Workforce Resource: Total Compensation Statement & Calculation Sheet

Part of any successful recruitment and retention strategy is having a competitive compensation and benefits package. This is achieved most successfully by providing employees with a Total Compensation Statement.

A Total Compensation Statement communicates and provides an employee with a picture of the value of an employee’s compensation package, including wages and other costs which are typically shown in an employee’s paystub. However, a Total Compensation Statement shows the hidden costs, many paid by the employer on behalf of the employee, such as employer-paid healthcare, retirement, payroll taxes, and other supplements that employers provide. The purpose is to provide employees with the full picture of compensation and arm them with information about how your organization stacks up against your competitors.

Attached are two samples of Total Compensation Forms that can be used by AAA member companies. The forms offer the ability for our members to personalize by inserting their company logo.  These are typically issued on a quarterly, bi-annual, or yearly basis.

Total Compensation and Benefits Statement
The Total Compensation and Benefits Statement is a fillable PDF form that performs the calculations as you enter the different compensation-related items. The costs are shown in two columns, one for the employee wages and other costs, and the other for the often-hidden cost paid by the employer on the employee’s behalf.

Total Compensation Calculation Spreadsheet
The Total Compensation Calculation Spreadsheet is also a fillable PDF form that performs the calculations as you enter the different compensation-related items. There is a column that allows the employer to provide a Description of the benefit item listed. The costs are shown in two columns, one for the employee wages and other costs, and the other for the often-hidden cost paid by the employer on the employee’s behalf.

About the AAA Workforce Committee
The AAA Workforce Committee was formed by the AAA Board of Directors with the committee charge to evaluate and assist AAA member companies with the factors that impact the recruitment and retention of qualified EMS employees. If there are compensation or benefit items that we failed to include that you believe should be part of these documents, please let us know!
Send your feedback to

Survey for EMS Educators | Please Share!

Please share this email and survey link with EMS education providers in your area! If your ambulance service operates its own training program, please also complete the survey on its behalf. Thank you for helping us gather this critically important data!


Dear Education Partner/Collaborator,

As a leader in Emergency Medical Services and a member of the American Ambulance Association, the Association leadership is trying to better understand the current challenges regarding the new and current workforce. One of our goals this year is to better understand the impact that Covid-19 has placed on education institutions offering programs in emergency medical services.

Therefore, I am requesting your help in completing a short survey and answer five short questions through the link below to help gather data and try to determine the short- and long-term effects we might expect because of any potential disruption in the graduation or completion of future students entering the field of EMS?


We appreciate your time and effort towards helping us better understand the future of our EMS workforce and begin building more solutions to try and recruit and retain our workforce for long term sustainability. If you have any questions, please feel free to reach out to me directly or contact the American Ambulance Association’s CEO, Maria Bianchi at

Thanks for considering.

Your Name
Your Title
EMS Service Name

ResponderStrong | Personalized Wellness for Emergency Responders

Grit Digital Health Introduces World’s First Personalized Wellness Platform for Emergency Responders

Access YOU | ResponderStrong

At a time when emergency responders are under immense stress, innovative health tech organization develops YOU | ResponderStrong wellness tool to support comprehensive well-being for at-risk group

DENVERAug. 27, 2020 /PRNewswire/ — Grit Digital Health LLC, a tech startup at the intersection of behavioral health, well-being and technology, has partnered with The Anschutz Foundation, Global Medical Response (GMR) and All Clear Foundation to create YOU | ResponderStrong — the world’s first personalized wellness platform for emergency responders. Emergency responders face well-being challenges (e.g. shift work, consistent exposure to trauma, and working in high risk environments) that put them at higher risk for mental health issues and suicide, yet barriers make it difficult to seek out available resources and discuss concerns, leaving many to struggle with these challenges alone.

For emergency responders, rescuing others is second nature, but the mental and physical impacts can be debilitating if left unaddressed. Studies show that first responders are more likely to die by suicide than in the line of duty, 20 to 25 percent of all first responders experience post-traumatic stress and the life expectancy of a first responder is 20 years less than average.

“Responders shouldn’t pay for their service with their lives, either in longevity or quality,” said Rhonda Kelly, founder of ResponderStrong and director of health, wellness and resilience for GMR. “Especially now when the stressors are so extreme and prolonged, burnout is on a meteoric rise. The result of our failing to meet our basic human needs, burnout is one of our biggest enemies. This tool is a tremendous aid in supporting our self-care, building our resiliency, and improving our quality of life.”

Using a human-centered research and design process, the founding partners of brought together national leaders across various emergency responder verticals (law enforcement, EMS, fire service, dispatch and healthcare workers, etc.) to uncover the needs, motivations and challenges of these populations with respect to their mental health and well-being. The insights gathered during this process highlighted the increased pressure and new risks currently facing emergency responders across the country.

