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HomeMy WebLinkAboutItem 10k - Continuing Education, Quality Improvement & Nurse Educator for Fire Department DATE: June 6, 2023 TO: Honorable Mayor and City Council FROM: Chen Suen, Fire Chief By: Richard Oishi, Acting Deputy Fire Chief SUBJECT: CONTRACT WITH UCLA MEDICAL CENTER FOR PREHOSPITAL CARE FOR PARAMEDIC AND EMERGENCY MEDICAL CONTINUING EDUCATION (“CE”), QUALITY IMPROVEMENT (“QI”) SERVICES, AND A NURSE EDUCATOR IN THE AMOUNT OF $34,800 CEQA: Not a Project Recommendation: Approve SUMMARY The County of Los Angeles and the State of California Health and the Emergency Medical Services (“EMS”) Authority require that paramedic and EMS agencies continue to fulfill EMT-Basic and EMT-Paramedic continuing education (“CE”) and recertification requirements for its EMS personnel and to provide quality improvement services (“QI”) to maintain or enhance the quality of patient care. Essential to the success of a quality EMT- Paramedic CE program is a dedicated Nurse Educator. The Regents of the University of California, on behalf of the UCLA Center for Prehospital Care (“UCLA”), provides both of these essential services. It is recommended that the City Council approve a contract with UCLA Medical Center for prehospital care to provide paramedic and emergency medical continuing education (“CE”), quality improvement (“QI”) services, and a dedicated Nurse Educator for the Fire Department in the amount of $34,800 for Fiscal Year 2023-24. This agreement also allows priority enrollment for the Fire Department personnel to the UCLA Daniel Freeman Paramedic Program. The contract will be for a three-year term with an option to renew for an additional two one-year contract extensions thereafter (see Attachment). BACKGROUND Founded in 1988, the UCLA Center for Prehospital Care (“CPC”) designs, develops and offers primary medical education, continuing education, and quality improvement programs to meet the needs of the prehospital community and conducts research to Contract with UCLA Medical Center for Continuing Education, Quality Improvement & Nurse Educator June 6, 2023 Page 2 of 4 advance the emergency medical services system. For over 30 years, UCLA’s CPC has delivered customized, state-of-the-art education to firefighters, emergency medical technicians (“EMTs”), paramedics, law enforcement, registered nurses, medical students, medical residents, and physicians. Locally, since 2001, the UCLA Medical Center for Prehospital Care has provided personalized, onsite continuing education and quality improvement services for the Arcadia Fire Department through a dedicated university-backed nurse educator. Since 2017, the Fire Department has had the benefit of working with the same dedicated UCLA Nurse Educator, which has provided consistency and a full and complete understanding of the work involved in supporting the Department’s medical services program. Some of the key responsibilities that this role supports include the following: conducting ride-along education for the paramedic staff; delivering quality, improvement-based continuing education; reviewing critical incidents and providing immediate feedback; and assisting in the annual Los Angeles County Department of Health Services onsite Emergency Medical Services audit. Because of their ability to provide a unique and unmatched prehospital EMS educational service, the UCLA Center for Prehospital Care has been instrumental in placing the Arcadia Fire Department in the forefront within the Los Angeles County for delivering the highest quality of prehospital care to its community. Their services have also brought recognition to the Fire Department within the Emergency Medical Services field for the quality improvement and high level of documentation, enabling the Arcadia Fire Department to be considered a model for other EMS agencies within the Los Angeles County. DISCUSSION For several years, the Fire Department has been receiving excellent state mandated prehospital care training through UCLA’s continuing education, quality improvement, and Nurse Educator services. The Fire Department’s current Nurse Educator has already developed an efficient system to review its patient care reports; provides direct field observation; assists in fact-finding for specific incidents; attends the Los Angeles County EMS Agency Quality Improvement Committee meetings to gather information regarding updates and changes to policies and/or procedures; and understands the unique urgent medical needs of this community. Through UCLA, the Department’s current Nurse Educator would continue to conduct onsite continuing education in prehospital and emergency medicine to maintain certification and licensees of the Department’s fifty-five (55) EMT-Basic and EMT-Paramedic personnel. Additionally, the Nurse Educator would continue to provide quality improvement to maintain or enhance the quality of patient care. Contract with UCLA Medical Center for Continuing Education, Quality Improvement & Nurse Educator June 6, 2023 Page 3 of 4 Since 2001, the UCLA Medical Center for Prehospital Care has provided superior performance and excellent onsite education to the Arcadia Fire Department. The work assigned to UCLA