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 EMS care with the potential to decrease unnecessary COVID-19 transports to hospitals. If adopted these could alleviate a significant load on the currently strained healthcare system, and decrease additional infectious disease exposures among the community and healthcare providers. NOTE: protocols would have to be approved by state or local medical oversight

This guidance applies to all PSAP and EMS delivery models including but not limited to; free standing, third-service; fire-based, hospital-based, independent volunteer, private and related emergency medical service providers.

  •  For all requests for emergency care (including interfacility transports) the dispatcher/call taker should ask the following questions:
    • Has the Patient had a positive COVID-19 test?
    • Is the Patient A COVID-19 Person Under Investigation (PUI)? – (PUI is defined as: A patient who has been tested for COVID-19 but has not received their result).
    • Does the patient have Flu-like symptoms (fever, chills, tiredness, cough, muscle aches, headaches, sore throat or runny nose)?
    • The dispatcher/call taker should document any positive findings in their report.
    • NOTE: Recent travel is no longer a recommended question
  •  If the caller answers YES to ANY of the above, this information should be relayed to response agencies and the Modified COVID-19 Response Procedure should be followed
  • If the caller answers NO to ALL of the above – response agencies should follow their normal response procedure
    Modified COVID-19 Response (Caller answered YES to ANY PSAP/Dispatch screening questions)
  •  First Responders/Emergency Medical Responders (non-transport)
    • It is recommended First Responders/Emergency Medical Responders NOT respond to limit potential exposures.
    •  If First responders/Emergency Medical Responders respond, it is recommended that their response is limited to life safety only.
  •  Emergency Medical Services (transport units)
    •  It is recommended that, when possible, only one EMS clinician make contact with the patient using PPE (while N95, eye protection, gown, gloves, and face shield continue to be the recommended standard, during times of limited supplies or limited availability of resupply, eye protection, gloves and surgical mask are acceptable alternatives).
      o If treatment and transport are required, consider having a single EMS clinician, in PPE, approach and treat the patient while isolating other EMS clinicians, family members and bystanders away from the patient.
    • If transporting, it is advised that family members should not accompany the patient. Consideration may be given if the patient is a minor or vulnerable adult. However, the CDC recommends against family members riding in the ambulance. For more information, see the Interim Guidance for Emergency Medical Services (EMS) Systems and 911 Public Safety Answering Points (PSAPs) for COVID-19.
      o Consider treat-in-place/treat-no-transport guidelines (as approved by state or local medical oversight) for medically stable patients with the CDC identified COVID-19 signs and symptoms:

      •  Fever as defined as 100.4 or greater without fever medications
      • Dry cough
      • Aches
      • Fatigue
  • Examples of PSAP/ECC Resources:

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.

Your EMS Reputation Depends on Three Cs

Your EMS Reputation Depends on Three Cs—Credentials, Courtesy, Community

In EMS, your reputation is critical. Your character moves with you from provider to provider and from squad to squad; EMS is a small world where people know about you before you even step foot in the door.

People react to you based on judgments from not only real life, but also your digital life. With Facebook, Snapchat, Instagram and other social media networks so prevalent today, your social media profile serves as the basis of your reputation both professionally and privately.

Unfortunately, social media blunders abound among EMS providers, affecting their reputations and their future hiring ability. You can find hundreds of examples doing a quick online search; here are just two.

Three South Carolina responders fired for making statements like “idiots shutting down I-126. Better not be there when I get off work …” (Kaplan, 2016, para. 3)

A Brockton, Mass. dispatcher who said of a pregnant overdose patient, “She needs to be left to rot …” (Shephard, 2018, para. 5)

A better way to think of your reputation is the “Three Cs” — Credentials, Courtesy and Community.

