Paramedics Plus Alameda Appendices Redacted - Web - 2of6

Good
Good
121
13
Good
Good
122
14
Good
Good
123
15
Good
Good
124
16
MISCELLANEOUS RESPONSE PERFORMANCE
17
125
Good
Good
126
18
Good
Good
19
127
128
20
Good
LOST UNIT HOURS

Good
21
129
130
22
EMD QUALITY ASSURANCE REVIEWS
23
131
132
24
95%
25
133
134
26
PATIENT CARE REPORTS

Good
Good
27
135
QUALITY ASSURANCE REVIEWS
136
28
9
95% Overall Protocol compliance was achieved
29
137
138
30
HOSPITAL CLOSURE/DIVERSION OCCURRENCES
31
139
FIELD CLINICAL STUDIES

STROKE PATIENT COMPLIANCE
Good
Good
% of Suspected Hemorrhagic Strokes with OLMC Consult
140
32
Good
OTHER CLINICAL STUDIES
Good
33
141
Good
CARDIAC ARREST SURVIVAL RESULTS

Good
142
34
Good
Good
35
143
Good
Good
144
36
Good
37
145
Good
CONTINUING EDUCATION COMPLIANCE

Good
146
38
FLEET / MATERIALS
Good
39
147
Good
SAFETY AND RISK

Good
148
40
41
149
Good
Good
150
42
Good
43
151
152
44
45
153
EMPLOYEE FULL TIME EQUIVALENT HEADCOUNT
154
46
There are currently 13 full-time paramedics, 9 part-time paramedic, 20 full-time EMTs, and 1
part-time EMTs in the orientation pipeline.
47
155
156
OK CQI Report October 09
Clinical Quality Improvement Report

October 2009
157
Clinical Quality Improvement

Executive Summary Report
October 2009
Introduction
The report that follows is a summary of the clinical CQI actions for the month of
September. For further detail into any, all, or areas not listed in the summary report,
contact the EMSA Q.I. Hotline at (396-9299) or qihotline@emsa.net, leave your
questions, and return number. Someone from the Q.I. department will follow up with
you as soon as possible.
This report represents 100% of all electronic patient care reports for the month of
September. A portion of the PCRs are selected for manual review based on an apparent
protocol deviation. The PCRs are reviewed manually to determine if the deviation was
clinically indicated. There were a total of 470, or 4.3
% of the total PCRs that
were manually reviewed because of a possible protocol deviation and a total of 653
priority one transports that were reviewed as well. In the system we had a total of 5386
transports in the Eastern Division and 5554 in the Western Division for a total of 10940
total transports.
Paramedic Clinical Management

There was a 99% and 99% rate for correct assessment in the Eastern and Western
Divisions respectively and a 99% rate for correct management in Tulsa with a 99% rate
in OKC
Protocol Utilization
The most frequent protocol deviations in the Eastern Division were SVT, Destination,
and Airway Management. In the Western Division they were Destination, Capnography,
and ACS, and code Termination.
Procedure Report
The procedural report is based on 5386 transports in the Eastern Division and 5554
transports from the Western Division for a total of 10940 transports within the system.
The overall success rate for IV this month in the Eastern and Western Divisions were
91% and 91% respectively.
There were a total of fifteen (15) IOs successfully placed in Eastern division and thirteen
(13) successfully placed in the Western division by EMSA medics. There were three (3)
IO placed by TFD and six (6) placed by OCFD.
158
Eastern Division Airway

Total # of Cases
% Successful
# of Oral and success rate
# Cardiac Arrest
# Nasal and Success Rate
% Airway correctly Managed
40
33 of 40 patients attempted or 83%
100%
Of the seven (7) patients where oral/nasal intubation failed, four (4) had a combitube
placed and the other three (3) had their airway controlled using less invasive techniques.
The reasons for the missed intubations are listed below:
Reason
Anatomical Difficulties
Clenched Teeth
Fluid Obstruction
Gag Reflex
Traumatic Airway
Number
3
1
1
1
1
Western Division Airway

Total # of Cases
% Successful
# of Oral and Success Rate
# Cardiac Arrest
# Nasal and Success Rate
% Airway Correctly Managed
53
100%
Of the eight (8) patients where oral/nasal intubation failed, three (3) had a combitube
placed; two (2) were intubated by fire and the other three (3) had their airway controlled
using less invasive techniques. The reasons for the missed intubations are listed below:
Reason
Anatomical Difficulties
Fluid Obstruction
Traumatic Airway
Clenched Teeth
<60sec
<120sec
Eastern
28/33
29/33
Western
85% 40/45
88% 41/45
Number
3
1
1
3
89%
91%
159
Total number of oral intubations performed by other agencies such as First Responders or
Physicians on scene, compared to the number of oral intubations performed by EMSA
medics.
Eastern Division:
Western Division:
7/8 (Success/Attempt) performed by TFD, 1/1 by JFD and 33 by

EMSA medics. These numbers are taken from the EMSA PCRs.
15/18 (Success/Attempt) performed by OCFD, 2/2 by EFD, 0/1 for
WAFD, 1/1 by YFD and 45 by EMSA medics. These numbers are
taken from the EMSA PCRs.
Educational Activities:
The team meetings for the month of October were as listed below:
Eastern Division: Wilderness training with 186 participants.
Western Division: ICS training with 183 participants.
Q.I. Hotline activity:

Received a call on the QI Hotline regarding the excellent job done by Sarah Woodring
and Tony Goddard. The call came from Edmond Fire who wanted to report that the crew
was extremely compassionate and went the extra mile to make sure the patient got the
best care possible.
160
Percentage of Patients Evaluated by Age Groups
Eastern Division
Western Division
AgeRangeEastern
Division
2.51%
1.20% 3.84%
AgeRange
WesternDivision
2.51%
1.40%
<1
31.93%
19.99%
<1
15
616
40.53%
3.86%
15
33.76%
20.49%
1735
3665
>65
616
1735
37.98%
3665
>65
161
Priority One Trauma Returns:
Eastern Division:
40 (10% of trauma pts) total returned priority one to receiving Emergency Departments,
28(70%) met the Priority One Trauma criteria by documentation on the patient care
form.
The destinations of the priority one-trauma case are as follows:
SFH 18(45%)
SJMC 21(53%)
HMC 1 (2%)
The one (1) P-1 patient taken to HMC was a burn patient.
Western Division:
67(11% of trauma pts) total returned priority one to receiving Emergency Departments,
57(85%) met Priority One Trauma criteria by documentation on the patient care form.
The destinations of the priority one-trauma cases are as follows:
OUMC 65 (97%)
SAH 1 (2%)
BMC 1 (2%)
The two (2) patients not taken to OU, one (1) burn went to BMC and one (1) MVC to
SAH by patient choice after education by the medic.
162
Eastern Division Priority II
Total of 99 patients (25% of trauma pts).
Western Division Priority II
Total of 101 patients (17% of trauma pts).
163
Trauma Scene Times
10:01
11:24
11:12
9:26
10:11
10:15
10:00
10:02
11:25
14:07
10:07
11:29
10:34
9:39
10:05
11:01
9:08
11:44
13:20
11:02
16:22
12:58
10:56
19:12
16:48
14:24
12:00
9:36
7:12
4:48
2:24
0:00
11:13
Trauma scene times are comprised from trauma cases returned priority one to the
appropriate Trauma center.
Eastern Division
11:33
9:53
9:11
9:07
8:38
9:44
9:24
10:30
10:50
8:18
9:40
10:10
10:17
10:24
8:44
9:13
8:12
8:41
8:28
9:36
6:43
13:04
10:49
12:00
9:17
14:24
10:02
The Eastern Divisions Trauma Scene Times are made up from 40 cases that met the
criteria. There were 20 cases of scene times greater than 10 minutes that have
extenuating circumstances that were excluded from this calculation. There were 5 cases
of scene times greater than 10 minutes without documented extenuating circumstances.
7:12
4:48
2:24
0:00
Western Division
The Western Divisions Trauma Scene Times are made up from 67 cases that met the
criteria. There were 22 cases of scene times greater than 10 minutes that have
extenuating circumstances that were excluded from this calculation. There were 19 cases
of scene times greater than 10 minutes without documented extenuating circumstances.
164
14%
16%
15%
16%
17%
16%
17%
16%
16%
16%
15%
17%
17%
14%
14%
14%
15%
15%
15%
14%
13%
17%
13%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
14%
Non-Transports after contact:
Series1
Eastern Division
There were 12 occurrences where the FOS was not contacted when indicated.
Compliance to completed assessment was 99%. The medics that were non-compliant
were counseled individually.
11%
12%
12%
12%
11%
10%
11%
11%
11%
10%
10%
11%
11%
11%
11%
11%
11%
11%
9%
10%
9%
9%
10%
14%
12%
10%
8%
6%
4%
2%
0%
10%
292 calls were canceled by TPD, of those 252(86%) were after EMSA was on scene.
86 calls were canceled by TFD, of those 49(57%) were after EMSA was on scene.
Series1
Western Division
There were 8 occurrences where the FOS was not contacted when indicated. Compliance
to completed assessment was 99%. The medics that were non-compliant were counseled
individually.
337 calls were canceled by OCPD, of those 208(62%) were after EMSA was on scene.
203 calls were canceled by OCFD, of those 125(62%) were after EMSA was on scene.
165
166
March
AE
December
September
June
March
Last Center Value

