Mental Health and Substance Use Disorders in EMS

From JEMS on October 9, 2020

Recognizing and Supporting EMS Providers with Mental Health and Substance Use Disorders

By Meredith M. O’Neal, MA; Simone Joannou, MA; and James Langabeer, PhD, EMT

About 30 percent of first responders develop mental health disorders, including depression, Acute Stress Disorder (ASD) and post-traumatic stress disorder (PTSD), as compared with 20 percent in the general population.3 Another common occupational risk factor includes acute and chronic exposure to both primary and secondary trauma, the latter referring to the phenomenon of emotional and moral attachment to the experience of the individuals they rescue.

These overwhelming demands from first responders can lead to compassion fatigue, a depleted capacity for empathy that results in various behavioral issues including depression and anxiety. Burnout is a similar phenomenon of exhaustion resulting from occupational strain such as overwork and lack of support from leadership. These conditions have been found to directly contribute to the more than doubled suicide rates among medics than other professionals.

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EMS Sleep Health Study—Agencies Wanted

From the National Association of State EMS Officials

OMB Control Number: 2127-0742
ICR Reference Number: 201811-2127-003
Expiration Date: 08/31/2022

Who?

Daniel Patterson, PhD, NRP from the University of Pittsburgh Department of Emergency Medicine is leading a research study that seeks to examine the impact of a sleep health and fatigue education and training program tailored to Emergency Medical Services (EMS) clinicians. This research study has financial support from the National Highway Traffic Safety Administration to the National Association of State EMS Officials (NASEMSO). The University of Pittsburgh has partnered with the NASEMSO as a sub-contractor for purposes of conducting this research study.

What?

This research study is an experiment that will test the impact of a new sleep health and fatigue training education program. The program is designed to improve the individual EMS clinician’s sleep health and reduce work-related fatigue through education and training. The program will be administered entirely online (via the internet) and will be accessible to EMS clinicians located at the EMS agencies that agree to participate in this research study.

When?

The study team will begin recruiting EMS agencies to participate in this study in late January 2020. Each agency will be asked to participate for a total of 24 weeks. Participation is voluntary.

How?

Researchers will ask EMS agency administrators to help recruit individual EMS clinicians at their agency to participate in this research study. Participation will be completely voluntary and confidential. The study team will mostly use data collection tools available via the Internet. Some data collection will involve mobile phone text messages. The research study’s website will be secure and require a unique login (username and password) from each individual EMS clinician. Some EMS clinicians may be asked to wear a wrist actigraph to measure sleep and complete a reaction time test at the start and end of a few scheduled work shifts during the study period.

Who is Eligible?

The study team is seeking participation from EMS agencies located in the United States (including Alaska and Hawaii). Criteria for eligibility include: [1] The EMS agency provides EMS services (including 911 response and transport). [2] The EMS agency provides ground-based EMS services 24-hours a day. Agencies limited to air-medical services only are not eligible. [3] The EMS agency employs between 50 and 300 EMS paid full-time and part-time clinicians/personnel. Agencies that use an all-volunteer staffing model are not eligible. [4] Agencies restrict their EMS clinicians to use their personal mobile phones/smartphones during shifts are not eligible. [5] Operations that provide both fire suppression and EMS 911 response and transport are eligible and encouraged to participate.

Remuneration

Those who qualify for the study and choose to participate will receive remuneration worth approximately $35 U.S. dollars. All individual participants will receive remuneration in the form of a gift card totaling approximately $35 in value. A $5 gift card will be distributed at the beginning, when the individual enrolls, every month the individual is involved in the study, and at the end of the study (month 6). All gift cards will be distributed via U.S. Mail directly to individual participants.

Interested?

If you are the administrator/manager of an EMS agency that is eligible to participate, and wish to participate or wish to know more about this study, please contact the study principal investigator (Daniel Patterson, PhD, NRP) at: pdp3@pitt.edu or 412-864-3830.