has been performed in a timely, reliable, and efficient manner. UCLA is the only provider who conducts in-house continuing education in prehospital and emergency medicine to maintain certification and licensure as EMT-Basic or EMT- Paramedic while providing quality improvement service to sustain or enhance the quality of patient care. UCLA also provides the state mandated American Heart CPR and First Aid certification for Fire Department personnel. Lastly, the UCLA Center for Prehospital Care is the only provider that has a university backed paramedic school, and the proposed contract guarantees priority admission for qualified Arcadia Fire Department staff. The Fire Department’s existing contract with UCLA involves a highly specialized field dealing with paramedic and emergency care assessments, skills, and training services supplied by its Nurse Educator to Fire paramedics and EMS personnel so they could continually offer exceptional paramedic care to patients, while meeting the mandates set by the State of California EMS Authority’s and the Los Angeles County Department of Health Services. With an ever-increasing call volume that the Fire Department has been responding to for at least a decade (with at least 70% of calls being medically-related), consistency and proficiency in this type of patient care service delivery is vital more than ever. Other cities who are utilizing such services offered by UCLA include the Cities of Downey, El Segundo, Glendale, Manhattan Beach, Monrovia, Montebello, Monterey Park, Redondo Beach, San Gabriel, San Marino, Santa Fe Springs, and West Covina. Based on their reliability, service, and the excellent relationship between the Department’s Nurse Educator and UCLA, it is recommended that a three-year contract be executed, with the option to renew for an additional two one-year contract extensions. ENVIRONMENTAL ANALYSIS The proposed actions do not constitute a project under the California Environmental Quality Act (“CEQA”), based on Section 15061(b)(3) of the CEQA Guidelines, as it can be seen with certainty that they will have no impact on the environment. Thus, these matters are exempt under CEQA. FISCAL IMPACT Sufficient funds in the amount of $38,300 have been allocated in the Fire Operating Budget for Fiscal Year 2023-24 for this service contract. The UCLA Medical Center for Prehospital Care has agreed to an annual increase based on the Consumer Price Index (“CPI”) in the Greater Los Angeles Area, not to exceed 3% per year. Contract with UCLA Medical Center for Continuing Education, Quality Improvement & Nurse Educator June 6, 2023 Page 4 of 4 RECOMMENDATION It is recommended that the City Council approve a contract with UCLA Medical Center for Prehospital Care for Paramedic and Emergency Medical Continuing Education (“CE”), Quality Improvement (“QI”) Services, and a Nurse Educator in the amount of $34,800, with an option to renew for an additional two one-year contract extensions, after the initial three-year contract term. Attachment: Contract with UCLA Medical Center - 1 - UCLA Center for Prehospital Care And The City of Arcadia Services Agreement This Agreement (“Agreement”) is made and entered as of July 1, 2023 (“Effective Date”) by and between The Regents of the University of California, on behalf of the UCLA Center for Prehospital Care (“UCLA”) and The City of Arcadia (“City”), on behalf of the Arcadia Fire Department (“Department”). RECITALS A. The UCLA Center for Prehospital Care conducts continuing education in prehospital and emergency medicine services for students to maintain licensure as an EMT-Basic and Paramedic (referred to as “CE Programs”) and provides quality improvement services to maintain or enhance the quality of patient care (referred to as “QI Services”). B. Department desires to utilize the CE and related services to maintain the certifications of Department personnel and to continue to deliver quality patient care to their Department members and community. NOW THEREFORE, the parties hereby agree as follows: “Attachment” - 2 - Article 1 Rights and Responsibilities of UCLA 1.1 Provide an EMS Educator ("EMS Educator"). UCLA shall provide an EMS Educator to Department to conduct CE Programs as described herein. The EMS Educator shall be subject to the mutual approval and selection of both Department and UCLA. 1.2 Provide CE Programs. The EMS Educator will provide two (2) to three (3) hours of CE over three shifts each month which will include hands-on practical skills each quarter based on a mutually agreeable schedule. A minimum of 24 hours of CE shall be delivered annually to meet requirements for EMT recertification and Paramedic re-licensure. A summary of CE services are detailed in Exhibit “B.” 1.3 Provide QI Services. The EMS Educator shall develop, coordinate and maintain a quality improvement plan for Department. This shall include: developing a system to review Department's policies, patient care, and documentation, coordinate bi-annual quality improvement meetings, providing direct observation under field conditions, developing a plan to evaluate the competency of Department personnel, assisting in fact-finding regarding patient care delivered by Department personnel or questions about