NHTSA COVID PPE & Resource Reporting Tool

NHTSA asks EMS agencies across the U.S. to take a few minutes each week to report PPE, personnel status within their agency.

EMS and its public safety colleagues continue to serve at the frontlines in the fight against the COVID-19 pandemic. Resource procurement and distribution of personal protective equipment and staffing shortages continue to challenge EMS leaders. It is vital that local, State and Federal officials have the information they need to help address these issues.

The NHTSA Office of EMS, with support from the team at the NEMSIS Technical Assistance Center, has designed a reporting tool to allow for a consistent, real-time method of reporting PPE supply status and personnel shortages. Your participation in the EMS COVID Resource Reporting Tool provides objective evidence to ensure your local agency’s resource status is understood by State and National EMS leadership, and that your resource needs are being prioritized.

While this information will be available to State and Federal Officials, this reporting tool does not supersede coordination with local and state emergency management, public health, or healthcare coalitions. Organizations should still follow local and state procedures for reporting information and requesting supplies or other additional resource needs.

NHTSA is asking agencies to take a few minutes each week, preferably on Monday mornings, to complete the online form. You can find the form, as well as a video and other information explaining how the information is used and how to complete the form, here.

For questions regarding this process, please contact nemsis@hsc.utah.edu.

EMS COVID Resource Reporting Tool

Rural EMS COVID-19 Preparedness Checklist

From the Federal Healthcare Resilience Working Group

Product (EMS47) Purpose

This checklist serves as a reference for rural response agencies to evaluate their current preparedness and identify areas that need further mitigation measures. The evaluation of checked items can serve as a guide to develop solutions. Further, if this process is used by partner agencies, strengths can be aligned to facilitate collaborative planning and maximize preparedness efforts.

Developed By

The Federal Healthcare Resilience Working Group (HRWG) is leading the development of a comprehensive strategy for the US healthcare system to facilitate resiliency and responsiveness to the threats posed by COVID-19. The Working Group’s EMS/Pre-Hospital Team is comprised of public and private-sector EMS and 911 experts from a wide variety of agencies and focuses on responding to the needs of the pre-hospital community. This team includes subject matter experts from the National Highway Traffic Safety Administration (NHTSA) Office of Emergency Medical Services (OEMS), National 911 Program, Federal Emergency Management Agency (FEMA), US Fire Administration (USFA), US Army, US Coast Guard (USCG), Department of Homeland Security (DHS) Cybersecurity and Infrastructure Security Agency (CISA) and non- federal partners representing stakeholder groups. Through collaboration with experts in related fields, the team develops practical resources for field providers, supervisors, administrators, medical directors, and associations to better respond to the COVID-19 pandemic.

Intended Audience

State, Local, Tribal, and Territorial Governments (SLTTs), First Responders (Law Enforcement, Fire & Rescue, Emergency Medical Services (EMS) and 911 communication personnel) with a focus on those in rural areas.

Expected Distribution Mechanism

EMS.gov, OEMS stakeholder Calls, EMS stakeholder organization’s membership distribution Email mechanisms, USFA website, HRWG external affairs, add to the HRWG Rural Tool kit, ASPR TRACIE, IHS Tribal EMS distribution list, EMS for Children (EMS-C) distribution, HRSA rural partners. Request assistance distributing to FEMA/HHS RECs

Primary Point of Contact

NHTSA Office of EMS, nhtsa.ems@dot.gov, 202-366-5440

Date Published August 26, 2020

Rural EMS COVID-19 Preparedness Checklist

Introduction

Emergency Medical Services in rural segments of the US are disproportionally impacted by the COVID-19 pandemic due to a myriad of issues, including workforce, revenue, and other unique stressors present within the rural environment. Identification and development of preparedness and resilience efforts are imperative to ensure all facets of the response community have the knowledge and tools to effectively respond.

Purpose

This checklist is a reference for rural response agencies to use to evaluate their current position and identify areas that need further mitigation measures. The collection of checked items can serve as a template towards solution development. Further, if this same process is used by other partner agencies, collaboration between partners can facilitate cooperative planning and preparedness efforts that leverage the qualities of each organization.

