CAAS | GVS V3.0 Draft for Public Comment #2
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Author: AAA Staff
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Ukraine Relief | OSF Healthcare System
OSF Healthcare System of Peoria, Illinois, is working to organize donations of medical supplies and retired ambulances for Ukraine. Most recently, they were able to send 350 pallets of cargo in addition to an ambulance to assist.
If your organization would like to participate, please reach out to Christopher Manson, Vice President of Government Relations, at Christopher.M.Manson@osfhealthcare.org.
Our thoughts are with all those impacted by this tragic conflict.
NACIDD & NACSD | Public Meetings 4/1 & 4/6
From ASPR on March 31, 2022
The National Advisory Committee on Seniors and Disasters (NACSD) and the National Advisory Committee on Individuals with Disabilities and Disasters (NACIDD) will soon host public meetings of these two advisory committees.
The next NACIDD meeting takes place on Friday, April 1 from 11:30 a.m. to 2:30 p.m. ET and the next NACSD meeting is on Wednesday, April 6 from 11:00 a.m. to 2:00 p.m. ET.
Join board members, distinguished guests, federal leaders, and other experts to discuss the challenges, opportunities, and priorities in meeting the unique health needs of older adult populations and people with disabilities during and after disasters and public health emergencies.
Advanced registration for these meetings is required and can be accessed, along with additional meeting agendas and public information, through the online event pages for the NACIDD and NACSD.
The agendas for each of the next meetings include time to hear from the public. The floor will be open to hear as many relevant comments as possible. To learn how to request a speaking time, please visit each committee’s event page. You can send questions about the NACSD to NACSD@hhs.gov and questions about the NACIDD to NACIDD@hhs.gov.
HHS PRF | EMS Funding Letter to Secretary Becerra
March 24, 2022
The Honorable Xavier Becerra
Secretary of Health and Human Services
Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201
Dear Secretary Becerra:
Ground ambulance service organizations and fire departments continue to struggle financially from the enduring economic effects of the COVID-19 public health emergency (PHE). Our respective members face sharp increases in the costs of fuel, equipment, medical supplies, and staffing as we deal with a severe shortage of paramedics and emergency medical technicians (EMTs) which has been an issue for years but exacerbated by the pandemic. We implore you to help ensure communities around the country have access to 9-1-1 emergency and non-emergency ground ambulance services through the remainder of the PHE and beyond with an infusion of $350 million from returned and/or unspent money in the Provider Relief Fund (PRF).
We greatly appreciate the funding that ground ambulance service organizations and fire departments have already received from the PRF. The funds have been a lifeline for many of our respective members and their ability to continue to serve their communities. However, as the Phase 4 distribution of funds demonstrated, more funding is needed for ground ambulance services. Our members indicate the funds they received in Phase 4 covered approximately 50% of their lost reimbursement and increased costs from July 1, 2020, to March 31, 2021, whereas previous distributions were closer to 88%. We therefore respectfully request an immediate distribution of $350 million or 10% of the annual Medicare expenditure on ground ambulance services.
We request that the funds be distributed in a similar manner as the Tranche 1 distribution from the PRF. The automatic, across-the-board deposit of funding was especially helpful for small and rural ground ambulance service organizations. These rural organizations provide care in underserved areas and are often daunted even by an abbreviated application process. To ensure equity for all communities, we support universal direct deposit.
Additionally, we encourage HHS to make these payments based on the National Provider Identification (NPI) number of the ground ambulance service organization or fire department rather than Tax ID Number (TIN). In the case of moderate and large cities, many municipal departments may share a TIN while maintaining distinct NPIs. Providing these payments according to TIN may unintentionally comingle funds intended for different departments such as fire departments, public health departments, and local government-run hospitals or clinics.
The American Ambulance Association (AAA), International Association of Fire Chiefs (IAFC), International Association of Fire Fighters (IAFF), National Association of Emergency Medical Technicians (NAEMT), and National Volunteer Fire Council (NVFC) represent the providers of vital emergency and non-emergency ground ambulance services and the paramedics, EMTs and firefighters who deliver the direct medical care and transport for every community across the United States.