policy for specific incidents and attending the Los Angeles County EMS Agency Quality Improvement Committee meetings to gather information regarding updates and changes to policies and/or procedures and reporting to the Department. A summary of QI Services are detailed in Exhibit “B.” 1.4 Provide General/Administrative Support. The EMS Educator will collaborate and coordinate activities with the quality improvement committee and Department leadership (as identified in Section 3.2) and monitor compliance with local and state regulations during the - 3 - term of this Agreement and as set forth in Exhibit “B.” A description of the Administrative Support Services is set forth in Exhibit “B.” 1.5 Additional Services. The EMS Educator may provide additional CE Program and administrative services beyond time or effort of the services described in Exhibit “B” to meet the needs of Department at additional fees, as agreed to by the parties. 1.6 Program Enrollment. UCLA will provide Department with the ability to enroll qualified students into UCLA’s Paramedic and Paramedic Refresher courses at discounted tuition Department rates. Article 2 Confidentiality 2.1 Definition. For purposes of this Agreement, the term “Confidential Information” shall mean any information, including protected health information (PHI), disclosed in order to accomplish the work under this Agreement by one party (“Disclosing Party”) to another party (“Receiving Party”) that is considered confidential by the Disclosing Party, and is considered confidential or privileged under federal or state law, provided such information is in writing or other tangible form and clearly marked as confidential when disclosed, or is so designated in writing within thirty (30) days of such disclosure. The parties agree to disclose only information that is necessary to the work, and/or as required or permitted under federal or state law, and to send such information directly to the parties noticed in Section 9 of this Agreement. 2.2 Obligations of the parties. The Receiving Party agrees, to the extent permitted by law, that Confidential Information shall remain the property of the Disclosing Party and that the Receiving Party shall only use, disclose or distribute Confidential Information within its own organization as is reasonably necessary to carry out the intent of this Agreement, and/or as - 4 - required or permitted under federal or state law. For the period of the Agreement and following the expiration or termination of the Agreement, Confidential Information shall not be used or disclosed to others except in furtherance of this Agreement, provided, however, that the foregoing obligation of non-use and non-disclosure shall not apply to any portion of the Confidential Information that: 2.21 is or shall have been known to the Receiving Party before receipt thereof; 2.22 is or shall have been disclosed to the Receiving Party by a third party; 2.23 is or shall have become known to the public other than through the Receiving Party; 2.24 is independently created by the Receiving Party’s personnel who have had no exposure to the Confidential Information; or 2.25 is required by state or federal law, regulation, a court of competent jurisdiction or any rules of civil procedure applicable to any court or administrative proceeding to be disclosed. 2.3 Return of Confidential Information. Upon the expiration or earlier termination of this Agreement and the written request of the Disclosing Party, to the extent permitted by law, the Receiving Party shall promptly return to the Disclosing Party or certify destruction of all Confidential Information of the Disclosing Party received by the Receiving Party and any copies made thereof, whether in written, electronic or any other form, except Receiving Party may maintain an archival copy of the Confidential Information on the Receiving Party’s servers as long as the confidentiality obligations in Section 2.2 continue to be complied with. - 5 - Article 3 Rights and Responsibilities of Department 3.1 Provide Space and Equipment. Department shall provide a classroom sufficient to provide quality instruction, audiovisual equipment; access to Department training equipment and supplies for the purposes of instruction; and a desk with securable file space, internet access and use of a printer and photocopier for use by the EMS Educator while at the Department. 3.2 Designate QI Person. Department shall designate a person responsible for CE in Department and to receive the information under this Agreement (“Department Designee”). 3.3 Responsibility. Department understands and accepts the responsibility for the clinical activities and care provided by its employees and agents and for the implementation of the services under this Agreement. Department agrees that UCLA shall not be responsible for these clinical activities or the implementation of quality improvement services. Article 4 Term 4.1 The term of this Agreement shall be for three (3) years from the Effective Date through June 30, 2026. This agreement shall automatically renew for two (2) additional one-year terms unless terminated earlier as set forth by this Agreement. - 6 - Article 5 Termination 5.1 Termination without Cause. Either party may terminate this Agreement at any time without cause by providing the other party with sixty (60) days written notice as set forth in Article 9 below. 