EmailMeForm
2021 Quality and Safety Course
We are pleased that you are interested in the NAEMSP® Quality and Safety Course.
Thank you for your interest and application.
Full Name (include medical credentials)
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Organization (if any):
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Address
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City, State Zip
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Phone:
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Email
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Medical Service/System
EMS System/Service
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Size of Service
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Service Type
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Your Role
Medical Director
Quality Director
Other
How long have you been practicing/in this current role?
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Confirmation
In order to ensure that participants have the basic infrastructure to develop a meaningful capstone project we are asking that the following course requirements are met.
I confirm that I have access to clinical electronic clinical data reporting.
Click here to confirm statement.
I confirm that I have access to medical and operational leaders.
Click here to confirm statement.
I confirm that I have knowledge and am able to lead change in both clinical and operational practices.
Click here to confirm statement.
I confirm that I will be able to regularly commit blocks of time to participate in monthly 1-2 hour monthly calls, review data and selected literature, plan and execute a capstone project and other assignments.
Click here to confirm statement.
Open-Ended Questions
What data do you currently analyze?
What is on your dashboard?
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Word Limit: 300
Describe your prior experiences with quality improvement in your agency/system.
What were the specific challenges?
How did you address them?
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Word Limit: 300
What do you hope to accomplish in an expanded course?
Are there particular areas that require improvement in your agency (not a commitment)?
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Word Limit: 300
Required Documentation
Upload CV
Add File
Upload Letter of Support.
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Add File
Personally-written letter from your EMS agency, system or local leadership in support of your capstone project, stating you will get support in your efforts on the capstone project.