Our members take on substantial risk every day to treat, transport, and test potential COVID-19 patients, and play a vital role in providing vaccinations to individuals in their homes. Ground ambulance service organizations and fire departments, however, urgently need the additional
$350 million to help offset the increased costs and lower reimbursement resulting from our vital response to the pandemic.
Thank you in advance for your consideration of this request.
Sincerely,
American Ambulance Association
International Association of Fire Chiefs
International Association of Fire Fighters
National Association of Emergency Medical Technicians
National Volunteer Fire Council
NASEMSO | Model EMS Clinical Guidelines v3
From NASEMSO on March 23, 2022
Overview
The National Model EMS Clinical Guidelines Project was first initiated by NASEMSO in 2012 and has produced three versions of model clinical guidelines for EMS: the first in 2014, a revision 2017, and now this third version in 2022. The guidelines were created as a resource to be used or adapted for use on a state, regional or local level to enhance prehospital patient care and can be viewed here. These model protocols are offered to any EMS entity that wishes to use them, in full or in part. The model guidelines project has been led by the NASEMSO Medical Directors Council in collaboration with six national EMS physician organizations, including: American College of Emergency Physicians (ACEP), National Association of EMS Physicians (NAEMSP), American Academy of Emergency Medicine (AAEM), American Academy of Pediatrics, Committee on Pediatric Emergency Medicine (AAP-COPEM), American College of Surgeons, Committee on Trauma (ACS-COT) and Air Medical Physician Association (AMPA). Co-Principal Investigators, Dr. Carol Cunningham and Dr. Richard Kamin, led the development of all three versions. Countless hours of review and edits are contributed by subject matter experts and EMS stakeholders who responded with comments and recommendations during the public comment period.
NASEMSO gratefully acknowledges the Technical Expert Panel, the Technical Reviewers, and many others who volunteered their time and talents to ensure the success of this project.
The comprehensive review and revision of these guidelines was made possible by funding support from the National Highway Traffic Safety Administration Office of EMS and the Health Resources and Services Administration Maternal and Child Health Bureau EMS for Children Program.
For More Information
Andy Gienapp, MS, NRP
Deputy Executive Director
andy@nasemso.org
HHS IEA | COVID-19 Update for March 21, 2022
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HHS Office of Intergovernmental and External Affairs COVID-19 Update for
March 21, 2022 |
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Marvin B. Figueroa, Director
U.S. Department of Health and Human Services
Intergovernmental and External Affairs 200 Independence Ave., S.W. Washington, D.C. 20201 |
Connect With Us     |
HHS OIG Report on Telehealth for Medicare Beneficiaries in COVID-19
From HHS Office of Inspector General on March 15, 2022
Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19 Pandemic
WHY WE DID THIS STUDY
The COVID-19 pandemic created unprecedented challenges for how Medicare beneficiaries accessed health care. In response, the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) took a number of actions to temporarily expand access to telehealth for Medicare beneficiaries. CMS allowed beneficiaries to use telehealth for a wide range of services; it also allowed beneficiaries to use telehealth in different locations, including in urban areas and from the beneficiary’s home.
This data brief provides insight into the use of telehealth in both Medicare fee-for-service and Medicare Advantage during the first year of the COVID-19 pandemic, from March 2020 through February 2021. It is a companion to a report that examines the characteristics of beneficiaries who used telehealth during the pandemic. Another report in this series identifies program integrity concerns related to telehealth during the pandemic. Understanding the use of telehealth during the first year of the pandemic can shed light on how the temporary expansion of telehealth affected where and how beneficiaries accessed their health care. This information can help CMS, Congress, and other stakeholders make decisions about how telehealth can be best used to meet the needs of beneficiaries in the future.
HOW WE DID THIS STUDY
We based this analysis on Medicare fee-for-service claims data and Medicare Advantage encounter data from March 1, 2020, to February 28, 2021, and from the prior year, March 1, 2019, to February 29, 2020. We used these data to determine the total number of services used via telehealth and in-person, as well as the types of services used. We also compared the number of services used via telehealth and in-person during the first year of the pandemic to those used in the prior year.
