Strategic Plan ProjectTask: Students will select an organization that has a homeland security mission. Remember this is an organization not a subject/topic or mission.This assignment consists of condu

TRANSITIONING FOURTEEN VOLUNTEER FIRE STATIONS INTO A COMBINATION DEPARTMENT WITH CAREER ALS QUICK RESPONSE VEHICLE

A Strategic Planning Project Submitted

By

(Your Name)

to

University of Maryland University College

HMLS 304

Professor

(Professor’s Name)

(Date)

TABLE OF CONTENTS

CHAPTER

1. INTRODUCTION

Background ……………………………………………………………..4

Statement of the Problem……………………………………………….5

Operational Definitions…………………………………………….…...7

Significance of the Study..…………….………………………………..9

Summary………………………………………………………………..10

2. LITERATURE REVIEW

Pertinent Studies……………………………………………………….. 12

Reflection …………….………………………………………………... 15

Summary……………………………………………………………….. 15

3. STRATEGIC PLAN

Introduction…………………………….………………………………. 17

Restatement of the Problem…………………………………….………. 17

Mission and Vision Statement…………………………………………..18

Strategic Plan Description……………………………………………….19

Summary………………………………………………………………... 27

4. CONCLUSION AND RECOMMENDATIONS

Conclusion………………………………………………………………29

Recommendations………………………………………………………30

REFERENCES …………………………………………………………………31

CHAPTER ONE

INTRODUCTION

Background

Fire and Emergency Medical Services (EMS) protection in Carroll County is provided by fourteen private, non profit fire stations, which maintain service for the entire county. The Carroll County Volunteer Emergency Services Association (CCVESA) is a group that oversees the fourteen stations. The group consists of a President, two Vice Presidents, Treasurer, Secretary, and then five representatives from each of the fourteen stations. The “Officers” are voted on each year at an annual convention by the members of the CCVESA. The CCVESA meets monthly and works toward unifying the fourteen stations on many issues dealing with the fire service.

The county volunteer system evolved in a time when people lived and worked within their community and most employers would allow employees to leave work to fight fires and handle medical emergencies. In recent years, more people have started working in communities other than where they reside. People also generally live very busy lives making their availability to volunteer diminish. Many of the volunteer stations are seeing a reduction in the number of people responding to emergencies resulting in their units not being able to respond to the calls. As the number of volunteers continues to drop, the county still has a need to provide a service and has started looking into combination stations. The CCVESA is looking into the current need to fill the gaps due to the loss of volunteers. It is necessary to form a strategic plan on how to handle the diminishing support of the volunteers and their ability to respond to emergencies within the community. The plan will allow the CCVESA a framework for replacing the volunteers and improving the quality of patient care.

Carroll County covers 449.13 square miles, with an approximate population of 169,353 based on the quick facts from the U.S. Census Bureau for 2008 (U.S. Census Bureau, 2010). Each year, the county responds to approximately 17,848 calls for assistance (Safety, 2008). Currently 66% of the calls within the county are medical in nature and 12% of our calls from mutual aid contracts outside the county are medical in nature (Safety, 2008).

Statement of the Problem

The volunteer system has recently come under criticism with the recent budget crisis. It has been recommended that a committee be established to compile a plan to hire full time Advanced Life Support (ALS) staff as well as a paid Engineer for each station. This task would be overseen by the CCVESA and the personnel would also be overseen by the CCVESA to ensure consistency among the fourteen companies. By having one group responsible as opposed to each of the fourteen companies, the CCVESA feel it will allow employees to be moved from station to station if the need arises to fill vacancies or cover an extra busy area. The discussion and recommendation came about due to each of the fourteen companies purchasing their own equipment. This resulted in a need for expensive fire apparatus and transport vehicles for fourteen different stations creating a duplication of services. Many of the stations house two engines as well as a special service piece, several utility vehicles, and an ambulance. At this time only one of the fourteen companies does not house an ambulance. In fact we have three stations that house two ambulances and two stations house three ambulances. This has created an enormous duplication of services.

