"Fire departments involved with emergency medical service (EMS) delivery are being challenged to diversify this role through the addition of expanded scope of practice processes. The purpose of this research was to determine if the Sierra Vista fire department (SVFD) should expand their current EMS service delivery process or focus instead on improving clinical outcomes for our customers. This study employed a historical, evaluative, and action research methodology to answer the following questions: 1. What clinical outcome(s) does the EMS research literature identify as an indication that an EMS system is functioning effectively? 2. How effective is the SVFD's EMS process in achieving the clinical outcome(s) identified in question one? 3. Does the literature offer any theories or models the Sierra Vista fire department can use as a framework for deciding whether it should expand current levels of EMS service? The procedures used for this study included an extensive review of the EMS research literature as well as informal interviews with stakeholders intimate with the SVFD's EMS system. The results of this study revealed that two factors - a rapid advanced life support (ALS) response of eight minutes or less and out of hospital cardiac arrest survival - are the clinical indicators of a well functioning EMS delivery system. Since the SVFD does not measure either factor, the effectiveness of the local EMS system is unknown. Therefore, a decision matrix was created to guide the SVFD into an expanded scope role without compromising current service levels. It was recommended the SVFD: 1) immediately begin measurement of clinical indicators to establish system effectiveness; 2) begin an expanded scope process using off-duty personnel; 3) prospectively evaluate the process on a regular basis."
United States. Federal Emergency Management Agency, Learning Resource Center: http://www.lrc.fema.gov/