“One challenge that has been clear for first responders is figuring out the balance between being able to perform their jobs and also act in the other roles they fill as parents and spouses,” said Caleb Demers, LCSW, who works directly with emergency responders as a clinical social worker and member of the LEADER program at McLean Hospital. “Many patients we work with use a lot of energy attempting to not ‘bring the work home,’ but now that is a tangible fear with more immediate consequences. We see first responders work very hard to maintain confidence and competence in their roles, but when their supports are not as accessible, it affects their mental health.”

The solution is a digital platform, available 24/7, with hundreds of evidence-based resources and tools to support emergency responders with their personal and professional well-being. The first platform of its kind, YOU | ResponderStrong uses a tailored profile and proprietary health assessments to personalize the experience for each emergency responder that creates an account. The platform delivers customized online resources and tools across three areas of well-being: Succeed (financial and career success), Thrive (mental and physical health) and Matter (purpose and connections). The foundations of this comprehensive approach lie in Grit Digital Health’s proprietary well-being model.

“High stress work environments invariably lead to stress that carries into one’s personal life,” said Nathaan Demers, Psy.D., VP and director of clinical programs at Grit Digital Health. “It’s essential that we support the comprehensive well-being of emergency responders by decreasing the stigma and providing educational resources regarding how to support peers, as well as oneself. This is especially important in times of heightened stress, as we see now in light of COVID-19.”

The platform is built on a research-backed tool called YOU, a personalized well-being software created for college campuses and later expanded to serve rural veterans, community mental health centers, workplace wellness and now emergency responders. The platform provides an experience aligned with key research insights gathered from emergency responders: maintaining confidentiality, keeping data secure, including crisis information and providing 24/7 access to support any need any time. Data provided to tap into the platform’s personalization algorithm is completely anonymous, an essential aspect in building trust with emergency responders using the platform.

“Emergency Responders sacrifice more than most and shoulder unfathomable burdens to keep us all safe,” said Janell Farr, president of All Clear Foundation. “They are so focused on helping others that they often don’t take time to help themselves. And if they would like to, options have previously been limited. With YOU | ResponderStrong, responders can now easily assess their overall well-being and immediately access content to enhance their health, well-being and everything in-between.”

The platform is currently undergoing further testing and iteration efforts. Grit Digital Health will collaborate with the founding partner organizations to roll out a second version of the ResponderStrong wellness tool in fall 2020. The release will include learnings from testing with emergency responders and analysis of impact/engagement data. See the tool in action by visiting

About Grit Digital Health

Grit Digital Health develops behavioral health and well-being solutions through design and technology that envision a new way to approach mental health and well-being. The company solves complex health problems through innovation and creativity, including products that address veteran transitions to civilian life, student loneliness and well-being, employee satisfaction and the mental health of working-age men. For more information, visit

About All Clear Foundation

All Clear Foundation is a nonpartisan, nonprofit 501(c)3 supporting First Responders by creating, convening, amplifying and funding innovative programs to improve their life expectancy and wellbeing – as well as the wellbeing of their families. In addition to YOU | ResponderStrong, the foundation has curated a First Responder Resource Database with thousands of resources for responders and their families, and recently launched  ResponderRel8, a peer-to-peer chat app that enables First Responders to connect, celebrate and commiserate with peers without fear or stigma getting in the way, and anonymously if they choose. To learn more about All Clear Foundation’s programs or to join the cause, visit

About The Anschutz Foundation

Founded in 1984, The Anschutz Foundation was created by Philip F. Anschutz as a private charitable foundation. Over three decades, the foundation has given substantially to hundreds of nonprofit organizations primarily concentrated in Colorado. The Anschutz Foundation currently makes more than 500 grants annually. In 2016, The Anschutz Foundation received the Outstanding Foundation award from National Philanthropy Day in Colorado. This annual event celebrates exceptional philanthropic and volunteer contributions in Colorado. For more information, visit

About Global Medical Response (GMR)

With more than 38,000 employees, Global Medical Response teams deliver compassionate, quality medical care, primarily in the areas of emergency and patient relocation services in the United States, the District of Columbia and around the world. GMR was formed by combining the industry leaders in air, ground, managed medical transportation, and community, industrial/specialty and wildland fire services. Each of our companies have long histories of proudly serving the communities where we live: American Medical Response (AMR), Rural Metro Fire, Air Evac Lifeteam, REACH Air Medical Services, Med-Trans Corporation, AirMed International and Guardian Flight. Combined, we completed 4.9 million patient transports last year utilizing 7,000 ground vehicles, 111 fire vehicles, 306 rotor-wing aircraft and 106 fixed-wing aircraft. We are the largest medical transport company in the world, focusing on intimate and high-service solutions at a local level. For more information, visit

SOURCE Grit Digital Health LLC

Childcare Benefit: Kindercare Discount & Priority Placement

AAA understands that EMS staff often experience significant challenges securing quality, reliable childcare, and that these challenges have been exacerbated by school and daycare closures caused by COVID-19. We are here to help!

