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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.
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.
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
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:
- Use of warning lights and siren in emergency medical vehicle response and patient transport. Prehosp and Disaster Med. 1994;9(2):133-136.
- Grant CC, Merrifield Analysis of ambulance crash data. The Fire Protection Research Foundation. 2011. Quincy, MA.
- 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.
- Ray AF, Kupas DF. Comparison of crashes involving ambulances with those of similar-sized vehicles. Prehosp Emerg Care. 2005;9(4):412-415.
- S. Fire Administration. Firefighter fatalities in the United States in 2013. 2014. Emmitsburg, MD.
- Maguire Transportation-related injuries and fatalities among emergency medical technicians and paramedics.
Prehosp Disaster Med. 2011;26(5): 346-352.
- Maguire BJ, Hunting KL, Smith GS, Levick Occupational fatalities in emergency medical services: A hidden crisis.
Ann Emerg Med, 2002;40: 625-632.
- 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.
- Clawson JJ, Martin RL, Cady GA, Maio RF. The wake effect: emergency vehicle-related collisions. Prehosp Disaster Med. 1997; 12 (4):274-277.
- 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
- 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.
- 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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NASEMSO | Evidence Based Guidelines for Prehospital Pain Management
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Wall Time Toolkit
Extended ambulance patient offload times (APOT), or “wall times,” at hospitals are causing long waits for 911 and interfacility patients and exacerbating the EMS workforce shortage. Ambulance services across the country are continually trying to meet demand with fewer resources; when EMS providers are kept out of service for extended periods of time because they are unable to transfer patient care at the hospital, wait times for both 911 and inter-facility patients increase and both emergency and non-emergency calls pile up.
We recognize that the issue of extended wall times is not new, but an existing problem exacerbated by the ongoing battle with COVID-19 across the country. Increased wall times are a symptom of a much larger problem for which there is no easy solution.
This toolkit will provide an overview of EMTALA, highlight the intersection between EMTALA and APOT, and address some frequently asked questions along with links to resources and examples of how services are addressing this issue across the country.
EMTALA – Emergency Medical Treatment and Labor Act
Summary of Major Provisions
- The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that was enacted as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 (42 U.S.C. §1395dd).
- EMTALA provides that when an individual comes to an emergency department, he/she/they must be stabilized and treated, regardless of their insurance status or ability to pay.
- EMTALA is often referred to as the “anti-dumping” law and was designed to prevent hospitals from transferring uninsured or Medicaid patients to another hospital without, at a minimum, providing a medical screening examination to ensure they were stable for transfer.
- EMTALA requires the hospital to provide a screening examination to determine if an emergency medical condition exists and, if so, provide stabilizing treatment to resolve the patient’s emergency medical condition.
- EMTALA requires Medicare-participating hospitals with emergency departments to screen and treat the emergency medical conditions of patients in a non-discriminatory manner to anyone, regardless of their ability to pay, insurance status, national origin, race, creed, or color.
EMTALA & Ambulance Patient Offloading Times (APOT)
- EMS agencies have been struggling with extended Emergency Department patient offload times. This has been exacerbated over the last few years of the COVID-19 pandemic.
- This has impacted the ability of EMS agencies to provide services and respond to ambulance service requests. Additionally, it is impacting many public safety agencies that are responding to medical emergencies.
- Centers for Medicare & Medicaid Services (CMS) issued a memorandum on extended ambulance patient offload times and EMTALA in July 2006.
- In the memorandum, CMS noted “Many of the hospital staff engaged in such practice believe that unless the hospital “takes responsibility” for the patient, the hospital is not obligated to provide care or accommodate the patient”
- CMS stated that this practice may result in a violation of the Emergency Medical Treatment and Labor Act (EMTALA) and “raises serious concerns for patient care and the provision of emergency services in a community.”
- Additionally, CMS notes that this practice may also result in a violation of 42 CFR 482.55, the Conditions of Participation for Hospitals for Emergency Services, which requires that a hospital meet the emergency needs of patients in accordance with acceptable standards of practice.
