County Administrator
Government/Citizen Resources
Strategic Plan

May, 2001

I. Introduction

The Caroline County Department of Fire and Rescue consists of six volunteer fire departments (companies) and three volunteer rescue squads (companies) that have each acted independently of each other until recently. Each company has a strong reputation in the community and has prided itself on it’s own “individuality”.

It is imperative to be able to improve on the “system approach” as it is today will require all the leaders and members of the companies to think “outside of the box”. The “way we did business twenty years ago” is not a good enough reason to continue those management practices.

Values were developed in three main areas; Staffing, Operations, and Training. The fourth area, Resources, is inherently part of each of the three issue areas with an unstated but clearly necessary remaining goal of providing adequate system financing.

A. Adopt the following common vision statement –

“To create a high performance volunteer based Emergency Services System to meet the current and future needs of the citizens of Caroline County.”

B. Adopt the following mission statement –

To provide the citizens of our county and those who may pass through with the most proficient delivery of fire protection, emergency medical and disaster related services that can be accomplished by prudently using all resources available to us with special focus being placed on the most valuable resource, “Our People”.”

May, 2001

C. Establish the following as Caroline’s EMS System Design

D. Establish the following minimum EMS response goals:

1. Emergency Response
Rescue companies will attempt to reduce their “No Response” category by 15% of each of the previous year’s total. Create and implement a transport tier to address non-emergent transport needs.
2. Create and implement “treat & refer” or “non-transport” track to allow referral of non-emergent patients to other more appropriate treatment venues.

E. Establish the following minimum fire and rescue response staffing goals:

1. Three ambulance crews on duty throughout the County on a 24/7 basis.
2. Place fire and EMS crews in the stations to reduce response times.
3. One Advanced Life Support provider on duty as part of ALS rapid response program on duty 24/7 basis.

F. Establish the following minimum fire response goals:

1. Emergency Response
Fire companies will attempt to reduce their “No Response” category by 13% of each of the previous years total.

It is crucially important in a volunteer system to have a clearly defined and measurable mission and a common vision, since each volunteer brings their own particular perspective and vision to the organization. If there is no common vision, no common mission the organization sets itself up for endless debate and division between its’ members. The vision proposed is simple and straightforward – to build the best Emergency Services System possible. The mission statement proposed is also simple – to provide outstanding service. The system design, response, and staffing goals are based on national and regional standards for a “high performance” Emergency Services System. Fire response will definitely benefit by providing personnel in the stations on a 24/7 basis. In short they are the performance goals necessary to meet the vision and mission.

The vision and mission recognize that providing outstanding service must be our primary purpose, and at the same time provide for services to be offered by the volunteer system to every extent possible. This creates the “best of both worlds” situation for the County and it’s citizens. Customer service in a timely manner is the recognized imperative and volunteerism is allowed to flourish so that appropriate care can continue to be rendered in the most cost effective means possible.

II. Staffing and Management Strategies Necessary to Meet System Goals

A. Implement true retention and recruitment programs that are integrated into the very fiber of the organization to insure the future viability of the volunteer base.

1. Implement County-wide Public Relations Program

a. TV/Radio Ads
b. Print Ads
c. Brochures
d. Video Tapes
e. Posters
f. Newsletters
g. Create a speakers bureau
h. Explore potential of businesses and new hospital
i. Department of Fire & Rescue Web Page
j. Public CPR and First Aid Classes
k. Other sources

2. EMS Captain to supervise the Recruitment & Retention Programs

3. Implement Coordinated Membership Application Process

a. Uniform membership types/requirements
b. Uniform volunteer expectations (job descriptions)
c. Uniform Annual Provider Evaluation of job performance
d. Uniform Membership Application Process
e. Informational Program for personnel who have shown interest
f. Require orientation presentation as part of every training course sponsored by the Department

4. Move to uniform approach to membership

a. All applicants who pass background, DMV and reference checks automatically presented to the company for probationary status.
b. Uniform extendible 180-day probationary status that serves as critical review of applicant with written evaluation(s).
c. Require review by recommending committee of all applicants for active membership.
d. Company accepting or denying active member status at end of probationary period.