  • Credentials may also be called Continuing Education, as it’s vital to keep learning throughout your career. Many of the best paramedics and EMTs are lifelong learners; in contrast there are others who take the NREMT exam and then never do more to see EMS from a wider perspective.
  • Courtesy means being courteous not only to your patients and coworkers but also to yourself. When others feel comfortable around you, it is easier to develop those close ties and professional relationships that boost your reputation.
  • Community refers to both where you live and the broader EMS community at large. The public and our industry look to us to build and improve a framework where we can all grow and thrive. Professional norms promote collaboration, knowledge sharing and a collective responsibility for improving ourselves and our treatments.

So, let’s follow the “Three Cs” to improve EMS as a community. Let’s have better, more convenient education that goes beyond the “same old, same old.” Let’s push our medical directors for improved, evidence-based treatments. Let’s pull each other up and be leaders at the healthcare table. Lastly, let’s stand out in the community with reputations that reflect the consummate professionals we truly are.

Scott F. McConnell is Vice President of EMS Education for OnCourse Learning and one of the Founders of Distance CME, which recently launched a new learning platform. Since its inception in 2010, more than 10,000 learners worldwide have relied on Distance CME to recertify their credentials. Scott is a true believer in sharing not only his perspectives and experiences but also those of other providers in educational settings

References

(Kaplan, 2016, para. 3) “Three S.C. first responders fired for threatening comments about protesters” Retrieved from https://www.washingtonpost.com/news/post-nation/wp/2016/07/13/three-s-c-first-responders-fired-for-threatening-comments-about-protesters/ 

(Shephard, 2018, para. 5) “Dispatcher put on leave for harsh Facebook comments” Retrieved from https://www.ems1.com/ems-social-media/articles/378700048-Dispatcher-put-on-leave-for-harsh-Facebook-comments/

Make a Difference: EMS and Human Trafficking

When we think of trafficking, we generally think of drugs or weapons, not human beings. Yet the problem exists in numerous communities where EMS responders deliver care.

Human trafficking is defined by the United Nations as “the recruitment, transportation, transfer, harboring, or receipt of persons by improper means for an improper purpose.” (End Slavery Now, 2018, para. 1) A more succinct definition comes from Kathryn Brinsfield, MD, MPH, Assistant Secretary for Health Affairs and Chief Medical Officer for the Department of Homeland Security: “Human trafficking is modern-day slavery.” (DHS, 2017, para. 3)

Why is this so important in today’s EMS field? We are the first on scene, we are the ones invited inside where others are not and we are the ones who see an injured person’s environment.  Our interactions with others can help us spot some of the tell-tale indicators.

Unfortunately, there are many reasons people are trafficked:

  • Domestic Slavery: People are brought into private homes to work as slave labor, with no options to leave.
  • Sex Trafficking: Children, men and women are forced into the commercial sex industry
  • Forced and Bonded Labor: People are forced to work under the threat of violence for no pay — often to repay a debt — without the ability to leave
  • Forced Marriage: Women and children are forced to marry another against their will and without their consent.

As an industry, there is much that EMS can do. We must keep our ears and eyes open, and report things that raise red flags in our minds. Some of the most common indicators we will see as emergency responders are:

  • Signs of abuse, wounds or bruising in various stages of healing or malnutrition
  • Scars or mutilations, including tattoos showing ownership
  • Language or cultural barriers preventing injured persons from communicating with you
  • Submissive or nervous appearances
  • Security measures like overly hardened doors or windows preventing movement of people

DHS has a great educational sheet with additional indicators to look for: click here for a printable copy. While a particular situation may turn out not to be what you suspect, report your suspicions regardless so trained law enforcement experts can evaluate the situation. Your hunch may save a life or multiple lives. Call Immigration and Customs Enforcement at 1-866-DHS-2-ICE (1-866-347-2423) or online here. You can also receive additional training here.

References

Slavery Today (2018). Retrieved from   http://www.endslaverynow.org/learn/slavery-today

EMS’s Role in the Effort to End Human Trafficking (2017). Retrieved from https://www.ems.gov/newsletter/marapr2016/end-human-trafficking.html

Changing the Face of EMS for the New Century

EMS has always been the forefront of medicine, delivering care to the sick and injured in various roles dating as far back as the Civil War. It has come a long way from the days of horse and buggy. Yet, where are we going now?

