About CAAS in General
The Commission on Accreditation of Ambulance Services was established to encourage and promote quality patient care in America’s medical transportation system. Based initially on the efforts of the American Ambulance Association, the independent Commission established a comprehensive series of standards for the ambulance service industry.
Accreditation signifies that your service has met the “gold standard” determined by the ambulance industry to be essential in a modern emergency medical services provider. These standards often exceed those established by state or local regulation. The CAAS standards are designed to help increase operational efficiency and decrease risk and liability across the entire spectrum of the organization.
The process includes a comprehensive self-assessment and an independent external review of the EMS organization. This independent process provides verification to your Board of Directors, city council, medical community and others that quality care is provided to the community.
All ambulance systems are eligible for the three-year accreditation including private, public, fire department and hospital-based.
In March 1982, the American Ambulance Association (AAA) sponsored a Needs Assessment Workshop in Kansas City, Missouri, to analyze the status of the EMS industry. The participants compiled a list of the twenty most pressing issues facing emergency medical services, the first of which was the need for high quality industry standards. In May 1984, the AAA Board of Directors authorized the formation of its Ad Hoc Committee on Accreditation and Standards. The standards that grew out of this committee’s work were consensus-based–with input from professionals across the EMS industry. The development of the process by which an agency could become certified to these standards followed.
In 1990, an independent Commission on Accreditation of Ambulance Services (CAAS) was incorporated, bringing together a board of representatives from the American Ambulance Association, the Emergency Nurses Association, the International Association of Fire Chiefs, the National Association of Emergency Medical Technicians, the National Association of EMS Physicians, and the National Association of State EMS Directors. In 1993, the first agencies were accredited by the Commission.
Currently, there are more than 170 CAAS-accredited agencies in 39 U.S. states, Canada and the West Indies, with more than 200 agencies working on new applications. See the CAAS Accredited Agencies Map.
CAAS accreditation is designed to help EMS agencies increase organizational performance and efficiency, increase clinical quality, and decrease risk and liability. Accreditation provides a template for making comprehensive organization changes that improve the overall performance of the organization. An independent review validates that accredited agencies are adhering to the highest standards in the industry.
ACCREDITATION IS IMPORTANT TO YOUR:
Patients (and your community)
Accreditation assures your patients that the service has met the Commission’s high standard for quality patient care and that the service stands ready to care for their families if needed.
Accreditation assures local officials that your service has undergone careful scrutiny by an independent review process. In future years, many local officials are expected to require ambulance accreditation.
Your medical community can be confident that your service is providing quality patient care in accordance with nationally-accepted standards. Ambulance accreditation is also important because of the important role you play in the health care team.
Your ambulance service will receive the recognition it deserves for its outstanding achievements. Your staff will be proud to be affiliated with a service which has met the Commission’s high standards. Accreditation may also provide you with a competitive advantage particularly when marketing your service.
EMS began in the United States in the 1970s with federal agencies pressuring the states to establish standards for ambulance services. The term EMS was formalized with the “EMS Systems Act of 1973.” Typically, states were able to set only minimum standards which might be described as the poorest you’re willing to accept. In 1982, at an American Ambulance Association workshop, the need for high-quality standards was identified. A working committee was established, and over the next eight years, standards were developed through consensus of EMS experts from all over the country. In other words, the best EMS thinkers and practitioners, working together, determined those standards that should be met by a quality service. In 1990, an independent Commission on Accreditation of Ambulance Services (CAAS) was established to begin the process of accrediting ambulance services using these quality standards. CAAS is sponsored by the American Ambulance Association, the American College of Emergency Physicians, the National Association of EMS Physicians, the National Association of State EMS Directors, the National Association of EMTs, and the International Association of Fire Chiefs, with liaison representation from The National Highway Transportation Safety Administration.
The standards are very comprehensive, but are flexible enough to relate to agencies of all sizes and types. There are over 100 of them, covering all aspects of ambulance operations. They include standards for agency management; financial management, budgeting and strategic planning; relations with outside agencies; mutual aid and disaster coordination; community education and relations; human resources and personnel management, hiring, credentialing, training, problem resolution, and performance evaluations; clinical standards; quality improvement; safe operations and risk management; vehicles, equipment, and facilities; and communications/dispatch.