Several companies are seeing the need for additional help when responding to emergencies and have started to hire their own paid EMS providers to cover the times of day when they found their response times were in jeopardy. As a result, a committee is being formed to start compiling statistics on late and no responses for each of the fourteen stations in an attempt to determine where help is needed the most. Statistics can be retrieved from the Carroll County Office of Public Safety who oversees the 911 system. It will be necessary to conduct a study to determine where levels of service are inconsistent. The strategic planning committee will also need to take into account the minimum recommendations for initial manpower as set forth by the National Fire Protection Association. All fourteen fire stations agree that they can no longer effectively run the EMS service for the county without implementing a combination department to assist in handling medical emergencies. However, all fourteen stations do not agree on what the best method to covert from a volunteer system to a combination system. By establishing a combination department, EMS would be provided by paid staff and that staff would report directly to a supervisor who is hired by the CCVESA. This would help to take down any barriers that exist due to district boundaries bringing EMS into a single entity with one set of standards and operating guidelines. Allowing for unified training programs and the ability to pull from a large group of employees to cover shifts as opposed to the current situations of having no one to cover if some one cannot make it to the station on any particular day. This would keep providers from working for multiple stations and accidently scheduling themselves at multiple stations for the same shift. At this point each station is working independently to hire their own staff and establish their own work schedules and rules in an attempt to fill the gaps. As a result, we are getting duplication of services among the fourteen stations and a tug of war between the stations. Those stations that have more money are able to offer a higher salary and essentially “stealing” medics from each other in attempt to cover shifts.

Operational Definitions

Ambulance – a vehicle used by emergency medical personnel to transport ill or injured persons

with medical needs (Glossary of Emergency Medical Technology, 2010).

Advanced Life Support (ALS) – a level of emergency care consisting of “invasive life-saving

procedures including the placement of advanced airway adjuncts, intravenous infusions, manual defibrillation, electrocardiogram interpretation, advanced airway management and administration of medication” (Glossary of Emergency Medical Terminology, 2010).

Basic Life Support (BLS) – “basic life support consists of essential non-invasive life-saving

procedures, such as CPR, bleeding control, splinting broken bones, artificial ventilation, and basic airway management. Basic life support level providers include emergency medical technicians and certified first responders” (Glossary of Emergency Medical Terminology, 2010)

Carroll County Volunteer Emergency Services Association (CCVESA) – organization comprised

of elected officers, full time staff members, and five delegates from each station. The CCVESA is a mechanism for the stations to govern their collective selves, establishing and enforcing standards on manning, training, apparatus construction and equipment. The CCVESA also creates a way for companies to interface with the fire station, county and state government (County, 2010).

Combination Department – “Fire departments where personnel consist of both paid and volunteer Members” (Barr & Eversole, 2003, p.926).

Consolidation – an act or instance of consolidating; the state of being consolidated; unification:

consolidation of companies (Dictionary.com).

Emergency Medical Services (EMS) – “The delivery of medical services to people experiencing

medical emergencies, specifically in a pre-hospital setting” (Barr & Eversole, 2003, p.923).

Emergency Medical Services Operations Division – a committee comprised of a representative

from each of the fourteen stations that is overseen by a chairperson appointed by the CCVESA. ‘This group is charged with maintaining the EMS system within the county in regards to compliance, training, protocols, and disciplinary measures for providers.” (Barr & Eversole, 2003, p.932).

Emergency Medical Service System – A complex, coordinated system of emergency medical

resources startegically located to respond in a timely manner to reduce physical and emotional impact related to medical emergencies regardless of patient’s ability to pay (Barr & Eversole, 2003).

Emergency Medical Technician (EMT) – a certified medical provider who is trained to provide

basic life support (BLS) treatment such as CPR, bleeding control, splinting broken bones, artificial ventilation, and basic airway management (Glossary of Emergency Medical Terminology, 2010).

Maryland Institute for Emergency Medical Services Systems (MIEMSS) – a statewide network

that includes volunteer and career EMS providers, medical and nursing personnel, communications, transport systems, trauma and specialty care centers, and emergency departments. Oversees and coordinates all components of the statewide EMS system in accordance with Maryland statute and regulation (Maryland Institute for Emergency Services Systems, 2010).

Mutual Aid Contract – a contract between two or more emergency medical service agencies to

help provide medical services in a jurisdiction when the regular resources are overwhelmed (Barr & Eversole, 2003).

National Fire Protection Association - The National Fire Protection Association (NFPA) is an

international nonprofit organization that was established in 1896.  The company’s

mission is to reduce the worldwide burden of fire and other hazards on the quality of life

by providing and advocating consensus codes and standards, research, training, and

education (National Fire Protection Association, 2009).