The American Ambulance Association is proud to share that we have partnered with Kindercare to offer EMS providers priority childcare placement as well as a 10% discount on tuition. Please share this information with your staff! Visit for full details.

Kindercare Locations

AAA member employee families receive priority placement at all 1600 Kindercare centers.

Childcare Services & Age Range

AAA member employees save 10% on full-time, part-time, and drop-in tuition for children ages six weeks to 12 years at any KinderCare Learning Center or Champions before- and after-school sites nationwide.

Existing  Kindercare Families

This offer is available to new families as well as those already enrolled in a participating center.

Tuition Discount Guide

  1. Search for a center or site that is near you (Search All Centers)
  2. Schedule a tour of the center or site online or by phone with the center information provided.
  3. When you enroll (or if you’re already enrolled), let your Center Director know you are a member of American Ambulance Association and that you are eligible for a 10% tuition benefit.
  4. Your Center Director will apply the discount on your next billing cycle.


FBHA Workshop | Saving Those Who Save Others

American Ambulance Association mental and behavioral health partner the Firefighter Behavioral Health Alliance is offering two sessions of their “Saving Those Who Save Others” virtual workshop.

Saving Those Who Save Others

December 17
Afternoon Session: 14:00 ET | Register►
Evening Session: 19:00 ET | Register►

This Zoom seminar, typically $25, is free to AAA members! Please enter “AAA member” in the comment section of the registration page and you will not be charged for your attendance.

FBHA understands the stress COVID 19 has brought to fire and EMS organizations in regard to educating your members on behavioral health, PTSD and suicide awareness. To date, FBHA has cancelled over 80 workshops across the US this year. Since we are not able to travel and businesses are still on lockdown, we are offering another option.

We are excited to offer needed training virtually! We are offering our “Saving Those Who Save Others” workshop on the Zoom platform. During the workshop, we will discuss PTSD within the fire and EMS services as well as suicide awareness, plus recommendations to help yourself and your department.

Two classes will be offered on December 17, 2020. The afternoon class is at 1300 hours (CST) and the evening class is at 1900 hours (CST). The 2 hour class is $25.00.

CMS Releases CY 2021 Physician Fee Schedule

The Centers for Medicare & Medicaid Services (CMS) has released the Physician Fee Schedule Proposed Rule for Calendar Year (CY) 2021 which has traditionally included proposed changes to the Ambulance Fee Schedule for the same year. The American Ambulance Association (AAA) has confirmed with CMS that the reason there are no references to the Ambulance Fee Schedule in the Proposed Rule is because the temporary add-ons were built into the regulations themselves.  Thus, the governing regulations already indicate that the temporary add-on payments for ground ambulance transports are effective for services furnished through December 31, 2022.  The regulations are at 42 CFR §414.610 (c)(1)(ii) and 42 CFR §414.610 (c)(5)(ii).

The Proposed Rule also seeks to extend or make permanent several of the telehealth waivers CMS has implemented during the public health emergency.  Because CMS does not believe it has the authority to reimburse ambulance providers or suppliers for services provided without transportation also occurring, these waivers have not applied to ground ambulance.  However, we will review these provisions of the rule closely to identify potential opportunities to include ground ambulance providers and suppliers in these policies.

JAMA | COVID-19 Medical Leave for EMS in NYC

From JAMA Network Open

Medical Leave Associated With COVID-19 Among Emergency Medical System Responders and Firefighters in New York City

In New York, New York, from March 1 to May 31, 2020, 201 102 individuals were diagnosed with coronavirus disease 2019 (COVID-19), resulting in 51 085 hospitalizations and 16 834 deaths.1 The Fire Department of the City of New York (FDNY), the largest in the US, responds to nearly 1.5 million emergency medical calls per year in a city of more than 8.4 million people. Active paid FDNY responders include 4408 emergency medical service (EMS) responders and 11 230 firefighters. These FDNY responders are required to don personal protective equipment before patient contact per US Centers for Disease Control and Prevention guidelines.2 In this cohort study, we compared medical leave of FDNY responders during the pandemic with prior years.

Continue Reading


Prezant DJ, Zeig-Owens R, Schwartz T, et al. Medical Leave Associated With COVID-19 Among Emergency Medical System Responders and Firefighters in New York City. JAMA Netw Open. 2020;3(7):e2016094. doi:10.1001/jamanetworkopen.2020.16094

COVID Testing for EMS

This document provides a brief overview of COVID-19 testing to inform decision-making for first responders including emergency medical service (EMS), Fire & Rescue, Law Enforcement and 911 telecommunicators.