One look at the trajectory of Nursing indicates where we are headed. When Nursing first started, the profession was comprised of caring women who were viewed and treated as indentured servants, subservient to the male dominated physicians. Nursing evolved when the “servant” became educated. What followed were thousands of women beginning to diagnose, conduct research and improve outcomes in the healthcare field. Soon thereafter, they broke free of the care assistant model they were in. I see EMS following the same path.

The ambulance industry started out as transporters, with a curriculum that was adopted and funded by the Department of Transportation (DOT). The industry has roots in DOT, Police Departments, Fire Departments and the military, but are truly physician extenders that should be firmly rooted in Health Departments. EMS is now developing a language, doing research, obtaining national accreditation for our schools, even supporting continuing education with CAPCE. But we need to do more.

Outreach will help accomplish what many have started.  We need to consider the picture the public has of EMS, especially when we have overlooked self-promotion for decades.

Let’s be the ones who show the public what EMS is and is capable of.  I look forward to EMS education mirroring, “The Georgia Trauma Commission,” which collaborated with the Georgia Society of the American College of Surgeons and the Georgia Committee on Trauma to create the “Stop the Bleed” campaign. This inspiring crusade is designed to train school teachers, nurses and staff across the state on how to render immediate and potentially life-saving medical aid to injured students and co-workers while waiting for professional responders to arrive.” (2018, para. 4)  This type of training gives us face time with the public so they can learn what we do and what we do not.

One of the other important outreach programs to help us in this endeavor is the Community Paramedic Program. We are seeing this education transform EMS into new and exciting roles in the community. “First responders frequently respond to calls for social services. So, the emergency responders may know of people who need some sort of services or resources,” (Todd) Babbitt, a former fire chief, said. “This team could help connect those people with the services they need. It’s about getting everybody to work together and communicate.” (2018, para. 4)

What we can do is start to get EMS in front of the public. Teach. And open our historically closed doors to the folks that make it easier to do our jobs. Educate others and learn together how our roles are changing modern day healthcare while embracing the change. Otherwise we risk being left in the dust by our progressive healthcare brethren.

References

(2018, Feb 1st, 2018). Ga. School Nurses Train to Stop the Bleed. The Brunswick News. Retrieved from https://www.emsworld.com/news/219782/ga-school-nurses-train-stop-bleed

(Ed.). (2018, January 30th, 2018). Conn. Fire Chiefs to Form Community Action Team. Norwich Bulletin. Retrieved from https://www.emsworld.com/news/219757/conn-fire-chiefs-form-community-action-team

Is Narcan the Answer?

There has been a lot of talk recently in social media and the news about leaving Narcan behind after a reversal of an opioid overdose. A new voluntary program in Pittsburgh, PA allows the state to pay for Narcan atomizers that EMS can leave with friends and family of OD patients. The media buzz revolves around the idea that we are enabling this cycle of addiction; “There is some pushback that maybe you’re enabling the problem a little bit, but at least in the short term, reduce the chances that person is going to die and you create more opportunities to get them into treatment,” said Mark Pinchalk, patient care coordinator for Pittsburgh EMS.” (Media, 2018, para. 3) I agree with Mr. Pinchalk that as an EMS Provider we are not there to judge, we are there to render aid.

One of my early instructors said, “Scott, your purpose is to leave the patient better than the way you found them.” I have taken that long ago statement to heart ever since, trying to leave the patient better than the way I found them whether that is medically as in a Diabetic whose blood glucose I raise from 20mg/dl to 130mg/dl or the person who receives a ride to the hospital to be  checked out. EMS is about providing care. When we use our own judgements or opinions on our patients, it impedes or influences the care we provide.

These particular cases seem to bring out strong opinions surrounding a delicate issue. Thousands of people die every year from Opioid overdoses. A healthy percentage of them get their start on prescription pain killers. So where do we help? How do we not judge going to the same address three or four times a week to treat the same person in the same situation? These are just some of the tough questions providers and services face every day in America. Although we are trying to hold back the tide with a broom, it is up to us to provide the same level of care each and every time, regardless of the person or situation.