Paramedic – a licensed medical provider who is trained to provide advanced life support (ALS)

treatment, including invasive procedures such as intravenous infusions, manual defibrillation, electrocardiogram interpretation, advanced airway management and administration of medication (Paramedic, 2010).

Quick Response Vehicle (QVR) – designed to provide quicker response of advanced life support

personnel to the scene of a medical or traumatic emergency (River Falls Area Ambulance Service, 2006).

Volunteer Fire Station – a fire station with a roster comprised of all volunteer personnel

(Barr & Eversole, 2003).

Significance of the Study

By looking at several other jurisdictions that have consolidated, there is a major benefit to taxpayers with increased service levels and a removal of the duplication of services by function and geographic region. However, one major drawback is the possibility of a takeover by a government agency as a result of elected officials or officers of the CCVESA. Many fear that once we get this system in place, the county government will step in and take control away from the CCVESA pushing the volunteers out all together.

It is necessary to bring together the stakeholders from Carroll County Government, officers and delegates of the CCVESA, and a handful of residents from the community. This group would prepare an outreach initiative for the community to look at consolidating EMS services, providing paid staff, and quick response ALS vehicles. The community should be engaged via the internet, intranet, mail and media campaigns, as well as community forums to offer their suggestions and insight on the project. A web page for the project should be provided to allow members of the community to watch the progress of the project as well as participate in the process. Finally, the stakeholders should arrange to speak to local community groups and give presentations on how the community would benefit by consolidating the stations.

Summary

There is a need to improve the fire and EMS service within Carroll County due to a lack of volunteers. With the diminishment of volunteers, it is necessary for the county to begin looking at alternative ways to continue to protect and preserve the community as it has in the past. The strategic planning process will allow the county to look at several alternatives and determine the risks as well as the benefits that they have to offer. Currently, the protection for the county is being handled by fourteen independent stations. It is necessary to find a means to help save tax payers money without jeopardizing their service. It is also important to attempt to reduce the duplications in service that are currently happening as a result of the fourteen independent organizations. While the transition could be hard to implement and may not gain full support along the way, a strong strategic plan will help ease the adjustment. The consolidation will help create a more efficient EMS system by reducing response times and increasing the quality of patient care.

CHAPTER TWO

Literature Review

Faced with increased response times, increased service demands, and a lack of volunteers, Carroll County is looking at an alternative method to provide Fire/EMS service efficiently and productively. The purpose of this literature review is to look at pertinent information from a variety of sources to identify consolidations from around the United States. The research question used for the purpose of this literature review will be, “What were the experiences of other companies that have gone through a fire department consolidation?” We will focus on benefits, operational and functional issues, factors prompting consolidation, as well as other influencing factors. There has been a long history of medical services provided by fire stations however; it was not until the late 1960’s when fire based EMS systems were formally established (Pratt, Pepe, Katz, & Persse, 2007).

We will start with the factors that prompted consolidation. In the Blue Ribbon Report, the authors discuss the tremendous contribution that volunteers give to our community (Scott & Buckman III, March 2004). This report prepared by the International Association of Fire Chief’s (IAFC) discusses how to preserve and improve the future of the volunteer service. The authors point out that many stations are often under-funded and ill-equipped and have a difficult time retaining volunteers (Scott & Buckman III, March 2004). The blame has been placed on poor leadership and the lack of programs to help one acquire the knowledge and skills necessary for effective management (Scott & Buckman III, March 2004). In the book, Managing Fire Services, the author sites the following reasons to be the most influential catalysts for change by cities and counties considering changing the way they provide fire service. The factors are as follows:

1. “Growth in demand for service, especially ambulance and rescue services.

1. Municipal budget constraints and/or contractual labor demands.

1. Not enough volunteers during daylight hours.

1. Pressure to improve the productive use of paid firefighter “downtime.”

1. The complexity of modern firefighting and the length of training

volunteers required to meet community fire-safety standards.

1. Economics of scale” (Managing Fire Services, 1988, p. 439).

Although the CCVESA and local government officials are looking towards a consolidation for different reasons, Jan Thomas stresses that it is critical that the ultimate goal of consolidation is to enhance fire protection services for our citizens (Thomas, 1994). The goal must be recognized by everyone involved in the process no matter what their reasons for consolidation may be. Point Montara and Half Moon Bay Fire Districts began looking at consolidation efforts and initially found it not possible due to salary differences (Rice, August 1992). Salaries were adjusted and other areas of service integrated which led to the question, “why do we need two stations within seven miles of each other? Point Bay fire district covers six square miles, has eight paid personnel with a budget of $940,000. The Half Moon Bay Fire District covers 40 square miles, has 23 full time employees and a budget of $3.5 million” (Rice, August 1992, p. 2).

