US News: AAA, NAEMT, IAFC Urge PPE for First Responders

WaPo: SNS Nearly Depleted

By Nick Miroff, Washington Post |  April 1, 2020 at 10:00 p.m. EDT

The government’s emergency stockpile of respirator masks, gloves and other medical supplies is running low and is nearly exhausted due to the coronavirus outbreak, leaving the Trump administration and the states to compete for personal protective equipment in a freewheeling global marketplace rife with profiteering and price-gouging, according to Department of Homeland Security officials involved in the frantic acquisition effort.

Read the full article►

CMS Waives Restrictions on Ground Ambulances During COVID-19 Pandemic

The Centers for Medicare and Medicaid Services (CMS) promulgated an interim final rule with comment period (IFC) entitled “Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency.”  Consistent with the recommendations the AAA made to CMS, for the duration of the public health emergency (PHE), the IFC allows ground ambulance service providers and suppliers to transport patients both on an emergency or non-emergency basis to any destination that is equipped to treat the condition of the patient consistent with Emergency Medical Services (EMS) protocols established by state and/or local laws where the services will be furnished.  In related guidance, CMS has suspended most Medicare Fee-For-Service (FFS) medical review during the emergency period due to the COVID-19 pandemic, waived patient signature requirements, and is pausing the Repetitive, Scheduled Non-Emergent Ambulance Transport Prior Authorization Model. The policies of the IFC are effective retroactively to March 1, 2020.

On March 11, the AAA sent CMS a letter specifically requesting for the agency to waive during the COVID-19 pandemic the regulatory restrictions that prevent coverage for transport to alternative destinations.  Separately, the AAA has been pressing CMS to provide relief from signature requirements. The AAA had also been working with CMS to lifting of these restrictions and others to eliminate barriers the current Medicare regulations in responding to the COVID-19 crisis.

Paying for Transports to Alternative Destinations.  During the duration of the crisis, CMS has expanded the list of destinations for which Medicare covers ambulance transportation to include all destinations, from any point of origin, that are equipped to treat the condition of the patient consistent with Emergency Medical Services (EMS) protocols established by state and/or local laws where the services will be furnished.

These destinations may include, but are not limited to: any location that is an alternative site determined to be part of a hospital, critical access hospital (CAH) or skilled nursing facility (SNF), community mental health centers, federal qualified health clinic (FQHCs), rural health clinics (RHCs), physicians’ offices, urgent care facilities, ambulatory surgery centers (ASCs), any location furnishing dialysis services outside of an ESRD facility when an ESRD facility is not available, and the beneficiary’s home.

This expanded list of destinations applies to medically necessary emergency and non-emergency ground ambulance transports of beneficiaries during the PHE for the COVID-19 pandemic.  The IFC does not waive the medically necessary requirements for ground ambulance transport of a patient in order for an ambulance service to be covered.

The AAA is working closely with CMS to confirm that patients who require isolation meet the medical necessity requirements.

Suspension of Audits and Relief on Patient Signatures.  In guidance released separately, CMS indicates that it is suspending nearly all audits of providers and suppliers for the duration of the PHE.

CMS has suspended most Medicare Fee-For-Service (FFS) medical review during the emergency period due to the COVID-19 pandemic. This includes pre-payment medical reviews conducted by Medicare Administrative Contractors (MACs) under the Targeted Probe and Educate program, and post-payment reviews conducted by the MACs, Supplemental Medical Review Contractor (SMRC) reviews and Recovery Audit Contractor (RAC). No additional documentation requests will be issued for the duration of the PHE for the COVID-19 pandemic. Targeted Probe and Educate reviews that are in process will be suspended and claims will be released and paid. Current postpayment MAC, SMRC, and RAC reviews will be suspended and released from review. This suspension of medical review activities is for the duration of the PHE. However, CMS may conduct medical reviews during or after the PHE if there is an indication of potential fraud.

