I need you to do Assignments!

- Now that planning and implementing our program is almost done, we need to do another evaluation.  This evaluation will evaluate our program and measure its success.  We want to ensure that our program has seamlessly been adopted by Gold Cross Ambulance.  We will evaluate different aspects of our program to see if they meet the standard of success.  What to evaluate in our program are health issues, social issues, economic issues, policies/legal/procedures, environmental factors, program feasibility and costs, and associated risks.  We will also evaluate the actual number results of our program is producing to see if our program is pumping out positive numbers.  After getting the results from this evaluation our team can make changes to make this program as effective as possible. To speaking about why these areas were selected to evaluate, the answer below:

. Health issues: we want to know if the patient diagnosis on the streets was accurate and we would want to know if the patient accumulated any additional injuries in transport to the hospital.  If the patient diagnosis wasn’t accurate then that could mean our criteria for spinal clearance could need some improvement.  In addition, if the patient acquires additional injuries under the Paramedics of EMT’s care then that could pose a big liability.

. Social Issues: social issues could include if the community is in support of our program.  If the community isn't in support of our program then that could really hinder our success and really cause problems when the paramedics or EMT’s are called to help a patient.  The patient may not know the raw facts about spinal immobilization and this could cause a feeling of uncertainty and uncooperative of the patient.

. Economic issues: our prediction was that implementing this program would save Gold Cross Ambulance money and equipment.  It is necessary to evaluate this aspect to see if we truly are successful at saving money and equipment.  If we aren’t saving resources then we would need to look into why we aren’t, there could be a possibility that the majority of our calls are high trauma patients that will get backboarded regardless.  We know that this process of getting used to a new protocol is a long one and we are prepared to see results that aren't immediately in our favor.

. Policies/Procedure: this is probably one of the most important things to evaluate in our evaluation process.  Our program is based on a series of guidelines, policies, and procedures to properly use spinal clearance in trauma patients for our personnel to use.  If these guidelines aren’t working properly it makes our whole program ineffective.  A good way to evaluate our procedure is to communicate with the paramedics and EMT’s to get their opinion: if the procedure is hard to work with, if it seems to prove effective, if there is any part that could use some improvement.  Communicating with the front line personnel that have to work with this every single day is key to this evaluation.  If the personnel have a problem with the procedure then it is necessary that these problems get fixed immediately to make our personnel happy.

. Legal issues: legal matters would include issues in regards to the patient feeling that they didn't get the right care so they are getting the law involved.  If a patient tries to sue Gold Cross then this damage the reputation of the company.  In order to prevent these kinds of situations, the patient needs to be informed that these spinal clearance guidelines are effective in protecting the patient.  In addition, during the process of implementing our program, our team would need to have good communication with the states Bureau of Emergency Management to see if our procedures are adequate with the states standards.

. Environmental factors: by environment factors we mean that if the physical area that the paramedics and EMT’s work in is affected by our program.  For example, our program isn't going to be that effective if our personnel is only receiving calls to save people from car accidents on the highway; these cases usually involve too high of trauma in the patient that they will need their spine immobilized regardless of what kind of injuries that they sustain.  Or on the other hand, maybe our personnel are only receiving calls to help the elderly with falls and minor trauma; this could produce great positive results for our spinal clearance guidelines.  This is important to evaluate because this could contribute to get getting really good positive results or some pretty negative results.

. Program Feasibility and Costs: this ties in directly with the whole process of starting the program and implementing a new program into the agency.  Upon going through the process of planning this program we set up goals and deadlines to accomplish and a budget.  Evaluating this can show our team if we made our deadlines and stayed within the budget.  If our team didn’t reach the deadlines or went over the budget the feasibility of the program declines, making it really hard to implement this program.  One of our main goals was to make the process of implementing this program into Gold Cross agency as seamless as possible. Evaluating this can show us how seamless it was actually was.

. Initial number results: these number results show us the actual numbers of how many times we are successfully using the spinal clearance guidelines.  This number could be as simple as asking the Paramedics and EMT’s to keep a log of how many times they didn’t use a backboard when they originally would have before the program.  Like previously said, it’s expected to be a slow startup so initial results will be smaller but over time they should increase.  However, if we have dramatically low results then something needs to get changed.  Our spinal clearance guidelines could be ineffective, our Paramedics or EMT’s weren't properly trained, and maybe the Paramedics and EMT’s aren’t enthusiastic to be implementing this new protocol. It could be any number of things and we would need to get to the root of the problem. It is going to impact our program in positively way because if we get all this information will help to improve our study rapidly and perfectly.

