TRACTION IN FORWARD AND REVERSE
FOR 1/2 TON TO CLASS 8 VEHICLES
• UTILITY TRUCKS
• FIRE TRUCKS
• SCHOOL BUSES
• PLOW TRUCKS
• TRACTOR TRAILERS
*Approved for use in states with chain control areas
appropriate individual within the PCR author’s department—often
the EMS supervisor or quality improvement manager, depending on
the organization’s policies.
Because the PCRs are reviewed by the software immediately, feedback and coaching can be provided while the call is still fresh
in the minds of the EMTs and
In addition, the compliance
with the entire bundle and
with each of the criteria can be
measured and tracked at the
individual, department and systemwide levels.
Pinellas County also implemented a campaign to ensure
that each EMT and paramedic
in the system understood the clinical and legal risks associated with
patient refusals, how to conduct and evaluate a proper EMS cognitive evaluation, the rationale for obtaining two sets of vital signs, the
importance of good documentation and the seven tests included in
the refusal bundle of care.
The campaign was conducted via email, Facebook and newsletters,
as well as in the classroom. Conversations about patient refusals were
built into new employee orientation and field training officer programs.
“We didn’t just turn this system on full throttle overnight,” one
EMS captain said. “We rolled it out over 18 months of planning and
lots of beta testing. Full implementation felt for some people like we
went from 0 to 1,000 mph, but they have been impressed by how much
improvement we’ve made so quickly.”
Once the campaign was well underway, the clinical leadership teams
began providing feedback to crews whenever a call was flagged in First-
Pass. Each department handles the coaching and feedback process in
a way that works for them. One department prefers group emails and
communication over individual feedback, while another department
schedules weekly one-on-one meetings with every medic on its team.
Even though they customize the feedback process, all 19 departments provide feedback quickly and carry the same patient-centered
non-punitive message; they also coordinate efforts with the county
medical director and follow the same policies to determine when it is
necessary to notify Jameson.
The results of their efforts to improve care for patients who refuse
transport have been dramatic (See Figure 2, p. 63.).
“For the longest time, QA was viewed as the, ‘ What have you done
wrong today club,’” an EMS captain said. “With our change to Just
Culture combined with the nearly instantaneous feedback facilitated
by FirstPass, we can concentrate on what [we] are doing right. I send
out a thank-you letter signed by the chief for every medic that has
100% performance on our clinical protocols. I used to send out 12 to
20 a month, now it’s between 170 and 180 a month.”
Transitioning to a true quality management system, rather than a
quality assurance system that only looks for mistakes and slaps pro-
viders on the wrist, has also allowed for evaluation not just of adher-
ence to clinical protocols but also whether those protocols are, in fact,
the best for the system.
That goes not only for
refusals, but for other patient
care bundles being continuously assessed in the system,
including cardiac arrest, major
trauma, acute coronary syndrome
“Once we have the system
reliably providing care in alignment with the protocols and
documenting it properly, it’s possible to evaluate trends and really
see how well the protocol is serving our patients,” Jameson said.
“We fine-tuned our chest pain
protocol to optimize recogni-
tion of STEMI faster and to better manage pain as early as possible.”
By tracking performance over time, building a non-punitive
just culture, using near real-time analysis tools, and having a truly
patient-centered, collaborative approach,
the departments delivering EMS in Pinellas
Because the PCRs are reviewed
by the software immediately,
feedback & coaching can
be provided while the call
is still fresh in the minds of
the EMTs & paramedics.
— Continued on page 62