Thank you to Nebraska Medicine for the development and testing of this innovative process for the decontamination and reuse of N95 masks.
Download the PDF report.
Thank you to Nebraska Medicine for the development and testing of this innovative process for the decontamination and reuse of N95 masks.
Download the PDF report.
Join Dr. Ed Racht, Chief Medical Officer, and Randy Strozyk, Executive Vice President Operations for Global Medical Response and Hanan Cohen, Director of MIH-CP and Jim O’Connor, Vice President for Empress Ambulance Service for a compelling webinar straight from the front lines of the COVID-19 pandemic. The panelists will discuss workforce safety and wellness, treatment and transport changes, lessons learned, and the challenge of providing services in some of the hardest-hit areas of our country.
Ed Racht, M.D.
Chief Medical Officer, Global Medical Response
Dr. Ed Racht has been involved in Emergency Medical Services and healthcare systems for more than 30 years. He currently serves as Chair of the Texas EMS, Trauma and Acute Care Foundation, an organization that provides advocacy, strategic planning and healthcare system credentialing in the State of Texas.
Dr. Racht has been Chief Medical Officer for American Medical Response (AMR) since 2010. Prior to this role, he served as the Chief Medical Officer and Vice President of Medical Affairs for Piedmont Newnan Hospital in metro Atlanta. Dr. Racht was the first full-time Medical Director for the Austin/Travis County Emergency Medical Services System, where he spent 13 years. The System was nationally recognized in the Institute of Medicine’s Report on the state of emergency care for its collaborative approach to challenging healthcare integration issues.
Dr. Racht received his undergraduate and medical degree from Emory University in Atlanta and completed his residency at the Medical College of Virginia.
Dr. Racht is the recipient of numerous awards including being named EMS Medical Director of the Year for the State of Texas, the American Heart Association’s Paul Ledbetter MD Physician Volunteer of the Year Award and was named a “Hero of Emergency Medicine” in 2008 by the American College of Emergency Physicians. In 2015, he was the first recipient of the Joseph P. Ornato Excellence in Clinical Leadership Award, and in 2011 received the Slovis Award for Educational Excellence by the U.S. Metropolitan Municipalities Medical Director Consortium. He is also the third Inductee in the Texas EMS, Trauma and Acute Care Foundation Hall of Fame.
Executive Vice President of Operations, Global Medical Response
Randy Strozyk has been a leader in emergency medical services for more than 40 years and is an integral part of the GMR/AMR executive team. As SVP of Executive Operations, he is engaged in our overall operations and specific areas such as internal and external integration and our event Medical Services. He has extensive experience in EMS operations and management. He is a long time member of the American Ambulance Association and is presently the AAA Secretary. Strozyk began his career as a paramedic. He holds a Bachelor of Science degree in microbiology from Washington State University and an MBA from California State University.
Vice President, Empress Ambulance Service
Jim O’Connor is the Vice President of Empress Ambulance of Yonkers, New York. Empress is part of the PatientCare EMS Solutions organization. He has been involved in the Emergency Medical Service (EMS) for over four decades and was one of the first paramedics in Westchester County, New York.
Empress is the contracted provider of 911 emergency medical services (EMS) for the cities of New Rochelle, Yonkers, White Plains and Mount Vernon. Empress has a staff of over 500 employees and has been operating in Westchester County since 1985. They also provide all levels of inter-facility ambulance transportation services for some of the most prestigious hospital systems in the New York metropolitan area.
Jim has been active with many EMS organizations and has held Board positions locally, regionally and on a national level. He was a founding member and first Chairman of the Westchester County Regional EMS Council and has served on the Hudson Valley Regional EMS Council, the New York State EMS Council and the American Ambulance Association in Washington, D.C.
Director of MIH-CP, Empress Ambulance Service
Hanan Cohen is the Director of Corporate Development and Community Paramedicine at Empress EMS a large progressive regional ambulance service and EMS provider. He is a Paramedic and Community Paramedic with 30 years’ experience in EMS and Hospital Administration. His focus has been on new program design and application. He has been the administrator for multiple hospital clinical departments as well as a Level 1 Trauma Center. His EMS career has included, rural, suburban and urban EMS systems.
