EMS Narratives | Friday Night [Under The] Lights

EMS Narratives Columns

Below is the first in a series of monthly personal narratives from EMS leaders. If you would like to submit a column for consideration, please email hello@ambulance.org.

Written Friday, November 25, 2022 | By Ed Racht, MD

Happy Friday, and happy Thanksgiving weekend. I hope by now your blood sugar is slowly but surely heading back to baseline despite all the leftovers calling you from the fridge. Worth it though, right? My dad taught me long ago, “everything in moderation—even moderation.”

So, I want to tell you something tonight, especially because it is the Thanksgiving season. I’ve been thinking for a while about how to say this without sounding cliché, routine, robotic, or insincere. And then—as so often happens in life—I got a little help from a very unlikely encounter.

This past Saturday, my bestie, Heather, and I went to try a local diner for breakfast. This place has been around since air was invented. Cash only. Same tables and seats since the day they opened. Part Formica, part particle board countertops. None of the coffee cups match. Open only until 2:00PM and always closed on Sundays. The ham & cheese omelet is $7.99. Biscuits, bread, or hashbrowns only. Everyone that comes in knows everyone else. And it is packed all the time.

We chose a booth in the corner by the window because our server told us that was the warmest table she had available. She was right.

As we sat drinking our coffee in mismatched mugs, we both noticed an elderly man sitting by himself at the end of the counter. He had placed his walker against the ATM along the wall (cash only, remember?).

Then he slowly got up from his stool, grabbed that walker, and carefully wobbled his way to the restroom. It was one of those moments where we both watched and quietly prepared to jump up to help prevent what seemed like an inevitable fall. We didn’t want to offend him with an offer to help but didn’t want him taking a trip to ground either.

We looked across the table at each other and did that mutual raised eyebrow thingy. Ugh. “Warmest booth we have,” she said. Great.

A few minutes later, he slowly made his way back to his spot. But he went a few feet too far this time with the walker, making a beeline directly toward the warmest booth in the diner. He stopped for a minute (what the heck?) grabbed the handwritten check off our table and turned around, without saying a word, and made his way back to his seat. His walker made those sequential two inch turns.

Great. How do you tell an older man he has OUR check (and why did we come here again)?

“Excuse me?” We both said, eyebrows up again.

He turned to us and said, “I’ve got it.”

Wait. What?

He said, “I come up here every day for breakfast when they’re open. Twice a month, I like to buy somebody else’s breakfast. I’ve got it.”

Wow. We sat in stunned silence as this gentleman made his way back to the counter and sat down on his stool.

To make a long story short, we thanked him and struck up a small conversation with him. A few minutes in, he asked, “can I get closer?”

Of course.

So once again we went through the diner-walker challenge and he made his way over to the warmest booth in the restaurant and sat with us for the next hour. We talked about all sorts of things. His wife had been a nurse (mental health was her specialty). He told us about where they had lived and their adventures. He talked a little about his opinions of healthcare today (you can fill in those blanks).

At one point, he told me he lived in Texas and he’d always travel into Mexico to get his medications because they were so much cheaper than in the US. I asked him if he was nervous about going.

He laughed, and said, “I always went in the morning. Bad guys don’t get up early.”

Now, I’ve been in EMS for a few years and you know what? He’s right. Holy crud. Funny and spot-on relevant.

So, why am I telling you about Gary (his real name, by the way)? First, I need to cover a few more things to pull the meaning of this story together. Bear with me.

Fair warning. This next part doesn’t feel Thanksgivingy, but I’m going to argue that it’s at the very heart of a meaningful “thanks.”

Take a look at some of the toughest parts of our world right now:

  • How can we ever understand recent senseless acts of violence—and how will we ever comfort our own who responded?
  • What do we do about the fact that a recent survey shows that nine in 10 nurses believe the quality of patient care often suffers due to nursing shortages?
  • And, by the way, the majority added that they feel guilty about taking a break because they think they must always be on call (55%).
  • … resulting in half of the nurses polled admitting they have considered leaving the nursing profession altogether (50%).
  • And how about this one? According to a AAA survey of 258 EMS organizations across the country, nearly a third of the workforce left their ambulance company after less than a year. Eleven percent left within the first three months!
  • Did you know that the number of serious patient safety incidents reported to The Joint Commission jumped in 2021, reaching the highest annual level seen since the accrediting body started tracking them in 2005?
  • And … In Minnesota, nearly 60% of the state’s EMTs and about 15% of Paramedics did not provide patient care in 2021. This suggests that they left the EMS workforce altogether.

I’ll stop there, because I think you get the gist. How (and why) do I go from a Gary story to this?

This is, without a doubt, the most challenging period of EMS and healthcare history that we have faced together. Ever.

It’s really, really hard right now. And it’s hard in a different way than we’ve ever faced. Clinically hard. Operationally hard. Financially hard. Culturally hard.

Which also means that it’s personally hard. Whether you are directly providing care to a patient or supporting all the complexities that make that interaction possible and effective, it’s hard on us. The facts above reflect exactly that.

