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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COVID-19 employee Travel FAQ

Over the last week, we have received several questions from AAA members about various COVID-19 impacts on EMS organizations.  As the infection numbers around the country are on the rise, many new issues have arisen that are posing issues with many EMS employers.

  1. Travel Orders

What can I do when our employee voluntarily chooses to travel out of state and, due to state level travel orders which require mandatory quarantine for 14 days upon their return, the employee cannot work and is seeking to be paid emergency leave under the Families First Coronavirus Act (FFCRA) or take additional unpaid leave during the quarantine period?

As an employer, you have several options.  One of the most important things to know is that your employee does have to abide by any federal, state, or local quarantine order.  However, this does not mean that the employer is helpless in addressing this the issue of employee voluntary travel.  The last few months have been incredibly trying on all of us, particularly those who are on the front lines battling the COVID-19 pandemic, it is understandable that employees are looking to take vacations out of state.  While this is understandable, the employee is still making a decision that can impact their health and their employment, as well as, the health of their coworkers and patients.

Employer Option 1

As an EMS employer, the FFCRA specifically permitted EMS agencies the right to exclude emergency responders from the group of employees who are eligible to take emergency leave under the FFCRA. Despite this, many EMS employers have decided to provide their employees with emergency paid leave under the FFCRA.  The employer can choose to pay the employee emergency leave under the FFCRA during the mandatory travel quarantine.

Employer Option 2

As stated in Option 1, the FFCRA specifically permitted EMS agencies the right to exclude emergency responders from the group of employees who are eligible to take emergency leave under the FFCRA. Most of those employers who have decided to provide emergency leave under the FFCRA, their intent was to provide the emergency leave to employees who, through no fault of their own, were exposed to COVID-19 and required to quarantine.  However, an employer has the right to exclude some employees, such as those who decide to voluntarily travel outside state, and as a result, required to quarantine upon return.  The key is to ensure that you have an established policy, it is applied consistently, and has been meaningfully communicated to your employees.  This is the best practice for mitigating any discrimination or disparate treatment claims.

Employer Option 3

The employer can choose to discipline the employee for choosing to leave the state, despite the travel order.  If an employee knowingly travels out of state, despite the existence of a mandatory travel quarantine order, the employer can discipline that employee for any quarantine related attendance issues.  The employer cannot let that employee return to work unless they have abided by any travel orders.  Several of the states who have issued orders, include an option to avoid a 14-day quarantine order if they have a negative COVID-19 test within three days of returning to their home state.  Alternatively, they can end the 14-day quarantine period if they receive a negative test after returning to their home state.

Employer Best Practice

The best bet for employers is to contemplate the possible issues that could arise with your employees as a result of the local travel orders.  Employers should draft a policy that delineates the work-related implications of employee travel.  This policy should be communicated through multiple channels, and ideally, be acknowledged in writing by your employees.  This will provide your employees with a clear understanding of the implications of deciding to travel out of state during the pandemic.

  1. COVID-19 Parties

Several member organizations have asked what actions they can or should take when they learn that an employee has attended a COVID-19 party.  These events, which defy logic, particularly for those of us who consider EMS, healthcare and EMS personnel, healthcare workers, are parties where uninfected people go to a party with known infected people to mingle and see who becomes infected.

Option 1

Under the General Duty clause of the Occupational Health and Safety Act (OSHA), an employer has an obligation to provide a workplace which is “free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees”.  This includes if an employer is aware that there are employees who are engaging in behavior that may create a workplace hazard, like attending events such as a COVID-19 party.

If an employer discovers that an employee has attended an event like a COVID-19 party or a large scale event where protective measures were not taken, such as mandatory mask wearing and social/physical distancing, the employer has a duty to investigate and take action.  This would include requiring that the employee remain out of work for the recommended quarantine time or upon a negative COVID-19 test.  The employer could pay for this test but is not required to.  If the employee voluntarily took part in this event and the exposure was not work-related, they would not be obligated to pay for the COVID-19 test.

Option 2

For the many reasons stated above, the employer has an obligation to the rest of its workforce to ensure that this potentially infected employee does not expose the rest of the workforce.  The employer would be justified in addressing this issue through their disciplinary process.  As is always recommended, I recommend that employers communicate with their employees to let them know that the choices they make outside of the workplace have implications inside the workplace.  While this should be obvious to our employees, not all operate by the same playbook.

Employers should be aware that there are state laws that limit the level at which an employer can dictate an employee’s “off duty” time.  For example, an employer in New York cannot take work action against an employee for their personnel time political activities.  However, an employer may address the employee if that off duty conduct involves their employee’s failure to be safe by wearing a mask and maintaining social/physical distancing while attending a political event or political-based protest.  As previously mentioned, employers have obligation to provide a workplace that is free from “recognized hazards”.

Employer Best Practice

I recommend that employers consult with their local attorneys if they faced with taking work-related action for an employee’s off duty conduct if they are in a state with off duty conduct laws.  The best way to ensure you protect your workforce is to ensure that the organization has a comprehensive policy and procedure manual that is updated every year.  Additionally, all employees, including supervisory personnel, should sign an acknowledgement annually. Lastly, it is recommended that the organization highlight a few policies throughout the year.  Specifically, I recommend that organizations log all incidents, complaints, and discipline to permit trending of workplace activity which suggest which policies and procedures need to be highlighted.

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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CISA: Emergency Services Sector Active Shooter Guide

The FBI designated 28 shootings in 2019 as active shooter incidents. The 28 incidents resulted in 247 casualties, 97 people killed, and 150 people wounded, excluding the shooters. No community appears immune from these potential incidents; therefore, it is important for every community to develop an Active Shooter Program.

The purpose of this guide is to provide emergency services personnel with the basic building blocks for developing an Active Shooter Program with communities. This guide highlights resources and planning considerations, which will enhance emergency services organizations’ ability to develop or improve community planning and preparedness for active shooter incidents.

Download Guide

For more information, email the Emergency Services Sector-Specific Agency at essteam@cisa.dhs.gov.

Coronavirus (COVID-19) Impacts on the EMS Workplace

There has been a great deal activity and press coverage over the past few weeks relative to the Coronavirus (COVID-19). This activity has generated several questions from EMS organizations regarding how to handle the impact on the workplace. Healthcare workers have been identified by the Occupational Safety and Health Administration (OSHA) as a group of workers who are at an increased risk of exposure to COVID-19. There are many steps EMS organizations can take to best prepare their workplace and protect their personnel.

EMS agencies are already required to follow and maintain OSHA’s Infection Control Standards for Bloodborne and Airborne Pathogens (29 CFR 1910.1030). If EMS organizations and their employees are diligent in maintaining these standards, they will already be doing nearly everything that is being recommended for employers to combat the spread of COVID-19. The Centers for Disease Control (CDC) released their Interim Guidance for Businesses and Employers, which includes additional practical recommendations for employers to utilize to further combat the spread of COVID-19, including:

  1. Actively encouraging sick employees to stay home;
  2. Separating sick employees from the rest of the workforce;
  3. Encouraging workers to stay home when sick, respiratory etiquette, and hand hygiene by all employees;
  4. Performing routine environmental cleaning;
  5. Advising employees before traveling to take certain steps.