He has spent the past several years researching, developing and implementing MIH-CP programs at Empress EMS providing collaborative community health programs with multiple hospitals in Westchester County and New York City. He is a Certified Ambulance Compliance Officer and member of the American Ambulance Association Payment Reform Committee.
The National Business Emergency Operations Center (NBEOC) is FEMA’s virtual clearing house for two-way information sharing between public and private sector stakeholders to help people before, during, and after disasters.
The NBEOC was created to enhance communication and collaboration with private industry partners and ensure their integration into disaster operations at a strategic and tactical level. During response operations, NBEOC members are linked into FEMA’s National Response Coordination Center (NRCC), activated Regional Response Coordination Centers (RRCCs), and the broader network of emergency management operations to include our state and federal partners.
The NBEOC offers a platform to share information on impacts, operating status, and recovery challenges, as well as access to information to support business continuity decisions, and integration into planning, training, and exercises. Participation in the NBEOC is voluntary and open to all organizations with significant and multistate geographical footprints in the private sector, which include large businesses, chambers of commerce, trade associations, universities, think-tanks, and non-profits.
The Cybersecurity and Infrastructure Security Agency (CISA) executes the Secretary of Homeland
Security’s responsibilities as assigned under the Homeland Security Act of 2002 to provide strategic
guidance, promote a national unity of effort, and coordinate the overall federal effort to ensure the
security and resilience of the Nation’s critical infrastructure. CISA uses trusted partnerships with
both the public and private sectors to deliver infrastructure resilience assistance and guidance to a
broad range of partners.
Functioning critical infrastructure is imperative during the response to the COVID-19 emergency for both public health and safety as well as community well-being. Certain critical infrastructure industries have a special responsibility in these times to continue operations.
This guidance and accompanying list are intended to support State, Local, and industry partners in identifying the critical infrastructure sectors and the essential workers needed to maintain the services and functions Americans depend on daily and that need to be able to operate resiliently during the COVID-19 pandemic response.
This document gives guidance to State, local, tribal, and territorial jurisdictions and the private sector on defining essential critical infrastructure workers. Promoting the ability of such workers to continue to work during periods of community restriction, access management, social distancing, or closure orders/directives is crucial to community resilience and continuity of essential functions.
Read the Food & Drug Administration’s Frequently Asked Questions (FAQs) regarding the mask and gown shortage.
Demonstrate the value of EMS in the COVID-19 crisis!
#EMS is on the very front lines of the #COVID19 epidemic. We provide on-demand #mobilehealthcare for the most vulnerable patient populations, 24/7. Help AAA showcase the incredible importance of #Paramedics, #EMTs, and #Dispatchers in the response to this pandemic. Would you please capture a photo of yourselves in action, holding a simple sign? It is essential that we communicate visually with legislators, regulators, and the general public to help them understand the critically important role we play in saving and sustaining lives. #AlwaysOpen #StayHomeForUs
If practical, please consider showing your medics standing apart from one another (social distancing) if they are not in PPE.
Dear Fellow AAA Members,
I write to you today during what we all recognize as an extraordinary time for EMS. As we collectively serve on the very front lines of the COVID-19 epidemic, we know that the most challenging times are still ahead. However, I am heartened by the collective resolve of the members of the American Ambulance Association to provide 24/7 on-demand mobile healthcare, no matter the circumstances.
As President of the Association, I am sharing below a brief summary of the AAA’s activities to support its members in the face of this devastating disease.
Members will receive updates via our Digest e-newsletter as we continue to make progress on these and other issues.
Please don’t hesitate to reach out to staff at firstname.lastname@example.org or 202-802-9020 if we can be of any assistance. Thank you again for your service to your communities during this very difficult time.
