The Commission on Accreditation of Ambulance Services

Overview of Version 3.0 Changes

In the autumn of 2008, the Commission on Accreditation of Ambulance Services (CAAS) standards revision committee was tasked with the responsibility to review and revise the CAAS standards as necessary in order to ensure that the standards continue to set the Gold Standard of care in the medical transportation industry.   After nearly a year of hard work by dedicated EMS experts, version 3.0 was approved by the CAAS Board of Directors and will be effective January 1, 2010. 

A transition plan was also developed to allow agencies time to convert to the new standards.  All agencies submitting applications between January 1, 2010 and December 31, 2010 will have the opportunity to submit on either v2.5 or v3.0.  All submissions received on or after January 1, 2011 must be on the new 3.0 version of the application. 

The following is a brief overview of the changes you will find in version 3.0.  This is only intended as a guideline; agencies are responsible for thoroughly reviewing the new standards prior to beginning the application/reapplication process.  For consistency, some minor formatting changes were made throughout the documents.  Formatting changes that do not affect the standards or characteristics are not highlighted here.

Introduction Section

XI.   Regulatory Agency Contact Information:  This is a new field intended to provide CAAS with better contact information regarding oversight/regulatory groups that an agency is responsible to.

XII.E   Level/Type of Service Provided:  A new field has been added to document the use of special teams by an agency.  Examples may include: wilderness rescue, bike teams, swift water rescue, SWAT teams, etc.

XVIII. Provider Type:  This is a language change only.  To better reflect industry terminology the term “Private” provider was changed to “Non-Governmental” and the term “Public Utility Model” was changed to “Public Utility Authority.”  

Section 101 Organization

101.01.04 Licensure:  A list of example documents was added to better direct agencies to the appropriate documents CAAS requires. 

101.02.01 Chain of Command:  Principal Administrative Officer(s) was changed to Executive Officers.   Additionally, the term Quality Improvement/CQI has been changed to Performance Improvement throughout the CAAS standards, to better reflect current industry terminology. 

Section 102 Inter-Agency Relations

No content changes were made to any of the standards or characteristics in this section. 

Section 103 Management

103.01.01 Policies and Procedures: The term CQI was changed to Performance Improvement to reflect current industry terminology.   Additionally, the Mandatory Training policy requirements were expanded to include current federally required training.

103.01.04 Legal Review:  Previously, this standard did not specifically require re-evaluation by legal counsel, although it was implied.  CAAS now requires that an agency have its policy and procedure manuals reviewed by legal counsel at least every three years, to ensure compliance with federal, state and local requirements. 

103.04.01 Records Maintenance: The term CQI was changed to Performance Improvement.

103.04.02 Data Back-up:  This characteristic was revised to include HIPAA and NEMSIS compliance language.  Additionally, if an agency utilizes an electronic patient care report (ePCR) type program, that agency must have a HIPAA compliant policy and procedure for how information and records will be exchanged, transmitted, reproduced and securely stored.

Section 104 Financial Management  (contains two NEW characteristics)

104.02.02 Monitoring Financials:  This characteristic was revised to better describe the expectations for identifying, monitoring and tracking of budget variances.

104.02.03 Accountant Review:  The phrase “minimally once per year” was changed to “annually”. 

104.03.02 Education and Training (NEW):  This is a new characteristic under the Accounts Receivable standard that was added to ensure agencies are properly educating and training all billing and coding personnel on proper procedures and compliance related issues. 

104.03.03 Continuing Education (NEW):  This is also a new characteristic under the Accounts Receivable standard, requiring annual continuing education for all billing and coding personnel to ensure ongoing compliance with proper billing practices.

Section 105 Community Relations and Public Affairs

No content changes were made to any of the standards or characteristics in this section. 

Section 106 Human Resources

106.01.01 Credentials: Since credential requirements vary by provider type, the Agency Response column was modified to specify that all credentials required are to be identified by provider level/type.  Additionally, federally required training was added under Other Certificates that must be identified.

106.05.03 Affirmative Action/ Diversity: This characteristic was revised to add language requiring agencies to demonstrate local recruiting efforts based upon the demographic/ diverse makeup of the service area.  Agencies must have a plan to strive to match community diversity in their hiring practices.

106.06.01 Orientation Training: This characteristic was revised to specify that orientation programs be tailored to employee’s specific job descriptions.  Additional language was added to include base elements required for all employee orientation programs.

106.06.01 Ongoing Training: This characteristic was revised to specify that ongoing training requirements be tailored to employee’s specific job descriptions.  Additional language was added to include base elements required for all employee CME’s.

106.06.03 Continuing Medical Education:  The term CQI Program was changed to Performance Improvement Program.

Section 201 Clinical Standards

201.01.01 Medical Direction: CQI Initiatives was changed to Performance Improvement Initiatives.

201.02.01 Protocol Existence: This characteristic was revised to include language regarding protocol changes, to ensure such changes are based upon current medical evidence, local practice standards, emerging technologies and national organization guidelines.

201.03.01 Patient Care Records: This characteristic was revised to clarify minimum content requirements and also includes a new requirement for date and time the PCR was distributed to the receiving facility.  This new requirement is necessary for continuity between the pre-hospital provider and the receiving facility (see 201.03.02)

201.03.02 Distributing Medical Records: This characteristic was revised to address and accommodate the more common use of electronic patient care reports (ePCR’s) in the medical transportation industry.  Regardless of the type of PCR program utilized, it is required that the receiving facility be provided with a patient care report at the time patient care is transferred.  If medical protocol and medical direction allow for a delay in the distribution of the completed report (e.g.: emergent departures based upon call volume) then an intermediary report must be provided that contains the minimum requirements of 201.03.02. Agency personnel must use their best efforts to transfer complete medical documentation at the time the patient is delivered.  At a minimum, the CAAS standard now requires that the full, completed PCR must be presented to the receiving facility before the end of shift.

