2024 ODEMSA Agency Info Update

2024 ODEMSA Agency Info Update
Your cooperation and attention to detail in completing this update are immensely appreciated. Together, we are enhancing the efficiency and effectiveness of emergency medical services across our region. Thank you for being an essential part of this effort.

Your Information and Privacy Matters

Please be assured that the information you provide will be instrumental in fostering a more connected and responsive EMS region. It allows hospital infection control staff, EMS liaisons, council staff, board members, and when requested, the Virginia Office of EMS to update their contacts and quickly connect with necessary personnel. The information provided in this agency update will not be shared with sales representatives or sold in any way.

Save and Continue Later

Throughout the process of completing this year's annual update, you now have the option to save your progress. Should you need to pause at any point, you can save your current progress and resume later. Simply complete the page you are on and click "Save" to utilize this feature. You will receive an email with instructions on how to return to your submission.

Understanding the Importance of Every Question

We understand that some of the questions in this form may seem less relevant at first glance. However, we assure you that each piece of information plays a crucial role in enabling us to deliver superior service to you and everyone in our region. Your comprehensive responses are essential in helping us achieve our goal.

Navigating Position Titles

As you fill out the form, you might notice that some roles or titles may not perfectly match the ones within your agency. For instance, if your agency doesn't have a "Training Officer" but has a "Training Assistant" responsible for similar tasks, we kindly ask you to share their contact information. This adjustment ensures that ODEMSA has the correct point of contact for any training-related inquiries, allowing us to maintain effective communication and coordination.

Providing Effective Contact Information

When it comes to contact details, we emphasize the importance of direct contact information over general office or station numbers. Generic station phone numbers do not enable us to contact you promptly. Direct contact details significantly improve our ability to disseminate updates and maintain effective communication. If the form offers fields for both primary and secondary phone numbers, but you have only one number, please input it just once. This helps us streamline our communication process.

Review and Submit

After completing the update, the final page will enable you to review the information you have entered. We strongly advise you to save a copy for your records before submitting. To do this, click the "Print" button at the bottom of the very last page. You can then choose to print a physical copy or save the information as a file. This ensures that you retain a personal copy in addition to the one submitted. It's a valuable precaution in case there are issues with your submission during the process.

Technical Assistance

Should you encounter difficulties progressing to the next page, please make sure to complete the form using a computer rather than a mobile phone. Additionally, it is advised to avoid using Microsoft Edge. We recommend using the latest versions of Chrome or Firefox. If you need further assistance, please REPLY ALL to the email you received or call Ryan Scarborough at (804) 560-3300, extension 104.

Easily Pre-populate Your Form in Just a Few Steps:

By following the steps below, you'll be able to leverage the last year's update to expedite completion.

If your agency name is missing from the drop-down, please email us.

DO NOT ATTEMPT TO BYPASS THE AGENCY NAME OR AUTO-COMPLETE TO ENTER DATA UNLESS ADVISED TO DO SO.

Click Here to Contact Us.
Step2Trigger
Step 1. Select your agency name from the list to auto-fill the agency number. *
Step 2. Click 'Load Agency Data' to automatically populate the form with available information.*
Step 3: Click Next

VDH/OEMS Agency Number:
No leading zeros needed.
Full Agency Name:*
Do not use acronyms or abbreviations
Agency Planning District:*
Agency Phone #:*
Agency Fax #:
Agency Website URL:*
Agency Facebook URL:*

Mailing Address

Please enter or verify your agency's mailing address. Note, you will also need to provide or confirm your physical address on the following page.
Address Line 1 (mail):*
Address Line 2 (mail):
Suite/apartment number
City (mail):*
State (mail):*
Zip (mail):*

Physical Building Address

Please enter or verify your agency's physical address below. If your mailing address is identical to your physical address, you can select the "Same as Mailing Address" option. Note: Selecting this option will overwrite any previously entered information on this page.
Address Line 1 (physical):*
Address Line 2 (physical):
Suite/apartment number
City (physical):*
State (physical):*
Zip (physical):*