Categories

Categorization will assist in focusing attention into specific areas, as needed. Although it is important to review all categories, many may not require the same amount of attention others. Additional items might be required in some categories since local needs will vary greatly across the country.

Planning

  • Engage with local emergency management agency, 911 call center, local health department, first responding partners (law enforcement, search and rescue, etc.), mutual aid agencies, local hospitals, and local long-term care facilities to identify needs and plan
  • Ensure agency infection control policies are consistent with local, state, and CDC’s COVID- 19 infection prevention
  • Review protocols, policies, and procedures for rapidly implementing appropriate infection control and prevention practices for potential COVID-19
  • Ensure availability of an adequate, clearly indicated areas for the disposal of biological/infectious waste in ambulances and facilities
  • Review and update Patient Care Reporting forms and programs to allow for reporting PPE use and shortages, special studies,
  • Ensure mutual aid processes / agreements are updated and
  • Determine if there are any higher-risk areas within your district that might pose a higher level of impact from COVID-19, such as nursing/long-term care facilities, assisted living facilities, correctional facilities, tribal communities,
  • Identify and define the process to engage telehealth consultation facilities for telehealth resources to respond to specific needs (e.g. one medical oversight resource vs separate facilities for primary care, cardiac, trauma, )
  • Determine the availability of alternative forms of transportation, such as rotary or fixed-wing aircraft to facilitate interfacility
  • Determine the procedures for contacting and required information to request rotary wing and fixed wing programs

Strategy

  • Monitor the COVID-19 pandemic at CDC’s COVID-19 website, state health department websites, and your local health
  • Review plans for implementation of surge capacity procedures and management of scarce resources by engaging local hospitals or acceptable alternate destinations and emergency management
  • Ensure processes are in place to engage FEMA, which begins with the emergency management processes via the local and state level management points of
  • Develop contingency plans for hospital reroute/diversion due to COVID positive patient or surge capacity issues
  • Develop a plan with local hospitals to manage inter-facility transport
  • Establish for a Medical Operations Coordination Cell (MOCC) if
  • Determine if a medical-centric Community Risk Reduction program benefits your community

Personal Protective Equipment (PPE) and Supplies

  • Review hand hygiene policies and supplies (e.g., accessible alcohol-based hand rub).
  • Review supplies of appropriate
  • Plan how to obtain adequate supplies of appropriate -PPE.
  • Review supplies of appropriate cleaning and disinfection products (e.g., EPA-registered disinfectant appropriate for coronavirus in healthcare settings).

Workforce/Recruiting

  • Ensure prehospital providers who will provide patient care have been medically cleared, fit- tested, and trained for respirator .
  • Review policies and procedures for screening and work restrictions for exposed or ill providers ensuring that they have ready access, including via telephone, to medical consultation,
  • Provide education and training to prehospital providers regarding COVID-19 diagnosis, how to limit COVID-19 exposures, appropriate PPE use, effective communication with staff at healthcare facilities, sick leave policies, and how to report suspected COVID-19 cases within your agency along with procedures to take following unprotected exposures (e.g. not wearing recommended PPE).
  • Evaluate availability of current staff, including conflicting work assignments, second jobs, employee risk factors such as age, etc., to ensure an adequate level can be
  • Determine the need for procedures to ensure the safety of personnel when working in close quarters, such as social distancing, sleeping arrangement alteration,
  • Evaluate the need/benefit of adding or increasing financial incentives

Revenue/Funding

  • Evaluate the need for future expenses over the next 12
  • Evaluate and implement alternative fundraising
  • Identify state and / or federal assistance programs, grants, that could be beneficial, and consider pre-staging required information, forms,

HHS Renews the Declaration of a Public Health Emergency

On July 23, HHS Secretary Alex M. Azar III renewed the COVID-19 Public Health Emergency declaration.

