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HomeMy WebLinkAboutJustification Summary10. Justification Summary: A) Problem description: The City of Miami's Department of Fire -Rescue (MFR) current staff training program may have a negative impact on Quality Patient Care, which could subsequently increase the morbidity and mortality rate in the City. MFR does not have enough manikins to train its 458 paramedics in proper assessment and treatment of Advance Life Support (ALS) patients, Paramedics currently average 1 intubation per year. At this time, MFR does not have the capacity to reach the American Heart Association (AHA) 2000 guidelines for advance cardiac life support (ACLS) and basic life support (BLS) recommendation, which states that: "maintenance of intubation skills required a minimum of 6 intubations per year, either in actual patients or in manikin practice," On many occasions, the only training MFR can offer is on real calls with real patients. This is not the ideal situation for the patient or the care giver and can lead to irreversible life threatening mistakes. For decades MFR's goal has been to equip each fire -rescue member with a higher level of comprehensive training. This level of training will allow them to react efficiently in new and ever changing emergency situations they face on everyday basis. In year 2004 MFR had 82,393 alarms, in which 16,200 were ALS patients (388 of these needing intubation), 12,320 were trauma related, 7,260 were cardiac related, 1,254 were stroke related, and 540 were Dead on Arrival. In addition, Miami continues to be a gateway for poor immigrants, and its economy relies heavily on tourism. Low-income families and the elderly are the city's most vulnerable groups. In 2002 Miami's median income was $20,883, and 31% of its residents lived in poverty. Seventeen percent of its population was aged 65 and older and 40% of them lived in poverty. Their special needs routinely puts' heavy demands on MFR's staff. The increasing numbers and high frequency of patients needing ALS assessment, treatment and procedures, stresses the importance of having all EMS personnel adequately trained to answer to any emergency medical situation. B) Present situation: Presently our Paramedics receive 32 hours of ALS training every two years and our EMTs receive 32 hours of BLS training every two years. A big portion of the paramedic testing is scenario -based megacode using a rhythm generator, 3 lead EKG and verbalizing scenarios. This situation provides for very limited hands-on experience. With most of the scenario verbalized, the EMS member is left to practice their skills on live patients or inadequate BLS manikins. Last year, MFR responded to 82,393 alarms in which 16,200 were ALS patients (388 needing intubation), 12,320 were trauma related, 7,260 were cardiac related, 1,254 were stroke related and 540 were Dead on Arrival. C) Proposed solution: MFR proposes the purchase of an advanced Manikin (SirnMan) to be utilized in daily training sessions of its staff. In addition, MFR will provide to some of its staff a "One -on -One training session with a Subject Matter Expert". This intensive 2 day training session will take place at SimMan Training Laboratory in Gateville, Texas. This group will be able to use their training experience by the manufacturer to replicate and ensure the quality of the training with the rest of the staff at our City of Miami training facilities. This training will enable our EMS personnel to act instinctively in the most appropriate and effective manner. MFR strongly advocates the ability to adequately train all of our employees in clinical and decision -making skills during realistic patient care scenarios. These proposed solutions will allow the Department to simulate every type of medical or trauma condition treated in the field. SimMan will provide a multi -disciplinary educational tool that will maintain and test our clinical and decision - making skills in a safe, learning environment. Simulation training is paramount to our Quality Management Program that identifies key areas that require additional training focus. SimMan will provide a wide -range of realistic patient presentations that will provide scenarios with training in areas such as, patient airway, obstructed airway (a huge advantage over simple intubation manikins), cardiac rhythms, lung sounds, trauma, and other relevant patient care situations. SimMan will revolutionize our training, testing, and Quality Management programs and bring these areas to another level not possible without this grant. A training manikin that simulates ACLS, advanced trauma life support (ATLS), and difficult airway management medical emergencies would allow the Department to effectively train and test our employees' clinical and decision -making skills during realistic patient -care scenarios. The manikin is extremely realistic, and specifically designed to meet scenario -based training needs of anesthesia, ACLS, AILS, and difficult airway management. MFR will implement the manikin into everyday training of all field staff, It will provide MFR the ability to cover every aspect and every situation found in a pre -hospital setting while training our employees. It allows a hands-on approach to all skills performed in the emergency setting. In addition, it will allow MFR employees to add new skills which may be needed on critical trauma scenes in the field. Employees having trouble with a certain skill can spend time practicing skills with the Manikin. Treating the sick and injured is stressful unto itself, practice makes for less stressful and better patient care. D) Consequences if not funded: If this grant is not funded, MFR will have to continue to have ar, inadequate rpply of training tools to address the needs of its paramedics and EMTs. Our employeesiwill scramble to perform skills not easily performed in an urban setting. Failure to invest adequately in the training of our EMS personnel will have serious adverse effects on their performance, and therefore the community's perception/opinion of its City of Miami Fire -Rescue Department. Lack of adequate training may lead to improper treatment of the patient resulting in poor patient outcomes and costly civil liability. Most important, it could also lead to an increase of morbidity and mortality rate in the city. E) The geographic area to be addressed: This grant will serve the entire 34.5 square miles of the City of Miami. The City has 365,000 residents, and welcomes over 1.2 million people coming to work, visiting and doing business on an everyday bases within city limits. Among large cities, Miami is the poorest in the State and the 4th poorest in the US. it continues to be a gateway for poor immigrants, and its one-sided economy relies heavily on tourism. Low-income families and the elderly are the city's most vulnerable groups. In 2002 Miami's median income was $20,883, and 31 % of its residents lived in poverty. Seventeen percent of its population was aged 65 and older and 40% of them lived in poverty. Their special needs routinely puts' heavy demands on MFR's 911 system, which handled 82,393 calls for assistance in 2004. F) The proposed time frames: : Months 1 to 3: Present award to the City commissioners for approval, purchase the manikin; coordinate training at SimMan Training Lab, set up training schedule for the staff. Months 4 to 12: Perform training session at SimMan Lab, document personnel training. G) Data Sources: 2000 U.S. Census data for the City of Miami, 2004 City of Miami Management Information System, 2004 City of Miami Department of Fire -Rescue Incident Report System, 2002 City of Miami Department of Fire -Rescue 5 Year Strategic Plan, American Heart Association (AHA) 2000 guidelines for ACLS and BLS. H) Statement attesting no duplication: The City of Miami MFR project to purchase a Manikin and train its staff does not duplicate any previous efforts or activity on another grant under this grant program.