The National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention (CDC), is seeking public comment on current evidence-based, workplace and occupational safety and health interventions to prevent work-associated stress, support stress reduction, and foster positive mental health and well-being among the nation’s health workers, including first responders and EMS clinicians. The NHTSA Office of EMS is committed to working with our Federal partners to prioritize efforts that address the high rates of stress, burnout, depression, anxiety and suicide among members of the EMS community. This request for information is an opportunity to make sure your voice is heard.
NIOSH invites comment on best practices, promising practices or successful programs related to providing stress prevention and mental health services to health workers, including but not limited to employee assistance programs, screenings, supervisor trainings, workplace policies, talk therapy, mindfulness, peer support and mobile apps.
Comments and responses may be submitted here through Friday, November 26, 2021.
AAA President Shawn Baird shared with @foxandfriends how the #EMS workforce shortage is impacting our communities. Congress must act to provide #heropay and training, and to cut red tape keeping military medics from serving at home! @NAEMT_@NEMSMAnewshttps://t.co/sfHOLx3W7c
“Companies have had to close, consolidate or come up with new strategies to answer calls, said American Ambulance Association President Shawn Baird, who added that there is simply not enough EMS personnel to cover calls in many parts of the country, especially during the pandemic.”
Our paramedics and emergency medical technicians (EMTs), as well as the organizations that they serve, take on substantial risk every day to treat and transport patients that call 9-1-1. But our nation’s EMS system is facing a crippling workforce shortage, a long-term problem that has been building for more than a decade. It threatens to undermine our emergency 9-1-1 infrastructure and deserves urgent attention by the Congress.
The most sweeping survey of its kind — involving nearly 20,000 employees working at 258 EMS organizations — found that overall turnover among paramedics and EMTs ranges from 20 to 30 percent annually. With percentages that high, ambulance services face 100% turnover over a four- year period. Staffing shortages compromise our ability to respond to healthcare emergencies, especially in rural and underserved parts of the country.
The pandemic exacerbated this shortage and highlighted our need to better understand the drivers of workforce turnover. There are many factors. Our ambulance crews are suffering under the grind of surging demand, burnout, fear of getting sick and stresses on their families. In addition, with COVID-19 halting clinical and in-person trainings for a long period of time, our pipeline for staff is stretched even more.
The challenge is to make sure that the paramedics and EMTs of the future know that EMS is a rewarding destination. Many healthcare providers have extensive professional development resources, but that simply does not exist for EMS. COVID-19 has put additional pressures on the health care system and added another layer of complexity to the emergency response infrastructure.
HRSA EMS Training Funding
Fortunately, there are immediate and long-term solutions. Although the provider relief funds are essential and helpful to address the challenges of the pandemic, we need funding for EMS that addresses paramedic and EMT training, recruitment, and advancement more directly. The Congress can provide specific direction and funds to the Health Resources and Services Administration (HRSA) to help solve this workforce crisis. Those funds can be used to pay for critical training and professional development programs. Some of our members have already begun offering programs and would benefit from additional funding support from HRSA. Funding public-private partnerships between community colleges and private employers to increase the applicant pool and training and employment numbers through grants could overcome the staffing deficit we face.
Paramedic and EMT Direct Pay Bump
In addition, more immediately targeting funds for EMS retention could address the shortage we are experiencing day to day. To help ambulance services retain paramedics and EMTs, we request funds through HRSA to be paid directly to paramedics and EMTs. These earmarked funds could be distributed to each state with specific guidance that the State Offices of EMS distribute the funds to all ground ambulance services using a proportional formula (per field medic).
COVID-19 Medicare Reimbursement Increase
With capitated payments by federal payors, there are limited funds to transfer into workforce initiatives. Increasing Medicare payments temporarily would be meaningful to compete with other employers and other jobs. This could help infuse additional funds into the workforce and create innovative staffing models that take into account hospital bed shortages and overflow.
Congressional Hearings on EMS Workforce Shortage
The workforce shortage crisis facing EMS spans several potential Committees of jurisdiction. This critical shortage is particularly felt in many of our rural and underserved communities. As Congress moves on the steps we have outlined above, we also urge you to organize hearings in the appropriate Committees to develop long-term solutions and focus the country’s attention on these urgent issues.
Thank you in advance for continuing to ensure that our frontline responders have the resources necessary to continue caring for our patients in their greatest moment of need, while maintaining the long-term viability of our nation’s EMS system.
Thank you for your consideration. Sincerely,
Shawn Baird
President
American Ambulance Association
Bruce Evans
President
National Association of Emergency Medical Technicians
Today, the U.S. Department of Health and Human Services’ (HHS) Office for Civil Rights (OCR) issued guidance to help the public understand when the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule applies to disclosures and requests for information about whether a person has received a COVID-19 vaccine.
