经过Mike McEvoy, Ph.D., RN, CCRN, REMT-P
You’ve probably never met a firefighter whose goal was to be the worst possible emergency responder. It’s not likely that such a person exists; and if he’s out there somewhere, he won’t last for long. Quality is the building block of the fire service. What department would not like to be the all-around best? Enter Quality Improvement (QI) programs. Typically involving EMS operations, QI programs spread from hospitals to virtually all facets of medicine. Today, they are mandated by law for EMS in many parts of the country.
不幸的是，许多QI计划并未以乐观和建设性的方式运行，这会使它们对EMS/Fire Service有所帮助。结果，QI吸引了许多酋长和EMS提供商的黑眼睛，他们对Qi计划不佳的破坏性结果感到失望。有效的QI计划在消防服务中取得了绝对的成功，这是有充分理由的。Qi的底线是质量。
First, a little philosophy of what QI really is. To many of us, QI conjures up images of a crew sitting in some back room reviewing patient care records. In truth, review of run reports is only a small part of the QI process. Or at least it should be only a small part.
QI has three major components: prospective, concurrent, and retrospective. Prospective QI includes activities that ensure quality patient care before the truck rolls. Equipment and staffing standards, checklists, operational policies and SOGs, medical protocols, copies of certifications, and a program for continued EMS education are all examples of prospective QI. Concurrent QI includes activities that monitor and ensure quality at the time the service is being provided. Supervision or oversight by the medical director/advisor is an example of concurrent QI. Retrospective QI involves activities that look back to see if quality service was given. Review of run reports, response surveys mailed to patients and families, interface with other EMS responder agencies, surveys of receiving hospitals, response time studies, and high risk call reviews are all activities reflective of retrospective QI.
在城镇高级生命支持（ALS）救护车到达之前，一个小型志愿消防区提供了EMS的第一反应和早期除颤，该救护车服务使用五个简单的元素启动了QI计划。
首先，该部使用从其区域EMS计划机构获得的审计审查表对100％的EMS运行报告进行了审查。每月，部门发布摘要数据供所有成员审查。在特殊情况下，部门的医疗顾问对个人消防员进行了审查。在EMS演习中审查了文档的趋势。早些时候，决定该部门的每个成员都将参加Run Report Review，这一举动改善了团队合作和相互理解。整个部门很快就熟悉了为质量报告提供的数据元素。在一年之内，第一响应者和EMT在EMS电话上的文档从平庸到杰出。今天仍然很棒。
其次，该部门决定对每次心脏骤停电话进行详细的活动审查。心脏骤停是需要个人分析的高风险事件。从自动化外部除颤器（AED）下载的数据与响应时间和场景活动相关，以促进最佳的患者结果。这些评论将注意力集中在场景性能上，并通过邻近消防部门获得的数据为基准。通过训练和在职教育以及设备配置的变化，该部门的到来平均减少了20秒。去年，由于QI分析，该部门将AED掌握在消防警察手中，他们经常在第一部火灾设备之前到达。
Third, the department began mailing a patient satisfaction survey after each EMS call. About 80% of the surveys are returned completed, and these are posted in the fire station. The results of these surveys have been so helpful in improving morale that the department began sending them to fire and rescue customers as well. Frequently, customers send donations with the completed surveys. An issue identified by these surveys helped the department recognize a need to more clearly differentiate its firefighters from ambulance responders. Changes in practice, including large FIRE lettering on work shirts, more traditional firefighter attire, and strategic positioning of the engine-rescue resolved this misidentification. Without a doubt, it is important for taxpayers to see their fire department at work. QI helped the department recognize and fix this problem.
Fourth, the department undertook a review of all EMS equipment and staffing. Support from the Board of Fire Commissioners has allowed the department to keep current with developments in medical equipment and technology. County and state EMS mandates minimum equipment and staffing for each piece of apparatus responding to an EMS call. The department committed to ensuring that all its vehicles exceed these minimum standards. To monitor this, the department developed an EMS equipment checklist in conjunction with standards for maintenance, service, and equipment repair. A computer database was created to track firefighter EMS certifications and a printout of certification levels and expiration dates is routinely generated. The medical advisor works with members to assist in keeping EMS certifications current.
第五，为部门的医疗顾问编写了职位描述，其中包括提供医疗监督。这样可以确保只有合格的人接听EMS的电话，可以继续接受医学教育，并保留EMS培训和认证记录。通常，医疗顾问通常通过观察到EMS电话的现场来评估EMS提供商的技能。
这EMS气程序是简单而全面。我t is designed to help firefighters provide the best possible care to patients and prepare the best possible documentation of their actions on calls. From the start, the program endeavored to be not a source of stress but rather a positive and helpful influence to firefighters. The efforts have not only demonstrated improved patient care and better documentation but have also developed greater confidence and provided a good deal of positive feedback from customers directly to the firefighters who cared for them. Another important benefit (somewhat hidden from frontline personnel) is the greater legal protection that improved care and documentation has afforded the department.
考虑您自己的部门。您的QI计划是否反映了我们所有人都必须最好的愿望？还是对消防员和行政管理来说更烦人？质量是消防服务的基础。一个好的QI程序至少需要是垫脚石。
Mike McEvoy博士，RN，CCRN，REMT-P，是纽约Saratoga县的EMS协调员。他是前法医心理学家，现在在奥尔巴尼医学中心的心脏外科ICU工作，并在纽约的奥尔巴尼医学院任教。他是克利夫顿公园半岛公园救护车队的护理人员，也是西新月（纽约）消防局的医疗顾问。他目前担任纽约州EMS理事会和州紧急医疗咨询委员会的成员，并且是纽约州消防局长协会董事会成员。