Now, I’ve been in EMS for a year or two (insert big-eye emoji), and one of the most rewarding feelings on the planet is creating order out of someone else’s chaos. I honestly believe that people like you choose this profession and support this profession in large part to make other people’s lives better.

Our mission is among the purest and most important on the face of the earth. Just think about how many people enjoyed a Thanksgiving with the people they loved because someone years before fixed their distorted anatomy or disrupted physiology.

It’s easy to forget the massive good a profession, an organization, or an individual can do. Gary gave us a little gift. When I first saw him, I was certain we would end up having to help him. But instead, he helped us.

When we work hard to take care of our patients, our communities, each other, our organization and our profession—They. Take. Care. Of. Us.

So. When our workplace is supportive, people want to join us. When our partners are fun, we seek them out. When our medicine is strong and sound, the medical profession embraces us. When our operation is accountable, we grow, evolve, and thrive when the art and science changes. When we come together as a team, we become the model of effective care. And when all that happens, WE, as individuals, can help tackle all the tough stuff in the most effective way possible.

I’d love to have more people choose EMS as a profession. I’d love to see them seek out advancement and growth. I’d love to see the science evolve to support better outcomes in unplanned illness and injury. I’d love to see hospital metrics and EMS metrics get better, not languish. I’d love to help communities become safer. And I would absolutely love for every one of us individually to be a part of that. I promise. That’s the way we make things so much better.

So tonight, on this day after Thanksgiving, I want to tell you that I’m not just thankful for what you do, I’m also extremely grateful. My daughter taught me there’s a difference. The definition of thankful is “pleased and relieved.” The definition of grateful is “feeling or showing an appreciation of kindness and gratitude.” In that spirit, I wanted to share that I’m grateful for you and I’m grateful for EMS.

We need the best in one another right now. There are four legs in our Bench of EMS Strength:

  • Taking care of ourselves
  • Taking care of our partners
  • Taking care of our patients
  • Taking care of our organizations

There is plenty of hard stuff ahead, so let’s do this. We can sit in the warmest booth in the place. I’m so grateful for that.

So, that’s it from my World. Happy Friday, and happy Thanksgiving.

Ed

Savvik |Ford Vehicles – 3 Day Order Window

The Ford order bank for Super Duty (F250-F600) will open for government orders on 11/7/2022 and will close on 11/10/2022.
This will be the only opportunity to order Super Duty for the entire 2023 model year using a Government Price Concession.
Our vendor understands that it will be challenging for some government customers to project there needs for the entire year, but unfortunately these are the parameters that Ford has set out for them.
Members that are interested in making a purchase during this window will have 30 days to send a purchase order after placing the order. If no PO is received then Ford will automatically cancel the order.
If the Savvik member happens to have a non-government Fleet Id Number (FIN), they can begin ordering 10/20/2022 and will have the ability to order up to 5 units per quarter.

Savvik Buying Group announces partnership with American Nitrile

Savvik Buying Group
Mickey Schulte
713-504-7737
mschulte@savvik.org

FOR IMMEDIATE RELEASE

October 5, 2022 – Savvik Buying Group announces partnership with American Nitrile

St. Cloud, Minnesota – Savvik Buying Group is proud to announce a national distributor partnership with American Nitrile for domestically made nitrile gloves.  A focus of Savvik in 2022 is to find domestic sources of supply to avoid disruptions going forward with the supply chain.  “As Savvik celebrates our 25th year serving our members, we are excited to partner with American Nitrile.  Having domestic production with a top-of-the-line glove will position Savvik members to avoid supply chain disruptions on a vital product.” said Executive Director Mickey Schulte.

American Nitrile will be manufacturing at its new 530,000 sq ft. manufacturing plant in Grove City, Ohio beginning this fall.  American Nitrile’s production facility will leverage best-in-class manufacturing processes and automation to reduce the impact of higher labor costs and displace volume sourced from Asia, while creating hundreds of new jobs for workers in Ohio. The facility includes a state-of-the-art water treatment and reclamation system that recycles 50% of the wastewater generated by the manufacturing process. This, coupled with the elimination of emissions from transpacific shipping, results in a substantially reduced carbon footprint for nitrile gloves manufactured by American Nitrile when compared to their Asian competitors. “We believe that American manufacturing deserves a comeback,” said Jacob Block, founder, and CEO of American Nitrile.

Please visit Savvik and American Nitrile at EMS World, booth 1002.

About Savvik

Savvik serves over 15,000 public safety services in the United States with a variety of product and public bids.  Formed in 1997, our membership includes EMS, Fire, Law Enforcement, Hospitals, Education, and related agencies.  For more information visit www.savvik.com

About American Nitrile

American Nitrile is a Columbus, Ohio based privately held company focused on manufacturing medical and non-medical for healthcare, government, and industrial use. The company will manufacture approximately 3.6 billion nitrile gloves per year when fully operational. For more information, visit www.AmericanNitrile.com.

Save on MME! Savvik Vendor Spotlight

Who is MME?

 

Master Medical Equipment specializes in sales and service of defibrillators, ventilators, infusion pumps and accessories for EMS and fire. They have the vision to be the industry leader in recertified medical equipment; to earn their customers through quality, value, service, and respect. 