CMS also indicates in this guidance that a beneficiary’s signature will not be required for proof of delivery, as it relates to durable medical equipment services, during the PHE.  In a follow-up exchange with CMS, the AAA has confirmed that this policy of not requiring a beneficiary’s signature also applies to ground ambulance providers and suppliers. The AAA has requested that this clarification for ground ambulances also be provided in a written FAQ.

Pause in the Non-Emergency Prior Authorization Model.  CMS has paused the claims processing requirements for the Repetitive, Scheduled Non-Emergent Ambulance Transport Prior Authorization Model, effective March 29 until the end of the PHE.  During this pause, claims for repetitive, scheduled non-emergent ground ambulance transports for the COVID-19 pandemic in States in which the model operates will not be stopped for pre-payment review if prior authorization has not been requested by the fourth round trip in a 30-day period. During the pause, the MAC will continue to review any prior authorization requests that have already been submitted, and ambulance suppliers may continue to submit new prior authorization requests for review during the pause. Claims that have received a provisional affirmative prior authorization decision and are submitted with an affirmed unique tracking number (UTN) will continue to be excluded from future medical review. Following the end of the PHE for the COVID-19 pandemic, the MACs will conduct postpayment review on claims otherwise subject to the model that were submitted and paid during the pause.

Telehealth Services.  While CMS does not provide authority for ambulance organizations to bill directly for telehealth services, it does modify for the duration of the PHE the “direct supervision” requirements to allow physicians enter into a contractual arrangement with an entity that provides ambulance services to allow the physician to use the ambulance organization’s personnel as auxiliary personnel under a leased agreement.  Under such circumstances, the provider or supplier would seek payment for any services it provided from the billing physician and would not submit claims to Medicare for such services directly.

Ongoing work of the AAA.  The rule does not address two critical issues:  (1) reimbursement for treatment in place and (2) direct reimbursement for telehealth services.  The AAA will continue to work with CMS and the Congress to address these issues that are critical to meeting the needs of patients and your community during the epidemic.

Weekly COVID-19 Member Calls

EMS providers serve on the front lines of the COVID-19 pandemic. The American Ambulance Association is here to help! Join us for weekly interactive discussions to share best practices and insights as well as to overcome common challenges.

We look forward to facilitating the exchange of ideas and critically important information.

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Register for one or both of the calls above, then check out Zoom’s handy guide.

Not near a computer? Use the Zoom iPhone app or Zoom Android app!

NIEHS Worker Training Program COVID-19 Resources

The National Institute of Environmental Health Sciences (NIEHS) Worker Training Program (WTP) has been tracking information about the coronavirus disease 2019 (COVID-19) as it pertains to protecting workers involved in emergency response and cleanup activities performed in the United States. This page contains health and safety resources for workers who may be at risk of exposure to COVID-19.

Training Resources

The National Clearinghouse creates training tools to aid in the development of awareness-level courses or other awareness-level materials. These tools provide health and safety guidance to workers who work in industries with the potential for exposure to COVID-19.

WTP Resources

COVID-19 is a new disease and we are still learning much about it, including how it spreads. This Training Tool will be updated with new information as the situation evolves.

WTP Awardee Resources

WTP Technical Workshops

Federal Links and Documents

Centers for Disease Control and Prevention (CDC)

CDC National Institute for Occupational Safety and Health (NIOSH)

Federal Aviation Administration (FAA)

National Institutes of Health (NIH)

NIH National Institute for Allergy and Infectious Disease (NIAID)

NIH National Library of Medicine (NLM)

Occupational Safety and Health Administration (OSHA)

U.S. Department of Labor

U.S. Environmental Protection Agency (EPA)

State/Local Links and Documents

Please refer to your local and state Department of Health for additional state-specific guidance on COVID-19.