As a result of the continued consequences of Coronavirus Disease 2019 (COVID-19) pandemic, on this date and after consultation with public health officials as necessary, I, Alex M. Azar II, Secretary of Health and Human Services, pursuant to the authority vested in me under section 319 of the Public Health Service Act, do hereby renew, effective July 25, 2020, my January 31, 2020, determination that I previously renewed on April 21, 2020, that a public health emergency exists and has existed since January 27, 2020, nationwide.

John Hopkins | How to better protect EMS personnel from infectious disease?

Download PDF Report Emergency medical services systems and providers are on the front lines of the health response to large-scale disasters, including COVID. EMS professionals in the United States have provided medical care and transportation during pandemic influenzas, importations of Ebola, and other high-consequence pathogens, but none have had the widespread systemic effects of COVID….

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CDC Elevates First Responders to Highest Priority for COVID-19 Testing

On April 27, the CDC issued an update to its Guidance on “Evaluating and Testing Persons for Coronavirus Disease 2019” in which “first responders with symptoms” are now in the category of “highest priority” as to the prioritization of groups who should be tested for COVID-19. The AAA has been advocating to federal agencies and…

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NREMT Statement to National Governors Association

COVID-19 Impact on Essential Critical Infrastructure Workers and Requested URGENT Action of Governors to Ensure Continuity of the Supply of Certified Emergency Medical Services Professionals (EMTs & Paramedics) and other Essential Critical Infrastructure Workers. Statement by the National Registry of Emergency Medical Technicians. Download PDF Problem: The national COVID-19 pandemic containment efforts inadvertently impact a…

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CMS NEWS: Trump Administration Launches New Healthcare Toolkit

Trump Administration Launches New Toolkit to Help States Navigate COVID-19 Pre-Hospital/Emergency Medical Services (EMS) Resources At President Trump’s direction, the Centers for Medicare & Medicaid Services (CMS) and the Assistant Secretary of Preparedness and Response (ASPR) released a new toolkit to help state and local healthcare decision-makers maximize workforce flexibilities when confronting 2019 Novel Coronavirus…

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Supplemental Funding for Emergency Medical Services

COVID-19: Supplemental Funding for Emergency Medical Services Developed by the Healthcare Resilience Task Force Emergency Medical Services (EMS) Prehospital Team. Download PDF 1. Purpose: This paper outlines two supplemental funding options for Emergency Medical Services (EMS) agencies affected by the COVID-19 pandemic. 2. Scope: This information applies to private non-profit organizations as well as for-profit…

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CISA Releases Version 3.0 of the Essential Critical Infrastructure Workers List

Private Sector Update Created and distributed by the U.S. Department of Homeland Security Private Sector Office private.sector@dhs.gov April 17, 2020 The Cybersecurity and Infrastructure Security Agency (CISA) has released Version 3.0 of the Essential Critical Infrastructure Workers list. Version 3.0 provides clarity around a range of positions needed to support the critical infrastructure functions laid…

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911 and Emergency Medical Services (EMS) Algorithms

911 and Emergency Medical Services (EMS) Algorithms Developed by the Healthcare Resilience Task Force Emergency Medical Services (EMS) Prehospital Team. Download PDF Attached, please find the latest document released by the Health Systems Resiliency Task Force.  Please use the communication mechanisms at your disposal to share this information with your members, constituents and clients.  All…

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Grants and Tax Credits Toolkit

Grants and Tax Credits Toolkit Download materials from Akin Gump including aid summaries and how-to guides on qualifying for tax credits and deferments and applying for financial assistance. Paycheck Protection Provision Loans Summary Five Steps to an SBA PPP Loan Five Steps to Getting a Self-Employed Paycheck Protection Plan (PPP) Loan Five Steps to Claim…

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Personal Protective Equipment Supply for Emergency Medical Services (EMS)

Personal Protective Equipment Supply for Emergency Medical Services (EMS) Document Developed by the Healthcare Resilience Task Force Emergency Medical Services (EMS) Prehospital Team.  Download PDF Current Situation Personal Protective Equipment (PPE) supplies, including N-95 respirators and gowns, are in short supply due to the COVID-19 pandemic. These shortages are anticipated to resolve over time as…