The Industry’s Best:
That’s the MME Promise.
The MME Promise ensures you get quality medical devices with the guarantee of lower prices and fewer headaches. It means you don’t have to sacrifice your entire budget to secure quality equipment. It means you don’t need to worry about the reliability and functionality of their products. It means you can bypass the hustle and cost from other companies and what it ultimately means is a better experience, which leads to a happier you.

MME thoroughly tests each unit to ensure it meets the MME Five-Point Inspection Guarantee, passes all manufacturer guidelines, and satisfies FDA safety certifications before they ship to you. This is the MME Seal of Approval, and all equipment is backed by the MME name and reputation.

Having been in the business for over 15 years, MME has a reputation for excellent, professional medical equipment at an affordable price. MME staffs only the brightest military-trained and certified biomedical technicians to restore premium equipment to like-new condition and offer that equipment WORLDWIDE for almost half the price.

Savvik | Summer of Gloves

It’s the first day of summer!

The perfect time to remind our members that we don’t need a sale, coupon code, or promotion to have the lowest prices on gloves in the industry.

Our partners at Henry Schein have dozens of glove options to help you find the gloves that fit your organization for the lowest price.

Congratulations to our Winners!

Flush Syringes

Still available in the Savvik Store!

Savvik Member Discounts Available through our publicly bid contract with TKK Electronics!Are you planning to purchase new rugged mobile computers, tablets, vehicle docks, or networking and security solutions?

TKK Electronics is part of the Savvik network and offers exclusive discounts on the latest technologies for EMS, fire, law enforcement, and both state and local government agencies.

We’re also teaming up with our technology partners at Zebra to offer additional Savvik member discounts on some of the latest Zebra solutions. These include trade-in rebates of $100 per device when you trade in your qualifying hardware and upgrade to Zebra’s groundbreaking L10 Series rugged tablets.

Here’s a quick rundown of the Savvik member benefits we provide:

  • No minimum order requirement
  • National bid pricing
  • 24/7 online ordering
  • Dedicated, experienced support

Is your organization ready for Cost Collection? We can help!

Together with the American Ambulance association, we’re offering FREE Amber software to agencies that need it.

EMS.Gov | Know the Signs of Monkeypox

EMS News

Recognize Monkeypox
In Prehospital Settings

EMS and healthcare clinicians should know the signs of Monkeypox

The National Emerging Special Pathogens Training and Education Center (NETEC) is providing updates about the recently evolving situation regarding the spread of Monkeypox, a rare but potentially serious viral disease. Monkeypox has emerged in countries in which it is not normally found, including the United States. To ensure early detection and isolation of the infected, EMS/prehospital and hospital clinicians should be on alert for signs of the disease.

Monkeypox can spread between humans via contact with skin lesions and infected respiratory droplets. It is important to recognize and report cases of the disease to the local public health department for surveillance purposes.

Visit the link above or review these EMS strategies for preventing the spread of monkeypox:

If you suspect a case of Monkeypox, contact your state health department for possible initiation of special pathogen transport protocols.

More Information

Sign up to receive the latest news from the Office of EMS, including webinars, newsletters and industry updates.

Contact Us

1200 New Jersey Avenue, SE
Washington, DC 20590
nhtsa.ems@dot.gov

Infection Prevention and Control for the EMS/911 Workforce: Public Comment Requested

Draft Report on Infection Prevention and Control for the EMS/911 Workforce Released: Public Comment Requested
From EMS.gov on April 12, 2022

The draft report for the technical brief on Infection Prevention and Control for the Emergency Medical Services (EMS)/911 workforce has been released by the Evidence-based Practice Center (EPC) Program at the Agency for Healthcare Research and Quality (AHRQ). The draft report is available for review and feedback through April 22, 2022 on Effective Healthcare’s website.

The technical brief summarizes the latest evidence on infectious pathogen exposure among the EMS/911 workforce and offers recommendations for the prevention, recognition, and control of infectious diseases and other related exposures that may be acquired in occupational settings.

The AHRQ is requesting feedback from the community to improve the final technical brief. The agency values feedback and will consider all comments received.

Submit Input

AHRQ is a government agency that produces evidence-based guidance to improve the quality of healthcare delivery. It coordinates these efforts with partners in the field to ensure the evidence is understood and put into practice. For more information on the EPC Program, visit here. This project is supported by NHTSA’s Office of EMS, which strives to reduce death and disability by providing leadership and coordination to the EMS community in assessing, planning, developing, and promoting comprehensive, evidence-based emergency medical services and 911 systems.

Ukraine Relief | OSF Healthcare System

OSF Healthcare System of Peoria, Illinois, is working to organize donations of medical supplies and retired ambulances for Ukraine. Most recently, they were able to send 350 pallets of cargo in addition to an ambulance to assist.

If your organization would like to participate, please reach out to Christopher Manson, Vice President of Government Relations, at Christopher.M.Manson@osfhealthcare.org.

Our thoughts are with all those impacted by this tragic conflict.