When evaluating the benefits of a consolidation you must first look at the benefits found in other stations throughout the United States. According to Charles Rule, former fire chief, in an article in American City and County magazine some of the benefits of consolidation are “enhanced career opportunities, joint training facilities, specialization in various functions” (Thompson, 1992). You also have the ability to “have more efficient personnel allocation, faster response times, increased service levels for dollars spent, and better use of resources and reorganization” (Thompson, 1992, p. 25). It is important to remember that a consolidated system that allows your agency to offer better service for the same money is, in effect, a cost savings (Hagstrom, 1999).

We now begin to look at the operational and functional issues involved with a consolidation. In the magazine American City and County, Stephanie Thompson suggested that labor groups such as unions should be involved from the beginning of the process or it will be doomed to fail (Thompson, 1992). She also stated that the consolidation effort can not be a disguise for an attempt to reduce personnel (Thompson, 1992). Reorganizing peronnel will need to occur during the consolidation to remove duplication of services. The important thing is that personnel need to be assured that they will have a place in the organization and that their future is secure (Tualatin Valley Fire and Rescue : Case Study and Outline Implementation, January 1996). William Hewitt describes how your current fire officers need to evaluate the operational and functional issues within the station. In Recreating the Fire Service, he states, “A major problem being experienced by many fire service leaders is that are having an ongoing love affair with the here and now” (Hewitt, April 1995, p. 153). They tend to be action oriented people and fail to look at the long range plans for the station. Instead, “they focus on what is happening today and let tomorrow worry about tomorrow” (Hewitt, April 1995, p. 153). Hewitt said that by creating a 5-10 year plan the station will survive with a here and now officer because the future will mapped out for them (Hewitt, April 1995, p.153).

Finally, we come to the other factors that effect consolidation efforts. Mary Jo Wagner quotes Chief Jeff Johnson of Tualatin Valley Fire and Rescue saying, “The four main obstacles to a merger or consolidation are turf, power, politics, and control” (Wagner, 1996, p. 23). In the same article Mary Jo speaks with Retired Chief Jack Snook who added that the biggest issue with consolidations is a loss of control (Wagner, 1996). Opposition to consolidation comes in many forms and by many types of people as change is never easy. John Kotter, professor of leadership at Harvard offers eight major factors why change may fail:

1. Not establishing a great enough sense of urgency.

1. Not creating a powerful enough guiding coalition.

1. Lacking a vision.

1. Under communicating the vision.

1. Not removing obstacles to the new vision.

1. Not sytematically planning for and creating short-term wins.

1. Declaring victory too soon.

1. Not anchoring changes in the organization’s culture (Kotter, 1995, p.

59).

Information flow will be key to a successful consolidation. Chief Johnson of Tualatin Valley Fire and Rescue suggests that you keep your elected officals and staff well informed is the key to “rumor control” (Wagner, 1996, p. 24).

Reflection

By evaluating the research listed above, it was hoped to gain a better understanding of other stations who have consolidated. This understanding will help us proceed in evaluating our consolidation needs and efforts in our own community. The objective of this review was to explore if consolidation of fire protection agencies could improve the delivery and efficiency of our EMS service to Carroll County. With the information obtained, it has been proven that consolidations can offer many benefits to both the fire departments and the community.

Summary

The literature review proved very helpful to this project. There are several communities in the United States that have taken on the project of consolidation. Many of those communities were very successful by utilizing organized and comprehensive plans. For those who were not successful there were mitigating factors that needed to be addressed before a successful consolidation could occur. The literature review gave credence to this research. The public is in need of better Emergency Services with regards to EMS response times and effective personnel. The county must look toward innovative solutions such as consolidating the stations and utilizing ALS quick response vehicles. The consolidation of the fourteen stations will provide both financial and operational benefits, which will result in greater efficiency and service to the citizens of Carroll County. With regularly scheduled 24 hour on duty personnel in strategically located stations, the fire station has the “potential for the most rapid delivery of advanced pre-hospital 9-1-1 emergency response and care (Pratt, Pepe, Katz, & Persse, 2007).