5. Implement Personnel Improvement Program for Membership Issues

a. Follow-up with applicants lost
b. Exit interviews with members who leave

6. Implement Mentoring Program

a. Develop mentors within the organizations
b. Create standard mentoring process with defined steps and goals

7. Create Volunteer Growth Ladder

a. Create “growth” ladder for volunteers with standard and attainable steps to maintain interest and promote progression through “volunteer ranks” while at the same time insuring that a member may “opt” out at any step that they wish to maintain (i.e. driver only status, BLS status, ALS status, Firefighter I, etc.) without any negative stigma associated, at the same time encouraging and providing incentives to rise to the ALS level.
b. Create “management track” to develop leadership pool.
c. Make necessary training available and encourage the membership to utilize the yearly Fire and Rescue Training Calendar to plot their professional development strategy.

B. Create retention program that starts on day one of membership

1. Reorganize as Necessary to remove Impediments to Volunteering

a. Uniform operational approaches
   i. Standard recruitment S.O.G.’s
   ii. “No Borders/Territories Mentality”

b. Make leaders into managers
   i. Schedule management time in lieu of some “duty” time to free manager’s time for management duties.
   ii. Uniform officer standards and expectations

2. Remove “politics”, “favoritism”, and “personality conflicts/issues” from the equation of normal membership

a. Standard application of uniform rules removes favoritism
b. Create good managers including “conflict resolution” skills
c. Reduce meetings and issues considered by General Memberships to only those necessary
d. Empower managers (officers including crew chiefs) to make routine decisions to provide standard and uniform expectations of members

C. Insure adequate management (leadership) of volunteers

1. Create minimum officer standards for each office in the volunteer companies

a. Uniform officer slates within companies
b. Uniform Job Descriptions
c. Uniform Performance Evaluations (minimum yearly)

2. Provide management training to potential officers

a. Create Officers Track in overall training program with incremental requirements of training or experience in lieu of training as part of officer standards b. Provide training program for both operational and administrative officers

The volunteers have recognized that “people” issues must be the number one priority to continue a volunteer emergency service system and insure provision of services. The values, goals, and objectives listed above recognize this priority and represent a revolutionary change in thinking. Until now the companies have intended to maintain themselves as autonomously as possible – working as a unit only where prudent. Historically the companies have celebrated their individuality and unity within the CCEUO. Throughout this plan the basic thinking is now radically different. The volunteers themselves have recognized the need to change previous approaches and to work much closer together.

The proposed goals are also the result of the volunteers taking a critical look at the model under which they have been operating and frankly admitting it’s weaknesses and addressing the necessary changes to improve those weaknesses. In adopting these goals, values, and objectives of the companies operating together takes a predominant role over the individual components. The basic thinking and organization will evolve at a rapid pace. The goals, values, and objectives address everything from the basic image we present, to the way we present it, to the manner in which we manage ourselves. The intent of these goals is to mature the volunteer system to the next level of professionalism. To present and market our volunteer approach in a positive manner to gain new volunteers and to remove liabilities of our management to retain the volunteers that we have and gain.

III. Operational Strategies Necessary to Meet System Goals

A. Improve response times to meet stated system goals

1. Move system to Emergency Medical Dispatch (EMD) driven system

a. Improve on current EMD program and change system as necessary to ensure more accurate categorizing of patient needs to allow tiered response
b. Insure that the communications system is kept aware of resources (duty crews).
c. Develop and implement “dispatch time” goals or “benchmarks” to facilitate meeting the overall system response time goals

2. Implement operational approaches that reduce response time.

a. Create reasonable goals or “benchmarks” for response time component that can be directly impacted through management approaches at the company level such as “out-of-station” time.
b. Develop and implement a reasonable system status plan, which is cognizant of the limitations associated with our system, to position units in the most advantageous positions to cover areas of anticipated call activity.

3. A. Replace stations as necessary or upgrade existing stations to serve as “mini-bases” for response and to allow better staging of response capabilities in system status management plan.

B. Provide sufficient crews to meet system staffing goals

1. Create and implement staffing plan

a. Better coordination of crew scheduling at the company level.
b. Redistributing available personnel on an “as needed” basis or “per shift” basis including intermixing of members from separate companies to make as many volunteer crews as possible from the volunteers available on a given day or during a particularly high volume time period.
c. Adding additional supplemental career staffing as necessary to augment the volunteers.
d. On a regular basis re-evaluating use of supplemental staffing to consider issues such as the 5 am to 7 am time period which is problematic for some volunteers.

