Recommendation 1:  One Force, One Standard
The Department of Fire and Emergency Medical Services shall transition to a fully integrated, all-hazards agency. 

• Same basic requirements for all EMS and fire personnel through basic training courses, while maintaining various levels of specialization within the force.
• Basic pay and benefits parity between current single-role medical providers and dual-role providers.

Recommendation II: Raise EMS Standards Through Strong Leadership
Reform Department structure to elevate and strengthen the EMS mission.

• Appointment of Assistant Chief for EMS - appoint an Assistant Chief for Emergency Medical Services (EMS) responsible for analysis and planning for all medical units, including strategic planning, budgeting, program evaluation, special operations, and prevention.
• Maintain Medical Director –Medical Director at the rank of Assistant Fire Chief will provide medical oversight for all aspects of emergency medical services provided by FEMS. 
• More EMS Management - increase number of EMS Battalion Chiefs and Captains who are specialized EMS providers at various levels of the agency and update current standards for EMS personnel and protocols.

Recommendation III: Improve Patient Services
Improve the level of compassionate, professional, clinically competent patient care through enhanced training and education, performance evaluation, quality assurance, and employee qualifications and discipline.

• Training and Education - comprehensive training and educational programs for emergency medical technicians and paramedics as well as evaluation of current employee proficiency.
• Performance Evaluations with Excellence in Mind – annual clinical performance evaluation of all personnel with medical certification based on clearly documented protocols for patient care.
• Quality Assurance - institute a comprehensive system to assess quality of EMS service with an eye to improving response time evaluation and overall quality of EMS service.

Recommendation IV: Enhance Emergency Responsiveness
Enhance responsiveness and crew readiness by revising deployment and staffing procedures.

• Response Time Evaluation – 100 percent compliance with National Fire Protection Association Standards to achieve more rapid transport responses.
• Employee Preparedness - consider shorter shifts for all employees and other recommendations to ensure employee alertness.
• Continuity of Service – assign employees to ambulance duty for fixed periods.
• District-wide Coverage - enable an adequate number of units to meet response time targets and provide coverage when any area of the District is short staffed.
• Service Delivery Alternatives – make full range of District vehicles and personnel available for EMS service.

Recommendation V: Improve Public Education and Coordination
Reduce misuse of EMS and delays in patient transfers by ensuring public awareness, interagency coordination and hospital accessibility.

• Patient Outreach and Education –develop a public education program about appropriate use of the 911 system to teach patients with chronic needs about services available to them and how to most efficiently and rapidly get emergency medical services.
• 911 Service Employee Training – ensure that call takers and dispatchers have improved training and enhanced ability to distinguish between emergency and non-emergency medical calls. 
• Hospital Partnerships – District government will meet regularly with local hospitals to clarify and improve issues such as drop times, diversion, and closure, and to improve procedures for tracking patient outcomes.

Recommendation 6: Increased Oversight for Enhanced Enforcement
Strengthen Department of Health (DOH) oversight of emergency medical services.

• Improved Oversight of Emergency Service Providers - draft legislation or regulations or other administrative actions to improve oversight of all EMS providers and ambulance companies in the District of Columbia to include certification and reporting requirements through DOH. 
• Adoption of National Transportation Standards – immediate adoption of the National Highway Traffic Safety Administration standards for EMS certification at all levels of training and as the minimum standard for the District of Columbia.