JAMA | COVID-19 Medical Leave for EMS in NYC

From JAMA Network Open

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

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

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Citation

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

Narcissists, Psychopaths, and Masks

From Newsweek on July 22

Two recent studies looked at the relationship between personality traits and reactions to restrictions put in place to slow the spread of the coronavirus COVID-19. Researchers found that people possessing so-called “Dark Triad” traits—narcissism, psychopathy and Machiavellianism—were less likely to comply with restrictions or engage in preventative measures against the pandemic. However, researchers also emphasized the small role personality traits have in the overall response to pandemic restrictions, like face-mask mandates and social-distancing requirements.

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NY | Mohawk Named REMO’s EMS Agency of the Year

From EMS World on July 24

Mohawk Ambulance Service has been announced as the recipient of this year’s regional EMS Agency of the Year Award given by the Regional Emergency Medical Organization (REMO). Additionally, Edward Marchand, a member of Mohawk’s Training Center staff, was named as the recipient of this year’s Educator of Excellence award and Dr. Heidi Cordi, Mohawk’s Medical Director, received the Physician of Excellence Award.

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AJC | New COVID-19 cases push hospitals to capacity

From the Atlanta Journal-Constitution,  featuring AAA Board leader Chuck Kearns.

On a recent day, several ambulances packed the hospital bays outside one hospital’s emergency room, as an unusual number of paramedics waited in the hallway with their patients in cots, ready to drop them off. But there were no beds to receive them, and crews can’t leave until patients are admitted. That can take hours, said  Chuck Kearns, chief of Chatham County EMS, the region’s 911 provider.

“One patient was held for seven hours; it’s unheard of,‘’ Kearns said.

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NY Daily News | Tom Ridge: First Responders Need Us Now

From Tom Ridge’s op-ed in the NY Daily News

By the time the EMTs reached my hotel room in Austin, Tex., I was already unconscious on the floor. Moments earlier I had dragged myself to the phone and called for help as chest pains began to overwhelm me. I later learned those first responders resuscitated me more than once as they used their medical training to keep me alive until we arrived at the hospital. That’s where doctors and nurses and a lot of machines took over. I had suffered a major heart attack. The care I received at that medical center was extraordinary. But not for the immediate care I received from that small team of EMTs, I never would have made it.

That was back in 2017. I’ve since recovered and feel great, often thinking about  those heroic first responders, whom I was lucky enough to meet and personally thank a year later. I especially think of them and their colleagues today as COVID-19 creates huge budget problems for local governments that threaten their jobs and our nation’s ability to respond to this and future crises.

Ridge was governor of Pennsylvania and first U.S. Secretary of Homeland Security. He co-chairs the Bipartisan Commission on Biodefense.

Ambulance Crews and In-Home Care Providers Seek Collaboration

From Home Health Care News

Ambulance Crews and In-Home Care Providers Seek Collaboration—Not Competition

As hospitals continue to experience overcapacity challenges due to the COVID-19 emergency, 911 ambulance crews and community paramedics have found themselves treating more patients at home.

Historically, ambulance crews and community paramedics — both of which operate in the emergency medical services (EMS) space — have always provided some degree of care in the home setting. To do so, they’ve often worked alongside traditional home health and home care agencies, too.

“There’s been a certain amount of care [or treatment] in the home for many years,” Hanan Cohen, paramedic and director of corporate development at Empress EMS, told Home Health Care News. “On the 911 system, it’s not at all uncommon for an EMS crew to respond to a multitude of emergencies. After assessing and, sometimes, treating the person, … they may decide not to go to the hospital.”