President, American Ambulance Association
This guidance is written to offer American Ambulance Association members the situational background and a list of resources and websites with which to draw guidance and further updates on the latest situation with COVID-19, colloquially referred to as “Coronavirus.” Key information for this update has been drawn from the NHTSA EMS Focus series webinar What EMS, 911 and Other Public Safety Personnel Need to Know About COVID-19, which took place on February 24, 2020. The on-demand recording is available below.
The COVID-19 Coronavirus Disease was first reported in Wuhan China in December 2019. CDC identifies that it was caused by the virus SARS – CoV-2. Early on, many patients were reported to have a link to a large seafood and live animal market. Later, patients did not have exposure to animal markets which indicates person-to-person transmission. Travel-related exportation of cases into the US was first reported January 21, 2020. For reference the first North American EMS experience of COVID-19 patient transport, including key lessons learned, can be found in the EMS 1 article Transporting Patient 1.
Global investigations are now ongoing to better understand the spread. Based on what is known about other coronaviruses, it is presumed to spread primarily through person-to-person contact and may occur when respiratory droplets are produced when an infected person costs or sneezes. Spread could also occur when touching a surface or object that has the virus on it and when touching the mouth, nose, or eyes. Again, research is still ongoing, and advice and guidance will inevitably follow.
For the cases that have been identified so far, those patients with COVID19 have reportedly had mild to severe respiratory illness with symptoms including fever and shortness of breath. Symptoms have typically appeared 2 to 14 days after exposure. Both the WHO and CDC advise that patients that have been to China and develop the symptoms should call their doctors.
To date, 30 international locations, in addition to the US, have reported confirmed cases of COVID-19 infection. Inside the US, two instances of person-to-person spread of the virus have been detected. In both cases, these occurred after close and prolonged contact with a traveler who had recently returned from Wuhan, China.
The CDC activated its Emergency Operations Center (EOC) on January 21 and is coordinating closely with state and local partners to assist with identifying cases early; conducting case investigations; and learning about the virology, transmission, and clinical spectrum for this disease. The CDC is continuing to develop and refine guidance for multiple audiences, including the first responder and public safety communities.
As at the date of publication there is still no specific antiviral treatment licensed for COVID-19, although the WHO and its affiliates are working to develop this.
The following are recommended preventative measures for COVID-19 and many other respiratory illnesses:
The Centers for Disease Control (CDC) has issued its Interim Guidance for Emergency Medical Services (EMS) Systems and 911 Public Safety Answering Points (PSAPs) for COVID-19 in the United States.
The guidance identifies EMS as vital in responding to and providing emergency treatment for the ill. The nature of our mobile healthcare service delivery presents unique challenges in the working environment. It also identifies that coordination between PSAPs and EMS is critical.
Key points are summarized below:
The link between PSAPs and EMS is essential. With the advent of COVID19 there is a need to modify caller queries to question callers and determine the possibility that the call concerns a person who may have signs or symptoms and risk factors for COVID19.
The International Academy of Emergency Dispatch (IAED) recommends that agencies using its Medical Priority Dispatch System (MPDS) should use its Emerging Infectious Disease Surveillance (EIDS) Tool within the Sick Person and Breathing Problem protocols. For those that are not MPDS users, IAED is offering its EIDS surveillance Tool for Coronavirus, SRI, MERS and Ebola-free of charge under a limited use agreement.
The CDC recommends that while involved in the direct care of patients the following PPE should be worn:
Once transport is complete, organizations should notify state or local public health authorities for follow up. Additionally agencies should (if not done already) develop policies for assessing exposure risk and management of EMS personnel, report any potential exposure to the chain of command, and watch for fever or respiratory symptoms amongst staff.
While not specific to COVID-19, agencies should:
The COVID19 situation constantly evolving. Agencies should defer to their local EMS authorities, Public Health departments, and the CDC for definitive guidance. Going forward, the AAA will continue to both monitor the disease and alert issues to the membership.
By Eric van Doesburg, MP Cloud Technologies
This sponsored post is not endorsed by the American Ambulance Association. It reflects the views of the author.