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Considerations for State Emergency Medical Service Offices in Response to COVID-19

Considerations for State Emergency Medical Service Offices in Response to COVID-19 Developed by the Healthcare Resilience Task Force Emergency Medical Services (EMS) Prehospital Team. Download PDF Integration of Emergency Medical Services (EMS) into the state emergency management structure Ensure that the state EMS Office, including the state EMS medical director, is represented in, or has…

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Public Service Answering Points (PSAPs)/Emergency Communications Centers (ECCs) Call Screening

Public Service Answering Points (PSAPs)/Emergency Communications Centers (ECCs) Call Screening Document Developed by the Healthcare Resilience Task Force Emergency Medical Services (EMS) Prehospital Team. Download PDF This document is intended to provide procedural guidance to Public Safety Answering Points (PSAPs) and Emergency Medical Service (EMS) agencies on practices that could result in improved call screening and…

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EMS Week 2020

FOR IMMEDIATE RELEASE

March 16, 2020

EMS STRONG LAUNCHES “READY TODAY. PREPARING FOR TOMORROW.” CAMPAIGN TO HONOR EMS PROFESSIONALS

Campaign unifies the profession and brings awareness to National EMS Week, May 17-23, 2020

 WASHINGTON March 16, 2020– The American College of Emergency Physicians (ACEP), in partnership with the National Association of Emergency Medical Technicians (NAEMT), is proud to announce this year’s EMS STRONG campaign theme: READY TODAY. PREPARING FOR TOMORROW. The annual EMS STRONG campaign provides opportunities to recognize the Emergency Medical Services (EMS) community, enhance and strengthen the profession on a national level and celebrate National EMS Week, May 17-23, 2020.

The campaign brings together key organizations, media partners and corporate sponsors that are committed to recognizing and fortifying the EMS community, commending recent groundbreaking accomplishments and increasing awareness of National EMS Week.

“As we enter a new decade, we look ahead to the future of prehospital care. This future will include dramatic improvements in patient care, thanks to advances in research, information sharing and life- changing technology,” says William P. Jaquis, MD, FACEP, President of ACEP. “During National EMS Week, and throughout the year, we are proud to recognize EMS and fire professionals who tirelessly serve their communities and care for patients and their families every day.”

EMSSTRONG.org serves as a resource for stakeholders and the public to learn of inspiring stories from EMS practitioners, ways to get involved and EMS Week ideas, activities and templates. The website, which is also home to the annual EMS Week Planning Guide, encourages EMS professionals and stakeholders to promote their own industry and share content on social media platforms.

“The 2020 theme ‘Ready Today. Preparing for Tomorrow’ reflects what individual EMS professionals and organizations do every day as they respond to calls for help at any time and in any place,” explains

NAEMT President Matt Zavadsky. “The EMT and paramedic care of tomorrow will continue to expand into services that include community paramedicine, injury and illness prevention training and CPR and bleeding control education.”

EMS Week dedicates each weekday to specific themes under the “Ready Today. Preparing for Tomorrow.” umbrella. First responders are encouraged to plan activities and events around these themes in their communities.

  • Monday, May 18: EMS Education Day
  • Tuesday, May 19: EMS Safety Day
  • Wednesday, May 20: EMS for Children Day
  • Thursday, May 21: Save-A-Life Day (CPR & National Stop the Bleed Day)
  • Friday, May 22: EMS Recognition Day

Integral to the campaign’s success is the continuing involvement of the corporate sponsors, strategic association partners and strategic media partners.

Corporate Supporters include:

Genentech, American Red Cross, DrFirst, Health Scholars, Stryker, Teleflex, NHTSA/Office of EMS, National Registry of Emergency Medical Technicians (NREMT), AdvancedCPR Solutions, Aero Healthcare, Air Methods, Laerdal Medical, McKesson Medical-Surgical, North American Rescue, Sprint and Zoll.