This guidance is intended to be a refresher for employers. The recommendations by the CDC are consistent with best practices for employers regardless of a potential pandemic. However, our workforce can become complacent and it is important that EMS organizations remind their teams to be diligent and have supervisory staff monitor for adherence to these practices and company policies.

Frequently Asked Questions

Over the past week there have been several questions posed by EMS organizations on employer related issues related to COVID-19. We thought we would share those questions and encourage members to reach out with questions not addressed in this FAQ. We will be sure to share those questions with members and will provide additional guidance as it becomes available.

Are there any limits to the medical questioning or screening of current or potential employees?

Yes, Employers are limited when performing medical screenings or making medically related inquiries of employees or job candidates regardless of the current COVID-19 virus concerns. Often, medical screenings or inquiries can identify medical conditions which are protected under the Americans with Disabilities Act (ADA). To the extent to which they are permitted, any medical inquiry or screening must be job related and consistent with business necessity. In those circumstances, any information must be kept confidential.

The Equal Employment Opportunity Commission (EEOC) re-released Pandemic Preparedness in the Workplace and the Americans with Disabilities Act which provides guidance for employers on how to prepare for a pandemic in the workplace while maintaining compliance with the ADA.

Employer Permitted Screening/Questioning

  1. Questions designed to identify non-medical reasons for work absences (such as public transportation interruptions)
  2. Post-offer medical examinations required of all similarly situated employees in same job category.
  3. During a declared pandemic, employers can ask employees if they are experiencing pandemic-like symptoms. Responses must be kept confidential, consistent with other employee-related medical information.
  4. Taking employee’s temperatures is permitted in a widespread pandemic but this may not be a reliable manner for identifying those employees ill with the COVID-19 virus.
  5. Employers can inquire about potential exposure to pandemic if the employee traveled to an area affected by the COVID-19 pandemic.
  6. Employers can ask an employee if the reason an employee missed work was for a medical reason.

What do we do if we have an employee who is concerned about exposure and wishes to miss work? Additionally, what if the employee’s concern is due to an underlying medical condition, such as pregnancy, and asks to stay out of work?

There are several important issues to address with both questions. First, employers need to review all company policies regarding leave from work to ensure compliance with the relevant leave laws including, leave as an accommodation under the ADA, Family and Medical Leave Act (FMLA), and state-level Paid FMLA or Sick Leave laws. Additionally, employers should review their policies regarding any other paid or unpaid leave to be certain that all policies clearly delineate how leave requests are handled under these policies.

For the most part, when an employee is seeking to miss work due to exposure concerns, employers should handle these requests as they would any other requested leave from work. This is where it is important to utilize your Human Resources (HR) professionals. HR can evaluate the request for leave to ensure that the reason the employee is requesting the leave isn’t due to an underlying disability under the ADA or a “serious health condition” under FMLA. In both instances, an employer has numerous obligations and may be required to approve the leave. In some instances, the employee could be seeking FMLA due to a family member who is ill with COVID-19 who they must care for. In these instances, employers would follow their normal FMLA practices.

As it relates to the first employee, the presumably healthy employee who is concerned with being exposed to COVID-19, any leave would be provided consistent with the employer’s attendance and time off policies. This is different than how you would address the employee who is pregnant and seeking to miss work due to concerns of virus exposure. Pregnancy and pregnancy related medical conditions can qualify as a “disability” under the ADA.

Pregnancy itself is not necessarily a “disability” under the ADA. Only when the pregnancy or a pregnancy related medical condition interferes with one or more major life activities, may it qualify as a “disability” under the ADA. Employers are required to engage in the “interactive process” to determine if the employee can be provided with a “reasonable accommodation” that would permit the employee to perform the essential functions of their position. A reasonable accommodation can include leave from work. It is important that you document these requests and the subsequent process to ensure consistent handling and record keeping.

These can be incredibly difficult issues to handle, especially with all the information and media attention surrounding this virus. Members who need assistance with these potentially challenging compliance issues can contact the AAA and its consultants for assistance.

What should we do if an employee is exposed to, or suspected of having contracted COVID-19?

OSHA has created a COVID-19 Resources Webpage to assist employers with planning and addressing employer issues related to the Coronavirus. In addition, the CDC’s guidance for employers provides recommendations and strategies to prepare for, and deal with, COVID-19 in the workplace. This includes how to address the employee-related aspects of this virus.

However, under the General Duty Clause of OSHA, employers must “furnish to each of his employee’s employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees.” This includes removing known hazards from the workplace, including sick or contagious employees.

Aside from the efforts to prepare and address exposures, employers have been seeking guidance from a workers’ compensation perspective and how to handle quarantines and exposures for employees. It is important to remember that an occupational exposure to COVID-19 is no different than any other occupational exposure. EMS organizations should be sure to do the following:

  • Review their company policies relative to work injuries, exposures, and illnesses to be sure that they are clearly drafted and instruct both employee and supervisors what to do in the event of an exposure.
  • Ensure you have reviewed the Infection Control and Bloodborne and Airborne Pathogens Standards and that your employees have access to, and utilize their Personal Protective Equipment (PPE).
  • Confirm that there is adequate workplace postings and communications to ensure that all employees understand how to report any suspected occupational exposure.
  • Confirm with all management personnel that they understand how to appropriately investigate any workplace exposure in collaboration with human resources or company safety or occupational health officer.
  • Contact the Infection Control Officer at the healthcare facilities in your catchment area to ensure that they have the appropriate contact information for your service in the event that they need to contact your organization due to a known exposure.
  • Contact the public health agency in your catchment area to ensure that your organization is engaged with public health officials in your service area to stay informed.
  • Be sure that employees understand and are leaving a copy of the Ambulance Patient Care Report at a receiving facility at the time of transport to ensure that the receiving facility’s Infection Control Officer can notify the EMS organization in the event that an ambulance patient is later determined to have, or be suspected of having COVID-19.
  • If an employee reports exposure to COVID-19, employers should notify their workers compensation insurance carrier to begin the claims process.
  • In most states, being exposed to a contagious disease or illness is not itself compensable under workers’ compensation. To be compensable under most state worker’s compensation laws, the employee has to actually contract the contagious illness or disease and be able to show that the contagious disease or illness exposure occurred in the course of their employment. Some professions, such as healthcare, are inherently more likely to be exposed to the contagious disease or illness. Often, healthcare workers are still required to show a “but for” causation. If the employee can meet this burden, then the workers’ compensation claim for this illness will likely be compensable.
  • Employees who have a workplace exposure and have been placed in quarantine or are being treated will be handled a bit differently. These exposures or illnesses would be handled like any other occupational exposure or illness. The employee should complete an Injury & Illness Incident Report form to ensure that the employer has all of the information needed to appropriately investigate and report the illness, both to their workers compensation insurance carrier and on their OSHA Log of Work-Related Injuries & Illnesses.

Can I make my employees stay home if they have been exposed or are exhibiting symptoms of COVID-19? If so, must I pay employees for the time missed?

Yes, generally you can require an employee to stay home from work. Employers have an obligation under the General Duty Clause of OSHA to provide a safe workplace for all employees. This would include protecting the health and safety of the other workers in your workplace.