Last Data Value
Sigma for Limits
Base for Limits
September
June
0.268
0.25
0.01102
Average MR
Special Cause(s) Detected
0.4
0.38
0.36
0.34
0.32
0.3
0.28
0.26
0.24
0.22
0.2
March
December
Chart Type: Custom
June
June
March
12/4/2009
1 Beyond Control Limit

9 On One Side of Average
6 Trending Up or Down
14 Alternating Up & Down
December
A.
B.
C.
D.
September
Period
September
September
June
March
December
Special Cause Flag

A
December
Eastern Division No Haul %

EF
March
TRUE
#####
June
E.
F.
G.
H.
X.
September
June
March
December
September
BPChart 3M
Database Column
1
2 of 3 Beyond 2 Sigma
15 Within 1 Sigma
8 Outside 1 Sigma
Excluded or Missing Data
Eastern Division No Haul %
167
168
Personnel Injuries
169
170
Viehicle Contact Report
171
172
# of shifts off late in pay period
Current Average
Current Median
Sigma for Limits
Base for Limits
49.725
46.5
9.336901876
Average MR
1/14/2010
A. 1 Beyond Control Limit

B. 9 On One Side of Average
C. 6 Trending Up or Down
D. 14 Alternating Up & Down
p(no trend) = 0.000
Chart Type: Custom
Period
E
E.
F.
G.
H.
X.
15 Within 1 Sigma
8 Outside 1 Sigma
Database Column
1
wk11-11
wk12-8
wk1-6
wk2-3
wk3-3
wk3-31
wk4-28
wk5-26
wk6-23
wk7-21
wk8-18
wk9-15
wk10-13
wk11-10
wk12-08
wk1-5
wk2-2
wk3-1
wk3-29
wk4-26
wk5-24
wk6-21
wk7-19
wk8-16
wk9-13
wk10-11
wk11-8
wk12-6
wk 1-3-09
wk1-31
wk2-28
wk3-28
wk4-25
wk5-23
wk6-20
wk7-18
wk8-15
wk9-12
wk10-10
wk11-7
20
40
60
80
100
Special Cause Flag
OKC Off Late Shifts

OKC Off Late Shifts
173
174
Transports by Priority
Western Division
Priority 1
Priority 2
Priority 3
Priority 4
Totals
Calls Transports
2233
1939
4628
3185
427
418
2
1
7290
5543
Budgeted TX
Projected TX
Actual TX
Actual vs. Budget
Projected vs. Budget
5110
5543
5543
433
433
Eastern Division
Priority 1
Priority 2
Priority 3
Priority 4
Totals
Calls Transports
2065
1721
4262
2803
827
821
28
25
7182
5370
Budgeted TX
Projected TX
Actual TX
Actual vs. Budget
5332
5370
5370
38
38
Patients
1939
3185
418
1
5543
Month October
No Haul %
13%
31%
2%
50%
24%
Budgeted UH
Projected UH
Actual UH
Actual vs. Budget
Patients
1721
2803
821
25
5370
Budgeted UH
Projected UH
Actual UH
Actual vs. Budget
Calls Transports Transports

4298
3660
3660
8890
5988
5988
1254
1239
1239
30
26
26
14472
10913
10913
Budgeted TX
Projected TX
Actual TX
Actual vs. Budget
10442
10913
10913
471
471
17621
18506
18506
885
885
No Haul %
17%
34%
1%
11%
25%
Summary Data
Priority 1
Priority 2
Priority 3
Priority 4
Totals
Special Event UH
Scheduled UH 19137.25
Adjustments
631.65
Actual UH 18505.6
Lost UH 1350.06
Effective UH 17155.54
Budget UHU
0.29
Projected UHU
0.30
Actual UHU
0.30
Actual vs. Budget
0.01
0.01
Effective UHU
0.32
Special Event UH
Scheduled UH 14558.75
Adjustments
523.02
Actual UH 14035.73
Lost UH
1021.2
Budget UHU
0.34
Projected UHU
0.38
Actual UHU
0.38
Actual vs. Budget
0.04
0.04
Effective UHU
0.41
15682
14036
14035.73
-1647
-1647
No Haul %
15%
33%
1%
13%
25%
Budgeted UH
Projected UH
Actual UH
Actual vs. Budget
Special Event UH
Scheduled UH
33696
Adjustments 1154.67
Actual UH 32541.33
Lost UH 2371.26
Budget UHU
0.31
Projected UHU
0.34
Actual UHU
0.34
Actual vs. Budget
0.02
0.02
Effective UHU
0.36
33303
32541
32541
-762
-762
Budget Summary By Priority

Western Division
Budget
Actual Projected
1695
1939
1939
2999
3185
3185
414
418
418
2
1
1
5110
5543
5543
To Budget
244
186
4
-1
433
Combined
Budget TX Actual TX Projected
Priority 1
3209
3660
3660
Priority 2
5895
5988
5988
Priority 3
1317
1239
1239
Priority 4
21
26
26
10442
10913
10913
Totals
To Budget
451
93
-78
5
471
Priority 1
Priority 2
Priority 3
Priority 4
Totals
Eastern Division
Budget
Actual Projected To Budget
1514
1721
1721
207
2896
2803
2803
-93
903
821
821
-82
19
25
25
6
5332
5370
5370
38
Priority 1
Priority 2
Priority 3
Priority 4
Totals
Fiscal Year To Date

Budget*
Actual
Variance
East
57746
56053
-1693
West
56094
57253
1159
Combined
113840
113306
-534
*based on full month budget figure
Information through October 31
175
176
wk2-9
wk12-29
wk3-22
0.378
0.44861111
0.1757
Average MR
0:00:00
12:00:00
24:00:00
wk11-17
Last Center Value

Last Data Value
Sigma for Limits
Base for Limits
Lost Hours
36:00:00
wk7-26
wk10-18
wk1-10
wk11-29

wk9-6
11/13/2009
A.
B.
C.
D.
wk2-21
Chart Type: Custom
Period
Special Cause Flag
E.
F.
G.
H.
X.
wk5-16
wk4-4
wk5-3
wk10-31
wk9-19
wk8-8
wk6-27
BPChart 3M
Database Column
1
15 Within 1 Sigma
8 Outside 1 Sigma
Western Division Lost UHU - Late Sign On/Crew Late

Western - Late Sign On/Crew Late
177
wk6-14
178
Performance Data
January 7, Key
2010
2010 01 07
Compliance: Week
Compliance: MTD : QTD
OKC
Tulsa
91.5%
90.5%
91.5%
91.5%
90.5%
90.5%
5.4
5.4
1.4
1.5
Effective UHU: WK : MTD

Budgeted Effective UHU : Trans/Day
0.291
0.291
0.423
0.423
0.320
180.2
0.405
182.6
Trans/ Day
92%
Exceptions + or - : MTD : QTD
Actual / plan : N
Shifts Produced / Plan

Shifts produced
Week
96%
165.6
104%
Week : Plan
91.8
174.7
95%
88.0
64.6
68.0
Medics (N / Plan) : N
107%
94
84%
57
EMTs (N / Plan) : N
103%
90.5
121%
82
102%
102%
90%
90%
1.4%
1.4%
0.9%
0.9%
Produced / Scheduled UH (WK : MTD)

Lost Unit Hours WK : MTD
Payroll Data: Special Pays:
XOT : PT Hours
325
669.9
759.5
10,006
464.8
983.5
% Fleet OOS : Critical Failures

Vehicle contacts
6%
% Next Acad Filled Medic : EMT
0%
0%
10%
0%
Actual: Medic EMT
Plan: Medic EMT
10
10
Date next Acad
14%
Medic : EMT
Open shifts coming week Medic : EMT

Call outs past week
March
5
February
10
21
15
2
14
179
1/20/106:50AM
180
wk2-9
wk12-29
wk3-22
0.07
0.01319444
0.05810
Average MR
0:00:00
4:48:00
9:36:00
14:24:00
wk11-17
Last Center Value

