Consent 1.F.
City Council Regular Business Meeting
- Meeting Date:
- 01/26/2026
- TITLE
- Approval of American Heart Association - endorsed Resuscitation Quality Improvement Program
- PRESENTED BY:
- Sara Naylor
- Department:
- Fire
Presentation:
No
Legal Review:
Yes
Project Number:
N/A
RECOMMENDATION
Approve the transition from the current instructor-led CPR, ACLS, and PALS training model to the American Heart Association–endorsed Resuscitation Quality Improvement (RQI) program for Billings Fire Department personnel.
EXECUTIVE SUMMARY
The Billings Fire Department provides advanced life support services across the City of Billings, where rapid, high-quality resuscitation directly impacts survival and neurological outcomes for cardiac arrest and critically ill patients. CPR, ACLS, and PALS competencies are among the most time-sensitive and high-risk skills performed by fire-based EMS providers.
The Department’s current training model relies on centralized, instructor-led renewal events conducted on a biennial or alternating-year cycle. While this approach satisfies minimum certification requirements, it requires removing entire engine companies from their assigned response areas and redistributing coverage throughout the city to accommodate training schedules.
The proposed RQI program represents a transition from episodic certification events to a continuous, evidence-based training and competency model that allows personnel to maintain required certifications while remaining in their assigned response areas.
The Department’s current training model relies on centralized, instructor-led renewal events conducted on a biennial or alternating-year cycle. While this approach satisfies minimum certification requirements, it requires removing entire engine companies from their assigned response areas and redistributing coverage throughout the city to accommodate training schedules.
The proposed RQI program represents a transition from episodic certification events to a continuous, evidence-based training and competency model that allows personnel to maintain required certifications while remaining in their assigned response areas.
BACKGROUND (Consistency with Adopted Plans and Policies, if applicable)
The American Heart Association has clearly documented that CPR and resuscitation skills degrade rapidly, often within three to six months following traditional classroom-based training. National resuscitation research has demonstrated that infrequent, event-based training does not reliably sustain high-quality psychomotor performance for low-frequency, high-risk events such as cardiac arrest and pediatric resuscitation.
In response, the American Heart Association formally endorses low-dose, high-frequency training models, including RQI, which emphasize:
Frequent short skills assessments
Objective performance measurement
Immediate feedback and remediation
Continuous competency validation rather than single-point testing
AHA-supported data demonstrate that these models improve CPR quality metrics and better align training performance with real-world cardiac arrest care.
Under the current instructor-led system, personnel are consolidated at a single training location, requiring:
Engine companies to be taken out of their assigned response areas
Temporary unit relocation and coverage redistribution
Increased supervisory workload to manage system coverage throughout the day
The RQI model allows personnel to complete required training in short, distributed time blocks without routinely removing entire companies from service. This approach preserves:
Engine company availability
Geographic response balance
Predictable response times
Overall system resiliency
Both major hospitals in Billings transitioned to the RQI training model several years ago. Since implementation, hospital partners have reported measurable improvements in resuscitation performance, including improved return of spontaneous circulation (ROSC) rates. Aligning the Fire Department’s training model with local hospitals strengthens system-wide continuity of care and supports improved patient outcomes from pre-hospital care through hospital resuscitation.
In response, the American Heart Association formally endorses low-dose, high-frequency training models, including RQI, which emphasize:
Frequent short skills assessments
Objective performance measurement
Immediate feedback and remediation
Continuous competency validation rather than single-point testing
AHA-supported data demonstrate that these models improve CPR quality metrics and better align training performance with real-world cardiac arrest care.
Under the current instructor-led system, personnel are consolidated at a single training location, requiring:
Engine companies to be taken out of their assigned response areas
Temporary unit relocation and coverage redistribution
Increased supervisory workload to manage system coverage throughout the day
The RQI model allows personnel to complete required training in short, distributed time blocks without routinely removing entire companies from service. This approach preserves:
Engine company availability
Geographic response balance
Predictable response times
Overall system resiliency
Both major hospitals in Billings transitioned to the RQI training model several years ago. Since implementation, hospital partners have reported measurable improvements in resuscitation performance, including improved return of spontaneous circulation (ROSC) rates. Aligning the Fire Department’s training model with local hospitals strengthens system-wide continuity of care and supports improved patient outcomes from pre-hospital care through hospital resuscitation.
FISCAL EFFECTS
The RQI program represents an incremental cost compared to the current instructor-led model.
Over a two-year cycle:
No new staffing, equipment purchases, or ongoing operational funding is required beyond the quoted program cost.
When evaluated against operational efficiency, reduced system disruption, and improved patient outcomes, the cost difference represents a strategic investment rather than an added burden on the City’s budget.
Over a two-year cycle:
- The current instructor-led model costs approximately $37,226
- The RQI program costs approximately $47,488
- The difference is approximately $10,262 over two years, or $5,131 per year
No new staffing, equipment purchases, or ongoing operational funding is required beyond the quoted program cost.
When evaluated against operational efficiency, reduced system disruption, and improved patient outcomes, the cost difference represents a strategic investment rather than an added burden on the City’s budget.
STAKEHOLDERS
ALTERNATIVES
City Council may:
- Approve; or,
- Not Approve