Overview of testing for SARS-CoV-2 (the virus that causes the disease COVID-19): The Food and Drug Administration (FDA) is the U.S. government entity responsible for regulating medical devices, including tests and devices like those being used to detect SARS-CoV-2. Because of the public health emergency caused by a novel coronavirus, the FDA has issued multiple Emergency Use Authorizations (EUA) for various types of medical devices, including tests. Final validation of these tests still needs to be completed through all of the normal FDA clearance processes and receive approval by the FDA under the traditional marketing pathways approval processes. A list of tests that have been issued EUAs is available at EUA Information:

Types of Testing:

  • Molecular: The molecular diagnostic tests look for evidence of an active infection by detecting either the genetic material of the pathogen or a unique marker of it. This type of test detects signs of the virus’s genetic material. One type of molecular testing is called a reverse transcriptase – polymerase chain reaction (RT-PCR). This method requires only a small sample size of the pathogen (ex. from blood or saliva) and amplifies segments of the virus’ genetic code and replicates it in order to show its presence and allow it to be more easily detected. A positive result indicates the presence of actual infectious viral material in the body. However, these results cannot alone determine if the pathogen remains viable (e.g., infective) or is dead and no longer infective. The presence of such material does not necessarily indicate if the patient is infectious (although for provider safety, patients with a positive test should be presumed infectious) but simply that such material is there. Test samples are usually obtained from humans using a special nasal swab designed for this purpose.
  • Antigen: The antigen diagnostic tests quickly detect fragments of pathogen proteins found on or within the virus from human testing samples often from a swab of the nasopharyngeal cavity. However, antigen tests may not detect all active infections. Antigen tests are very specific for the virus but are often not as sensitive as molecular RT-PCR tests because of the certainty of positive samples used to develop the actual test. Positive results from antigen tests are highly accurate but there is also a higher chance of false negatives. As a result, negative results do not rule out infection. Until well-validated antigen testing is available, negative results from this approach may warrant confirmatory testing using a molecular test (i.e. an antigen test may need to be confirmed with a RT-PCR test prior to making treatment decisions to help prevent the possible spread of the virus due to a false negative).
  • Serological: The serology tests look for the presence of antibodies, which are specific proteins made in response to an infection as part of the body’s attempt to fight that infection. It does not specifically indicate current (active) disease. It is important to remember that the development of antibodies takes some time, usually weeks, to develop after exposure to the infection. There are also different types of antibodies that are developed and can be tested for individually (i.e. IgG, IgM). Depending upon when someone was infected and the timing of the test, antibodies may not have developed in sufficient quantities to be detected by the test. We currently don’t know if detection of antibodies, and at what level, indicates immunity, and/or protection from future exposure. Similarly, there is another concern that any detected antibodies may instead reflect other strains of more commonly occurring coronaviruses, such as variations of the common cold.

Testing Limitations: No test is 100% accurate 100% of the time.

a. Specificity: Specificity is a measure of a test’s ability to correctly generate a negative result for people who don’t have the condition that’s being tested for (also known as the “true negative” rate). A high-specificity test will correctly rule out almost everyone who doesn’t have the disease when the test is negative and won’t generate a high percentage of false-positive results. (Example: a test with 90% specificity will correctly return a negative result for 90% of people who don’t have the disease but will return a positive result — a false-positive — for 10% of the people who don’t have the disease and should have tested negative.)

b. Sensitivity: Sensitivity is a measure of how often a test correctly generates a positive result for people who have the condition that’s being tested for (also known as the “true positive” rate). A test that’s highly sensitive will identify almost everyone who has the disease and not generate many false-negative results. (Example: a test with 90% sensitivity will correctly return a positive result for 90% of people who have the disease but will return a negative result — a false-negative — for 10% of the people who have the disease.)

c. There are currently a variety of tests which have not been reviewed by FDA but may be purchased to test for COVID-19. The concern with false negatives relates to the higher potential for future transmissions whereas the concern for a false positive relates to unnecessary diagnostic or medical procedures for the patent and wasted PPE use for the provider. A false negative result could lead to additional exposure to contacts of the patient, including first responders and EMS personnel.

Testing Evaluation Tips:

a. Testing for first responders and EMS clinicians should be coordinated with the EMS Medical Director and other local/state public health agencies.

b. Check the FDA site (COVID-19 Testing EUA Recipients) to determine whether the test you are considering purchasing has received an EUA by the FDA.

c. Work with the EMS Medical Director to identify the test error rate to determine whether the results can be relied upon and if actions should be made based upon the data obtained.

d. Purchase tests only through verified suppliers to ensure authenticity. There have been reports of counterfeit tests being sold to unsuspecting clients.

e. Follow the test instructions exactly to avoid increasing the error rate and to achieve full test performance. Use Clinical Laboratory Improvement Amendments (CLIA)-certified labs for test processing, if required, based on the specific test.

Research References:

CDC Serology Testing:
Emergency Use Authorizations:
FAQs on Diagnostic Testing for SARS-CoV-2:
FDA Contact Information on Testing:
• Toll-free line 24 hours a day: 1-888-INFO-FDA option *;
• Email to report shortages:;
Email applicable diagnostic tests: COVID19DX@FDA.HHS.GOV
FDA Statement Regarding COVID-19 Antigen Testing:
Serology Test FAQs:
CDC recommendations for the Testing of COVID 19:
Infectious Disease Society of America (IDSA) primer on serological testing :*

Always In Our Hearts

Please join the American Ambulance Association in honoring those who have fallen serving their communities in the COVID-19 pandemic.