WHAT WE FOUND
Over 28 million Medicare beneficiaries used telehealth during the first year of the pandemic. This was more than 2 in 5 Medicare beneficiaries. In total, beneficiaries used 88 times more telehealth services during the first year of the pandemic than they used in the prior year. Beneficiaries’ use of telehealth peaked in April 2020 and remained high through early 2021. Overall, beneficiaries used telehealth to receive 12 percent of their services during the first year of the pandemic. Beneficiaries most commonly used telehealth for office visits, which accounted for just under half of all telehealth services used during the first year of the pandemic. However, beneficiaries’ use of telehealth for behavioral health services stands out. Beneficiaries used telehealth for a larger share of their behavioral health services compared to their use of telehealth for other services. Specifically, beneficiaries used telehealth for 43 percent of behavioral health services, whereas they used telehealth for 13 percent of office visits.
WHAT WE CONCLUDE
Telehealth was critical for providing services to Medicare beneficiaries during the first year of the pandemic. Beneficiaries’ use of telehealth during the pandemic also demonstrates the long-term potential of telehealth to increase access to health care for beneficiaries. Further, it shows that beneficiaries particularly benefited from the ability to use telehealth for certain services, such as behavioral health services. These findings are important for CMS, Congress, and other stakeholders to take into account as they consider making changes to telehealth in Medicare. For example, CMS could use these findings to inform changes to the services that are allowed via telehealth on a permanent basis.
House Passes MedPAC Ambulance Report Delay
Last night, the United States Senate passed language as part of the FY 2022 Omnibus Appropriations Package that would delay the due date of the Medicare Payment Advisory Committee (MedPAC) report analyzing ambulance cost data. The U.S. House of Representatives had passed the package on Wednesday. The delay in the MedPAC report is a victory for the AAA and our members as we spearheaded efforts for the delay.
We thank Senators Chuck Schumer, Catherine Cortez Masto, Ron Wyden, Mike Crapo and Debbie Stabenow and Representatives Richard Neal, Kevin Brady, Frank Pallone and Catherine McMorris Rogers for championing and assisting with passage of the provision.
The delay in the timing of the MedPAC report was necessary due to CMS postponing the beginning of ambulance cost data collection by two years to account for the COVID-19 pandemic. Even though data collection had been delayed, MedPAC indicated that they were compelled to stick to the statutory deadline of issuing a report – with very little or no new ambulance data – to Congress by March 15, 2023.
With little to no new data, MedPAC would have likely reinstated their recommendations from their 2002 ambulance report which did support most of the temporary ambulance increases but at the cost of cutting BLS non-emergency services by 5.75%. MedPAC had also recommended doing away with rural and super rural increases in favor of a low volume adjuster which would disrupt reimbursement levels for rural providers without having more detailed data if indeed the proper approach.
The language from the FY2022 Omnibus Appropriations Package is as follows:
SEC. 311. REVISION OF THE TIMING OF MEDPAC REPORT ON AMBULANCE COST DATA.
Section 1834(l)(17)(F)(i) of the Social Security Act (42 U.S.C. 1395m(l)(17)(F)(i)) is amended by striking ‘‘Not later than March 15, 2023, and as determined necessary by the Medicare Payment Advisory Commission thereafter’’ and inserting ‘‘Not later than the second June 15th following the date on which the Secretary transmits data for the first representative sample of providers and suppliers of ground ambulance services to the Medicare Payment Advisory Commission, and as determined necessary by such Commission thereafter,’’.
Next week, we will be launching a Call to Action asking AAA members to reach out to their members of Congress to cosponsor the Protecting Access to Ground Ambulance Medical Services Act (H.R. 2454, S. 2037) Medicare Ambulance which would extend the temporary Medicare ambulance increases for five years. The increases expire at the end of this year and the five-year extension is necessary to provide time for the MedPAC report and the Congress to act.