CHAPTER THREE

STRATEGIC PLAN

Introduction

“Strategic planning is a systematic process for drawing a vision for a community’s future” (Gordon, 2005, p. 5). It is a never ending process assessing the best outcomes of environmental forces. Essentially the plan helps communities control the future by understanding and forecasting change. This strategic plan has been formulated due to a lack of volunteers and an increased demand for emergency services within Carroll County.

Restatement of Problem

The volunteer system has recently come under criticism with the recent budget crisis. It has been recommended that a committee be established to compile a plan to hire full time ALS staff as well as a paid Engineer for each station. This task would be overseen by the CCVESA and the personnel would also be overseen by the CCVESA to ensure consistency among the fourteen companies. By having one group responsible as opposed to each of the fourteen companies, they feel it will allow employees to be moved from station to station if the need arises to fill vacancies or cover an extra busy area. The discussion and recommendation came about due to each of the fourteen companies purchasing their own equipment. This resulted in a need for expensive fire apparatus and transport vehicles for fourteen different stations creating a duplication of services. Many of the stations house two engines as well as a special service piece, several utility vehicles, and an ambulance. At this time only one of the fourteen companies does not house an ambulance. In fact we have three stations that house two ambulances and two stations house three ambulances. This has created an enormous duplication of services.

Several companies are seeing the need for additional help when responding to emergencies and have started to hire their own paid EMS providers to cover the times of day when they found their response times were in jeopardy. Many of the stations were noticing a decline in the number of available and qualified volunteers resulting in late or no responses for their units. As a result, a committee is being formed to start compiling statistics on late and no responses for each of the fourteen stations in an attempt to determine where help is needed the most. Statistics can be retrieved from the Carroll County Office of Public Safety who oversees the 911 system. It will be necessary to conduct a study to determine where levels of service are inconsistent. The committee will also need to take into account the minimum recommendations for initial manpower as set forth by the National Fire Protection Association. All fourteen fire stations agree that they can no longer effectively run the EMS service for the county without implementing a combination station to assist in handling medical emergencies. However, all fourteen companies do not agree on what the best method to covert from a volunteer system to a combination system. By establishing a combination station, EMS would be provided by paid staff within the volunteer station and that paid staff would report directly to a supervisor who is hired by the CCVESA. This would help to take down any barriers that exist due to district boundaries bringing EMS into a single entity with one set of standards and operating guidelines. This would allow for unified training programs and the ability to pull from a large group of employees to cover shifts as opposed to the current situations of having no one to cover if some one cannot make it to the station on any particular day. This would also keep providers from working for multiple stations which keeps us from moving providers around to fill holes in the schedule when they accidently schedule themselves at multiple stations for the same shift. At this point each station is working independently to hire their own staff and establish their own work schedules and rules in an attempt to fill the gaps. As a result, we are getting duplication of services and a tug of war between the stations. Those stations that have more money are able to offer a higher salary and essentially “stealing” medics from each other in attempt to cover shifts.

Mission Statement

(Put your organization’s new mission statement here)

Vision Statement

(Put your organization’s new vision statement here)

Strategic Plan Description

We need to begin the process by announcing and promoting the process for strategic planning. You need to promote the process by involving key elected and appointed officials and informing local government managers to foster a community wide understanding of and support for the plan. It will be necessary to identify who the active members will be from each of the major stakeholder groups and select them to represent each of the identified groups. The most important step is to identify a facilitator for the entire process to help keep things on task and in line during discussions. We need to rally support from the community by engaging all stakeholders and providing information about the process and the expected outcomes. You then move into the strategic planning process and lay the groundwork by collecting all relevant data and statistics. Once this has been established you begin your plan by moving into creating the vision and mission statements as well as your goals, objectives, and tactics. The vision for Carroll County Emergency Services is “to exhibit a high degree of integrity and professionalism providing quality services and benefits daily and in times of crisis by protecting life, freedom, and property of all citizens and increasing a partnership with our citizens, local governments, and private and public businesses” (Office of Public Safety Vision Statement, 2009). This statement helps to reflect the collective understanding of the situation including the standard of living that is expected by the citizens of Carroll County. The strategic plan begins with this vision and allows us to set the tone for the entire process and the plan itself. “The mission statement identifies the local government’s role in pursuing the community’s vision” (Gordon, 2005, p. 31). The mission of Carroll County Emergency Services is “to protect the lives, property and environment in Carroll County and surrounding areas through prevention, public education, response, and non-emergency services. We will maintain the highest level of response readiness to deliver fire and EMS services in a safe, competent, and caring manner when requested” (Office of Public Safety Mission Statement, 2009).