2. Increase available volunteer pool (Strategies covered in Staffing and Recruitment areas)

3. Fully create and implement ALS Response Tier on 24/7 basis

a. Volunteer Field Medic Program
b. Career Field Medic Program
c. Encourage progression of members through strategies in staffing and training sessions.

C. Meet needs of non-emergent patient populations

1. Add recognized non-emergency transport component to system.
2. Create a medically sound “Treat and Refer” program which removes the unnecessary burdens of transporting patients not requiring emergency department intervention by treating patients in the out-of-hospital setting and referring them to more appropriate treatment venues for definitive care. This will effectively reduce the workload and subsequent drain on the volunteers and the emergency resources of the system.

a. Train AIC’s (Attendant-in-Charge) to recognize possible “Treat and Refer” patients
b. Create public/private partnership between Caroline County and one or more of the local health care networks to provide;

i. Enter into a public/private partnership between Caroline County and a physician’s group under contract to the above-mentioned health care network to provide this new tier of service as a physician’s office outreach program.

The operational goals follow the basic thinking of the staffing goals – closer relationships between the companies and the need for uniform approaches. The underlyinhe operational goals create a system which is “customer driven” or put plainly a system which is designed wholly to carry out it’s mission. The goals also represg theory of the goals proposed is for the companies to operate together as one unit to take best advantage of limited resources for the most efficient approach possible. Additionally tent a shift in thinking of what we have called system abuse – the needs of non-emergent patients.
These goals recognize that this is a legitimate need and propose to meet this need in ways that do not drain our emergency response capabilities. The most radical thinking in these goals is in creating an entirely new role or track within the system of “Treat and Refer”. The underlying thinking of this proposal is to recognize the very basic fact that EMS systems have designed themselves for a very narrow role of truly emergent patients, while the system’s customers have asked for a much broader response. Studies show that up to 50% of the patients encountered by EMS do not require treatment at an Emergency Department.
The proposal is to recognize this and design the scope of the system to include methods to treat these patients in a more efficient manner. The proposal more specifically is to provide this expanded scope through a strategic public/private partnership at no cost to the tax base. Put another way this proposal recognizes a need and proposes to address it in the most efficient way possible.
The thinking is new, radical, and definitely “outside of the box”. It is also, therefore, the most dubious to conventional thinking. The question of this approach is not by medical necessity but grows out of looking for a better way to provide customer service.

IV. Training Strategies Necessary to Meet System Goals

A. Provide a quality-training program for all of the system components to meet the needs of the companies and staff.

1. Continuously maintain a dedicated Fire and Rescue Training Center which has space to accommodate two classrooms, adequate restrooms, break space, parking, and parking lot space for driver training courses, etc. which is centrally located, easily accessible from interstate and close to dining and lodging services.

2. Coordinate all training through the above-mentioned training center. (This will include the offering of all training courses at the center).

a. Utilize the Fire and Rescue Training Center for monthly “informational” sessions as part of overall recruitment strategy.
b. Incorporate all training records into the centralized database at Fire and Rescue Administration.
c. In addition to offering management tract organize and offer specialized sessions such as team building, leadership retreats, etc.

B. Complete implementation of QA/QI Program and fully integrate process into training program.

1. Prehospital Patient Care Reports

C. Create and implement quality control system for fire and rescue instructors.

1. Student critiques
2. Monitoring system

Understanding the importance of training in a fire and rescue system and more particularly in a volunteer system is sometimes difficult. We recruit through training. We retain through training. We also discipline through training. Training is our only real quality assurance tool. We must train our people in patient care, management, safety, fire ground operations, emergency response, driving, scene control and a host of issues to make them prepared to operate in what is in all reality a very stressful and uncontrolled environment.

We must instill confidence in judgement and skills through training and we use training to correct improper actions. Recruitment and training is the foundation of our whole operation. We cannot even hope to operate without a strong and effective training program. The training goals proposed are very basic. However, their importance to the success of the overall system should not be underestimated. To train personnel effectively, the system must have several things.

First, we must have an adequate site to offer training. The physical facility is not only important – it is necessary. Second, we must have the necessary equipment. Third, we must have a strong program that defines the needs of our personnel and identifies deficiencies through a sound Quality Assurance program that includes data collection and outcome oriented information. The training program must also have sound instruction and sound physician input and oversight. The proposed goals meet these needs. The goals proposed meet these needs.