PINELLAS COUNTY EMS BENCHMARKS FOR PERFORMANCE EXCELLENCE

Definitions:

Benchmark: The identification and implementation of EMS “best practices” to achieve superior patient care and organizational performance.

Sentinel Event: Should have a significant functional impact on those affected; be well-defined and easy to diagnose in the field and practice settings; be sufficiently prevalent to permit the collection of adequate data; have a natural history that varies with use and effectiveness of medical care; have a well-defined medical management approach; and be well understood in terms of its socioeconomic effects. Certain performance benchmarks have been established for these Sentinel Events allowing us to review system performance using the following:

Clinical Benchmarks:

Cardiovascular Events

Sudden Cardiac Arrest (SCA):

Defined as patients meeting local inclusion criteria for resuscitation. Excludes patients presenting with lividity, rigor mortis, obviously unsurvivable trauma, decomposition or a valid DNRO.

• Time interval from call received at the Public Safety Answering Point (PSAP) to the notification of the EMS response units. Should be less than 45 seconds 90% of the time.
• Time interval from ambulance notification to the start of their response from a post location. Should be less than 45 seconds 90% of the time.
• Time interval from First Responder notification to the start of their response from a fixed site location. Should be less than one minute between the hours of 0800-2030hrs and two minutes between the hours of 2231-0759 90% of the time.
• Time interval from the first arrival (BLS/ALS) provider on the scene. Should be within 4.2 minutes 90% of the time.
• Time interval from First Responder (ALS) notification of the unit arrival on the scene. Should be within seven minutes and 30 seconds 90% of the time.
• Time interval from Ambulance (ALS) notification to the unit arrival on the scene. Should be within 10 minutes 90% of the time.
• Verbally reporting the physical presence of ALS care with the patient (at patient) to the central communications center. Should be reported 90% of the time.
• Time interval from the reported “at patient” location to the first defibrillatory shock for all SCA patients presenting in VF/VT. Should be within 90 seconds 90% of the time as outlined in the First Responder agreement.
• Time interval from the reported “at patient” location to departure from the scene to the hospital. Should be less than 20 minutes 90% of the time.
• Measurement of epinephrine usage based upon the time interval for confirmed drug access route (IV/ET) to the patient’s arrival at the hospital. Will be measured for patients not experiencing ROSC/ROSV using local protocols.
• Measurement of Cordarone usage, post-shock rhythm with patient outcome
• Measurement of Bystander CPR w/o EMD instruction (already trained)
• Measurement of Bystander CPR with EMS instruction (trained over telephone)
• Outcome measures applied to the Utstein Template.

Chest Pain:

• Chest Pain score documented pre-treatment using 10 scale
• Chest Pain relief documented post-treatment using 10 scale
• % reduction of Chest Pain
• Narcotic use documented, including the amount administered
• MI recognized by the caregiver and documented
• ECG strips attached to the patient care report (PCR)
• Thrombolytic assessment completed for MI patient
• Cardiac alert notification provided to the receiving hospital
• Aspirin administered to patient w/o contraindication
• Double Lumen started for MI patient
• At least two sets of vitals taken

Respiratory

Intubation:

• Number of patients considered for advanced airway with % placed
• Number of patients (%) with misplaced airway @ ED
• Number of extubations before ED
• Percent of “tube check” (confirmation) @ ED bed
• Number of Naso tubes with misplacement or extubation
• Number of Oral tubes with misplacement or extubation
• Site of placement (Field or Ambulance)

Shortness of Breath:

• Pre-treatment score using 10 scale
• Post-treatment score using 10 scale
• % Reduction of problem

Trauma:

Serious Injury

Defined as patients who are recognized by the EMS system to be severely injured enough to warrant urgent care and expeditious transport using rotary-wing and ground resources to a Trauma Center (TC). Would include:

• Each patient defined by the field clinician to meet State guidelines to be classified as a Trauma Alert (TA)
• Each patient transported using rotary-wing aircraft to a Trauma Center (TC).
• Time interval from call received at the Public Safety Answering Point (PSAP) to the notification of the EMS response units. Should be less than 45 seconds 90% of the time.
• Time interval from ambulance notification to the start of their response from a post location. Should be less than 45 seconds 90% of the time.
• Time interval from First Responder notification to the start of their response from a fixed site location. Should be less than one minute between the hours of 0800-2030hrs and two minutes between the hours of 2231-0759 90% of the time.
• Time interval from the First arrival (BLS/ALS) provider on the scene. Should be 4.2 minutes 90% of the time.
• Time interval from Ambulance (ALS) notification to the unit arrival on the scene. Should be within 10 minutes 90% of the time.
• Verbal reporting of the physical presence of ALS care with the patient (at patient) to the central communications center. Should be reported 90% of the time.
• Time interval from the reported “at patient” location to the determination of Trauma Alert (TA). Should be within five minutes.
• Time interval from the reported “at patient” location to the determination of rotary-wing transportation. Should be within five minutes.
• Time interval from the arrival of EMS service until the patient is transported by ground resources. Should be within 10 minutes 90% of the time.
• Time interval from the arrival of EMS service until the patient is air transported. Should be within 28 minutes 90% of the time.
• Time interval from the arrival of rotary-wing transportation until the patient is transported. Should be within 10 minutes 90% of the time.
• Time interval from the patient’s “estimated time of injury” until ground transportation. Should be within 35 minutes 90% of the time.
• Time interval from the patient’s “estimated time of injury” until the arrival at the TC. Should be within 45 minutes 90% of the time.
• Time interval from the patient’s “estimated time of injury” until the arrival of rotary-wing transportation at the TC. Should be within one hour.
• Patients that meet TA criteria that are not transported to a TC.
• % ED patients discharged compared to TA methodology
• Comparison of Field Impression to ED Impression

Education:

Continuing Medical Education (CME)

Defined as: Medical training mandated by the State of Florida EMS and the OMD. Preparing personnel for proficiency in specific job skills and regularly validating individual competencies. Compliance with the criteria for County certification shall be maintained continuously.

• Measure of continual compliance to CME shall be monthly with 90% of the EMS system attending within the first offering (Primary month).
• Completion of a given CME topic (offering) shall be completed @ 100% within 90 days of the initial offering.