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ESO Announces Peer-Reviewed COVID-19 EMS Research

From Yahoo Finance via Cision

ESO Announces Peer-Reviewed Research Describing Characteristics of COVID-19 EMS Encounters with Linked Hospital Diagnoses

Key Findings from the Report Include:

  • COVID-19 Diagnoses and Ailments: Those with COVID-19 hospital diagnoses were more likely to present with elevated heart and respiratory rate, hypoxia and fever during the EMS encounter.
  • COVID-19 Suspicion: A COVID-19 EMS suspicion was documented for 78 percent of hospital-diagnosed COVID-19 patients.
  • Patient Origin: EMS responses for patients with COVID-19 were more likely to originate from a skilled nursing or assisted living facility.
  • PPE Usage: PPE usage by EMS was more frequently documented on records of patients who had hospital diagnosed COVID-19.
  • Dispatch Complaints: While dispatch complaints for hospital-confirmed COVID-19 patients most commonly included general illness and breathing difficulties, there were also cases dispatched as falls, chest pain, and strokes.
  • Demographic Insights: Consistent with reported in-hospital findings, African American and Hispanic patients made up a disproportionately larger number of COVID-19 diagnoses.

In Memory of Jack Stout

Updated July 20 to include a link to  Jack Stout’s obituary.

It is with heavy hearts that the American Ambulance Association shares news of the peaceful passing of EMS legend Jack Stout. Our thoughts are with the Stout family as well as Jack’s many friends and mobile healthcare colleagues. Thank you, Jack, for your leadership and vision which live on in your son, Todd, as well as in the life-saving actions of EMS professionals around the world. Rest in peace.

Read Jack Stout’s obituary in the Falls City Journal.

AJC | Ambulance companies hit hard by COVID costs

From the Atlanta Journal Constitution by Yamil Berard on  July 17, 2020

“We are gravely concerned that various factors related to this pandemic are pushing ambulance services to the breaking point,‘’ Georgia ambulance executive Pete Quinones wrote to a top official at the Georgia Department of Community Health.

One request by the Georgia Ambulance Providers Association has been to urge the Georgia Trauma Commission to release up to $29 million in block grants to support EMS staffing over the next six months.

“Without that, we don’t have the financial ability to keep a state of readiness,‘’ said Terence Ramotar, director of government affairs for the southeast region for American Medical Response, the exclusive 911 ambulance provider for DeKalb County.

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California’s 50 years of prehospital medicine

From EMS1 on July 14 by AAA Communications Chair Rob Lawrence

The history of our history: 50 years of prehospital medicine: A transatlantic tale of former army doctors, paramedic development, cardiac arrest survival, and Johnny and Roy

Fifty years ago, on July 15, 1970, then California Governor Ronald Reagan signed into law the Wedworth-Townsend Paramedic Act. The law created the conditions for the establishment of the first accredited paramedic training program in the United States.

The story of American paramedicine did not begin in California or even in the U.S., but in Belfast, Northern Ireland. The inspiration for this program came from World War II era British Royal Army Medical Corps (RAMC) Medical Officer, Professor Frank Pantridge, MD.

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CNN | Louisville mayor to be investigated for handling of protesters and EMT Breonna Taylor’s case

From CNN ‘s  “Louisville mayor to be investigated for handling of protesters and Breonna Taylor’s case” on July 16

The Government Oversight and Audit Committee (GOA) of the Louisville Metro Council filed an order Monday to officially launch an investigation “into the action and inaction of the Fischer Administration,” according to a press release from the city.
Though it has not happened yet and there is no timeline to finish the investigation, the GOA plans to subpoena former Louisville Metro Police Department Chief Steve Conrad and current Chief Robert Schroeder as part of their investigation, according to the release.
CNN has reached out to the mayor’s office for comment.
Taylor, a 26-year-old EMT, was shot eight times after police broke down the door to her apartment while executing a nighttime warrant in a narcotics investigation on March 13.

CMS Announces Resumption of Program Integrity Functions

On July 7, 2020, CMS updated its Coronavirus Disease 2019 (COVID-19) Provider Burden Relief Frequently Asked Questions (FAQs).  As part of this update, CMS indicated that it would resume several program integrity functions, starting on August 3, 2020.  This includes pre-payment and post-payment medical reviews by its Medicare Administrative Contractors (MACs), the Supplemental Medical Review Contractor (SMRC), and the Recovery Audit Contractors (RACs).  This also includes the resumption of the Prior Authorization Model for scheduled, repetitive non-emergency ambulance transports.  These programs had been suspended by CMS in March in response to the COVID-19 pandemic.

