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to renew their accreditation (County of Santa Barbara, 2015).Effects of Accreditation RegulationsRequirements for initial accreditation in Santa Barbara County include employment as an EMT within the county, attending orientation to the EMS system and class on local policies, evaluation by a field training officer, a minimum number of patient contacts while orienting, and a minimum number of hours worked with a training officer. Renewal of accreditation requires a minimum number CE hours every two years.There are specific classes EMTs must take within the CE category and some classes are required yearly and quarterly. The EMS Agency monitors CE attendance and fulfillment of requirements very closely.Getting their EMTs to all of the required CE is a challenge for employers. CE is paid time and usually overtime because the EMTs may not attend CE while working. If the agency increases CE requirements, it affects the budgets of fire departments, ambulance companies, and any other EMT employer. Getting staff to attend the required CE is often a challenge. Fire department EMTs work 24-hour shifts and the last thing they want to do is attend CE on their day off. EMTs that work for private companies work a variety of shifts, which makes it even more challenging to attend. If employers give their EMTs time off to attend CE then they have fewer personnel to respond to emergencies, which can affect care or delay responses. The EMTs and their employers request the EMS Agency to hold more opportunities for CE, but this option would cost 7
HEALTH CARE AND THE LAWthe agency more than it is budgeted for. CE policies have a significant effect on the operations of EMT employers.My ExperienceFor three years, I was the Performance Improvement Coordinator for the Santa Barbara EMS Agency. My responsibilities included recommending educational programsand training, scheduling CE, teaching and training EMTs, and revising policy related to accreditation requirements. CE requirements for accreditation are always a point of contention between the EMT employers and the EMS Agency. The requirements were a genuine challenge for the employers. However, the EMS Agency could not cut corners on EMT education. We knew that in our county, less education led to more patient care issues.An example of this was advanced airway control. We had numerous problems with EMT attempts to intubate patients. These were sentinel events and I investigated each one to identify contributing factors. It was clear that EMTs needed more intubation training but their employers simply could not afford the extra CE and they knew there would be some very angry EMTs if they had to give up more days off. We were eventually able to find a compromise. The EMS Agency designed the curriculum and testing for the intubation training, and we approved designees from each employer who could teach their own employees on their own schedule and convenience. This one of thebenefits of a local agency; it is able to be responsive to local needs.