Medical control and quality management program

The Medical Program Director (MPD) is responsible for providing medical oversight and guidance to Emergency Medical Services Technicians and Paramedics. The MPD must develop or adopt written prehospital patient care protocols to direct Emergency Medical Services personnel in patient care as per the WAC 246-976-920.

Medical direction is provided by the Medical Program Director who coordinates with hospital emergency departments, dispatch centers, the Director of Paramedic Training at Harborview Medical Center, and the agencies and fire departments who employ EMTs and Paramedics.

Mission and values: 

It is the mission of the Emergency Medical Services Division to increase survival and reduce disability from out-of-hospital medical emergencies in King County. This is achieved through partnerships with other agencies, providing the highest quality of patient care and innovative leadership. The mission is best accomplished through the application of organizational values. These values can be expressed as follows:

1. A commitment to quality, beginning with a goal of providing quality patient care. We endeavor to achieve quality in virtually every program or service we provide.
   
   
2. Providing services in an efficient, systematic, and fiscally responsible manner is a value that helps to ensure we receive the respect and support needed to accomplish our mission.
   
   
3. Using innovation, creativity, evaluation, and research to guide our mission, we search for ways to improve how services are delivered and how patient care is provided.
   
   
4. This system is a unique and complex blend of county, cities, fire districts, hospitals, individual paramedics, emergency medical technicians (EMTs), dispatchers, physicians, private ambulance companies, citizens, elected officials, and countless others dedicated to emergency medical services. Maintaining open communications and a commitment to cooperation and consensus building with these entities is essential to our continued success.
   
   
5. Individual success equates to organizational success. When individuals within the system succeed in their role, the system as a whole succeeds. The EMS Division encourages and supports individual excellence.
   
   
6. Service to the citizens of King County and our partners in the EMS community is a strongly held value. For some, the service is to provide direct patient care. For others, the service is to support the regional network of providers delivering care.
   
   
7. Our EMS system has always valued scientific research, evaluative studies, and data analysis. We actively participate in the gathering of this kind of information for possible application in the field of EMS.

The following summarizes the general EMS quality management infrastructure in King County as depicted in the EMS Division's 2005 Quality Management Plan. This plan has been reviewed and approved by the Washington State Department of Health and reflects the complex, interactive nature of providing EMS care in the region. There are five major sections: Regional Medical Control, Advanced Life Support (ALS) Program, Basic Life Support (BLS) Program, Emergency Medical Dispatch, and Regional Services.

Regional Medical Control

The Medical Program Director (MPD) is responsible under the Washington Administrative Code (WAC) and Revised Code of Washington (RCW) for medical control and direction of all certified EMS personnel in King County.  This is accomplished through a delegation of medical oversight to individual medical directors of paramedic programs and emergency room-based, on-line medical control for ALS personnel.  The MPD also oversees the development of policies and procedures related to the provision of ALS and BLS services, and provides written treatment guidelines for BLS personnel.

Advanced Life Support (ALS) Program

The goal of quality improvement in ALS is to ensure the provision of the highest level of paramedic services in King County, an internationally recognized program. There are a variety of components to the paramedic program that create a solid foundation based on standardized training, provide ongoing program oversight, and establish a system of quality management.

Major quality improvement activities for ALS services in King County:

These activities are monitored by the individual medical program directors and supported by the King County Medical Program Director (see Section A. Regional Medical Control). Paramedics are required to complete a standardized training program and recertify on a regular basis. The following sections detail the specifications.

• Paramedic Assessment and Oversight
• Sentinel Event and Inquires
• ALS Medical Incident Report Form (MIRF) Review

Basic Life Support (BLS) Program

The goal of quality improvement in BLS is to ensure the provision of the highest level of basic life support services in King County. There are a variety of components to the BLS program that create a solid foundation based on standardized training, provide ongoing program oversight, and establish a system of quality management. They include Emergency Medical Technician (EMT) Training and Certification, EMT Competency Based Training, and EMT/Defibrillation oversight.

Emergency Medical Dispatch (EMD) Program

The goal of EMD Quality Improvement is to increase the incidence of appropriate dispatching for EMS units and enhance the EMD program and training for dispatch agencies. The Dispatch Review Committee (DRC) regularly reviews both trending and sentinel event data to monitor dispatch activities. Results are used to evaluate the quality and impact of EMD training provided by the EMS Division and the consistency and appropriateness of the use and application of the Criteria Based Dispatch (CBD) Guidelines. These guidelines offer a mechanism for providing standardized dispatching across the county. The QI process includes a feedback system to dispatchers, supervisors, and the EMS Division. It also provides an opportunity to conduct QI in key areas and conduct system wide review in areas where there is over utilization of ALS services.

Regional Services Programs

The EMS Division is committed to providing exceptional regional emergency medical services in King County. The following programs reflect a commitment to a comprehensive regional quality improvement approach to service delivery.

The CEEMS program seeks federal grants and private donations to support research in the field of pre-hospital emergency care for cardiac events. CEEMS collaborates with faculty, residents, and students from the University of Washington.  The focus of CEEMS research has been to evaluate each of the links in the chain of survival.

The EMS Division oversees a variety of quality assurance activities to ensure appropriate and efficient administration of EMS personnel, finances, and long-term planning.  This includes the administration of contracts, risk management, financial monitoring and forecasting, strategic planning, and data management.