 

CAAS | GVS V3.0 Draft for Public Comment #2

CAAS_Logo_Final_for_Avectra_200by200.jpg
Driven to a Higher Standard
CAAS Releases GVS V3.0 Draft for Public Comment #2
CAAS GVS Announcement
GVS-LOGO-V3-1BD-FINAL-200by2200px(1)_2106244.jpg

The Commission on Accreditation of Ambulance Services (CAAS) formed a Ground Vehicle Standard Revision Committee to develop V3.0 of the GVS document.  Based on industry collaboration, this Committee has developed a list of proposed changes to V2.0.

Based on the feedback received during Public Comment Period #1, CAAS has now opened Public Comment Period #2, which starts April 1, 2022 and concludes May 31, 2022. In accordance with ANSI protocol, only items that have been changed through the Public Comment #1 period are open for additional comment and review during this second period. Those items are highlighted in yellow on the attached proposal document. Comments on other provisions are not accepted during this process. Interested parties who care to comment on the changes should complete the online feedback form and submit their input during this public comment period. The GVS Committee will review all submissions received during the Public Comment Period #2 and will consider each of the comments received. The CAAS GVS V3.0 document has a scheduled effective date of July 1, 2022.

If you have any questions, please contact Mark Van Arnam, Administrator, CAAS GVS.

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Facebook Twitter Linkedin Other

Commission on Accreditation of Ambulance Services (CAAS)

1926 Waukegan Road Phone: (847) 657-6828
Suite 300 Fax: (847) 657-6825
Glenview, Illinois E-mail: CAAS Staff
60025-1770 Website: www.caas.org

Ukraine Relief | OSF Healthcare System

OSF Healthcare System of Peoria, Illinois, is working to organize donations of medical supplies and retired ambulances for Ukraine. Most recently, they were able to send 350 pallets of cargo in addition to an ambulance to assist.

If your organization would like to participate, please reach out to Christopher Manson, Vice President of Government Relations, at Christopher.M.Manson@osfhealthcare.org.

Our thoughts are with all those impacted by this tragic conflict.

 

NASEMSO | Model EMS Clinical Guidelines v3

From NASEMSO on March 23, 2022

The NASEMSO Model EMS Clinical Guidelines project team is delighted to unveil Version 3 of the National Model EMS Clinical Guidelines. In completing Version 3, the project team has reviewed and updated all existing guidelines, as well as added four new guidelines. Version 3 of the Guidelines, similar to the original version released in 2014, was completed by a team of EMS and specialty physicians comprised of members of the NASEMSO Medical Directors Council and representatives from six EMS medical director stakeholder organizations. In addition, all guidelines were reviewed by a team of pediatric emergency medicine physicians, pharmacologists and other technical reviewers.

Overview

The National Model EMS Clinical Guidelines Project was first initiated by NASEMSO in 2012 and has produced three versions of model clinical guidelines for EMS: the first in 2014, a revision 2017, and now this third version in 2022. The guidelines were created as a resource to be used or adapted for use on a state, regional or local level to enhance prehospital patient care and can be viewed here. These model protocols are offered to any EMS entity that wishes to use them, in full or in part. The model guidelines project has been led by the NASEMSO Medical Directors Council in collaboration with six national EMS physician organizations, including: American College of Emergency Physicians (ACEP), National Association of EMS Physicians (NAEMSP), American Academy of Emergency Medicine (AAEM), American Academy of Pediatrics, Committee on Pediatric Emergency Medicine (AAP-COPEM), American College of Surgeons, Committee on Trauma (ACS-COT) and Air Medical Physician Association (AMPA). Co-Principal Investigators, Dr. Carol Cunningham and Dr. Richard Kamin, led the development of all three versions. Countless hours of review and edits are contributed by subject matter experts and EMS stakeholders who responded with comments and recommendations during the public comment period.

NASEMSO gratefully acknowledges the Technical Expert Panel, the Technical Reviewers, and many others who volunteered their time and talents to ensure the success of this project.

The comprehensive review and revision of these guidelines was made possible by funding support from the National Highway Traffic Safety Administration Office of EMS and the Health Resources and Services Administration Maternal and Child Health Bureau EMS for Children Program.

For More Information

Andy Gienapp, MS, NRP
Deputy Executive Director
andy@nasemso.org

HHS OIG Report on Telehealth for Medicare Beneficiaries in COVID-19

From HHS Office of Inspector General on March 15, 2022

Telehealth Was Critical for Providing Services to Medicare Beneficiaries During the First Year of the COVID-19 Pandemic

WHY WE DID THIS STUDY

The COVID-19 pandemic created unprecedented challenges for how Medicare beneficiaries accessed health care. In response, the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) took a number of actions to temporarily expand access to telehealth for Medicare beneficiaries. CMS allowed beneficiaries to use telehealth for a wide range of services; it also allowed beneficiaries to use telehealth in different locations, including in urban areas and from the beneficiary’s home.

