedstoconsiderbothstabilizationanddefinitivecare.Thisdeterminationshouldbefreeofpolitical
considerationsandrequiresthatthecapabilitiesofthefacilitiesareclearlyunderstoodbyprehospitalpersonnel.
Hospitalresourcecapabilitiesmustbeknowninadvancesothatappropriateprimaryandsecondarytransportdecisions
canbemade.
Status
Statutoryauthorityforthecategorizationofhealthcarefacilitieshasexistedsince1976.Theinitialintentofthestatute
wastoensuretheavailabilityofcareatanyhospitalforanyonerequiringthatcare.Theimplementationofthedirectives
ofthisstatutebeganintheearly1980'sandhasbeenadheredtouptothepresent.Thecriteriaforthelevelsof
categorizationhavebeendevelopedbycommitteeandhaveremainedstableforthepastfouryears.Categorizationis
integraltomanyaspectsofEMS,andthepresenceofsuchaprogramintheStateofWisconsinistobeapplauded.
However,theteamfoundmajordeficienciesintheadministrativeprocessandtheutilizationoftheannualreport.
Thepracticeofrequestingalistofthepersonnelandresourcesavailablewithoutaformalandstandardizedverification
processallowsforthepotentialfor"selfcategorization."Thereportisnotpromulgatedtoprehospitalcareproviders,
andisnotusedintriageandtransferdecisions.Theprocessofcategorizationpresentlyhaslittleimpactonthedelivery
ofhealthcareintheState.
43
Thereisnoformaldesignationprocessforspecialtycare,andtherearenotriageortransferguidelinesbasedonhospital
capabilities.Thecurrentprocessofcategorizationisassociatedwithanapproximatecostofsixthousanddollars
annuallyplus0.5FTE.
Recommendations
Verticalcategorizationofhospitalemergencycapabilitiesshouldbestrengthenedandintegratedintothe
prehospitalofPrehospitalcare.
DevelopastandardizedverificationprocessunderthesupervisionoftheStateEMSMedicalDirector.
Integrateverifiedcategorizationresultswithtriageandtransferprotocols.
Distributetheannualcategorizationreporttoallprehospitalcareprovidersaspartoftheinitialtrainingprocessand
atallrecertificationcourses.
Makeuseofverifiedcategorizationresultsinthedevelopmentofaregionalizedsystemofemergencycare.
F.COMMUNICATION
Standard
AneffectivecommunicationssubsystemisanessentialcomponentofanoverallEMSsystem.Beginningwithauniversal
systemaccessnumber,suchas911,thecommunicationsnetworkshouldprovideforprioritizeddispatch,dispatchto
ambulancecommunication,ambulancetoambulance,ambulancetohospital,andhospitaltohospitalcommunicationto
ensurethereceivingfacilityisreadyandabletoacceptthepatient.
Status
TheEMScommunicationsystemisinadequate,indisrepair,obsolete,andmayadverselyimpactmedicaldirectionand
optimumprehospitalemergencypatientcare.
CitizenaccesstotheEMSsystemvia911,whichwasonceamandatedrequirement,servesapproximately60%ofthe
population.
Emergencymedicaldispatchersarenotrequiredtobetrainedorlicensed.Notificationandassemblyofambulance
crewsissometimesaccomplishedusingineffectiveorprimitiveequipmentandprocedures.Thisreportedlycauses
delaysindeliveryofappropriatecare.
44
Recommendations
ProvidesufficientongoingfundingtosupportEMScommunicationsystemsdesign,equipment,training,and
maintenance.
ConductacomprehensiveevaluationofcurrentandprojectedEMScommunicationsneeds.Pursueplansto
integrateEMSintoastatewide,stateofthearttelecommunicationssystem.
Complete911citizenaccessinallcounties.
Repair,maintain,andmakeinterimimprovementsinEMSuseoftheexistingWisconsinStatePatrolCommunications
Networktoassurecontinuedaccesstomicrowavelinkagesbyitinerantambulances.
Restore,repair,andmaintaintheexistingEMScommunicationssystemtoassuretheavailabilityofmedicaldirection
foradvancedlifesupportunitsandotherambulanceunitsuntilastatewidesystemcanbeimplemented.
EstablishadequateEMSpersonnelpagingsystemsinallruralareas.
Improveemergencypatientcarethroughtheprovisionofappropriatetrainingandlicensureofemergencymedical
dispatchers.
G.EVALUATION
Standard
AcomprehensiveevaluationprogramisneededtoeffectivelyplanandimplementastatewideEMSsystem.EachEMS
systemmustberesponsibleforevaluatingtheeffectivenessofservicesprovidedvictimsofmedicalortraumarelated
emergencies.ThestatewideEMSsystemshouldbeabletostatedefinitivelywhatimpacthasbeenmadeonthepatients
servedbythesystem.EMSsystemmanagersmustbeabletoevaluateresourceutilization,scopeofservice,patient
outcome,andtheeffectivenessofoperationalpolicies,procedures,andprotocols.AneffectiveEMSsystemevaluates
itselfagainstpreestablishedstandardsandobjectives,sothatimprovementsinservice,particularlydirectpatientcare,
canoccur.Theserequirementsarepartofanongoingqualityassurance(QA)systemtoreviewsystemperformance.The
evaluationprocessshouldbeeducationalandongoing.OAreviewsshouldoccuratallphasesofEMSsystem
managementsothatneededpolicychangesortreatmentprotocolrevisionscanbemade.
I
Status
WiththeexceptionoftheEMTDprogramandlaudableeffortsfortraumadatacollectionandanalysisintheMilwaukee
andMadisonareas,datacollectionisinconsistent,illdefined,andnonintegrated.Thereareinsufficientresourcesinthe
StateEMSSection,bothinfundingandpersonnel,toachievestatewidedatacollection,entry,andanalysis.Data
collectionisfurtherhamperedbylackofmandatoryuseofastandardambulancereportform.Theobsoleteformwhich
45
isavailablefromtheStatehasbeenshowntohaveanextremelypoorcompletionrateonvariousitemsandisnot
compatiblewithrapiddataentrybyopticalscanningorothermeans.Continuedprovisionofthisinadequateformisnot
assuredduetoinsecurefunding.Thereisnoregionaldatacollectionoranalysisotherthaninthemajorurbanareas.
Becauseofthealmosttotallackofameaningfuldatacollectionsystem,qualityassuranceassessmentsarenotpossible,
norareassessmentsoftheimpactofspecialprojectsonmortalityandmorbidity.Thedataavailablethroughvarious
stateagenciesarenotcorrelatedwithambulancerunreportstoproduceminimaloutcomeassessments.
Unlessacomprehensivedatacollectionplanisdevelopedandimplemented,theStateofWisconsinwillbeunableto
assessthequalityofcarereceivedbyitscitizensinanythingotherthanananecdotalfashion.Additionally,theimpactof
newstateexpendituressuggestedinthisreportuponthehealthofthecitizensofWisconsinwillbeunknown.Those
chargedwithgrantingoutsidefundingwillalsobeextremelyhesitanttocontinueauthorizingsuchfunds.
Recommendations
Enactenablinglegislationtopermitongoingfundingofacentralized,comprehensive,statewidedatacollection
programintheStateEMSSectionassoonaspossible.Astatewidetraumaregistrymustbeincludedinthis
program.Itisimperativethatsuchaprogrambecomputerbased,bothtominimizepersonnelcostsandto
maximizedataanalysis.Thisprogramshouldincludefundingforpersonnelwithexpertiseindatacollectionand
analysis.
Thesuccessofsuchaprogramdependsuponthemandatoryuseofasinglestandardizedambulancerunreport.
ThisdatamustbecompiledbytheStateEMSSection.
Implementformalqualityassuranceprogramsatthelocal,regional,andstatelevelforallcategoriesofEMScare.
ProvidethecollecteddatatoEMSmanagersandprovidersforeducationandqualityassurance.
Linkcurrentlyavailabledatabasesformaximizationofinformation.
H.PUBLICINFORMATIONANDEDUCATION
Standard
PublicawarenessandeducationabouttheEMSsystemisessentialtoaqualitysystemandisoftenneglected.Public
informationandeducationeffortsmustservetoenhancethepublic'sroleinthesystem,itsabilitytoaccessthesystem,
46
andthepreventionofinjuries.Inmanyareas,EMSpersonnelprovidesystemaccessinformationandpresentinjury
preventionprogramswhichultimatelyleadtobetterutilizationofEMSresourcesandimprovedpatientoutcome.
Status
TheStateofWisconsinhasdevelopedseveralhighqualitypublicinformationandeducationtoolsthroughspecificgrant
projects,includingtheHighwaySafety's"RoadWarriorprogram,EMSTheInvisiblePublicHealthService,
workshops,EMSforChildren"publicserviceannouncements,posters,articles,andtheWisconsinEMTAssociation's
StatewideInjuryPreventionProgramtopromoteEMTpubliceducation.
TheintroductionofanEMSpubliceducationandinformationprogramattheWisconsinStateFairisanexcellentwayof
reachingalargenumberofpeople.Wisconsinshouldbeproudofthelargelyvolunteersupportofthisevent.
TherehasbeenalackofcentralizedcoordinationofEMSpublicinformationactivitiesresultinginalackofcontinuity.No
onehasbeenchargedwithensuringthatpublicinformationprograms,whicharedevelopedundergrants,willcontinue
whenthegrantsendorthatanongoingpublicinformationprogramisinplace.
Inmostcases,acontrolledanalysisoftheeffectivenessoftheeducationalprogramswasnotconducted.Thisisan
importantelementtoensurepubliceducationcampaignsareactuallyhavinganyimpactandtosupportfuturefunding
oftheseprograms.
Recommendations
SecureongoingfundingtoensurethattheStateEMSSectioncandevelopanddistributepublicInformation
materialsandevaluatetheeffectivenessofthepublicinformationprograms.
EmployapublicinformationandeducationstaffpersonwithinDHSStofosterandcoordinateEMSpublic
informationandeducationactivities,includinginjuryprevention.
EncouragetheinvolvementofEMSproviders(especiallyvolunteers)inpublicinformationandeducationprograms
relatingtoEMSandinjuryprevention.
PublishastateEMSnewsletterwhichprovidestimelyinformationtoEMSprovidersincluding,butnotlimitedto,
sharing"local"publicinformationideasandactivities.
47
1.MEDICALDIRECTION
Standard
EMSisamedicalcaresystemthatincludesmedicalpracticeasdelegatedbyphysicianstononphysicianproviderswho
managepatientcareoutsidethetraditionalconfinesofofficeorhospital.Asbefitsthisdelegationofauthority,itisthe
physician'sobligationtobeinvolvedinallaspectsofthepatientcaresystem.
Specificareasofinvolvementinclude:
planningandprotocols
onlinemedicaldirectionandconsultation
auditandevaluationofpatientcare.
Status
OnlinemedicaldirectionismandatedforadvancedlifesupporttechniquesexceptEMTD.EMTDcanbeperformedon
standingorders.AmedicaldirectorisrequiredforallAdvancedLifeSupport(ALS)servicesbutisnotrequiredforBasic
LifeSupport(BLS)servicesorFirstResponderservices.Physicianinputappearstobeparticularlystronginthelarge
urbancentersandinspecialprogramssuchasEMSforChildrenbutisvariableandoftenweakornonexistentinrural
areas.Physicianinvolvementinplanning,developmentofprotocols,andevaluationofprehospitalpatientcareis