- EMTALA defines[1] when a patient “presents” at an emergency department in the following way:
(1) Has presented at a hospital’s dedicated emergency department, as defined in this section, and requests examination or treatment for a medical condition, or has such a request made on his or her behalf. In the absence of such a request by or on behalf of the individual, a request on behalf of the individual will be considered to exist if a prudent layperson observer would believe, based on the individual’s appearance or behavior, that the individual needs examination or treatment for a medical condition;
(2) Has presented on hospital property, as defined in this section, other than the dedicated emergency department, and requests examination or treatment for what may be an emergency medical condition, or has such a request made on his or her behalf. In the absence of such a request by or on behalf of the individual, a request on behalf of the individual will be considered to exist if a prudent layperson observer would believe, based on the individual’s appearance or behavior, that the individual needs emergency examination or treatment;
(3) Is in a ground or air ambulance owned and operated by the hospital for purposes of examination and treatment for a medical condition at a hospital’s dedicated emergency department, even if the ambulance is not on hospital grounds. However, an individual in an ambulance owned and operated by the hospital is not considered to have “come to the hospital’s emergency department” if –
(i) The ambulance is operated under communitywide emergency medical service (EMS) protocols that direct it to transport the individual to a hospital other than the hospital that owns the ambulance; for example, to the closest appropriate facility. In this case, the individual is considered to have come to the emergency department of the hospital to which the individual is transported, at the time the individual is brought onto hospital property;
(ii) The ambulance is operated at the direction of a physician who is not employed or otherwise affiliated with the hospital that owns the ambulance; or
(4) Is in a ground or air nonhospital-owned ambulance on hospital property for presentation for examination and treatment for a medical condition at a hospital’s dedicated emergency department. However, an individual in a nonhospital-owned ambulance off hospital property is not considered to have come to the hospital’s emergency department, even if a member of the ambulance staff contacts the hospital by telephone or telemetry communications and informs the hospital that they want to transport the individual to the hospital for examination and treatment. The hospital may direct the ambulance to another facility if it is in “diversionary status,” that is, it does not have the staff or facilities to accept any additional emergency patients. If, however, the ambulance staff disregards the hospital’s diversion instructions and transports the individual onto hospital property, the individual is considered to have come to the emergency department.
[1] 42 CFR § 489.24(b) – Special responsibilities of Medicare hospitals in emergency cases.
APOT Strategies
- EMS agencies who are experiencing extended ambulance patient offload times should engage the hospital leadership to collaborate to identify possible solutions. Often, we assume that the hospital leadership is aware that the EMS crews are being held for extended periods of time. Also, the hospital may not understand how APOT is impacting your organization and the overall EMS and public safety response. Emphasize that EMS is one piece of a larger EMS system.
- EMS agencies should consider educating or reminding the hospital leadership about their obligations under EMTALA.
- Consider placing a transfer coordinator or another member of your staff to stay with patients during the transition between EMS and ED care. The EMS agency is under no obligation to do this and could set a precedent or expectation by the hospital that extended APOT is the EMS agency’s responsibility. However, it may serve to free up valuable EMS resources.
EMTALA & APOT Frequently Asked Questions
- Are EMS personnel required to remain with the patient until an emergency department personnel “accept” report or “takes over care” of the patient?
Answer: No, the EMS crew is not legally required to remain with the patient until the hospital personnel take a report or take over patient care. As the EMTALA provisions above cite, the EMS crew may choose to remain with the patient but, as soon as that patient arrives on hospital property or enters the emergency department, the hospital is legally responsible for the patient.
- What if the patient’s condition requires constant attention and the patient cannot be left alone without causing the patient harm?
Answer: If the patient’s condition dictates that the patient cannot be safely left alone, the crew would have an ethical obligation to continue to care for the patient until care can be safely transferred to the appropriate caregiver. The EMS crew should continue to provide patient care and should contact a supervisor or Officer in Charge (OIC) at their agency to inform them of the situation and request assistance with facilitating the transfer of care.
- What do I do if the emergency department staff fail/refuse to take a report or take over care of the patient?
Answer: The EMS crew should attempt to provide a verbal report to an emergency department staff member if possible. If no one is available, or the hospital staff will not make someone available to take a verbal report, the crew should tell an ED staff member that the EMS crew will be leaving the patient, where the patient was left and the patient’s general condition. EMS providers should document how long they waited after arriving at the ED, where they left the patient, which ED staff member they notified, and the patient’s condition when they left in their patient care report. EMS providers should be sure to leave a copy of their patient care report or an abbreviated patient care report with the hospital staff or with the patient.
In some states, extended APOT may be reportable to the state-level oversight agency, such as the state EMS Office or the Department of Public Health.
If hospitals are unresponsive to the initial conversation, you could also consider escalating the issue to your State Survey Agency, the agency primarily charged with taking EMTALA complaints.