5.2 Termination for Cause. Either party may terminate this Agreement for cause or a material breach by providing the other party with thirty (30) days written notice as set forth in Article 9 below. If the breaching party fails to cure the breach within thirty (30) days of receipt of the notice of breach, the termination shall be effective at the end of the thirty (30) day period. Article 6 Payment 6.1 Compensation for Services. Department agrees to compensate UCLA for the services provided by the Educator under this Agreement. Department agrees to pay UCLA $34,745.31 per year for the services covered under this Agreement. UCLA shall bill the Department $2,895.44 monthly. At the end of each one year term, as set forth in Article 4.1. UCLA shall increase the cost of services by changes in the consumer price index in the Greater Los Angeles Area, not to exceed 3% per year, to cover cost of living changes. Department shall pay the amount due within thirty (30) days of receipt of the invoice from UCLA. 6.2 Compensation for Additional Services. Department agrees to compensate UCLA for additional services referred to in Section 1.5 requested by the Department and approved by UCLA at an approved billable rate. The approved rate will be shared with Department annually. - 7 - 6.3 Payment. Any payment to UCLA made pursuant to this Agreement shall be made by check payable to the Regents of the University of California and mailed to: UCLA Cashiering Department Box 957448 757 Westwood Plaza, Ste. 1119 Los Angeles, CA 90095-7448 Article 7 Insurance 7.1 The parties agree to obtain and maintain the insurance set forth in Exhibit “A.” Article 8 Indemnification 8.1 Department agrees to defend, indemnify, and hold harmless UCLA, its officers, employees and agents from and against any and all liability, loss, expense (including reasonable attorneys’ fees) or claims for injury or damages arising out of the performance of this Agreement, but only in proportion to and to the extent such liability, loss, expense, attorneys’ fees, or claims for injury or damages are caused by or result from the negligent or intentional acts or omissions of Department, its officers, employees or agents. 8.2 UCLA agrees to defend, indemnify, and hold harmless Department, its officers, employees and agents from and against any and all liability, loss, expense (including reasonable attorneys’ fees) or claims for injury or damages arising out of the performance of this Agreement, but only in proportion to and to the extent such liability, loss, expense, attorneys’ fees, or claims for injury or damages are caused by or result from the negligent or intentional acts or omissions of UCLA, its officers, employees or agents. - 8 - Article 9 Notice 9.1 Any notice required to be given to any party is deemed to have been given and to be effective on the date of delivery if delivered in person or by nationally recognized overnight courier such as Federal Express, or five (5) days after mailing if mailed by first-class certified mail, postage paid, to the respective addresses given below or to any other address as designated in writing to the other party: UCLA: Carmina Lu Center Administrator UCLA Center for Prehospital Care 1100 Glendon Ave, Suite 1200 Los Angeles, CA 90024 Department: ________________ ________________ ________________ Article 10 Use of Name 10.1 Neither party may use the name of the other, including the name UCLA, the Regents of the University of California, or the University of California, in any advertising, publicity, or otherwise, without the prior written approval of the authorized representative of the other party. For UCLA, any such request shall be sent to the names and addresses in Article 9 above. - 9 - Article 11 General Terms 11.1 Relationship. This Agreement is not construed as creating a partnership, joint venture, or agency relationship among the parties. The relationship between the parties shall at all times be that of independent contractors. 11.2 Governing Law. This Agreement shall be interpreted and construed according to the laws of the State of California. 11.3 Modifications. Any amendments or modifications to this Agreement must be in writing and signed by authorized representatives of both parties. 11.4 Assignment. Neither party may assign its rights, duties, or obligations under this Agreement, either in whole or in part, without the prior written consent of the other party. 11.5 Severability. The provisions of this Agreement are severable. If any provision of this Agreement is determined to be invalid or unenforceable under any controlling body of law, the invalidity or enforceability does not in any way affect the validity or enforceability of the remaining provisions of this Agreement. 11.6 Waiver. Waiver by any party of any breach of any provision of this Agreement or warranty or representation shall not be construed as a waiver of any subsequent breach of the same or any other provision. The failure to exercise any right in this Agreement shall not operate as a waiver of such right. 