Did you know that one of the most common practices in our industry could put your company at financial risk? Transporting patients not qualified for ambulance transportation is a hot topic these days as it has heavily contributed to the rise of Medicare fraud cases. This issue has grown even more relevant recently with a case in Florida, where not only was the EMS company found liable of fraud, but it was the first time several hospitals were held culpable as well.¹
While the burden of proof falls on the government to satisfy the statutes in the Federal False Claims Act, the fact is investigators are becoming more aggressive in fighting these types of billing schemes.
“The fact is investigators are becoming more aggressive in fighting these types of billing schemes.”
Yes, there are some bad actors in our industry like any other, but more times than not employees simply may be unaware of the qualifications needed when dispatching non-emergency transport.
Thankfully, a company can protect its financial future simply by having the necessary protocols in place.
For ambulance transportation to be covered by Medicare for a patient, the answer must be “yes” to at least one of the three criteria listed below:
Dispatchers must ask these specific questions in order to understand the scope of the situation – a step that should be incorporated into your business’ procedures immediately. If it is determined that the patient meets none of the above criteria, then an alternative transportation source must be sought and you have a couple of options.
Uber™ and Lyft™ have not only affected how we approach transportation as a society but have left a prominent mark on the EMS industry as well. According to a University of Kansas study, the use of ambulance transportation dropped 7% in cities that adopted ride-sharing platforms.² Consider the formation of a partnership with these companies as a low-cost alternative for non-emergency transport that could reduce your liability and develop a sustainable revenue stream for the future without a lot of overhead. Of course, just because the patient may not meet the Medicare criteria for non-emergency transport doesn’t mean that they are in a condition to be able to ride in a car by themselves. This is where the situation can become a little tricky. Is Uber™ or Lyft™ really the bestoption for an elderly person who may have some mild form of dementia and is being released after having a medical episode?
As an alternative, another option would be setting up your own fleet of non-emergency transport to cater to your clients’ specific needs. These non-emergency shuttles can ensure a consistent and legal discharge process to keep you in compliance and managing dispatch on your terms. It also allows for a higher level of patient care during the transport than a ride-sharing service can provide.
With the stakes for fraudulent claims getting higher, you’ll want to make sure you have a protocol in place that protects your business, employees, and clients from any hint of impropriety. However, with the right planning and core systems/partnerships, it will make the process for handling non-emergency transport that much easier… and possibly lead to new revenue channels not available in the past. That’s something we can all get excited about.
On March 6, 2019, the HHS Office of the Inspector General (OIG) posted OIG Advisory Opinion 19-03. The opinion related to free, in-home follow-up care offered by a hospital to eligible patients for the purpose of reducing hospital admissions or readmissions.
The Requestor was a nonprofit medical center that provides a range of inpatient and outpatient hospital services. The Requestor and an affiliated health care clinic are both part of an integrated health system that operates in three states. The Requestor had previously developed a program to provide free, in-home follow-up care to certain patients with congestive heart failure (CHF) that it has certified to be at higher risk of admission or readmission to a hospital. The Requestor was proposing to expand the program to also include certain patients with chronic obstructive pulmonary disease (COPD). According to the Requestor, the purpose of both its existing program and its proposed expansion was to increase patient compliance with discharge plans, improve patient health, and reduce hospital inpatient admissions and readmissions.
Under the existing program, clinical nurses screen patients to determine if they meet certain eligibility criteria. These include the requirement that the patient have CHF and either: (1) be currently admitted as an inpatient at Requestor’s hospital or (2) be a patient of Requestor’s outpatient cardiology department, and who had been admitted as an inpatient at Requestor’s hospital within the previously 30 days. The clinical nurses would identify those patients at higher risk of hospital admission based on a widely used risk assessment tool. The clinical nurses would also determine whether the patient had arranged to receive follow-up care with Requestor’s outpatient CHF center. Patients that do not intend to seek follow-up care with the CHF center, or who have indicated that they intend to seek follow-up care with another health care provider, would not be informed of the current program. Eligible patients would be informed of the current program, and offered the opportunity to participate. The eligibility criteria for the expanded program for COPD patients would operate in a similar manner.