This data brief provides insight into the use of telehealth in both Medicare fee-for-service and Medicare Advantage during the first year of the COVID-19 pandemic, from March 2020 through February 2021. It is a companion to a report that examines the characteristics of beneficiaries who used telehealth during the pandemic. Another report in this series identifies program integrity concerns related to telehealth during the pandemic. Understanding the use of telehealth during the first year of the pandemic can shed light on how the temporary expansion of telehealth affected where and how beneficiaries accessed their health care. This information can help CMS, Congress, and other stakeholders make decisions about how telehealth can be best used to meet the needs of beneficiaries in the future.

HOW WE DID THIS STUDY

We based this analysis on Medicare fee-for-service claims data and Medicare Advantage encounter data from March 1, 2020, to February 28, 2021, and from the prior year, March 1, 2019, to February 29, 2020. We used these data to determine the total number of services used via telehealth and in-person, as well as the types of services used. We also compared the number of services used via telehealth and in-person during the first year of the pandemic to those used in the prior year.

WHAT WE FOUND

Over 28 million Medicare beneficiaries used telehealth during the first year of the pandemic. This was more than 2 in 5 Medicare beneficiaries. In total, beneficiaries used 88 times more telehealth services during the first year of the pandemic than they used in the prior year. Beneficiaries’ use of telehealth peaked in April 2020 and remained high through early 2021. Overall, beneficiaries used telehealth to receive 12 percent of their services during the first year of the pandemic. Beneficiaries most commonly used telehealth for office visits, which accounted for just under half of all telehealth services used during the first year of the pandemic. However, beneficiaries’ use of telehealth for behavioral health services stands out. Beneficiaries used telehealth for a larger share of their behavioral health services compared to their use of telehealth for other services. Specifically, beneficiaries used telehealth for 43 percent of behavioral health services, whereas they used telehealth for 13 percent of office visits.

WHAT WE CONCLUDE

Telehealth was critical for providing services to Medicare beneficiaries during the first year of the pandemic. Beneficiaries’ use of telehealth during the pandemic also demonstrates the long-term potential of telehealth to increase access to health care for beneficiaries. Further, it shows that beneficiaries particularly benefited from the ability to use telehealth for certain services, such as behavioral health services. These findings are important for CMS, Congress, and other stakeholders to take into account as they consider making changes to telehealth in Medicare. For example, CMS could use these findings to inform changes to the services that are allowed via telehealth on a permanent basis.

 

Lights & Siren Vehicle Operations on Emergency Medical Services (EMS) Responses

Joint Statement on Lights & Siren Vehicle Operations on Emergency Medical Services (EMS) Responses

February 14, 2022

Douglas F. Kupas, Matt Zavadsky, Brooke Burton, Shawn Baird, Jeff J. Clawson, Chip Decker, Peter Dworsky, Bruce Evans, Dave Finger, Jeffrey M. Goodloe, Brian LaCroix, Gary G. Ludwig, Michael McEvoy, David K. Tan, Kyle L. Thornton, Kevin Smith, Bryan R. Wilson

Download PDF Position Statement

The National Association of EMS Physicians and the then National Association of State EMS Directors created a position statement on emergency medical vehicle use of lights and siren in 1994 (1). This document updates and replaces this previous statement and is now a joint position statement with the Academy of International Mobile Healthcare Integration, American Ambulance Association, American College of Emergency Physicians, Center for Patient Safety, International Academies of Emergency Dispatch, International Association of EMS Chiefs, International Association of Fire Chiefs, National Association of EMS Physicians, National Association of Emergency Medical Technicians, National Association of State EMS Officials, National EMS Management Association, National EMS Quality Alliance, National Volunteer Fire Council and Paramedic Chiefs of Canada.

In 2009, there were 1,579 ambulance crash injuries (2), and most EMS vehicle crashes occur when driving with lights and siren (L&S) (3). When compared with other similar-sized vehicles, ambulance crashes are more often at intersections, more often at traffic signals, and more often with multiple injuries, including 84% involving three or more people (4).

From 1996 to 2012, there were 137 civilian fatalities and 228 civilian injuries resulting from fire service vehicle incidents and 64 civilian fatalities and 217 civilian injuries resulting from ambulance incidents. According to the

U.S. Fire Administration (USFA), 179 firefighters died as the result of vehicle crashes from 2004 to 2013 (5). The National EMS Memorial Service reports that approximately 97 EMS practitioners were killed in ambulance collisions from 1993 to 2010 in the United States (6).

Traffic-related fatality rates for law enforcement officers, firefighters, and EMS practitioners are estimated to be 2.5 to 4.8 times higher than the national average among all occupations (7). In a recent survey of 675 EMS practitioners, 7.7% reported being involved in an EMS vehicle crash, with 100% of those occurring in clear weather and while using L&S. 80% reported a broadside strike as the type of MVC (8). Additionally, one survey found estimates of approximately four “wake effect” collisions (defined as collisions caused by, but not involving the L&S operating emergency vehicle) for every crash involving an emergency vehicle (9).