Last Data Value
Sigma for Limits
Base for Limits
Lost Hours
19:12:00
wk10-18
wk1-10
Chart Type: Custom
wk2-21

wk9-6
11/13/2009
A.
B.
C.
D.
wk11-29
Period
wk5-16
E.
F.
G.
H.
X.
wk9-19
wk8-8
BPChart 3M
Database Column
1
15 Within 1 Sigma
8 Outside 1 Sigma
wk6-27
wk7-26
wk6-14
wk5-3
Special Cause Flag
wk10-31
wk4-4
Western Division Lost UHU - Late Start Mechanical
Western Late Start Mechanical
181
182
Appendix 10 Sunstar Sterling Application 2009
183
Table of Contents
Glossary of Terms and Abbreviations
Page G1
Organizational Profile..
Page i
Category 1.0: Leadership. Page 1

1.1 Senior Leadership.
Page 1
1.2 Governance and Social Responsibilities..
Page 5
Category 2.0: Strategic Planning
Page 8
2.1 Strategic Development..
Page 8
2.2 Strategic Deployment Page 10

Category 3.0: Focus on Patient, Other Customers, and Markets
Page 13
3.1 Patient, Other Customer, and Health Care Market Knowledge..
Page 13
3.2 Patient and Other Customer Relationships and Satisfaction...
Page 15
Category 4.0: Measurement, Analysis, and Knowledge Management
Page 18
4.1 Measurement, Analysis, and Improvement of Organizational Performance.. Page 18

4.2 Management of Information, Information Technology, and Knowledge
Page 21
Category 5.0: Workforce Focus..
Page 24
5.1 Workforce Engagement Page 24

5.2 Workforce Environment..
Page 28
Category 6.0: Process Management Page 32

6.1 Work Systems Design...
Page 32
6.2 Work Process Management and Improvement.
Page 35
Category 7.0: Results Page 37

7.1 Health Care Outcomes.
Page 37
7.2 Patient and Other Customer-Focused Outcomes..
Page 39
7.3 Financial and Market Outcomes.
Page 42
7.4 Workforce- Focused Outcomes Page 43
184
7.5 Process Effectiveness Outcomes..
Page 45
7.6 Leadership Outcomes...
Page 49
provider contract costs.
GLOSSARY OF TERMS AND

ABBREVIATIONS
AAA. American Ambulance Association-The
American Ambulance Association represents ambulance services across the United States that participate in serving more than 75% of the U.S. population with emergency and nonemergency care
and medical transportation services. The AAA was
formed in response to the need for improvements
in medical transportation and emergency medical
services.
AAR. After Action Review- A meeting developed
to critique an event or incident to identify successes and area.
ACE. Accredited Center of Excellence-A 3-year
accreditation by the National Academy of Emergency Dispatch based on 20 indicators of performance for improvement.
ACLS. Advanced Cardiac Life Support- Certification required for paramedics
ACSI. American Customer Satisfaction IndexUsed for comparative data.
Administration and Support Staff- Includes all
non-certified personnel in areas other than directly
related to patient care (office personnel, mechanics, and materials personnel)
Ad Valorem Tax- A tax based on the value of real
estate which used to fund the EMS first responders
(fire department operations).
AHA. American Heart Association-is a non profit
organization in the United States that fosters appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease
and stroke.
ALS. Advanced Life Support.
Alternate- Employee who has been trained and
certified for a specialty position but only work that
position on an as needed basis (CCT, SSC, MHT).
Ambulance Service Agreement- Agreement between the Pinellas County Authority and Paramedics Plus to be the sole provider of ambulances services in Pinellas County. The term of the agreement is five years with possible two 3-year extensions.
Ambulance User Fees- Fees that are charged to
patients (or insurers) who use the ambulance services, which are typically reimbursed by the patients insurer. These fees fund the ambulance
AQUA- AQUA Quality Improvement Software automates the entire emergency dispatch case review
process. It assists the dispatcher with many tasks
such as data entry, compliance scoring, record keeping, reporting and more. It helps ensure that emergency
dispatchers in your agency are providing quality service in compliance with all standards established by
the National Academies of Emergency Dispatch. It
pinpoints specific training needs and liability risks,
and helps you document continuous improvement
efforts. In today's world, public safety agencies simply must have a defendable quality improvement program to help protect them from liability lawsuits.
AQUA is a powerful tool that helps the dispatcher
meet this need with minimal commitments of time
and personnel.
Assistant Supervisor- An employee who has been
selected through an interview process and trained to
perform the role of a supervisor. Assistant supervisors work their regular shifts in the field and fill in for
supervisors when the need arises.
Auth. Authority- Refers to the Pinellas County EMS
Authority
BCC. Board of County Commissioners
BLS. Basic Life Support- Certification required for
EMTs and paramedics.
BTLS. Basic Trauma Life Support- Certification
required of paramedics.
CAAS. Commission on Accreditation of Ambulance Services- A 3-year accreditation established
to encourage and promote quality patient care in
America's medical transportation system. Accreditation signifies that the 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.
CAD. Computer Aided Dispatch.- The software
utilized to receive requests for service and to assign
those requests to available resources.
Call-Taker- System Status Controller/Dispatcher
whos primary duty is to answer the phones including
9-1-1 calls.
CAMTS. Commission on Accreditation of Medical
Transport Systems- The Commission on Accreditation of Medical Transport Systems is dedicated to
improving the quality of patient care and safety of the
transport environment for services providing ro-
Glossary of Terms and Abbreviations - Page G1
185
torwing, fixed wing and ground transport systems.

Capnography- is the monitoring of the concentration
or partial pressure of carbon dioxide (CO2) in the respiratory gases. It is used in our system to assist in
assessing respiratory patients and confirming endotracheal intubation tube placement.
CCT. Critical Care Transport.
CDE. Continuing Dispatch Education- Classes
required for dispatchers to maintain their certification.
Clinical Staff- Includes all certified personnel (EMTs
and Paramedics) who are involved in the care of our
patients.
CME. Continuing Medical Education Classes
held monthly through the St Petersburg College that
all licensed personnel must attend. Credits for these
classes count towards re-certifications.
EMS Services- Ambulances are deployed throughout the county using a flexible ambulance deployment model called System Status Management
(SSM). This model ensures that the correct number
of ambulances are in the right location at the right
time when they are needed. By accurately predicting
when and where ambulances will be needed, we are
able to exceed contract response time requirements
and optimize our financial performance (Figure P.12). Response to the callers location is either emergency (lights and siren) or non-emergency in a customized ambulance staffed with a paramedic and an
Emergency Medical Technician (EMT).
DOC. Director of Communications.
DOCS. Director of Clinical Services
DOHS. Director of Health and Safety
DOIT. Director of Information Technology
CME Steering Committee- Committee that meets

monthly to determine the educational offerings to the
EMS providers in the county.
DOO. Director of Operations
COO. Chief Operating Officer.
Dynamic Post Plan- The plan in which we use to

strategically position our ambulances throughout the
county to respond to emergencies. These strategic
locations may change every hour of the day and day
of the week.
CPI. Consumer Price Index.

CPR. Cardiopulmonary Resuscitation.
Crew-Refers to an ambulance crew usually consisting of a paramedic and EMT.
CSFs. Critical Success Factors- People, Quality,
Responsible Financially, and Service.
Daily Performance Analysis Graph- A graph used
in the PULSE meetings that reviews the last days
performance. It layers actual call volume for each
hour of the day, number of ambulances that were
deployed, duration of bed delays, and emergency
response time compliance that was achieved in each
hour of the day.
Dispatch Services- 9-1-1 calls that are triaged as
medical calls by the Pinellas County 9-1-1 dispatch
center are transferred to the Sunstar Paramedics
communications center to provide pre-arrival instructions to callers and dispatch the closest ambulance
using Computer Aided Dispatch (CAD) and GPS.
Non-emergency transport requests are received directly to the Sunstar Paramedics communication
center.
800 MHz Radio System- Each ambulance is
equipped with an on-board radio and two portable
radios that allow communication between dispatch,
other EMS agencies, and area hospitals.
186
DOSS. Director of Support Services
EE. Employee.
EKG. Electrocardiogram- Displays cardiac rhythm.
EMD. Emergency Medical Dispatch- A standard of
emergency call taking developed by the National
Academy of Emergency Dispatch.
EMS. Emergency Medical Services.
EMS Authority. The entity designated by the Board
of County Commissioners to oversee all EMS, fire
department, Medical Control and Educational contracts.
EMT. Emergency Medical Technician.
Enhanced 9-1-1 A system in the communication
center that displays the location of the calling party.
ePCR. Electronic Patient Care Report. Electronic
documentation of patient care performed by paramedics in the field.
EVOC. Emergency Vehicle Operations Course. A
mandatory training course all employees that operate emergency vehicles must successfully complete
that covers vehicle operation and safety.
Field. Term used to reflect the environment where

EMTs and Paramedics work.
Fiscal Year- The timeframe in which we base our
strategic planning process and reporting data, and
also coincides with our ambulance contract years;
October 1 September 30.
FISH. Fresh Ideas Start Here. A process in which
employees can offer suggestions or request improvements by name or anonymously. All forms submitted are reviewed in the Directors meeting weekly
and feedback is provided to the authors of each
form.
FTO. Field Training Officer- A designated employee who newly hired employees are placed with
to mentor and train for a specific amount of time. All
new hires are provided with an itinerary and a check
off sheet for skills and many other items such as policies and procedures.
Gallop Organization-provides a variety of management consulting, human resources and statistical
research services.
GEMS. Geriatric Education for Emergency Medical Services.
ITLS. International Trauma Life Support- A certification required of paramedics.

