EMS Systems

Virginia Office of EMS: State Strategic and Operational Plan (2007 – 2010) 

§32.1-111.3 of the Code of Virginia requires the development of a comprehensive, coordinated, statewide emergency medical services plan by the Virginia Office of EMS (OEMS). The Board of Health must review, update, and publish the plan triennially, making such revisions as may be necessary to improve the effectiveness and efficiency of the Commonwealth’s emergency care system. The objectives of the plan shall include, but not be limited to the seventeen objectives outlined in §32.1-111.3.

This operational plan identifies the specific initiatives required of the OEMS staff in executing the 2007 – 2010 Strategic Plan. Each objective and action step is intended to accomplish those items most critical to the Strategic Plan in the given fiscal year. The Strategic Plan is designed to improve priority areas of performance and initiate new programs. Therefore, much of the routine, but important work of the OEMS staff is not included in the Operational Plan.

No later than 3 months prior to the end of a particular fiscal year the OEMS staff will evaluate progress on the plan and begin the process of creating the Operational Plan for the next fiscal year.

In most cases “accountability” should be the name of a person who has the lead responsible for the implementation of the objective or action step. If another individual, department or council shares responsibility that individual, department or council will also be identified with an asterisk (*). The Status Review column will be reviewed quarterly. Only those objectives and items relevant to the time frame will be a part of the review. Any changes in the objective or action steps should be noted in writing on the form at that time.

Legend of Prioritization of Strategic Initiatives:

Urgent: Work must begin during FY 07 (July 1, 2006 – June 30, 2007).

Very Important: Work should begin on this strategic initiative before the end of the upcoming fiscal year (FY) 2007.

Important: Can wait. Work should begin after Urgent and Very Important initiatives are underway.

Summary of Strategic Initiatives and Objectives from State EMS Strategic Plan (2007 – 2010)

This document lists the objectives to achieve each strategic initiative identified for each of the four (4) core strategies of the Plan. The Core Strategies are 1) Develop Partnerships, 2) Create Tools and Resources, 3) Develop Infrastructure, and 4) Assure Quality and Evaluation.

State EMS Planning Process

One page summary of steps required to be completed by each standing Committee of the state EMS Advisory Board by July 31, 2009.

State EMS Advisory Board Standing Committee Planning Template

This document is a guide and overlay to provide direction to the Committee Chairs of each standing Committee of the State EMS Advisory Board to develop mission, vision, and value statements as well as identify existing strengths/weaknesses, action strategies and steps for implementation.

State Emergency Medical Services System: A Model (July 2008)

A recent report by the Institutes of Medicine (IOM) underscores that:

“In states and regions across the country, there is substantial variation among emergency and trauma care systems. These systems differ along a number of dimensions, such as the level of development of trauma systems, the effectiveness of state EMS offices and regional EMS councils, and the degree of coordination between fire, EMS, hospitals, trauma centers, and emergency management.” And, as a result:

“…today the system is more fragmented than ever, and the lack of effective coordination and accountability stand in the way of further progress and improved quality of care. EMS has an opportunity to move toward a more integrated and accountable system through fundamental, systemic changes. Or it can continue on its current path and risk further entrenchment of the fragmentation that stands in the way of system improvement.”

The premise of the Model State Emergency Medical Services System Project accepts the challenge of these observations.

State EMS Advisory Board Retreat, Meeting Minutes– Placement of OEMS within State Gov’t (Jan. 5, 2007)

The relocation of the Office of EMS within state government was a prevalent issue before the State EMS Advisory Board throughout 2006. At the May 12, 2006 EMS Advisory Board meeting a motion was passed that recommended the Governor of Virginia through the Board of Health of Virginia to “seek input from the State EMS Advisory Board to determine the most appropriate location in the organizational structure of state government for the Office of EMS to allow it to most effectively fulfill its mission.“

At the November 8, 2006 Board meeting a decision was made to have a Board retreat that would focus only on the issue of placement of the Office of EMS within state government. The purpose would be to allow the Board and all interested EMS stakeholders to have an arena to openly discuss and evaluate how the location of the Office of EMS in state government affects the provision of EMS service and the overall mission of the EMS system. The retreat was held on Friday, January 5, 2007 at the Richmond Marriott West.

IOM: Future of Emergency Care-EMS At the Crossroads (June 2006)

Emergency Medical Services provides the first comprehensive study on this topic. This new book examines the operational structure of EMS by presenting an in-depth analysis of the current organization, delivery, and financing of these types of services and systems. By addressing its strengths, limitations, and future challenges this book draws upon a range of concerns:

  • The evolving role of EMS as an integral component of the overall health care system.
  • EMS system planning, preparedness, and coordination at the federal, state, and local levels.
  • EMS funding and infrastructure investments.
  • EMS workforce trends and professional education.
  • EMS research priorities and funding.