In the guidance, OCR reminds the public that the HIPAA Privacy Rule does not apply to employers or employment records. The HIPAA Privacy Rule only applies to HIPAA covered entities (health plans, health care clearinghouses, and health care providers that conduct standard electronic transactions), and, in some cases, to their business associates. The HIPAA Privacy Rule applies to most EMS providers but only as it relates to it’s patient’s Protect Health Information (PHI).
Today’s guidance addresses common workplace scenarios and answers questions about whether and how the HIPAA Privacy Rule applies. The Privacy Rule does not apply when an individual:
Is asked about their vaccination status by a school, employer, store, restaurant, entertainment venue, or another individual.
Asks another individual, their doctor, or a service provider whether they are vaccinated.
Asks a company, such as a home health agency, whether its workforce members are vaccinated.
Generally, the Privacy Rule does not regulate what information can be requested from employees as part of the terms and conditions of employment that an employer may impose on its workforce
The Privacy Rule does not prohibit a covered entity or business associate from requiring or requesting each workforce member to:
Provide documentation of their COVID-19 or flu vaccination to their current or prospective employer.
Sign a HIPAA authorization for a covered health care provider to disclose the workforce member’s COVID-19 or other vaccination record to their employer.
Wear a mask–while in the employer’s facility, on the employer’s property, or in the normal course of performing their duties at another location.
Disclose whether they have received a COVID-19 vaccine in response to queries from current or prospective patients.
OCR stated that they are issuing this guidance to help consumers, businesses, and health care entities understand when HIPAA applies to disclosures about COVID-19 vaccination status and to ensure that they have the information they need to make informed decisions about protecting themselves and others from COVID-19.
This week, the Safer Federal Workforce Task Force released new guidance on COVID-19 workplace safety protocols for Federal contractors and subcontractors. On September 9, President Biden signed Executive Order 14042, Ensuring Adequate COVID Safety Protocols for Federal Contractors, which directed executive departments and agencies to ensure that all federal contractors and subcontractors comply with all guidance published by the Task Force. These workplace safety protocols will apply to all covered contractor and subcontractor employees in covered contractor workplaces even if they are not working on Federal Government contracts.
Overview of Workplace Safety Protocols for Federal Contractors and Subcontractors
Pursuant to the guidance issued this week, and in addition to any requirements or workplace safety protocols that are applicable because a contractor or subcontractor employee is present at a Federal workplace, Federal contractors and subcontractors with a covered contract will be required to conform to the following workplace safety protocols:
COVID-19 vaccination of covered contractor employees, except in limited circumstances where an employee is legally entitled to a medical or religious accommodation;
Compliance by individuals, including covered contractor employees and visitors, with the Guidance related to masking and physical distancing while in covered contractor workplaces; and
Designation by covered contractors of a person or persons to coordinate COVID-19 workplace safety efforts at covered contractor workplaces.
The guidance provides details regarding who is included under these new rules. Under the latest guidance, a “Covered Contractor Employee” means any full-time or part-time employee of a covered contractor” working on” or “in connection with” a covered contract or working at a covered contractor workplace. This includes employees of covered contractors who are not themselves working on or in connection with a covered contract, except for those employees who only perform work outside the United States or its outlying areas. This means that all ambulance service employees, who perform work related to or in connection with the contract, such as dispatchers, human resource and billing personnel, training staff, etc. are subject to the new requirements. This includes employees working from remotely or from home, who are performing work in connection with the contract.
Under the guidance, a “Covered Contractor Workplaces” are locations controlled by a covered contractor at which any employee of a covered contractor working on or in connection with a covered contract is likely to be present during the period of performance for a covered contract. This includes those workplaces such as ambulance stations, administrative offices, etc.
Vaccination of Covered Contractor Employees
Covered contractors must ensure that all their covered employees are fully vaccinated for COVID-19 unless the employee is legally entitled to an accommodation. Covered contractor employees must be fully vaccinated no later than December 8, 2021. The guidance detailed that vaccination is required of all employees, even if they have previously been infected with COVID-19.
Proof of COVID-19 Vaccination
Under this guidance, the contractor or subcontractor must review the covered employee’s documentation to prove vaccination status. The guidance identifies the list of acceptable documents an employee can furnish to prove vaccination, including:
Copy of Immunization Record from a healthcare provider or pharmacy
Copy of the COVID-19 Vaccination Record Card (CDC Form MLS-319813_r, published 9/3/2020)
Copy of Medical Records documenting the vaccination
Copy of Immunization Records from a public health or State Immunization Information System
Copy of any other official documentation verifying vaccination with information of:
Vaccine name
Date of administration
Name of healthcare professional or clinic site administering the vaccine
*Digital copies of these records are acceptable (jpg, scanned PDF, etc.)