Eligible patients that elect to participate in the current program or the expanded program would receive in-home follow up care for a thirty (30) day period following enrollment. This follow up care would consist of two visits every week from a community paramedic employed by the Requestor. As part of this in-home care, the community paramedic would provide some or all of the following services:
The community paramedic would use a clinical protocol to deliver interventions and to assess whether a referral for follow-up care is necessary. To the extent the patient requires care that falls outside the community paramedic’s scope of practice, the community paramedic would direct the patient to follow up with his or her physician. For urgent, but non-life threatening conditions, the community paramedic would initiate contact with the patient’s physician.
The Requestor certified that the community paramedics would be employed by the Requestor on either full-time or part-time basis, and that all costs associated with the community paramedic would be borne by the Requestor or its affiliates. The Requestor further certified that no one involved in the operation of the program would be compensated based on the number of patient’s that enroll in the programs. While one of the states in which the Requestor operates does reimburse for community paramedicine services, Requestor certified that it does not bill Medicaid for services provided under the program.
The question posed to the OIG was whether any aspect of the program violated either the federal anti-kickback statute or the prohibition against the offering of unlawful inducements to beneficiaries.
In analyzing the program, the OIG first determined that the services being offered under the program offer significant benefit to enrolled patients. The OIG specifically cited the fact that one state’s Medicaid program reimbursed for similar services as evidence of this value proposition. For this reason, the OIG concluded that the services constitute “remuneration” to patients. The OIG further concluded that this remuneration could potentially influence a patient’s decision on whether to select Requestor or its affiliates for the provision of federally reimbursable items and services. Therefore, the OIG concluded that the program implicated both the anti-kickback statute and the beneficiary inducement prohibition.
The OIG then analyzed whether the program would qualify for an exception under the so-called “Promoting Access to Care Exception.” This exception applies to remuneration that improves a beneficiary’s ability to access items and services covered by federal health care programs and which otherwise pose a low risk of harm. The OIG determined that while some aspects of the program would likely fall within this exception, other aspects would not. Specifically, the OIG cited the home safety assessment as not materially improving a beneficiary’s access to care.
Having concluded that there was no specific exception that would permit the arrangement, the OIG then analyzed the arrangement under its discretionary authority, ultimately concluding that the program posed little risk of fraud or abuse. In reaching this conclusion, the OIG cited several factors:
OIG advisory opinions are issued directly to the requestor of the opinion. The OIG makes a point of noting that these opinions cannot be relied upon by any other entity or individual. Legal technicalities aside, the OIG’s opinion is extremely helpful to the industry, as it lays out the factors the OIG would consider in analyzing similar arrangements. Thus, the opinion is extremely valuable to ambulance providers and suppliers that current operate, or are considering the operation of, similar mobile integrated health and/or community paramedicine programs.
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:
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:
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.
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
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:
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:
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
For ambulance services, HIPAA compliance is a particularly sensitive issue. Because of the sensitive nature of the health data that EMS and EMT professionals deal with on a daily basis, HIPAA Privacy and Security standards must be carefully adhered to.
This issue becomes even more sensitive when you consider that most of the data collected during pre-hospital care will likely be collected, tracked, and documented on a mobile device. Laptops, smartphones, and tablets are indispensable tools for ambulance care. Most of these devices will have access to electronic health records (EHR) platforms, which will in turn be connected to the rest of a hospital’s EHR data.
While mobile devices can provide convenience in life-or-death situations, they are also particularly vulnerable to the risk of a data breach. A data breach of unsecured health information can lead to serious HIPAA violations and put patient privacy at risk.
The kind of health information that these devices have access to is called protected health information, or PHI. PHI is any demographic information that can be used to identify a patient. Common examples of PHI include names, dates of birth, medical information, insurance ID numbers, addresses, full facial photos, and telephone numbers, to name a few.
The HIPAA Rules set specific standards for maintaining the privacy, security, and integrity of PHI. Though the regulation can seem complex, the standards are in place to safeguard PHI. As per HIPAA, ambulance services necessarily fall under the category of Covered Entities, meaning that they are responsible for maintaining compliance with both the HIPAA Privacy Rule and the HIPAA Security Rule.