Will leaving Narcan at the scene save lives? Yes, I believe so. Will it encourage more drug use? I can’t be sure. Time will tell.

In comparison, studies show making birth control available to teens actually reduces sexual activity and reported pregnancies. Consider 2017 data that shows “Among adolescent females aged 15 to 19, 42 percent report having sex at least once. For males, that number was 44 percent. The numbers have gradually dropped since 1988, when 51 percent of female and 60 percent of male teens reported having had sex.” (Welch, 2017, para. 4)

So for now, I encourage the opportunity, as the law allows, to provide Narcan, knowing it doesn’t make the problem go away. And I look forward to EMS impacting this youthful epidemic. How? Community Paramedicine are the resource to embrace. Just like any other frequent patient, community paramedics will help those get the services they need including the much-needed follow up care.


Scott F. McConnell is Vice President of EMS Education for OnCourse Learning and one of the Founders of Distance CME, which recently launched a new learning platform. Since its inception in 2010, more than 10,000 learners worldwide have relied on Distance CME to recertify their credentials. Scott is a true believer in sharing not only his perspectives and experiences but also those of other providers in educational settings.

References

Media, C. (Ed.). (2018, Jan, 26th, 2018). Local EMS starts program to leave Naloxone with OD victims. WPXI.com. Retrieved from http://www.wpxi.com/news/top-stories/local-ems-starts-program-to-leave-naloxone-with-od-victims/689842523

Welch, A. (2017, June 22nd, 2017). Are today’s teens more responsible about sex? CBS News. Retrieved from https://www.cbsnews.com/news/teen-sex-trends-birth-control-cdc-report/

AAA Members Serve in Disaster Relief

Expedited Application Processing to Join Federal Disaster Response

We are seeing unprecedented, catastrophic flooding in Texas and it looks as though disaster response efforts could potentially continue for the foreseeable future.

American Medical Response (AMR), has been a member of the AAA since 1992. The AMR Office of Emergency Management (OEM), within its national ambulance contract as the Federal EMS provider has responded to the state of Texas in its role as the FEMA prime contractor. The company has engaged a number of EMS companies who have responded to the Hurricane Harvey deployment. Many AAA member companies are disaster subcontractors for AMR and have proudly responded to federally-declared disasters since 2007.

Because of the potential protracted length of this storm and recovery efforts, AMR is now processing new applications to augment its existing operations. To help with those efforts, AAA wants to extend information about becoming a network provider for AMR. If your organization is interested in applying, please use this PDF application.

When officially deployed by AMR as a subcontractor, EMS providers are compensated portal-to-portal. During deployments, lodging, subsistence, and fuel may be provided. If not provided, EMS subcontractors will be reimbursed for approved expenses.

We recognize that many EMS providers are regulated by local or state agencies and may have restrictions when it comes to responding to out-of-area disasters. The EMS needs of local communities are primary and participation in the AMR Emergency Response Network is not intended to undermine those obligations. States may have Emergency Management Assistance Compact (EMAC) agreements with ambulance services; therefore, AMR will not utilize assets that are committed under EMAC.

We are all hoping the waters will recede and first responders will be able to return to their homes soon, but we could be looking at prolonged recovery, and we know our AAA members are always called to serve.

For additional information, you can contact:

Laura Vigus
Laura.Vigus@amr.net
214-793-4073

Thank You, Participating Members!

AAA is deeply proud to represent dozens of member organizations who deploy at a moment’s notice to serve in large-scale disasters like Hurricane Harvey as part of AMR’s federal emergency contract. Thank you for your service to our nation.

