Have you ever received a performance review that truly drove you to work harder? It is time for employers to rethink the manner and method of providing employee performance feedback. In fact, the concept of performance feedback needs to evolve from a formal annual process to a more fluid ongoing dialogue about the nature and quality of the workplace relationship. EMS organizations continue to struggle with retaining employees, both field personnel and frontline supervisors. This program will discuss why traditional employee performance feedback models often hurt performance. We will cover the latest research on what truly drives employee performance and the innovative ways that high-performance teams are utilizing meaningful performance feedback tools in today’s workplace. Lastly, this session will discuss the important role that organizational culture plays in driving employee performance regardless of the performance feedback model your organization adopts. No matter the model, if your organizational culture does not support a transparent, trusting, and accountable relationship between leadership and your workforce, you will continue to struggle.
March 18, 2021, 3:54 PM EDT
Features Empress EMS and REMSA!
By Phil McCausland
During the height of the pandemic, a quiet financial crisis was brewing for ambulance companies.
As hospitals became overwhelmed and patients begged not to be taken to crowded emergency rooms for fear of potential infection, paramedics and emergency medical technicians began treating patients where they met them — outside homes, alongside roadways, in parking lots.
The trouble is that ambulance companies are only paid to transport people, not for treating them.
Now, an aid package in the American Rescue Plan and a new federal health care program could provide a financial lifeline for ambulance companies and herald a permanent shift in emergency medicine as a whole.
The attempt to reimburse ambulance companies began with a bill introduced by Sens. Catherine Cortez Masto, D-Nev., and Bill Cassidy, R-La., but the legislation was ultimately rolled into the $1.9 trillion Covid relief bill. Cortez Masto voted for the plan, and Cassidy did not.
“Our first responders have gone above and beyond in caring for patients during the pandemic, and it’s just wrong that ambulance companies weren’t getting paid unless they took patients to the hospital,” Cortez Masto said.
On March 15, the AAA, IAFC, IAFF, NFVC, NAEMT, and the Congressional Fire Services Institute sent a letter to congressional leaders in support of legislation (H.R. 1868) to extend the current moratorium on the 2% Medicare sequestration cut. The moratorium is currently scheduled to expire on March 31 and H.R. 1868 would extend the moratorium until December 31. Below is a copy of the letter.
This week, the House passed House Resolution 233 with the rules for debate and consideration of H.R. 1868. Congressmen Schneider (D-IL) and McKinley (R-WV) introduced H.R. 315 and Senators Sheehan (D-NH) and Collins (R-ME) introduced S. 748 which would extend the moratorium through the end of the public health emergency.
March 16, 2021
The Honorable Nancy Pelosi Speaker
U.S. House of Representatives
Washington, DC 20515
The Honorable Kevin McCarthy Minority Leader
U.S. House of Representatives
Washington, DC 20515
The Honorable Charles Schumer Majority Leader
United States Senate
Washington, DC 20510
The Honorable Mitch McConnell Minority Leader
United States Senate
Washington, DC 20510
Dear Speaker Pelosi, Majority Leader Schumer, Minority Leader McConnell and Minority Leader McCarthy:
Thank you for your continued support of front-line medical workers throughout the COVID-19 pandemic. Our paramedics, emergency medical technicians (EMTs) and firefighters, as well as the organizations that they serve, take on substantial risk every day to treat, transport and test potential COVID-19 patients. We write today to express our deep concern with the impending 2% Medicare sequestration cut scheduled to take effect on April 1, 2021.
The American Ambulance Association (AAA), International Association of Fire Chiefs (IAFC), International Association of Fire Fighters (IAFF), National Association of Emergency Medical Technicians (NAEMT), National Volunteer Fire Council (NVFC) along with the Congressional Fire Services Institute (CFSI) 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. We have all experienced the strain on our services, and need financial assistance and support as we remain the frontline responders to our nation’s coronavirus patients. The sequestered cuts, if implemented, would further strain the provision of these critical services.
Our costs of operating have increased exponentially in response to COVID-19, as we maintain full readiness to combat the pandemic and continue to provide 24-hour vital non-COVID-19- related services. Our costs for personal protective equipment (PPE), overtime pay, and other expenses directly related to COVID-19 remain high. At a time when we are facing considerable economic strain due to the COVID-19 pandemic, we respectfully urge Congress take action before April 1, 2021 to extend the 2% Medicare sequestration moratorium. We would like to voice our strong support for bipartisan legislation, H.R. 1868, to prevent the 2% sequester cut.
Our organizations greatly appreciate both the financial support provided through congressionally enacted COVID-19 relief legislation, as well as the recognition of the dangers of providing these critical services on a daily basis. However, the impact of the pandemic on our resources and services remains and the implementation of additional Medicare cuts at this time would be harmful to our members.
We thank you in advance for your consideration and helping ensure that EMS agencies and personnel have the resources they need to continue to respond to the COVID-19 pandemic and the funding to maintain the short and long-term viability of our operations.