Resumption of Medicare Fee-For-Service Medical Reviews

 CMS suspended most Medicare FFS medical reviews on March 30, 2020.  This included pre-payment medical reviews conducted by its MACs under the Targeted Probe and Educate program, as well as post-payment reviews by its MACs, the SMRC, and the RACs.  CMS indicated that, given the importance of medical review activities to CMS’ program integrity efforts, it expects to discontinue its “enforcement discretion” beginning on August 3, 2020.

CMS indicated that providers selected for review should discuss any COVID-related hardships that might affect the provider’s ability to respond to the audit in a timely fashion with their contractor.

CMS further indicated that its contractors will be required to consider any waivers and flexibilities in place at the time of the dates of service of claims selected for future review.

Resumption of Prior Authorization Model

 Under the Repetitive, Scheduled, Non-Emergent Ambulance Transport Prior Authorization Model, ground ambulance providers in affected states are required to seek and obtain prior authorization for the transportation of repetitive patients beyond the third round-trip in a 30-day period.  The Prior Authorization Model is currently in place in Delaware, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia, West Virginia, and the District of Columbia.

On March 29, 2020, CMS suspended certain claims processing requirements under the Prior Authorization Model.  During this “pause,” claims for repetitive, scheduled, non-emergency transports were not be stopped for pre-payment review to the extent prior authorization had not been requested prior to the fourth round trip in a 30-day period.  However, CMS continued to permit ambulance providers to submit prior authorization requests to their MACs.

CMS indicated that full model operations and pre-payment review would resume for repetitive, scheduled non-emergent ambulance transportation submitted in the model states on or after August 3, 2020.  CMS stated that the MACs will be required to conduct postpayment review on claims that were subject to the model, and which were submitted and paid during the pause.  CMS further indicated that it would work with the affected providers to develop a schedule for postpayment reviews that does not significantly increase the burden on providers.

CMS stated that claims that received a provision affirmation prior authorization review decision, and which were submitted with an affirmed Unique Tracking Number (UTN) will continue to be excluded from most future medical review.

NEMSIS Update to COVID-19 Trends

This document is provided by NHTSA in an effort to help State EMS Officials track particular EMS activations occurring during the COVID 19 pandemic. This document will be updated periodically to provide current information regarding temporal variations in the type and characteristics of EMS activations occurring in the U.S. during the COVID 19 outbreak.

Please contact the NEMSIS Technical Assistance Center for updates to this document. Contact N. Clay Mann at clay.mann@hsc.utah.edu.

Download Update

AAA’s Terence Ramotar on Morning Joe

Terence Ramotar, President of the Florida Ambulance Association and AAA Board member, discusses how the coronavirus crisis in Florida is impacting ambulance services on MSNBC’s Morning Joe!

This morning, AAA Alternate Director and Florida Ambulance Association President Terence Ramotar made a compelling case…

Posted by American Ambulance Association on Thursday, July 16, 2020

Updated CDC Guidance for EMS

On July 15, 2020 the Centers for Disease Control issued an updated guidance for EMS personnel in response to the ongoing Public Health Emergency.

Summary of Key Changes for the EMS Guidance:

  • Reorganized recommendations into 2 sections:
    • Recommended infection prevention and control (IPC) practices for routine activities during the pandemic.
    • Recommended IPC practices when caring for a patient with suspected or confirmed SARS-CoV-2 infection.
  • Added recommendations that were included in healthcare IPC FAQs addressing:
    • Universal use of PPE for healthcare personnel working in communities with moderate to sustained transmission of SARS-CoV-2, the virus that causes COVID-19
    • Creating a process for responding to SARS-CoV-2 exposures among healthcare personnel and others.

Read the Full Guidance

2020 Ambulance Ride-Along Toolkit

AAA ambulance emt member legislation

2020 Ride-Along Toolkit Now Available!

Educating your members of Congress about ambulance industry issues makes them more likely to support our policy efforts. An easy and effective way to educate them is to invite them to participate in a local Ambulance Ride-Along!