These two rules set limits for how and when PHI must be stored and accessed. Below, we list a few of the major components of the HIPAA Rules that all ambulance services can implement in order to keep PHI safe and secure on the go.
These are just a few of the ways that ambulance services can protect PHI and comply with HIPAA mobile device standards.
In addition to the actions listed above, a total compliance program that addresses the full extent of the law must be in place in order to prevent HIPAA violations and data breaches.
Addressing HIPAA compliance can help ambulance services confidently treat their patients without worrying about the risk of data breaches or government fines.
Congratulations! You were selected for the Paramedic Supervisor position, if you accept, we’ll start the transition immediately.
I remember the excitement I had when I heard those words so many years ago. The excitement that carried strongly through 2 days of celebrating with my husband, anticipating the new world I was about to be part of; making a mental list of all the mountains I couldn’t wait to move! This excitement was quickly drowned by a sinking feeling deep in my gut. It felt like running out of gas on a country highway at one in the morning and your cell phone is dead; it’s dark, there is nobody around, and you cannot phone a friend.
Whether it comes right away, or later—because of the reaction of people we thought were friends or feeling overwhelmed in a new situation you were expected to handle with precision, we’ve all felt that feeling as a new leader. By sharing our stories with one another, the success and the failures, we all grow.
I remember getting so much advice from those who walked the road before me, some solicited some not. The stories were sometimes shocking, often comical and always gave me perspective and insight into my own blunders – most importantly the stories many shared with me taught me the importance of humility and the ability to laugh at myself, admit my mistakes, learn and move on. At some point, the tide started turning, and friends and colleagues began asking me for my stories and advice. Although I often felt like I wasn’t experienced (i.e. old enough) to be offering any advice I realized it’s not necessarily the age or years of experience behind the story that makes it meaningful. The power is in the ability to share an experience through storytelling—finding common ground amongst the hierarchy of titles and job descriptions.
I think it is easy to lose sight of how our words and actions can affect others as we are wrapped up in our day to day and moving down the checklist of tasks. The influence of a leader in an organization, even an informal leader, is long lasting and not to be taken for granted. Over the past year, I’ve been talking to many EMS leaders of the past and present. I’ve been asking them what they wish they would have known when they first started their leadership journey, and what advice they might give to others just starting out. Here are 10 of the most common answers I received.
Congratulations to the AAA members who received Commission on the Accreditation of Ambulance Services (CAAS) accreditation or reaccreditation in November and December!
We are seeing unprecedented, catastrophic flooding in Texas and it looks as though disaster response efforts could potentially continue for the foreseeable future.
American Medical Response (AMR), has been a member of the AAA since 1992. The AMR Office of Emergency Management (OEM), within its national ambulance contract as the Federal EMS provider has responded to the state of Texas in its role as the FEMA prime contractor. The company has engaged a number of EMS companies who have responded to the Hurricane Harvey deployment. Many AAA member companies are disaster subcontractors for AMR and have proudly responded to federally-declared disasters since 2007.
Because of the potential protracted length of this storm and recovery efforts, AMR is now processing new applications to augment its existing operations. To help with those efforts, AAA wants to extend information about becoming a network provider for AMR. If your organization is interested in applying, please use this PDF application.
When officially deployed by AMR as a subcontractor, EMS providers are compensated portal-to-portal. During deployments, lodging, subsistence, and fuel may be provided. If not provided, EMS subcontractors will be reimbursed for approved expenses.
We recognize that many EMS providers are regulated by local or state agencies and may have restrictions when it comes to responding to out-of-area disasters. The EMS needs of local communities are primary and participation in the AMR Emergency Response Network is not intended to undermine those obligations. States may have Emergency Management Assistance Compact (EMAC) agreements with ambulance services; therefore, AMR will not utilize assets that are committed under EMAC.
We are all hoping the waters will recede and first responders will be able to return to their homes soon, but we could be looking at prolonged recovery, and we know our AAA members are always called to serve.
