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.