Other Links and Documents

OCR Guidance on COVID-19 and HIPAA Disclosures

Office for Civil Rights Guidance on COVID-19 and HIPAA disclosures to law enforcement, paramedics, other first responders, and public health authorities
 by Kathy Lester, J.D., M.P.H.

 On March 24, the Office for Civil Rights (OCR) released guidance clarifying that any covered entity may share the name or other identifying information of an individual who has been infected with, or exposed to, COVID-19 with law enforcement, paramedics, other first responders, and public health authorities without an individual’s authorization.  This clarification allows ground ambulance entities and their personnel to share the information consistent with the guidance.  It also allows other covered entities such as hospitals, physicians to share the information with ground ambulance entities and their personnel.  Finally, there are no HIPAA restrictions on non-covered entities, such as law enforcement, families, public health departments, and 911 call centers (not otherwise covered entities), from sharing the information.  There may be State confidentiality laws that apply as well, and the AAA encourages ground ambulance entities to review the laws in the States in which they operate.

The authority to share this information is in the existing HIPAA regulation – this is not a waiver or a change in the current law.  OCR highlights the current authority in the guidance.

  • Disclosure of PHI pursuant to treatment (45 C.F.R. § 164.506(c)(2)). Covered entities may disclose PHI to another covered entity for purposes of treatment, payment, or health care operations.  The guidance provides the example of a skilled nursing facility (SNF) disclosing PHI about a COVID-19 positive individual to emergency transport personnel who will be treating a patient during the transport of the individual to a hospital emergency department.  This is an example and not the only scenario to which the disclosure policy applies.
  • Disclosures required by law (45 C.F.R. § 164.512(a)). Covered entities may disclose PHI when such disclosure is required by law.  The guidance provides the example of a hospital disclosing PHI about a COVID-19 positive individual to public health officials when such a disclosure is required by state law.  Again, this is an example and not the only scenario to which the disclosure policy applies.
  • Disclosure to public health authorities (45 C.F.R. §§ 164.512(b)(1) & 164.501 (definition of public health authority). Covered entities may disclose PHI about a COVID-19 positive individual to a public health authority that is authorized by law to collect or receive such information for the purpose of controlling disease, injury, or disability.  The purposes include public health surveillance, public health investigations, and public health interventions.  Examples of public health authorities include the Centers for Disease Control and Prevention and state, tribal, local, and territorial public health departments).
  • Disclosures when risk of infection to a person (45 C.F.R. § 512(b)(1)(iv)).  Covered entities or public health authority may disclose to a person – including first responders – who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition, if the covered entity or public health authority is authorized by law to notify such person as necessary in the conduct of a public health intervention or investigation.  The guidance provides the example of a county health department disclosing such information to a police office to prevent or control the spread of COVID-19.  This authority would also apply to ground ambulance personnel, even though the example does not reference them specifically.
  • Disclosures to prevent or lessen a serious and imminent threat to the health and safety of a person or the public (45 C.F.R. § 164.512(j)(1)). Covered entities may disclose PHI to a person or the public to prevent or lessen a serious and imminent threat to the health and safety of a person or the public when the disclosure is made to someone the person making the disclosure believes that doing so will prevent or lessen the threat.  The guidance provides an example of disclosing COVID-19 status to firefighters, child welfare workers, mental health crisis personnel, or others – which would include ground ambulance personnel as well.  The covered entity must believe in good faith that the disclosure is necessary to prevent or minimize the threat of imminent disclosure to the person or public.
  • Disclosure to a correctional institution or law enforcement having lawful custody of an inmate or other individual under certain circumstances (45 C.F.R. § 164.512(k)(5)). Covered entities may disclose PHI related to an inmate’s positive COVID-19 status under the following circumstances:
  • Providing health care to the individual;
  • The health and safety of the individual, other inmates, officers, employees, and others present at the correctional institution, or persons responsible for the transporting or transferring of inmates;
  • Law enforcement on the premises of the correctional institution; or
  • The administration and maintenance of the safety, security, and good order of the correctional institution.