For additional information, you can contact:
AAA is deeply proud to represent dozens of member organizations who deploy at a moment’s notice to serve in large-scale disasters like Hurricane Harvey as part of AMR’s federal emergency contract. Thank you for your service to our nation.
Alert Ambulance Service Inc (NJ)
Alliance Mobile Health (MI)
Amcare Ambulance (VT)
America Ambulance Service Inc.
American Trans Med(SC)
Anniston EMS (AL)
Baca/Crestone Ambulance Service (CO)
Beauport Ambulance Service Inc (MA)
Bell Ambulance Inc. (WI)
Bennington Rescue Squad(VT)
Cape County Ambulance(MO)
Central Emergency Medical Service Inc. (GA)
Citywide Mobile Response Corp (NY)
Community (Mid Georgia) (GA)
Community Ambulance Genesis (OH)
Community Care Ambulance Network (OH)
Community EMS (MI)
Community EMS Dayton (OH)
Elgin Medi Transport(IL)
Elizabeth Township EMS (PA) (12167)
Empress Ambulance Service Inc (NY)
F-M Ambulance Service Inc (ND)
Fraser Medical Services(IA)
Guardian Angel Ambulance Service Inc (PA)
Humboldt General Hospital (NV)
Huntsville Emergency Medical Services Inc(AL)
Huron Valley/Jackson Community Ambulance(MI)
Lakes Region EMS Inc (WI)
Life EMS (OK)
Lifecare of Virginia(VA)
Lifeguard Ambulance (TN)
Lifeguard Columbia County (FL)
Lifeguard Knoxville (TN)
Lifeguard Mobile (AL)
Lifeguard Morgan County (AL)
Lifeguard Nashville (TN)
Lifeguard Santa Rosa (FL)
Lifeline Ambulance (IL)
Medfleet Systems Inc (FL)
Medshore Ambulance Service (SC)
Medstar Ambulance (MI)
Memorial Hospital of Converse County (WY)
Metro Medical Services Inc (IL)
Mobile Medical Response Inc.(MI)
Mohawk Ambulance (NY) Parkland
Newport Ambulance Service Inc.(VT)
Newton County Ambulance(MO)
North Shore University Hospital (NY) Northwell Health
Pafford Medical Services (AR)
Port Jefferson Volunteer Ambulance Corp Inc.
Professional Ambulance and Oxygen(MA)
Professional Med Team Inc.(MI)
Regional Ambulance (VT)
Riverside Ambulance (AR)
Rockland Mobile Care(NY)
Rockland Paramedic Service(NY)
Spirit Medical Transport (OH)
Star EMS/Miles Grubb Assoc.(MI)
Stat EMS (MI)
Summit County Ambulance(CO)
Superior Air-Ground Ambulance Service Inc (IL)
Taney County (MO)
TLC Emergency Medical Services Inc.(NY)
Trace Ambulance Service(IL)
Tri Hospital EMS(MI)
Tri-Township Ambulance Service(MI)
Valley Ambulance Authority (PA)
Governor Kay Ivey recently signed into law Alabama’s REPLICA legislation, HB250. Alabama joins ten other states—Colorado, Texas, Virginia, Idaho, Kansas, Tennessee, Utah, Wyoming, Mississippi, and Georgia—in this forward-thinking interstate compact.
REPLICA, the Recognition of EMS Personnel Licensure Interstate Compact, recognizes the day-to-day movement of EMS personnel across state lines. It extends the privilege to practice under authorized circumstances to EMS personnel based on their home state license, as well as allows for the rapid exchange of licensure history between Compact member states..
Learn more about how REPLICA participation can help your state at http://www.emsreplica.org.
By Cindy Elbert
President, Cindy Elbert Insurance Services, Inc
If you’re doing business online, you need cyber-insurance. This fact was never made truer than on May 12, 2017 when 50,000 businesses in at least 74 countries were hit by a ransomware attack code named “WannaCry”. Hackers demanded companies to pay a $300 ransom fee or their files would be published on the Internet. The data thieves targeted mostly hospitals and other medical facilities because their data not only included names, home addresses, addiction histories, financial information and religious affiliations but also disclosed patients’ mental health and medical diagnoses, HIV statuses and sexual assault and domestic violence reports. A gold mine of personal information for those with dark purposes.