For EMS, the purpose of using L&S is to improve patient outcomes by decreasing the time to care at the scene or to arrival at a hospital for additional care, but only a small percentage of medical emergencies have better outcomes from L&S use. Over a dozen studies show that the average time saved with L&S response or transport ranges from 42 seconds to 3.8 minutes. Alternatively, L&S response increases the chance of an EMS vehicle crash by 50% and almost triples the chance of crash during patient transport (11). Emergency vehicle crashes cause delays to care and injuries to patients, EMS practitioners, and the public. These crashes also increase emergency vehicle resource use through the need for additional vehicle responses, have long-lasting effects on the reputation of an emergency organization, and increases stress and anxiety among emergency services personnel.

Despite these alarming statistics, L&S continue to be used in 74% of EMS responses, and 21.6% of EMS transports, with a wide variation in L&S use among agencies and among census districts in the United States (10).

Although L&S response is currently common to medical calls, few (6.9%) of these result in a potentially lifesaving intervention by emergency practitioners (12). Some agencies have used an evidence-based or quality improvement approach to reduce their use of L&S during responses to medical calls to 20-33%, without any discernable harmful effect on patient outcome. Additionally, many EMS agencies transport very few patients to the hospital with L&S.

Emergency medical dispatch (EMD) protocols have been proven to safely and effectively categorize requests for medical response by types of call and level of medical acuity and urgency. Emergency response agencies have successfully used these EMD categorizations to prioritize the calls that justify a L&S response. Physician medical oversight, formal quality improvement programs, and collaboration with responding emergency services agencies to understand outcomes is essential to effective, safe, consistent, and high-quality EMD.

The sponsoring organizations of this statement believe that the following principles should guide L&S use during emergency vehicle response to medical calls and initiatives to safely decrease the use of L&S when appropriate:

  • The primary mission of the EMS system is to provide out-of-hospital health care, saving lives and improving patient outcomes, when possible, while promoting safety and health in communities. In selected time-sensitive medical conditions, the difference in response time with L&S may improve the patient’s
  • EMS vehicle operations using L&S pose a significant risk to both EMS practitioners and the public. Therefore, during response to emergencies or transport of patients by EMS, L&S should only be used for situations where the time saved by L&S operations is anticipated to be clinically important to a patient’s outcome. They should not be used when returning to station or posting on stand-by
  • Communication centers should use EMD programs developed, maintained, and approved by national standard-setting organizations with structured call triage and call categorization to identify subsets of calls based upon response resources needed and medical urgency of the call. Active physician medical oversight is critical in developing response configurations and modes for these EMD protocols. These programs should be closely monitored by a formal quality assurance (QA) program for accurate use and response outcomes, with such QA programs being in collaboration with the EMS agency physician medical
  • Responding emergency agencies should use response based EMD categories and other local policies to further identify and operationalize the situations where L&S response or transport are clinically Response agencies should use these dispatch categories to prioritize expected L&S response modes. The EMS agency physician medical director and QA programs must be engaged in developing these agency operational policies/guidelines.
  • Emergency response agency leaderships, including physician medical oversight and QA personnel should monitor the rates of use, appropriateness, EMD protocol compliance, and medical outcomes related to L&S use during response and patient
  • Emergency response assignments based upon approved protocols should be developed at the local/department/agency level. A thorough community risk assessment, including risk reduction analysis, should be conducted, and used in conjunction with local physician medical oversight to develop and establish safe response
  • All emergency vehicle operators should successfully complete a robust initial emergency vehicle driver training program, and all operators should have required regular continuing education on emergency vehicle driving and appropriate L&S
  • Municipal government leaders should be aware of the increased risk of crashes associated with L&S response to the public, emergency responders, and patients. Service agreements with emergency medical response agencies can mitigate this risk by using tiered response time expectations based upon EMD categorization of calls. Quality care metrics, rather than time metrics, should drive these contract
  • Emergency vehicle crashes and near misses should trigger clinical and operational QA reviews. States and provinces should monitor and report on emergency medical vehicle crashes for better understanding of the use and risks of these warning devices.
  • EMS and fire agency leaders should work to understand public perceptions and expectations regarding L&S use. These leaders should work toward improving public education about the risks of L&S use to create safer expectations of the public and government

In most settings, L&S response or transport saves less than a few minutes during an emergency medical response, and there are few time-sensitive medical emergencies where an immediate intervention or treatment in those minutes is lifesaving. These time-sensitive emergencies can usually be identified through utilization of high-quality dispatcher call prioritization using approved EMD protocols. For many medical calls, a prompt response by EMS practitioners without L&S provides high-quality patient care without the risk of L&S-related crashes. EMS care is part of the much broader spectrum of acute health care, and efficiencies in the emergency department, operative, and hospital phases of care can compensate for any minutes lost with non-L&S response or transport.