201.04.01 Staffing: This characteristic was revised to clarify staffing certification and qualification standards for each level of service provided.  Additionally, language was added requiring special policies and procedures for agencies that staff specialty teams.

201.05.01 Triaging Service Requests: Triage requirements that ensure call taking personnel have established protocols for accepting or declining requests for service now also include SCT requests (see also 204.01.02).

201.05.02 Response Time Standards:  This characteristic was revised to allow for system response time standards that are established by the regulatory oversight agency and the medical director that may be different than the default 8:59 90% standard due to system design.

201.05.03 Response Time Reporting:  Language was added to clarify that response time analysis shall use a fractile method for monitoring compliance (not average response times.)

201.06.01- 201.06.06  Clinical Standards Performance Improvement Program:  as previously indicated, the term CQI Program has been replaced with Performance Improvement Program to reflect current industry terminology.  If an agency prefers to use CQI or other terminology to describe its quality review and improvement program, it may continue to do so as long as the minimum requirements are met for all associated standards and characteristics. 

Section 202 Safe Operations and Managing Risk (contains one NEW characteristic)

202.01.01 Driving Standards:  This characteristic was revised to more closely match insurance industry standards.   “Annual” driving record requirements have been revised to “biennial” (every other year.)  An agency may elect to run all employees on alternate years, or may divide its workforce into two groups and run odd/even years.  Driving records must be maintained on all employees with driving privileges and cannot be older than two years, regardless of the agency’s monitoring cycle.

202.02.01 Employee Safety:  This characteristic was revised to include the use of reflective outer garments compliant with current federal standards.

202.03.01 Patient Safety: This characteristic was revised to expand on minimum requirements for patient safety.  Policy shall address patient lifting and moving, use of movement and carrying devices, appropriate use of shoulder/torso/leg straps, and the special considerations required for handling special needs or SCT patients.

205.05.03 Medical Error Reporting (NEW): This is a new characteristic that requires an agency to have a written policy/procedure addressing reporting and handling of medical errors. This policy must include: medical director involvement, definition of incidents requiring reporting, investigation process, resolution of incidents, feedback for involved individuals, and tracking and trending mechanisms.

Section 203 Equipment and Supplies

203.03.03 Locking Ambulances and ALS Supplies Security:  This characteristic was revised to include “requiring ambulances to be locked or otherwise secured when they are unattended.”  The requirement for locking ALS supplies has not changed, however an added component exists requiring “tamper-evident” devices that will present crews with obvious evidence of tampering.    The term “unattended” is intended to mean any vehicle that is not in direct and constant sight of employees.   “Otherwise secured” is intended to allow for vehicles to remain unlocked in an otherwise secure location (e.g.: a locked garage bay.)

Section 204 Communications Center

204.01.01 Policies and Procedures:  This characteristic was revised to address contracting with an outside entity for dispatch services.  If an agency contracts with an outside entity- that entity must have all of the policies and procedures and meet all applicable communications standards. 

204.01.02 Call-taking: Language was added to address agencies that do not regularly provide SCT services, to ensure that the agency will have established policies and procedures for personnel to follow in the event that a request for SCT level service is received.  (See also 201.05.01)

204.01.03 SCT Call-taking:  Additional language was added regarding the confirmation of appropriate transfer documents “does not have to occur before a crew is dispatched to the transferring facility, but must occur before the patient transport begins prior to departure from the transferring facility.”

204.01.05 Communications Abilities: This characteristic was revised to clarify the portable communications device expectations.  CAAS requires two agency-issued portable, push to talk communications devices per vehicle, both capable of instant/immediate communications with the communications center.  It is required that the agency shall have a demonstrable plan for field providers to communicate with one another in the event of separation.   This means each crew member must be able to speak with the communications center immediately in the event of an emergency (call for help or extra resources).  This also means that the crews must have a real-world, practical method for quickly communicating with one another if they are separated (to better facilitate patient care.)  Demonstrable means that the onsite reviewers will confirm this communication ability meets the expectations of the CAAS standard.   Agency issued means agency owned and maintained.  Employee owned devices are not consistently reliable and will not be accepted.

204.02.01 Contingency Plan:  Additional minimum requirements were added to the contingency plan, to specifically include telephone, radio and paging communications, as well as CAD hardware and software, back-up power supply and off-site communications in the even of an incident within the Communications Center building.

204.02.02 Practice Plan:  Language was added to clarify the expectation that the plan will be fully implemented, tested and critiqued, a minimum of two times each year.  The characteristic was revised to allow for an actual communications center disaster (if appropriately executed and critiqued) to serve as ONE of the annually required simulation exercises.

204.03.01 Communications Maintenance:  This characteristic was revised to include an additional minimum requirement addressing service contracts for maintenance of communications equipment.

204.04.01 Training: This characteristic was revised to require a policy/procedure describing the initial and ongoing training requirements for communications employees.  Minimum requirements were also provided.

204.07.01 Communications Performance Improvement:  “Communications CQI” was changed to “Communications Performance Improvement.”