JEMS. Journal of Emergency Medical Services.
Joint Labor Management Committee- The purpose
of the Joint Labor-Management Committee is to encourage the parties to collective bargaining disputes
to agree directly on the terms of such agreements or
on a procedure to resolve these disputes. The Committee makes every effort to achieve voluntary settlements and to encourage a constructive long-term
relationship between the parties. The Committee
also serves as forum for discussion of larger issues,
unrelated to specific disputes, of mutual concern.
Leadership Meetings Quarterly meetings were the
LT meet with the supervisors to discuss organizational knowledge and performance.
LET. Leadership Effectiveness Training
LT. Leadership Team Includes the COO, directors
and managers.
MARVLIS. Mobile Area Routing and Vehicle Location Information System - A system used in dispatch that utilizes historical call data to predict demand on an hour by hour basis.
GPS. Global Positioning System. A system designed to designate the location of an object by a
triangulation of a minimum of four satellites.
MMA. Materials Management Assistant.
GSA. Governor Sterling Award.

Headcount Analysis- Analysis performed to determine if the current number of clinical personnel as
well as the anticipated number of personnel in 3
months and in 6 months will be enough to meet the
predicted call volume.
MPDS. Medical Priority Dispatch- A set of protocols used in the dispatch center by 9-1-1 call-takers
to provide pre-arrival instructions while EMS units
are responding to the call. The MPDS is in part
based on published standards by the National Association of EMS Physicians, the American society for
Testing and Materials, the American College of
Emergency Physicians, the U.S. Department of
Transportation, the National Institutes of Health, the
American Medical Association, and more than 20
years of research, development, and filed testing
throughout the world. The protocol contains 34 Chief
Complaint Protocols, Case Entry and Exit information, call termination scripts, and additional verbatim
instruction protocols for automatic external defibrillator support, CPR, childbirth assistance, airway and
breathing, and the Heimlich maneuver.
HPEMS. High Performance Emergency Medical

Services-The timely use of analytic models and
tools in the planning and implementation of resources in an Emergency Medical Services (EMS)
system to match supply with demand. The end goal
of this model is to facilitate the effective and cost efficient allocation of resources.
HIPAA. Health Insurance Portability and Accountability Act.
IAEP. International Association of EMTs and
Paramedics.
ISERA- Deployment planner that analyzes target
staffing levels and finds the most efficient allocation
of shifts to match ambulance resources with call volume demands.
MMRS. Metropolitan Medical Response System.
MVV. Mission, Vision, and Values.

NAED. National Association of Emergency Dispatchers.
NAEMT. National Association of Emergency
Medical Technicians
187
National Registry- A national certification that establishes uniform standards for training and examination of personnel active in the delivery of emergency ambulance service.
Ninthbrain- Software program that provides on-line
training, incident tracking, automated compliance
alerts, database for certification renewals and vaccination records, and QI tools.
NIMS. National Incident Management TrainingOn February 28, 2003, President Bush issued
Homeland Security Presidential Directive-5. HSPD-5
directed the Secretary of Homeland Security to develop and administer a National Incident Management System (NIMS). NIMS provides a consistent
nationwide template to enable all government, private-sector, and nongovernmental organizations to
work together during domestic incidents.
NOMAD- Computer and software used in the ambulance that includes mapping, call information, and
the ability to change unit status.
OLMC. On line Medical Control- A service provided
by the Office of the Medical Director to provide instant contact with a doctor for pre-hospital patient
consultation. During these consultations, the on line
doctors approve specific procedures such as administration of medication. OLMC also provides patient
reports to receiving facilities depending on the patients condition during the consult.
OMD. Office of the Medical Director- The contracted entity responsible for providing a Medical Director physician who oversees all of the clinical aspects within the EMS system through a complete set
of protocols called a Medical Operations Manual.
OSHA. Occupational Safety and Health Administration
PALS Meeting- Paramedic Advanced Life Support
meetings held monthly in which all EMS coordinators
attend.
PALS. Pediatric Advanced Life Support.
Paramedic- A person trained and certified to provide
emergency medical treatment.
PAT Program- Positive Action Taken- Method used
to provide employee recognition.
PBS. Patient Business Services- The department
where patient care reports are reviewed for accuracy
and completeness before going to the county billing
department for billing.
PCR. Patient Care Report.
188
PEPP. Pediatric Education for Pre-hospital Providers.

Pinellas County EMS- The Pinellas County Emergency Medical Services (EMS) Authority was created
through a Special Act of the Legislature. Chapter 80585, Laws of Florida, created the countywide EMS
district investing all powers in a seven member,
elected board, empowered to oversee and regulate
all emergency medical service activities in the
County. The Special Act was approved by a countywide voter referendum in 1980. The Authority owns
the trade-name Sunstar EMS, and holds the license
for paramedic ambulance services in the county. Pinellas County's EMS Authority provides a "One
Tier" (all units are advanced life support (ALS) level; meaning all paramedic), "Dual Response" (two
paramedic units are sent to each 9-1-1 emergency
call) system. We are a "Public Utility Model (PUM)"
EMS system. Pinellas County is the second largest,
PUM in the nation.
PIP. Performance Improvement Plan
PM. Preventive Maintenance.
Preceptor- Employees who work with new employees to provide coaching and mentoring during their
initial orientation period.
ProQA- ProQA Dispatch Software integrates the
power of the National Academy Protocols with today's critical computer technologies. It helps emergency dispatchers move smoothly through Case Entry and Key Questioning. It assists dispatchers in
quickly determining the appropriate Determinant
Code for each case and clearly displays the response configuration specifically assigned to the
code by local agency authorities. ProQA then guides
dispatchers in providing all relevant Post-Dispatch
and Pre-Arrival Instructions, as well as important
case completion information.
PTCA. Percutaneous Transluminal Coronary Angioplasty- One of the most common procedures for
opening damaged or obstructed coronary arteries.
PTO. Paid Time Off. PTO are hours that can be utilized for pay when the employee is not at work on a
regularly scheduled shift whether they are out sick or
on a prescheduled vacation. PTO is accrued based
on longevity with the company.
PULSE. Performance Utilization, Late-call, System Evaluation- A daily meeting in which future demand is evaluated and production is reviewed. Also
in this meeting, requests for service that exceed our
contractual obligation to the Authority due to human
error are reviewed and employees are provided
feedback.
Pulse Oximetry- a non-invasive method allowing

the monitoring of the oxygenation of a patient's hemoglobin.
SSC. System Status Controller- Another name for

dispatcher, this is a highly trained and certified employee who works in the Communications Center.
PUM. Public Utility Model- An EMS system that is

designed where the government not only regulates
and oversees system performance, but the ambulance service provider (contractor) is held accountable to meet or exceed performance requirements.
This can include termination of the provider contract
and even fines being imposed. In Public Utility Model
EMS system design, the government is a
"purchaser" of First Responder paramedic, and paramedic ambulance transport services through a competitive (bidding) process insuring that the most costeffective provision of EMS services is guaranteed.
SSM. System Status Management- The dynamic