The guidance specified that a signed attestation by the employee is not acceptable proof of vaccination. Additionally, the guidance stated that recent COVID-19 antibody tests do not satisfy the requirements under these rules.
Masking and Physical Distancing While in Covered Contractor Workplaces
Covered contractors must ensure that all individuals, including covered contractor employees and visitors, comply with published CDC guidance for masking and physical distancing at a covered contractor workplace. The guidance provided more details on these masking and physical distancing requirements. These include requiring unvaccinated individuals to mask indoors and in certain outdoor settings regardless of COVID-19 transmission levels. Contractors are required to monitor the community transmission levels on the CDC COVID-19 Data Tracker County View website on a weekly basis.
COVID-19 Coordinator Designation
Covered contractors must designate a person or persons to coordinate implementation of, and compliance with, these workplace safety protocols at covered contractor workplaces. Their responsibilities to coordinate COVID-19 workplace safety protocols may comprise some or all of their regular duties. This individual can be the same person who is designated under other state or local COVID-19 safety requirements.
Finally
The guidance makes it clear that the rules applicable to all federal contractors and supersedes any state or local rules or regulations that are contrary to these provisions. That means that any rules that prohibit mask or other COVID-19 related safety mandates, or otherwise contradict the rules under this guidance will not excuse a federal contractor’s obligations under these rules.
The guidance will be finalized by the Office of Management & Budget in the coming days. In the meantime, if you have any questions or need assistance, contact the AAA at hello@ambulance.org.
Resources include guidance documents, links to the latest from the CDC, and information about vaccine safety and administration
With cases of COVID-19 surging again across the country, EMS clinicians and leaders may once again be responding to increased numbers of PUIs, have questions about handling exposures, and be looking for information about coronavirus vaccines.
The EMS.gov COVID-19 Resources for EMS page continues to provide a number of helpful tools, on topics ranging from crisis standards of care to first responder mental health. The source of each resource is clearly identified, including documents created by the Federal Healthcare Resilience Working Group EMS/Prehospital Team.
The NHTSA Office of EMS once again would like to thank EMS clinicians and our public safety and healthcare colleagues across the country for your dedicated service. What you do is vital to our communities and our nation. We urge you to take steps to ensure the health and safety of you, your patients and your families and protect yourself from COVID-19, stress, and other dangers.
HHS Announces $103 Million from American Rescue Plan to Strengthen Resiliency and Address Burnout in the Health Workforce
Today, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced the availability of an estimated $103 million in American Rescue Plan funding over a three-year period to reduce burnout and promote mental health among the health workforce. These investments, which take into particular consideration the needs of rural and medically underserved communities, will help health care organizations establish a culture of wellness among the health and public safety workforce and will support training efforts that build resiliency for those at the beginning of their health careers.
“The Biden-Harris Administration is committed to ensuring our frontline health care workers have access to the services they need to limit and prevent burnout, fatigue and stress during the COVID-19 pandemic and beyond,” said HHS Secretary Xavier Becerra. “It is essential that we provide behavioral health resources for our health care providers – from paraprofessionals to public safety officers – so that they can continue to deliver quality care to our most vulnerable communities.”
Health care providers face many challenges and stresses due to high patient volumes, long work hours and workplace demands. These challenges were amplified by the COVID-19 pandemic, and have had a disproportionate impact on communities of color and in rural communities. The programs announced today will support the implementation of evidence-informed strategies to help organizations and providers respond to stressful situations, endure hardships, avoid burnout and foster healthy workplace environments that promote mental health and resiliency.
“This funding will help advance HRSA’s mission of developing a health care workforce capable of meeting the critical needs of underserved populations,” said Acting HRSA Administrator Diana Espinosa. “These programs will help to combat occupational stress and depression among our health care workers as they continue their heroic work to defeat the pandemic.”
There are three funding opportunities that are now accepting applications:
Promoting Resilience and Mental Health Among Health Professional Workforce – Approximately 10 awards will be made totaling approximately $29 million over three years to health care organizations to support members of their workforce. This includes establishing, enhancing, or expanding evidence-informed programs or protocols to adopt, promote and implement an organizational culture of wellness that includes resilience and mental health among their employees.
Health and Public Safety Workforce Resiliency Training Program – Approximately 30 awards will be made totaling approximately $68 million over three years for educational institutions and other appropriate state, local, Tribal, public or private nonprofit entities training those early in their health careers. This includes providing evidence-informed planning, development and training in health profession activities in order to reduce burnout, suicide and promote resiliency among the workforce.