Emergency Medical Services is one of three books in the Future of Emergency Care series. This book will be of particular interest to emergency care providers, professional organizations, and policy makers looking to address the deficiencies in emergency care systems.

Focus Group work from the EMS Advisory Board Retreat (April 7, 2005)

EMS Advisory Board Retreat Presentation

Facilitated Discussion of State EMS Plan ———————– Focus Group Break-outs

Six (6) Focus Groups were identified. Each group was asked to consider the following questions when discussing how to accomplish each goal of the Plan:

  • Will legislation have to be introduced?
  • Will a change in administrative regulations be required?
  • How will project be funded?
  • Identify the affected parties and constituents?
  • Long term or short term goal?

Each group met for a 90 minutes and afterwards reported back to the full retreat to give a report of their actions.

Group 1: Integration of EMS Services
EMS Attributes: EMS System Coordination, Regional EMS Council Coordination, Administration, Infrastructure, RSAF, System Finance

Group 2: EMS Education
EMS Attributes: Training, Research, Medical Direction, EMSC

Group 3: EMS System Evaluation
EMS Attributes: Planning, Performance Improvement, Data, and Information Systems

Group 4: Emergency Preparedness
EMS Attributes: Disaster Coordination, Communications, Transportation, Critical Care

Group 5: Community Education
EMS Attributes: Public Information and Education, Technical Assistance to Local Governments, Advocacy, Public Assess

Group 6: Human Services
EMS Attributes: Human Resources, Recruitment and Retention, CISM, Leadership and Management

Joint Legislative Action Review Commission (JLARC) Report – House Document 37, Review of Emergency Medical Services in Virginia. (Nov 2004).

House Joint Resolution 133 of the 2004 General Assembly calls for the Joint Legislative Audit and Review Commission (JLARC) to conduct a comprehensive review of pre-hospital emergency medical services (EMS) in Virginia. The mandate lists several broad areas the study is to address, such as reviewing and assessing emergency care services in Virginia, identifying emerging issues and problems in the EMS system, and considering the effect of issues such as health care costs, funding for emergency medical care, third-party reimbursement, and indigent care on the EMS system.

The Strategic Planning, Service Area Planning, Performance Based Budgeting (Document will be available soon)

Legislation (HB2097) enacted by the 2003 General Assembly required each state agency to develop a strategic plan.  VDH’s strategic plan contains the agency’s vision and mission statements, 11 agency goals, and other provisions.

A key component of the strategic planning process was the identification and development of service area plans.  VDH has 41 service area plans, which are reflective of the large number and wide variety of public health services that we provide.  The service area plans contain objectives, performance measures, and strategies.  Each of the 41 service area plans (2 service area plans relate to EMS) may be viewed by clicking on that service area plan’s link.  There is also a link to view the agency strategic plan.  The strategic plan is, in many ways, a high-level summary of the service area plans.

VDH’s strategic plan and service area plans will be regularly updated.  Key opportunities for updates will be in December, when the Governor introduces the Budget Bill, and in May when the General Assembly enacts the Appropriation Act.

State Office of Emergency Medical Services (601 402 04)

The Virginia Emergency Medical Services (EMS) system is very large and complex, involving a wide variety of EMS agencies and personnel, including volunteer and career providers functioning in volunteer rescue squads, municipal fire departments, commercial ambulance services, hospitals, Regional EMS Councils and, a number of other settings to enable the EMS community to provide the highest quality emergency medical care possible to those in need. Every person living in or traveling through the state is a potential recipient of emergency medical care. The VDH, Office of Emergency Medical Service (OEMS) is responsible for developing an efficient and effective statewide EMS system.

Products and services in this Service Area Plan include:

EMS System Coordination and Integration of Health Services
EMS Education, Training and Medical Direction
Critical Care, Trauma Centers and Poison Control Centers
EMS Registry (formerly PPCR)
Emergency Operations
EMS for Children
EMS System Evaluation and Research
Human Resources Management and Technical Assistance
Public Information and Education
Regulation and Compliance
Critical Incident Stress Management
Communication Systems
Regional EMS Councils

Statewide planning and coordination is essential to assure the availability of quality emergency medical care across the Commonwealth and to provide a more coordinated response in large scale or mass casualty events requiring resources from a large number of EMS agencies and personnel. All aspects of the EMS system are included in statewide planning and coordination. The Office of Emergency Medical Services has developed a 5-Year-Plan that addresses specific services including: technical assistance related to general EMS system design and operation, EMS communications system design and implementation, recruitment & retention of EMS personnel, EMS training and continuing education for all levels of EMS providers, specialty care center designation, Critical Incident Stress Debriefing, and public information and education. The State EMS Advisory Board, its many committees, and the eleven designated Regional EMS Councils are essential partners in the statewide and regional planning and coordination effort.

