AUDIT COMMITTEE SUMMARY
March 19, 2019
Audit of San Antonio Fire Department
EMS Medical Direction and Training Contracts
Report Issued February 20, 2019
Objective
Determine if the SAFD/UT Health EMS Medical Direction and Training contracts are effectively managed to comply with key terms of the interlocal agreements.
Background
SAFD operates the Emergency Medical Services (EMS) providing emergency medical care and ambulance transport to hospital emergency rooms for those determined to be in need.
Part of fulfilling this mission involves the initial training and continuing education completed by SAFD medical personnel. The City of San Antonio contracts with UT Health Science Center (UT Health) to provide EMS training oversight and paramedic training to firefighters. Currently, the City has two agreements with UT Health to accomplish these goals.
The EMS Medical Control and Training Agreement was created to ensure SAFD Emergency Medical Technicians (EMT) obtained professional training and continuing education at all levels from qualified instructors. The EMS Medical Direction Agreement was created to ensure that a licensed and board certified Texas physician will act as SAFD’s Medical Director and is available at any time to respond to EMS personnel.
Scope & Methodology
The audit scope was from October 1, 2017 to June 30, 2018.
We interviewed SAFD EMS personnel, SAFD fiscal personnel, and the UT Health’s Emergency Health Services personnel. To establish our testing criteria, we reviewed the EMS Medical Control and Training agreement and the EMS Medical Direction agreement.
We visited classrooms, labs, and training facilities used for initial and continuing education. We reviewed supporting documentation of reimbursement requests submitted by UT Health for completeness, accuracy, and reasonableness.
Furthermore, we reconciled all new SAFD cadets to UT Health’s training records to verify that all cadets are actively licensed through the Texas Department of State Health Services.
Conclusion
SAFD is working with the UT Health Science Center (UT Health) to ensure that both initial emergency medical training and continuing education training for EMS personnel is being performed. UT Health’s national registry pass rates for SAFD personnel for the past three years are above 94%. All UT Health instructors assigned to the SAFD training program have the required licenses and certifications. Finally, we verified that the UT Health’s programs are meeting the Texas Department of State Health Services course standards and that field audits of SAFD personnel ensure that new cadets are being monitored for proper field skills.
However, there are opportunities to strengthen the controls associated with SAFD’s reimbursement process of UT Health’s invoices and monitoring the EMS training program for continuous improvement.
We recommend SAFD Management:
• Ensure that all non-payroll expenses submitted by UT Health are reviewed and supported by proper documentation prior to payment.
• Implement monitoring controls to ensure that all contract requirements are completed. Additionally, SAFD Management should establish and report performance measures to adequately assess the training program which includes student pass/fail rate, student performance in the field, employee tenure, and turnover rates.
Fire Department Management agreed with the audit findings and has developed positive action plans to address them.