HOT (red light and siren) responses put EMS providers and the public at significant risk. Studies have demonstrated that the time saved during this mode of vehicle operation and that reducing HOT responses enhances safety of personnel, with little to no impact on patient outcomes. Some agencies have ‘dabbled’ with responding COLD (without lights and sirens) to some calls, but perhaps none as dramatic as Niagara Region EMS in Ontario, Canada – who successfully flipped their HOT responses to a mere 10% of their 911 calls! Why did they do it? How did they do it? What has been the community response? What has been the response from their workforce? Has there been any difference in patient outcomes? Join Niagara Region EMS to learn the answers to these questions and more. Panelists from co-hosting associations will participate to share their perspectives on this important EMS safety issue!
Speakers
Kevin Smith, BAppB:ES, CMM III, ACP, CEMC
Chief
Niagara Emergency Medical Services
Jon R. Krohmer, MD, FACEP, FAEMS Director, Office of EMS
National Highway Traffic Safety Administration
Team Lead, COVID-19 EMS/Prehospital Team
Douglas F. Kupas, MD, EMT-P, FAEMS, FACEP Medical Director, NAEMT
Medical Director, Geisinger EMS
Matt Zavadsky, MS-HSA, NREMT Chief Strategic Integration Officer
MedStar Mobile Integrated Healthcare
Bryan R. Wilson, MD, NRP, FAAEM Assistant Professor of Emergency Medicine
St. Luke’s University Health Network
Medical Director, City of Bethlehem EMS
Robert McClintock Director of Fire & EMS Operations
Technical Assistance and Information Resources
International Association of Fire Fighters
Mike McEvoy, PhD, NRP, RN, CCRN Chair – EMS Section Board – International Association of Fire Chiefs
EMS Coordinator – Saratoga County, New York
Chief Medical Officer – West Crescent Fire Department
Professional Development Coordinator – Clifton Park & Halfmoon EMS
Cardiovascular ICU Nurse Clinician – Albany Medical Center
FDA In Brief: FDA Revokes Emergency Use Authorizations for Certain Respirators and Decontamination Systems as Access to N95s Increases Nationwide
For Immediate Release:
The following quote is attributed to Suzanne Schwartz, M.D., M.B.A., director of the Office of Strategic Partnerships and Technology Innovation in the FDA’s Center for Devices and Radiological Health
“Throughout the pandemic, the FDA has worked closely with our federal partners at the Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health (NIOSH), the Occupational Safety and Health Administration (OSHA) and with manufacturers to protect our front-line workers by facilitating access to the medical supplies they require. As a result of these efforts, our country is now better positioned to provide health care workers with access to NIOSH-approved N95s rather than using non-NIOSH-approved respirators or reusing decontaminated disposable respirators.
Early in the public health emergency, there was a need to issue emergency use authorizations (EUAs) for non-NIOSH-approved respirators as well as decontamination and bioburden reduction systems to disinfect disposable respirators. Today, those conditions no longer exist. Our national supply of NIOSH-approved N95s is more accessible to our health care workers every day.
Today, the FDA is taking additional action by announcing the revocation of EUAs for imported, non-NIOSH-approved respirators as well as decontamination and bioburden reduction systems because of an increase in domestically-manufactured NIOSH-approved N95s available throughout the country. As access to domestic supply of disposable respirators continues to significantly improve, health care organizations should transition away from crisis capacity conservation strategies that were implemented at the onset of the pandemic.”
Additional Information
The U.S. Food and Drug Administration announced it is revoking EUAs of all non-NIOSH (National Institute of Occupational Safety and Health)-approved disposable respirators, which includes imported disposable respirators such as KN95s, along with revoking EUAs for decontamination and bioburden reduction systems.
All manufacturers of decontamination and bioburden reduction systems have requested, and the FDA has proceeded with, the revocation of their EUAs, effective June 30, 2021.
Since the beginning of the pandemic, NIOSH has approved more than 875 respirator models or configurations, with some of these manufactured by approximately 20 new, domestic NIOSH-approval holders. In addition, as of today, there are more than 6,400 total respirator models or configurations on the NIOSH-certified equipment list which have met the NIOSH-approved EUA criteria and thus are FDA-authorized. These include:
more than 600 filtering facepiece respirator (FFR) models (of which there are over 530 N95 FFR models),
more than 5,500 elastomeric respirator configurations, including new elastomeric respirators without an exhalation valve, and
more than 360 powered air purifying respirator configurations.
FDA has also withdrawn two related decontamination and bioburden reduction guidance documents:
Recommendations for Sponsors Requesting EUAs for Decontamination and Bioburden Reduction Systems for Face Masks and Respirators During the Coronavirus Disease 2019 (COVID-19) Public Health Emergency: Guidance for Industry and Food and Drug Administration Staff
Enforcement Policy for Bioburden Reduction Systems Using Dry Heat to Support Single-User Reuse of Certain Filtering Facepiece Respirators During the Coronavirus Disease (2019) Public Health Emergency
The FDA recommends health care personnel transition from extended use of disposable respirators to single-use for single-patient interactions as appropriate. See the letter to health care personnel for additional information.