Sponsoring Organizations and Representatives:

Academy of International Mobile Healthcare Integration
American Ambulance Association
American College of Emergency Physicians
Center for Patient Safety
International Academies of Emergency Dispatch
International Association of EMS Chiefs
International Association of Fire Chiefs
National Association of EMS Physicians
National Association of Emergency Medical Technicians
National Association of State EMS Officials
National EMS Management Association
National EMS Quality Alliance
National Volunteer Fire Council


References:

  1. Use of warning lights and siren in emergency medical vehicle response and patient transport. Prehosp and Disaster Med. 1994;9(2):133-136.
  2. Grant CC, Merrifield Analysis of ambulance crash data. The Fire Protection Research Foundation. 2011. Quincy, MA.
  3. Kahn CA, Pirallo RG, Kuhn EM. Characteristics of fatal ambulance crashes in the United States: an 11-year retrospective Prehosp Emerg Care. 2001;5(3):261-269.
  4. Ray AF, Kupas DF. Comparison of crashes involving ambulances with those of similar-sized vehicles. Prehosp Emerg Care. 2005;9(4):412-415.
  5. S. Fire Administration. Firefighter fatalities in the United States in 2013. 2014. Emmitsburg, MD.
  6. Maguire Transportation-related injuries and fatalities among emergency medical technicians and paramedics.

Prehosp Disaster Med. 2011;26(5): 346-352.

  1. Maguire BJ, Hunting KL, Smith GS, Levick Occupational fatalities in emergency medical services: A hidden crisis.

Ann Emerg Med, 2002;40: 625-632.

  1. Drucker C, Gerberich SG, Manser MP, Alexander BH, Church TR, Ryan AD, Becic Factors associated with civilian drivers involved in crashes with emergency vehicles. Accident Analysis & Prevention. 2013; 55:116-23.
  2. Clawson JJ, Martin RL, Cady GA, Maio RF. The wake effect: emergency vehicle-related collisions. Prehosp Disaster Med. 1997; 12 (4):274-277.
  3. Kupas DF. Lights and siren use by emergency medical services: Above all, do no harm. National Highway Traffic Safety Administration. 2017. Available online at https://www.ems.gov/pdf/Lights_and_Sirens_Use_by_EMS_May_2017.pdf
  4. Watanabe BL, Patterson GS, Kempema JM, Magailanes O, Brown LH. Is use of warning lights and sirens associated with increased risk of ambulance crashes? A contemporary analysis using national EMS information system (NEMSIS) Ann Emerg Med. 2019;74(1):101-109.
  5. Jarvis JL, Hamilton V, Taigman M, Brown LH. Using red lights and sirens for emergency ambulance response: How often are potentially life-saving interventions performed? Prehosp Emerg Care. 2021; 25(4): 549-555.

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Statement for House Ways & Means Hearing on America’s Mental Health Crisis

Committee on Ways and Means

U.S. House of Representatives Hearing on “America’s Mental Health Crisis”

Statement of Shawn Baird, President, American Ambulance Association

February 2, 2022

Chairman Neal, Ranking Member Brady, and members of the Committee, on behalf of the members of the American Ambulance Association (AAA), I greatly appreciate the opportunity to provide you with a written statement on America’s Mental Health Crisis. Simply put, America’s hometown heroes who provide emergency medical services and transitional care need the Congress to recognize the significant stress and trauma paramedics and emergency medical technicians (EMTs) have experienced as a result of this pandemic. The AAA urges members of Congress not to forget these heroes and to expressly include all ground ambulance service personnel in efforts to address America’s Mental Health Crisis.

Emergency medical services (EMS) professionals are ready at a moment’s notice to provide life-saving and life-sustaining treatment and medical transportation for conditions ranging from heart attack, stroke, and trauma to childbirth and overdose. These first responders proudly serve their communities with on-demand mobile healthcare around the clock. Ground ambulance service professionals have been at the forefront of our country’s response to the mental health crisis in their local communities. Often, emergency calls related to mental health services are triaged to the local ground ambulance service to address.

While paramedics and EMTs provide important emergency health care services to those individuals suffering from a mental or behavioral health crisis, these front-line workers have been struggling to access the federal assistance they need to address the mental health strain that providing 24-hour care, especially during a COVID-19 pandemic, has placed on them. We need to ensure that there is equal access to mental health funding for all EMS agencies, regardless of their form of corporate ownership so that all first responders can receive the help and support they need.

EMS’s Enhanced Role in the Pandemic

As if traditional ambulance service responsibilities were not enough, paramedics and EMTs have taken on an even greater role on the very front lines of the COVID-19 pandemic. In many areas, EMS professionals lead Coronavirus vaccination, testing, and patient navigation. As part of the federal disaster response subcontract, EMS personnel even deploy to other areas around the country to pandemic hotspots and natural disasters to bolster local healthcare resources in the face of extraordinarily challenging circumstances.

Mental & Behavioral Health Challenges Drive Staffing Shortages on the Front Line

Myriad studies show that first responders face much higher-than-average rates of post- traumatic stress disorder[1], burnout[2], and suicidal ideation[3]. These selfless professionals work in the field every day at great risk to their personal health and safety—and under extreme stress.

Ambulance service agencies and fire departments do not keep bankers’ hours. By their very nature, EMS operations do not close during pandemic lockdowns or during extreme weather emergencies. “Working from home” is not an option for paramedics and EMTs who serve at the intersection of public health and public safety. Many communities face a greater than 25% annual turnover[4] of EMS staff because of these factors. In fact, across the nation EMS agencies face a 20% staffing shortage compounded by near 20% of employees on sick leave from COVID-19. This crisis-level staffing is unsustainable and threatens the public safety net of our cities and towns.