COVID-19 fatalities among EMS clinicians

From EMS1
by
By Brian J. Maguire, Dr.PH, MSA, EMT-P
Barbara J. O’Neill, PhD, RN
Scot Phelps, JD, MPH, Paramedic
Paul M. Maniscalco, PhD(c), MPA, MS, EMT/P, LP
Daniel R. Gerard, MS, RN, NRP
Kathleen A. Handal, MD

The devastating effects of the COVID-19 pandemic resonate around the world. Escalating infection and death rates are reported daily. While emergency medical services clinicians have been operating at the far forward front lines of the COVID-19 pandemic from the start, their infections, lost work time, long-term clinical manifestations and deaths have not been adequately reported or recorded [1]. In this article, we examine currently available EMS COVID-19 mortality data in order to describe the extent of EMS losses and to compare the risks for EMS clinicians to the risks for other related professions.

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DOL | Employee vs Independent Contractor

From Seyfarth on September 22, 2020

DOL Proposes Its First-Ever Interpretation on Independent Contractor vs. Employee

By: Noah A. Finkel, Camille A. Olson, Louisa J. Johnson, and John R. Skelton

For decades, companies have wrestled with whether certain workers must be treated as employees subject to various employment laws and company rules or whether they are appropriately classified as independent contractors with different terms of engagement, work, and pay and tax consequences. Amid a changing economy and evolving business models, companies continue to consider the application of an alphabet soup of federal employment statutes plus the laws of the states in which they do business, many of which contain different definitions of “employee” and conversely “independent contractor,” few of which provide clear guidance on how to meet the definition of independent contractor status.

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PA | $20,000 Signing Bonus, $25/Hour—Zero Applicants

From JEMS 

Cumberland Goodwill EMS (PA) hang up a help wanted sign, but no one answered.

Assistant Chief Nathan Harig tells ABC 27 they’re seeing a shortage of paramedics and are trying to hire a paramedic for an open position. One problem: not one person applied despite the agency offering a $20,000 signing bonus and $25 per hour pay.

“We’re doing everything we can to try to motivate people to come on in but it’s just not working,” Harig told the station.

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CARES Act Reporting Requirements Released

All recipients of payments from the Department of Health and Human Services’ Provider Relief Fund (PRF) are required to comply with the reporting requirements described in the Terms and Conditions and specified in future directions issued by the Secretary.

Providers that received more than $10,000 in grants will have to report on how they spent funds on coronavirus-related expenses and lost revenue in 2020 by Feb. 15, 2021. If providers do not spend all their grant funds by the end of 2020, they will be required to submit a final report on the remaining funds by July 31, 2021.

Any recipient of PRF payments may be subject to auditing to ensure the accuracy of the data submitted to HHS for payment.  Any recipients identified as having provided inaccurate information to HHS will be subject to payment recoupment and other legal action.

For more details, please refer to the Terms and Conditions associated with each payment distribution and the Reporting Requirements and Auditing FAQs.

Read more from HHS

NHTSA: EMS Accessing PPE

The National Highway Traffic Safety Administration has released a memo reinforcing the best methods for EMS agencies to request PPE supplies:

  • The preferred method of EMS agencies to obtain PPE is via ordering through the normal supply distribution chains from which they normally order EMS supplies and equipment. The supply chain distributors are becoming more stable in their access to PPE components. In addition, in the near future, Boundtree will have available a larger supply of N95 NIOSH Tested/Approved respirators for purchase, which EMS can tap into
    purchasing;
  • PPE push at the national level is not possible without a Resource Request from the States. Local EMS agencies should work with their local emergency management agency with requests pushed up to the state emergency management agency or for EMS PPE Resource Requests where there are still elevated (albeit decreasing or stabilizing) COVID-19 cases. Once those formal Resouce Requests are received at the federal level,
    they will be reviewed and acted upon.

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Free! Food, Beverages, Personal Care for EMS

Request Food, Beverages, and/or Personal Care Items for Your Staff

 

FREE FOR THE ASKING: PRODUCTS AND SERVICES AVAILABLE TO COVID-19 FRONTLINE HEROES

Frontline Impact Project Works with Corporate Donors to Provide Food, Beverages, Personal Care Items and Mental Health Services to Frontline Heroes

NEW YORK — Amid a devastating Covid-19 resurgence, Frontline Impact Project is offering the nation’s healthcare workers and first responders access to non-PPE donations. Created by The KIND Foundation, Frontline Impact Project has become a primary vehicle through which the business community has shown support for the men and women who are keeping America’s communities healthy. The platform offers institutions a streamlined way to request and receive resources that will lift spirits and boost morale.