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The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.
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?
SURVEY: https://www.surveymonkey.com/r/227TKTK
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 mbianchi@ambulance.org.
HOT (red light and siren) responses put EMS providers and the public at significant risk. Studies have demonstrated that the time saved during this mode of vehicle operation and that reducing HOT responses enhances safety of personnel, with little to no impact on patient outcomes. Some agencies have ‘dabbled’ with responding COLD (without lights and sirens) to some calls, but perhaps none as dramatic as Niagara Region EMS in Ontario, Canada – who successfully flipped their HOT responses to a mere 10% of their 911 calls! Why did they do it? How did they do it? What has been the community response? What has been the response from their workforce? Has there been any difference in patient outcomes? Join Niagara Region EMS to learn the answers to these questions and more. Panelists from co-hosting associations will participate to share their perspectives on this important EMS safety issue!
Speakers
Kevin Smith, BAppB:ES, CMM III, ACP, CEMC
Chief
Niagara Emergency Medical Services
Jon R. Krohmer, MD, FACEP, FAEMS
Team Lead, COVID-19 EMS/Prehospital Team
Director, Office of EMS
National Highway Traffic Safety Administration
Douglas F. Kupas, MD, EMT-P, FAEMS, FACEP
Medical Director, NAEMT
Medical Director, Geisinger EMS
Matt Zavadsky, MS-HSA, NREMT
Chief Strategic Integration Officer
MedStar Mobile Integrated Healthcare
Bryan R. Wilson, MD, NRP, FAAEM
Assistant Professor of Emergency Medicine
St. Luke’s University Health Network
Medical Director, City of Bethlehem EMS
Robert McClintock
Director of Fire & EMS Operations
Technical Assistance and Information Resources
International Association of Fire Fighters
Mike McEvoy, PhD, NRP, RN, CCRN
Chair – EMS Section Board – International Association of Fire Chiefs
EMS Coordinator – Saratoga County, New York
Chief Medical Officer – West Crescent Fire Department
Professional Development Coordinator – Clifton Park & Halfmoon EMS
Cardiovascular ICU Nurse Clinician – Albany Medical Center
To better understand EMS provider and leadership perceptions on the impact of fatigue on the EMS workforce, EMS1 and the American Ambulance Association are surveying EMS providers, supervisors and senior leadership about fatigue symptoms, sleep disorders and mitigation strategies. Please take a few moments to complete the survey below and pass it along to your colleagues. We will share the results and discuss in a future webinar. Thank you for your participation.
The American Ambulance Association HR Consultant discusses options open to EMS managers to ensure providers are vaccinated
The word of the week is vaccine, but is it giving EMS leaders a headache already? Host Rob Lawrence discusses the issues with American Ambulance Association HR Consultant, Scott Moore. Rob and Scott discuss the options open to managers to ensure all are vaccinated, while acknowledging the hope that science and understanding will prevail. They also discuss the other major news item of the week, EMS funding and the lack of it as reduced incomes put the very viability of service delivery at risk.
Scott Moore is a Massachusetts licensed attorney and possesses certifications as both a Professional in Human Resources (PHR) and the Society for Human Resources Management Certified Professional (SHRM-CP). He is a member of the American Bar Association (ABA), the Massachusetts Bar Association (MBA), the Northeast Human Resource Association (NEHRA), and the Society for Human Resource Management (SHRM).
In addition, Scott is an active member of the American Ambulance Association and has been a site reviewer for the Commission for the Accreditation of Ambulance Services (CAAS) for many years.
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.
As the demographics of our nation change, it becomes ever more essential for emergency medical services to foster a diverse and inclusive workplace more representative of the communities that we serve. To support this mission, the American Ambulance Association seeks tips, ideas, and perspectives from our membership on best practices for attracting, recruiting, and retaining the EMS workforce of tomorrow.
For this project, we are using the word “diversity” to refer to characteristics including—but not limited to—race, sex, gender identity, ethnicity, sexual orientation, religion, socioeconomic class, disability, and/or age.
While we are truly appreciative of all responses, AAA especially welcomes the perspectives of those who are themselves members of groups historically less represented in the EMS workforce.
If you would like to contribute your thoughts to this project, please complete our short form below. You do not need to disclose your identity if you do not wish to do so.
CMS Relaxes Physician Certification Statement Signature Requirements During Public Health Emergency for COVID-19
By Kathy Lester, J.D., M.P.H.