· Include both what you are going to look at and how you will assess it. Tie this to stakeholder’s needs, program resources, and program goals and objectives.

There are many areas to look at and assess, but we are going to focus on stakeholder’s needs, program resources, and our program goals and objectives. The main areas that we are going to look at is the health issues, social issues, economic issues, policies/legal/procedures, environmental factors, program feasibility and costs, and associated risks; we are going to assess all of these factors differently. Every main areas has a different situation, it more need to be careful to tie these up. Evaluate our program was helpful to consider the main changes we made to selective spinal immobilization. Changing the guidelines for the program should improve the service in future that was the achieved goal to us, besides, carry our program to the community. From our stand of view, we see the program from two sides providers and receivers, while combined those two sides we make attention for the weaknesses to get them useful. To assess the program we need to review and analyze the data of the program in the areas of selective spinal immobilization. Also, we need to identify the strengths and weaknesses after analysis in the selective spinal immobilization, which are operated. this is meant to reduce the large amount of data into a powerful and manageable program. This data should be covering all the areas such as program and health organizations.             

· Include research/evaluation design. How we will obtain the information and how to determine success or failure including standards and comparable.

- We are going to gather the information through a focus group type survey. The survey would engage the medical directors, director of operations, the quality improvement and quality assurance department, EMTs, and Paramedics. The instruments we want to use include: a recording sheet, a structured questionnaire, and a video or audiotape. We want to conduct this assessment face-to-face, so a videotape or audiotape is useful. We are going to ask them questions about our program “Clearance Guideline of Selective Spinal Immobilization” to get feedback to determine our success or failure. In addition, we will make survey to them to evaluate our program. The survey will include some questions about the effective and quality of our program. These questions are the following:

1. How do you see our program, is it impact the guideline of the selective spinal immobilization or the health of patient? For sure if it is applied correctly, it will impact positively and reduce damages and injuries that caused by the random decision of selective spinal immobilization.

2. Do you think, there is a difference before and after the program of clearance guideline of selective spinal immobilization applied? Yes there is a difference after the program is used such as it takes short duration of transportation. Also, saving the equipment to do the spinal immobilization and backboard.

3. Do you think the new guideline of selective spinal immobilization will impact the social issues? Yes, it will impact the social. For example of these impacts may be; the patient may feel more psychologically comfortable knowing that he/she is backboarded and c-collared.

4. Is the new guideline of selective spinal immobilization will impact the economy of the agency?  Yes, it will impact the economy of the agency by saving a lot of equipment that used in selective spinal immobilization.

5. Is the policies/legal/procedures of the new guideline of selective spinal immobilization impact the nature of job? Yes, it will impact the nature of the job through making the procedures easy and clarifying the policies and legal issue.

6. On scale of 1 to 5, how would you rate our program of selective spinal immobilization? The majority rated our program 4.5 out 5. In results, also this determines the success of our program.

- According to our focus group survey, written and practical test for trainers, and quarterly report and evaluation, we are able to determine the success or failure in our program.

- The standards of our program “Clearance Guideline of Selective Spinal Immobilization” fit the requirements and evaluation of the governmental and privacy agencies such as BEMS and CDC. Existing standard of care: based on existing protocols, for both major and minor trauma pre-hospital providers are to use spinal immobilization. Apart from creating ambiguity in the choice to immobilize, the lack of lucidity has the prospective to augment practice unpredictability and may augment liability for pre-hospital suppliers. In practice, pre-hospital providers normally immobilize most clients based on extent of injury alone with extremely little focus on clinical evaluation or presentation. A remote spinal immobilization authorization guideline in minor trauma requires being established.

- There are a lot of comparable programs to our program. For example, there was similar study done in Canada.  This study involved over 1.3 million patients as the whole country participated.  This study proved that with over 1.3 million patients annually less than 1% had a c-spine fracture and less than .5% had a spinal cord injury.  What we should take out from this study is to observe what other countries are doing and how it’s impacting them.  Canada implemented the C-spine rule and now they are benefiting from it; they are saving money, eliminating the overcrowding of the emergency room, and stress on the pre hospital providers.

Referance: Evaluation of the safety of C-spine clearance by paramedics: design and methodology. Vaillancourt et al. 2011, BMC Emergency Medicine, p. 11:1.