The guidance provides the example of a physician at a medical facility sharing an inmate’s positive COVID-19 status with correctional guards.

For all of these disclosures, with the exception of those that are required by law or for the purpose of treatment, the covered entity must provide the minimum amount of information necessary to accomplish the purpose.  For example, the guidance states that a hospital should not distribute a list of individuals who are COVID-19 positive or suspected to have the virus to EMS personnel, but rather disclose the information on a case-by-case basis about the specific patient being treated.  Similarly, a 911 call center that is a covered entity may provide such information to a police office or similar personnel being dispatched to the scene to allow the responder to take the necessary precautions.

The guidance also provides additional examples that reference specific types of covered entities, but these are just examples.  The laws apply to all covered entities and not just those highlighted in the examples.

NHTSA | PPE Challenges: Important Information for the First Responder Community

From NHTSA’s Office of EMS on March 25 via email.

PPE Challenges: Important Information for the First Responder Community

We are all aware of the challenges of obtaining personal protective equipment (PPE) during this pandemic. We hope this information will help address concerns and clarify the replenishment request process.

The current shortage applies to all health care disciplines – the challenges you are experiencing are being felt by your peers. As a nation, we are working very hard to address the challenges through ramped up production and distribution as resources become available. First Responders are recognized as a high priority component of the nation’s critical infrastructure. Decisions regarding PPE allocation are based on specific and identified need and are being prioritized based on those needs.

It may be helpful to reinforce to the first responder community the process for submitting your requests for resupply. It is critical that requests are submitted through the proper process.

Process:

  1. Continue to submit your request for replenishment of PPE through your normal distribution supply chain. While the supply remains limited, filling those orders will be challenging and you may not receive your entire requested order.
  2. To request supplies from state or federal resources (eg: stockpiles or reserves), you must submit those requests through your established local emergency management structure. Based on that structure in your state, your request may be then processed through the emergency management chain or through the public health chain to state level emergency management. From the state level, it will be transmitted to the federal level. Final decisions for health care material are made by HHS which will then order distribution of the material.
  3. When submitting that request, indicate the following:
    Agency
    Specific material and quantity request
    Detailed risk / exposure justification for the request
    Current on-hand requested supplies
    Burn rate of current supplies
    Other information pertinent to the request
    Alternatives that are available and risks associated with pending gaps

This information will be critical in helping to determine the reallocation plan. Please understand that your request is important and is being considered seriously in the context of similar requests from your peers. The shortage of PPE will continue to challenge the COVID-19 response. Following the appropriate process for requesting supplies will be critical to your success.

Thank you,

Jon R. Krohmer, MD, FACEP, FAEMS
Director, Office of EMS

Weekly EMS PPE Shortage Survey & Map

Help AAA and IAFC track shortages of Personal Protective Equipment! Please complete this survey WEEKLY BY NOON ET ON FRIDAYS throughout the duration of the COVID-19 pandemic.

The survey results will be used to gauge the inventory of PPE for Fire & EMS Departments and the supply chain needs.

Complete Weekly PPE Survey

Webinar: A Report From the Front Lines of the COVID-19 Response

FREE WEBINAR

A Report From the Front Lines of the COVID-19 Response

View On-Demand Webinar

Register Here▶

A Report from the Front Lines – What the 911 provider for New Rochelle, NY and the largest ambulance service provider in the U.S. have learned and what you should know to protect your staff and serve your communities

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.

View Global Medical Response’s COVID-19 resource site►

Presenters:

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.

Randy Strozyk
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.

Jim O’Connor
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.

Hanan Cohen
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.