inconsistentandprobablysubstandardinalargeportionofWisconsinEMSservices.
OverallphysicianinvolvementinEMSappearsweak.ThereisnoStateEMSMedicalDirectorandnomandatedstatewide
standardsforeitherlocalmedicaldirectorsoronlinemedicalphysicians.
Recommendations
ThepositionofStateEMSMedicalDirectorshouldbeimmediatelyestablishedwithintheStateEMSSection.This
physicianwouldbechargedwithfosteringphysicianinvolvementatthelocallevel,aswellasfacilitatingthe
developmentofregionalemergencymedicalcouncils,qualityassuranceprograms,andstandardizationoftraining
forbothonlinemedicalcontrolphysiciansandEMSservicemedicaldirectors.
EstablishMinimumstandardsforthosephysiciansfunctioningasonmedicalcontrol.Theseshouldinclude,butnot
belimitedto,ACLS,ATLS,andPALS.TheStateEMSSectionshouldprovidetrainingandfinancialassistanceto
potentialmedicalcontrolphysicians.
Establishminimumstandardsofflinemedicaldirectors.Standardsshouldinclude,butnotbelimitedto,expertise
inEMSeitherbytrainingorexperience,aswellasrequirementsforonlinemedicalcontrol.TheStateEMSSection
shouldprovidetrainingformedicaldirectorsbyadaptingcurrentlyavailablecoursesasindicatedbylocalneeds.
48
MandatemedicaldirectionofBasicLifeSupportandFirstResponderservices.
Provisionofpatientcarebymedicalpersonnelinthefieldshouldbeunderthedirectionandcontrolof
appropriatelyqualifiedphysicians.
Reducerelianceupononlinemedicaldirectiontoinitiatelifesavingprocedures.Statesponsoredguidelinesshould
beavailableforadaptationbyregionalEMScouncils.Suchguidelinesshouldhavespecifiedmandatoryonline
contactpoints.
LiabilityforofflinemedicaldirectionactivitiesshouldbelimitedandassumedbytheStateforthosephysicianswho
havecompletedstatemandatedtraining.
EstablishregionalEMScouncilstoassistinplanning,implementing,andevaluatingprograms.Suchcouncilsshould
haveastrongphysicianrepresentationandprovideinputtotheStateEMSAdvisoryCommittee.
J.TRAUMASYSTEMS
Standard
Toprovideaquality,effectivesystemoftraumacare,eachStatemusthaveafullyfunctionalEMSsysteminplace.
EnablinglegislationshouldexistforthedevelopmentofthetraumasystemcomponentoftheEMSsystem.Thisshould
includetraumacenterdesignation(usingACSCOTguidelinesasaminimum),triageandtransferguidelinesfortrauma
patients,datacollectionandtraumaregistrydefinitionsandmechanisms,mandatoryautopsies,systemmanagement,
andqualityassuranceofthesystem'seffectontraumapatients.Rehabilitationisanessentialcomponentofany
statewidetraumasystem.
Status
ThereisnoformalstatewidesystemoftraumacareintheStateofWisconsin.Ahighleveloftraumacareisavailablein
certainmetropolitanareas,especiallyinMilwaukeeandMadison.Theseislandsofexcellencehavebeendeveloped
throughthecontinuedcommittedeffortsofafewandhavebeenaccomplishedwithoutadequatestatesupportor
direction.TheteambelievesthatthebasicelementsofastatewidetraumasystemareavailablewithintheState,butno
coordinatedefforttobringtheelementstogetherhasoccurred.
Recommendations
Itisstronglyrecommendedthatstatewidedevelopmentofaformaltraumasystembeinstituted.Suchasystem
shouldoccurunderenablinglegislationwithlongrangefundingtoaIevelthatwouldsupportinstitutional
49
requirementsandregionalizationmandates.Suchlegislationmustincludebutshouldnotbelimitedtothe
following:
1. RegulationandoversightofthetraumadesignationprocessbytheDepartmentofHealthandSocialServices,
2. DesignationoftraumacentersbynationallyacceptedstandardssuchasthoseoftheAmericanCollegeof
Surgeons;
3. Regionalizationoftraumacaretoincludesmallerruralhospitalswithinthetraumasystem;
4. Ensuretheadequateparticipationandinputfromthoseinvolvedintheentireprocess;
5. Provisionfortheoutsidereviewandverificationofthedesignationprocess
6. Developmentoftriageandtransferguidelinesthetraumapatients;
7. Developmentofastandardizedcomputerizedstatewidetraumaregistrytoincludeprehospitalcare,acutefacility
care,andrehabilitativecare,
8. Mandatedautopsiesonalltraumarelateddeaths;and
9. Ongoingassessmentofsystemneedsandqualityassurance.
50
K.CURRICULUMVITAE
CarlR.Boyd,MD,FACS
4750WatersAvenue,Suite213
Savannah,GA31404
Director,TraumaServices,MemorialMedicalCenter,Savannah,GA
MedicalDirector,LifestarHelicopterEMS
MedicalDirector,MedstarEMS
AssociateDirector,SurgicalEducation
ClinicalProfessorofSurgery,MedicalCollegeofGeorgia,Augusta,GA
ClinicalProfessorofSurgery,MercerCollegeofMedicine,Macon,GA
ORGANIZATIONS/APPOINTMENTS
AmericanCollegeofSurgeons,GeorgiaCommitteeonTrauma
Chairman
JournalofAirMedicalTransport
EditorialBoard
AmericanCollegeofSurgeons
Fellow
AmericanAssociationfortheSurgeryofTrauma
Fellow
EasternAssociationfortheSurgeryofTrauma
BoardofDirectors
51
SocietyofCriticalCareMedicine
UniversityAssociationofEmergencyMedicine
NationalAssociationofEMSPhysicians
AmericanTraumaSociety
AssociationofAirMedicalServices
AmericanSocietyofParenteralandEnteralNutrition
AmericanMedicalAssociation
SouthernMedicalAssociation
GeorgiaMedicalSociety
GeorgiaSurgicalSociety
MedicalAssociationofGeorgia
52
JohnLChew,Jr.
DOT/NHTSANTS42
4007thStreetSW
Washington,DC20590
(202)3665440
Coordinator,EMSTechnicalAssistanceProgram
NationalHighwayTrafficSafetyAdministration
ASTMF.30CommitteeonEmergencyMedicalServices
SubcommitteeonTraining
EmergencyMedicalTechnicianARevisionProject
ProjectDirector
'TechnicalAssistanceProgram
ProjectDirector
U.S.NationalParkService
PastDirector,EmergencyMedicalServices
NationalSafetyCouncil
EMSCommittee
FederalInteragencyCommitteeonEMS
Chairman,ProviderSubcommittee
NationalRuralHealthAssociation
EMSTaskForce
NationalRegistryofEmergencyMedicalTechnicians
53
BoardofDirectors
StandardsandExamCommittee
JournalofWildernessMedicine
EditorialReviewBoard
AeromedicalResearchFoundation
BoardofDirectors,ExOfficio
54
ArthurF.Harman
AlabamaDepartmentofPublicHealth
EmergencyMedicalServicesDivision
434MonroeStreet
Montgomery,AL36104
Director,EMSDivision
NationalAssociationofStateEMSDirectors
AmericanLungAssociationofAJabama,AdvisoryBoardMembe
AJabamaPublicHealthAssociation
StateAdvisoryCouncilonSIDS
AlabamaEMTAssociation.
AmericanCollegeofSurgeons
CommitteeonTrauma,AssociateMember
SafeKidsCommittee
StateDisasterPreparednessTeamMember
55
KarlaHolmes,RN,MPA
BureauofEmergencyMedicalServices
UtahDepartmentofHealth
288N.1460W.
SaftLakeCity,UT84116
(801)538M5
DirectorofEMSTraining
NationalCouncilofStateEMSTrainingCoordinators(NCSEMSTC)
Chairperson,ExecutiveCommittee
PastViceChairperson,ExecutiveCommittee
PastParliamentarian,ExecutiveCommittee
CommitteeChairperson,PublicationReviewCommittee
WrittenTestBlueprintCommittee
PlanningCommittee,ParamedicCommittee
LiaisonforNCSEMSTCtoACEPEMSCommittee,NHTSA,NASEMSD
EmergencyNurseAssociation
UtahEMSBureauLiaison
USDOT,NHTSAAlcoholPreventionCurriculumforEMSProvidersCurriculumProject
Chairperson
56
DonaldE.Kerns,EMTP
IowaDepartmentofPublicHealth
EmergencyMedicalServices
LucasStateOfficeBuilding
DesMoines,IA503190075
(515)2813239
ProgramManager,EMSSection
ExecutiveCommittee
LegalRecognitionCommittee
LiaisontoAmericanRedCross
IowaEMSAssociation
CharterMember
LegislativeCommittee
ConventionCommittee
1989FriendofEMSAward
IowaTraumaRegistrySystemPlanningCommittee
Governor'sCommitteeonDevelopmentalDisabilities
EMSTechnicalCommitteeChair
ChildsafeCommittee
57
WilliamF.Rutherford,MD
UniversityHospitalsofCleveland
2074AbingtonRoad
Cleveland,OH44106
(216)8448956
StaffPhysician,DepartmentofEmergencyMedicine
AssistantProfessorofCriticalCare,CaseWesternReserveUniv
MedicalDirector,UniversityAjrCare
MedicalAdvisor,OhioAssociationofAirMedicalServices
AssociationofAirMedicalServices
MedicalAdvisoryCommitteeRegion3Advisor
UniversityHospitalsofCleveland
ResuscitationCommitteeChair
DepartmentofEmergencyMedical
QualityAssuranceCommitteeChair
AmericanHeartAssociationAdvancedCardiacUfeSupport
NationalFaculty
NortheastOhioAffiliate,AmericanHeartAssociation
EmergencyCardiacCareCommitteeChair
AmericanCollegeofEmergencyPhysicians
SocietyofCriticalCareMedicine
InternationalTaskForceonDisasterMedicine
58
APPENDIXE2001NHTSAREASSESSMENT
59
STATEOFWISCONSIN
AREASSESSMENT
OF
APRIL2426,2001
NationalHighwayTraffic
SafetyAdministration
TechnicalAssistanceTeam
BobW.Bailey
DrewE.Dawson
TheodoreR.Delbridge,MD,MPH,FACEP
MarkE.King
StuartReynolds,MD,FACS
60
BACKGROUND
Injuryistheleadingcauseofdeathforpersonsintheagegrouponethrough44,aswellasthemost
commoncauseofhospitalizationsforpersonsundertheageof40.Thefinancialcostsofinjuriesare
staggering:injuriescostbillionsofdollarsinhealthcareandsocialsupportresources.In1990,for
example,thelifetimecostsofallinjurieswereestimatedat$215billionannually.Theseestimatesdo
notincludetheemotionalburdenresultingfromthelossofachildorlovedone,orthetollofsevere
disabilityontheinjuredpersonandhisorherfamily.Eachyearover40,000peoplelosetheirliveson
ournation'sroads,andapproximately70percentofthosefatalitiesoccuronruralhighways.The
NationalHighwayTrafficSafetyAdministration(NHTSA)ischargedwithreducingdeathandinjuryonthe
nation'shighways.NHTSAhasdeterminedthatitcanbestuseitslimitedresourcesifitseffortsare
focusedonassistingstateswiththedevelopmentofintegratedemergencymedicalservices(EMS)
programsthatincludecomprehensivesystemsoftraumacare.
Toaccomplishthisgoal,in1988NHTSAdevelopedaTechnicalAssistanceTeam(TAT)approachthat
permittedstatestoutilizehighwaysafetyfundstosupportthetechnicalevaluationofexistingand
proposedemergencymedicalservicesprograms.FollowingtheimplementationoftheAssessment
ProgramNHTSAdevelopedaReassessmentProgramtoassistthoseStatesinmeasuringtheirprogress
sincetheoriginalassessment.TheProgramremainsatoolforstatestouseinevaluatingtheirstatewide
EMSprograms.TheReassessmentProgramfollowsthesamelogisticalprocess,andusesthesameten
componentareaswithupdatedstandards.ThestandardsnowreflectcurrentEMSphilosophyandallow
fortheevolutionintoacomprehensiveandintegratedhealthmanagementsystem,asidentifiedinthe
1996EMSAgendafortheFuture.NHTSAservesasafacilitatorbyassemblingateamoftechnicalexperts