Brave of Heart Scholarship
The Brave of Heart Fund was founded in May 2020 by the Foundations of Cigna and New York Life and administered by E4E Relief. It was established to provide charitable grants and emotional support services to families of frontline healthcare workers, volunteers, and support staff whose lives were lost in the fight against COVID-19.
Now, the Brave of Heart Fund continues to honor the hard work and sacrifice of healthcare workers and their families via scholarship funding for their spouses, domestic partners, and children.
Applications are now being accepted online.
Up to $25,000.00 annually is available in scholarship funding, depending on an eligible applicant’s academic focus, student status, and other criteria.
Eligible Applicants
- Must be a spouse, domestic partner, or child of a healthcare worker, volunteer, or support staff whose life was lost in the fight against COVID-19.
- Must plan to enroll in accredited studies at the undergraduate or graduate levels, in community college, or in vocational and technical schools.
- May be non-traditional students and individuals enrolled in part-time coursework.
- Do not have to be previous recipients of Brave of Heart Fund grants; recipients of previous grant funding are also still eligible.
Application Deadline
For Fall 2022 semester scholarships:
April 20, 2022
3:00PM Central Standard Time
HRSA eNews | Expanding Health Care Access and Resources in Underserved Populations,
| HRSA eNews March 3, 2022 |
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In his State of the Union address, President Biden announced an ambitious strategy to address our national mental health crisis. At the Health Resources and Services Administration, we stand with the President in his call for unity in our national response and know that for the millions of Americans living with a mental health condition or caring for a loved one with a mental health condition, the time for action is now.
In February, HRSA announced the winners of the Promoting Pediatric Primary Prevention Challenge, $66.5 million to support community-based vaccine outreach efforts, more than $560 million in pandemic relief payments to health care providers, funding to increase virtual care quality and access, and new funding to support primary care residency programs.
With this funding, nearly $19 billion will have been distributed from the Provider Relief Fund and the American Rescue Plan Rural provider funding since November 2021
Our 
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Climate change influences human health and diseases in numerous ways. Underserved communities stand to bear the brunt of these climate-induced risks (e.g., extreme heat, poor air quality, flooding, extreme weather events). HRSA and CDC’s Climate and Health Program invite you to consider the impacts of climate change on the U.S. health care system. CDC will share its work to build resilience to these public health effects.
Patient Safety Awareness Week is March 13-19. We are hosting an event in partnership with the Agency for Healthcare Research and Quality (AHRQ), the Centers for Disease Control and Prevention (CDC), the Centers for Medicare & Medicaid Services (CMS), the Food and Drug Administration (FDA), the Indian Health Service (IHS), and the National Institutes of Health (NIH).
Children’s mental health continues to be a top priority for state leaders across both legislative and executive branches of state government. With COVID-19 exacerbating the challenges children are facing, there is much more work to be done.
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House Energy & Commerce Hearing on COVID-19 Frontlines
On March 2, the House Energy and Commerce Subcommittee on Oversight and Investigations held a hearing on “Lessons from the Frontline: COVID-19’s Impact on American Health Care.” Subcommittee Chair Diane DeGette (D-CO) and members Lorie Trahan (D-MA) and Tom O’Halleran (D-AZ) referenced the important role of EMS during their comments. The AAA submitted written comments for the hearing record requesting that the Subcommittee help address the EMS workforce shortage, access to grant funding for all EMS provider types and stability with funding for ground ambulance services. Here is a link should you want to watch a recording of the hearing.
NAEMT | Quick Survey on EMS Utilization of COVID-19 Waivers
EMS Utilization of COVID-19 Waiver Survey
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VHA Office of Community Care Overview
In this series of live webinars provider participants will receive an overview of Community Care which includes the background on Community Care programs and the corresponding VA regulations. In-dept discussions on topics from referrals and authorizations, authorized emergency and unauthorized emergency care, urgent care, claims, and more. This webinar will take place in February, April, June, and August in 2022.