The second part of this question will depend on numerous factors including, any applicable state paid leave laws, company sick or paid time off benefits, or other past company practices which paid employees for similarly missed time.

The bottom line, you must pay the employee consistent with any mandatory state sick leave requirements, paid company leave benefits, or consistent with any past pay practices for pay in such situations. The goal will be to treat the employee consistent with all federal or state laws, company policy, or past business practice. When employers treat similarly situated employee differently, they run the risk of potential discrimination claims.

Can I reduce staffing or require some workers to work from home or telecommute?

Yes, while most of the job duties performed by EMS organization workers are the kind that require presence at the workplace, there are some administrative positions that can be performed remotely or at home. In these instances, employers still have several things to consider before asking employees to work remotely.

First, employers who decide to have employees work remotely must ensure that the work performed remotely is done so in a compliant manner. For example, billing personnel working remotely will have to access Protected Health Information (PHI) during the course of performing their duties. It is important that the EMS agency ensures that the Administrative, Physical, and Technical safeguards required under the Privacy and Security Rule of the Health Insurance Portability and Accountability Act (HIPAA) are complied with in that remote setting.

Second, any FLSA non-exempt employee needs to continue to track all time worked to ensure the employer can accurately pay all employees. Employers must establish policies, to the extent that they do not already exist, that govern remote workers or telecommuting. Employers should review all existing organizational policies and ensure that they are adapted to address remote working or telecommuting. This includes addressing the steps employees need to take should they need to be absent from work, including how to “call out sick” or must miss work.

Third, employers need to ensure that employees who require an ADA reasonable accommodation in the workplace can still be provided that accommodation when working remotely, if needed. It is important for employers to remember that they are still required to comply with all work-related laws and regulations even for remote or telecommuting workers.

Do employers have to pay workers who are out of work?

That depends on the reason for the employee being out of work, your state law, and the employer’s policies.

  • Voluntary absence from work due to employee’s concern of future exposure?

    Absent any state paid leave requirements, if the employee has voluntarily decided not to come to work due to their concern of exposure to the virus, then you would need to pay them consistent with your organization’s policy regarding paid time off. If the employee has no paid time off available, then the employer is not required to pay them.
    There is nothing that prevents an employer from paying their employees if they choose to, but it is generally not required. Employers with labor unions should consult their collective bargaining agreements (CBA) for any paid time off provisions.

  • Voluntary isolation or quarantine following suspected exposure?

    Generally, employees who are placed in quarantine due to exposure to COVID-19 are not compensable under most state’s workers’ compensation laws. Nothing prevents an employer from filing a claim with their workers’ compensation insurance carrier. However, it is highly unlikely that the insurance carrier will consider this a compensable illness or injury.

    As stated above, absent any state paid leave requirements, if the employee does not come to work due to their exposure to the virus, then you would need to pay them consistent with any state-mandated paid time off or your organization’s policy regarding paid time off. If the employee has no paid time off available, then the employer is not required to pay them.

    There is nothing that prevents an employer from paying their employees if they choose to, but it is generally not required. Again, employers with labor unions should also consult their collective bargaining agreements (CBA) for any paid time off provisions.

  • Employee absence due to acquiring or exhibiting symptoms of COVID-19?

    If an employee misses work due to acquiring COVID-19 or exhibiting the virus’ symptoms, the employer should follow their normal work-related illness practices as provided under workers’ compensation. Whether the illness is compensable under workers’ compensation is determined under state workers’ compensation law. Typically, if an illness is compensable under workers’ compensation, the first several days are unpaid and can be paid under any state mandated sick or employer paid time off policy.

    If the employee has no paid time off available, then the employer is not required to pay them. There is nothing that prevents an employer from paying their employees if they choose to, but it is generally not required. Employers with labor unions should also consult their collective bargaining agreements (CBA) for any paid time off provisions.

Does employee absence from work due to COVID-19 qualify for Family & Medical Leave under the Family & Medical Leave Act (FMLA)?

Generally, employees who exhibit a mild case of COVID-19, which does not require continuing treatment or hospitalization, it is highly unlikely that the individual’s condition would rise to the level of a “serious health condition” as defined under the Family & Medical Leave Act (FMLA) leave. If the employee has a more serious case of the illness, then the employee could qualify for job protected leave under FMLA. In that case, the employer should follow the required steps under FMLA, including furnishing the employee with a Notice of Eligibility and Rights & Responsibilities, Certification of Health Care Provider Employee’s Serious Health Condition, and subsequent FMLA Designation Notice as required under FMLA.

However, if the employee is caring for a parent or child with a serious health condition, the virus itself, or another underlying medical condition that is worsened by the virus, it may trigger job-protected leave under FMLA. Under FMLA, the employer would provide the employee the Notice of Eligibility and Rights & Responsibilities, the Certification of Health Care Provider for Family Member’s Serious Health Condition, and the Designation Notice and would handle consistent with FMLA. It is recommended that all employee leave is tracked and logged for record keeping purposes and to ensure consistent handling of leave requests.

Employee absences that are caused by their need to provide childcare due to their child’s daycare or school closure, would not trigger protected leave under FMLA. Such leave may be covered under an employer’s other paid or unpaid time off or leave policies or under state required paid or unpaid leave.

What options does an employer have when it comes to staffing shortages created by COVID-19?

Employers should set a staffing contingency plan and policies if the employer has difficulty with staffing due to a pandemic. This policy should be broadly communicated to all employees. Many EMS agencies have hold-over policies that provide that an employee may have to stay on duty for a subsequent shift due to staffing shortages.

In these instances, it is best practice to set parameters around these policies, including the circumstances under which the policy will be implemented, notice to the hold-over employee, and considerations for maximum continuous and total weekly working hours. In addition, the policy should provide for employee self-reporting and fatigue protocols which include non-retaliation protections for employees who express fatigue or safety concerns.

Employee who are held over must be paid consistent with federal, state, and local wage laws, including any applicable overtime provisions of the Fair Labor Standards Act (FLSA). Non-exempt salaried employees should be paid consistent with federal, state, or local overtime wage laws. FLSA Exempt employees do not have to be paid overtime for hours worked over forty (40) hours.

Employers who have a unionized workforce should refer to the Collective Bargaining Agreement (CBA) for any provisions impacted by hold-over or pay practices.

What can/should we do if an employee refuses to work with another employee due to concerns of exposure to COVID-19?

It is important for employers to learn or understand why this employee is refusing to work with the other individual. If the employee is refusing to work with the other individual because that individual is exhibiting virus-like symptoms, then that employee should not be in the workplace anyway. Under OSHA, employers have an obligation to furnish to employees a place of employment which is free from recognized hazards that are causing or are likely to cause death or serious physical harm to other employees. This would include exposure to employees suspected of having COVID-19.

Under OSHA, an employee is only entitled to refuse to work if they believe they are in imminent danger. OSHA has recommended actions for an employee to take if they believe performing the task or working would pose an imminent danger. The right to refuse work is protected if all of the following conditions are met:

  • Where possible, you have asked the employer to eliminate the danger, and the employer failed to do so; and
  • You refused to work in “good faith.” This means that you must genuinely believe that an imminent danger exists; and
  • A reasonable person would agree that there is a real danger of death or serious injury; and
  • There isn’t enough time, due to the urgency of the hazard, to get it corrected through regular enforcement channels, such as requesting an OSHA inspection.