Strategic Association Partners include:

American Ambulance Association, Association of Air Medical Services, Commission on Accreditation for Prehospital Continuing Education, Committee on Accreditation of Educational Programs for the EMS Professions, International Association of Fire Chiefs, International Association of Flight and Critical Care Paramedics, International Public Safety Association, National Association of EMS Educators, National Association of EMS Physicians, National Association of State EMS Officials, National EMS Management Association, National Fire Protection Association, National Registry of EMTs and National Volunteer Fire Council.

Strategic Media Partners include:

EMS1.com, EMS World and JEMS/EMS Today

For more information on the campaign, please visit: EMSSTRONG.org.

 

COVID-19 Update II for EMS

First Case of 2019 Novel Coronavirus in the United States

The New England Journal of Medicine has rapidly published a peer-reviewed paper on the Snohomish County WA ‘Patient 1’. This was the first reported case of COVID 19 in the US. This seminal document, which given the magnitude of the case and its initial findings is released in full here

The work by Michelle L. Holshue, M.P.H., Chas DeBolt, M.P.H., Scott Lindquist, M.D., Kathy H. Lofy, et al for the Washington State 2019-nCoV Case Investigation Team was turned round in just over 5 weeks and below is an ‘Executive summary’ ( as extracted from the paper) but the full paper and range of results should be read in full.

Patient Presentation

On January 19, 2020, a 35-year-old man presented to an urgent care clinic in Snohomish County, Washington, with a 4-day history of cough and subjective fever. On checking into the clinic, the patient put on a mask in the waiting room. After waiting approximately 20 minutes, he was taken into an examination room and underwent evaluation by a provider. He disclosed that he had returned to Washington State on January 15 after traveling to visit family in Wuhan, China. The patient stated that he had seen a health alert from the U.S. Centers for Disease Control and Prevention (CDC) about the novel coronavirus outbreak in China and, because of his symptoms and recent travel, decided to see a health care provider.

On admission, the patient reported persistent dry cough and a 2-day history of nausea and vomiting; he reported that he had no shortness of breath or chest pain. Vital signs were within normal ranges. On physical examination, the patient was found to have dry mucous membranes. The remainder of the examination was generally unremarkable. After admission, the patient received supportive care, including 2 liters of normal saline and ondansetron for nausea.

Viral Presence

Both upper respiratory specimens obtained on illness day 7 remained positive for 2019-nCoV, including persistent high levels in a nasopharyngeal swab specimen (Ct values, 23 to 24).

Stool obtained on illness day 7 was also positive for 2019-nCoV (Ct values, 36 to 38).

Nasopharyngeal and oropharyngeal specimens obtained on illness days 11 and 12 showed a trend toward decreasing levels of virus

Day 8: Condition Improves

On hospital day 8 (illness day 12), the patient’s clinical condition improved. Supplemental oxygen was discontinued, and his oxygen saturation values improved to 94 to 96% while he was breathing ambient air. The previous bilateral lower-lobe rales were no longer present. His appetite improved, and he was asymptomatic aside from intermittent dry cough and rhinorrhea. As of January 30, 2020, the patient remains hospitalized. He is afebrile, and all symptoms have resolved with the exception of his cough, which is decreasing in severity.

History Taking

This case report highlights the importance of clinicians eliciting a recent history of travel or exposure to sick contacts in any patient presenting for medical care with acute illness symptoms, in order to ensure appropriate identification and prompt isolation of patients who may be at risk for 2019-nCoV infection and to help reduce further transmission. Finally, this report highlights the need to determine the full spectrum and natural history of clinical disease, pathogenesis, and duration of viral shedding associated with 2019-nCoV infection to inform clinical management and public health decision making.

Conclusion

There is little doubt that this paper is about to become a globally sited document as we continue to deal with COVID 19. As far as EMS and our first response to it goes, the paper reinforces the key actions currently being taken

 

Sample COVID-19 Policies for Mobile Healthcare Providers

Thank you to the following organizations for sharing their policies as examples.

Global Medical Response maintains a COVID-19 page to provide information to all members of the GMR community—clinicians and non-clinicians.