whodemonstrateexpertiseinemergencymedicalservicesdevelopmentandimplementation.These
expertsdemonstrateleadershipandexpertisethroughinvolvementinnationalorganizationscommitted
totheimprovementofemergencymedicalservicesthroughoutthecountry.SelectionoftheTechnical
AssistanceTeamisalsobasedonexperienceinspecialareasidentifiedbytherequestingState.
Examplesofspecializedexpertiseincludeexperienceinthedevelopmentoflegislativeproposals,data
gatheringsystems,andtraumasystems.Experienceinsimilargeographicanddemographicsituations,
suchasruralareas,coupledwithknowledgeinprovidingemergencymedicalservicesinurban
populationsisessential.
TheWisconsinBureauEmergencyMedicalServicesandInjuryPreventioninconcertwiththeWisconsin
BureauofTransportationSafetyrequestedtheassistanceofNHTSA.NHTSAagreedtoutilizeits
technicalassistanceprogramtoprovideatechnicalreassessmentoftheWisconsinStatewideEMS
program.NHTSAdevelopedaformatwherebytheEMSofficestaffcoordinatedcomprehensive
briefingsontheEMSsystem.
61
TheTATassembledinMadison,Wisconsin,onApril2426,2001.Forthefirstdayandahalf,over30
presentersfromtheStateofWisconsin,providedindepthbriefingsonEMSandtraumacare,and
reviewedtheprogresssincethe1990assessment.Topicsforreviewanddiscussionincludedthe
following:
GeneralEmergencyMedicalServicesOverviewofSystemComponents
RegulationandPolicy
ResourceManagement
HumanResourcesandTraining
Transportation
Facilities
Communications
TraumaSystems
PublicInformationandEducation
MedicalDirection
Evaluation
TheforumofpresentationanddiscussionallowedtheTATtheopportunitytoaskquestionsregarding
thestatusoftheEMSsystem,clarifyanyissuesidentifiedinthebriefingmaterialsprovidedearlier,
measureprogress,identifybarrierstochange,anddevelopaclearunderstandingofhowemergency
medicalservicesfunctionthroughoutWisconsin.Theteamspentconsiderabletimewitheachpresenter
sothattheycouldreviewthestatusforeachtopic.
FollowingthebriefingsbypresentersfromtheWisconsinBureauofEmergencyMedicalServicesand
InjuryPrevention,publicandprivatesectorproviders,andmembersofthemedicalcommunity,theTAT
sequesteredtoevaluatethecurrentEMSsystemaspresentedandtodevelopasetofrecommendations
forsystemimprovements.
62
Whenreviewingthisreport,pleasenotethattheTATfocusedonmajorareasforsystemimprovement.
Unlikethestatesinitialassessmentwhichcontainedmanyoperationalrecommendations,severalof
whichwereidentifiedasapriority,thisreportoffersfeweryetbroaderrecommendationsthattheteam
believestobecriticalforcontinuedsystemimprovement.
63
ACKNOWLEDGMENTS
TheTATwouldliketoacknowledgetheWisconsinDepartmentofTransportation,Bureauof
TransportationSafetyandtheWisconsinDepartmentofHealthandFamilyServices,Bureauof
EmergencyMedicalServicesandInjuryPreventionfortheirsupportinconductingthisassessment.
TheTATwouldliketothankallofthepresentersforbeingcandidandopenregardingthestatusofEMS
inWisconsin.EachpresenterwasresponsivetothequestionsposedbytheTAT,whichaidedthe
reviewersintheirevaluation.Manyoftheseindividualstraveledconsiderabledistancetoparticipate.
SpecialrecognitionandthanksshouldbemaderegardingtheextraordinaryeffortstakenbyJonMorgan,
DirectorofBureauofEMSandInjuryPrevention,andhisstaff,andthebriefingparticipantsfortheir
wellpreparedandforthrightpresentations.Inaddition,theTeamapplaudsthewellorganized,
comprehensivebriefingmaterialsenttotheteammembersinpreparationforthereassessment.
SpecialthanksalsotoDonHagen,BureauofTransportationSafety,forprovidingassistancetotheTAT.
64
INTRODUCTION
Wisconsinisalarge,beautifulanddiversestate.Thecontrastoflargeurbanareasandsmallsparsely
populatedruralcommunitiescreateschallengesforprovidingacomprehensive,qualitystatewideEMS
system.Tothispoint,thespiritofvolunteerism,neighborshelpingneighbors,andpeopleworkinghard
toprovidestateoftheartcaretoWisconsinscommunitieshavemetthesechallenges.
In1990WisconsinrequestedaNHTSAassessmentofitsEMSsystem.Usingtheresulting
recommendationsasaguide,WisconsinhasmadetremendousstridesinimprovingitsEMSsystem
duringthepastelevenyears.
Nowisthetimetorecognizepastaccomplishmentsandlookboldlytothefuture.Thisreassessment
reportrepresentsoneofthetoolsthatWisconsinEMShaschosentoguideitseffortsintothisdecade.
Despitetheoutstandingprogressofthepastelevenyears,muchremainstobedone.Someofthe
barrierstoprogressthatexistedelevenyearsagoarestillpresenttoday.Dedicatedpeoplethroughout
thestate,bothpaidandvolunteer,doingajobwithlittlerecognitionandinadequateresourceshave
createdmonumentalachievements.ButevendedicationandhardworkcancarryWisconsinonlysofar.
Currently,resourcesarebeingcutandpersonnelandfinancialsupporttomaintainandcontinue
improvingtheEMSsysteminWisconsinhaveerodedtothepointthatthesystemisindangerof
collapse.Evenwithahostofvolunteers,astable,continuingfundingsourcemustbeobtainedforthe
BureauofEMSandInjuryPreventionandpersonnelresourcesmustbeallocatedtomeetthedemand
forservicestothepublic,theEMSvolunteerandcareerpersonnelandotherEMSsystempartners.The
politicalleadershipinWisconsinmustaddresstherealneedsfacingtheWisconsinEMSsystemand
ensurethatstablefundingmechanismsandpersonnelresourcesareavailabletomaintainagood
systemandmakeitevenbetter.
ThespiritofthepeopleofWisconsinwillundoubtedlyleaditsEMSsystemdowntheappropriateroad
andcreatethebestpossiblecarefortheircommunities.
WISCONSINEMERGENCYMEDICALSERVICES(WEMS)
TheTechnicalAssistanceTeamrevisitedthetenessentialcomponentsofanoptimalEMSsystemthat
wereusedintheStateofWisconsin,AnAssessmentofEmergencyMedicalServices,onNovember13
15,1990.Thesecomponentsprovidedanevaluationorqualityassurancereportbasedon1989
standards.Whileexaminingeachcomponent,theTATidentifiedkeyEMSissues,reviewedtheStates
progresssincetheoriginalreport,assesseditsstatus,andusedthe1997ReassessmentStandardsasa
basisforrecommendationsforEMSsystemimprovement.
REGULATIONANDPOLICY
Standard
Toprovideaquality,effectivesystemofemergencymedicalcare,eachEMSsystemmusthaveinplace
comprehensiveenablinglegislationwithprovisionforaleadEMSagency.Thisagencyhastheauthority
toplanandimplementaneffectiveEMSsystem,andtopromulgateappropriaterulesandregulations
foreachrecognizedcomponentoftheEMSsystem(authorityforstatewidecoordination;standardized
treatment,transport,communicationandevaluation,includinglicensureofoutofhospitalservicesand
establishmentofmedicalcontrol;designationofspecialtycarecenters;PIERprograms).Thereisa
consistent,establishedfundingsourcetoadequatelysupporttheactivitiesoftheleadagencyandother
essentialresources,whicharenecessarytocarryoutthelegislativemandate.Theleadagencyoperates
underasingle,clearmanagementstructureforplanningandpolicysetting,butstrivestoachieve
consensusamongEMSconstituencygroupsinformulatingpublicpolicy,proceduresandprotocols.The
roleofanylocal/regionalEMSagenciesorcouncilswhoarechargedwithimplementingEMSpoliciesis
clearlyestablished,aswellastheirrelationshiptotheleadagency.Supportivemanagementelements
forplanninganddevelopingeffectivestatewideEMSsystemsincludethepresenceofaformalstate
EMSMedicalDirector,aMedicalAdvisoryCommitteeforreviewofEMSmedicalcareissuesandstate
EMSAdvisoryCommittee(orBoard).TheEMSAdvisoryCommitteehasaclearmission,specified
authorityandrepresentativemembershipfromalldisciplinesinvolvedintheimplementationofEMS
systems.
ProgressSince1990
Withlimitedresourcesandconsiderablededication,theWisconsinEMSsystemhasmadeimpressive
progresswithimplementationofthe1990EMSAssessmentrecommendationsincluding:
EnactedlegislationtodesignatetheDepartmentofHealthandFamilyServicesasthestateEMSlead
agencyincludingaclearspecificationofitsauthorityandresponsibilities.
ProvidedseveraladditionalFTEstotheBureauofEMSandInjuryPrevention.
66
EstablishedthelegalauthorityforaStateEMSMedicalDirectorandcontractedwithawellqualified
physician.
EstablishedastatewidePhysicianAdvisoryCommittee.
Established,viastatute,amultidisciplinarystateEMSBoardandspecifieditsresponsibilities.
EnactedlegislationestablishingtheStateTraumaAdvisoryCouncil,authorizingcreationofastatewide
traumacaresystem,grantingrulemakingauthoritytothedepartment,requiringastatewidetrauma
caresystemreporttobesubmittedtothelegislatureandestablishinganinitialappropriationforthe
traumasystem.
Submittedthestatetraumasystemsreporttothelegislature.
EnactedlegislationforthelicensureofFirstRespondersandforFirstResponderDefibrillation.
Publishedguidelinesfortheregulationofinterhospitaltransfersandareintheprocessofupdating
thoseguidelines.
Status
AmajoraccomplishmentfortheWisconsinEMSSystemhasbeentheelevationoftheEMSSectionto
theBureauofEmergencyMedicalServicesandInjuryPrevention,achangewhichhasimprovedthe
statureofEMSwithintheDepartmentandimprovedaccesstoDepartmentleadership.
ThereareseveralmajorlawsgoverningemergencymedicalservicesinWisconsin,including:
Section146.50establishesconfidentialityprotectionsforEMSRecordsandprovidesbroadauthorityto
theDepartmentfor:
emergencymedicalservicespersonnellicensing,certificationandtraining;
67
licensingofambulanceserviceproviders;
licensureofEmergencyMedicalTechnicians(FirstResponder,Basic,IntermediateandParamedic);
developingadministrativerulesregardingthequalificationsofEMSmedicaldirectors;
investigationofcomplaints;
approvingEMSeducationandtrainingprograms.
Section146.53establishesthedepartmentasthestateEMSleadagency,broadlydelineatestheirduties
andauthoritiesandprovidesthemwithcomprehensiverulemakingauthority.Thislawalsorequires
thedevelopmentofastateEMSplan.
Section146.55providestheauthorityforthedevelopmentofemergencymedicalservicesprogramsat
thelocallevelandrequiresthesubmissionofoperationalplanstotheDepartment.Further,itrequires
astateEMSmedicaldirectorandestablishestheFundingAssistanceProgram(FAP),whichfundstuition
oftheEMTBasictrainingprogramsandspecifiesanentitlementfundingprogramtoambulance
services.
Section146.56requirestheDepartmenttodevelopandtoadministerastatewidetraumacaresystem.