We have created a draft letter for use in communicating with your State Survey Agency; be sure to update the draft letter to include specific examples and data that illustrate the particular issues your service is facing and the steps you’ve taken to try and resolve the issue so far.
- Can I be accused of patient abandonment if I leave a patient in the ED without a member of the ED staff taking over the care of the patient?
Answer: Because the legally becomes the hospital’s responsibility upon arrival on hospital property or upon arrival in the ED, it is highly unlikely that a claim of abandonment could be sustained. The most important thing EMS providers can do is to exercise reasonable care of the patient before, upon, and after arrival at the ED. EMS providers who reasonably attempt to furnish a report to the ED staff or who ensure that the patient can be safely left at the ED with either an abbreviated or full patient care report will likely be protected from liability.
Additional Resources
Best Practices for Mitigating Ambulance ED Delays webinar
California Emergency Medical Services Authority Ambulance Patient Offload Time (APOT) webpage
Statewide Method of Measuring Ambulance Patient Offload Times
State Survey Agency Directory
This is the agency primarily charged with receiving EMTALA complaints.
Wall time Collaborative a partnership to reduce ambulance patient off-load delays
presentation from 2013
In the News:
EMS crews forced to wait hours to drop patients at overwhelmed hospitals
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.
HRSA Federal Office of Rural Health Policy Updates
From HRSA’s Federal Office of Rural Health Policy
What’s New
HRSA Rural Public Health Workforce Training Network Program – applications due March 18. HRSA anticipates awards for more than 30 community-based organizations that will join an effort to train and place public health professionals in rural and tribal areas. Eligible applicants include minority-serving institutions of higher education, Critical Access Hospitals, community health centers, nursing homes, Rural Health Clinics, substance use providers, and state or local workforce development boards. Each grantee will receive approximately $1.5 million for a three-year project. FORHP will hold a webinar for applicants on Wednesday, January 5 at 1:00 pm ET. For those unable to view online, see the Events section below for dial-in information.
HRSA Rural Residency Planning and Development (RRPD) Program – deadline extended until January 11. The Health Resources and Services Administration (HRSA) revised the program sustainability requirements and extended the deadline for RRPD grant applications. Applicants should review the changes and can resubmit their applications if needed. HRSA will only review your last submitted application. This program aims to increase opportunities for physicians to train in rural residencies. A total of $10.5 million will develop 14 new rural residency programs accredited by the Accreditation Council on Graduate Medical Education (ACGME). Eligible applicants include rural hospitals, GME consortiums, and tribal organizations. For questions, email RuralResidency@hrsa.gov.
HRSA Small Health Care Provider Quality Improvement Program Funding Opportunity – applications due March 21. HRSA will be making approximately 40 awards of up to $200,000 each to support the planning and implementation of quality improvement activities in rural communities. Applicants must be rural domestic public or private nonprofit entities with demonstrated experience serving, or the capacity to serve, rural underserved populations in a HRSA-designated rural area. FORHP will hold a technical assistance webinar for applicants via Zoom on Wednesday, January 26, 2022 from 2-3 p.m. ET. A recording will be available for those who cannot attend.
Share Your Experiences on Rural Emergency Preparedness and Response. The Rural Health Information Hub (RHIhub) wants to hear about how rural communities, health care facilities, public health departments, first responders, tribes, rural serving organizations, and others have had to adapt, collaborate, and innovate in the face of disasters and public health emergencies. They are looking for examples of lessons learned, successes, challenges, or other helpful information to highlight related to emergency preparedness, response, and recovery for a variety of disasters. Examples will be shared in an emergency preparedness toolkit on the RHIhub website.
Spread the Word About Vaccine Boosters. The U.S. Department of Health & Human Services released new resources – posters, flyers, videos, and talking points – to help promote the extra protection from COVID-19 boosters. All vaccinated adults aged 18+ are eligible for a booster. Search by zip code to find nearby locations providing adult and pediatric vaccines and boosters for COVID-19 and the flu at vaccines.gov.
Ongoing: HRSA Payment Program for RHC Buprenorphine-Trained Providers. In June 2021, HRSA launched an effort to improve access to substance use disorder treatment by paying for providers who are waivered to prescribe buprenorphine, a medication used to treat opioid use disorder. Rural Health Clinics (RHCs) still have the opportunity to apply for a $3,000 payment on behalf of each provider who trained to obtain the waiver necessary to prescribe buprenorphine after January 1, 2019. Approximately $1.5 million in program funding remains available for RHCs and will be paid on a first-come, first-served basis until funds are exhausted. Send questions to DATA2000WaiverPayments@hrsa.