Two days earlier, a data breach at the Bronx Lebanon Hospital Center in New York compromised the medical records of at least 7,000 people. According to NBC News, “Leaks from the Rsync servers, which transfer and synchronize files across systems, are common. How many more nude photos of patients or ultrasound images will be exposed because of misconfigured Rsync backups?”
On May 4, 2017, a group calling themselves TheDarkOverload uploaded almost 180,000 stolen patient/medical records from three companies onto the Internet because they refused to pay a ransom. The databases stolen were in the .csv format and contained health information about cardiac diagnoses and psychiatric conditions such as depression, along with date of birth and social security numbers.
Most ransomware attacks are led by organized criminal groups utilizing a network of computers infected with malware that then poisons other computers once a spam message is opened. An example of a spam malware would be emails falsely marked as being from a co-worker or friend asking a recipient to open an attached file. Or, an email might come from a trusted institution, like a bank or merchant, asking you to perform a specific task. In other instances, hackers will use scare tactics such as claiming that a victim’s computer has been used for illegal activities to bully victims. When the malware is executed, it encrypts files and demands a ransom to unlock them.
Imagine the nightmare scenario of medical teams out on the field relying on electronic devices such as tablets, laptops, smartphones and PDAs to access patient care records suddenly discovering that their data has been locked, captured by malicious malware., held for ransom with lives in the balance.
Companies need the protection cyber liability insurance offers now more than ever.
Ransomware attacks and cyber theft will not be defeated any time soon. So now is the time to ask: How do you store sensitive information? How do you control access to sensitive information? Do you utilize a firewall and protection software? Do you allow employees and others remote access to your data bases? Do you have a written security policy? And, most importantly, do you have cyber liability insurance? Is it safe? If your company stores customer information, especially billing and medical data, then there is no question about it: You must protect yourself from the growing legion of cyber predators. You need cyber liability insurance.
Cindy Elbert is President of Cindy Elbert Insurance Services, Inc. She is a licensed Property & Casualty Insurance broker/agent, and a proud member of the American Ambulance Association, California Ambulance Association, Arizona Ambulance Association, and The Independent Agents Association.
Cindy has been assisting ambulance providers with their insurance needs since 1982. She understands your questions and concerns and with her relationships with insurance underwriters she can provide you with coverage and service you deserve.
Visit the CEIS booth at the AAA Annual Conference & Trade Show!
CAAS GVS Remount Forum
June 7, 2017
NEW LOCATION: Harris Conference Center
The Commission on Accreditation of Ambulance Services, Ground Vehicle Standard Division (CAAS-GVS) will be holding an open forum for organizations involved in the remounting of ambulances. The intent of this meeting is to identify and establish a dialogue with FSAMs and third party Remounters of ambulances in an effort to collect information that may be used in an identified project to create standards for the ambulance remount industry.
Any organization with interest in this topic is invited to attend, including ambulance builders, remounters, regulators, customers and component/material vendors.
This is an information gathering session only. Input from this meeting will be for the use of the GVS Committee once a remount standard project has been defined and scheduled. No decisions will be made or standards created at this meeting.
The meeting will be held on June 7, 2017, from 12:00 pm-5:00 pm EDT, at the Harris Conference Center in Charlotte, NC.
Pre-registration for the meeting will be required. Additional information and a registration link can be found on the www.groundvehiclestandard.org website.
Use the Savvik Buying Group Discount included with your AAA membership to purchase ZOLL products and save big! Simply ask your ZOLL sales representative to apply the Savvik contract rates to your next purchase.
Ask your ZOLL rep to use the AAA’s Savvik Buying Group contract to receive these savings.
For more information or to contact your local sales manager or by visiting the ZOLL corporate website at http://www.zoll.com.