Agency Demographics

Please enter the number of providers affiliated with your agency in the spaces provided below.
Number of Emergency Medical Responders (EMR):*
Number of Emergency Medical Technicians (EMT):*
Number of Advanced Emergency Medical Technicians (AEMT):*
Number of Intermediates:*
Number of Paramedics:*
Agency Units/Equipment

This section is designed to assess the number of ambulances your agency operates to understand the unit-to-resident ratio better. Additionally, we aim to identify any specialty units available in the region for planning purposes. Examples of specialty units/equipment include crash trucks, quick response vehicles, bariatric ambulances, or All Terrain Vehicle (ATV) response units, IV pumps, ventilators, among others.
Number of Ambulances Licensed by VDH/OEMS:*
Item 1 QTY
Item 1 Type
Item 1 Unit Number
Item 1 Additional Info
Item 2 QTY
Item 2 Type
Item 2 Unit Number
Item 2 Additional Info
Item 3 QTY
Item 3 Type
Item 3 Unit Number
Item 3 Additional Info
Item 4 QTY
Item 4 Type
Item 4 Unit Number
Item 4 Additional Info
Item 5 QTY
Item 5 Type
Item 5 Unit Number
Item 5 Additional Info
Item 6 QTY
Item 6 Type
Item 6 Unit Number
Item 6 Additional Info

Our agency does not have any specialty equipment or units.
Team 1 >> Team/Group
Team 1 >> Details
Team 2 >> Team/Group
Team 2 >> Details
Team 3 >> Team/Group
Team 3 >> Details
Team 4 >> Team/Group
Team 4 >> Details
Team 5 >> Team/Group
Team 5 >> Details
Team 6 >> Team/Group
Team 6 >> Details

Our agency does not have any specialty teams or groups.

Agency Primary Contact Information

This person is usually the Super User that is listed with the Virginia Office of EMS. As a reminder, when it comes to contact details, we emphasize the importance of direct contact information over general office or station numbers. Direct contact details significantly improve our ability to disseminate updates and maintain effective communication. If there is no secondary phone number please leave it blank. This helps us streamline our communication process.
Primary Contact Full Name:*
Primary Contact Title:*
Primary Contact Phone # (Primary):*
Primary Contact Ext (Primary):
Primary Contact Phone # (Secondary):
Primary Contact Ext (Secondary):
Primary Contact Email:*
example@example.com

Peer Support Contact Info
This contact information is the same as the Agency's Primary Contact.

Click to Auto Fill
Peer Support Contact Full Name:*
Peer Support Contact Title:*
Peer Support Contact Phone #:*
Peer Support Contact Ext:
Peer Support Contact Email:*
example@example.com

Youth Program or Junior Squad Contact Info
This contact information is the same as the Agency's Primary Contact.

Click to Auto Fill
Youth Contact Full Name:*
Youth Contact Title:*
Youth Contact Phone #:*
Youth Contact Ext:
Youth Contact Email:*
example@example.com

EMS for Children (EMSC) Champion Contact Info
This contact information is the same as the Agency's Primary Contact.

Click to Auto Fill
EMSC Contact Full Name:*
EMSC Contact Title:*
EMSC Contact Phone #:*
EMSC Contact Ext:
EMSC Contact Email:*
example@example.com

Mobile Integrated Healthcare/Community Paramedicine Contact Info
This contact information is the same as the Agency's Primary Contact.

Click to Auto Fill
MIH Full Name:*
MIH Contact Title:*
MIH Contact Phone #:*
MIH Contact Ext:
MIH Contact Email:*
example@example.com

Emergency Manager Info

If your agency operates within a city or county and utilizes the local Emergency Manager, please select "No" and then indicate the specific locality you defer to for city or county emergency management.
Does your agency have an emergency manager? (Refer to the note above for details.)*

YesNo
Enter the entity/locality that handles emergency management for your agency.*
Emergency Manager Full Name:*
Emergency Manager Email:*
example@example.com
Emergency Manager Phone #:*
EM Contact Ext:

EMS Physician (OMD) Contact Info*

Please provide the information below to ensure we can contact your EMS Physician promptly if necessary.
EMS Physician (OMD) Full Name:*
EMS Physician (OMD) Phone # (Primary):*
EMS Physician (OMD) Ext (Primary):
EMS Physician (OMD) Phone # (Secondary):
EMS Physician (OMD) Ext (Secondary):
EMS Physician (OMD) Fax #:
EMS Physician (OMD) Email:*
example@example.com

Business Contact Info

Please provide details for the individual responsible for agency/business. This may include roles such as the President, CEO, Executive Director, etc. Kindly specify the highest-ranking position in your agency that aligns with this category.
This contact information is the same as the Agency's Primary Contact.