· We will be sure to address our process, impact and outcome evaluations.

- Process: there are various stages in the process of our program. First, our program is to achieve changing in the guideline of the selective spinal immobilization. Our goal is to make clearance guideline of selective spinal immobilization, which is clear, specific, and informative. Objectives in our program provide the guidelines for the application of strategic and procedural plans to set new protocol and guideline. Second, before the program is applied, we need to develop the program through gathering information, feedbacks from professional supporters, and previous similar program. Third, we review the limitations, and the key areas of limitations are finance, human resources, materials, power and, machinery. Fourth, after the goal, program developing, and limitation are laid down, our next step in the process is to decide the program period. We found out that two years is long enough to permit the fulfillment of the commitments. Fifth, the most important step in our process is to formulate the policies and strategies. After the goals are defined and program premises are identified, we formulated the policies and strategies of the new clearance guideline of selective spinal immobilization. Sixth, after the formulation of overall operating program, the application of operating the program is started. The program consists of procedures, programmers, schedules, budgets, and rule. Such program is required for the implementation of basic program. Operational program reflects commitments as to methods, time, money, etc. This program is useful in the implementation of long-range programs. Along with the supporting, plans, the timing and sequence of activities is determined to ensure continuity in operations. The final step in our process is the integration of our program. Review and revision may be necessary before the program is put into operation. Moreover, the program must be communicated and explained to those responsible for putting them into practice. The participation and cooperation of subordinates is necessary for successful implementation of the program. Established the program should be reviewed periodically so as to modify and change them whenever necessary.

- Check interventions: We don’t need to make any change in our program currently. We are waiting for feedback, quarterly report, and quarterly evaluation in order to make a decision of making any changes in the program. The program “Clearance Guideline of Selective Spinal Immobilization is going to be used by the Gold Cross agency. By following the new guideline, protocol, procedure, and the policies, they will do it correctly. During training staff section of new guideline of selective spinal immobilization, we offer symbolic gifts, participation certification, and serve food. Therefore, that will motivate the volunteer to participate in the program. The resources of our program include: 9 hours a week, Gold Cross facilities, equipment from Gold Cross, and money obtain from donation and grants for the professional trainer personnel. In fact, we are at the right track and we are doing what we want to occur which is have trained care providers who are able to apply the new guideline of selective spinal immobilization to reduce the damages and injuries that caused by wrong decision of spinal immobilization. Our program needs are covered by Gold Cross, except money, which include: room to train staff, equipment, trainers, and etc. We have got 150 volunteers who have trained on the new guideline of selective spinal immobilization by Jack Meersman and others professional trainers. At the end, we are expecting to have high quality of applying new guideline of selective spinal immobilization. Also, impacting the health, social, and economic positively after two years of implementation of the program.

- Impact: There are Social, Health and Economic Impacts. Social impact: The program impact large amount of the public that wouldn't essentially need to take decision of selective spinal immobilization to be transported to the hospital. Some of these social impacts could be: whether the patient really trusts the judgment call of the EMT or Paramedic.  The patient may feel more psychologically comfortable knowing that he is backboarded and c-collared. Therefore, after applying the program “the new guideline of selective spinal immobilization” for sure is going to be more better for community in terms being more saver and healthier. Health impact: during the time of trauma patient needs the EMTs and Paramedics need to follow a certain criteria and make a judgment call whether they feel like this patient needs spinal immobilization. Putting a patient on a backboard when they don't really need it can cause more damage to the patient, such as: decrease the lung function, airway compromise, and pressure sores in the head & lower back. Economic impact: the program would impact only the economy of agency through saving the equipment of spinal immobilization; saving equipment will result in saving money.

- Outcome: After two years of applying the program, we expecting the outcome of our program are to have trained care providers who can take the correct decision of selective spinal immobilization. Once there are trained care providers that will lead to have less damage and injuries and that will lead to have less programs damage and save lives. In addition, to reduce the high expenses to low expenses that mean maintaining save money and equipment. The long-term outcome is to have better service and effective guideline of selective spinal immobilization.  According to the studies that we have mentioned last time, the new guideline of selective spinal immobilization would improve the current guideline of selective spinal immobilization. By comparing the data from need assessment and current data for sure there will be many differences that would lead to have better service and high standard of care. In terms of satisfaction of stakeholder, target audience, agency, they will be happy because the program and the new guideline will bring positive consequences. In terms of direction, we are still do what we wanted to do but what we need more is promotion of our program.