Problem Identification:
While Maryland is world renowned for having a well-
coordinated Statewide Emergency Medical System (EMS), Baltimore City’s emergency medical system is inadequate in many respects.

Recommended Action:
Work with the City’s Fire Department and local hospitals
to have Baltimore’s EMS system nationally accredited.

Organizational, Service Improvement

Functional/Operational Area:
Fire and Health Departments

Estimated Annual Impact:
Cannot be Estimated

Estimated Implementation Costs:

Barriers to Implementation:

Projected Implementation:
60 – 90 days to develop an organizational improvement plan using the Commission on Accreditation of Ambulance Services (CAAS) criteria; 1 – 2 years to achieve CAAS accreditation

Next Steps:
Assemble a planning team consisting of personnel from the
Health and Fire Departments and representatives of key stakeholder groups. Interested volunteer experts from local hospitals and the Maryland Institute for Emergency Medical Service Systems (MIEMSS) should also be engaged.

An EMS system includes many components, including: the
emergency ambulance service, 911 communications center, training resources, hospital emergency departments, and first-responder services. Given these complexities, the task of improving EMS requires coordination among many agencies and organizations.

The long-term success of the City’s EMS system needs to take into account how EMS will interact with public health initiatives, as well as Baltimore’s larger health care system. Health care organizations are fast becoming integrated networks with multiple hospitals, physician offices, and payor requirements. These sites are integrated by way of telecommunications and information system links, reliant on transport systems, and financing arrangements. To harmonize EMS improvement efforts with an evolving health care system, a cooperatively developed strategic plan is essential.

In fashioning a strategic plan, the City should turn to many local experts who are knowledgeable in EMS-related matters. In 1994 and 1995, a team of volunteer EMS experts was assembled and drafted Maryland’s State EMS Plan. These experts came from MIEMSS, Johns Hopkins, the University of Maryland, and other local organizations. This comprehensive plan is viewed as a national model.

Program assessments conducted by external peer reviewers serve as an important catalyst for quality improvement programs. EMS accreditation and peer reviews help assure citizen taxpayers and elected officials that the local EMS agency has the components and processes necessary to ensure efficient and high quality service. Furthermore, outside assessments help ensure that the local EMS organization is responsive, and capable of sustaining quality even with changes in management.

The Commission on the Accreditation of Ambulance Services (CAAS) has promulgated national standards that are useful in reviewing both public and private sector EMS organizations. CAAS criteria address the following areas:

– Organization
– Interagency Relations
– Management
– Financial Management
– Community Relations and Public Information
– Personnel and Personnel Processes
– Clinical Standards
– Other Standards of Operation
– Equipment and Facilities
– Communications

At the present time, there are 63 ambulance services nationwide that have been CAAS accredited.