Section15.197establishesastatetraumaadvisorycounciltoassistinplanningandimplementingthe
traumasystem.Section146.58specifiestheresponsibilitiesofthestateEmergencyMedicalServices
Board.
TheDepartmentofTransportationhasstatutoryresponsibilityfortheinspectionandlicensureof
ambulancevehicles.ThereisalsoaPublicAccessDefibrillationstatute.
Thereareseveralmajorsetsofadministrativerulesincluding:
HFS110relatingtoAmbulanceProviderandEMTBasiclicensure;
HFS111relatingtothelicensingofEmergencyMedicalTechniciansIntermediate;
HFS112relatingtothelicensingofEMTParamedics.Thisiscurrentlyunderrevisiontoaddress
interfacilitytransports;
HFS113relatingtotheCertificationofFirstRespondersDefibrillation;
68
HFS125relatingtoDoNotResuscitateOrders;
Trans309relatingtoinspectionofambulancevehicles.
ThereareseveraldifferentgroupsthatprovideadvicetotheDepartment,includingtheEMSBoard,the
StateTraumaCareAdvisoryCouncilandthePhysicianAdvisoryCommittee.Eachoftheseboardsor
committeeshasavarietyofdifferentsubcommittees.TheEMSCCommittee,acommitteeoftheEMS
Board,alsohasseveraldifferentsubcommittees.TheDepartmentiscommendedforitsextensive
collaborationinthedevelopmentofdepartmentpriorities,guidelinesandadministrativerules.
However,therolesandtheinterrelationshipsofthevariousadvisorycommitteesarenotclear.For
instance,onememberoftheEMSBoardisrequiredtobeamemberoftheStateTraumaAdvisory
Council.However,theformalrelationshipbetweenthesetwogroupsisnotclearlydelineated.Asthe
traumasystemevolves,theabsenceofadefinedrelationshipwillbecomeproblematic.
TheFundingAssistanceProgram(FAP)providesstateGeneralPurposeRevenueforEMTBasictraining
andlimitedoperationalsupportforambulanceservices.Theamountoffundingtoindividualambulance
servicesisquitelimited.However,atthestatelevel,thesefundsrepresentasignificantexpenditure
resultingonlyinlimitedsystemwideimpact.
TheDepartmenthasbeenrequiredtosubmitnumerousreportstothelegislature.Everyreporthas
beenpresented,asrequired.Thequalityofthereportshasbeenexcellentandhasobviouslyconsumed
considerableeffort.However,frequentlythelegislaturedoesnottakeactiononthereportsandthe
Departmentandthevariousconstituencygroupsarenotnotifiedofthereportsfinaldisposition.There
isapparentlynotaclearlydefinedmethod,noristheretheability,fortheDepartmentortheEMSBoard
toinitiatelegislation.Therehavebeenavarietyofdefeatedlegislativeeffortsincluding:amandatefor
uniformdatacollection,theassessmentoffinesfornoncompliancewithlicensureandcertification
requirements,andvariouseffortstoincreasethebudgetoftheBureauofEMSandInjuryPrevention.
TheEMSBoardhasbeenincrediblyactive,meetingatleasteverytwomonths.Theamountofvolunteer
timeandeffortdedicatedbyEMSBoardmembersistrulyamazing.TheEMSBoardprovidesaclear
formalandeffectivemethodforassuringpublicdialogueonEMSissues.TheBoardisfrequently
frustratedbythedelayinappointments.Theredoesnotappeartobeasystematicmethodinwhichthe
departmentprovidesinputtotheGovernorsofficeonEMSBoardappointments.
69
TherecurrentlyisnostatutoryprovisionforthelicensureofairorwaterEMSservices.Rulespertaining
tointerfacilitytransferarecurrentlybeingrevised.Theserulesalsoaddressthecontinuingeducation
requirementsofEMSinstructors.
ThebudgetfortheBureauofEMSandInjuryPreventioniscomprisedofGeneralPurposeRevenue,
PreventiveHealthandHealthServicesBlockGrantandotherfederalfundingsources.Becauseeachof
thesefundingsourcesisextremelyvolatile,thereisnotanongoing,stablesourceoffundingforthe
Bureau.Theabsenceofadequateandongoingfundinghasbeendetrimentaltotheoveralloperation
andcontinuityoftheBureau.Thereisinsufficientfundingtoaccomplishprogramprioritiesandexisting
staffpositionsarefrequentlyvacantforextendedlengthsoftime.
Frequently,thereareunfundedmandatesfromthelegislature;thelegislaturehasestablishedprograms
(e.g.FirstRespondercertification),buthasnotprovidedthedepartmentwithsufficientresourcesto
managetheprogram.ThishasresultedinthefrustrationoftheBureaustaff,theDepartmentandEMS
providerorganizations.Theongoingpaucityofresources,Bureaustaff,andstatelegislativesupportis
threateningtheveryintegrityoftheWisconsinemergencymedicalservicessystem.
Recommendations
TheStateofWisconsinshouldassureanadequate,stableandongoingsourceoffundingandpersonnel
resourcesfortheBureauofEMSandInjuryPrevention.Examplesfromotherstatesincludean
assessmentonmotorvehicleregistration,afeeondriverslicenses,anassessmentonmovingtraffic
violationsandavarietyofothers.
TheEMSBoard,incoordinationwithotheradvisorybodiesandvariousconstituencygroups,should
developastrategicplantoeducatepolicymakersregardingtheimportanceoftheemergencymedical
servicessystem,includingthefinancialandresourcethreatstoitsongoingviability.
TheEMSBoardandtheBureauofEMSandInjuryPreventionshouldbetterdelineateandstreamlinethe
interrelationshipsofthevariousadvisorycouncilsandcommittees.Toassurecoordinationand
continuity,allcommitteesandcouncilsshouldreportthroughtheEMSBoard.
70
TheEMSBoardshouldreviewthecurrentuseofFAPfunds,includinganevaluationofwhetherthese
fundsarecurrentlymakingthebiggestpossibleimpactontheWisconsinEMSsystem.TheBoardshould
explorealternativesforutilizationofFAPfundsandmakerecommendationstothelegislature.This
mightinclude,forinstance,agrantprogramcoordinatedwiththeprioritiesoutlinedinthestateEMS
plan.
TheEMSBoardandtheDepartmentshould,consistentwithWisconsinstatelawsandpolicies,develop
methodsforimprovedlegislativeadvocacy.Thereshouldbeanestablishedmechanismforassuring
legislationisintroduced,whenneeded,toaddressEMSsystempriorities.
TheDepartmentandtheGovernorsofficeshoulddevelopaprocedureandatimetabletoexpeditethe
appointmentofmemberstotheEMSBoardandclarifytheroleoftheDepartmentinsuggesting
appointments.
TheDepartmentshould,inconjunctionwiththelegislativebranch,determinethestatusofeach
legislativereportwhichhasbeensubmittedandshouldreportitsfindingstotheEMSBoard,thevarious
committeesandcouncilsandtotheconstituencygroups.
TheDepartmentshouldpursuelegislativeauthorityforadministrativepenalties,includingfinesfor
violationofEMSstatutesandadministrativerules.
TheDepartmentshouldpursuelegislativeauthoritytoestablishcomprehensiveregulationand
enforcementofair,groundandwaterEMSservices.
RESOURCEMANAGEMENT
Standard
Centralcoordinationandcurrentknowledge(identificationandcategorization)ofsystemresourcesis
essentialtomaintainacoordinatedresponseandappropriateresourceutilizationwithinaneffective
EMSsystem.AcomprehensiveStateEMSplanexistswhichisbasedonastatewideresource
assessmentandupdatedasnecessarytoguideEMSsystemactivities.Acentralstatewidedata
71
collection(ormanagementinformation)systemisinplacethatcanproperlymonitortheutilizationof
EMSresources;dataisavailablefortimelydeterminationoftheexactquantity,quality,distributionand
utilizationofresources.Theleadagencyisadequatelystaffedtocarryoutcentralcoordinationactivities
andtechnicalassistance.ThereisaprogramtosupportrecruitmentandretentionofEMSpersonnel,
includingvolunteers
ProgressSince1990
Centralizedauthorityandresponsibilityforprogramregulation,management,developmentand
coordinationwasprovidedtotheDepartmentin1993legislation.
TheEMSSectionwasupgradedtoBureaustatusin1998.
Threestaffpositionswereadded.
TheFundingAssistanceProgram(FAP)offsetsthecostsfortrainingofEMTBasics.
AStateEMSMedicalDirectorpositionwasestablishedandhasbeenfilledsinceMarch1995.
AformalStateEMSPlanwasfirstdevelopedin1995andhasbeenregularlyupdated.
AStateEMSBoardwasstatutorilyestablishedin1993.
Status
WisconsinsstatewideEMSplanwasdevelopedin1995andupdatedin1997and1999.Itisscheduled
foranotherupdatethisyear.Theplanisbeingfollowedcloselyforcontinueddevelopmentofthe
statesEMSsystem.Inaddition,thestatusoftheBureauofEMSandInjuryPrevention,asleadagency,
hasbeenstrengthened.
72
ThreeadditionalelementsofchangehaveinfluencedtheresourcemanagementaspectoftheBureaus
operationinrecentyears.First,staffinghasincreasedmodestly.Secondly,theStateEMSMedical
Directorspositionisstaffedthroughacontract.Andlastly,theEMSBoardhasbeenactiveand
successfulinaffectingthestateEMSsystem.
Althoughmodeststaffingincreaseshaveoccurred,somepositionswithintheBureauhavebeenfrozen
orreallocated.Thus,theBureauisunabletostaffandimplementsomestatutorilymandated.While
therehasbeenlegislativesupportforauthorityandleadershiponEMSactivities,fundingsupportis
shrinking.Asaresult,anumberofprogramshavenotbeenimplementedwithresultingnegative
systemimpact.Theseinclude:technicalassistance;datasupport,collection,andanalysis;first
respondercertification;andthedispatchandcommunicationsprogram.
TheBureauhasaccesstoadministrativedatasourcesthatcanbeusedforresourcemanagement.
Theseincludegeographicalinformationsystem(GIS)softwarethatcanbeusedtoshowlocationsof
hospitals,EMSagenciesandaeromedicalprograms.Effortsareongoingtostreamlinetheprovider
agencyoperationsplansubmissionprocessintoawebbasedapplication.Theseinnovationsmayenable
systemmanagerstoplan,allocateresources,administerservicesmoreefficientlyandstudysystem
trendingandconductperformancereview.
Thestatescriticalincidentstressmanagement(CISM)programsaregrowinginnumberandappearto
beevolving.Thereappearstobelittlecentralcoordinationofactivityormutualaidamongteams.
Additionally,someteamslackprofessionalclinicalstaff.
Recruitmentandretention,asanongoingissueforvolunteerism,hasreceivedconsiderableattentionin
recentyears.Twostudieshavebeenconductedwiththeinitialconclusionthatthereareonlypocketsof
concern.Morerecentinformationindicatestheremaybemoreconcernthanoriginallythoughtandthat
furtheractionandmonitoringisnecessary.
Recommendations
TheBureaushould:
73
Securestablefundingsourcestoensureadequatestaffingforresourcemanagementactivitiesincluding,
butnotlimitedto:
TechnicalAssistance;
DataSupport,Collection,andAnalysis;
FirstResponderCertification;
Dispatch/CommunicationProgram.
DevelopprogramsforcontinuingtherecruitmentandretentionofvolunteerEMSpersonnel.
Verifysubmittedambulanceserviceoperationplansthroughperiodic,onsiteevaluations.