Click to Auto Fill
Business Contact Full Name:*
Business Contact Title:*
Business Contact Phone # (Primary):*
Business Contact Ext (Primary):
Business Contact Phone # (Secondary):
Business Contact Ext (Secondary):
Business Contact Email:*
example@example.com

Operational Contact Info

Please provide the contact information for the person responsible for the overall day-to-day operations of your agency, such as the Chief, Operations Officer, Chief of Operations, Vice President of Operations, etc.
This contact information is the same as the Agency's Primary Contact.

Click to Auto Fill
Click ONLY if:

Our agency has no title that fits this category.
Ops Contact Full Name:*
Ops Contact Title:*
Ops Contact Phone # (Primary):*
Ops Contact Ext (Primary):
Ops Contact Phone # (Secondary):
Ops Contact Ext (Secondary):
Ops Contact Email:*
example@example.com

Secondary Operational Contact Info

This contact should be the individual who would assume the responsibilities of the Primary Operational Contact in their absence. Please provide the details of your agency's Vice President, Deputy Chief, Deputy Director, etc., as applicable.
This contact information is the same as the Agency's Primary Contact.

Click to Auto Fill
Click ONLY if:

Our agency has no title that fits this category.
2nd Ops Contact Full Name:*
2nd Ops Contact Title:*
2nd Ops Contact Phone # (Primary):*
2nd Ops Contact Ext (Primary):
2nd Ops Contact Phone # (Secondary):
2nd Ops Contact Ext (Secondary):
2nd Ops Contact Email:*
example@example.com

Training Contact Info

Please provide the contact information for the individual responsible for training within your agency. While they do not need to be a certified Education Coordinator, this should be the person we contact for disseminating information about protocol updates, training materials, or in-person/virtual classes being offered.
This contact information is the same as the Agency's Primary Contact.

Click to Auto Fill
Training Contact Full Name:*
Training Contact Title:*
Training Contact Phone # (Primary):*
Training Contact Ext (Primary):
Training Contact Phone # (Secondary):
Training Contact Ext (Secondary):
Training Contact Email:*
example@example.com
Would your agency be interested in participating in a pilot program focused on training for the care of older adults?*

YesNo

Recruitment & Retention Contact Info

We kindly request that you provide the name and contact information of the individual responsible for recruitment and/or retention within your agency. This individual could hold the position of Membership Chair, Director of Human Resources, or a similar role.
This contact information is the same as the Agency's Primary Contact.

Click to Auto Fill
Click ONLY if:

Our agency has no title that fits this category.
R&R Full Name:*
R&R Title:*
R&R Phone # (Primary):*
R&R Ext (Primary):
R&R Phone # (Secondary):
R&R Ext (Secondary):
R&R Email:*
example@example.com

Optional Follow-up Questions

This will allow us to better understand the impact of the discontinuation of the regional drug box program moving forward.
If your agency currently stocks additional medications, on average how much do you spend annually on these?
With the regional program ending, what is your estimated annual spending on medications for the next fiscal year?
What do you estimate as the initial startup costs for your program, including equipment, software, locks/seals, and any other necessary items?
What are the estimated ongoing costs for your program, covering equipment, software, locks/seals, alarm system monitoring, etc.?
Regarding the funding for this new operational model, how does your agency plan to support it financially?
Will the discontinuation of the regional drug box program affect your agency's response times, operational efficiency, or patient care in any way?
Is there specific support or resources from ODEMSA or other entities that would aid in a smoother transition for your agency?