COVID-19 Resources
NARHC Assistance with Federal Programs for COVID-19 Testing, Vaccine Distribution, and Provider Relief Fund. The National Association of Rural Health Clinics (NARHC) has background information and guidelines in its collection of technical assistance webinars for all COVID-related programs designated for Rural Health Clinics.
Federal Office of Rural Health Policy Resources for COVID-19. A set of Frequently Asked Questions (FAQs) from our grantees and stakeholders.
Rural Health Clinic Vaccine Distribution (RHCVD) Program. Under the program, Medicare-certified RHCs will receive direct COVID-19 vaccines in addition to their normal jurisdictions’ weekly allocation. Contact RHCVaxDistribution@hrsa.gov for more information.
Community Toolkit for Addressing Health Misinformation. The new resource asks for participation from individuals, teachers, school administrators, librarians, faith leaders, and health care professionals to understand, identify, and stop the spread of misinformation. The toolkit includes common types of misinformation and a checklist to help evaluate the accuracy of health-related content.
Online Resource for Licensure of Health Professionals. As telehealth usage increased during the pandemic, FORHP funded new work with the Association of State and Provincial Psychology Boards to reduce the burden of multi-state licensure. The site provides up-to-date information on emergency regulation and licensing in each state for psychologists, occupational therapists, physical therapists assistants, and social workers.
HRSA COVID-19 Coverage Assistance Fund. HRSA will provide claims reimbursement at the national Medicare rate for eligible health care providers administering vaccines to underinsured individuals.
HHS Facts About COVID Care for the Uninsured. The U.S. Department of Health & Human Services (HHS) helps uninsured individuals find no-cost COVID-19 testing, treatment, and vaccines. The HRSA Uninsured Program provides claims reimbursement to health care providers generally at Medicare rates for testing, treating, and administering vaccines to uninsured individuals, including undocumented immigrants. There are at-a-glance fact sheets for providers and for patients in English and Spanish.
CDC COVID-19 Updates. The Centers for Disease Control and Prevention (CDC) provides daily updates and guidance, including a section specific to rural health care, COVID-19 Vaccination Trainings for new and experienced providers, and Tips for Talking with Patients about COVID-19 Vaccination.
HHS/DoD National Emergency Tele-Critical Care Network. A joint program of the U.S. Department of Health & Human Services (HHS) and the U.S. Department of Defense (DoD) is available at no cost to hospitals caring for COVID-19 patients and struggling with access to enough critical care physicians, nurses, respiratory therapists, and other specialized clinical experts. Teams of critical care clinicians are available to deliver virtual care through telemedicine platforms, such as an app on a mobile device. Hear from participating clinicians, and email to learn more and sign up.
Mobilizing Health Care Workforce via Telehealth. ProviderBridge.org was created by the Federation of State Medical Boards through the CARES Act and the FORHP-supported Licensure Portability Grant Program. The site provides up-to-date information on emergency regulation and licensing by state as well as a provider portal to connect volunteer health care professionals to state agencies and health care entities.
New: Reaching Farm Communities for Vaccine Confidence. The AgriSafe Network is a nonprofit organization that provides information and training on injury and disease related to agriculture. Their health professionals and educators created a social media toolkit that aims to provide clear messages about COVID-19 vaccination for agriculture, forestry, and fishing workers.
Funding and Opportunities
SAMHSA Grants for Rural Emergency Medical Services Training – February 14. The Substance Abuse and Mental Health Services Administration (SAMHSA) will make 27 awards of up to $200,000 each to recruit and train emergency medical services (EMS) personnel with a focus on mental and substance use disorders. Eligible applicants are rural EMS agencies operated by a local or tribal government and non-profit EMS agencies.
Policy Updates
Send questions to ruralpolicy@hrsa.gov.