What does it mean to be a hero? Paramedics, EMTs, nurses, and firefighters risk their lives every day to serve on the…

Posted by American Ambulance Association on Tuesday, June 30, 2020

Critical Care Decontamination System (CCDS) for N95 Respirators

Prehospital Use of the Critical Care Decontamination System (CCDS) for
N95 Respirators

Download as PDF

Use of personal protective equipment (PPE) during the COVID-19 pandemic response is at unprecedented levels. In order to slow usage rates and maintain supply chain stability, the U.S. Food and Drug Administration (FDA) has authorized an Emergency Use Authorization (EUA) for the emergency use of an N95 respirator decontamination system. This is one of several EUAs for decontamination technologies granted by the FDA. This document is intended to provide basic information on the Critical Care Decontamination System (CCDS) for pre-hospital use.


  • Method: vapor phase hydrogen-peroxide (VPHP)
  • For use in decontaminating N95 or N95-equivalent respirators
  • Respirators can undergo up to 20 decontamination cycles with the CCDS.
  • Due to incompatibility, the CCDS is not authorized for use with respirators containing cellulose-based materials.
  • All compatible N95 respirators provided to CCDS must be free of any visual soiling or contamination (e.g., blood, bodily fluids, makeup).
  • If N95 respirators are soiled or damaged, they will be disposed of and not returned after decontamination.
  • Healthcare personnel should follow the instructions provided by the CCDS program in Instructions for Healthcare Personnel
  • There is not a cost for use of the system
  • First responders will have access to the system(s) in their region
  • Healthcare facilities and first responder agencies need to request a Site Location Code from the CCDS program.
  • The Site Location Code must be placed by the healthcare facility or first responder agency on each of their N-95 respirators.
  • This is not a one-for-one exchange program –if the N95 cannot be disinfected, it will not be replaced. Decontaminated N95s will be returned to the healthcare facility with the designated facility code and chain-of-custody forms.

The CCDS location for your area can be found by contacting your state or local EMS agency/public health agency / Emergency Operations Center (EOC).

NOTE: If there is not one in your area, a request can be submitted through your local EOC to
utilize others.

Further information can be found on the CCDS Site

New Hampshire | Hazard Pay for EMS

Days after announcing plans for Stay at Home 2.0, New Hampshire Gov. Chris Sununu announced the allocation of $40 million in aid for communities across the state dealing with the COVID-19 pandemic…

Also using the CARES Act funding, a stipend for hazard pay is being made available to police officers, firefighters, EMS personnel and correctional officers. Full-time workers will receive $300 a week, while part-time workers receive $150 a week.

Innovative 9-1-1 Call Handling for COVID-19


Download as a PDF

Federal Healthcare Resilience Task Force EMS/Prehospital Team: As the COVID 19 pandemic continues to evolve, Public Safety Answering Points (PSAPs)/Emergency  Communications Centers (ECC) may need to revise procedures and redirect resources for handling  incoming calls for COVID-19 Information and Low Acuity Medical Complaints. These revisions may  require administrative, technical and operational protocols, policies and procedures to be  modified. This document provides guidance and considerations for these modifications and examples of how a sample of a few individual PSAPs/ECCs have handled/redirected these calls in response to the COVID-19 pandemic.

Developed By
The Federal Healthcare Resilience Task Force (HRTF) is leading the development of a comprehensive strategy for the U.S. healthcare system to facilitate resiliency and responsiveness to the threats posed by COVID-19. The Task Force’s EMS/Pre-Hospital Team is comprised of public and private-sector Emergency Medical Service (EMS) and 911 experts from a wide variety of agencies and focuses on responding to the needs of the pre-hospital community. This Team is composed of subject matter experts from NHTSA OEMS, National 911 Program, CISA, CDC, FEMA, USFA, US Army, USCG, and non-federal partners representing stakeholder groups and areas of expertise. 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.

How to use this document: The general guidance and examples included in this document can be used to assist PSAP/ECC directors with the implementation and/or modification in Standard Operating Procedures (SOPs) and Emergency Medical Dispatch (EMD) protocols, for receiving and responding to two types of calls:
1. Calls for COVID-19 Information.
2. Calls for patients with Low Acuity Medical Complaints.

It is very important that PSAP/ECC directors refer to local medical direction, health department and other local COVID initiatives to ensure that the PSAP/ECC does not sustain any liability for the redirection of calls. This document was completed by representatives from the Association for Public Safety Communications Officials (APCO), the APCO Institute, the International Academies of Emergency Dispatch (IAED), the National Association of State 911 Administrators (NASNA), the National Emergency Number Association (NENA), and Power Phone; as well as their members and some of their clients.