“Every local government group working on a strategic plan needs to carry out an environmental scan that considers the various environments that make an impact on the jurisdiction” (Gordon, 2005. p. 33). The external environment is the formal jurisdiction and the surrounding areas. This means that not only do we look at our own area but we also need to consider mutual aid companies. We need to analyze how other fire stations are handling EMS in their jurisdictions and how that could essentially affect Carroll County. Included are the agreements that have been made to receive mutual aid services for our own communities as well as provide mutual aid services to the immediate outlying areas. We have to consider how those involved in the mutual aid agreements will handle the transition and could this essentially dissolve our mutual aid agreement. Finally, we also must consider the current local, state, and national EMS standards and policies and be sure that our current plans are in line with those standards already in place.

The internal environment is the local government itself on a local, state, and regional level. In Carroll County we have three commissioners who are ultimately responsible for things on a county level. All aspects of the strategic plan have to be presented to these three people before moving forward. It is extremely important to have the support of all three commissioners prior to moving forward with the planning and implementation process. Factors that need to be considered during the environmental scan include economic, social, and political. When looking at economic factors you need to evaluate employment growth, composition of workforce, taxes, and the aging population. It is important to consider the age of your current workforce because as the group gets older you will start losing employees to retirement and you need to be able to refill those positions with new employees. When looking at social factors you need to evaluate population growth, demographics, the aging population, and social capital. You need to use the census as your tool to determine the population growth and any major changes in the demographics of your jurisdiction. Once again the aging population could greatly impact both your employment as well as your demand for services. As the population ages there is a greater demand for emergency medical services and transports to local hospitals. Social capital involves how well the members of the community interact with one another, is there cohesiveness between the neighbors and the stations in Carroll County. When looking at political factors you need to evaluate Carroll County Government, the current budget, and staffing. You need to determine if the current budget can handle the costs associated with the consolidation in its current state in the future. There needs to be ways that the costs can be offset by another source of revenue to guarantee the ability to fund the positions being created by the plan.

Strengths, Weaknesses, Opportunities, Threats (SWOT) Analysis

Strengths

1st Call coverage Education/ Training

High School Program (Vo-Tech) EMS Vehicles

First Responder Program Paging

Communications Center 12 lead equipment

Experienced providers Rip and Run Printouts

Agency collaboration Mutual Aid relationships

Emergency Medical Dispatch

Call prioritization (emergency vs. non emergency)

Weaknesses

Response Times 2nd & 3rd call coverage

Recruitment of volunteers Retention of volunteers

Staffing Only 1 hospital in county

Amount of ALS Certified providers Funding

Opportunities

Grants Public Education on Call reporting

Media Coverage Recruitment

Benefits Package for Career Providers and volunteer benefits

Multi Agency Training Awareness of EMS

Use of Media Training (funded and non-funded)