HUMANRESOURCESANDTRAINING
Standard
EMSpersonnelcanperformtheirmissiononlyifadequatelytrainedandavailableinsufficientnumbers
throughouttheState.TheStateEMSleadagencyhasamechanismtoassesscurrentmanpowerneeds
andestablishacomprehensiveplanforstableandconsistentEMStrainingprogramswitheffectivelocal
andregionalsupport.Ataminimum,alltransportingoutofhospitalemergencymedicalcarepersonnel
aretrainedtotheEMTBasiclevel,andoutofhospitaltrainingprogramsutilizeastandardized
curriculumforeachlevelofEMSpersonnel(includingEMSdispatchers).EMStrainingprogramsand
instructorsareroutinelymonitored,instructorsmeetcertainrequirements,thecurriculumis
standardizedthroughouttheState,andvalidandreliabletestingproceduresareutilized.Inaddition,
theStateleadagencyhasstandardized,consistentpoliciesandproceduresforcertification(andre
certification)ofpersonnel,includingstandardsforbasicandadvancedlevelproviders,aswellas
instructorcertification.TheleadagencyensuresthatEMSpersonnelhaveaccesstospecialtycourses
suchasACLS,PALS,BTLS,PHTLS,ATLS,etc.,andasystemofcriticalincidentstressmanagementhas
beenimplemented.
ProgressSince1990
74
Wisconsinhasmadesignificantprogresstowardmeetingtherecommendationsofthe1990NHTSA
assessment.
Thestatehastheauthoritytoapprovealltrainingcentersandcourses.Astandardizedinstructor
trainingprogramhasbeenimplementedandstandardsforinstructorsarenowstatedinrule.
AnevaluationandmodificationofallnationalcurriculausedinEMStraininghasbeencompleted.
FirstResponderDefibrillationcriteriahavebeenstandardized.FirstRespondercertificationis
authorizedbuthasnotbeenimplementedduetoshortagesinpersonnelandfinancialresources.No
progresshasbeenmadeinimplementingstandardizedtraining,licensure,andcertificationof
EmergencyMedicalDispatchers.
Status
TheBureauhastheauthoritytoapprovealltrainingcentersandallcourses.Instructorsarecertified
andnewruleswillprovidefortherecertificationofinstructors.ThestatecertifiesFirstResponders
Defibrillation,EMTBs,EMTIsandEMTPs.Thestateiscurrentlyintheprocessofimplementinganew
levelcalledEMTBasicI.V.,whichiscomparabletothepriorEMTIlevel.Thiswillallowforadditional
skillsattheEMTBasiclevel.ThenewnationalEMTIcurriculumwillalsobeimplemented,andin
WisconsinisinitiallyreferredtoastheEMTIEnhanced,butwillbecometheEMTIafterthetransition.
AlthoughthestatehastheauthoritytocertifyFirstResponders,ithasnotdonesoduetothelackof
personnelandfinancialresources.ThestatehascompletedanindepthreviewoftheNationalStandard
CurriculaandhasmodifiedthemtomeetthespecificneedsofWisconsin.Thestatehasnotconducted
anevaluationoftheEMSEducationAgendafortheFuturetodetermineitsimpact.
Bridgecoursesarecurrentlyofferedbutnotateverylevel.ThroughtheinvolvementoftheEmergency
MedicalServicesforChildren(EMSC)program,pediatrictraininghasbeenincorporatedatalllevels.
Thereare22approvedtrainingcenters.Sixteenofthecentersaretechnicalcollegesandsixare
hospitals.However,thereisnoindependent,externalverificationoftrainingcentersbyanationalEMS
accreditationorganizationasspecifiedintheEMSEducationAgendafortheFuture.
75
TheBureauandtheWisconsinTechnicalCollegeSystemsBoard(WTCSB)jointlyprovideathreeday
instructor/coordinatorcourseonanannualbasis.
AllEMSpersonnellicensesexpireeverytwoyearsinJune.Duringthelastcycleittook56monthsfor
theBureautorenewthelicenses.InanefforttoimprovelicenseturnaroundtimetheBureauhas
initiatedanewprocessthatwillrequirepersonnelinformationtobesubmittedbyeachserviceona
rostersignedbythelocalmedicaldirector.Itisunclearwhetherornotthequalityoftheprocesswillbe
maintained.
Recommendations
TheStateEMSBoardshould:
EvaluatethecomplianceoftheWisconsinEMSeducationsystemwiththeEMSEducationAgendafor
theFutureandmakespecificrecommendationstoensurethattheWisconsinEMSeducationsystemis
consistent.
TheBureaushould:
Establishamechanismtoobtainandutilizedatatodeterminethatapprovedtrainingcentersare
providingqualityinstruction.
DevelopcoursestoallowEMSpersonneltobridgefromtheentrylevelofcertificationthrougheach
leveluptoEMTParamedic.
Developamethod,suchasrandomaudits,toensuretheconsistentreliabilityandqualityofthere
licensingprocess.
TRANSPORTATION
Standard
Safe,reliableambulancetransportationisacriticalcomponentofaneffectiveEMSsystem.The
transportationcomponentoftheStateEMSplanincludesprovisionsforuniformcoverage,includinga
76
protocolforairmedicaldispatchandamutualaidplan.Thisplanisbasedoncurrentformalneeds
assessmentoftransportationresources,includingtheplacementanddeploymentofalloutofhospital
emergencymedicalcaretransportservices.Thereisanidentifiedambulanceplacementorresponse
unitstrategy,basedonpatientneedandoptimalresponsetimes.Theleadagencyhasamechanismfor
routineevaluationoftransportservicesandtheneedformodifications,upgradesorimprovements
basedonchangesintheenvironment(i.e.,populationdensity).Statewide,uniformstandardsexistfor
inspectionandlicensureofallmodesoftransport(ground,air,water)aswellasminimumcarelevelsfor
alltransportservices(minimumstaffingandcredentialing).Alloutofhospitalemergencymedicalcare
transportservicesaresubjecttoroutine,standardizedinspections,aswellasspotcheckstomaintaina
constantstateofreadinessthroughouttheState.Thereisaprogramforthetrainingandcertificationof
emergencyvehicleoperators.
ProgressSince1990
Sincethe1990NHTSAassessmentprogresshasbeenmadeinseveralareas.
TheBureauhasbecomemoreinvolvedwiththeWisconsinDepartmentofTransportation(DOT)in
developingambulanceinspectionrules.Theyhavealsomaderecommendationsregardingambulance
inspectorqualifications.
Standardsarenowinplaceforuniformrequirementsforambulanceequipmentincludingpediatric
equipment.
Status
Locallawenforcementagenciesreportedlyrespondtoapproximately96%ofmotorvehiclecrashesin
Wisconsin.ThetrainingforlocallawenforcementpersonnelistheresponsibilityoftheDepartmentof
Justice,withlittleinteractionwiththeBureauofEMSandInjuryPrevention.
AmbulanceinspectionsareconductedbystatepatrolpersonnelandaretheresponsibilityofDOT.The
BureauworkswithDOTtodeveloptheambulancelicensingrulesandmakesothersuggestions
regardingqualificationsofinspectionpersonnel.Therearenoairorwaterambulanceregulations.
77
Therearenoestablishedcriteriaforreviewingoperationsplansanddeterminingwhetherornottoissue
anambulancelicense.Standardequipment,includingpediatricequipment,isnowrequiredonall
ambulances.
CurrentrulesallowforBasicLifeSupportambulancestobestaffedbyoneEMTandoneEMTtrainee.
ProposedruleswouldallowforthestaffingofParamedicunitsbyoneParamedicratherthantwo.The
Bureau,EMSBoard,AmericanCollegeofEmergencyPhysicians(ACEP)andothersbelievethischange
wouldallowformoreEMSprovideragenciestodeliverparamediclevelcareinruralareas.
Thereisnostatewidemutualaidorambulanceplacementplan.Airambulancesestablishtheirown
serviceareaswithnouniformrationale.Itisunclearifthenumberanddistributionofairambulances
servethestateeffectively.
Recommendations
TheBureaushould:
Obtainlegislativeauthoritytoestablishcomprehensiveregulationsforair,waterandgroundEMS
services.
Developastatewideairambulancecoverageplan.
Developobjectivecriteriaforapproval/disapprovalofambulanceserviceoperationplans.
Developastatewidemutualaidplan.
Developaprogramtospotcheckambulanceservicesforcompliancewithmedicalequipmentand
staffing.
SupporttheproposedruleallowingoneEMTParamedicperEMTParamedicambulance.
78
FACILITIES
Standard
Itisimperativethattheseriouslyillpatientbedeliveredinatimelymannertotheclosestappropriate
facility.Theleadagencyhasasystemforcategorizingthefunctionalcapabilitiesofallindividualhealth
carefacilitiesthatreceivepatientsfromtheoutofhospitalemergencymedicalcaresetting.This
determinationshouldbefreeofpoliticalconsiderations,isupdatedonanannualbasisandencompasses
bothstabilizationanddefinitivecare.Thereisaprocessforverificationofthecategorizations(i.e.,on
sitereview).ThisinformationisdisseminatedtoEMSproviderssothatthecapabilitiesofthefacilities
areknowninadvanceandappropriateprimaryandsecondarytransportdecisionscanbemade.The
leadagencyalsodevelopsandimplementsoutofhospitalemergencymedicalcaretriageand
destinationpolicies,aswellasprotocolsforspecialtycarepatients(suchasseveretrauma,burns,spinal
cordinjuriesandpediatricemergencies)basedonthefunctionalassessmentoffacilities.Criteriaare
identifiedtoguideinterfacilitytransportofspecialtycarepatientstotheappropriatefacilities.Diversion
policiesaredevelopedandutilizedtomatchsystemresourceswithpatientneeds;standardsareclearly
identifiedforplacingafacilityonbypassordivertinganambulancetoanotherfacility.Theleadagency
hasamethodformonitoringifpatientsaredirectedtoappropriatefacilities.
ProgressSince1990
None.
Status
FollowingtheinitialEMSassessmentin1990,therewerefiverecommendationsdirectedatidentifying
theclinicalcapabilitiesofWisconsinshospitals,andutilizationofthatinformationtoassurethatthe
rightpatientistransportedtothecorrecthospital.Thisissuereceivedanappropriatelylowpriority
consideringtheconstraintsofmanpowerandfunding.Therefore,theissueoffacilitycategorizationwas
foldedintoactivitiesrelatedtothetraumasystem,whichisasyetnotcompleted.
Therehasbeennoprogressinfacilitycategorizationpendingtheinstitutionofatraumasystem,with
thepresumptionthattraumacategorizationreflectscapabilitiesacrossallmedicaldisciplines.Thismay
notbetrue.Intheinterim,EMStransportdecisionshavereliedonphysicianreferralpreferencesand
perceivedfacilitycapabilities.However,thishasnotproducedconcreteinformationtobeusedforthe
developmentofrationalEMStriageortransferguidelines.Itisunknowniftherearestillstatutory
requirementsforfacilitycategorization.
79
Recommendations
TheBureaushould:
Initiateaprocesstodocumentwhatisalreadyknownaboutthecapabilitiesofallhospitalsthat
interfacewithWisconsinEMS.
Incorporatethisinformationintotheprehospitaltriageandinterfacilitydestinationpoliciesbeing
developed.
AssessthecurrentimpactofhospitaldiversiononEMSservices,particularlyinurbanareas.Develop