Medicare Rule Adds 1,000 Physician Residency Slots and Other GME Policies. Last week, the Centers for Medicare & Medicaid Services (CMS) finalized several graduate medical education (GME) proposals that will enhance the health care workforce and fund additional medical residency positions in hospitals serving rural and underserved communities. This Fiscal Year 2022 Medicare Inpatient Hospital Payment Final Rule adds 1,000 new Medicare-funded residency positions prioritizing hospitals that serve areas with the greatest needs. It also allows new opportunities for rural teaching hospitals participating in an accredited rural training track to increase their full time equivalent (FTE) caps. The rule also allows hospitals beginning a new medical residency training program to reset their FTE caps and per-resident amounts under qualifying circumstances. Rural hospitals seeking a cap reset must start new residency training programs by December 2025. Finally, CMS seeks comments on alternative methods to prioritize additional FTE resident cap slots and the review process to determine eligibility for per resident amounts or FTE cap resets in specified situations.
CMS Suspends Enforcement of Vaccine Mandate While Court Ordered Injunctions Remain in Effect (pdf). This month, CMS issued a memo to State Survey Agency Directors indicating that the agency will not enforce the new rule stipulating vaccination for health care workers in certified Medicare/Medicaid providers and suppliers (including nursing facilities, hospitals, dialysis facilities and all other provider types covered by the rule). Health care facilities may voluntarily choose to comply with the Interim Final Rule at this time.
Learning Events and Technical Assistance
Assistance for Rural Public Health Workforce Funding Applications – Wednesday, January 5 at 1:00 pm ET. FORHP will hold a one-hour webinar via Zoom for those applying for the Rural Public Health Workforce Training Network Program. Applications are due March 18th for the grant that will invest $48 million to place newly trained public health professionals in rural areas. To dial in: 1-833-568-8864; Participant Code: 86083981. Contact RPHWTNP@hrsa.gov for more information or a recording of the webinar.
Resource of the Week
Federally Qualified Health Centers and the Health Center Program. This recently updated topic guide at the Rural Health Information Hub includes new FAQs on Medicare reimbursement for telehealth services, insight on financial and operational performances of health centers, and the differences between a Federally Qualified Health Center and a Rural Health Clinic.
Approaching Deadlines
Last Day for RHCs to Spend COVID-19 Testing Funds – December 31
Department of Labor Stand Down Grants for Veterans Services – December 31
USDA Guaranteed Loans for Rural Rental Housing – December 31
COVID-19 Extension for Medicare Graduate Medical Education (GME) Affiliation Agreement – January 1
Treasury Department New Markets Tax Credit Program – January 3
CDC Grants for New Investigators/Research for Interpersonal Violence Impacting Children/Youth – January 4
HRSA Family-to-Family Health Information Centers (F2F HICs) – January 5
NIHB/CDC Building Capacity for Tribal Infection Control – January 7
Nominations Sought for Indigenous Health Equity Committee – extended to January 7
NIH Research for AI/AN End-of-Life Care – January 8
Burroughs Wellcome Fund Seed Grants for Climate Change and Health – January 10
USDA Farm to School Grants – January 10
HHS Grants for Family Planning Services – January 11
HRSA Rural Residency Planning and Development (RRPD) Program – extended to January 11
HRSA Nurse Corps Loan Repayment Program – January 13
HRSA Nurse Faculty Loan Program – January 13
HRSA Rural Communities Opioid Response Program – Implementation – January 13
SAMHSA Grants for Rural Emergency Medical Services Training – February 14
CDC Research on Telehealth Strategies for PrEP and ART – January 18
Comments Requested: DEA Regulation of Telepharmacy Practice – January 18
NIH Researching Behavioral Risk Factors for Cancer in Rural Populations – January 18
Department of Labor YouthBuild Program – January 21
CDC Centers for Agricultural Safety and Health – January 24
ACL Empowering Communities for Chronic Disease Self-Management – January 25
ACL Empowering Communities to Deliver and Sustain Falls Prevention Programs – January 25
CDC Seeking Public Input on Work-Related Stress for Health Workers – Extended to January 25
HRSA Delta Region Rural Health Workforce Training Program – January 25
CDC Cancer Prevention and Control for State, Territorial, and Tribal Organizations – January 26
HRSA Access to HIV Services for Women and Children – January 28
HRSA Rural Health Network Development Planning Program – January 28
HHS COVID-19 and Health Equity Impact Fellowship – extended to January 31
HHS Technology Challenge for Racial Equity in Postpartum Care – January 31
HRSA Centers of Excellence for Training Minorities in Health Professions – January 31
SAMHSA-American Psychiatric Association Diversity Leadership Fellowship – January 31
HRSA Leadership Education in Adolescent Health – February 1
Indian Health Service Forensic Healthcare Services for Domestic Violence Prevention – February 2