Hospitals are encouraged to make requests in whatever quantity they need. Requests as small as 25 items and as large as 30,000 items have been fulfilled. Typically, a hospital asks for one item per employee in one or more categories, including food, beverages, gum/mints, housing, skincare, hygiene, sanitizer, virtual fitness and mental health. Hospitals are also encouraged to make requests outside of the aforementioned categories if they have a need.  In addition to public and private hospitals of all sizes, institutions eligible for donations include assisted living facilities, nursing homes, community healthcare centers, outpatient clinics and EMS squads.

Norman Stein, Chief Development Officer and Senior Vice President, Boston Medical Center, says, “It is of vital importance we provide our frontline caregivers with nourishment as they work tirelessly to care for our patients and community, and the donation from Frontline Impact Project has certainly helped us stay committed to that goal.”

Sean Gibson, Manager, Duke University Hospital’s Trauma Center, echoed Stein’s sentiment saying, “We are grateful for Frontline Impact Project’s support of our healthcare community. We need everyone’s help to overcome this global health crisis, and donations such as this make a notable difference for our workers on the front lines.”

At www.frontlineimpact.org, representatives from frontline institutions can submit requests for resources along with a reference to validate the institution’s legitimacy. After a request has been submitted, Frontline Impact Project matches the requester with a corporate donor(s). The donor(s) then work to deliver the product and/or service directly. While not every request is fulfilled, Frontline Impact Project does all it can to ensure needs are met.

To date, nearly 60 corporate partners, including KIND, Unilever, Extra Gum, Nestlé, Keurig Dr Pepper, Justin’s, Hint, Harry’s, RISE Brewing Co., Headspace and Image Skincare, have donated more than 3.6 million products. The platform has made 537 matches across 41 states.

“We are prepared to support the needs of frontline healthcare workers and first responders no matter how long it takes for this crisis to pass,” says Michael Johnston, President of The KIND Foundation. “Frontline workers’ needs will inevitably change in the days and weeks to come. Our intention is to recruit diverse partners now so that we are poised to meet new and unexpected needs later.”

Visit the Frontline Impact Project website for more information. Direct questions to Jonathan Yates at jyates@lubetzky.org.

The situation

COVID-19 is one of the greatest humanitarian, health and economic crises of our time, and its impacts continue to be felt every day. Back in the spring, as the severity of the virus became known, The KIND Foundation (in consultation with Project N95) created Frontline Impact Project (FIP) to support those risking their lives to keep us safe. FIP matches healthcare workers and first responders with donated products and services. Three months later, we remain focused on helping frontline heroes who are working extraordinary hours in taxing circumstances. With support from more than 50 partners, including KIND, Unilever, Extra Gum, Nestlé, Keurig Dr Pepper, Justin’s, Hint, Harry’s, Headspace and Image Skincare, we hope to ease their stress and bring levity to their days. To date, FIP has generated 425 matches across 40 states and, together with its inaugural partner KIND, donated more than 2.5 million products. In the words of one beneficiary, “There is a big smile beneath my mask.”

While we’re proud of our impact, there is a lot of work ahead, especially as COVID ravages new parts of the country. According to a recent survey of frontline institutions, 100% of respondents said that their workers still have many needs beyond PPE. For example:

  • The volunteers at a Boston clinic, who are so busy treating homeless COVID+ patients that they barely have time to eat;
  • The ER nurse whose face is breaking out and indented due to a tight N95 mask, and whose hands are chapped from constant washing.
  • The ICU workers who are experiencing unprecedented levels of stress and psychological trauma which, if left untreated, can result in chronic burnout among other things.

Of those surveyed, more than half said that they need food and beverages, and one-in-five said that personal care and wellness products would be beneficial. Other commonly cited needs included disinfectant/sanitizer; mental health support; and housing/transportation. We are committed to providing these items and more for the duration of the crisis.

