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	Southern Tier Regional Emergency Medical Services Council

Introduction

The primary goal of an EMS System is to reduce death and disability from injuries and/or illnesses. As research continues into the impact that prehospital care has on the ultimate outcome of patients, the need to evaluate the quality of the care that we as individuals and organizations provide becomes paramount. However, because we don't exist in isolation we must evaluate our care as it relates to the EMS System in which we practice and, ultimately, to the rest of New York State.

Health care is a dynamic field constantly in a state of change. New discoveries and new technologies are constantly on the horizon. This is especially true in the field of EMS. In order to ensure that our patients are receiving the best care that we can provide, we must routinely evaluate our standards of care and identify areas of strengths and weaknesses. Then we must be willing to share our strengths and correct our weaknesses.

Quality Improvement (QI) is a program of systematic evaluation to ensure excellence. Instead of asking "Who caused this to happen?", QI asks "What is wrong with the process that caused this to happen?" It is a judgment linked to mechanisms or a system to effect positive change. That judgment is based on acceptable standards of care provided by written protocols and on-line medical control.

A quality improvement program has several components. These are case review, evaluation of indicators, tracking and evaluation of repeating problems, incidents and complaints and scanning monitors.

Quality improvement activity is a means to guarantee continuous quality of care to our patients, educational programs for our providers and a means for identifying areas of concern before they become problems. It requires the cooperation of all EMS players from first responder to the New York State Medical Advisory Committee (SEMAC). It must recognize common needs for education, structured feedback, professionalism, mutual respect and, above all, confidentiality of all quality improvement activities.

Confidentiality: Notwithstanding any other provision of law, none of the records or documentation or committee actions or records required pursuant to Section 3001.6 of Article 30 shall be subject to disclosure under Article 6 of the Public Officers Law or Article 31 of the Civil Practice Law and Rules, except as provided in any other provision of law. No person in attendance of an Area Quality Improvement Committee shall be required to testify as to what transpired thereat. The prohibition related to disclosure of testimony shall not apply to the statements made by any person in attendance at such a meeting who is a party to an action or proceeding, the subject of which was reviewed at the meeting. Prohibition of disclosure of information from the prehospital reporting system shall not apply to information which does not identify the ambulance service or individual. Any person in good faith and without malice provides information to further the purpose of this section or who, in good faith and without malice participates on the Regional Quality Improvement Committee, or on the Area Quality Improvement Committee, shall not be subject to any action, civil damages or other relief as a result of such activity.

New York State Department of Health Code and Federal regulations give hospitals a responsibility for prehospital quality improvement activity. This recognizes that EMS patients are hospital patients in the field and that prehospital care is an extension of emergency physician care. Written regional protocols are developed by off-line medical control physicians to direct real-time care. With this mechanism in place and hospital involvement identified, we can measure the system as a whole against established standards. Following are the pieces of legislation that impact the QI process.