Prior to the webinar, please send any questions you have to vha13communitycaresupportstaff@va.gov +
Mar 17, 2022
1:00 pm EST
Apr 21, 2022
1:00 pm EST
May 19, 2022
1:00 pm EST
Jun 16, 2022
1:00 pm EST
Jul 21, 2022
1:00 pm EST
Aug 18, 2022
1:00 pm EST
Sep 15, 2022
1:00 pm EST
FAIR Health | Ground Ambulance Services in the United States
From FAIR Health in February 2022
“Currently, no federal law protects consumers against “surprise” bills from out-of-network ground ambulance providers. Some state and local governments regulate ground ambulance surprise billing practices; however, such laws may not apply to all health plans or ambulance providers in an area. Because of the substantial policy interest in ground ambulance services, FAIR Health drew on its vast database of private healthcare claims to illuminate multiple aspects of such services across the nation, including utilization, costs, age, gender, diagnoses and differences across states.”
CoAEMSP | Now Accepting Applications for Site Visitors
EMS1 Webinar | Navigating a path to career satisfaction
Limited options for professional growth and the lack of a clear career path are barriers to recruitment, retention and career longevity.
The EMS Burnout Repair Kit series, presented by EMS1 and Zoll, equips individuals at all levels in EMS with tools for dealing with the primary sources of burnout, helping them emerge as better, happier providers and more complete people.
In this installment, a panel comprised of individuals representing different career paths in EMS and leaders from progressive agencies will discuss resources for career advancement and resiliency, how to find the path that is right for you, and how agencies can support providers in advancing their careers.
Join the live discussion, March 1 at 1 p.m. CT
Meet the speakers
Carly Alley
Carly Alley is the executive director for Riggs Ambulance Service in Merced, California. Earlier in her career, Alley served as a firefighter-EMT in the U.S. Forest Service while earning her paramedic certification. After being hired by Riggs, she transitioned to the agency’s tactical EMS program, where she spent 10 years as the team leader before moving into administration.
Michael Fraley, BS, BA, NRP
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Michael Fraley has over 25 years of experience in EMS in a wide range of roles, including flight paramedic, EMS coordinator, service director and educator. Fraley began his career in EMS while earning a bachelor’s degree at Texas A&M University. He also earned a BA in business administration from Lakeland College.
When not working as a paramedic or the coordinator of a regional trauma advisory council, Michael serves as a public safety diver and SCUBA instructor in northern Wisconsin.
John (JP) Peterson, MS, MBA
JP Peterson is the newly appointed executive director at Mecklenburg EMS Agency (MEDIC) in Charlotte, North Carolina. He started his career as an EMT in Chicago in 2000 and most recently served as vice president of Florida operations for PatientCare EMS Solutions.
He is licensed as a paramedic in Florida and North Carolina, and holds National Board Certification as an occupational therapist. He has completed Six Sigma Yellow Belt certification and is a graduate of the American Ambulance Association, Ambulance Service Manager Course. JP received the Pinellas County Commissioner, John Morroni Award for first responders in 2013.
JP is a past president of the Florida Ambulance Association. He is a member of the North Carolina Association of EMS Administrators as well as the AAA Bylaws, Professional Standards and Ethics committees.
NEMSAC | National EMS Advisory Council Meeting Webcast March 2–3
The National EMS Advisory Council will be holding a virtual meeting on Wednesday and Thursday, March 2-3. Members of the public can register for the webcast here.
NEMSAC meets several times each year to discuss issues facing the EMS community and provide advice and recommendations regarding EMS to the National Highway Traffic Safety Administration in the Department of Transportation and to the Federal Interagency Committee on EMS.
The agenda for each day includes time for NEMSAC subcommittee deliberations in the morning, with the webcast council meeting convening at 12:00 pm ET on Wednesday, March 2, 2022, and 1 pm ET on Thursday, March 3, 2022. Items on the council’s agenda include:
– FICEMS COVID-19 Response
– National Suicide Hotline Update
– Reviewing the Need for EMS and Obstetric Collaboration
– Rural, Tribal and Frontier EMS Challenges
– Improving Stroke Triage and Transport Protocols for EMS
– Public Comment
Individuals registered for the meeting interested in addressing the council during the public comment periods must submit their comments in writing to Clary Mole at clary.mole@dot.gov by 5pm ET on February 24, 2022.