Increased Staffing Billing

Paid for Call Standardized system

Threats

Volunteer Burn-out Funding – budget support

Liability / HIPPA Equipment Condition and Maintenance

Natural & Man Made Disasters Resource Availability

Infection Control for EMS Time Away from Home

Change in local government leadership Provider Safety

The overall goal of the strategic plan is to provide 24/7 EMS coverage to all Carroll County citizens. This can be obtained through numerous objectives and tactics over the life of the plan. By designing a strategic plan, the citizens of Carroll County can be assured that when they call 911, they will receive the best care possible in the quickest and most efficient manner. We need to begin by trying to gain public and government support for the plan. It is essential to get as many stakeholders as possible on board with the plan so that they too can assist in marketing the plan to the public. The plan can only be successful with the support of both the governmental constituents and the citizens who live and work in Carroll County. This can be achieved by mailing out informational flyers, offering an opinion survey, and holding several community meetings where questions can be asked as well as answered. In addition, we can develop and air community service announcements on TV and Radio. Developing an interactive website would also be helpful for people to visit so they can view the progress of the plan as well as provide feedback. Once support has been established for the plan then it is important to move into the logistics of how we are going to fund the project. We will need to evaluate sources such as grants, increase in taxes for citizens, and the possibility of billing for EMS services. Once funding as been established then we need to move toward the actual staffing objectives. To begin we need to determine what the qualifications will be for EMS staff. To accomplish this we will need to review the current Maryland State requirements for EMS as well as those of other stations who have been successful at consolidation. It will then be necessary to develop competencies requirements and training materials that can be used for all new employees. Once the criteria has been established then it is necessary to move on to determining a timeline for implementing the new 24/7 EMS coverage. To start we will need to look at current qualifications of our providers and the time needed to get our providers to specific certification levels. We can look at other combination stations for implementation time tables to determine what is considered a reasonable and realistic time frame. We then need to look at available resources that can be utilized until all new staff is trained. Can we afford to pay overtime or will we need to find other ways to cover the shifts until everyone has met the training requirements? Before anyone can be hired, we need to establish a set of standard operating procedures as well as a job description for the employees. We will need to look at other stations that have paid staff in order to determine what we should expect from the providers. Once we have gathered this information we need to lay it out as an employee handbook as well as a set of operating procedures that can be referenced by all employees. Finally we will need to begin to train the personnel and start the transition to 24/7 EMS. To begin we need to hold a station meeting to discuss and inform personnel about transition. We need to let them know the qualifications and training time line and what will be expected by everyone while the transition is taking place. We will need to place ads for Paramedics and Emergency Medical Technicians (EMT’s) in attempt to gain enough employees to cover all of the necessary shifts to get a full 24/7 schedule. Once the personnel have been hired we will begin to hold training sessions for new employees and the transition will have officially begun.

Implementation Plan

To help fund this plan, it will be necessary to lay the ground work and estimate just how much the plan will cost to get up and running. The Carroll County Government already subsidizes the fire stations budgets by issuing a quarterly check. This money is to help the departments cover the day to day operating expenses as well as any salaries that they may be paying for staff. This allotment by no means covers the actual costs of running the station but does help offset some of the expenses. Many volunteer stations are relying on fundraising to make up the remaining money needed to run the day to day operations. For this plan to be funded, it will be necessary to evaluate the current money being distributed to the stations and determine if any of that money will be available for use. To help secure funding for the plan, it will be necessary for the stations to provide the county with an estimate of how much money they receive as a result of EMS billing. This money could essentially be used to fund a large portion of the plan. Currently, the stations are using this money to make up the shortfalls in salaries as well as purchase any equipment and supplies for EMS. Many of the companies have a surplus of money at the end of each year that could be used to assist in the funding of 24/7 EMS. It will also be necessary to seek out any grant opportunities that are available such as the Staffing for Adequate Fire & Emergency Response (SAFER) Grants or the Assistance to Firefighters Grant (AFG) programs. The SAFER grant was “created to provide funding directly to fire stations in order to help them increase the number of trained firefighters available for their community” (AFG, 2010). The AFG programs “primary goal is to meet the firefighting and emergency response needs of fire departments and nonaffiliated emergency medical service organizations” (AFG, 2010). Both of these grants could be secured to help get the plan up and running and sustain the plan in the years to come. In addition, the billing process needs to be re-evaluated to be sure that each station is billing the same way. Currently each station handles their own billing so some may be making more money then others who do not actively participate in the process. If these two funding sources do not heed enough money to keep the plan moving, then it will be necessary to consider an increase in taxes for the citizens of Carroll County. That may come with some hesitation at first however, once citizens realize that they will be getting a much better service as a result of the tax increase, I believe they will come on board.

As with any plan, it is important that you have a contingency plan in place for the unexpected things that may arise. The most important thing is to remember that you may not always meet your deadlines. That does not mean that you will not succeed, it means that you need to regroup and try again. If we do not meet a deadline, then it will be necessary to make adjustments to the remainder of the plan to accommodate the set back. While the plan is unfolding, it will be necessary to be sure that service is not interrupted or delayed. Therefore, it will be important to keep a list of those people who are trained and able to perform the duties should an opening occur. When an opening does occur then you can begin going down the list to find someone who would be available. This will not be a long term plan because you can not rely on the volunteers forever as they are the reason you are moving forward with the strategic plan in the first place. As for funding contingencies, I believe we have incorporated enough sources to secure the funding that we should not fall short. However, should we fall short, then we would have to fall back to relying on the volunteers and finding ways to increase fundraising efforts or possibly even billing fees. At this time we do not take anyone to collections that do not pay their bill. If the insurance does not pay we only send one bill to the patient and then it is left open but never forwarded to any agency. If funding was scarce we could always become more aggressive with the billing process and attempt to collect more of the money that is owed. We could even research to find out if the fees we are currently charging are competitive with other organizations that provide the same service. If we found we were not competitive we could alter our process and increase the fees to bring ourselves in line with the rest of the market.