The Centers for Medicare & Medicaid Services (CMS) has released guidance that recognizes the difficulty ambulance service providers and suppliers may have during the COVID-19 Public Health Emergency (PHE) in obtaining a physician certification statement (PCS) signed by a physician or other authorized professional. The question and answer below indicates that CMS (and its contractors by extension) will not deny claims during a future medical audit even if there is no signature for non-emergency ambulance transports, absent an indication of fraud or abuse. Ambulance service providers and suppliers should indicate in the documentation that a signature was not able to be obtained because of COVID-19. The AAA advises completing the PCS form and then indicating if a physician, or other appropriate personnel, has not signed it by writing “COVID-19 Public Health Emergency” on the signature line. CMS also reminds providers and suppliers that medical necessity still needs to be met.
The American Ambulance Association has been advocating for CMS to ease its restrictions on signature requirements during the COVID-19 PHE. The FAQ posted by CMS is consistent with our recommendations.
The specific Q&A is below:
Q. For ambulance services that require a physician, or, in lieu of that, certain non-physician personnel, to sign and certify that a non-emergency ambulance transport is medically necessary, are these signature requirements not required during the COVID-19 PHE?
A. We understand that in certain situations during the COVID-19 PHE it may not be feasible to obtain the practitioner signature. Therefore, for claims with dates of service during the COVID- 19 PHE (January 27, 2020 until expiration), CMS will not review for compliance with appropriate signature requirements for non-emergency ambulance transports during medical review, absent indication of fraud or abuse. Ambulance providers and suppliers should indicate in the documentation that a signature was not able to be obtained because of COVID-19. However, we note that Medicare Part B covers ambulance transport services only if they are furnished to a Medicare beneficiary whose medical condition is such that other means of transportation are contraindicated, and the beneficiary’s condition must require both the ambulance transportation itself and the level of service provided in order for the billed service to be considered medically necessary.
The Department of Treasury has announced that the $350 billion appropriated under the CARES Act for the Paycheck Protection Program has been exhausted. However, Congressional leaders are currently negotiating an economic stimulus package to act as a bridge between the CARES Act and the next comprehensive package stimulus package. A core provision of the bridge package is an allocation of an additional $250 billion for the Paycheck Protection Program. If your operation is in the process or plans to apply for a loan under the Paycheck Protection Program, you should move forward with your efforts. The AAA is advocating that the bridge package or next comprehensive package include more funding for ambulance services.
This guidance is written to offer American Ambulance Association members the situational background and a list of resources and websites with which to draw guidance and further updates on the latest situation with COVID-19, colloquially referred to as “Coronavirus.” Key information for this update has been drawn from the NHTSA EMS Focus series webinar What EMS, 911 and Other Public Safety Personnel Need to Know About COVID-19, which took place on February 24, 2020. The on-demand recording is available below.
General Information
Background
The COVID-19 Coronavirus Disease was first reported in Wuhan China in December 2019. CDC identifies that it was caused by the virus SARS – CoV-2. Early on, many patients were reported to have a link to a large seafood and live animal market. Later, patients did not have exposure to animal markets which indicates person-to-person transmission. Travel-related exportation of cases into the US was first reported January 21, 2020. For reference the first North American EMS experience of COVID-19 patient transport, including key lessons learned, can be found in the EMS 1 article Transporting Patient 1.
Spread and Identification
Global investigations are now ongoing to better understand the spread. Based on what is known about other coronaviruses, it is presumed to spread primarily through person-to-person contact and may occur when respiratory droplets are produced when an infected person costs or sneezes. Spread could also occur when touching a surface or object that has the virus on it and when touching the mouth, nose, or eyes. Again, research is still ongoing, and advice and guidance will inevitably follow.
For the cases that have been identified so far, those patients with COVID19 have reportedly had mild to severe respiratory illness with symptoms including fever and shortness of breath. Symptoms have typically appeared 2 to 14 days after exposure. Both the WHO and CDC advise that patients that have been to China and develop the symptoms should call their doctors.
COVID-19 Prevention and Treatment
To date, 30 international locations, in addition to the US, have reported confirmed cases of COVID-19 infection. Inside the US, two instances of person-to-person spread of the virus have been detected. In both cases, these occurred after close and prolonged contact with a traveler who had recently returned from Wuhan, China.
The CDC activated its Emergency Operations Center (EOC) on January 21 and is coordinating closely with state and local partners to assist with identifying cases early; conducting case investigations; and learning about the virology, transmission, and clinical spectrum for this disease. The CDC is continuing to develop and refine guidance for multiple audiences, including the first responder and public safety communities.
As at the date of publication there is still no specific antiviral treatment licensed for COVID-19, although the WHO and its affiliates are working to develop this.
The following are recommended preventative measures for COVID-19 and many other respiratory illnesses:
Wash your hands often with soap and water for at least 20 seconds.