uniformcriteriatobeusedinmakingemergencydepartmentdiversiondecisions.
COMMUNICATION
Standard
AreliablecommunicationssystemisanessentialcomponentofanoverallEMSsystem.Theleadagency
isresponsibleforcentralcoordinationofEMScommunications(orworkscloselywithanothersingle
agencythatperformsthisfunction)andthestateEMSplancontainsacomponentforcomprehensive
EMScommunications.ThepubliccanaccesstheEMSsystemwithasingle,universalemergencyphone
number,suchas911(orpreferablyEnhanced911),andthecommunicationssystemprovidesfor
prioritizeddispatch.Thereisacommon,statewideradiosystemthatallowsfordirectcommunication
betweenallproviders(dispatchtoambulancecommunication,ambulancetoambulance,ambulanceto
hospital,andhospitaltohospitalcommunications)toensurethatreceivingfacilitiesarereadyandable
toacceptpatients.Minimumstandardsfordispatchcentersareestablished,includingprotocolsto
ensureuniformdispatchandstandardsfordispatchertrainingandcertification.Thereisanestablished
mechanismformonitoringthequalityofthecommunicationsystem,includingtheageandreliabilityof
equipment.
80
ProgressSince1990
Nocommunicationssystemfundingsourceshavebeenidentified.
Evaluationofstatewidecommunicationsneedsandpotentialinfrastructuredevelopmentisongoing.
E911coveragewillbeinplacefor99%ofthepopulationby2002.
MicrowavesystemintegrationwithEMSfrequenciesianolongerneededandequipmentisbeing
removed.
TheexistingEMScommunicationssystemworksandissupplementedbystandingordersandcellphone
systems.
TheEMSBoardisconsideringthedevelopmentoflegislationfortrainingandlicensureofEMS
dispatchersanddispatchcenters.
Status
TheWisconsinEMSsystemisservedbyanoutdatedVHFandUHFradiosystemforambulanceto
hospitalcommunications.WhileprovidersandtheEMSBoardagreethatthecurrentsystemis
outdated,theyfeelitmeetstheirneedsandissupplementedinseveralareasbystandingordersand
cellularphonesystems.Nosingle,statewideEMScommunicationssystemexists.Rather,afragmented
andnoninteroperablesystemisinplace.However,itappearstomeettheneedsandsatisfactionof
EMSprovidersintheirdaytodayoperations.Localdispatchsystemsrangefromstateoftheartto
systemsthatareold,outdatedandpossiblyoutofcompliancewithFCCstandards.
Thestatehaspartneredwithotheragenciesandstakeholderstoattempttoremedythesituationby
identifyingitsneedsanddevelopingaplanforacomprehensivetelecommunicationssystem.Thestudy
conductedbyEvansandAssociatesfortheWisconsinInteragencyCommitteeonRadioTowerSites
(WICORTS)in1992providedrecommendations.However,absenceoffundingprohibitedcontinuation
ofthisinitiative.
81
E911accesstolocalEMSsystemscontinuestoimproveandisalmostuniversalinWisconsin.Itis
believedthatE911willbeoperationalinallcountiesbutoneby2002.CurrentactivitybytheSystems
ManagementCommitteeoftheEMSBoardrevolvesaroundawhitepaperandpotentiallegislation
whichwouldenabletheEMSBureautoestablishtraining,dispatchcenterstandardsandEMSdispatcher
standardsforlicensure.Fundingforstaffsupportofthisprogramisalsoproposed.
AnotherconsiderationforacomprehensiveEMScommunicationssystemisstandardsformedical
controlresourcehospitals.Currently,noneexistandhospitalradiosarestaffedrandomlybyphysicians
andphysiciansurrogates.Thereisnosystemformonitoringtheonlinemedicalcontrolstructurefor
qualityassurancepurposes.
TheWisconsinEMSCommunications/TelemetryStandardsandGuidelineswerereleasedin1983.They
areslatedforrevisionutilizingthe1992NHTSAEMSCommunicationsPlanningGuideline.
Recommendations
TheBureaushould:
PursuestatutorytrainingandlicensurestandardsforEMSdispatchersanddispatchcenterstoinclude
fundingforprogramsupportandpersonnel.
CompletetherevisedcomprehensivestateEMScommunicationsplan.
Establishonlinemedicalcontrolandresourcehospitalstandards.
NetworkwithotherstateEMSofficesandstateandnationalEMSandcommunicationsassociationsfor
informationandsolutionstoEMScommunicationsproblems.
Takeappropriateactionstodisallowsevendigittelephonenumberadvertisingforemergency
ambulanceserviceaccesswhere911isavailable.
PUBLICINFORMATION,EDUCATIONANDPREVENTION
82
Standard
Toeffectivelyservethepublic,eachStatemustdevelopandimplementanEMSpublicinformationand
education(PI&E)program.ThePI&EcomponentoftheStateEMSplanensuresthatconsistent,
structuredPI&Eprogramsareinplacethatenhancethepublic'sknowledgeoftheEMSsystem,support
appropriateEMSsystemaccess,demonstrateessentialselfhelpandappropriatebystandercareactions,
andencourageinjuryprevention.ThePI&Eplanisbasedonaneedsassessmentofthepopulationtobe
servedandanidentificationofactualorpotentialproblemareas(i.e.,demographicsandhealthstatus
variable,publicperceptionsandknowledgeofEMS,typeandscopeofexistingPI&Eprograms).Thereis
anestablishedmechanismfortheprovisionofappropriateandtimelyreleaseofinformationonEMS
relatedevents,issuesandpublicrelations(damagecontrol).Theleadagencydedicatesstaffingand
fundingfortheseprograms,whicharedirectedatboththegeneralpublicandEMSproviders.Thelead
agencyenliststhecooperationofotherpublicserviceagenciesinthedevelopmentanddistributionof
theseprograms,andservesasanadvocateforlegislationthatpotentiallyresultsininjury/illness
prevention.
ProgressSince1990
Althoughthereisinadequatefundingandstafftosupportsystemwidepublicinformationand
education,theWisconsinEMSsystemhasmadeprogressinaccomplishingtheobjectivessincethelast
assessment:
SomeBureauofEMSandInjuryPreventionstaffarenowworkingonpublicinformationandeducation
activities.
ThereisaseparatesectionofInjuryPreventionlocatedintheBureauofEMSandInjuryPrevention;
therearestaffdedicatedtoinjuryprevention.
TherehasbeensomeprogressininvolvingEMSprovidersinpublicinformationandinjuryprevention.
TherearemanypublicinformationandeducationactivitiesincludedintheEMSprovidershandbook.
83
Status
TheBureauofEMSandInjuryPreventionhasreceivedafouryearCentersforDiseaseControland
Prevention(CDC)granttodeveloptheinfrastructureforastatewideinjurypreventionprogram,
includingeffortstoincreasetheinvolvementofEMSprovidersininjuryprevention.TheEMSC
coordinatorfacilitatessomepublicinformationandeducationactivities.
TheBureauhasintegratedaconsiderableamountofpublicinformationandeducationwithitsregular
customercontacts.ExamplesincludethedevelopmentofanoutstandingEMSandInjuryPrevention
websiteanddevelopinganumberedmemoseriestokeepEMSprovidersinformedofcurrentEMS
developments.ThestatehighwaytrafficsafetyofficesponsoredatrainthetrainersprograminPublic
Information,EducationandRelations(PIER).Since2000,aquarterlyEMSandinjuryprevention
newsletter,HiLightsandSirens,hasbeendevelopedandwidelydistributedtoalargeaudience
includingEMSproviders,otherhealthcareproviders,publichealthdepartments,lawenforcement
agencies,firepersonnel,advocacygroupsandothers.
Therehasbeenconsiderableprogresswiththeestablishmentofastatewideinjurypreventionprogram.
AnInjuryPreventionSectionsupervisorhasbeenhired,andtherehasbeenworkinsuicideprevention,
fallspreventionandinvolvementwithSafeCommunities.TheInjuryPreventionSectionwillbeguiding
thedevelopmentofastrategicplanforinjuryprevention,includingidentificationofthemethodsby
whichEMSproviderscanbeinvolved.ThesecondannualstateConferenceonChildhoodEmergencies
includesinjurypreventiontopics.
TheEMSCprogramhasdonesubstantialworktopromotenumerousprograms;includingtheChildAlert
Program,BasicEmergencyLifeSupportSkillsforSchools,ProjectADAM,theConferenceonChildhood
Emergenciesandlegislativeadvocacy.TheenthusiasmandenergyoftheEMSCstaff,theEMSCAdvisory
Committeeandvolunteersarecommendable!
Recommendations
TheBureauofEMSandInjuryPreventionshoulddevelopabroadbasedpublicinformationand
educationplanwhichtargets,inpart,policymakersandthegeneralpublic.Amongothertopics,this
shouldaddressemergencymedicalservicesandtraumasystems.
84
TheBureaushouldincorporategraduatesofthePIERprograminitsplanstoinvolveEMSprovidersin
improvedpublicinformationandeducation.
TheambulanceprovidersshouldincludeinformationaboutEMSpublicinformation,educationand
injurypreventionactivitiesintheirambulanceoperationsplans.
TheBureaushouldincludeadditionalinformationaboutpublicinformationandeducationinthe
WisconsinEMSandInjuryPreventionHandbook.
MEDICALDIRECTION
Standard
EMSisamedicalcaresystemthatinvolvesmedicalpracticeasdelegatedbyphysicianstononphysician
providerswhomanagepatientcareoutsidethetraditionalconfinesofofficeorhospital.Asbefitsthis
delegationofauthority,thesystemensuresthatphysiciansareinvolvedinallaspectsofthepatientcare
system.TheroleoftheStateEMSMedicalDirectorisclearlydefined,withlegislativeauthorityand
responsibilityforEMSsystemstandards,protocolsandevaluationofpatientcare.Acomprehensive
systemofmedicaldirectionforalloutofhospitalemergencymedicalcareproviders(includingBLS)is
utilizedtoevaluatetheprovisionofmedicalcareasitrelatestopatientoutcome,appropriatenessof
trainingprogramsandmedicaldirection.Therearestandardsforthetrainingandmonitoringofdirect
medicalcontrolphysicians,andstatewide,standardizedtreatmentprotocols.Thereisamechanismfor
concurrentandretrospectivereviewofoutofhospitalemergencymedicalcare,includingindicatorsfor
optimalsystemperformance.Physiciansareconsistentlyinvolvedandprovideleadershipatalllevelsof
qualityimprovementprograms(local,regional,state).
ProgressSince1990
ThepositionofStateMedicalDirectorfortheEmergencyMedicalServicesProgram(StateEMSMedical
Director)wasestablished.
85
MinimumcredentialrequirementswereestablishedforphysiciansservingasEMSmedicaldirectors.
MedicaldirectionbecamerequiredforallEMSproviderscredentialedatthelevelsofFirstResponder
DefibrillationthroughEMTParamedic.
DevelopmentofstandingordersforEMSproviderswasenabled.
SomestatewideEMSprotocolshavebeendeveloped.
Status
InthepastelevenyearsagreatdealhasbeenaccomplishedtoimprovethestateofEMSmedical
directioninWisconsin.Thecurrentstatemedicaldirectorfortheemergencymedicalservicesprogram
enjoysabundantrespectforhisknowledge,integrity,andcommitmenttotheprogram,andheisseen
ashighlycredible.ThePhysicianAdvisoryCommitteehasbecomeavaluableresourcefordeliberating