Indian Health Service Substance Abuse and Suicide Prevention Program – February 2
Indian Health Service Zero Suicide Initiative – February 2
National Health Service Corps Loan Repayment Programs – Extended to February 3
CDC Research to Prevent Firearm-Related Violence and Injuries – February 4
RWJF Summer Health Professions Education Program for Underrepresented Minorities – February 5
HRSA Predoctoral Training in Public Health Dentistry and Dental Hygiene – February 7
SAMHSA Harm Reduction Program – February 7
VA Supportive Services for Veteran Families – February 7
USDA Farm and Food Worker Relief Grants – February 8
IHS Tribal Self-Governance Negotiation – February 10
IHS Tribal Self-Governance Planning – February 10
CDC Strengthening Infection Prevention – February 11
CDC Evaluating Substance Use Prevention Incorporating ACEs Prevention – February 22
HRSA Mobile Health Training – Nurse Education, Practice, Quality and Retention – February 22
USDA Rural eConnectivity Broadband Loan and Grant Program – February 22
Rural Communities Opioid Response Program-Behavioral Health Care Technical Assistance (RCORP-BHCTA) – March 9
HRSA Rural Public Health Workforce Training Network Program – March 18
HRSA Small Health Care Provider Quality Improvement Program – March 21
FCC/USAC Rural Health Care Connect Fund – April 1
FCC/USAC Telecommunications Program – April 1
USDA Local Food Purchase Assistance Program – April 5
Ongoing Opportunities
HHS/DoD National Emergency Tele-Critical Care Network
Extended Public Comment Period for FCC’s COVID-19 Telehealth Program
FCC Emergency Broadband for Individuals and Households
FEMA COVID-19 Funeral Assistance
HRSA Payment Program for Buprenorphine-Trained Clinicians – Until Funds Run Out
AgriSafe Nurse Scholar Program – March 2022
AHRQ Health Services Research Demonstration and Dissemination Grants – September 2022
AHRQ Research to Improve Patient Transitions through HIT – December 2022
American Indian Public Health Resource Center Technical Assistance
ASA Rural Access to Anesthesia Care Scholarship
Burroughs Wellcome Fund Seed Grants for Climate Change and Health – Quarterly through August 2023
CDC Direct Assistance to State, Tribal, Local, and Territorial Health Agencies
CDC Training Pediatric Medical Providers to Recognize ACEs
Delta Region Community Health Systems Development Program
Department of Commerce American Rescue Plan Funding for Indigenous Communities – September 2022
Department of Commerce: Economic Development Assistance Programs
Department of Labor Dislocated Worker Grants
DRA Technical Assistance for Delta Region Community Health Systems Development
EPA Drinking Water State Revolving Fund
FEMA/SAMHSA Crisis Counseling Assistance and Training Program (CCP)
GPHC & RWJF: Rapid Cycle Research and Evaluation Grants for Cross-Sector Alignment
HRSA Technical Assistance for Look-Alike Initial Designation for the Health Center Program
Housing Assistance Council: Housing Loans for Low-Income Rural Communities
HUD Hospital Mortgage Insurance Program
IHS Tribal Forensic Healthcare Training
IHS/DOD Medical Supplies and Equipment for Tribes (Project TRANSAM)
NARHC Certified Rural Health Clinic Professional Course
NIH Project Talk Initiative Host Site Applications
NIH Dissemination and Implementation Research in Health – May 2022
NIH Practice-Based Research for Primary Care Suicide Prevention – June 2022
NIH Research – Alcohol and Other Substance Use – Various Dates Through August 2022
NIH Research: Intervening with Cancer Caregivers to Improve Patient Outcomes – September 8, 2022
NIH Research on Minority Health/Health Disparities – September 8, 2022
NIH Research on Palliative Care in Home/Community Settings – September 8, 2022
NIH Intervention Research to Improve Native American Health – Various Dates Until September 2023
NIH Researching the Role of Work in Health Disparities – Various Dates Until September 2024
NIH Special Interest Research – Pandemic Impact on Vulnerable Children and Youth – May 2024
Nominations for National Advisory Committee on Migrant Health
Primary Care Development Corporation Community Investment Loans
Rural Graduate Medical Education Planning and Development
RWJF Investigator-Initiated Research to Build a Culture of Health
RWJF Pioneering Ideas Brief Proposals
SBA Guaranteed Loans for Small Business
Southeast Rural Community Assistance Loans
USDA Community Facilities Program
USDA Community Food Projects Technical Assistance
USDA Drinking Water and Waste Disposal for Rural and Native Alaskan Villages
USDA Economic Impact Initiative Grants
USDA Emergency Community Water Assistance Grants
USDA Healthy Food Financing Initiative Technical Assistance
USDA Intermediary Relending Program
USDA Rural Business Development Grants
USDA Rural Business Investment Program
USDA Rural Energy Savings Program
USDA Technical Assistance for Healthy Food Financing Initiative
USDA Telecommunications Infrastructure Loans
USDA Funding for Rural Water and Waste Disposal Projects
USDOT Rural Opportunities to Use Transportation for Economic Success (R.O.U.T.E.S)
The Announcements from the Federal Office of Rural Health Policy are distributed weekly. To receive these updates, send an email with “Subscribe” in the subject line.