Drug Box Inventory Point of Contact

Please provide the name and contact details of the individual who will serve as the primary point of contact for the ODEMSA Program Coordinator. This contact will be responsible for addressing inquiries related to drug boxes, including but not limited to, quarterly drug box inventory reports, missing Patient Care Reports (PCRs), signature inquiries, issues related to medication waste, and any other concerns pertaining to drug box management.
If your agency has been issued an ODEMSA Regional Drug Box you MUST provide a contact.
This contact information is the same as the Agency's Primary Contact.

Click to Auto Fill
Click ONLY if:

Our agency DOES NOT carry ODEMSA Drug Boxes.
Drug Box Contact Full Name:*
Drug Box Contact Title:*
Drug Box Contact Phone # (Primary):*
Drug Box Contact Ext (Primary):
Drug Box Contact Phone # (Secondary):
Drug Box Contact Ext (Secondary):
Drug Box Contact Email:*
example@example.com

Data Compliance

The data compliance reports are are provided to the Director of OEMS, the Division of Regulation and Compliance Enforcement and the Rescue Squad Assistance Fund (RSAF) grants program. Historically, these reports have been used by the State Financial Assistance Review Committee (FARC) to influence RSAF grant allocations based on compliance levels. It's important to note that OEMS has indicated the return of RSAF funding in Fall 2024.
Data Compliance Date (Hidden)
Data Compliance Ref Month (Hidden)
Data Compliance Score (Hidden)
Data Compliance Status (Hidden)
As of {dataQuality341}, your agency's data compliance score for the month of {dataQuality347} was {dataQuality343}. According to the standards set by the Virginia Office of EMS, this score is considered {dataQuality345}.
Great Job!
Given the current status, your agency's scores are below the acceptable threshold. Would your agency be interested in receiving support to enhance your data compliance score?*

Yes, we would appreciate assistance to improve our score.No, we have identified the issues and are actively working on solutions.No, we prefer to manage the improvements internally.

Electronic Patient Care Records Contact

Please provide the contact details of the individual responsible for administering your agency's ePCRs software.
This contact information is the same as the Agency's Primary Contact.

Click to Auto Fill
PCR Admin Full Name:*
PCR Admin Title (include agency/entity name if outside your agency):*
PCR Admin Phone # (Primary):*
PCR Admin Ext (Primary):
PCR Admin Phone # (Secondary):
PCR Admin Ext (Secondary):
PCR Admin Email:*
example@example.com
Would your agency be interested in participating in a regional workgroup dedicated to data quality, compliance, and best practices for EMS Electronic Patient Care Reports (ePCRs)? This potential initiative aims to unify insights from ePCR software admin, agency leadership, and hospital representatives for the betterment of data handling and usage.*

Yes, we are interested.No, we are not interested at this time.Possibly, we need more information before deciding.

Performance Improvement and Quality Assurance/Improvement (QA/QI) Contact Info

Please provide the contact details of the individual responsible for performance improvement, quality assurance, and/or quality improvement within your agency.
This contact information is the same as the Agency's Primary Contact.

Click to Auto Fill
PI/QA/QI Full Name:*
PI/QA/QI Title:*
PI/QA/QI Phone # (Primary):*
PI/QA/QI Ext (Primary):
PI/QA/QI Phone # (Secondary):
PI/QA/QI Ext (Secondary):
PI/QA/QI Officer Email*
example@example.com

Sub-Council Representative Contact Info

Please provide the contact details of the individual who will represent your agency at the ODEMSA Sub-Council meetings for your planning district. This contact should ideally be involved in decision-making processes or hold a position that allows for comprehensive understanding and communication of your agency's perspectives and needs.
This contact information is the same as the Agency's Primary Contact.

Click to Auto Fill
Sub-Council Rep Full Name:*
Sub-Council Rep Title:*
Sub-Council Rep Phone # (Primary):*
Sub-Council Rep Ext (Primary):
Sub-Council Rep Phone # (Secondary):
Sub-Council Rep Ext (Secondary):
Sub-Council Rep Email:*
example@example.com

Infection Control Officer (Primary DICO) Contact Info

Each agency is required to have a Designated Infection Control Officer. This section allows for the entry of up to three individuals who fulfill this role or contribute to the infection control processes within your agency. Please provide the contact details for each Designated Infection Control Officer.
This contact information is the same as the Agency's Primary Contact.