EMSclinicalissues,advisingthestateEMSmedicaldirector,andcreatingusefulproductsforthestate
EMSmedicaldirector,theBureauofEMSandInjuryPrevention,andlocalEMSmedicaldirectors.More
than250physiciansprovidemedicaldirectionforthestates450localEMSprograms.Forurbanand
suburbanprograms,usuallyprovidinghigherlevelsofservice,thesephysiciansaretypicallyvery
qualifiedandprogressive.Inmoreruralsettings,medicaldirectorsmayhavelimitedEMSrelated
experienceandexpertise,butprovidethisneededserviceinfulfillmentofasenseofcivicduty.Their
qualificationsmaybenomorethanbeingalicensedphysicianandwillingnesstoserve.Ahandbook
developedbythePhysicianAdvisoryCommitteeisavaluableresourceforEMSmedicaldirectorsandis
requiredreading.
Thescopeofserviceorpractice(i.e.,specificoptionsforcare)ofeachEMSprogramis,toalargeextent,
atthediscretionofthelocalEMSmedicaldirector,withinconfinesestablishedbytheBureauofEMS
andInjuryPrevention.StandingorderscanprovideEMSpersonnelwiththenecessaryauthorizationto
deliverimmediatelyneededtreatment.Additionally,EMSmedicaldirectorsmaydesignateother
physiciansornonphysicianstoprovideonlinemedicalcontrolviaradioortelephonecommunications.
However,therearenostatewidestandardsregardingthequalificationsofpersonnelwhomightdeliver
thisservice.
86
Emergencymedicalservicesmedicaldirectors,afterdueprocess,mayrestricttheclinicalactivitiesof
individualEMSpractitionersundertheirauspices.ThisauthoritywithregardtoEMTParamedicsis
currentlypendingintherulemakingprocess,butisexpectedsoon.
TheaccountabilityofEMSmedicaldirectorsisdifficulttoestablish.TheauthorityofthestateEMS
medicaldirectorwithregardtolocalEMSmedicaldirectorsisambiguous.
Recommendations
TheBureaushould:
ContinuetoworktoenhancetherequiredcredentialsofEMSmedicaldirectors,baseduponthelevelof
theEMSprogramsinvolved.
Establishminimumcredentialsforthosewhomaybedesignatedtoprovideonlinemedicalcontrol,
possiblyrequiringcompletionofabasestationprovidercourse.
DevelopperiodicstatewideandregionalforumsforlocalEMSmedicaldirectorstomeetwiththestate
EMSmedicaldirectorandotherBureaustaff,discusscommonissues,andsharesolutions,andexploit
electronicoptionsforfacilitatingcontinualinteractionamongEMSmedicaldirectors.
Ensurethatallinterfacilitypatienttransportsareconductedwithadequatemedicaldirectionand
appropriateavailabilityofonlinemedicalcontrol.
DevelopdueprocessguidelinesforusebylocalEMSmedicaldirectors.
Ensurethatthestatemedicaldirectorfortheemergencymedicalservicesprogramistheleadcontactat
theDepartmentofHealthandFamilyServicesregardingclinicalcareimplicationsforanycontemplated
EMSsystempolicyorprocedurechange.
Clarifytheauthorityofthestatemedicaldirectorfortheemergencymedicalservicesprogramwith
regardtolocal/regionalEMSmedicaldirectors.
87
TRAUMASYSTEMS
Standard
Toprovideaquality,effectivesystemoftraumacare,eachStatemusthaveinplaceafullyfunctional
EMSsystem;traumacarecomponentsmustbeclearlyintegratedwiththeoverallEMSsystem.Enabling
legislationshouldbeinplaceforthedevelopmentandimplementationofthetraumacarecomponent
oftheEMSsystem.Thisshouldincludetraumacenterdesignation(usingACSCOT,ACEP,APSACOT
and/orothernationalstandardsasguidelines),triageandtransferguidelinesfortraumapatients,data
collectionandtraumaregistrydefinitionsandmechanisms,mandatoryautopsiesandquality
improvementfortraumapatients.Informationandtrendsfromthetraumaregistryshouldbereflected
inPIERandinjurypreventionprograms.Rehabilitationisanessentialcomponentofanystatewide
traumasystemandhencetheseservicesshouldalsobeconsideredaspartofthedesignationprocess.
Thestatewidetraumasystem(ortraumasystemplan)reflectstheessentialelementsoftheModel
TraumaCareSystemPlan.
ProgressSince1990
InresponsetotherecommendationsoftheNHTSATechnicalAssistanceTeam(TAT),alegislativestudy
committeewasconvened,resultinginthepassageofWisconsinActs16&251in1993.
TheEMSBoarddevelopedaninitialTraumaReport.
Inresponsetothe1996Traumareport,initialtraumalegislationwaspassedin1997.WisconsinAct154,
1997,gavestatutoryauthorityfortheBureauofEMSandInjuryPreventiontoappointaStatewide
TraumaAdvisoryCouncil(STAC)andtodeveloprulesandtoimplementthesystem.
TheDHSandSTACwerechargedtoprepareareportonimplementationofastatewidetraumacare
system,tobesubmittedtothelegislatureonJanuary1,2001forreviewbytheJointCommitteeon
Finance.Thereportoutlinesthedevelopmentofaninclusivetraumasystemaddressingmost,butnot
all,oftherecommendationsoftheTAT.Thereporthasbeensubmittedandisawaitingapprovalofthe
JointFinanceCommitteeandsubsequentfunding.
88
Status
TheDepartmenthasanenablingstatutetoformanadvisorycouncil,towriteatraumasystemplan,and
toseekapprovalandfundingforthesystem.Astatetraumacoordinatorhasrecentlybeenhiredto
assistinsystemdevelopmentandinitiation.Manyoftheessentialcomponentsofatraumasystemare
available,includingEMSsystems,atraininginfrastructure,andestablishedregionaltraumareferral
patterns.AlthoughtheWisconsinStateAmericanCollegeofSurgeonsCommitteeonTraumaseemsnot
tobeengagedinthetraumasystemeffort,thatorganizationoffersATLSaccessinfoursitesadequate
forthetrainingneedsofphysiciansandphysicianextenders.Wisconsinhas128welldistributed
hospitals,twoofwhichareLevelIandACSverified,andnineofwhichareidentifiedasLevelII,ofwhich
twoareACSverified.
Currently,theadvancementofthetraumaprogramishinderedbylimitationsinfunding,shortageof
staff,andbylimitedtraumaexpertisewithintheBureau.Thecurrenttraumasystemplandoesnot
includeaprovisionfordesignationoftraumahospitals,allowslevelIIIandIVhospitalstocertifywithout
verification,anddoesnotallowforcontrolofparticipantsbasedonsystemneeds.Thestatewidetrauma
registryimplementationstrategyisslow,allowingdelayinparticipationbysmallerhospitals,usesdata
setsthatvarybyhospitalsize,suggeststheuseofdatasourcesthatmaynotprovideaccuratetrauma
information,andseemsnottoemphasizetheimportanceofthesystemscomponent.Thesixyear
estimateddevelopmenttimelinewillsignificantlydelaythebenefitsofsystemandhospitalquality
improvement.
Recommendations
TheBureaushould:
ArrangeforanAmericanCollegeofSurgeonsCommitteeonTrauma,traumasystemsconsultation.
Seekstatutoryauthoritytodesignatetraumafacilities.
Identifyordevelopandfundanacceptableandconsistentstatewidetraumasystemsregistry.
89
Continuetopursuededicatedfundingforimplementationandoperationofthetraumasystem.
IftheACSverificationprocessistobeusedfordesignation,amendthestatutetoreflectathreeyear
designationcycle.
EVALUATION
Standard
Acomprehensiveevaluationprogramisneededtoeffectivelyplan,implementandmonitorastatewide
EMSsystem.TheEMSsystemisresponsibleforevaluatingtheeffectivenessofservicesprovidedvictims
ofmedicalortraumarelatedemergencies,thereforetheEMSagencyshouldbeabletostatedefinitively
whatimpacthasbeenmadeonthepatientsservedbythesystem.Auniform,statewideoutofhospital
datacollectionsystemexiststhatcapturestheminimumdatanecessarytomeasurecompliancewith
standards(i.e.,amandatory,uniformEMSrunreportformoraminimumsetofdatathatisprovidedto
thestate);dataareconsistentlyandroutinelyprovidedtotheleadagencybyallEMSprovidersandthe
leadagencyperformsroutineanalysisofthisdata.Preestablishedstandards,criteriaandoutcome
parametersareusedtoevaluateresourceutilization,scopeofservices,effectivenessofpoliciesand
procedures,andpatientoutcome.Acomprehensive,medicallydirected,statewidequality
improvementprogramisestablishedtoassessandevaluatepatientcare,includingareviewofprocess
(howEMSsystemcomponentsarefunctioning)andoutcome.Thequalityimprovementprogramshould
includeanassessmentofhowthesystemiscurrentlyfunctioningaccordingtotheperformance
standards,identificationofsystemimprovementsthatareneededtoexceedthestandardsanda
mechanismtomeasuretheimpactoftheimprovementsonceimplemented.Patientoutcomedatais
collectedandintegratedwithhealthsystem,emergencydepartmentandtraumasystemdata;optimally
thereislinkagetodatabasesoutsideofEMS(suchascrashreports,FARS,traumaregistry,medical
examinerreportsanddischargedata)tofullyevaluatequalityofcare.Theevaluationprocessis
educationalandqualityimprovement/systemevaluationfindingsaredisseminatedtooutofhospital
emergencymedicalcareproviders.Theleadagencyensuresthatallqualityimprovementactivitieshave
legislativeconfidentialityprotectionandarenondiscoverable.
ProgressSince1990
90
AreportregardingEMSdatacollectionneedswassenttothelegislaturein1995,resultinginno
legislativeaction.
TheWisconsinEMSInformationSystem(WEMSIS)wasdevelopedandwasmadeavailabletoEMS
provideragencies.
AspartofWEMSIS,astandardizedEMSpatientcarerecordwasdeveloped.
Qualityassurancecomponentsmustbeincludedinallambulanceoperationsplans.
PlanshavebeendevelopedtoprovidefeedbacktoEMSmanagersandproviderswhosubmitdatatothe
BureauofEMSandInjuryPrevention.
Status
Theprocessofevaluationandongoingqualityimprovementprogramsremainunderdevelopedin
Wisconsin.AtthecoreoftheissueisthelackofastatewidesystemforcollectingEMSrelateddata,lack
ofacentralrepositoryforEMSrelateddata,andlackoftechnicalandgeneralmanpowerresourcesto
analyzewhatrelativelylittledataareavailable.DevelopmentoftheWEMSISwasquiteanoteworthy
accomplishment,whichhasreceivedconsiderablerecognitionwithinandoutsideofWisconsin.
However,itswidespreadusehasbeenhamperedbyvariationintechnicalcapacityamongthestates
EMSprovideragenciesandlackoftechnicalsupport,amongotherthings.Currently,lessthan10%of
thestatesEMSprovideragenciesuseWEMSIS.Theremainingagenciesdonotroutinelysubmitdatato
acentralrepository.TherearenostandardproceduresforanalyzingdatasubmittedtotheBureauof
EMSandInjuryPreventionorforprovidingfeedbacktothosewhohavecontributedtothedatapool.
Thus,thereexistsapaucityofcredibleinformationtodescribethecurrentEMSsystemacrossthestate
ofWisconsin,orthatcanbeusedtomonitoritsstatus.Thereisnosystemthatcanbeemployedtohelp
assesstheeffectsofEMSsystemstructuralorprocesschangesintendedtocreateimprovements.
AttemptstodeterminetheeffectsofimprovementinitiativesoftenrelyonselfreportingbyEMS