How it works

  • Through FIP’s website, frontline institutions submit requests for resources. Submitters provide a reference for vetting to ensure the institution’s legitimacy. Departments or units within a larger institution are encouraged to work with their internal procurement team before submitting so that FIP can efficiently fulfill requests and help as many people as possible;
  • The system matches requesting institutions with relevant donors, and the donors subsequently deliver the products or services directly;
  • To ensure ample supply, FIP continually recruits corporate partners to donate non-PPE items.

 

Why it works

  • Times of great uncertainty call for maximum responsiveness. FIP is able to pivot quickly based on needs expressed directly from the frontlines. The platform is built to deliver resources to a range of institutions – from major hospital systems to volunteer EMS squads. Its customized approach guarantees that small institutions are not overlooked and those located in hot spots are prioritized.
  • On the demand side, FIP centralizes resources to create efficiencies and prevents institutions from being overwhelmed by individual corporate outreach.
  • On the supply side, FIP provides a solution for companies seeking a streamlined and flexible way to direct resources. Partners have access to a diverse network of institutions and assurance that their donations will be received by legitimate institutions in need.

Public Comment Requested for COVID-19 Vaccine Allocation

On September 1, 2020, the National Academies of Sciences, Engineering, and Medicine invited public comment on the Discussion Draft of the Preliminary Framework for Equitable Allocation of COVID-19 Vaccine, commissioned by the Centers for Disease Control and the National Institutes of Health. Input from the public, especially communities disproportionately affected by the COVID-19 pandemic, is essential to produce a final report that is objective, balanced, and inclusive. The public comment period will be open for 4 days, from 12:00 p.m. ET on Tuesday, September 1, until 11:59 p.m. ET on Friday, September 4.

Learn More or Comment

NYC emergency medical workers prepare for layoffs

From NBC News

The head of New York City’s emergency medical services union said Wednesday that the city is preparing to lay off hundreds of its members as the budget crisis grows during the coronavirus pandemic.

Oren Barzilay, president of FDNY EMS Local 257, blamed Mayor Bill de Blasio and his administration for the expected fallout.

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CBS | EMTs Are Quitting Their Jobs

From CBS News | “Emergency medical technicians are quitting their jobs — COVID-19 makes it too dangerous

Rather than expose himself to a stream of infected patients in Queens, Baer opted to retire last month, ending his career at least a full year earlier than he’d planned. That disqualified him from collecting his full pension, and Baer estimates he gave up between $2,000 and $4,000 a year in retirement benefits — a decision he doesn’t regret.

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Interim Guidance: COVID-19 and Field Trauma Triage Principles.

The Federal Healthcare Resilience Task Force has released interim guidance on COVID-19 and Field Trauma Triage Principles. This document provides a brief overview of how the Coronavirus Disease 2019 (COVID-19) impacts trauma triage for first responders, including Emergency Medical Service (EMS), fire & rescue, and law enforcement. The contents of this guidance document do not have the force and effect of law and are not meant to bind the public in any way. This guidance document is intended only to provide clarity to the public regarding existing requirements under the law or agency policies.

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Webinar: EMS, Stress and Cultivating Resilience

Special EMS Focus webinar on Thursday, Aug. 20, at 3 p.m. EDT /12 p.m. PDT will address the challenges and stresses of EMS work and offer practical advice for cultivating resilience

Adversity and stress are unavoidable aspects of serving as EMS clinicians, thanks to the challenges of everyday EMS work and the added difficulties brought on by extraordinary events, such as the COVID-19 pandemic. There are ways, though, to cultivate resilience, recognize and manage stress, and turn adversity into an opportunity for personal growth and becoming a better version of yourself.

In this webinar, two EMS veterans, leaders and resilience experts will engage in a conversation about self-awareness, self-care, and specific actions, practices and wisdom for living well.

Mike Washington, MSW, is a 27-year firefighter/EMT with the Seattle Fire Department, a mental health therapist and a multiple combat tour Marine veteran with a powerful story about his own journey to wellbeing. He’ll be joined by organizational psychologist John Becknell, PhD, a former paramedic who studies and works with EMS, fire and law enforcement in areas of living well, peer support, organizational culture and leadership development. Kate Elkins, MPH, an EMS specialist with the NHTSA Office of EMS and paramedic with more than two decades of EMS experience, will moderate.

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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.