This meeting will be open to the public. NHTSA is committed to provide equal access to this meeting for all program participants. Persons with disabilities in need of an accommodation should send your request to Clary Mole by phone at (202) 868-3275 or by email at Clary.Mole@DOT.gov no later than February 24, 2022. A sign language interpreter will be provided, and closed captioning services will be provided for this meeting through the WebEx virtual meeting platform.
National Emergency Medical Services Advisory Council Notice of Public Meeting This notice announces a meeting of the National Emergency Medical Services Advisory Council (NEMSAC).
2/17 | ASPR National Advisory Committee on Children and Disasters
From ASPR on February 14, 2022
The NACCD will conduct an inaugural public meeting (virtual) on February 17, 2022. The new advisory committee will be sworn in along with the presentation and discussion of challenges, opportunities, and priorities for national public health and medical preparedness, response and recovery, specific to the needs of children and their families in disasters.
Members of the public may attend the meeting via Zoom teleconference, which requires pre-registration, and may provide written comments, submit questions to the NACCD, and provide comments after the meeting by email to NACCD@hhs.gov.
Lights & Siren Vehicle Operations on Emergency Medical Services (EMS) Responses
Joint Statement on Lights & Siren Vehicle Operations on Emergency Medical Services (EMS) Responses
February 14, 2022
Douglas F. Kupas, Matt Zavadsky, Brooke Burton, Shawn Baird, Jeff J. Clawson, Chip Decker, Peter Dworsky, Bruce Evans, Dave Finger, Jeffrey M. Goodloe, Brian LaCroix, Gary G. Ludwig, Michael McEvoy, David K. Tan, Kyle L. Thornton, Kevin Smith, Bryan R. Wilson
Download PDF Position Statement
The National Association of EMS Physicians and the then National Association of State EMS Directors created a position statement on emergency medical vehicle use of lights and siren in 1994 (1). This document updates and replaces this previous statement and is now a joint position statement with the Academy of International Mobile Healthcare Integration, American Ambulance Association, American College of Emergency Physicians, Center for Patient Safety, International Academies of Emergency Dispatch, International Association of EMS Chiefs, International Association of Fire Chiefs, National Association of EMS Physicians, National Association of Emergency Medical Technicians, National Association of State EMS Officials, National EMS Management Association, National EMS Quality Alliance, National Volunteer Fire Council and Paramedic Chiefs of Canada.
In 2009, there were 1,579 ambulance crash injuries (2), and most EMS vehicle crashes occur when driving with lights and siren (L&S) (3). When compared with other similar-sized vehicles, ambulance crashes are more often at intersections, more often at traffic signals, and more often with multiple injuries, including 84% involving three or more people (4).
From 1996 to 2012, there were 137 civilian fatalities and 228 civilian injuries resulting from fire service vehicle incidents and 64 civilian fatalities and 217 civilian injuries resulting from ambulance incidents. According to the
U.S. Fire Administration (USFA), 179 firefighters died as the result of vehicle crashes from 2004 to 2013 (5). The National EMS Memorial Service reports that approximately 97 EMS practitioners were killed in ambulance collisions from 1993 to 2010 in the United States (6).
Traffic-related fatality rates for law enforcement officers, firefighters, and EMS practitioners are estimated to be 2.5 to 4.8 times higher than the national average among all occupations (7). In a recent survey of 675 EMS practitioners, 7.7% reported being involved in an EMS vehicle crash, with 100% of those occurring in clear weather and while using L&S. 80% reported a broadside strike as the type of MVC (8). Additionally, one survey found estimates of approximately four “wake effect” collisions (defined as collisions caused by, but not involving the L&S operating emergency vehicle) for every crash involving an emergency vehicle (9).