provideragencies,qualitativedatasubmittedbyEMSproviders,samplingtechniqueswithuncertain
validity,orgestalt.
Thestatemedicaldirectorfortheemergencymedicalservicesprogrammaintainsprincipalauthorityfor
maintainingthestatesEMSqualityassurance/improvementprogram.Anumberofinitiativeshave
beencompleted,orareunderdevelopment,intendedtoimprovethequalityofEMSinWisconsin.
91
However,astheavailabilityofcurrentdataistypicallylacking,ongoingassessmentoftheeffectsof
institutedchangesisimpossible.AlthoughEMSprovideragencies(i.e.,ambulanceservices)arerequired
toparticipateinqualityimprovementactivities,thereisnoassurancethattheyactuallyareengaged.
ThereisskepticismthatmanyEMSprovidersandmanagerspossessanadequateworkingknowledgeof
thefundamentalprocessesofevaluationandqualityimprovement.
WithinWisconsinstategovernmentandtheDepartmentofHealthandFamilyServices,thereseemto
becurrentprojectsandresourceswithwhichcollaborationcouldpotentiallyimprovetheabilityto
acquireandanalyzeEMSrelateddata.TheseincludetheBureauofHealthInformation,whichis
currentlychargedtoevaluatedatafromhospitalemergencydepartments,asuccessfulCrashOutcomes
DataEvaluationSystem(CODES)project,andafundedinjuryepidemiologistpositionwithintheInjury
PreventionSection.
Recommendations
TheBureaushould:
SeektheauthorityfortheBureauofEMSandInjuryPreventiontomandatethatEMSprovideragencies
submitspecificdataelementstoacentralrepository.
ConductaNHTSAEMSInformationSystems(EMSIS)workshop.
ConductaNHTSALeadershipWorkshopforQualityImprovement.
AssigntheInjuryPreventionSectionsinjuryepidemiologisttoevaluateallpossiblesourcesofEMS
relateddatainthestate,andtheirpotentialforlinkagewithacentralEMSdatabase.
DevelopandadequatelyfundthepositionofEMSdatamanagerandtechnicalconsultantwithinthe
BureauofEMSandInjuryPrevention.
92
DevelopWEMSISasaninternetbasedEMSpatientcarereportthatwouldautomaticallypopulatethe
statesEMSdatabase,enablingimmediatequeriesattheBureauofEMSandInjuryPreventionandalso
limitedqueriesbyEMSprovideragencies.
Providesummaryfeedbackinformation,derivedfromsubmitteddata,inapredictableperiodicmanner
tothestatesEMSprovideragencies.
DevelopacollaborativerelationshipbetweentheBureauofEMSandInjuryPreventionandtheBureau
ofHealthInformationthatfacilitatesdatasharingandlinkagetooutcomeinformation.
Developongoingqualityimprovementprograms,includingtemplatesforevaluationandactionthatcan
beadaptedatthestateandlocalEMSlevels.
SeeklegislationtoensurethatinformationderivedaspartofformalEMSpeerrevieworquality
improvementprojectsisnotdiscoverableduringcasesofcivilaction.
93
CURRICULUMVITAE
BobW.Bailey
10605HanarryCourt
Raleigh,NC27614
9198474198
Email:bbaily@nc.rr.com
President,BobBailey,Inc.
NorthCarolina,OfficeofEmergencyMedicalServices,Director,19851999.
NationalAssociationofStateEMSDirectors(NASEMSD),PastPresident
ExecutiveCommittee,variouscommitteechairs,NASEMSD
NationalAssociationofGovernorsHighwaySafetyRepresentatives,Liaison19901991
NationalAssociationofEMSPhysicians,Liaison
ManagementTeamEMSClearinghouse,NASEMSD19861991
NationalAssociationofStateEMSTrainingCoordinators
PastMemberBoardofDirectors
NorthCarolinaDivision,AmericanTraumaSociety,BoardofDirectors
NorthCarolinaGovernorsTaskForceonInjuryPreventionandControl
NorthCarolinaMedicalSocietyDisasterAndEMSCommittee
NorthCarolinaMedicalSocietyBioethicsSubcommittee,Advisor
ASTMF.30CommitteeonEmergencyMedicalServices
NationalEMSAlliance(NEMSA)
InitialCoordinationCommitteeChairman
94
NationalTrafficRecordsAssessmentTeam,Member,StatesofIdahoandDelaware.
EMSAgendaFortheFuture,SteeringCommittee
EMSforChildrenprogramsitevisitStatesofHawaii,VirginIslands,Minnesota,Maine,Oregon,
Florida,Colorado,andGeorgia
DOT/NHTSA,EmergencyMedicalServicesAssessmentProgram,TechnicalAssistanceTeam,
Member,StatesofLouisiana,Arizona,Florida,Idaho,Kansas,Kentucky,NewJersey,Virginia,Vermont,
WestVirginia,andAmericaSamoa
EMSReassessmentProgram,TechnicalAssistanceTeam,Member,StatesofMinnesota,Alaska,
ConnecticutandPennsylvania
BoardofDirectors,NationalRegistryEMTs19961999
NREMT,EMT,EMPT,PracticeAnalysisCommittee
NationalEMSCAdvisoryCommittee,Member,1996present
NCStateEMSAdvisoryCouncil(20002004)
95
DrewE.Dawson
MontanaDepartmentofPublicHealthandHumanServices
CogswellBuilding
CapitolStation
P.O.Box202951
Helena,MT59620
(406)4444458
Chief,HealthSystemsBureau
NationalRegistryofEmergencyMedicalTechnicians
BoardofDirectorsRepresentingNASEMSD
PlanningandDataCommittee,Treasurer
Chair,LEADSCommittee
PolicyandProceduresCommittee,
ViceChair,BoardofDirectors
Chairman,BoardofDirectors
StandardSettings,EMTBasicExaminationtechnicians
EMTBasicTransitionCurriculumGroup
ADHOCCommitteeonAmericanswithDisabilities
EMTP,EMTBPracticeAnalysisTaskForce
NHTSA
Member,UniformPrehospitalDataSetTaskForceandConsensusConference
96
InvitedParticipant
NHTSAWorkshoponMethodologiesforMeasuringMorbidityandOutcomesinEmergency
MedicalServices
DivisionofTraumaandEMS,HRSA
TraumaDataSetCommittee
TaskForceEvaluationTraumaSystems
ChairNationalEMSandEducationPracticeBlueprint
PastSecretary
LegalRecognitionCommittee
Chair,NationalRegistryCommittee
Chair,DataCommittee
President
USDOT,NHTSA,EMSTechnicalAssistanceTeam,Member,Ohio,Kentucky,Oklahoma,Utah,Missouri,
NationalParkServiceandCalifornia.
97
TheodoreR.Delbridge,MD,MPH
UniversityofPittsburgh
DepartmentofEmergencyMedicine
230McKeePlace,Suite500
Pittsburgh,PA15213
(413)6471107
FAX4126475053
Email:delbridget@msx.upmc.edu
AssistantProfessorofEmergencyMedicineandHealthServicesAdministration
ORGANIZATONS/APPOINTMENTS
Diplomat,AmericanBoardofEmergencyMedicine
DirectorofEmergencyServices,UniversityofPittsburghMedicalCenter
AssistantMedicalDirector,CityofPittsburghEMS,
AssociateMedicalDirector,STATMedEvacAirMedicalSystem
EMSFellowshipDirector,UniversityofPittsburgh
MedicalDirector,AirlineMedicalConsultationService,UniversityofPittsburgh
PennsylvaniaEmergencyHealthServicesCouncil
MedicalAdvisoryCommittee
EMSIRegionalEMSCouncil
MedicalDirectionCommittee
NationalAssociationofEMSPhysicians
98
SocietyofAcademicEmergencyMedicine
GrantsCommittee
Chair,EMSInterestGroup
AmericanCollegeofEmergencyPhysicians
ConsultingEditor(EMS)
AnnalsofEmergencyMedicine
PrincipalInvestigator
EMSAgendafortheFuture
EMSAgendafortheFutureImplementationGuide
DOT/NHTSA,TechnicalAssistanceTeam,Member,StatesofSouthCarolina,Colorado
99
MarkE.King,BA,AAS,CP,NREMTP
WestVirginiaOfficeofEMS
350CapitolStreet,RM515
Charleston,WV25301
(304)5583956FAX(304)5581437
Email:marking@wvdhhr.org
Director,WestVirginiaOfficeofEMS
NationalRegistryofEMTs,EMTParamedic
EmergencyMedicalTechnicianParamedic,WestVirginia
BasicTraumaLifeSupport,International,
PastNationalFaculty
WVBasicTraumaLifeSupport
PastAffiliateFaculty
WVAdvancedCardiacLifeSupport
PastAffiliateFaculty
PresidentElect
ConferenceCommitteeChair,RuralIssuesCommitteeChair
NationalRuralHealthAssociation,Chair,AdHocSubcommitteeforRural/FrontierEMS
PositionPaper
CentersforDiseaseControlandPreventionGrant
PrincipalInvestigator,FatalityAssessmentandControlEvaluationProgram
100
NationalResearchCouncil,TransportationResearchBoard,StrategicHighwaySafetyPlan,
Expert
AtlanticEMSCouncil
Member
NationalRegistryofEMTs,BoardofDirectors,StandardsandexaminationsCommittee,Practice
AnalysisCommittee,OralStationDevelopmentCommittee,DataCommittee,Strategic
PlanningCommittee,
NationalRuralEMSLeadershipConference,Invitee
EMSAgendafortheFuture,NationalLeadersConference,Invitee
EMSCFiveYearPlanTaskForce,Member
Former,NationalAssociationforSearchandRescue,FundamentalSearchandRescueCourseInstructor
USDOTNHTSAEmergencyMedicalServicesAssessmentProgram,TechnicalAssistanceTeam,Member,
StatesofNebraska,Tennessee,Connecticut,andPennsylvania.
MotherandChildHealthBureau,EMSforChildrenPartnershipGrant,PrincipalInvestigator
101
SusanD.McHenry
EMSDivision
U.S.DepartmentofTransportation
400SeventhStreetSW,NTS14
Washington,DC20590
(202)3666540
FAX(202)3667721
Email:smchenry@nhtsa.dot.gov
EMSSpecialist
(March1996topresent)
NationalAssociationofStateEMSDirectors(19791996)
PastPresident
PastChairman,GovernmentAffairsCommittee
NationalAssociationEMSPhysicians,Member
AmericanMedicalAssociation
CommissiononEmergencyMedicalServices(Former)
FoundingMember,PastSpeaker,HouseofDelegates
InstituteofMedicine/NationalResearchCouncil
PediatricEMSStudyCommittee,Member
102
CommitteeStudyingUseofHeimlichManeuveronNearDrowningVictims,Member
WorldAssociationonDisasterandEmergencyMedicine
ExecutiveCommittee,FormerMember
EditorialReviewerforPrehospitalandDisasterMedicine
103
StuartReynolds,MD,FACS
120ThirteenthStreet
Harve,MT59501
(406)2659785
FAX(406)2659785
Email:Stumt@hiline.net
GeneralSurgeon,NorthernMontanaHospital
Diplomate,AmericanBoardofSurgery
MontanaTraumaRegistryTaskForce
MontanaEMSAdvisoryCouncil,Chair
MontanaATLS,NationalFaculty
RockyMountainRuralTraumaSymposium
ProgramDirector
AmericanCollegeofSurgeons,Fellow
MTCommitteeonTrauma,Chairman19781988
ACSCommitteeonTrauma19861996
ATLSCommittee/NationalFaculty
ADHOCCommitteeforRevisionofOptimalResourcesDocument
PastChairman,EmergencyServices/PrehospitalSubcommittee
PastChairman,ADHOCCommitteeonRuralTrauma
CentersforDiseaseControl,ConsensusCommitteeonTraumaRegistries
TaskForceforAcuteCareSystem,Trauma,HRSA
104
USDOT,NHTSAEMSProgram,TechnicalAssistanceTeam,Member,StatesofAlaska,Iowa,Nebraska,
Tennessee,WestVirginia,IndianHealthService,NationalParkService,AmericanSamoaandAlaska
Reassessment.
105

EMS System Overview-A Call To Action

Enviado por

Dados do documento

Título original

Direitos autorais

Formatos disponíveis

Compartilhar este documento

Compartilhar ou incorporar documento

Opções de compartilhamento

Você considera este documento útil?

Este conteúdo é inapropriado?

Direitos autorais:

Formatos disponíveis

EMS System Overview-A Call To Action

Enviado por

Direitos autorais:

Formatos disponíveis

WISCONSIN

County Rescue Services

Você também pode gostar