Federal Court Enjoins the Federal Contractor Vaccine Mandates in KY, OH, TN
Please either or Join!
HHS/ASPR Project ECHO COVID-19 Clinical Rounds
From HHS/ASPR – Project ECHO COVID Clinical Rounds
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EMS.gov | Template Protocol for EMS Administration of Monoclonal Antibodies
From EMS.gov on August 27, 2021
To assist EMS agencies in planning, the NHTSA Office of EMS and HHS Office of the Assistant Secretary for Preparedness and Response have developed a template protocol for state EMS offices and EMS Medical Directors to use to assist in these programs. Some states have created blanket state-level authorizations for EMS administration; some states will still require provider authorization prior to administration. Please follow local protocols and regulations. This template is only designed to facilitate the development of those local protocols as needed. Please contact the NHTSA Office of EMS with any questions.
CMS Releases Medicare COVID-19 Vaccine Data Analysis and PUF
From CMS on August 25, 2021
Today, the Centers for Medicare & Medicaid Services (CMS) released two new resources with information on Medicare beneficiaries on whose behalf at least one fee-for-service (FFS) claim for the administration of the COVID-19 vaccine has been submitted to the Medicare program.
First, we released a paper titled Assessing the Completeness of Medicare Claims Data for Measuring COVID-19 Vaccine Administration. This paper presents preliminary findings on the count of individuals ages 65 and older with at least one COVID-19 vaccine administration claim in the Medicare data compared to the count of people 65+ with at least one COVID-19 vaccine dose in the data reported by the Centers for Disease Control and Prevention (CDC). Using data as of June 4th, 2021, we estimate that CMS received a claim for COVID-19 vaccine administration for roughly half of Medicare beneficiaries who have received at least one COVID-19 vaccine dose as compared to the estimated counts based on adjusted CDC figures (17.5 million out of 36.6 million). As a result, we recommend that the public apply significant caution when analyzing COVID-19 vaccine administration trends using Medicare claims data.
Second, we released the Medicare COVID-19 Vaccine Public Use File (PUF) which presents a high-level and preliminary overview of Medicare utilization and spending information from Medicare FFS claims for the administration of the COVID-19 vaccine. The PUF shows that between December 11, 2020 and June 30, 2021, Medicare payments for administration of the COVID-19 vaccine were over $1.1 billion. The PUF is based on Medicare FFS claims CMS received by August 6, 2021.
[Note: The Medicare FFS program is paying for COVID-19 vaccine administration on behalf of MA beneficiaries as well as for FFS beneficiaries receiving COVID-19 vaccinations in 2020 and 2021.]
EMS.gov | Information About COVID-19 for EMS Systems and Clinicians
From EMS.gov
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Monkeypox & COVID-19 Resources for EMS Clinicians
From EMS.Gov
Monkeypox Resources for EMS Clinicians
The arrival of an individual in the United States who was diagnosed with monkeypox, as well as the uptick in COVID-19 cases, are reminders that EMS clinicians must remain vigilant and prepared. The CDC is conducting contact tracing of the monkeypox case and local public health departments have been notified, and it is unlikely that EMS clinicians will be exposed to the monkeypox virus is low. However, reviewing information about the disease may still be helpful.
COVID-19 Resources for EMS
Low vaccination rates, the highly contagious delta variant, and increased social interaction has caused significant increases in rates of COVID-19 and related hospitalizations in many communities around the nation. The NHTSA Office of EMS continues to make resources available to help EMS clinicians, organizations and regulators safely maintain operations during the pandemic. Those resources are available on the EMS.gov COVID-19 Resources Page.