Congress is adjourned this week and will then again starting on August 7 for an entire month with members of Congress returning home to their districts and states. This is the perfect opportunity for you to educate your members of Congress about our issues, in particular the need for additional COVID-19 financial relief, reimbursement for Treatment in Place during the pandemic, access to FEMA Public Assistance grants and coverage for all paramedics and EMTs under the Public Safety Officers Benefit (PSOB) program.

The most effective way to deliver these key messages is to host your member of Congress or their staff on a tour of your operation and an ambulance ride-along. While COVID-19 has made a traditional ride-along difficult, you can still host them for a virtual site visit to show your operation and how you are handling the public health emergency. The AAA has made the process of arranging a ride-long or scheduling a meeting easy for you with our 2020 Congressional Ride-Along Toolkit.

Everything you need to arrange the ride-along or schedule a meeting during this time of social distancing and virtual participation is included in the Toolkit. Act now and invite your elected officials to join you on an Ambulance Ride-Along!

IRS Guidance on Taxation of HHS Provider Relief Funds

On July 7, 2020, the Internal Revenue Service published a series of Frequently Asked Questions that address the taxation of payments to health care providers under the HHS Provider Relief Fund.

As part of the Coronavirus Aid, Relief and Economic Security Act (CARES Act), Congress appropriated $100 billion to reimburse eligible health care providers for health care-related expenses and/or lost revenue attributable to the COVID-19 pandemic.  The Paycheck Protection Program and Health Care Enhancement Act appropriated an additional $75 billion to the Provider Relief Fund.

The first FAQ addressed the issue of taxation for for-profit health care providers.  Specifically, the IRS was asked whether a for-profit health care provider is required to include HHS Provider Relief Fund payments in its calculation of “gross income” under Section 61 of the Internal Revenue Code (Code), or whether such payments were excluded from gross income as “qualified disaster relief payments” under Section 139 of the Code.

The IRS indicated that payment from the Provider Relief Fund do not qualify as qualified disaster relief payments under Section 139 of the Code.  As a result, these payments are includible in the gross income of the entity.  The IRS further indicated that this holds true even for businesses organized as sole proprietorships.

The second FAQ addressed the issue of taxation for tax-exempt organizations.  The IRS indicated that health care providers that are exempt from federal income taxation under Section 501(a) would normally not be subject to tax on payments from the Provider Relief Fund.  Notwithstanding this general rule, the IRS indicated that the payment may be subject to tax under Section 511 of the Code to the extent the payment is used to reimburse the provider for expenses or lost revenue attributable to an unrelated trade or business as defined in Section 513 of the Code.

The IRS FAQ can be viewed in its entirety by clicking here.  Members are advised to discuss the issue of potential taxation of any relief funding they received with their tax professionals.

CNN | COVID-19 Data Will Be Sent to Trump Administration, Not CDC

From CNN’s “Coronavirus hospital data will now be sent to Trump administration instead of CDC” on July 15.

Hospital data on coronavirus patients will now be rerouted to the Trump administration instead of first being sent to the US Centers for Disease Control and Prevention, the Department of Health and Human Services confirmed to CNN on Tuesday.

The move could make data less transparent to the public at a time when the administration is downplaying the spread of the pandemic, and threatens to undermine public confidence that medical data is being presented free of political interference.

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For-profit providers have to pay taxes on COVID-19 relief grants

From Modern Healthcare on July 13, 2020

The IRS clarified that for-profit healthcare providers will have to pay taxes on the grants they received from the COVID-19 Provider Relief Fund.

The two laws that set aside $175 billion in grants to help providers cover lost revenue and coronavirus-related expenses didn’t explicitly state that the funds would be taxable. However, the IRS issued guidance stating that the grants are taxable income days before a tax filing deadline on July 15. The change means that grants to for-profit healthcare providers including hospitals and independent physician practices will be subject to the 21% corporate tax rate.

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