NORTH COAST EMS AGENCY AND THE EMERGENCY MEDICAL SERVICES ADMINISTRATORS ASSOCIATION OF CALIFORNIA

A. Introduction: Few areas of the country have successfully utilized data to determine public policy or evaluate the EMS system. The paucity of analytical information is particularly problematic as we approach managed care issues and increasingly turn to the courtroom for conflict resolution. In California, the EMS Systems Act requires that planning guidelines address "data collection and evaluation," and the legislature created the local EMS agency to "evaluate" the EMS system. The EMS System Standards and Guidelines, June 1993, specifies that the "local EMS system should have mechanisms to collect data regarding operational and clinical aspects of the system, covering all stages of the system. Both day-to-day quality assurance/ quality improvement audits and overall evaluations of system operations are necessary." Recommended standards include: evaluation of the response to, and the care provided to, specific patients; linkage of prehospital, dispatch, emergency department, in-patient and discharge records; establishment of an integrated data management system which includes system response and clinical data; and use of patient registries, tracer studies, and other monitoring systems to evaluate patient care at all stages of the system. Specific EMS system evaluation standards, however, have largely been left up to each agency to delineate. Special project funding was requested to organize a statewide, multi-disciplinary data conference designed to improve data utilization in EMS.

B. Project Description: Between June 30, 1996 and August 31, 1997, North Coast EMS, in partnership with the Emergency Medical Services Administrators Association of California, received California EMS Authority Prevention 2000 Block Grant support to undertake a joint endeavor to coordinate and conduct, in conjunction with the 1997 annual EMSAAC conference, a statewide data conference on report generation and quality indicators. Two consecutive special project contracts funded a single conference. The purpose of the conference was to provide EMS administrators, data managers, physicians, nurses, paramedics, EMTs and others with the opportunity to collectively participate in a statewide meeting designed to enhance the value of computer-generated data reports. Conference focus was on current state and national data utilization and statistical and research methodologies designed to evaluate the EMS system, investigate the efficacy of prehospital procedures, enhance quality improvement efforts and facilitate development of an improved statewide database.

C. Tasks/Methodology: The North Coast EMS Executive Director and EMSAAC Data Subcommittee, which was previously established to help standardize EMS data applications throughout the State, instituted a Data Conference Task Force for collaboration on all decisions involving conference coordination and location selection, speaker selection and approval, and program content. The Task Force and the EMSAAC President-elect decided to combine the data conference with the annual EMSAAC conference. The EMSAAC Conference Subcommittee was subsequently formed to oversee the conference. The group elected to subcontract with "Concepts Meeting and Trade Show Management" from San Diego for site selection, promotion, registration and on-site coordination. Conference Co-Coordinators (Barbara Pletz and Larry Karsteadt) then widely distributed a survey instrument to solicit input on conference ideas, current data applications and possible speakers. Recommendations for conference design were summarized and San Diego was selected as the site. The Subcommittee decided to have a mixture of full- and half-day sessions with two primary tracks: data and managed care. The Data Track included the National Highway Traffic Safety Administration’s (NHTSA) EMS Information System, the Status Report of California EMS Data Programs, an EMS Vendor/Provider Workshop, a Statistical Thinking Workshop and several EMS Data Innovation presentations from throughout California. A Friday afternoon session was also planned to help formulate recommendations for local and statewide EMS data system improvement. The conference, officially entitled Shaping EMS for the 21st Century: Data, Research, and a Changing Marketplace, was scheduled at the Princess Resort in San Diego between May 28 through May 30, 1997. A brochure and syllabus/conference guide were developed and distributed.

D. Outcomes: The conference was successfully completed and attended by over 200 people. Approximately 30 individuals also attended the open discussion at the end of the conference. Conference participants included EMS administrators, EMS data management coordinators, medical directors, nurses, paramedics and many others. Conference evaluations were "very good" to "excellent."

E. Conclusion: The San Diego Conference provided an excellent opportunity for participants to review current state and national data applications relevant to the EMS decision making process. Importantly, the NHTSA presentation on the EMS Information System and projected quality improvement standards was the first in the United States. The Statistical Thinking workshop provided an entertaining and invaluable overview of the application of statistics to EMS. State and local presentations on data innovations demonstrated that numerous projects are underway in California that will enhance our utilization of data and research methodologies. The fact that over thirty participants attended the recommendation session speaks highly of the collective interest in improving the usefulness of data management systems in California.