Updates from GMR Chief Medical Officer, Dr. Ed Racht

GMR Procedures

General Information for Caregivers

Compliance

HIPAA Reminder

FirstWatch Solutions

The intention of the COVID-19 Process/Policy Template is to provide agencies, medical directors, or others who want to utilize it, an outline/template on which to build an agency-specific policy/protocol to address COVID-19. This includes suggestions for development and/or oversight committees, outside partners and stakeholders, as well as preparation and process for EMS workers who provide best practice care for patients as well as providing for the protection of pre-hospital providers and medical director(s). Its application is totally up to the user.

This document is meant to be a living document that can be revised as circumstances or guidance changes. It can also be a discussion piece for those who choose to develop a different type of policy but may want to use some of the components of the document as a starting point.

Agency Guidance

CDC Interim Guidance for Emergency Medical Services (EMS) Systems and 911 Public Safety Answering Points (PSAPs) for COVID-19 in the United States
NEW March 6, 2020: CMS COVID-19 FAQs for Healthcare Providers (PDF Download)

March 5, 2020: CMS issued a second Healthcare Common Procedure Coding System (HCPCS) code for certain COVID-19 laboratory tests, in addition to three fact sheets about coverage and benefits for medical services related to COVID-19 for CMS programs.  https://www.cms.gov/newsroom/press-releases/cms-develops-additional-code-coronavirus-lab-tests

March 4, 2020: CMS issued a call to action to healthcare providers nationwide and offered important guidance to help State Survey Agencies and Accrediting Organizations prioritize their inspections of healthcare. https://www.cms.gov/newsroom/press-releases/cms-announces-actions-address-spread-coronavirus

February 13, 2020: CMS issued a new HCPCS code for providers and laboratories to test patients for COVID-19.  https://www.cms.gov/newsroom/press-releases/public-health-news-alert-cms-develops-new-code-coronavirus-lab-test

February 6, 2020: CMS gave CLIA-certified laboratories information about how they can test for SARS-CoV-2. https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/notification-surveyors-authorization-emergency-use-cdc-2019-novel-coronavirus-2019-ncov-real-time-rt

February 6, 2020: CMS issued a memo to help the nation’s healthcare facilities take critical steps to prepare for COVID-19.  https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/information-healthcare-facilities-concerning-2019-novel-coronavirus-illness-2019-ncov

4 Tips: Add Empathy to EMS Care

Empathy is about trying to understand, as best we can, someone else’s situation or experience. The question is, do we in EMS truly understand the word? Are we empathetical to ourselves and to the people we work with?

While some say that empathy comes from proper upbringing, today’s decline in civility means we see less and less of it displayed. A major contributing factor is the “tough” exterior we favor in each other: how often have you heard comments like “come on, just suck it up buttercup,” “you need to be tougher than that to be a medic,” or “we’re EMS, we eat our young.” Why are we like this, and why can’t we reinforce the empathy that naturally resides in all of us?

Empathy is a big part of our jobs, and we need to teach it to our students, our employees and each other. People need to feel that it’s OK to be empathetic and that it’s a natural part of the whole EMS picture.

One of the best techniques to foster empathy is active listening — not only to our patients but also to staff and co-workers. When you actively listen, you H.E.A.R. …

 Halt: Stop whatever else you are doing, end your internal dialogue on other thoughts, and free your mind to give the speaker your attention.

 Engage: Focus on the speaker. We suggest a physical component, such as turning your head slightly so that your right ear is toward the speaker as a reminder to be engaged solely in listening.

Anticipate: By looking forward to what the speaker has to say, you are acknowledging that you will likely learn something new and interesting, which will enhance your motivation to listen.

Replay: Think about what the speaker is saying. Analyze and paraphrase it in your mind or in discussion with the speaker and other classmates. Replaying and dialoguing the information you have heard will aid in understanding what the speaker is attempting to convey.”1

So always look at the other’s point of view and try to understand what he or she is facing. It just might change your attitude and make you a better provider.

References:
1  Wilson, Donna & Conyers, Marcus, “4 Proven Strategies for Teaching Empathy”. Edutopia, January 4, 2017.

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