For EMS, the purpose of using L&S is to improve patient outcomes by decreasing the time to care at the scene or to arrival at a hospital for additional care, but only a small percentage of medical emergencies have better outcomes from L&S use. Over a dozen studies show that the average time saved with L&S response or transport ranges from 42 seconds to 3.8 minutes. Alternatively, L&S response increases the chance of an EMS vehicle crash by 50% and almost triples the chance of crash during patient transport (11). Emergency vehicle crashes cause delays to care and injuries to patients, EMS practitioners, and the public. These crashes also increase emergency vehicle resource use through the need for additional vehicle responses, have long-lasting effects on the reputation of an emergency organization, and increases stress and anxiety among emergency services personnel.
Despite these alarming statistics, L&S continue to be used in 74% of EMS responses, and 21.6% of EMS transports, with a wide variation in L&S use among agencies and among census districts in the United States (10).
Although L&S response is currently common to medical calls, few (6.9%) of these result in a potentially lifesaving intervention by emergency practitioners (12). Some agencies have used an evidence-based or quality improvement approach to reduce their use of L&S during responses to medical calls to 20-33%, without any discernable harmful effect on patient outcome. Additionally, many EMS agencies transport very few patients to the hospital with L&S.
Emergency medical dispatch (EMD) protocols have been proven to safely and effectively categorize requests for medical response by types of call and level of medical acuity and urgency. Emergency response agencies have successfully used these EMD categorizations to prioritize the calls that justify a L&S response. Physician medical oversight, formal quality improvement programs, and collaboration with responding emergency services agencies to understand outcomes is essential to effective, safe, consistent, and high-quality EMD.
The sponsoring organizations of this statement believe that the following principles should guide L&S use during emergency vehicle response to medical calls and initiatives to safely decrease the use of L&S when appropriate:
- The primary mission of the EMS system is to provide out-of-hospital health care, saving lives and improving patient outcomes, when possible, while promoting safety and health in communities. In selected time-sensitive medical conditions, the difference in response time with L&S may improve the patient’s
- EMS vehicle operations using L&S pose a significant risk to both EMS practitioners and the public. Therefore, during response to emergencies or transport of patients by EMS, L&S should only be used for situations where the time saved by L&S operations is anticipated to be clinically important to a patient’s outcome. They should not be used when returning to station or posting on stand-by
- Communication centers should use EMD programs developed, maintained, and approved by national standard-setting organizations with structured call triage and call categorization to identify subsets of calls based upon response resources needed and medical urgency of the call. Active physician medical oversight is critical in developing response configurations and modes for these EMD protocols. These programs should be closely monitored by a formal quality assurance (QA) program for accurate use and response outcomes, with such QA programs being in collaboration with the EMS agency physician medical
- Responding emergency agencies should use response based EMD categories and other local policies to further identify and operationalize the situations where L&S response or transport are clinically Response agencies should use these dispatch categories to prioritize expected L&S response modes. The EMS agency physician medical director and QA programs must be engaged in developing these agency operational policies/guidelines.
- Emergency response agency leaderships, including physician medical oversight and QA personnel should monitor the rates of use, appropriateness, EMD protocol compliance, and medical outcomes related to L&S use during response and patient
- Emergency response assignments based upon approved protocols should be developed at the local/department/agency level. A thorough community risk assessment, including risk reduction analysis, should be conducted, and used in conjunction with local physician medical oversight to develop and establish safe response
- All emergency vehicle operators should successfully complete a robust initial emergency vehicle driver training program, and all operators should have required regular continuing education on emergency vehicle driving and appropriate L&S
- Municipal government leaders should be aware of the increased risk of crashes associated with L&S response to the public, emergency responders, and patients. Service agreements with emergency medical response agencies can mitigate this risk by using tiered response time expectations based upon EMD categorization of calls. Quality care metrics, rather than time metrics, should drive these contract
- Emergency vehicle crashes and near misses should trigger clinical and operational QA reviews. States and provinces should monitor and report on emergency medical vehicle crashes for better understanding of the use and risks of these warning devices.