You should take the following steps:

  • Ask your employer to correct the hazard, or to assign other work;
  • Tell your employer that you won’t perform the work unless and until the hazard is corrected; and
  • Remain at the worksite until ordered to leave by your employer.

However, if the employee is refusing to work with the other employee because of their belonging to, or being a member of, a category of people who are protected under Title VII of the Civil Rights Act or one of the other anti-discrimination statutes, that would violate law and an employer would be required to address this behavior. It is equally important that employers monitor workplace behavior, and the treatment of their employees by individuals not employed by the EMS organization, to ensure that they are not subject to direct or indirect discriminatory actions. This includes patients who refuse to be treated by your EMS personnel due to discriminatory motives or fears.

Important Reminder

Due to the nature of the work performed by EMS personnel and other healthcare workers, our workers are more likely than the general population to be exposed to workplace hazards, including viruses like COVID-19. It is important to remember that our teams face far greater a risk on a daily basis than those associated with this virus. Employers should remind their staff of the available benefits and services, such as Employee Assistance Programs, Support for Medics, Short-Term Disability, and available paid time off, should they wish to utilize them during this stressful time.

If we ensure that our employees are following our occupational safety practices and policies, they will significantly reduce the likelihood of workplace exposure or injury. This will not happen without every individual on the team taking ownership of fostering a culture of safety. Communication and monitoring are key to maintaining a safe work environment and significantly ease worker’s fears surrounding this virus.

As always, the American Ambulance Association and its team of staff and consultants can assist EMS organizations with these challenges. Be sure to visit the AAA website for more information.

HHS Releases Communication Checklist to Aid First Responders

HHS Releases Checklist to Aid First Responders in Communicating Effectively with Patients

The U.S. Department of Health and Human Services (HHS) Office of Civil Rights (OCR) has released a plain language checklist that is intended to aid First Responders during emergencies that involve individuals with Limited English Proficiency (LEP) and communications related disabilities. The AAA issued numerous articles to its members in 2016 about the newly published requirements for all healthcare providers, including EMS agencies, under the nondiscrimination provisions of the Affordable Care Act (ACA) Section 1557. The requirements are intended to prevent discrimination in the provision of healthcare and ensure that all individuals can meaningfully participate in their healthcare treatment, including those patients with LEP and other communications related disabilities.

The announcement yesterday is intended to provide additional resources for healthcare providers to ensure compliance with the ACA Section 1557. The checklist includes numerous recommendations and action steps that EMS agencies can utilize to ensure that they are serving all members of a community in a meaningful way. These recommendations include conducting research about the communities by accessing U.S. Census Bureau data, engaging Centers for Independent Living and local assistance groups, and by preparing emergency messaging that can be disseminated quickly to individuals with LEP and communications related disabilities.

It is important that EMS agencies recognize their obligations under Section 1557 of the ACA to ensure that they can meaningfully serve their communities and remain compliant with their obligations under the law. HHS OCR has published several resources to assist healthcare providers on their website. EMS agencies that are unsure if ACA Section 1557 rules apply to them or have questions about how they can comply can contact the AAA for assistance.

Access the checklist here►

EEOC Sexual Harassment Update Fall 2018

The Equal Employment Opportunity Commission (EEOC) released a Press Release yesterday encouraging employers to take “concrete steps to change their workplace cultures to prevent harassment”.  The EEOC held a meeting yesterday at their headquarters in Washington D.C. as it has been 12 months since the #MeToo movement first exploded in the media in October 2016.  Long before the #MeToo movement gained momentum, the EEOC assembled a Select Task Force on the Study of Harassment in the Workplace to try to ascertain the progress made in the last 30 years of anti-harassment efforts.  This Special Task Force released a report in June 2016 in which they state that sexual harassment in the workplace is still a significant problem and that many of the employer awareness and educational efforts have done little to reduce or prevent it.

The EEOC released the final 2018 fiscal year data regarding its efforts to fight or prevent workplace harassment.  The report included data that showed a 13.6% increase in sexual harassment charges and nearly 50% increase in harassment lawsuits.  EEOC Acting Chair Victoria A. Lipnic and Select Task Force Co-Chair Chai R. Feldblum, stated that there needs to be a holistic approach to fighting and preventing workplace sexual harassment.  For there to be a real impact, there needs to be a fundamental cultural change where leadership is engaged and accountable for ensuring that the appropriate policies, procedure, and educational programs in place.  This is not an instance in which implementing one of those elements will have a meaningful impact.  The message for employers is that they need to do more.

The AAA has been tackling this issue head on over the last year by providing front-line supervisors and EMS leaders with a practical educational program aimed at investigating sexual harassment incidents in an EMS workplace.  We have held nearly ten EMS Supervisor Simlabs over the last twelve months all over the country.  The final SimLab of 2018 will be held in Charlotte, NC on November 15, 2018.  In this one-day workshop, attendees learn the law related to workplace harassment and how to approach and perform a workplace investigation from both a strategic and legal perspective, to ensure the best outcome for both employee and organization.

Recovering Loss of Revenue from “not at fault” Accidents

When your units get hit by a third party and the vehicle is out of service, are you getting Loss of Revenue for the downtime while the unit is being repaired? Whether you answered yes or no to that question, reading this article will be the one of the most lucrative uses of your time this year.

A call comes in and your dispatcher does a perfect job of answering and scheduling the run. The EMT’s jump into the clean, fueled, and well stocked ambulance responding to the call. Then from out of nowhere, a car turns directly into the ambulance’s path rolling through a stop sign. Now what? You have two paramedics stranded on the side of the road who will be spending the next few hours on paperwork and drug testing. In addition, all the drugs and small equipment need to be removed or secured. Hopefully you have another unit to dispatch or your competitor may have already been called.

What happens next is key to getting maximum recovery for your losses caused by the accident.

Key items that help maximize your recovery from accidents:

  1. Educate and equip fleet drivers with the tools necessary to collect key accident information at the scene and relay it. This includes a description of the accident, clear color pictures of the accident scene, the damaged vehicles, and third-party driver’s license and insurance information.
  2. Gather as many witnesses as possible and statements from both drivers.
  3. On board videos are great, but if not, having a smart phone video of the damage and intersection can be very helpful if the liability is in question.
  4. Get an accurate and thorough estimate. Be aware that, for the most part, insurance companies are motivated to pay out the least amount possible to get the claim settled. Their adjusters are typically not trained accurately determine the damage to specialty vehicles or the equipment they may contain. Using a TPA with strong experience with commercial fleets is critical.

We are surprised how many firms don’t realize or understand what they are entitled to recover because of an accident where their driver was not at fault. Essentially, the law supports that the owner is entitled to the use of their “chattel” and compensation pursuant to the same. Here is an interesting titbit. Chattel is originally a Latin and old French term referring to moveable personal property. A good term to throw out at the next risk managers meeting to impress everyone. With that said, what you are entitled to and what shows up in your mailbox are two drastically different things. Insurance companies are motivated to pay the least amount possible and delay that payment as long as possible.