Click to Auto Fill
Primary DICO Full Name:*
Primary DICO Title:*
Primary DICO Phone # (Primary):*
Primary DICO Ext (Primary):
Primary DICO Phone # (Secondary):
Primary DICO Ext (Secondary):
Primary DICO Email:*
example@example.com
Does your agency have a secondary DICO?:*

YesNo

Infection Control Officer (Secondary DICO) Contact Info
This contact information is the same as the Agency's Primary Contact.

Click to Auto Fill
Secondary DICO Full Name:*
Secondary DICO Title:*
Secondary DICO Phone # (Primary):*
Secondary DICO Ext (Primary):
Secondary DICO Phone # (Secondary):
Secondary DICO Ext (Secondary):
Secondary DICO Email:*
example@example.com
Does your agency have a tertiary DICO?:*

YesNo

Infection Control Officer (Tertiary DICO) Contact Info
This contact information is the same as the Agency's Primary Contact.

Click to Auto Fill
Tertiary DICO Full Name:*
Tertiary DICO Title:*
Tertiary DICO Phone # (Primary):*
Tertiary DICO Ext (Primary):
Tertiary DICO Phone # (Secondary):
Tertiary DICO Ext (Secondary):
Tertiary DICO Email:*
example@example.com

Your Info

So that we can determine who within your agency completed this year's update, please provide your information below.
This contact information is the same as the Agency's Primary Contact.

Click to Auto Fill
Your Full Name:*
Your Title:*
Your Phone #:*
Your Ext:
Your Email:*
example@example.com
OPTIONAL: If there's any further information about your agency that you believe is relevant but wasn't specifically requested, or if there are details you wish to clarify, please use the text box below to share. This could include unique operational practices, innovative programs, or specific challenges your agency is facing.
Finishing Up

Thank you for your patience and diligence in completing this form. We're pleased to inform you that, based on the information you've provided today, we'll be able to pre-populate nearly all sections for you next year, making the process much smoother and faster!
Please click the button below to review and submit your agency update.

After completing the update, the final page will enable you to review the information you've provided. We recommend saving a copy for your records before submitting. To do this, click the "Print" button at the bottom of the next page. You can then choose to print a physical copy or save the information as a file. This ensures that you retain a personal copy in addition to the one submitted. It's a valuable precaution in case there are issues with your submission during the process.
Should be Empty:

	Qty	Item Type	Unit Number	Additional Info
Item 1
Item 2
Item 3
Item 4
Item 5
Item 6

	Team/Group	Details
Team 1
Team 2
Team 3
Team 4
Team 5
Team 6

2024 ODEMSA Agency Info Update

Your Information and Privacy Matters

Save and Continue Later

Understanding the Importance of Every Question

Navigating Position Titles

Providing Effective Contact Information

Review and Submit

Technical Assistance

Easily Pre-populate Your Form in Just a Few Steps:

Step 3: Click Next

Mailing Address

Physical Building Address

Agency Demographics

Agency Units/Equipment

Additional Information

Meetings and Programs

Agency Primary Contact Information

EMS Student Clinical Rotations Details

Peer Support Contact Info

Youth Program or Junior Squad Contact Info

EMS for Children (EMSC) Champion Contact Info

Mobile Integrated Healthcare/Community Paramedicine Contact Info

Emergency Manager Info

EMS Physician (OMD) Contact Info*

Business Contact Info

Operational Contact Info

Secondary Operational Contact Info

Training Contact Info

Recruitment & Retention Contact Info

Regional Drug Box Details

Optional Follow-up Questions

Drug Box Inventory Point of Contact

Data Compliance

Great Job!

NEMSIS 3.4 to 3.5 Rollout

Electronic Patient Care Records Contact

Performance Improvement and Quality Assurance/Improvement (QA/QI) Contact Info

Sub-Council Representative Contact Info

Infection Control Officer (Primary DICO) Contact Info

Infection Control Officer (Secondary DICO) Contact Info

Infection Control Officer (Tertiary DICO) Contact Info

Last Questions (You're Almost Done!)

Evaluation of Services

Regional Council SWOT Analysis

Your Info

Finishing Up