Use an alcohol-based hand sanitizer with at least 60% if soap and water are not readily available.
Avoid touching your eyes, nose, and mouth with unwashed hands.
Avoid contact with people who are sick.
Stay home when you are sick.
Cover your cough or sneeze with a tissue, then throw it away.
Clean and disinfect frequently touched objects and surfaces.
The guidance identifies EMS as vital in responding to and providing emergency treatment for the ill. The nature of our mobile healthcare service delivery presents unique challenges in the working environment. It also identifies that coordination between PSAPs and EMS is critical.
Key points are summarized below:
Recommendations for 911 PSAP Locations
The link between PSAPs and EMS is essential. With the advent of COVID19 there is a need to modify caller queries to question callers and determine the possibility that the call concerns a person who may have signs or symptoms and risk factors for COVID19.
The International Academy of Emergency Dispatch (IAED) recommends that agencies using its Medical Priority Dispatch System (MPDS) should use its Emerging Infectious Disease Surveillance (EIDS) Tool within the Sick Person and Breathing Problem protocols. For those that are not MPDS users, IAED is offering its EIDS surveillance Tool for Coronavirus, SRI, MERS and Ebola-free of charge under a limited use agreement.
Recommended Personal Protective Equipment (PPE)
The CDC recommends that while involved in the direct care of patients the following PPE should be worn:
Single pair of disposable examination gloves
Disposable isolation gown
Respiratory protection (N95 or higher)
Eye Protection (goggles or disposable face shield)
EMS Transport of a Patient Under Investigation (PUI) or Patient with Confirmed COVID19
Notify receiving healthcare facility so appropriate precautions can be put in place
Discourage family and contacts from riding in transport vehicle
Isolate the vehicle driver from the patient compartment by closing the windows between compartments and ensuring that the vehicle ventilation system is set to the non-recirculated mode
Document patient care
Cleaning EMS Transport Vehicles After Transporting PUI or Patient
Don PPE for cleaning with disposable gown and gloves, facemask, and goggles or face shield if splashes are anticipated
Routine cleaning and infection procedures should follow organizational standard operating procedures
Use protect use products with EPA-approved emergent viral pathogens claims
Once transport is complete, organizations should notify state or local public health authorities for follow up. Additionally agencies should (if not done already) develop policies for assessing exposure risk and management of EMS personnel, report any potential exposure to the chain of command, and watch for fever or respiratory symptoms amongst staff.
Employers Responsibilities
While not specific to COVID-19, agencies should:
Assess current practices and policies for infection control
Job- or task-specific education and training
PPE training and supply
Decontamination processes and supplies
Local EMS Considerations
PPE supplies
911 and EMD call taking activities
Appropriate approach to potential patients
Educational resources for EMS personnel
Interaction with local public health/healthcare systems/emergency management
Interaction with local fire and law enforcement
Considerations for local jails
Further Reading
World Health Organization (WHO)—For a wider perspective, the WHO provides both a daily live online briefing and written situation report.
The COVID19 situation constantly evolving. Agencies should defer to their local EMS authorities, Public Health departments, and the CDC for definitive guidance. Going forward, the AAA will continue to both monitor the disease and alert issues to the membership.
October Feature: Work-Life Balance and Productivity
Ten Tips for Fitting Work and Life Together
Would you like to move beyond feeling stressed or overwhelmed by your personal and work responsibilities? Or learn how to achieve personal and professional success on your own terms? “Knowing how to manage the way work and life fit together is a modern skill set we all need to succeed,” says Cali Williams Yost, an internationally recognized flexible workplace strategist and author of the books Tweak It: Make What Matters to You Happen Every Day and Work+Life: Finding the Fit That’s Right for You. Here are Yost’s 10 strategies:
Remember that work-life fit is unique for each of us. “Simply put, there is no work-life balance or perfect 5050 split between your work and your personal life,” Yost says. “If you do happen to hit a balance, you can’t maintain it because your realities are always changing, personally and professionally.” There’s also no “right way” to achieve a good work-life fit. Your goal is to find your unique, ever-changing fit, the way your work and personal realities fit together day-to-day and at major life transitions. Don’t compare yourself to others. Find the fit that’s right for you.
It’s also important to keep in mind that during major life changes — like becoming a parent, caring for an aging relative, relocating with a partner, going back to school, or easing your way into retirement — you may find yourself rethinking how you define success related to money, prestige, advancement, or caregiving. Throughout life, you may need to align and adjust your work and personal realities so they match with your vision and goals for the future.