11.7 Entire Agreement. This Agreement, and the Exhibits attached hereto, contain the entire Agreement between the parties with respect to the subject matter of the Agreement and supersedes all prior written or oral agreements with respect to the subject matter in the Agreement. - 10 - 11.8 No Third Party Beneficiaries. None of the provisions contained in this Agreement are intended by the parties, nor shall they be deemed, to confer any benefit on any person not a party to this Agreement. 11.9 Non-solicitation. Department agrees that it will not solicit UCLA EMS Educator(s) for employment at Department during the term of the Agreement and for twelve (12) months after the end of its term. 11.10 Review of electronic files. Department agrees that UCLA EMS Educator(s) will have access to review electronic patient care reports to review for audit purposes with respect to the services provided under this Agreement. 11.11 No Excluded Parties. Each party represents and warrants to the other party that: a) neither it nor any of its representatives who will provide services pursuant to this Agreement are currently excluded, suspended, debarred or otherwise ineligible to participate in federal health care programs, including Medicare and Medicaid programs; and b) neither it nor any of its representatives who will provide services under this Agreement have been convicted of a criminal offense related to the provision of health care items or services that would lead to mandatory exclusion from federal health care programs, but have not yet been excluded. 11.12 Compliance with Laws. Both parties agree that each shall comply with all applicable state and federal laws, rules, and regulations now in effect or hereafter adopted regarding the services provided under this Agreement, including but not limited to, those laws regarding the retention and availability of books and records related to the performance of obligations under this Agreement. Such action shall include, without limitation, compliance with the appropriate provisions of the Social Security Act and any applicable regulations, as related to the retention of records. IN WITNESS THEREOF, the parties hereto have executed this Agreement on the dates indicated. - 11 - By: CITY OF ARCADIA By: The REGENTS OF THE UNIVERSITY OF CALIFORNIA, on behalf of the UCLA Center for Prehospital Care “UCLA” By: By: Dominic Lazzaretto Constance Her City Manager Director, Special Projects & Dean’s Commitments Date: _________________________ Date: _________________________ ATTEST: By: Date: City Clerk By: __________________________ Mike J. Maurer City Attorney - 12 - Exhibit “A” Insurance I. UCLA UCLA at its sole cost and expense shall insure or self-insure its activities in connection with this Agreement by maintaining programs of self-insurance as follows: 1. Commercial Form General Liability Insurance (contractual liability included) with a limit of two million dollars ($2,000,000) per occurrence and a general aggregate of five million dollars ($5,000,000). 2. Business Automotive Liability insurance with a combined single limit of not less than five million dollars ($5,000,0000) per occurrence. 3. Professional Medical and Hospital Liability Self-Insurance Program with limits of one million dollars ($1,000,000) per occurrence and a general aggregate of five million dollars ($5,000,000). 4. Workers’ Compensation and Employers Liability Self-Insurance Program covering University’s full liability under the Workers’ Compensation Insurance and Safety Act of the State of California as amended from time to time. 5. Such other insurance in such amounts which from time to time may be reasonably required by mutual consent of the parties against other insurable risks relating to performance. It should be expressly understood, however, that the coverages required under Sections 1, 2, and 3 above shall not in any way limit the liability of UCLA. If such insurance is written on a claims-made form, it shall continue for three years following termination of this Agreement. The insurance shall have a retroactive date prior to or coinciding with the effective date of this Agreement. The coverages referred to under Sections 1 and 2 above shall include Department as additional insured. UCLA, upon execution of this Agreement, shall furnish Department with Certificates of Self-Insurance evidencing compliance with all requirements. II. Department Department at its sole cost and expense shall insure or self-insure its activities in connection with this Agreement by maintaining programs of self-insurance as follows: 1. General Liability Self-Insurance Program with a limit of one million dollars ($1,000,000) per occurrence and a general aggregate of five million dollars ($5,000,000). 2. Business Automobile Liability Insurance Program for owned, non-owned, or hired automobiles with a combined single limit of not less than two million dollars ($2,000,000) per occurrence with additional coverage available. - 13 - 3. Professional Medical Liability Insurance with limits of one million dollars ($1,000,000) per occurrence and a general aggregate of five million dollars ($5,000,000). 