American Ambulance Association
Congressional Fire Services Institute
International Association of Fire Chiefs
International Association of Fire Fighters
National Association of Emergency Medical Technicians
National Volunteer Fire Council
One of the first actions taken by the Biden Administration the day after the Inauguration was to issue an Executive Order directing OSHA to focus their efforts on protecting the American workforce. Following that Executive Order, OSHA has implemented a National Emphasis Program (NEP) to ensure that employees in high-hazard industries, including EMS providers, are protected from contracting COVID-19. The NEP is intended to augment OSHA’s educational and enforcement efforts with unprogrammed, COVID-19 related activities, including complaints, referrals, and severe incident reports. The March 12, 2021 announcement also states that it is updating the Interim Enforcement Response Plan to prioritize on-site workplace inspections. The NEP also includes plans to ensure that workers are protected from retaliation. Lastly, states that have an OSHA-approved state-level plan, have 60 days to notify OSHA if they already have the equivalent to an NEP plan or will adopt the federal plan.
What does this mean for EMS providers?
This should serve as an alert to EMS agencies that they should revisit their safety and risk programs, including their Respiratory Protection Programs, to ensure that they are prepared for a visit from OSHA.
Respiratory Protection Programs
At many EMS agencies, this is part of the bloodborne and airborne protection policies that have been in place for decades. I caution agencies to review their existing plan against OSHA’s Respiratory Protection Regulations. Under the regulations, all individuals who are mandated to wear an N95 or other respirator must complete a medical questionnaire that is reviewed by a physician or other healthcare provider prior to the employee having to donning the mask while working.
The regulation provides elements of a Respiratory Protection Program that includes identifying a Respiratory Program Administrator (RPA) that is designated by a Medical Director who will be responsible for developing, maintaining, and ensuring compliance with policies, procedures, and practices relative to the selection, storage, use, and maintenance of respirators. Additionally, the RPA is responsible for conducting or coordinating all training, fit testing, and recordkeeping required by the regulations.
OSHA has published a Small Entity Compliance Guide for the Respiratory Protection Standard. This is a 124-page document that outlines the Respiratory Protection Standards and provides sample templates and checklists that can be utilized by employers to assist with compliance. Like with patient care documentation, be sure that your Respiratory Protection Program documentation is sufficiently detailed and includes:
What do I do if I receive a call from OSHA?
It is unnerving to receive a phone call from a local, state, or federal oversight agency. However, contact from an oversight agency does not always mean that they have received a complaint. All U.S. Department of Labor agencies perform outreach in the various regions to educate and engage employers and different industry groups.
That being said, the U.S. DOL is a busy agency, especially during the pandemic. Most likely, if your organization is being contacted by OSHA, it is due to a complaint, referral, or data targeting run. The first two are self-explanatory. A data targeting run is the identification of a specific employer through analysis of data submitted to the agency. This is typically information such as electronically submitted workplace injury and illness data.
If you receive a call from OSHA, my recommendation is to listen more than you speak. Take copious notes and document the conversation immediately following the call. The OSHA representative will tell you why they are calling and will likely request various documents or other evidence be sent to their office. Do not expect that they will tell you who complained, and I would not ask. My suggestion, request that the representative email or fax over a letter identifying the representative, the documents or other information they are seeking, the date that you must furnish the information, and the method upon which they want the information sent.
You may not have firsthand knowledge of the issue or incident that led to the complaint to OSHA. That is okay. You can tell the representative that you and your team will investigate and/or compile the requested information following the call and respond. The investigator does not expect that you will necessarily have all the answers at the time of the call. You should be courteous and responsive but remember that a response that is carefully considered and crafted is likely to lead to the best result. Do not wing it! Lastly, no matter whether you know who complained or not, do not take any action that can be viewed as retaliatory against employees.
What do I do if an OSHA Investigator appears at my workplace?
Generally speaking, an OSHA Investigator will not just appear in your workplace. Not to say that they cannot. They certainly can. If an OSHA Investigator comes to your workplace you do have certain rights, but so does OSHA. OSHA has the right to arrive unannounced, gain access to the workplace without significant delay, and question employees privately. They will show you their OSHA credentials and you should ask for a business card.
An employer has the right to demand to see an inspection warrant. This is the document that is the basis for OSHA’s probable cause for the inspection. However, I do not recommend demanding the inspection warrant. This will most certainly put you and the OSHA investigator in an adversarial position. As they say, this can go one of two ways, hard or less hard.
An employer has the right to an opening conference. Many important things can happen during the opening conference. First, you can learn the nature of the complaint and related investigation and attempt keep the scope of the investigation as narrow as possible. Next, you can establish the probable cause for the visit and learn their plans for the investigation. This will likely include a worksite “walking around” inspection, interviews, document review, etc. You can better prepare once you know what to expect.
An employer has the right to accompany the OSHA Investigator during their site inspection. I recommend taking photos of anything that the investigator documents or inspects and documenting physical evidence or documents that they take during the inspection. You may also ask the investigator for a log of any evidence taken. Lastly, you should know that the investigator has the right to interview your employees privately. However, you have the right to be present during any management interview.
Bottom line, you should cooperate with the investigator. They are people too and generally want to help employers be complaint with the law. They are not looking to find violations. They are looking to ensure compliance and protect workers. From my time working at the U.S. DOL, I can attest that we appreciated cooperative and friendly employers who know the law and can quickly provide the information or documents we are seeking. The quicker and more responsive I found an employer to be, the greater likelihood my index of suspicion reduced, and that the employer was following the law.
OHSA has identified that the NEP will be in place for the next twelve (12) months. NEP plans are intended to be temporary but can be extended if the pandemic continues past the anniversary of the plan. While there were numerous industries listed in the OSHA notice, ambulance service providers were specifically identified as one of the high-risk industries that would be the focus of this new program.
If your service has questions or needs assistance with ensuring that your organization is compliant, be sure to contact email@example.com for assistance.