method of moving available resources to strategic
locations to cover the most demand based on the
number of resources available.
QAR. Quality Assurance Review- A review or investigation of patient care issues that are brought to
our attention.
Ride-a-longs. When administrative personnel such
as directors and managers ride with a crew for a shift
to provide opportunities for two-way communication
and see firsthand what field employees manage on a
daily basis.
Road Safety. A system in each emergency vehicle
in the Sunstar Paramedics fleet that monitors seatbelt usage, safe backing techniques and a vehicle
operator level or score which measures the operators performance. The standard is five or higher on a
scale of one to ten. This number is reached via a
formula that measures the number of infractions per
one hundred miles driven.
ROSC. Return of Spontaneous Circulation- Indicates when a patient regains a pulse.
Scorecard Meeting- Monthly meetings where the
managers and directors review department and organization scorecard performance.
SPP. Strategic Planning Process.
Shift Bid. When demand patterns dramatically
change or when unit hours being produced do not
adequately cover the demand a shift bid will be held.
This is a process in which all employees must bid on
a shift to work in a two-week rotation. Shifts are
awarded based on seniority.
STAR CARE- The acronym that our values are reflected in. Safe, Team-based, Attentive to human
needs, Respectful, Customer-accountable, Appropriate, Reasonable, and Ethical.
Stats Page- An automated page sent to designated
recipients three times daily with our performance in
each call priority by percentage and number of transports.
Sunstar Paramedics- The Pinellas County designated name for the ambulance server provider.
Sup.- Abbreviation for Supervisor
S.W.A.T. Special Weapons and Tactics - A group
of highly trained Paramedics that work in conjunction
with the Sheriffs Office to ensure deputy and potential patient safety on high risk incidents.
SWOT. Strengths, Weakness, Opportunities, and
Threats.
Talking Points. Pertinent items of information that
all members of the administrative staff communicate
to the workforce. These talking points can include
but are not limited to safety, new equipment, procedures and process improvement.
UH. Unit Hour- A unit hour is defined as a one hour
period of time when a fully staffed and fully stocked
ambulance can be assigned an emergency call.
UHU. Unit Hour Utilization- A number derived from
a formula to determine and measure workload by
dividing the number of transports by the number of
hours worked.
Utstein Template- Tool used for the measurement
of cardiac arrest survival.
SQC. Sunstar Quality Council- A monthly meeting

where the LT and some stakeholders gather together
to report on the overall system performance. Key
performance measures are reviewed at these meetings.
189
190
ORGANIZATION
PROFILE
191
Sunstar Paramedics 2009 Florida Governors Sterling Award Application

Organizational Profile
In October of 2004, the Pinellas County EMS Authority
first contracted with Paramedics Plus, a for-profit Limited Liability Corporation (LLC), as the single provider
of countywide paramedic ambulance services in Pinellas County, Florida. Contractual requirements mandate Paramedics Plus to operate under the county
trade name of Sunstar Paramedics. The Pinellas
County Emergency Medical Services (EMS) is considered a Public Utility Model (PUM) which makes it different from other EMS systems. The Pinellas Board
of County Commissioners (BCC) provides policy oversight for all EMS related activities in Pinellas County,
Florida. EMS services are contracted by both public
fire departments and a private ambulance company.
All are under performance-based agreements with
Pinellas County EMS Authority. The EMS system is
funded through two main sources, a countywide ad
valorem tax and ambulance user fees. The nineteen
fire department first responder agencies are funded
through ad valorem taxing of all business and homeowners in Pinellas County. The single countywide ambulance contractor does not receive any tax supported
revenues, instead, is funded entirely from EMS user
fees collected from approximately 90,000 patients
transported annually.
P.1a(1) Main Products and Services
Sunstar Paramedics is a 24/7 operation that serves
280 square miles and a population of 945,000 with
over 4 million visitors annually. The main products and
services of Sunstar Paramedics are: (1) Dispatch Services, and (2) Emergency Medical Services (EMS)
Operations. Key process requirements and performance measures for both are identified in Figure 6.1-1.
In 2008 (fiscal year), Sunstar Paramedics responded
to 176,605 requests for ambulance service
(approximately 73% 9-1-1 emergency and 27% nonemergency interfacility transports).
VISION
To be an organization that sets the standard for EMS by
providing extraordinary care and service to our customers
and community, continuously improving through innovation and technology, and being a great place to work.
MISSION
To provide compassionate quality care and service to our
community.
STAR CARE VALUES
Safe: Are my actions safe for me, for my colleagues,

for other professionals and for the public?
Team-based: Are my actions taken with due regard for

the opinions and feelings of co-workers, including those
from other agencies?
Attentive to human needs: Do I treat my patients, customer or colleagues as a person? Do I tell them what to
expect in advance? Do I treat their family and/or relatives
with similar respect?
Respectful: Do I act towards my patients, colleagues,
my customers, and the public with the kind of respect
that I want to receive my self?
Customer accountable: Can I look my patients and

customers in the eye and say I did my very best for
you?
Appropriate: Is my care or work appropriate medically, professionally, legally, and practically, considering
the circumstances I face?
Reasonable: Do my actions make sense? Would a colleague with similar experience make a comparable decision?
Ethical: Are my actions fair and honest in every way?
Dispatch Services: Citizens request our services either by dialing 9-1-1 for emergencies or a seven digit
telephone number for non-emergency ambulance
transport services. Specially trained paramedics
called System Status Controllers (SSCs) located in the
Sunstar dispatch center provide pre-arrival instructions
customized to the callers emergency, giving life saving instructions even before the arrival of paramedics.
Simultaneously while instructions are being provided,
the closest ambulance is located using Computer
Aided Dispatch (CAD) and GPS, and then dispatched
using the 800 MHz radio system.
EMS Operations: Ambulances are deployed throughout the county using a unique flexible ambulance deployment model called System Status Management
(SSM). This model ensures that the appropriate number of ambulances are in the right location at the right
time when they are needed based upon an on-going
systematic analysis of historical EMS 9-1-1 call volume. By predicting where ambulances will be needed,
we are able to exceed contract response time require-
192
Figure P.1-1: Mission, Vision, Values, CSF

ments (Figures 7.1-2, 3. 4) and are financially competitive (Figures 7.3-1, 2, 3, 4). Response to the callers
location is either emergency (lights and siren) or nonemergency in a customized ambulance staffed with a
paramedic and an EMT.
Organizational Profile - Page i

On emergency 9-1-1 calls, both a fire department unit
and a Sunstar ambulance respond to the emergency
and work together to provide quality patient care on
the scene of the emergency. Sunstar Paramedics
transports the patient to the hospital and the fire department is then available for another emergency call.
On non-emergency interfacility transports, a Sunstar
ambulance is dispatched alone and provides treatment
and transport to the intended destination.
P.1a (2) Organizational Culture
Annually, through a systematic Strategic Planning
Process (SPP) (Figure 2.1-1), we review and modify
as necessary, our vision, mission, values, Critical Success Factors (CSFs), measures, goals, and key action
plans. Our mission and vision are accomplished
through our four CSFs (Figure P.1-2), capitalizing on
our core competencies (agility, data analysis, and optimize use of resources), and frequently monitoring key
performance measures within the organizational
(Figure 2.2-2), department (on site), and employee
scorecards (on site). These methods enable us to focus on creating and balancing values for our key customers and partners. In our vision, we define as an
organization that sets the standard for EMS as performance on the key measures aligned to the organizational scorecard CSFs (Figure 2.2-1) that is in the
top 25 percentile of EMS organizations and is comparable to organizations who have been identified as role
models through the Baldrige and the Florida Sterling
Quality Award.
P.1a (3) Workforce Profile
Sunstar Paramedics has 516 employees which are
segmented into two key groups: (1) Clinical 428 emCritical Success Factors
(CSF)
CSF
Description
PEOPLE
Highly Engaged,
Caring, Skilled
and
Safe Workforce
QUALITY
Quality Care to
Our Patients
RESPONSIBLE
FINANCIALLY
Optimize
Financial
Performance
SERVICE
Exceed The
Expectations
of Our
Customers
ployees (83%) and (2) Administration and Support

91 employees (18%). Of our clinical employees, 57%
are paramedics, 42% are EMTs and 1% are nurses.
How staff ethnic diversity compares to that of Pinellas
County is shown below.
Pinellas County
Sunstar Paramedics
% Minority
17%
% Women
52%
11%
25%
Key requirements and expectations for both employee

groups are based upon the extensive research study
conducted by the Gallup Organization involving 80,000
managers and employees. The Gallup study showed
that companies that reflected positive responses to the
questions listed below had higher employee engagement (Figure 7.4-1) and were more productive
(Figures 7.1-2, 3, 4). Key workforce requirements include:
Do I know what is expected of me at work? (Fig. 7.42)
Do I have the right materials and equipment I need
to do my work right? (Fig. 7.4-2)
Sunstar Paramedics is a safe place to work. (Fig.
7.4-2)
At work, do I have the opportunity to do what I do
best every day? (Fig. 7.4-2)
In the last seven days have I received recognition or
praise for doing good work. (Fig. 7.4-2)
My supervisor or someone at work seems to care
about me as a person. (Fig. 7.4-2)
There is someone at work who encourages my development. (Fig. 7.4-2)
Key Performance Measures
% Overall employee engagement (Fig. 7.4-1)