Schedule for Performance Assessment

To be sure that we stay on track with the strategic plan, it will be necessary to assess the plan on a weekly basis to start. We will have team meetings every Monday morning to be sure that everyone has been accomplishing the tasks they were assigned. At that time we will be able to determine if we will be able to meet the deadlines that we have set up. If we determine that we can not finish a task in the allotted time, then it will be necessary to estimate a new deadline and then adjust the rest of the deadlines accordingly. If we find that meeting weekly does not allow us enough time to fully finish our tasks then we will move the meetings to bi-weekly until we get into the final stage of the plan which is implementation and evaluation. At that point in time, it will be necessary to only meet monthly as we will need to allow enough time for people to get settled into the new job. Obviously if problems arise then we will have to meet and deal with them immediately however, once the staff is in place we will only meet monthly.

Summary

The strategic plan that has been presented in this paper will allow Carroll County to move from a volunteer system that is lacking support and time from the volunteers into a combination station. Due to the lack of volunteers and their lack of time, it has been necessary for Carroll County to start turning towards a career EMS system. This system will be comprised of BLS units in ten of the fourteen fire stations and then Quick Response Vehicles (QRV) staffed by a paramedic to upgrade the BLS units when necessary. There will be a total of five Quick Response Vehicles to cover the County at any given time. Staff will work 24 hours shifts with a 72 hours period off before returning to duty. As a result, we will need to hire four shifts comprised of ten drivers, ten BLS providers, and five paramedics per shift. To help offset when staff need off work during a shift, we will also employ a group of part time staff. This will be made up of a group of five drivers, five BLS providers, and three paramedics. The part time staff will work as needed and will allow us to offer time off to our employees without running into an overtime situation. The plan has been well thought out and should be able to be implemented without too many problems along the way. Many other jurisdictions have been successful in moving from an all volunteer to a career based EMS system. This combination can cause some frustration between the career and volunteer staff but we will be sure to address any and all concerns along the way to ensure a smooth transition. All volunteers and staff will be included in the evaluation process and will have equal say when providing feedback about the plan. The final decisions will ultimately be made by the CCVESA but only after all feedback has been obtained and considered.

CHAPTER FOUR

CONCLUSION

This strategic plan helped me to realize the need for a combination station within Carroll County. The steps involved allowed me to gather very pertinent information that I may have not otherwise considered. I was able to determine that Carroll County is not very prudent on documentation or offering their mission and values within the CCVESA website. Much of the information that I attempted to gather on my specific agency was met with resistance. There is a lack of records showing when transitions have been made as well as changes in procedures and guidelines. I was unable to find any concrete financial information in the CCVESA as a whole and had to rely on what I was being told as opposed to an actual document.

I believe this strategic plan can be executed and successful within Carroll County. Road blocks will be found along the way especially when it comes to the transition process. The fire station is not going to be as supportive of this plan as initially they will see a reduction in the financial support from the county until the new EMS has a chance to gain money from billing. The county itself is in a transition year as we are going from a three commissioner board to a five commissioner board so we will be attempting this plan during a transition in how our county government operates. This may work against us initially as the three current commissioners have not announced that they will be running for a new term. This means we will be getting a whole new leadership and it will be necessary for the CCVESA to build new relationships within county government.

With the right liaison for this plan, the plan will be able to gain support and momentum to move forward and be successful with implementation. It is imperative that the liaison be someone who is passionate about the fire service and is also well known throughout the fire service and community. The liaison will act as the voice behind the strategic plan and interact with all members to ensure a smooth and successful transition.

RECOMMENDATION

For the plan to move forward, it is necessary to begin to gain the support of the stakeholders and government officials. It will be necessary for the liaison as well as members of the planning committee to attend as many community forums and meetings as possible to get the word out about the plan. If the crowd seems hesitant, then it will be necessary to bring in spokes people from other stations that were successful in transitioning to a combination department. These spokes people can show how beneficial the transition has been for their station and then the committee can show how beneficial it will be for Carroll County. It is extremely important for this first step to be completed prior to moving forward because gaining support will allow the committee to begin implementing the various phases of the plan. With support and financial assistance from Carroll County Government, this plan can become very beneficial and bring Carroll County back to providing fast, efficient, and high quality patient care once again.

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