EICC Pediatric Emergency Champion Program
From the Emergency Medical Services for Children Innovation and Improvement Center
September 1, 2021 – June 30, 2022
Purpose
This collaborative will develop individuals who are interested in improving the quality of pediatric care at your EMS agency, ED/hospital, or within your region. We will provide resources, example practices and networking opportunities at no cost to help push forward any effort for pediatric improvement.
What is a PECC?
A Pediatric Emergency Care Coordinator (PECC)–sometimes referred to as a pediatric champion or pediatric liaison–is a term that the EMSC program uses to refer to any individual who has a particular interest in or responsibilities related to pediatric emergency care. Sometimes this individual is dedicated solely to this role. However, depending on the pediatric volume of the EMS agency or hospital, this person may take on the PECC duties in addition to other responsibilities (e.g., educator, trauma coordinator, etc.). Various roles and responsibilities are often given to a PECC but common responsibilities include ensuring the availability of pediatric equipment, supplies and medications, pediatric education/training and advocating for pediatric considerations to be included in protocol/policy development.
Who should participate
Anyone that is interested in improving pediatric readiness within your EMS agency, ED/hospital, or within your region, to include EMSC State Partnership Programs. You do NOT need to have any formal pediatric training, or a title related to pediatric care. You already have everything you need to participate…an interest in pediatric emergency care
Why join?
We know that the presence of an individual with an interest in pediatric emergency care is strongly correlated with improved outcomes for children. No effort to improve pediatric emergency care is too small to make an impact. This collaborative will have a broad scope. No matter where your starting point is, we will provide you with tools to improve. There is no cost to participate, and you will have the opportunity to earn continuing education or Maintenance of Certification Part 4 credit. Learn more…
How it works
The collaborative will occur in two parts. During the first half, we will explore seven pediatric readiness areas of focus, evaluate your agency or ED/hospital level of pediatric readiness, and identify areas for improvement. In the second half, we provide coaching and tools to help you develop an improvement project. Learn more…
Location
All collaborative activates will be conducted online and through virtual meetings.
Study | Increasing Pediatric Care Coordination and Psychomotor Skills Evaluation
Thank you to Dr. John Russell of Cape County Private Ambulance for sharing this resource.
Ready for Children Part II: Increasing Pediatric Care Coordination and Psychomotor Skills Evaluation in the Prehospital Setting
(2021) Ready for Children Part II: Increasing Pediatric Care Coordination and Psychomotor Skills Evaluation in the Prehospital Setting, Prehospital Emergency Care, DOI: 10.1080/10903127.2021.1942340
Abstract
Objectives: Treating pediatric patients often invokes discomfort and anxiety among emergency medical service (EMS) personnel. As part of the process to improve pediatric care in the prehospital system, the Health Resources and Services Administration (HRSA) Emergency Services for Children (EMSC) Program implemented two prehospital performance measures -access to a designated pediatric care coordinator (PECC) and skill evaluation using pediatric equipment-along with a multi-year plan to aid states in achieving the measures. Baseline data from a survey conducted in 2017 showed that less than 25% of EMS agencies had access to PECC and 47% performed skills evaluation using pediatric equipment at least twice a year. To evaluate change over time, the survey was again conducted in 2020, and agencies that participated in both years are compared.
Methods: A web-based survey was sent to EMS agency administrators in 58 states and territories from January to March 2020. Descriptive statistics, odds ratios, and 95% confidence intervals were conducted.
Results: The response rate was 56%. A total of 5,221 agencies participated in both survey periods representing over 250,000 providers. The percentage of agencies reporting the presence of a PECC increased from 24% to 34% (p= <0.001). However, some agencies reported that they no longer had a PECC, while others reported having a PECC for the first time. Fifty percent (50%) of agencies conduct pediatric psychomotor skills evaluation at least twice/year, a 2% increase over time (p = 0.041); however, a third (34%) evaluate skills using pediatric equipment less than once a year. The presence of a PECC continues to be the variable associated with the highest odds (AOR 2.15, 95% CI 1.91–2.43) of conducting at least semiannual skills evaluation.
Conclusions: There is an increase in the presence of pediatric care coordination and the frequency of pediatric psychomotor skills evaluation among national EMS agencies over time. Continued efforts to increase and sustain PECC presence should be an ongoing focus to improve pediatric readiness in the prehospital system.