Most people assume that insurance companies make money when they generate more in premiums than they pay out in losses and expenses, but for the most part that’s not true. Most insurers are happy to break even on their underwriting and make their money by investing the premiums and keeping the investment returns.

What am I entitled to from a “not at fault” accident? There are a lot of factors influencing this, but essentially you are entitled to your physical damage, diminution of value, and loss of use/revenue. How much you are entitled to are the subjective negotiations that firms like ours engage in hundreds of times each day. Driver liability, statute of limitations and minimum policy limits vary from state to state. Typically, the state where the accident happens will be the applicable laws and regulations.

If I have a spare unit to take the place of the damaged vehicle, am I still entitled to Loss of Revenue? The short answer is yes, but getting the carrier to ink the check is another matter. There are real costs of having a spare unit which is why the law supports the loss of the use as a recoverable item. Acquisition cost, maintenance, licensing, certification, insurance, and storage are all costs incurred by having a spare unit.

Pursuing Loss Recovery

The following are steps fleets can take to help maximize recovery:

  1. Pursue all possible recoveries. There is often potential recovery from the third-party drivers in the form of an umbrella policy, company policy, or personal assets. Driver liability, statute of limitations and minimum policy limits vary from state to state. The key is to know which accidents offer what potential in which states, and then to pursue recovery using the latest industry tools as quickly as possible.
  2. Follow insurance industry documentation standards. The required forms need to be properly completed and submitted to the third-party driver’s insurance carrier. Knowing insurance industry regulations, standards, and the law are key to move the carriers to action. Technically, a carrier can wait 30 days after receiving a demand before taking action on the claim.
  3. A key component to Loss of Revenue is accurate records showing the income the unit generated prior to the accident. This is the hardest to recover and gets the most pushback from the insurance companies. Putting the data in a format that meets the insurance company’s needs varies by company.
  4. Even after the carrier has agreed to pay, be prepared to make a lot of follow-up calls and emails to get your claim paid. A common tactic used by carriers is to drag out the claim hoping you will either give up or accept less. Essentially wearing you down.

The second key recovery component is Diminution of Value (DV), or Loss of Market Value the vehicle suffers even after it is repaired. Age of the vehicle, miles, condition, and other factors determine this amount. Without a strong recovery plan or Third Party Administrator (TPA), we see significant diminution of value left on the table. The key here is strong data which supports your valuation utilizing use multiple sources and have extensive experience and a successful track record for recovering DV.

Getting accurate value when a vehicle is a total loss. The term “Total Loss” is an insurance term lacking legal definition. Carriers have often used title branding laws to determine if a vehicle is a “Total Loss”. While each state has different criteria for “branding” titles, vehicles can, and have been, paid as total losses with damage percentages well below the title branding statutes. Carriers often tout statements such as “Federal Guidelines” or “State Statutes” when attempting to settle claims. More accurately, legal entitlements are based upon what is called the Restatement of Torts, and defined by case law in each state. Typically, property and casualty insurance adjusters don’t understand these laws and again are motived to pay out the minimum possible. Engaging a firm that specializes in commercial fleet claims can provide an arm’s length transaction necessary to be pro-active on the front side in setting the claim up properly, which usually results in a higher recovery.

So how do you win at the recovery game? Well unfortunately you are in a game where the opponent is highly motivated to not pay or pay the least possible, has their own set of rules on how much you should get, and make most of their profit on dragging out a payment when they finally do decide to pay.

There are essentially three routes you can pursue.

  1. Handle the claims yourself. Unless you have extensive knowledge in the law and insurance industry, plus have ample time to talk to the voicemails of insurance carriers, this option may not be ideal.
  2. Let your insurance company handle the claim. They will pay your Physical Damage, but rarely does the policy have coverage for Loss of Revenue and Diminution of Value.
  3. Hire a TPA (Third Party Administer) to handle the claims for you. Select a firm with a long track record, experience with specialty vehicles, adequate technology, a strong legal department, and specializes in Loss of Revenue recovery. Make sure their fees are performance based and they only win if you do. They can recover Loss of Revenue, Diminution of Value (inherent and repair related) and other costs typically not recovered.

Few fleets have the number of trained personnel in each of these areas to adopt these best practices. If the fleet’s resources are already stretched to capacity, consider outsourcing to a TPA. The chances are the partnership will yield state-of-the-art best practices and more than pay for itself.

I hope you found this article helpful, don’t hesitate to contact me with any questions or to learn more.

Brian J. Ludlow is Executive Vice President for Alternative Claims Management. He is an entrepreneur and consultant to the insurance, financial, and transportation industries. Brian specializes in disruptive technologies. His firm has transformed the accident claims recovery process.

bludlow@AltClaim.com | 231-330-0515

Family Liaisons Following EMS Line of Duty Deaths

I was just a kid when I started in EMS. 23 years old, hungry for adventure, and ready for everything the world of EMS was prepared to give me. Car accidents, gunshot wounds, stabbings, intoxicated shenanigans, elderly falls, fist fights, medical emergencies, strokes, and cardiac arrest were all on my list of expected possibilities. One of the scenarios I had not thought of, and nobody presented to me throughout school and orientation, was the possibility of clocking in for shift and not going home. I do not recall line of duty deaths being a discussion point in the paramedic curriculum, job interview, or orientation process. I had experienced the unexpected loss of a younger sibling due to a motor vehicle crash before I started my journey in EMS, but the fact that life is short and unpredictable did not connect with the fact that I was knowingly and willingly walking myself into unknown and potentially dangerous situations with each response. Even after the UW Med Flight crash happened early in my career, and in my service area, we simply did not talk about our own potential for death as a direct result of our profession.

Years later, after many more line of duty deaths and even more reports of violence against EMS and healthcare workers, this topic weighs heavy on my mind. In my time as Staff Development Manager for a service, I pushed for the DT4EMS courses to train our medics on how to recognize potential dangers, escape those situations, and defend themselves if they are unable to escape.  We all know the ‘scene safe/BSI’ tagline and list of what things might make a scene unsafe is not enough. As the Rescue Task Force (RTF) formed, I watched as some were excited for the opportunity to be involved and others started to question their willingness to respond to so many unknown situations as their young families were beginning to grow. I started asking myself if EMS agencies are doing enough in terms of preparing themselves and their employees for the possibility of a line of duty death.

The Line of Duty Death Handbook, published in part by the AAA, is a great tool to start building policies, protocols and personnel records. The handbook guides you through the importance of having employees fill out emergency contact and next of kin forms, and keeping them updated, as well as assigning family liaisons and how to manage coverage for funeral services. As I reviewed this, I started thinking about the assignment of a family liaison—a member of your agency who knew the individual well and will be the primary contact for everything the family needs once the notification has been made. What type of person should be assigned this role, and what kind of training should they have? I sat down with KC Schuler, MDiv and board member for the Fox Valley Critical Incident Stress Management group to discuss.

What are some considerations services should make when putting together their line of duty death policy/procedure?