4. Workers’ Compensation and Employers Liability Self-Insurance Program covering Department’s full liability under the Workers’ Compensation Insurance and Safety Act of the State of California as amended from time to time. 5. Such other insurance in such amounts which from time to time may be reasonably required by mutual consent of the parties against other insurable risks relating to performance. It should be expressly understood, however, that the coverages required under Sections 1, and 2 above shall not in any way limit the liability of Department. If such insurance is written on a claims-made form, it shall continue for three years following termination of this Agreement. The insurance shall have a retroactive date prior to or coinciding with the effective date of this Agreement. The coverage referred to under Section 1and 2 above shall include Department as an additional covered party. Such a provision, however, shall apply only in proportion to and to the extent of the negligent acts or omissions of Department, its officers, employees and agents under this Agreement. Department, upon execution of this Agreement, shall furnish UCLA with Certificates of Insurance evidencing compliance with all requirements. III. NOTICE Each party shall provide the other with at least thirty (30) days advance written notice to the names set forth in Article 9 of this Agreement of any changes, modifications or cancellations of the above coverages. - 14 - Exhibit “B” Summary of Services Continuing Education Frequency Outcome Measure Provide three (3) hours of CE on three shifts each month. Every month This will provide 36 hours of CE annually if student attends all CE conducted on their scheduled shifts. Presentation of Mandatory CE (i.e., “EMS Update”, Bloodborne Pathogens, SIDS, Abuse reporting, etc.) Annually (or as required by DHS) Required items presented each year. Verified on calendar of topics approved by department. Competency assessment (i.e., quiz) of material presented. Every month (at the end of each CE session) 100% of the department meets the 80% passing threshold or receives remediation to achieve competency. Quality of presentation by EMS Educator. Every month (at the end of the CE session) 80% of students rate the presentation 4 (out of 5). Completed evaluations reviewed bi-annually with department. Overall quality of CE and QI program. Anonymous survey annually Results compiled and presented to Fire Chief. Maintain all CE records. Every month Prepare a CE packet that includes all required material for the audit including but not limited to rosters, lessons, objectives, posttests and evaluations. Prepare for the Los Angeles County Department of Health Services EMS Agency CE Audit. As scheduled Submit required annual survey information. Attend meeting and obtain re-approval of the department’s ability to deliver CE and be in good standing with DHS. Quality Improvement Frequency Outcome Measure The Nurse Educator shall ride along and evaluate Department personnel under field conditions and design and provide education to any specific needs identified. As needed Completion of ride-along documentation form. Documents reviewed with the Quality Improvement committee and Department leadership quarterly or more often if needed. Review 100% all EMS calls against performance indicators. Every month Performance threshold on indicators is 90%. Submission of performance indicators to DHS as required. Quarterly (or as required) Performance threshold on indicators is 90%. Support the Medical Director with special QI projects. As assigned Track and report data as required. Facilitate and attend the QI committee to review and discuss performance indicators. Quarterly Results presented to quality improvement committee and department leadership for discussion, recognition, areas for improvement, attention or continuing education. - 15 - Attend LACPQI, PAAC, PA, LACFA and other meetings as requested or required. Quarterly or as scheduled Department represented by the EMS Educator. Skills practice, remediation, verification for Paramedics and EMTs. Bi-annually and conducted during quarterly skills practice where possible Skills sheets verifying competency of selected skills reviewed with department leadership. Prepare for the Los Angeles County Department of Health Services EMS Agency Provider QI Audit. As scheduled Attend meeting and obtain re-approval of the department’s ability to deliver EMS and be in good standing with DHS. Liaison with the Los Angeles County EMS Agency, local base hospitals and/or fire departments. At committee meetings and or as incidents arise Resolution of concerns and dialogue with department leadership about complaints and concerns. General Administrative Frequency Outcome Collaborate with EMS Captain, Fire Chief and Medical Director. Quarterly, or more often if needed Formal and informal meetings/conversations. Ensure compliance with local and state EMS regulations and protocols. Ongoing Attend UCLA EMS Educator Service department meetings. Attend Los Angeles County Department of Health Services EMS Agency Provider Quality Improvement Meetings. Attend train- the-trainer EMS Update courses (annually). Overall quality of CE and QI program evaluation. Anonymous survey annually Results compiled and presented to quality improvement committee and department leadership.