% Customers rate workforce compassionate & caring (Fig. 7.2-3)
Overall employee workforce safety index (Fig. 7.4-3)
% Clinical employees meeting CME Attendance Req. (Figure 7.4-4)
% Overall EMD compliance (Fig. 7.1-1)
% Arrive emergencies within 10 minutes. (Fig 7.1-2)
% Arrive scheduled non-emergencies within 15 minutes (Fig 7.1-3)
% Arrive unscheduled non-emergencies within 60 minutes (Fig. 7.1-4)
% Cardiac arrest survival (Figure 7.1-5)
% Stemi patients going to correct facility (Fig. 7.1-7)
% Stroke alerts called appropriately (Fig. 7.1-8)
% Trauma alert patients arrive hospital within golden hour (Fig. 7.1-9)
Cost per unit hour (Fig. 7.3-1)
Cost per capita (Fig. 7.3-2)
Cost per transport (Fig. 7.3-3)
% Change in annual cost per unit hour (Fig. 7.3-4)
Response time compliance fines (Fig. 7.3-5)
% 9-1-1 customer satisfaction (Fig. 7.2-1)
% Non-emergency customer satisfaction (Fig. 7.2-9)
% EMS Authority key contract requirements met (Fig. 7.2-20)
Figure P.1-2: Organizational Scorecard, Critical Success Factors, and Measures

Organizational Profile - Page ii
193

The mission / purpose of Sunstar Paramedics (to
provide compassionate quality care and service to
our community) makes me feel my job is important.
(Figure 7.4-2)
My co-workers are committed to doing quality work.
(Figure 7.4-2)
In the last year, I have had the opportunity at work to
learn and grow. (Figure 7.4-2)
In October of 2004, when Paramedic Plus was
awarded the contract, we inherited a workforce that
was represented by a single bargaining unit, the International Association of Emergency Medical Technicians (EMTs) and Paramedics. They represent all
paramedics, EMTs, Materials Management Assistants
(MMAs), and fleet mechanics, for a total of 464 employees, or about 89% of the workforce. Eighteen percent of this bargaining unit pays dues monthly.
Sunstar Paramedics offers a variety of benefits including sign-on and retention bonuses, paramedic training
reimbursement, medical, dental and vision insurance
plans, short and long-term disability insurance, matching 401(k), paid holidays, vacation and sick pay, and
bereavement leave. Key health and safety requirements include Florida Workers Compensation and
OSHA regulations (Figure P.1-3).
save time by getting the right resources to the right

location at the right time.
NOMAD Computer and software used in the ambulance that includes mapping, call information, and
the ability to change unit status.
EPCR / Computers Patient care documentation is
performed electronically using Zoll Tablet PCR software and Panasonic Tough-Book laptops.
ISERA Deployment planner analyzes staffing levels and finds the most efficient allocation of shifts to
match resources with call volume.
ROAD SAFETY Ambulances equipped with data
recorder to monitor how staff drives on a second to
second basis. Monitors speed and aggressive driving
and gives an audible warning.
Pro-QA A quality improvement software that automates the entire emergency dispatch case review
process to ensure that emergency dispatchers are
providing quality service in compliance with all standards established by the National Academies of Emergency Dispatch.
AQUA Dispatch software that helps dispatchers
move smoothly through case entry and key questioning and assists dispatchers in quickly determining the
level of response mode.
Equipment
P.1a (4) Facilities, Technologies, Equipment
Ambulance We have 64 Type III AEV/Ford E450s
Facilities
to respond to and transport patients. Each ambulance
Sunstar Headquarters A 55,000 sq. ft. Pinellas
is equipped with a light system designed to give 360
County owned facility. Ninety percent of all employees
degree visibility in concert with high output sirens.
(clinical and administrative) are
deployed from this facility. It
Key Regulatory Areas
Key Measures
includes: an ambulance fleet
Contractual
Obligations
%
Arrive
emergencies
within 10 minutes (Fig.
maintenance facility, medical
Pinellas
County
EMS
7.1-2)
supply warehouse, state of the
Contract
% Arrive scheduled non-emergencies within 15
art dispatch center, four bay
minutes (Fig. 7.1-3)
deployment areas, and admin
% Arrive unscheduled non-emergencies within
istrative offices.
60 minutes (Fig. 7.1-4)
South County Hub A 1,200
% PCR proper billing information (Fig. 7.1-10)

sq. ft. facility. Seven percent of
% EMS Authority contract req. met (Fig. 7.2our employees are deployed
20)
from this facility in St. Petersburg.
Occupational Reg.
% Workers compensation cases reported < 24
Technologies
Florida Workers Comp
hours (Fig. 7.6-1)
Computer Aided Dispatch
Laws
% OSHA 300 reported less 7 days (Fig. 7.6-2)
(CAD) Computer Software
OSHA
# Substantiated EEOC complaints (Fig. 7.6-4)
system assists dispatch personnel handling and prioritizing
Accreditations
Maintain CAAS accreditation (Fig. 7.6-4)
requests for ambulance ser CAAS
Maintain ACE accreditation (Fig. 7.6-4)
vice. Enhanced 911 will send
ACE
Maintain AHA training facility accreditation
the location of the call to the
AHA Training Facility
(Fig. 7.6-4)
CAD system and display the
CAMTS (CCT Unit)
Maintain CAMTS accreditation (Fig. 7.6-4)
address on to the dispatcher.
Certifications
% Clinical employees meeting CME attenThe system allows the dis County EMT, Paradance requirements (Fig. 7.4-4)
patcher to see the location of
medic & RN Cert.
% Dispatchers meeting CDE requirements
the ambulance and track their
CME requirements
(Figure 7.4-6)
response route.
MARVLIS Mobile Area
Medical Privacy
Number of substantiated HIPAA violations (Fig.
Routing & Vehicle Location In
HIPAA
Patient
Privacy
7.6-4)
formation System designed to
Figure P.1-3 Regulatory Environment
194
Organizational Profile - Page iii

Chief Operating Officer (COO) of Pinellas County operations reports to the President of Paramedics Plus.
LP12 EKG Monitors Electrocardiogram monitors

are capable of EKG, cardiac pacing, defibrillation,
pulse oximetry, capnography, and non-invasive blood
pressure monitoring.
800 MHz Radios Each ambulance is equipped
with an on-board radio and two portable radios that
allow communication between dispatch, other EMS
agencies, and area hospitals.
Power Stretchers Every ambulance has a
stretcher that uses a hydraulic power system capable
of lifting patient loads of up to 750 lbs.
P.1b (2) Key Customer and Stakeholder Groups

Key
Customers
Emergency
Patients
124,064
(73%)
P.1a (5) Regulatory Environment

Sunstar Paramedics complies with local, state, and
federal regulations and accreditations requirements.
Figure P.1-3 outlines our key regulatory areas and
associated performance measures.
P.1b Organizational Relationships
P.1b (1) Organizational structure and governance
systems:
The Pinellas County EMS Authority was created
through a special act of the Florida Legislature after
approval of a countywide voter referendum in 1980.
The governing body of the Authority is the Board of
County Commissioners of Pinellas County. This seven
member elected board is empowered to oversee and
regulate all Emergency Medical Service activities in
the county. Pinellas County purchases EMS services
and is not a direct provider of patient care. It contracts
with 19 local fire departments for paramedic first responder services and with a single ambulance provider. The EMS Authority controls all funding, sets the
rates, bills, and collects user fees. Paramedics Plus is
owned by a not-for-profit hospital group, East Texas
Medical Center (ETMC), located in Tyler, Texas. The
Organization
NonEmergency
Patients
34,970
(27%)
EMS
Authority
Key Customer
Requirements & Expectations
Arrive quickly (Fig. 7.2-2)
Compassion and caring (Fig. 7.2-3)
Knowledgeable & competent (Fig.
7.2-4)
Tell me & my family what you are
doing and listen to my answers
(Fig. 7.2-5)
Polite and respectful (Fig. 7.2-6)
Professionalism (Fig. 7.2-7)
Overall quality of care (Fig. 7.2-8)
Arrive on-time (Fig. 7.2-10)
Knowledgeable (Fig. 7.2-11)
Courteous and kind (Fig. 7.2-12)
Gentle and careful lifting me (Fig.
7.2-13)
Talk with me & listen to my needs
(Fig. 7.2-14)
Professionalism (Fig. 7.2-15)
Helpful and caring (Fig. 7.2-16)
Make me comfortable (Fig. 7.2-17)
Overall quality of care (Fig. 7.2-18)
% EMS Authority key contract requirements met (Fig. 7.2-20)
Figure P.1-4 Key Customer Groups, Requirements

and Expectations
Communication Methods
Key
Suppliers
Zoll - Computer Aided Dispatch

(CAD) software, Electronic Patient Care Reporting
Physio Control - Supplies cardiac monitors
Bound Tree Disposable medical supplies
MARVLIS - Ambulance deployment
Priority Dispatch - Pre-arrival
instructions
Service agreements
User group meetings
Weekly visits
Conference calls
Regular meetings
Email
Telephone
Key
Partners
Local Fire Departments - Collaboration providing direct patient care