I think the first significant consideration should be conducting pre-incident training. I mean, are you starting the conversation about critical incident stress exposure all the way up to, and including, the possibility that they may never go home to their family, at orientation? During onboarding? So many of the EMTs and Paramedics coming in are young, and this may be their first job. In my experience, they can be somewhat blind to the possibilities. Early education and creating a culture of support—including letting them know you have their back (and their family’s back) in every potential scenario is important. The second consideration, I think, is to determine what scope you define as a line of duty death. The on-shift motor vehicle crash or incident resulting in death while on the clock is apparent, but what about suicide? If someone is having significant job-related stress and commits suicide, will that be looked at as a line of duty death, or not? This is something all organizations need to consider before such an event happens.

S: What type of actions would you recommend take place, or are discussed, as part of the orientation process?

KC: This is a great time for employees to fill out the emergency contact and next of kin form—this also provides an opening to discuss the possibility of death and the importance of filling out the form accurately and keeping it up to date. They are the best ones to tell you who you should notify in such a situation; guessing in the event of a death is not ideal. A portion of orientation and annual training should also be spent on mental health, including awareness, recognition of post-traumatic stress symptoms in themselves and their peers, and available support resources. Trained peer support and EAP can be very valuable in the management of work and home related stressors. Again, being intentional to build and sustain an organizational culture of support prior to an unfortunate tragedy like a line of duty death will help all those involved.

S: The Line of Duty Death Handbook talks about assigning a family liaison—a person who becomes the 24/7 primary contact for the family once notification has been made. This person should be available, in person and via phone, and dedicated to the family whether it is household chores such as mowing the lawn and grocery shopping, to communicating with out of town family members and arranging hotels. Who should be considered for such an assignment, and what might the service do to prepare these individuals?

KC: This is a high-intensity assignment, and this role should not be assigned to shifts in the beginning either. Being a family liaison is a big responsibility, and it is not a responsibility that should shift from person to person; ideally, the family will have one liaison for the duration. Trust is a significant factor—the family must trust the individual they are assigned, so that individual must be able to build that trust or recognize early if it is not a good match. Services should consider the following in their selection of a family liaison:

  1. Someone who is specially trained in being a family liaison. The nature of this position is demanding and can significantly interfere with the liaison’s personal life and responsibilities of emotionally supporting another. They need to be able to have clear boundaries, open lines of communication to leadership, and have a stellar support system in place as well. The International Critical Incident Stress Foundation does offer a 2-day LODD course.
  2. Preferably, the family liaison would not have any other roles (such as being an honor guard member) as they will likely have other duties and responsibilities throughout the process and at the funeral itself. The liaison duties need to be 100% dedicated to the family.
  3. Gender sensitivity—If the deceased is a male, you may want to assign a female liaison to the spouse as there can be a lot of strong emotions during this time and unhealthy attachments can form. You should consider gender identity and sexual preference in assigning a liaison as well.

Training and preparation of individuals for family liaison assignment should happen before an event like this ever occurs.

S: If I am a service director looking to send a few people to train for this, what type of people should I look for?

KC: If I had to provide a list of characteristics for liaison selection, it would probably include someone who:

  1. Does not gossip and respects confidentiality.
  2. Can make things happen—someone who is comfortable making, and either has the authority to make decisions on behalf of the service, or has direct contact with someone who can.
  3. Has a great support system of their own.
  4. Understands and respects boundaries—can set limits where appropriate and necessary.
  5. Is comfortable speaking, but also understands and can recognize the importance of silence, or when not to respond.

S: When it comes to families, there are a lot of dynamics a liaison might have to contend with such as divided families or family members that do not get along. If more than one individual is involved in a LODD, such as two members killed in a car accident, there may also be dynamics between those two families that need to be considered. What are your recommendations for addressing those type situations, where either a single family or multiple families may be at odds?

KC: If there is more than one family involved (i.e., two employees) you will want to assign each family a liaison, and those liaisons will need to be in close communication with each other and the organization leadership. One thing agencies may wish to consider is holding family support or family networking events throughout the year, before an event like this happens. I mean, beyond the Christmas parties and summer picnics where all families are invited—events that allow family members of your employees to get together, build relationships, and form a support system between families who understand the dynamic of supporting someone in EMS. If families are meeting for the first time as the result of a fatal accident, the dynamic will likely be much different (and more difficult) than if they are afforded a place to get to know each other and form bonds before such an event would happen. It is a lot easier to blame a stranger than a friend; it is easier to share pain and experience with someone you share a bond.

If there is pre-incident conflict within a family, such as animosity between divorced parents or an ex-spouse, these situations become more difficult to manage. Training will help the liaison better navigate and handle these situations.

S: You mentioned before, the importance of knowing the resources in your area—what would you say to those services who might plan to reach out to their local CISM or hospital for a family liaison or other support in this situation?

KC: As I mentioned before, EAP is a valuable resource but likely not the best as a stand-alone support in the event of LODD, and it certainly would not be able to function as a family liaison. Many hospitals may have pastoral care staff, such as myself; however, many would not have the capacity to operate as a family liaison or the awareness, authority, and connections to make decisions on behalf of your service. So, neither of these options would not be the best plan in my opinion. CISM teams can help in debriefings, but again, that is different than functioning as a family liaison. Some of your staff members that are trained as CISM peer counselors, however, may be excellent candidates for continued training in LODD and more specifically, as family liaisons.

S: You also mentioned how the family liaison should be taken off shift responsibility and assignments while they are functioning as the family liaison. What time frame should a service expect, and could the director or administrative staff function as the liaison to reduce scheduling disruptions?

KC: The time frame will be variable and unique to each situation; this is part of the importance of a service’s selection and training of these individuals. They need to determine when the family needs the high-intensity liaison, when to move to periodic support, and when to transition out to periodic or then eventual annual check-ins. They need to do this without creating a co-dependence.

A director or administrative staff would not be the ideal candidate for the family liaison assignment. The director will be busy dealing with many other operational details and would not be able to devote the time or attention to the family during the high-intensity phase. Ideally, the liaison will be someone the fallen individual knew, worked alongside, and had a good relationship with; someone who can share some stories with the family. The liaison’s ability to do this goes back to the importance of fostering the family/spousal support network as well.

There are many ways in which services can prepare for a line of duty death. Option one is to bury your head in the sand and pretend it will never happen to you. This, we know, is a lie; a lie to ourselves, our employees and their families. Option two is to address the potential with eyes wide open and full support starting in orientation and stretching through the selection of qualified employees for advanced training. Even if I am lucky enough never to experience a LODD personally, I would rather work for an organization adopting option two every time.

“It is a curious thing, the death of a loved one. We all know that our time in this world is limited and that eventually all of us will end up underneath some sheet, never to wake up. And yet it is always a surprise when it happens to someone we know. It is like walking up the stairs to your bedroom in the dark, and thinking there is one more stair than there is. Your foot falls down, through the air, and there is a sickly moment of dark surprise as you try and readjust the way you thought of things.”

― Lemony Snicket, Horseradish

OSHA Updates & Reminders 2018

It is important that employers remember that they must post a copy of their OSHA Form 300A which is a summary of workplace injuries starting February 1, 2018 through April 30, 2018.  The OSHA Form 300A is a summary of all job-related injuries and illnesses that occurred in an employer’s workplace during 2017.  If a company recorded no injuries or illnesses in 2018, the employer must enter “zero” on the total line. The form must be signed and certified by a company executive. The OSHA Form 300A Injury Summary must be displayed in a common area where notices to employees are usually posted.  In addition to posting these reports in the workplace, covered employers will have to electronically report their injury data on the Injury Tracking Application (ITA) by July 1, 2018.