 

CISA Guidance on Essential Critical Infrastructure Workforce

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 Now► 2020.03 Advisory Guidance on the Essential Critical Infrastructure Workforce

CMS Grants State of Florida’s 1135 Waiver Request for Coronavirus Response

On March 16, 2020, CMS approved an 1135 Waiver request submitted by the State of Florida. The State had requested the flexibility to waive prior authorization requirements, streamline its Medicaid enrollment process, and allow care to be provided in alternative settings to the extent an existing health care facility needs to be evacuated. The key provisions of the waiver are summarized below:

1. Payments to Out-of-State Providers: Under current CMS coverage guidelines, the Florida Medicaid Program had the authority to reimburse out-of-state providers that were not enrolled in the Florida Medicaid Program provided certain criteria were met. However, this authority was limited to situations involving: (a) a single instance of care furnished over a 180-day period or (b) multiple instances of care furnished to a single Florida Medicaid beneficiary over a 180-day period. Under the waiver, CMS is removing the 180-day restriction for the duration of the emergency.

2. Expedited Enrollments: With respect to providers that are not currently enrolled in the Medicare Program or with another State Medicaid Agency, CMS is waiving the following screening requirements: (a) the payment of the application fee, (b) the fingerprint-based criminal background checks, (c) the required site visits, and (d) the in-state/territorial licensing requirements. Under the waiver, the state would still be required to check enrolling providers against the OIG exclusion list, and confirm that the out-of-state provider is properly licensed in their home state.

3. Cessation of Revalidation Efforts: CMS granted Florida the authority to temporarily cease the revalidation of enrolled in-state Medicaid providers and suppliers who are directly impacted by the emergency.

4. Waiver of Prior Authorization Requirements: CMS has granted Florida the right to waive any prior authorization requirements that are currently part of the State Medicaid Plan. This waiver applies to services provided on or after March 1, 2020, and will continue through the termination of the emergency declaration.

5. Waiver Allowing Evacuating Facilities to Provide Services in Alternative Settings: CMS will allow facilities, including nursing facilities, intermediate care facilities for individuals with intellectual and developmental disabilities, psychiatric residential treatment facilities, and hospitals to be reimbursed for services rendered during an emergency evacuation to an otherwise unlicensed facility. This waiver will extend for the duration of the declared emergency; however, CMS will require the unlicensed facility to seek licensure with the state after 30 days.

Understanding Medicare, Medicaid, and SCHIP Coverage of Ambulance Services under a Declared National State of Emergency

On March 13, 2020, President Donald J. Trump announced a national state of emergency in response to the COVID-19 pandemic. Previously, HHS Secretary Alex Azar had declared a public health emergency under Section 319 of the Public Health Service Act in response to COVID-19.

This has prompted many AAA members to ask what impact, if any, these declarations have on the coverage of ambulance services under federal health care programs?

The short answer is that these declarations give CMS the authority under Section 1135 of the Social Security Act to waive certain Medicare, Medicaid, and SCHIP Program requirements. This waiver authority includes, but is not necessarily limited to:

• Waiving certain conditions of participation and/or certification requirements;
• Waiving certain pre-approval requirements;
• Waiving the requirements that a provider or supplier be licensed in the state in which they are providing services;
• Waiving EMTALA requirements related to medical screening examinations and transfers; and
• Waiving certain limitations on payments for services provided to Medicare Advantage enrollees by out-of-network providers.

One situation where an 1135 waiver may be of use to an ambulance provider or supplier would be where the ambulance provider or supplier is sending vehicles and crews to a state that is outside its normal service area. The ambulance provider or supplier is unlikely to be licensed by the state in which it is responding. As a result, under normal circumstances, it would be ineligible for payment under federal health care program rules. The 1135 waiver would permit it to submit claims for the services it furnishes in the other state.

Of more immediate significance to the current national emergency, an 1135 waiver may permit hospitals and other institutional health care providers to establish an off-site treatment center for initial screenings of patients. For example, hospitals may establish triage sites in parking lots and other open spaces for the initial intake of patients suspected of being infected with the COVID-19 virus. In theory, this waiver could also extend to drive-thru testing sites to the extent they are operated by the hospital or another health care provider. When a hospital has obtained an 1135 waiver to operate an off-site treatment center, the off-site area becomes a part of the hospital for Medicare payment purposes. Therefore, ambulance transports to an approved off-site treatment area should be submitted to Medicare using the “H” modifier for the destination.