Any ambulance operation can claim it is delivering quality service, but the accredited agency can prove it through its written or documented procedures, systems, and reports. An accredited agency will have proven Medical Director involvement in all matters that affect patient care, from protocol development to vehicle equipment, education programs, training, quality improvement, and response time standards. The accredited agency will have a written continuous quality improvement program tied to its continuing education for all staff. Reports will show when problems arise, define what they are, and show how they are resolved through retraining in the agency’s CQI program. The agency will further show how it tracks these developments for trends and how they analyze them for planned improvements. The accredited agency will track clinical training and certification of each patient care professional. Response time standards will be defined in writing and will be captured in daily, weekly, monthly, and annual reports. Pre-hospital providers will be properly credentialed for each medical transport run. The accredited agency will have strict procedures for safe handling of patients and their property, for accurate documentation of all patient care, for proper maintenance of all vehicles and medical equipment, for proper cleaning of vehicles and equipment, and for exacting decontamination when required. The accreditation process requires an agency to look closely at every aspect of its operation and to demonstrate through its policies and record keeping that it does as it says.
Accredited agencies report a strong feeling of pride among their employees – support staff as well as patient care providers – and they share ownership in their company’s success. Employee morale is enhanced by the knowledge that their company has a concern for their safety and training as well as stringent standards for patient care. Recruiting is also enhanced by the fact that quality people gravitate toward quality employers. In an accredited agency, all employment policies are clearly spelled out in terms of benefits, employee evaluations, expected conduct, and grievance procedures. Employees know exactly what to expect from their employers and what they are expected to contribute to the team effort. In an accredited agency, the emphasis is always on quality improvement, providing a positive daily focus.
A high-quality EMS system depends on cooperation among various types of public safety agencies and all local EMS providers. The CAAS-accredited agency must have preplanned, written processes for dealing with mutual aid requests in which all issues of liability, fees, reciprocity, and communications must be recounted. The agency must also have a written disaster plan to meet the community’s emergency needs in catastrophic events, and it must be practiced and evaluated annually.
An accredited agency is committed to partnering with communities and health care systems to provide accident prevention and safety education programs. Agency staff participates in public education and safety events. From exacting listings in telephone directories to written policies for handling complaints, donations, and media inquiries, the accredited agency must demonstrate its role within the community. Since an important aspect of community involvement is diversity, an accredited agency must demonstrate its efforts to assess and address cultural and language diversity within the communities it serves.
Comprehensive safety standards are required of accredited agencies, shielding patients, the employees, and the agency itself from unnecessary risk. There must be evidence of driving standards, a driver training program, proper use of safety restraints for patients and crews, and strict written policies to follow in case of vehicle crashes and other types of incidents. The minimum requirements for employee safety policies include facility safety, exposure control, scene safety, safe lifting, hazardous materials, employee wellness, safety committee duties, and adherence to all local, state, and federal requirements. The accredited agency must demonstrate that it reviews and reports all work-related injuries and infectious disease exposures, damage to company property, loss or theft of company property, potential clinical errors, and any suspected civil risks. With the accreditation standards’ focus on decreasing risk, an accredited agency functions at the highest possible safety level.
The accredited agency must prove that its vehicles meet all required federal, state, and/or local specifications and that the vehicles are cleaned and maintained to strict standards. The agency must have a preventive maintenance program, with records of all scheduled and unscheduled maintenance, for both the vehicles and the durable medical equipment inside. It must have policies governing the locking of drugs, needles and syringes; management of medicines in case of temperature extreme exposures; and proper handling of disposable medical items. The agency’s facilities must be clean and meet all relevant safety standards.