Medical Director Office - Establishes clinical protocols and
grants clinical privileges
Local Hospitals - Provides clinical outcome data
Saint Petersburg College Continuing Medical Education
(CME)
Monthly Fire Chief meeting

Equipment committee
Monthly PALS meeting
Monthly SQC meetings
RN Managers meeting
CME Steering Committee
Key Requirements
CAD system up time (Fig.
7.5-16)
Cardiac monitor maintenance on schedule (time)
(Fig. 7.5-18)
Zoll Software updates on
schedule (time) (Fig. 7.519)
Figure P.1-5: Key Suppliers, Partners, Communication Methods and Requirements

Organizational Profile - Page iv
195

Figure P.1-4 outlines Sunstar Paramedics three key
customer groups and their key requirements and expectations.
P.1b (3),(4) Key Suppliers, Partners, Collaborators,
and Distributors
Sunstar Paramedics key suppliers, partners, communications methods, and key requirements are listed in
Figure P.1-5.
P.2a Competitive Environment
P.2a(1) Competitive Position
The current contract for Paramedics Plus expires in
October 2009 with two possible 3-year extensions.
Because of tax reform legislation and decreasing property values, there is a funding gap of about 15 million
from the ad velorum revenue side which funds the 19
fire department first responders for FY2010. A committee has been established to evaluate the current system design and make recommendations to reduce
cost. The fire departments have requested to take
over transporting 9-1-1 patients and off set their costs
by shifting user fees from Sunstar Paramedics to the
individual fire department contractors.
P.2a(2) Principal Factors That Determine Success
The principal factors that determine our success are
meeting our ambulance contract requirements and
capitalizing on our advantages listed in Figure P.2-1.
P.2a(3) Comparative and Competitive Data
Key sources of comparative and competitive data from
within our industry include other local and national
EMS providers, the International City/County Management Association, Journal of Emergency Medical Services annual multi-city survey, and National Academy
of Emergency Dispatch. Key sources of comparative
data outside our industry include Baldrige and Florida
Sterling award winning organizations, National Bureau
of Labor and Statistics, and American Customer Satisfaction Index (ACSI). Limitations in obtaining data include lack of common data definitions and differences
in community demographics and contractual requirements.
P.2b Strategic Context
Sunstar Paramedics performs a SWOT analysis annually to update our strategic challenges and our strategic advantages. Figure P.2-1 outlines our key busi-
ness, operational, human resource, and sustainability

strategic challenges and advantages.
P.2c Performance Improvement System
Processes, initiatives and tools used to drive performance improvement include:
The organizational, department, and employee
scorecards the use of key performance measures
that are aligned to the four CSF to track performance
against goals/targets.
In 2006, an annual Baldrige organizational assessment was implemented. The results are used as inputs
into the strategic planning process.
Plan-Do-Check-Act (Figure P.2-2) is Sunstar Paramedics Performance Improvement System. All of the
directors, managers and supervisors have been introduced to the six-step approach to problem solving either through Six Sigma Yellow Belt training or in-house
classes.
Performance data and results are systematically aggregated and reviewed through our performance management system described in 4.1.
Daily reviews of system performance through
PULSE meetings (4.1b-1) and daily stats pages provide us with rapid improvement cycles and increased
agility.
Results and learning are shared through several internal and external meetings as listed in Figure 1.1-2 and
through our communication methods listed in Figures
1.1-1 and 5.1-1.
Figure P.2-2: Performance Improvement Model
Challenges
Business &
Operations
Human
Resource
Organizational
Sustainability
Advantages
1. Meeting contractual obligation with

increased population growth and call
volume.
2. Hospital bed delays.
1. Our core competencies (agility, data analysis, optimize use of resources).

2. Deployment of System Status Management.
3. National and regional paramedic

shortage.
4. Communicating with clinical mobile
workforce.
5. Contract expires in October 2009.
6. County committee evaluating transport
alternatives by the fire department.
3. Ability to match call volume demand with

flexible workforce scheduling.
4. Services provided at no cost to taxpayers.
Totally funded by user fees.
5. Positive relationships with key stakeholders.
Figure P.2-1: Key Challenges and Advantages
196
Organizational Profile - Page v
LEADERSHIP
197

Category 1: Leadership
1.1 Senior Leaders
Sunstar Paramedics is led by a Chief Operating Officer (COO), six directors and four managers who
make up the Leadership Team (LT). Reporting directly to the COO is the Director of Operations, Director of Clinical Services, Director of Support Services, Director of Health and Safety, Director of
Communications, and Director of Information Technology.
1.1a(1) Sunstar Paramedics values are reflected in
STAR CARE (Figure P.1-1). The LT reviews/sets
the organizations vision and values during step 1:
Input (Environmental scan, SWOT analysis, voice of
the customer), step 2: Analyze (Analyze inputs, prioritize challenges, review benchmarks), and step 3:
Set direction (Review mission, vision and values) of
the annual Strategic Planning Process (SPP) (Figure
2.1-1). Additional systematic approaches include a
review of ambulance contract requirements and any
amendments, past performance for each Critical
Success Factor (CSF) measure, and progress towards short and longer-term goals for each (Figure
2.2-1); input from key customers (Figure P.1-4) and
partners (Figure P.1-5) such as the Pinellas County
Authority executive staff and Office of the Medical
Director (OMD), customer satisfaction results
(Figures 7.2-1 to 20); employee engagement results
(Figures 7.4-1, 2), benchmarking best practices
within and outside our industry, legislative and regulatory requirements, industry trends, and community
demographics.
1.1a(1) The LT systematically deploys our vision
and values to the workforce, key suppliers and
partners, and customers through organizational,
department, and employee scorecards. In 2007 the
LT developed an organizational scorecard aligning
our mission, vision, values, CSFs, measures, goals,
and action plans in an easy to read one page document. In 2008, this was further deployed and integrated throughout the organization with the developWORKFORCE
P.1a(3)
Organizational, de Critical Success
partment, employee
Factors (CSF)
scorecards
Performance
Monthly newsletters
evaluations
Bi-weekly scoop
Weekly directors
newsletter
meeting
Bulletin boards
Open door policy
Face to face manda Code of conduct
tory employee meet Strategic plans
ings
Role modeling
Sunstar vision cards
Pulse meeting
Employee orientation Stats pages
ment of four department scorecards. Additional

methods are listed in Figure 1.1-1.
1.1a(1) The LTs personal actions reflect a commitment to the organizations values through active participation in setting and deployment of STAR
CARE values throughout the organization and participation in an annual badge ceremony where all
members of the LT agree to support our values. Additional approaches and deployment methods include participating in the SPP, creation and deployment of department and employee scorecards, personal involvement in daily PULSE and monthly
Scorecard and SQC Meetings, role modeling STAR
CARE values in their daily behavior, sending personalized thank you notes to employees, personally presenting employee recognition awards, actively participating in community events, and using customer
satisfaction and employee engagement survey results.
1.1a(2) Ethical behavior is one of the STAR CARE
values (Figure P.1-1). Senior leaders personally
promote an organizational environment that fosters, requires, and results in legal and ethical behavior by establishing policies, procedures, and frequent monitoring of organizational performance at all
levels. Sunstar Paramedics has professional conduct
and human resource policies that reflect our core
values and are reviewed bi-annually. These polices
are reviewed with new employees during orientation.
Additional approaches and deployment methods include: Starting in 2007 all employees receive annual
ethics training and in 2008 required employees to
annually sign a document signifying their commitment to our codes of conduct (Figure 7.6-5). Members of the LT write a monthly newsletter article on
legal and ethical behavior, department heads deploy
STAR CARE within each area they are responsible
for, and hold their staff accountable through immediate termination of employees who violate legal and
ethical behavior. In 2007, an ethics hotline was implemented to encourage the anonymous reporting of
SUPPLIERS / PARTNERS
Figure P.1-5
Contract agreements
Personal contact
Regular meetings
Email
Website
Conferences and trade
shows
Figure 1.1-1 Methods to Communicate and Deploy Vision and Values
198
Category 1 Leadership - Page 1
CUSTOMERS
Figure P.1-4
Satisfaction Surveys
Email
Website
Monthly report to county
Community meetings
Community involvement
Annual report
Monthly Sunstar Quality
Council (SQC) Meeting

legal or ethical behavior policies (Figure 7.6-4).
1.1a(3) The LT creates a sustainable organization
by continually ensuring our performance of key processes meet or exceed the Ambulance Service
Freq.
Meeting
Agreement Contract requirements, accomplishing

our CSFs, and capitalizing on our core competencies
(agility, optimize use of resources, and data analysis). This will ensure we remain the provider of ambulance transport services in Pinellas County, Flor-
Attendees
Purpose
CSF
3 x Day
Status Pages /
STATS
COO, LT, Sup, Auth,