Acadian Ambulance(TX)
Alert Ambulance Service Inc (NJ)
Alliance Mobile Health (MI)
Amcare Ambulance (VT)
America Ambulance Service Inc.
American Trans Med(SC)
Anniston EMS (AL)
Arizona Ambulance(AZ)
ATS Ambulance
Baca/Crestone Ambulance Service (CO)
Bangs Ambulance(NY)
Bartlesville Ambulance(OK)
Beauport Ambulance Service Inc (MA)
Bell Ambulance Inc. (WI)
Bennington Rescue Squad(VT)
Calex Ambulance(VT)
Cape County Ambulance(MO)
Central Emergency Medical Service Inc. (GA)
Citywide Mobile Response Corp (NY)
Community (Mid Georgia) (GA)
Community Ambulance Genesis (OH)
Community Care Ambulance Network (OH)
Community EMS (MI)
Community EMS Dayton (OH)
Elgin Medi Transport(IL)
Elizabeth Township EMS (PA) (12167)
Empress Ambulance Service Inc (NY)
Erway Ambulance(NY)
F-M Ambulance Service Inc (ND)
Fraser Medical Services(IA)
Guardian Angel Ambulance Service Inc (PA)
Humboldt General Hospital (NV)
Huntsville Emergency Medical Services Inc(AL)
Huron Valley/Jackson Community Ambulance(MI)
Lakes Region EMS Inc (WI)
Life EMS (OK)
Life EMS(MI)
Lifecare ambulance(MI)
Lifecare of Virginia(VA)
Lifeguard Ambulance (TN)
Lifeguard Columbia County (FL)
Lifeguard Knoxville (TN)
Lifeguard Mobile (AL)
Lifeguard Morgan County (AL)
Lifeguard Nashville (TN)
Lifeguard Santa Rosa (FL)
Lifeline Ambulance (IL)
Livingston EMS(MI)
Lyndon Rescue(VT)
Medfleet Systems Inc (FL)
Medshore Ambulance Service (SC)
Medstar Ambulance (MI)
Memorial Hospital of Converse County (WY)
Metro Medical Services Inc (IL)
METS Ambulance(MO)
Mobile Medical Response Inc.(MI)
Mohawk Ambulance (NY) Parkland
Newport Ambulance Service Inc.(VT)
Newton County Ambulance(MO)
North Shore University Hospital (NY) Northwell Health
Pafford Medical Services (AR)
Port Jefferson Volunteer Ambulance Corp Inc.
Professional Ambulance and Oxygen(MA)
Professional Med Team Inc.(MI)
ProMed Ambulance(AR)
Puckett EMS(GA)
Regional Ambulance (VT)
Riverside Ambulance (AR)
Rockland Mobile Care(NY)
Rockland Paramedic Service(NY)
Rugby (ND)
Seniorcare EMS(NY)
Southstar Ambulance(GA)
Spirit Medical Transport (OH)
Star EMS/Miles Grubb Assoc.(MI)
Stat EMS (MI)
Summit County Ambulance(CO)
Superior Air-Ground Ambulance Service Inc (IL)
Taney County (MO)
TLC Emergency Medical Services Inc.(NY)
Trace Ambulance Service(IL)
Trans Am(NY)
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Fentanyl Increasingly Dangerous to First Responders

Fentanyl is a powerful drug that can be 50 times more potent than heroin. First responders are being warned to take precautions to avoid being exposed to the drug. Photo courtesy of the Drug Enforcement Administration.

The explosion of the opioid epidemic that is responsible for thousands of overdoses and deaths is a consistent problem that EMS and law enforcement encounter on an almost daily basis. Usually, the victims of these powerful drugs, such as heroin and fentanyl, are opioid users, who EMS personnel and law enforcement are regularly called to assist. However, first responders are also being warned about the increased risks they face of being exposed to these deadly drugs, specifically fentanyl—a popular synthetic opioid that is 40 to 50 times more powerful than heroin. To respond to these dangers, the Drug Enforcement Administration (DEA) released a field guide called “Fentanyl: A Brief Guide for First Responders” for EMS and police who find themselves responding to opioid-related calls.

“We need everybody in the United States to understand how dangerous this is,” Acting DEA Administrator Chuck Rosenberg warned. “Exposure to an amount equivalent to a few grains of sand can kill you.”