COVID-19 Coronavirus EMS Advisory 1

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.

General Information

Background

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.

Spread and Identification

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.

COVID-19 Prevention and Treatment

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:

  • Wash your hands often with soap and water for at least 20 seconds.
  • Use an alcohol-based hand sanitizer with at least 60% if soap and water are not readily available.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Avoid contact with people who are sick.
  • Stay home when you are sick.
  • Cover your cough or sneeze with a tissue, then throw it away.
  • Clean and disinfect frequently touched objects and surfaces.

Interim Guidance for EMS and 911

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:

Recommendations for 911 PSAP Locations

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.

Recommended Personal Protective Equipment (PPE)

The CDC recommends that while involved in the direct care of patients the following PPE should be worn:

  • Single pair of disposable examination gloves
  • Disposable isolation gown
  • Respiratory protection (N95 or higher)
  • Eye Protection (goggles or disposable face shield)

EMS Transport of a Patient Under Investigation (PUI) or Patient with Confirmed COVID19

  • Notify receiving healthcare facility so appropriate precautions can be put in place
  • Discourage family and contacts from riding in transport vehicle
  • Isolate the vehicle driver from the patient compartment by closing the windows between compartments and ensuring that the vehicle ventilation system is set to the non-recirculated mode
  • Document patient care

Cleaning EMS Transport Vehicles After Transporting PUI or Patient

  • Don PPE for cleaning with disposable gown and gloves, facemask, and goggles or face shield if splashes are anticipated
  • Routine cleaning and infection procedures should follow organizational standard operating procedures
  • Use protect use products with EPA-approved emergent viral pathogens claims

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.

Employers Responsibilities

While not specific to COVID-19, agencies should:

  • Assess current practices and policies for infection control
  • Job- or task-specific education and training
  • PPE training and supply
  • Decontamination processes and supplies

Local EMS Considerations

  • PPE supplies
  • 911 and EMD call taking activities
  • Appropriate approach to potential patients
  • Educational resources for EMS personnel
  • Interaction with local public health/healthcare systems/emergency management
  • Interaction with local fire and law enforcement
  • Considerations for local jails

Further Reading

Conclusion

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.

2019 AMBY Award Winners Announced

The American Ambulance Association is proud to announce the recipients of the 2019 AMBY Awards. The AMBYs highlight excellence in EMS and the ingenuity and entrepreneurial spirit that epitomize  mobile healthcare. The mission of the awards is to showcase creativity and innovation in the ambulance industry by fostering a culture of collaboration, cooperation, and a passion for excellence in patient care. This year’s awards will be presented at the Annual Conference & Trade Show Awards Reception on November 5 in Nashville. Please join us in congratulating our 2019 winners!

Clinical Outcome Program

Medic Ambulance Service Inc.
CPR Initiative

Community Impact Program

Advanced Medical Transport
CPR Race to the Top

American Medical Response (Manchester/Nashua, NH)
Safe Station Project

Sunstar Paramedics
Health & Safety Fair

Employee Programs

American Medical Response (Buffalo, NY)
Recruitment/Training Program

Northstar EMS, Inc
Medical Director Engagement Through Technology

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Non-Emergency Transport: Avoiding the Fraud Trap [Sponsored]

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:

  • “Is the patient bed-confined?”
  • “Does the patient require assistance to get out of bed?”
  • “Is the patient unable to safely sit in a wheelchair for the duration of the transport?”

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.


Non-EMS Transport Options

Rideshare Partnership

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?

Add Non-Emergency Fleet

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.

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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.

¹https://www.modernhealthcare.com/article/20150511/NEWS/150519994