Harness the power of small actions or “tweaks”. Even small actions can have positive and lasting effects. When you’re feeling overloaded, for example, commit to taking two or three small but meaningful steps toward a better work-life fit. Plan a long weekend away with friends. Clean out your hall closet. Take an online class to learn a new skill. Then do it again and again. Small actions can have a big impact on your sense of well-being and control. To get started, check out more than 200 small, doable get-started actions suggested by 50 work, career, and personal life experts in Yost’s book Tweak It.
Create a combined calendar and priority list. On top of a busy job and home life, how will you fit everything else into your schedule? There’s exercise, eating well, vacation, sleep, career development, time with family and friends, caregiving responsibilities, and just general life maintenance. You can’t do it all. But you can be more intentional and deliberate about how you spend your time.
First, pull together all your work and personal to-dos and priorities into one combined calendar and list. This will help you determine how you want to prioritize the tweaks — small, meaningful work, career, and personal actions and priorities — to add to your work-life fit. For example, tweaks might include planning all meals and shopping for your groceries on Sunday or getting to exercise class every Tuesday and Saturday. Or they might include researching a vacation one afternoon, going to the movies with your sister, or attending a networking event. Building actions into your schedule makes it far more likely they’ll happen. And you’ll feel better as a result.
Take care of yourself in small ways. Small changes can make a big difference in how you feel. Manage stress during the day by closing your eyes for 15 seconds and taking a few deep breaths. Try to eat more healthfully by adding a vegetable to two of your meals during the day. Turn off the television and your electronic devices an hour before you go to bed to help you get the rest you need.
Preview a skill online before you pay to take a class. In a rapidly changing world, all of us need to keep updating our skills to meet new work and other realities. But going back to school can be expensive and time consuming. Before you invest a substantial amount of money in a class, try to preview a skill online. Watch or listen to any of the hundreds of thousands of videos or podcasts on an infinite number of topics that you can preview by downloading or streaming them. Watch them while you’re commuting, or listen to them while you walk. If you want or need more help than the video or podcast provides, invest in a class
Collect ideas for vacations — then take one. Taking a break to reenergize is more important than ever in our on-the-go world. And many people don’t take vacations just because they don’t know where to go. It takes some research to find a destination that you can afford, and some of us don’t do this until it’s too late. To get inspired, keep a jar or small box where you can store vacation ideas. Every time you hear a friend or relative talk about a wonderful vacation, write down what appeals to you about it and put it there. When you read an article about a place that sounds interesting, put that in the box or jar, too. Once a year, pick a destination from all of the vacation ideas you’ve accumulated.
Get things done while you’re enjoying family and friends. Cook dinner with your kids. When you prepare a meal together, you’re also spending time together. Take a walk with your close friend before work or a tae kwon do class with your partner on the weekend. You’ll be exercising while spending quality time together. At holiday times, plan a cookie exchange and donate some of the cookies to a women’s shelter.
Have 10 technology-free minutes each day with your children. Give the kids time when you aren’t distracted by electronic gadgets. Sit on the floor and do a puzzle. Ask teenagers how their day went, and just listen. Check your email only at certain times of the day, so you aren’t always on it when children need you. When you’re on the phone, turn around and face away from your computer so you aren’t distracted by email. Looking away from the screen will force you to pay attention to the person you’re talking with.
Plan for future caregiving responsibilities. Get a head start if you’re taking care of a grandparent or may be caring for a parent or other relative in the future. Sit down with the adults in your life who may require care. Try to clarify what they want, understand their financial resources, and come up with a plan for meeting their needs and wishes. Try to include in the meeting any family and friends who form a broader network of care, so you don’t have to do it all on your own. Don’t wait for a crisis.
Keep on top of everyday maintenance. Clean as you go, so the work doesn’t pile up. Put a load of laundry in the washing machine in the morning before you leave for work, and put it in the dryer when you get home. Keep a small bucket of cleaning supplies in the bathroom, and wipe down the shower, mirror, and toilet every morning. Set a timer for 10 minutes each weekend and assign each member of your family a task — vacuuming, dusting, straightening up. Check the owner’s manual of your car for the recommended maintenance schedule and write it on your calendar.
Free, confidential counseling for employees of AAA member organizations.
LifeWorks is your employee assistance program (EAP) and well-being resource. We’re here for you any time, 24/7, 365 days a year, with expert advice, resources, referrals to counseling, and connections to specialists including substance abuse and critical incident stress management professionals. If you could benefit from professional help to proactively address a personal or work-related concern, you can turn to LifeWorks.
Counseling is available at no cost to you. (Up to three sessions per issue.)
To meet individual needs and preferences, counseling is available face-to-face AND live by video.
All our counselors are experienced therapists with a minimum Master’s degree in psychology, social work, educational counseling, or other social services field.
Call LifeWorks, toll-free, 24/7, at 800-929-0068. Visit us online at login.lifeworks.com or by
mobile app (username: theaaa; password: lifeworks)
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