The warnings have become more urgent in recent months due to numerous cases of accidental overdoses and exposures involving EMS and police.

In May, Chris Green, a police officer with the East Liverpool Police Department, was accidentally exposed to fentanyl during a routine traffic stop after he inadvertently ingested the drug through his skin. Green needed four shots of Narcan, an emergency overdose medication, to be revived after collapsing from the effects of the drug. In another case, two Paramedics and a sheriff’s deputy in Hardford County, Maryland, were treated after showing signs of opioid exposure while treating an overdose victim.

“It is important to get the word out to everyone because it may be the first responder who needs to have Narcan administered,” said Baltimore City Health Commissioner Leana Wen.

The risks of accidental exposure are so high, in fact, that some emergency personnel have even begun carrying Narcan kits for drug-sniffing K-9s, just in case the dogs ingest the deadly drugs.

The DEA guide, along with a National Institute for Occupational Safety and Health manual on preventing fentanyl exposure, suggests certain precautions be taken to lower the risk of coming in direct contact with the substance. Personnel should be able to recognize the signs and symptoms of an overdose, be aware of the ways fentanyl can be ingested, and only allow trained professionals to handle substances that are suspect.

“Assume the worst,” Rosenberg said. “Don’t touch this stuff or the wrappings that it comes in without the proper personal protective equipment.”

The DEA video “Fentanyl: A Real Threat to Law Enforcement” offers advice on how police and EMS can protect themselves from the dangers of fentanyl.

Read more about fentanyl.

 

HHS to Administer $70 million in Funds to Combat Opioid Crisis

The Department of Health and Human Services (HHS) announced $70 million in grants to help communities and health care professionals combat the ongoing opioid crisis that is ravaging communities across the U.S. The majority of the money will be used to help prevent opioid-induced deaths and to provide treatment for people with opioid use disorders, including $28 million allotted for medication-based treatment. More than 33,000 lives were claimed in 2015 due to opioid overdoses.

$41.7 million of the funding is set to expand resources and training for first responders on how to use emergency treatments, such as Narcan, to help reverse and treat overdoses. In many cases, first responders are often the difference between life and death for opioid users who experience an overdose, so it is imperative health care professionals have access to the needed resources and training to help save lives. The additional funding aims to help paramedics, EMTs and other emergency service personnel gain access to much-needed resources.

“The grants we announce today clearly demonstrate our efforts to meet the opioid crisis with every tool at our disposal,” said Substance Abuse and Mental Health Services Administration Acting Deputy Assistant Secretary Kana Enomoto. “The evidence-based training, medication, and behavioral therapies provided here will save lives and help people with addictions start a path toward reaching their potential.”

In addition to the most recent grants, $485 million in grants were awarded in April to treat and prevent opioid abuse.

To read more about the grants, please visit the HHS web site.

Ransomware: A Ticking Time Bomb for Health Care

By Cindy Elbert
President, Cindy Elbert Insurance Services, Inc

If you’re doing business online, you need cyber-insurance. This fact was never made truer than on May 12, 2017 when 50,000 businesses in at least 74 countries were hit by a ransomware attack code named “WannaCry”. Hackers demanded companies to pay a $300 ransom fee or their files would be published on the Internet. The data thieves targeted mostly hospitals and other medical facilities because their data not only included names, home addresses, addiction histories, financial information and religious affiliations but also disclosed patients’ mental health and medical diagnoses, HIV statuses and sexual assault and domestic violence reports. A gold mine of personal information for those with dark purposes.

Two days earlier, a data breach at the Bronx Lebanon Hospital Center in New York compromised the medical records of at least 7,000 people. According to NBC News, “Leaks from the Rsync servers, which transfer and synchronize files across systems, are common. How many more nude photos of patients or ultrasound images will be exposed because of misconfigured Rsync backups?”

On May 4, 2017, a group calling themselves TheDarkOverload uploaded almost 180,000 stolen patient/medical records from three companies onto the Internet because they refused to pay a ransom. The databases stolen were in the .csv format and contained health information about cardiac diagnoses and psychiatric conditions such as depression, along with date of birth and social security numbers.