I. Calls for COVID Information
  • Purpose/Goal: To provide guidance for the redirection of callers requesting COVID-19
    information to local and state health departments, COVID-19 hotlines, websites, links, and
    non-emergency lines such as 311, 211, 411 or other 10-digit lines.

    • General Considerations:
      • Administrative
        • Coordinate messaging to be provided with the Medical Director, health care facilities, and health departments to ensure appropriate changes are consistent as the COVID-19 pandemic evolves.
        • Identify appropriate local health departments and/or other local agencies’ resources (e.g., those that administer non-emergent support lines, e.g. 211/311/411), to understand what links, websites, hotlines, three-digit lines, and 10-digit lines are available/operational.
        • Ensure relationships are established and supported and conduct information sharing sessions by all mission partners to be effective and provide continuous communications.
        • Frequently update local PSAPs/ECCs, emergency medical services (EMS) agencies, fire departments, public health (PH) agencies, emergency management agencies (EMA) and emergency operations centers (EOC), to ensure consistent messaging and evolving needs are met.
        • Establish an ongoing mechanism for updating/changing information as the COVID-19 pandemic evolves.
        • Identify any agreements/contracts/policies/ SOPs that need to be established. Agreements among emergency services organizations for 211, 311, and 411 should be consistent.
        • Review employee contracts/ collective bargaining agreements, to understand possible impacts due to changes in protocols, policies, and/or SOPs.
      • Technical
        • Implement a mechanism for collecting and aggregating data (such as number of calls by incident type, EMD codes, etc.) for program evaluation and decision. Establish a mechanism for collecting/reporting data on calls received exclusively seeking information. Utilize that data to develop public service announcements and post the response to FAQs on appropriate websites.
        • Toll-free numbers typically receive Automatic Number Information (ANI). If the PSAP/ECC transfers a 911 call to a toll free number via their selective router, the entity receiving the call may be able to call back the PSAP/ECC, using the ANI received upon call transfer. Work with service providers and receiving agencies, if possible, to ensure this function.
      • Operational
        • Promote the use of Public Safety Telecommunicator (PST) “Just-in-time” education, training and awareness of the technological tools available and changes in procedures.
        • Public education, training, and awareness may be key for public acceptance of alternate call handling. Examples of available resources include:

        • CDC self-checker, or other decision tree approved by a locally designated authority for the general public, on when to call 911 versus nurse/primary care provider/health dept./info line.
        • CDC Phone Advice Line Tool for possible COVID-19 patients
          • PSAP/ECC, who dispatch EMS, should know the status of all hospitals i.e., COVID only hospitals, which hospitals have no hospital beds or ICU units.
          • Utilize COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns
          Hopkins University* to understand COVID case locations
          • Consider HIPAA constraints (if the PSAP/ECC/EOC and/or their personnel fall under the category of “health care providers who transmit any health information electronically in connection with certain transactions”), seek/coordinate with legal counsel. Please see the COVID-19 and HIPAA:
          Disclosures to law enforcement, paramedics, other first responders and public health authorities.
II. Low Acuity Medical Complaints Requests

Purpose/Goal: To provide guidance for the redirection of low acuity medical complaints to alternate medical resources (e.g., Nurse Triage/Call Line, Telemedicine, Paramedic Triage) due to increase in call volume and/or decline in hospital, EMS and other resources as a result of the
COVID-19 pandemic.

  •  General Considerations:
    • Administrative
      • Work with local Medical Director to determine specific criteria for referral.
      • Work with current EMD personnel and local Medical Director to identify questions to be asked and the specific criteria the caller must meet to be transferred to alternate medical resources such as Nurse Call Line or Telemedicine Triage Line.
  •  Confirm local Medical Director approval for changes to the medical call handling process,
    and/or response changes, including changes in EMD questions and referrals to alternate medical resources.
  • Identify and execute any agreements/contracts that need to be established.
  • Revise current policies and procedures and/or implement temporary procedures for PSTs.
  • Consider additional security requirements if the alternate medical resource will be located in the PSAP/ECC (e.g. Criminal Justice Information Systems (CJIS), National Crime Information Center (NCIC), etc.)
  • For Triage/Call Lines not already established: ensure notification of completion of training for nurse triage and PSAP staff —to understand how referral process will work; and how processes may change due to evolving circumstances. (Example: as COVID expands within a specific jurisdiction, is the behavioral hotline still active for referral?)
  • Ensure agreements and arrangements with the alternate care resource to ensure they are ready to take calls.
  • Facilitate consistent interaction among local PSAPs/ECCs, EMS, PHs, EMAs and EOCs is essential, to ensure evolving needs are met.
  • If the medical resource line is not a 24 hours/7 days a week call line, develop a working schedule, and communicate often between the call line side and the PSAP/ECC side.
  • Consider Syndromic Surveillance1 processes where available.