Financial Assistance for Non Profit Emergency Medical Services Organizations and Localities (601 402 03)

This service area includes Rescue Squad Assistance Fund Grants, Financial Assistance to Localities to support Non Profit Emergency Medical Service (EMS) agencies, and funding provided to support the Virginia Association of Volunteer Rescue Squads (VAVRS). These items support the effective integration of personnel, transportation, communications, facilities, and education and training into a unified system that provides quality emergency medical care, thereby decreasing morbidity, mortality, and hospitalization. A comprehensive statewide system of emergency medical care offers an incentive for business and industry considering locating in the State.

OEMS 5-Year Work Plan (July 1, 1997 – June 30, 2002)

This document provides a vision and direction for the continued development and implementation of the emergency medical services system in the Commonwealth of Virginia for the five year period July 1, 1997 to June 30, 2002 and beyond. The document presents goals that are understandable, attainable and realistic for Virginia.

In developing this plan current legislative mandates were reviewed as stipulated in the Code of Virginia and a determination of where the EMS system should be in five years to meet these mandates. Current EMS knowledge, information, technology and trends were analyzed. The major EMS components for a comprehensive and effective EMS delivery system were identified. Based on best judgment, experience and training; and the guidance of the State Commissioner of Health; the Office of EMS staff collectively developed the 5-Year Plan.

The following assumptions are the basis for this plan:

1) An EMS system does exist in Virginia. This system includes a coordinated working relationship with hospitals, public service agencies and other providers of health care, supported by state, regional and local organizations, standards, guidelines, legislation, manpower, facilities, funding, etc.

2)  The foundation of the Virginia EMS System is strong and continuous medical direction of EMS providers in a diverse delivery system of volunteer, commercial and municipal agencies.

3)  Although the development of an organized emergency medical services system on a statewide basis began thirty years ago, we are entering a new era of that will challenge our talents, decision-making and resources more than the last thirty years combined.

EMS Agenda for the Future – Implementation Guide

This guide proposes a vision for the future of EMS and for EMS providers to use as a roadmap in building bridges between EMS and other aspects of our health care system. In the 21st century, EMS will be community-based health management, with the ability to identify and modify illness and injury risks, provide acute care for those with injuries or illness, and contribute to the care of those with chronic conditions. This manual discusses the 14 EMS attributes, and provides 90 suggestions for reaching future goals for EMS delivery.

EMS Agenda for the Future (August 1996)

This report serves as a guide for EMS providers and other medical or health professionals to examine knowledge compiled during the past 30 years and to create a vision for the future. The report focuses on aspects of EMS related to emergency care outside traditional health care facilities, and outlines the most important directions for future EMS development efforts. The Agenda describes 14 EMS attributes and provides recommendations for moving EMS into the 21st century. A promotional brochure is available to provide general information for large groups.

NHTSA Technical Assistance Team approach to State-wide EMS Reassessments

NHTSA has developed a Technical Assistance Team (TAT) approach that permits states to utilize highway safety funds to support the technical evaluation of existing and proposed emergency medical services programs. NHTSA serves as a facilitator by assembling a team of technical experts who have demonstrated expertise in emergency medical services development and implementation. These experts have demonstrated leadership and expertise through involvement in national organizations committed to the improvement of emergency medical services throughout the country. Selection to the Technical Assistance Team is also based on experience in special areas identified by the requesting State. Examples of specialized expertise include experience in the development of legislative proposals, data gathering systems, and trauma systems. Experience in similar geographic and demographic situations, such as rural areas, coupled with knowledge in providing emergency medical services in urban populations is essential.

NHTSA developed a format whereby , a team of outside experts (TAT) conducts a comprehensive assessment of the Statewide EMS program using an organized, objective approach and well-defined procedures that:

  • provide an overview of the program’s current status in comparison to pre-established standards;
  • note the program’s strengths and weaknesses;
  • provide recommendations for improvement.

The program is a tool for States to use in evaluating their statewide EMS programs.

Topics for review and discussion include the following:

General Emergency Medical Services Overview of System Components

  • Regulation and Policy
  • Resource Management
  • Human Resources and Training
  • Transportation
  • Facilities
  • Communications
  • Trauma Systems
  • Public Information and Education
  • Medical Direction
  • Evaluation
  • Disaster Systems

The forum of presentations and discussion allows the Technical Assistance Team the opportunity to ask questions regarding the emergency medical services system, clarify any issues identified in the briefing materials provided earlier by the STATE, and develop a clear understanding of how emergency medical services function throughout the STATE.

Following the briefings by presenters, the Technical Assistance Team sequesters to evaluate the current EMS system as presented and to develop a set of recommendations for system improvements.