Most ransomware attacks are led by organized criminal groups utilizing a network of computers infected with malware that then poisons other computers once a spam message is opened. An example of a spam malware would be emails falsely marked as being from a co-worker or friend asking a recipient to open an attached file. Or, an email might come from a trusted institution, like a bank or merchant, asking you to perform a specific task. In other instances, hackers will use scare tactics such as claiming that a victim’s computer has been used for illegal activities to bully victims. When the malware is executed, it encrypts files and demands a ransom to unlock them.

Imagine the nightmare scenario of medical teams out on the field relying on electronic devices such as tablets, laptops, smartphones and PDAs to access patient care records suddenly discovering that their data has been locked, captured by malicious malware., held for ransom with lives in the balance.

Companies need the protection cyber liability insurance offers now more than ever.

Why Your Company Needs Cyber Liability Insurance

  • A single data breach could cost your company thousands of dollars, not to mention the hit to your reputation.
  • Hackers can be halfway across the world—or at the desk next to you.
  • An employee losing a company laptop or cell phone could result in a major security breach.
  • The more personal information your company collects opens your exposure to the likelihood of a data breach attack.
  • As of March 28, 2017, Internet providers can collect and sell your web browser history opening more opportunities for data to be stolen.
  • The average forensic investigation runs $25,000 per server.

Cyberthreats By the Numbers

  • Sixty percent of uninsured small businesses close their doors within six months following a cyber attack.
  • According to the 2016 NetDiligence Cyber Claims study, Healthcare data breaches made up 19% of all breach sectors.
  • The average cost for a breached healthcare company is $717,000.
  • According to the Identity Theft Resource Center’s 2017 Data Breach report, almost 2 million records have been stolen so far this year, making up 22 percent of all breaches – and this is before the “WannaCry” ransomware attack.
  • Forty-seven states mandate that your company take certain measures in the event of a security breach

Protect Your Company

Ransomware attacks and cyber theft will not be defeated any time soon. So now is the time to ask: How do you store sensitive information? How do you control access to sensitive information? Do you utilize a firewall and protection software? Do you allow employees and others remote access to your data bases? Do you have a written security policy? And, most importantly, do you have cyber liability insurance? Is it safe? If your company stores customer information, especially billing and medical data, then there is no question about it: You must protect yourself from the growing legion of cyber predators. You need cyber liability insurance.

About the Author

Cindy Elbert is President of Cindy Elbert Insurance Services, Inc. She is a licensed Property & Casualty Insurance broker/agent, and a proud member of the American Ambulance Association, California Ambulance Association, Arizona Ambulance Association, and The Independent Agents Association.

Cindy has been assisting ambulance providers with their insurance needs since 1982. She understands your questions and concerns and with her relationships with insurance underwriters she can provide you with coverage and service you deserve.
www.ambulanceinsurance.com
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Spotlight: SSM Health Cardinal Glennon Children’s Hospital STARS Program

The Special Needs Tracking & Awareness Response System (STARS), was founded just over two years ago at SSM Health Cardinal Glennon’s Children’s Hospital in St. Louis, Missouri. The team at Cardinal Glennon realized that they needed to do something to address the growing number of children in the U.S. with special health care needs, many of whom are at a higher risk for repeated ambulance transports.

As an EMT for over 18 years, Patricia Casey, the Missouri Coordinator of the STARS Program, knows how intimidating it can be for a first responder to walk into a home that in many ways may look like a hospital room. Children with special health care needs can require many different types of in home medical equipment that first responders are often not familiar with. The STARS Program aims to make the job of the first responders easier while making children with medical needs and their parents more comfortable with ambulances in case they need to be transported in one.

Cardinal Glennon works with local ambulance districts to enroll children with special medical needs in that district’s STAR Program. Once a child is registered in STARS, they are given a unique patient identification number and a home visit is scheduled with the patient and their family to compile pertinent medical history. Participating ambulance companies then create a book with all of the stars in their area so that their first responders have access to the medical information on the go. If a STAR needs to be transported, their caregiver can relay their STAR number to the dispatcher who will then let the first responders know. First responders can then look up crucial medical information about the STARS patient, so they can be better prepared when they arrive on scene.