Also, a reminder to employers who are subject to OSHA or to those who operate in a state with an OSHA approved state level plan, the penalty amounts for OSHA violations are increasing effective January 2, 2018.  In accordance with the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015, the Department of Labor is required to adjust penalties for inflation each year. New penalties for willful and repeat violations are $129,336 per violation; serious, other-than-serious, and posting requirements are $12,934 per violation; and failure to correct violations is $12,934 for each day the condition continues.  The new penalty details can be found in the OSHA Enforcement Section of their website.

 

OSHA Electronic Injury Reporting Deadline Is Dec 15

Several months ago, we alerted AAA members that the Occupational Safety and Health Administration (OSHA) had announced that it would further delay the deadline for employers to electronically file injury data until December 1, 2017.  With that deadline quickly approaching, we wanted to make sure that our members were prepared and reporting the data correctly.

OSHA announced in July that it will be launching the new electronic Injury Tracking Application (ITA) on August 1, 2017.  The new rules are an effort to “nudge” employers to improve safety in the workplace by publishing employee injury data, as reported by employers.  Electronic data reporting would give job candidates and employees the ability to compare potential employers and their safety records.  Currently, most employers are required to record injuries that occur in the workplace, but this data is not easily available to candidates or OSHA itself.  It is anticipated that employers can expect greater investigative and enforcement actions after electronic injury reporting begins.

Under the Old & New Rules

Every year, ambulance services with 10 or more employees are required to record all workplace injuries that involve medical treatment beyond first aid, days away from work, restricted/transfer of duties, or loss of consciousness.  There are certain injuries that must be reported immediately to OSHA if they occur, workplace fatalities, hospitalization, loss of an eye, or an amputation.  The injury logs must be compiled and kept for five years.  Each year, employers are required to post a summary (Form 300A) of all workplace injuries in the workplace for from February 1 through April 30.

Currently, OSHA does not collect workplace injury information except through complaints from employees, onsite inspections, mandated reports of specific serious injuries, or through data collection from limited “high hazard” industries.  This new rule, will require that injury data reports be reported electronically to OSHA.  Many ambulance services already report this information electronically to the Bureau of Labor Statistics (BLS), who collects data on behalf of the Department of Labor but the employer specific information is not released publicly.  Under these new rules, employer injury data will be published.

Who Do These Rules Effect?

The electronic reporting requirements are based on the size of employer.  For the purposes of determining employer size, employers must count each individual employed at any time during the calendar year as one employee.  This includes full-time, part-time, seasonal, and temporary workers.  All employers with 250 or more employees in industries covered by the recordkeeping regulation must electronically submit to OSHA injury and illness information from OSHA Forms 300, 300A, and 301.  Employers with 20-249 employees must electronically submit information from OSHA Form 300A only.

Important Reporting Note:

The information that must be reported is determined by “Establishment” size.  Often this is confused by employers as being their entire “Firm”, even if they have multiple locations.  It is important to understand that you should be reporting data by Establishment location.  There are times that an Establishment can include more than one location, if they are close in geographic location as defined by OSHA.

For example, if one ambulance service has a headquarters located in one town and a satellite ambulance station located 20 miles away, those would be two “Establishments” under the OSHA Regulations. The employer would assign each of their employees to a specific “establishment” for the purposes of reporting.

In our industry, employees tend to work in multiple locations. For the purposes of ITA reporting, assign each to one. The employer would then count the number of employees (full time, part time, per diem, seasonal) at each location.  After totaling the employee count at each location, determine if their establishment size requires summary reporting or more detailed reporting.  For this year, only the summary data (Form 300A) needs to be reported for each establishment.

An employer could have a total of 400 employees working for their company but only must report the Form 300A information because those employees are evenly distributed amongst their eight separate “Establishments”.

Phase In

The new rules are being phased in by employer size.  In 2017, all employers, with 20 or more employees must report the information from OSHA Form 300A, which is the summary of all injury data by December 1, 2017.  By July 1, 2018, employers with 250 or more employees, will report all injury data from Forms 300, 300A, and 301 and employers with 20-249 employees will only report the data from the Form 300A.  Starting in 2019, all covered employers will have to report their 2018 injury information electronically by March, 2019.  Thereafter, all employers will report injury data electronically by March of each year.

Data Submission

OSHA has launched the Injury Tracking Application on August 1, 2017.  The electronic data submission process involves four steps:

  1. Creating an establishment (employer account);
  2. Adding 300A summary data;
  3. Submitting data to OSHA; and
  4. Reviewing the confirmation email.

The secure website offers three options for data submission. One option will enable users to manually enter data into a web form. Another option will give users the ability to upload a CSV file to process single or multiple establishments at the same time. A third option will allow users of automated recordkeeping systems to transmit data electronically via an application programming interface (API).

OSHA states that the creation of the account in the electronic Injury Tracking Application (ITA) will only take employers about ten minutes.  After creating an account, OSHA predicts that it will take employers about ten minutes to report the data on Form 300A.  For large employers reporting also required to submit Form 300 and 301 information, OSHA is predicting it will take about 10 minutes per incident.

For those who are already reporting injury information to the Bureau of Labor Statistics (BLS) electronically, you will be required to report the information to OSHA also.  OSHA states that it is working on eliminating the duplicate reporting requirements but that until they do, employers will have to input data to both agencies.

Conclusion

Employers only have until this Friday, December 1, 2017 to submit their first set of injury data from 2016.  If AAA members are uncertain if they are tracking and reporting injury data appropriately or believe that they need assistance with this new requirement, be sure to contact the AAA for assistance, we can assist you with this required reporting.

Time to handle 911 call demands with Paramedics

When discussing this new and growing field of pre-hospital care, there seems to be two unique paths that services are following. The first is the hospital-owned or contracted service, where community providers seek ways to decrease readmission rates for CHF, COPD, Pneumonia, Sepsis, MI and other chronic illnesses.

When a patient discharged with one of these targeted conditions is readmitted within a 30 day window, “hospitals face penalties of up to 3 percent of Medicare payments in 2018” (Gluck, 2017, para. 10). That is a lot of money. Consider, “Lee Health, Southwest Florida’s largest hospital operator, which is expected to lose $3.4 million in payments” (Gluck, 2017, para. 2). This model represents the if, or, and type of service, meaning if we can do it for less and there are providers willing to do this type of medicine, then we can save the expensive penalties from CMC.

The other model of community paramedicine is 911 abuse reduction. For years EMS has conditioned the public to call 911 for any emergency. But today, what we consider an emergency is far from the public’s perception of an emergency. “EMS has experienced a 37% increase in 911 calls since 2008.” (White, 2016, para. 6) Yet have we increased staffing proportionally to meet the demand? Afraid not since “only 50% of EMS services in 2008 were fully staffed, and more than 63% had a volunteer component as part of their staffing level” (“Critical Staffing Shortages,” 2015, para. 2).