  • Technical
    • Work with 911 service providers to ensure call transfer can be made
      while keeping the caller’s call-back number.
    • Ensure call transfer works both ways in the event that the call needs to be transferred back to the PSAP/ECC.
    • Implement one-button transfers of calls, if feasible.
    • Work with information technology (IT) services to accommodate any necessary changes to computer-aided dispatch (CAD) systems
  • Operational
    • Develop and execute 911 Public Safety Telecommunicator (PST) training on all new processes and procedures.
    • Update pandemic guide cards/protocols with COVID-19 related questions and transfer instructions—modifiable at agency level and approved by the local Medical Director.
    • Anticipate frequent changes as the pandemic progresses, which may include modified response criteria for EMS due to the depletion of personnel and other resources.
Examples of Low Acuity Call Redirection Protocols: The following are examples of PSAPs/ECCsthat have implemented protocols to redirect low acuity calls alternate medical resources:

1. Location: Seattle/King County Washington

  • Description: Referral Program
    For COVID-19, the Seattle Fire Department’s Mobile Integrated Health program stood up a referral program to address the secondary impacts of the COVID-19 pandemic. This included generally concerned 9-1-1 callers as well as individuals who have been cut off from social services,
    healthcare, caregivers, substance abuse resources, critical supplies, or other services due to quarantine/isolation/shelter-in-place, or ill family members. The city has a team of two firefighters and four case managers who are fielding these referrals and reach out to callers by phone or in person. It is believed that non-emergent 9-1- 1 calls will likely continue throughout the duration shelter-in-place lengthens.

Seattle is in the early stages of exploring how to use nurse triage (either on-site in the 911 center or remotely) to further handle non-emergent calls, however, such a program has not been operationalized.

  • Point of Contact:
    Jon Ehrenfeld
    Mobile Integrated Health Program Manager Seattle Fire Department
    O: 206-233-7109 | M: 206-771-0269

2. Location: Washington, DC; Office of Unified Communications (OUC)

  • Description: DC Nurse Triage Line
    Since 2018, DC’s Office of Unified Communications currently transfers a portion of their basic life support (BLS) calls to a nurse triage line (NTL), with the goal of keeping people out of the emergency department and treating people at home. While the nurses are housed within the 911 call center, this is a program under DC’s Fire and EMS Department. Other relevant points about this

    • Additional goal: Savings relate to not mobilizing EMS
    • Program has resulted in both a financial and human resources savings.
    • Office of Unified Communications (OUC) has incrementally increased the types of calls redirected to NTL. Now transferring 60-90 calls per day (approximately 6-10% of medical calls)
    • Public Service Ads – important to explain to the public the advantages of EMS tiered medical response that an RN answers NTL in advance of implementation to avoid caller resistance to call transfer.
    • Both OUC and EMS field units can call the NTL and initiate the process
    • Nurses answer calls from work stations within the OUC, and if needed, can access backup nurse triage personnel in TX and FL. Part of their protocol includes asking for insurance information, so patients can be coupled with appropriate clinics, MDs). Nurses also are able to schedule appointments for callers.
    • Targeting calls that were responded to, but not transported.
    • Now looking at how to anticipate changes in call volume relevant to COVID- 19 and how to change current protocols
    • A strong relationship with Fire & EMS and Medical Director is essential
    • Not a failure if NTL screens and determines that the patient needs a response. This is the safety net.
  • Point of Contact:
    Cleo Subido, Chief
    Office of Professional Standards and Development Office of Unified Communications
    2720 Martin Luther King Jr. Ave. SE Washington DC, 20032
    O: 202-340-7916

3. Location: Orleans Parish Communication District (New Orleans 9-1-1)

  • Description:
    All Orleans Parish Communication District (OPCD) Operations Staff are certified Emergency Medical
    Dispatchers (EMD) using protocols from the International Academies of Emergency Dispatch (IAED)*.
    Within those protocols are both a pandemic surveillance tool and a response protocol referred to as
    Protocol 36*.

Two directives and one guidance document enable the video medical triage process:
1. Emergency Directive 20-01 – Advising staffing to start using the surveillance tool.
(Issued 2/5/20)
2. Emergency Directive 20-02- Formally activating Protocol 36 (Issued 3/9/20)
3. Special Guidance advising elevating the pandemic level to Level 1

The pandemic protocol identifies calls that are low acuity for which an emergency department is not the best option. At that time, a paramedic initiates a video call with the patient and reviews their symptoms. In the current situation, in most cases, they are being advised to self-quarantine
and not go to an emergency
department. The process then places that person on a “self-quarantine registry” and someone from the staff calls the person daily to check on them. If their conditions get worse, the person is triaged again as a new patient and they may then get transported if needed.