Knowing that many medical devices in the homes of the STARS may be foreign to first responders, Cardinal Glennon’s staff provides free necessary trainings all around Missouri and now Illinois. Shelby Cox works as the Team Lead for EMS outreach, and Josh Dugal, RN, is the EMT-P STARS Coordinator for Illinois. Together with Casey, they help keep the program running smoothly. Each participating ambulance company appoints a STARS coordinator on their staff who will make biannual home visits and make sure the STARS medical information is up to date. Cardinal Glennon also sets up regular opportunities for STARS to visit their local first responders. Giving STARS the chance to get familiar with an ambulance and their local first responders prior to a medical emergency has been proven to help out both parties when an emergency occurs.

A paramedic who has responded to STARS calls explains that “the STARS system permitted me to have advanced medical knowledge before I walked through the door. There was no time lost backtracking to learn the patient’s history or baseline in the midst of a chaotic scene”. In addition to helping the first responders, the STARS program has been a huge reassurance to the parents of STARS whose children may often need medical assistance.

To learn more about Cardinal Glennon’s STARS program, visit their website or check them out on Facebook. Also check out Patricia Casey’s Article on the STARS Program which includes testimonials from both parents and first responders who have participated in the program.
Thanks to the entire team at Cardinal Glennon for your great work!

Do you know of other innovative programs being run by ambulance services? Share with the AAA so that we might feature those programs on the AAA Blog as well.

Pledge of Support to the Office of Homeland Security

AAA Board of Directors Resolution

Whereas, the American Ambulance Association (AAA) represents ambulance services across the United States that participate in serving more than 95% of the urban U.S. population with emergency and non-emergency care and medical transportation services, and

Whereas, AAA members play a key role in our nation’s homeland security as a first responder, and

Whereas, the members of the American Ambulance Association work closely with their community’s local emergency response services such as fire and rescue, hospitals, public health, long-term care and other community-based health care organizations, and

Whereas, the nation’s Paramedics and Emergency Medical Technicians are highly trained health care professionals on the front line everyday participating in the pre-hospital safety net for people all across America, therefore,

Be it resolved that the AAA Board of Directors, on behalf of its membership and the ambulance industry across the United States, does hereby pledge its commitment to the Office of Homeland Security, and its Director Tom Ridge, to assist in the planning and implementation of various homeland security operations within our area of expertise.

Adopted November 17, 2001
By the American Ambulance Association
Board of Directors

Call for Affirmation of Ambulance Services Vital Role in Disaster Response

AAA Board of Directors Resolution

Whereas, during a catastrophic disaster, act of terrorism or other public health threat, local ambulance services are an essential resource and a vital part of the emergency response system, and

Whereas, dramatic evidence of this critical role was the quick response of ambulance services immediately following the terrorists attacks on September 11, 2001, and

Whereas, the American Ambulance Association (AAA) represents ambulance services across the United States that participate in serving more than 95% of the urban U.S. population with emergency and non-emergency care and medical transportation, and

Whereas, especially during this time of heightened alert, affirming the role of the nation’s ambulance services in the local, state and federal homeland security planning and response is essential, therefore

Be it resolved that the AAA Board of Directors, on behalf of its membership and the ambulance industry across the United States, does hereby recommend the following…

  • Safety of ambulance service personnel and patients, and the security of ambulance facilities, supply inventories and vehicles;
  • Effective use of ambulance resources benefiting the patients and communities we serve;
  • Integration of local ambulance services into emergency management including: 1) mitigation, 2) preparedness, 3) response, and 4) recovery;
  • Timely cost reimbursement to offset the financial impact of disaster preparedness and response; and
  • Accurate recognition of critical role of ambulance service providers, before, during and after an event.

Adopted by the American Ambulance Association
Board of Directors
November 17, 2001

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