Sadly, to date, too few resources have been allocated to support the mental and behavioral health of our hometown heroes. I write today to ask for Congressional assistance to help the helpers as they face the challenges of 2022 and beyond.

Equity for All Provider Types

Due to the inherently local nature of EMS, each American community chooses the ambulance service provider model that represents the best fit for its specific population, geography, and budget. From for-profit entities to municipally-funded fire departments to volunteer rescue squads, EMS professionals share the same duties and responsibilities regardless of their organizational tax structure. They face the same mental health challenges and should have equal access to available behavioral health programs and services.

Many current federal first responder grant programs and resources exclude the tens of thousands of paramedics and EMTs employed by for-profit entities from access. These individuals respond to the same 911 calls and provide the same interfacility mobile healthcare as their governmental brethren without receiving the same behavioral health support from

Federal agencies. To remedy this and ensure equitable mental healthcare access for all first responders, we recommend that:

  • During the current public health emergency and for at least two years thereafter, eligibility for first responder training and staffing grant programs administered by the U.S. Department of Health and Human Services (such as SAMHSA Rural EMS Training Grants and HHS Occupational Safety and Health Training Project Grants) should be expanded to include for-profit entities. Spending on training and services for mental health should also be included as eligible program
  • Congress should authorize the establishment of a new HHS grant program open to public and private nonprofit and for-profit ambulance service providers to fund paramedic and EMT recruitment and training, including employee education and peer-support programming to reduce and prevent suicide, burnout, mental health conditions and substance use
  • Any initiatives to fund hero pay or death benefits for first responders should be inclusive of all provider models—for-profit, non-profit, and

The rationale for the above requests is twofold. First, ensuring the mental health and wellness of all EMS professionals—regardless of their employer’s tax status—is the right thing to do.

Second, because keeping paramedics and EMTs employed by private ambulance agencies who are on the frontlines of providing vital medical care and vaccinations during this pandemic is the smart thing to do.

Thank you for considering this request to support ALL of our nation’s frontline heroes. They are ready to answer your call for help, 24/7—two years into this devastating pandemic, will Congress answer theirs?

Please do not hesitate to contact American Ambulance Association Senior Vice President of Government Affairs, Tristan North, at tnorth@ambulance.org or 202-486-4888 should you have any questions.


  • Prevalence of PTSD and common mental disorders amongst ambulance personnel: A systematic review and meta-analysis. Soc Psychiatry Psychiatr 2018;53(9):897-909.
  • ALmutairi MN, El Mahalli AA. Burnout and Coping Methods among Emergency Medical Services Professionals. J Multidiscip Healthc. 2020;13:271-279. Published 2020 Mar 16. doi:10.2147/JMDH.S244303
  • Stanley, I. H., Hom, M. A., & Joiner, T. E. (2016). A systematic review of suicidal thoughts and behaviors among police officers, firefighters, EMTs, and Clinical Psychology Review, 44, 25–44. https://doi.org/10.1016/j. cpr.2015.12.002
  • Doverspike D, Moore S. 2021 Ambulance Industry Employee Turnover Study. 3rd Washington, DC: American Ambulance Association; 2021.

CAAS Releases GVS V3.0 Draft for Public Comment

The Commission on Accreditation of Ambulance Services (CAAS) formed a Ground Vehicle Standard Revision Committee to develop V3.0 of the GVS document. Based on industry feedback, this Committee has developed a list of proposed changes to V2.0.

To ensure that anyone with an interest in the medical transportation industry has a voice in the Standard revision process, CAAS has now posted the proposed changes for public comment. These proposed changes will be posted for 60 days, commencing January 7, 2022. Interested parties who care to comment on the changes should complete the online feedback form and submit their input during this public comment period.

The GVS Committee will review all submissions received during the period and will consider each of the comments received. Following this first round review, a second 60-day public comment period will be held to give further opportunity to comment on any items that may have been changed from the first draft as part of the process. The CAAS GVS V3.0 document has a scheduled effective date of July 1, 2022.

If you have any questions, please contact Mark Van Arnam, Administrator, CAAS GVS.

Colorado | What it’s like in the day of a Denver Health paramedic

From KDVR on January 3, 2022

DENVER (KDVR) — Denver Health paramedics are often first on the scene of an emergency. And when seconds matter, they make life or death decisions.

FOX31 joined them on a ride-along to see how they do their jobs and how they are holding up during the pandemic.

If you need help, Denver Health paramedics are just minutes away.

Continue Reading on KDVR

Jan 5 | EMS360: Fatigue Risk Management in EMS Webtool Demo

Fatigue Risk Management in EMS: Project Summary and Webtool Demo


Wed, Jan 5, 2022 11:00 AM – 12:15 PM EST

Five years after its launch, the Fatigue in EMS Project made available through funding support from the National Highway Traffic Safety Administration is reaching its conclusion with the launch of a biomathematical model/fatigue risk analyzer for EMS personnel. We will summarize the project and provide a live demonstration of the new webtool!