The article references increasing wages to help compensate for the decrease in trained providers by attracting more professionals to the field. With the CMC limiting payments and the major insurance companies following suit, doubtful this will be an option in the near future.

To reduce calls and increase levels of service, we can try to reeducate the public to what is a true emergency, but that is a long and slow process. For example, Philadelphia has started the trend and placed several billboards up around neighborhoods that contribute an ordinarily high amount of non-emergent 911 calls. Will this work? Time will tell but I would believe not enough to affect the volume of calls.

What about enlisting Community Paramedics in these situations? I believe this is a viable solution with nurses triaging the low acuity calls in the 911 center. Dispatching Community Paramedics armed with not only the usual equipment, but also the knowledge base to connect these patients with primary care physicians, social workers, and the programs that are available to them. This will help people receive the long-term care they deserve.

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

References
* Critical Staffing Shortages (2015)
* Gluck, F. (2017, February 7th, 2017). Lee Health will lose $3.4 million in Medicare payments because of readmission rates. USA Today
* White, D. (2016, February 16th, 2016). Community paramedic? program intended to reduce 911 calls. Manatee Technical College

Protecting EMS and What That Means

I have been seeing a lot of chatter on social media and reading quite a bit about ambulance services issuing ballistic vests and providers being allowed to arm themselves. Looking at the available data, consider the following:

  • 67% (95% CI = 63.7%–69.5%) of respondents reported that either they or their partner had been cursed at or threatened by a patient;
  • 45% (95% CI = 42.4%–48.3%) had been punched, slapped, or scratched and 41% (95% CI = 37.9%–43.7%) were spat upon;
  • Four percent (95% CI = 2.8%–5.0%) of the respondents reported that they or their partner had even been stabbed or involved in an attempted stabbing; and
  • 4% (95% CI = 2.5%–4.8%) reported being shot or involved in a shooting attempt by a patient.” (Oliver & Levine, 2014, para. 22).

When looking at the survey results, specifically the low percentages of violent activities, it would appear that such protections are not needed. However, I cannot support the notion that a provider feels that where they work this protection is essential to them. I think a closer, more current look with a larger sample will create a better perspective. This study is relatively small and would be better served if the questions were more focused.

When it comes to “arming EMS Providers” I do think we are far from that. To arm EMS Providers would certainly require specific training, educational classes, and buy in from legislators.

Consider what happens if I defend myself. Am I now obligated to treat the person I’ve harmed? Would I, should I, be held to the same standard of trying to deescalate a situation as the police? With the absence of training and ambiguity of the legal system, I do not think arming EMS providers at this point is the answer.

To me, we need better education, better perceptions from the general public, and most of all a unified EMS front at the national level that is tasked with moving our industry toward the 22nd century.

______

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

References

Oliver, A., & Levine, R. (2014). Workplace Violence: A Survey of Nationally Registered Emergency Medical Services Professionals

 

OSHA to Launch Electronic Injury Reporting on August 1, 2017

A few weeks ago, we alerted AAA members that the Occupational Safety and Health Administration (OSHA) had announced that it would further delay the deadline for employers to electronically file injury data.  The new rules, which require electronic injury data reporting were originally to take effect on July 1, 2017.  These rules were delayed until this December 1, 2017.  It was believed the requirements, an Obama administration initiative, might never see the light of day under the new administration.  However, OSHA announced Friday that all employers (ambulance providers) who employ twenty or more employees will be able to begin submitting electronic report injury data starting August 1, 2017.

OSHA announced Friday that it will be launching the new electronic Injury Tracking Application (ITA) on August 1, 2017.  The new rules are an effort to “nudge” employers to improve safety in the workplace by publishing employee injury data, as reported by employers.  Electronic data reporting would give job candidates and employees the ability to compare potential employers and their safety records.  Currently, most employers are required to record injuries that occur in the workplace, but this data is not easily available to candidates or OSHA itself.  It is anticipated that employers can expect greater investigative and enforcement actions after electronic injury reporting begins.

Under the Old & New Rules

Every year, ambulance services with 10 or more employees are required to record all workplace injuries that involve medical treatment beyond first aid, days away from work, restricted/transfer of duties, or loss of consciousness.  There are certain injuries that must be reported immediately to OSHA if they occur, workplace fatalities, hospitalization, loss of an eye, or an amputation.  The injury logs must be compiled and kept for five years.  Each year, employers are required to post a summary (Form 300A) of all workplace injuries in the workplace for from February 1 through April 30.

Currently, OSHA does not collect workplace injury information except through complaints from employees, onsite inspections, mandated reports of specific serious injuries, or through data collection from limited “high hazard” industries.  This new rule, will require that injury data reports be reported electronically to OSHA.  Many ambulance services already report this information electronically to the Bureau of Labor Statistics (BLS), who collects data on behalf of the Department of Labor but the employer specific information is not released publicly.  Under these new rules, employer injury data will be published.

Who Do These Rules Effect?

The electronic reporting requirements are based on the size of employer.  For the purposes of determining employer size, employers must count each individual employed at any time during the calendar year as one employee.  This includes full-time, part-time, seasonal, and temporary workers.  All employers with 250 or more employees in industries covered by the recordkeeping regulation must electronically submit to OSHA injury and illness information from OSHA Forms 300, 300A, and 301.  Employers with 20-249 employees must electronically submit information from OSHA Form 300A only.

Phase In

The new rules are being phased in by employer size.  In 2017, all employers, with 20 or more employees must report the information from OSHA Form 300A, which is the summary of all injury data by December 1, 2017.  By July 1, 2018, employers with 250 or more employees, will report all injury data from Forms 300, 300A, and 301 and employers with 20-249 employees will only report the data from the Form 300A.  Starting in 2019, all covered employers will have to report their 2018 injury information electronically by March, 2019.  Thereafter, all employers will report injury data electronically by March of each year.

Data Submission

The electronic data submission process involves four steps:

  1. Creating an establishment (employer account);
  2. Adding 300A summary data;
  3. Submitting data to OSHA; and
  4. Reviewing the confirmation email.

The secure website offers three options for data submission. One option will enable users to manually enter data into a web form. Another option will give users the ability to upload a CSV file to process single or multiple establishments at the same time. A third option will allow users of automated recordkeeping systems to transmit data electronically via an application programming interface (API).

OSHA states that the creation of the account in the electronic Injury Tracking Application (ITA) will only take employers about ten minutes.  After creating an account, OSHA predicts that it will take employers about ten minutes to report the data on Form 300A.  For large employers reporting also required to submit Form 300 and 301 information, OSHA is predicting it will take about 10 minutes per incident.

For those who are already reporting injury information to the Bureau of Labor Statistics (BLS) electronically, you will be required to report the information to OSHA also.  OSHA states that it is working on eliminating the duplicate reporting requirements but that until they do, employers will have to input data to both agencies.

Conclusion

The new Injury Tracking Application (ITA) does not launch until August 1, 2017. Employers will have until December 1, 2017 to submit their first set of injury data from 2016.  If AAA members are uncertain if they are tracking and reporting injury data appropriately or believe that they need assistance with this new requirement, be sure to contact the AAA for assistance.  Members should look to the Daily Digest or the AAA website for further announcements regarding this or any employment regulatory change that will impact our members.

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