OMD
Real time status of daily performance; contractual requirements
Daily
PULSE
COO, LT, Sup
P,Q,S
Daily
Sup/LT
Weekly
Employee Interactions
Directors
Daily performance, weekly schedule, late call

review
Emp. Engagement; coaching and feedback
P,Q
Q 3 wks
Supervisors
Monthly
Support
DOO, Sups, (DOC,

DOSS, DOCS)
COO, Admin EE
Review of departments; listening and learning; FISH

Form discussion
Planning and deployment of SP; review of measures
P,Q
Monthly
Super Support
COO, LT, Admin EE
Reinforce MVV; Listening and Learning; process improvements

Reinforce MVV; Listening and Learning; process improvements
Monthly
SQC
COO, LT, OMD, Auth
Review of Org. Scorecard measures
P,Q,R,
S
Monthly
Scorecard
COO, LT
Review of organization and department scorecards and

key process and support process measures
P,Q,R,
S
Monthly
Dept staff meetings
Dept head, EE
Dept review of any department performance measures

and plans
P,Q
Monthly
PALS meetings
COO, DOCS, DOSS,

FD, OMD, Auth
Listening and Learning; obtain info for Environmental

Scan; ID key partner req.
Monthly
Operations and
Fire Chiefs
meetings
MMRS
DOO, FD

DOO, DOSS, Partners

Monthly
Equipment
Committee
DOCS, Ed train Mgr.,

DOSS, EE, Auth, FD
Monthly
May-Oct
Strategic Planning
COO, LT

Scan; ID key partner and customer req.; discuss improvements
MVV, CSF, objectives, goals, measures, initiatives.
Monthly
Union
DOO, Ops Mgr., Union President
Planning; MVV; discuss key requirements
Bimonthly
Medical Control
Board
COO, DOCS, Partners

Quarterly
Headcount
COO, LT, key staff
Review of workforce staffing capacity and needs.
Quarterly
Safety Committee
DOHS, DOSS, EE,
Review of safety measures; Listening and Learning;

obtain info for Environmental Scan; ID key partner
requirements
Quarterly
Leadership
Meetings
ER Nurse Managers
Directors, Mgr., Sups
Planning; review of Org. Scorecard measures; Listening and Learning

P,Q,R,
S
Q
Med Dispatch
Review
DOC, OMD, Auth
Listening and Learning; Input for Environmental Scan;

ID key partner req.; Review/improve processes; review EMD measures
Monthly
Quarterly
Quarterly
COO, LT
COO, DOCS, Partners
Figure 1.1-2 Performance Review System

P,Q
P,Q
P,Q,R,
S
199

Freq.
Meeting
Attendees
Purpose
CSF
Quarterly
Public Safety Answering Point
DOC, Auth, Supplier
Listening and Learning; Input for Env. Scan;

ID key partner req.; Review/improve processes
QS
Monthly
or PRN
Emergency Mgt.
Steering Committee
Corporate Zoll
Conference Call
Materials Vendor
COO, LT, Supervisors,

key personnel
To ensure preparedness, mgt. continuity of

operations, and recovery of disasters; AAR
DOC, DOIT, Corp, Supplier

DOSS, Suppliers
Discuss key req.; process improvements; share

MVV
Discuss key req.; process improvements; share
MVV
Employee scorecard measures; discuss key
requirements; reinforce MVV
BiWeekly
As
Needed
Bi-Annual
Q
PQS
Employee Performance Review
Sup, EE
Quarterly
CME Steering
Committee
SPC, Auth, OMD, Ed &

Training, FD
Listening and Learning; obtain info for Environmental Scan; ID key partner req.
PQ
Quarterly
Joint Labor Mgt.
Union Rep, EE, Sup, Director
Listening and Learning; discuss key requirements; review MVV
Annual
LT Performance
Review
COO, Director, Manager
Planning; review employee performance
PQS
Annual
Strategic Planning
meeting
COO, LT
Set vision, values, CSF, measures and targets

to meet or exceed contractual requirements.
P,Q,R,
S
Figure 1.1-2 Contd Performance Review System
ida. Additional approaches and deployment methods

include our annual SPP (Figure 2.1-1), Performance
Management System (Figure 4.1-2), Performance
Scorecard System (Figure 4.1-1), Daily Pulse meetings, monthly organizational and department Scorecard meetings, regular meetings with our key partners (Figure 1.1-2), monthly SQC meetings, meeting
and exceeding customer requirements, meeting key
contractual and process requirements (Figure 6.1-1),
and disaster planning / Continuity of Operations
Planning.
Senior leaders create an environment for organizational performance improvement, accomplishment of our mission, strategic objectives, innovation, role-model performance, and organizational agility through our annual SPP and deployment of organizational, department, and employee
scorecards (Performance Scorecard System (Figure
4.1-1). Performance improvement and accomplishment of our mission and strategic objectives begins with a systematic four-step Performance Management System (Figure 4.1-2) which incorporates our SPP, Performance Scorecard System, Performance Review System and our Performance Improvement System to translate our mission
and vision into four CSFs(strategic objectives) and
associated measures, goals and action plans. Our
Performance Review System (Figure 1.1-2) lists the
various meetings used to create an environment for
organizational performance improvement. Creating
an environment for Innovations begin with our vision to be an organization that sets the standard for
EMScontinuously improving through innovation
and technology. Department directors and managers are encouraged to be innovative in achieving
200
organizational goals within their area of responsibility

through input from customers and employees, review
of performance measures, benchmarking, attendance at professional conferences and participation
in user groups. Employees are encouraged to identify and share innovative ideas through the Fresh
Ideas Start Here (FISH) program.
The LT creates an environment for role model
performance leadership through our vision to be
an organization that sets the standard for EMS and
through the establishment of measures, goals and
action plans that are aligned to each CSF. Goals are
established through a review of national, state, and
regional benchmarks, standards of care, contract
requirements, and past performance. Additionally our
accreditations create a focus on role model performance (CAAS, CAMTS, and ACE) (Figure 7.6-4). Sunstar Paramedics was the second in the nation to obtain all three of these accreditations. Completion of a
Baldrige and Sterling assessment in the past two
years is another method to achieve role model performance.
Organizational agility is one of our three core competencies and is demonstrated through our systematic review of performance, based on historic 9-1-1
call volume patterns analyzed on an hour by hour
basis. Daily, deployment levels are established for
the next day based upon predicted call volume and
patterns during Performance Utilization Late call
System Evaluation (PULSE) meetings. This allows
us to make real-time improvements for optimal performance on a daily basis. An ISERA Demand Graph
and Daily Performance Graph are used to make projections in emergency call volume and monitor per-

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MISCELLANEOUS RESPONSE PERFORMANCE

LOST UNIT HOURS

EMD QUALITY ASSURANCE REVIEWS

PATIENT CARE REPORTS

QUALITY ASSURANCE REVIEWS

HOSPITAL CLOSURE/DIVERSION OCCURRENCES

FIELD CLINICAL STUDIES

OTHER CLINICAL STUDIES

CARDIAC ARREST SURVIVAL RESULTS

CONTINUING EDUCATION COMPLIANCE

SAFETY AND RISK

EMPLOYEE FULL TIME EQUIVALENT HEADCOUNT

OK CQI Report October 09

Clinical Quality Improvement Report

Clinical Quality Improvement

Paramedic Clinical Management

Eastern Division Airway

Western Division Airway

7/8 (Success/Attempt) performed by TFD, 1/1 by JFD and 33 by

Q.I. Hotline activity:

Percentage of Patients Evaluated by Age Groups

Priority One Trauma Returns:

Eastern Division Priority II

Total of 99 patients (25% of trauma pts).

Western Division Priority II

Total of 101 patients (17% of trauma pts).

Trauma Scene Times

Non-Transports after contact:

Last Center Value

Special Cause(s) Detected

Chart Type: Custom

1 Beyond Control Limit

Special Cause Flag

Eastern Division No Haul %

Eastern Division No Haul %

Viehicle Contact Report

# of shifts off late in pay period

A. 1 Beyond Control Limit

Chart Type: Custom

Special Cause(s) Detected

Special Cause Flag

OKC Off Late Shifts

Calls Transports Transports

Budget Summary By Priority

Fiscal Year To Date

Information through October 31

Special Cause(s) Detected

Last Center Value

1 Beyond Control Limit

Chart Type: Custom

Special Cause Flag

Western Division Lost UHU - Late Sign On/Crew Late

Compliance: MTD : QTD

Effective UHU: WK : MTD

Exceptions + or - : MTD : QTD

Shifts Produced / Plan

Produced / Scheduled UH (WK : MTD)

% Fleet OOS : Critical Failures

% Next Acad Filled Medic : EMT

Actual: Medic EMT

Plan: Medic EMT

Date next Acad