- EMS and fire agency leaders should work to understand public perceptions and expectations regarding L&S use. These leaders should work toward improving public education about the risks of L&S use to create safer expectations of the public and government
In most settings, L&S response or transport saves less than a few minutes during an emergency medical response, and there are few time-sensitive medical emergencies where an immediate intervention or treatment in those minutes is lifesaving. These time-sensitive emergencies can usually be identified through utilization of high-quality dispatcher call prioritization using approved EMD protocols. For many medical calls, a prompt response by EMS practitioners without L&S provides high-quality patient care without the risk of L&S-related crashes. EMS care is part of the much broader spectrum of acute health care, and efficiencies in the emergency department, operative, and hospital phases of care can compensate for any minutes lost with non-L&S response or transport.
Sponsoring Organizations and Representatives:
Academy of International Mobile Healthcare Integration
American Ambulance Association
American College of Emergency Physicians
Center for Patient Safety
International Academies of Emergency Dispatch
International Association of EMS Chiefs
International Association of Fire Chiefs
National Association of EMS Physicians
National Association of Emergency Medical Technicians
National Association of State EMS Officials
National EMS Management Association
National EMS Quality Alliance
National Volunteer Fire Council
References:
- Use of warning lights and siren in emergency medical vehicle response and patient transport. Prehosp and Disaster Med. 1994;9(2):133-136.
- Grant CC, Merrifield Analysis of ambulance crash data. The Fire Protection Research Foundation. 2011. Quincy, MA.
- Kahn CA, Pirallo RG, Kuhn EM. Characteristics of fatal ambulance crashes in the United States: an 11-year retrospective Prehosp Emerg Care. 2001;5(3):261-269.
- Ray AF, Kupas DF. Comparison of crashes involving ambulances with those of similar-sized vehicles. Prehosp Emerg Care. 2005;9(4):412-415.
- S. Fire Administration. Firefighter fatalities in the United States in 2013. 2014. Emmitsburg, MD.
- Maguire Transportation-related injuries and fatalities among emergency medical technicians and paramedics.
Prehosp Disaster Med. 2011;26(5): 346-352.
- Maguire BJ, Hunting KL, Smith GS, Levick Occupational fatalities in emergency medical services: A hidden crisis.
Ann Emerg Med, 2002;40: 625-632.
- Drucker C, Gerberich SG, Manser MP, Alexander BH, Church TR, Ryan AD, Becic Factors associated with civilian drivers involved in crashes with emergency vehicles. Accident Analysis & Prevention. 2013; 55:116-23.
- Clawson JJ, Martin RL, Cady GA, Maio RF. The wake effect: emergency vehicle-related collisions. Prehosp Disaster Med. 1997; 12 (4):274-277.
- Kupas DF. Lights and siren use by emergency medical services: Above all, do no harm. National Highway Traffic Safety Administration. 2017. Available online at https://www.ems.gov/pdf/Lights_and_Sirens_Use_by_EMS_May_2017.pdf
- Watanabe BL, Patterson GS, Kempema JM, Magailanes O, Brown LH. Is use of warning lights and sirens associated with increased risk of ambulance crashes? A contemporary analysis using national EMS information system (NEMSIS) Ann Emerg Med. 2019;74(1):101-109.
- Jarvis JL, Hamilton V, Taigman M, Brown LH. Using red lights and sirens for emergency ambulance response: How often are potentially life-saving interventions performed? Prehosp Emerg Care. 2021; 25(4): 549-555.
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Bloomberg Radio | President Baird on the Workforce Shortage
Fantastic Bloomberg Radio interview with President Shawn Baird covering key causes and impacts of the EMS workforce shortage.
Balance of Power Podcast • Browse all episodes
https://www.bloomberg.com/news/audio/2022-02-11/balance-of-power-ems-worker…
Balance of Power: EMS Worker Shortage Crisis (Radio)
Shawn Baird, President of the American Ambulance Association, discusses the shortage of emergency medical workers and paramedics. He spoke with Bloomberg’s David Westin.