  • Point of Contact:
    Tyrell T. Morris, MBA CPE Executive Director
    Orleans Parish Communication District (New Orleans 9-1-1) 118 City Park Ave.
    New Orleans, LA 70119 O: 504-671-3615*


4. Location: Orange County Virginia Fire and EMS Department

  • Description: Area hospitals color code their status availability.
    • Code Green: Open
    • Code Yellow: Busy, not accepting trauma patients, running out of beds
    • Code Red: Very busy, only accepting life critical illness/injury
    • Code Black: Hospital lock down (i.e. pandemic), cannot accept more patients

PSAP/ECC receive fax updates of hospital status. PSTs page out the status of the hospital to the responders. Life or death situations can still go to the closest hospital and override the color codes except in Code Black situations.

  • Contact:
    Chief Nathan Mort
    Orange County Virginia Fire and EMS Department Cell: 540-406-1484

5. Location: New York City – Northwell Health

  • Description: The Northwell Health Center for EMS, Clinical Call Center, Centralized Transfer
    Center, Telehealth Center and Health Solutions provide NYC 311 and FDNY EMS 911 with an emergent stand up of call center operations in order to provide telemedicine-based services to callers seeking medical advice, clinical navigation of clinical care on the COVID-19 virus as well as work
    with the FDNY to take New York City-based low and medium acuity groups of 911 callers, as possible, and cleared with Medical Director. This system of care includes a comprehensive integrated system of 911 Emergency Medical Dispatcher (AEMD) Triage, Nurse based telephonic triage, care navigation and advice, Qualified Healthcare Provider (QHP – MD, NP, PA, LCSW telephonic/telemedicine services, QHP based telemedicine services, Community Paramedicine services, traditional EMS services and home-based Primary Care services.
  • At the Clinical Call Center, 12 RNs manage a steady flow of calls from patients and employees seeking clinical advice and navigation services including recently discharged patients whose multiple, chronic health issues make them a high risk for hospital readmission and patients seeking care during off hours from our physician practices. Using Emergency protocols, The International Academies of Emergency Dispatch’s (IAED) certified Emergency Communication Nurse System (ECNS), the nurses telephonically screen patients for priority symptoms and determine the level of care that
    the caller needs, weighing additional factors such as medication use and allergies. Once the type of care is determined, the Nurse can provide care instructions or arrange the appropriate level of care based on the patient’s clinical needs.
    Northwell 911 Telemedicine Resources*
  • Point of Contact:
    Jonathan Washko
    Assistant Vice President of the Center for EMS at Northwell Health

EMS Update: Sustaining Mental Health during COVID-19

NORA Public Safety Sector Council Meeting – EMS Sustainability Update

Sustaining Mental Health during COVID-19
Thursday April 30th, 2020 – 11:00am-11:30am EDT

The NORA Public Safety Sector Council, is hosting an EMS Sustainability Update at 11:00 EDT on Thursday April 30, 2020 via Zoom. The topic is Sustaining Mental Health during COVID-19. The attachment includes the agenda for the meeting as well as available resources and tools outlined on page 2.

Register Here

Registration is required using the link above. This is part of an ongoing series of updates to be hosted every other week. The registration link will register you for all occurrences and you can attend those you are interested in.


Healthcare Resilience Task Force: Three New Documents Released

The Prehospital [911 and Emergency Medical Services (EMS)] Team of the Healthcare Resilience Task Force has released three more informational documents. The first contains guidance for emergency communications stakeholders on available funding in the CARES Act. The second is a summary document on the status of the Emergency Medical Services (EMS) education pipeline during a series of recent conference calls with EMS stakeholder organizations. The third is a corrected version of the COVID-19 Crisis Standards of Care.

These documents will also be posted on and/or (as appropriate).  Two portals for COVID Resources were created which we will continue to update three times a week, with new links and documents containing information on a variety of COVID-related topics.  You will find COVID resources here on, and here on

Read Below:

SAFECOM and NCSWIC Guidance on CARES Act Grants

The Cybersecurity and Infrastructure Security Agency (CISA), in partnership with SAFECOM and the National Council of Statewide Interoperability Coordinators (NCSWIC), prepared guidance for emergency communications stakeholders on available funding in the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). Stakeholders are encouraged to review this guidance and apply for funding, where applicable. CARES Act money is available to all 50 states, five territories, and the District of Columbia, with several fast-approaching application deadlines

NHTSA EMS Education_Pipeline_Final

National Highway Traffic Safety Administration (NHTSA) staff prepared this summary document on the status of the Emergency Medical Services (EMS) education pipeline during a series of recent conference calls with EMS stakeholder organizations. Included is a list of national, State, and local considerations for EMS stakeholders.

EMS14_EMS Crisis Standards of Care_Final – (Corrected 4/28/2020)

In response to the COVID-19 pandemic, emergency medical services (EMS) agencies (including fire service, third government service, hospital-based, private for-profit, and private non-profit services) may need to adjust operations and standards of care in order to preserve and effectively allocate limited EMS and healthcare system resources in the face of overwhelming demand due to the national pandemic response. This document provides an overview of general considerations, potential strategies, and existing resources that EMS agencies may use to inform changes to their operations and standards of care.

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