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How Accreditation Can Drive Fire, EMS Success

The United States has been besieged by economic pressures not felt since the 1920s and 1930s, and the fire service hasn't been immune. Station closures, staff reductions, layoffs, brownouts and other effects resulted from the severe economic contraction now known as the Great Recession.

This new normal has pitted public-sector entities against anemic funding; this has forced the general public and our electorate to prioritize spending and core services. For the fire service, the challenge is to validate the services we deliver. This can be done most effectively via accreditation processes. Prompting critical internal process improvement and validation by external agencies may be a key driver of organizational survival.

Broward County, Fla., like many fire departments, provides EMS to its population. In fact, fire-based EMS has made great inroads throughout communities as a system that utilizes community-based resources of fire protection, cross-training those personnel in emergency medical care.

This system leverages community coverage that already exists; in many cases, the advent of a formalized national EMS system. Given enhanced fire-protection systems, life-safety code enhancements and accountability and a graying population base, many fire departments find their service demand to be increasingly driven by EMS.

EMS systems typically are well regulated at either the state or local level, ensuring compliance with licensing, training, continuing education and service standards. These, however, typically provide a minimum foundation for entry into EMS provision—not a ceiling or gold standard.

The Commission on Accreditation of Ambulance Services (CAAS) is a joint initiative among key EMS stakeholders; it developed standards aimed at ensuring adherence to high performance and quality provisions of all aspects of EMS delivery. One key component to achieving accreditation is documenting adherence to specific performance measures established by the Commission; another is validating these measures by an on-site peer examiner team, including an EMS physician.

The Commission awards three-year accreditation status. Broward County's rigorous accreditation process exceeded 36 months and culminated in Broward being the largest fire-based provider in the United States to have the CAAS-accredited designation awarded.

The Commission of Fire Accreditation International (CFAI) provides accreditation to agencies that meet the standards this Commission sets forth. Agencies are required to complete a comprehensive self-assessment of their services, programs, processes and procedures that addresses more than 250 performance indicators under 10 categories, from governance to finance. These require demonstration of successful adherence to core competencies that are supported by exhibits and references.

Additionally, successful agencies are required to have a formalized strategic plan and to use it to guide the department into the future. Finally, departments must complete a standard of cover that evaluates community risk and hazard assessment, current system performance and responding to the established risk and establish goals and benchmarks that future performance as well.

The CFAI process is results-oriented and data-driven, requiring an off- and on-site peer review to test and validate the assertions and data. Successful candidate agencies must receive formalized accreditation approval from the Commission after completing these processes.

Certainly, many would argue that the value of this process is the organization learning and process improvement that the agency develops as it undertakes accreditation initiatives. Opportunities for improvement exist in most organizations regardless of size; accreditation processes help agencies identify those opportunities and encourage including them as part of continual improvement.

Increasingly, consumers, elected officials and communities are being forced to prioritize spending, prioritize services and make difficult choices to ensure balanced budgets with less revenue. Independent accreditation assures stakeholders that entities are performing within the highest levels of performance as judged by commissions with knowledge of what's required for success.

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