Efficient call taking, effective resource deployment, and continuous communications capabilities are required to operate an effective EMS agency. The CAAS-accredited agency must have policies developed and reviewed with input from the Medical Director. Policies include exacting call-taking standards which document time events from time of request through the time the vehicle and crew are returned to service. Crews must be able to communicate instantly with one another and with the dispatch center. All call-takers must be trained as emergency medical dispatchers capable of providing pre-arrival instructions. All radio licenses must be current and displayed. There must be a thoroughly documented system for testing and maintenance of equipment and back-up power. The communications program requires ongoing, inter-agency dialogue to facilitate improved relationships and service coordination, and the agency must evidence prospective, concurrent, and retrospective initiatives designed to improve the service provided under their CQI program.
The accredited agency must be able to clearly delineate its ownership and organizational structure, show that it maintains all required licenses and contracts to do business, demonstrate its strategic planning and budgeting processes, provide evidence of legal review of its policy/procedure manuals, show how it educates its managers and supervisors and maintains all types of records. The accredited agency must clearly show who has financial responsibility, must prove that its financial records are reviewed at least annually for compliance with Generally Accepted Accounting Principles, have complete accounts receivable records and policies, evidence all insurance coverage to include financial risk issues, and have a written compliance program to address applicable laws relating to Health Care Fraud and Abuse. All policies and programs, as well as changes to them, must be systematically presented to all employees so that everyone in the agency understands and operates under the same rules and procedures.
Application Process Related
Five Steps to Accreditation
Step 1: SELF ASSESSMENT
You should familiarize yourself with the Commission’s Standards for the Accreditation of Ambulance Services. Then compare your service’s current operation to the Commission’s standards and implement any necessary changes.
Step 2: APPLICATION
When you feel that your service meets or exceeds the standards, the Accreditation Application Package can be purchased and completed. The completed application and appropriate application fee are then submitted to the Commission.
Step 3: EVALUATION
The Commission conducts an off-site review of the submitted application before scheduling an on-site review. The on-site review consisting of visitation, interviews and observation is conducted by a team of three site reviewers. The reviewers’ role is to gather information needed to verify that the service meets the standards established by the Commission.
Step 4: DELIBERATION
The actual determination of whether the service meets all requirements is made by an independent, impartial Panel of Commissioners. The Commissioners represent health care, law and business.
Step 5: ACCREDITATION
If successful, your service will be recognized for its excellence as defined by the Commission’s high standards. As an accredited ambulance service, you will be able to display the Commission’s accreditation logo with pride on your ambulance vehicles and in your advertising.
The process begins with a serious self-assessment of an EMS agency, comparing its operations to the accreditation standards. The agency then purchases an application package that guides them through the process of developing supporting documentation. The documentation is submitted to CAAS for an off-site review to determine the level of compliance of the paperwork submitted. An on-site review by a team of EMS experts, including a board certified emergency physician, spends at least two days at the agency to review all operational aspects of the service. Agencies report that this experience alone is worth far more than the costs of accreditation. The site review team then generates a report to CAAS. When all standards are successfully achieved, the agency’s report and follow-up material goes before the Panel of Commissioners, an independent, impartial group of individuals from EMS law, business, and healthcare, for accreditation determination.
The CAAS Standards Guide is an excellent resource for learning about the CAAS standards. However, please note that the CAAS Application Package provides all the documents necessary for applying for accreditation, including a copy of the CAAS Standards Guide.
All CAAS products are available at the CAAS Online Store.
There is no definable time frame for an agency to compile its accreditation materials. Some agencies have been able to complete everything for submission in about six months. Others have taken much longer. On average, it takes about one year to prepare all the paperwork, institute policies, and provide proof that policies are being met within the agency. Agencies usually appoint a CAAS Coordinator, and allow the coordinator to organize committees of individuals within the organization to contribute a portion of the overall work. Sharing the preparation ensures that everyone in an organization has an opportunity to contribute and provides buy-in for the accreditation.
Some agencies prefer to hire an outside consultant to assist with the preparation of accreditation materials. Others use peer reviewers from similarly configured accredited agencies to conduct a practice review. One of the best ways to learn about the process and how to begin, is to attend one of the CAAS accreditation seminars which are held at least twice per year at announced locations. Click here for all upcoming events.