HHS OCR Requests Feedback on HIPAA Privacy Rule

On January 28, 2019, the Office of Health and Human Services the Office for Civil Rights (HHS OCR) issues a Request for Information (RFI) seeking input from covered entities regarding several aspects of the Health Insurance Portability and Accountability Act (HIPAA).  Specifically, the HHS OCR is seeking input regarding several elements of the Privacy Rule, including the following:

  • Encouraging information-sharing for treatment and care coordination
  • Facilitating parental involvement in care
  • Addressing the opioid crisis and serious mental illness
  • Accounting for disclosures of PHI for treatment, payment, and health care operations as required by the HITECH Act
  • Changing the current requirement for certain providers to make a good faith effort to obtain an acknowledgment of receipt of the Notice of Privacy Practices

I am aware that several AAA member services who have struggled with many of the HIPAA restrictions regarding the sharing of PHI with other healthcare entities.  In particular, with regard to individuals who suffer opioid overdoses and efforts to ensure the individual has access to drug treatment programs.  Additionally, HHS OCR is seeking input from covered healthcare providers regarding the “good faith” efforts to obtain acknowledgement of the receipt of Privacy Practices.  This has been a considerable challenge for EMS given the nature of our healthcare delivery model.  The relaxing of this regulatory requirement would substantially reduce the burden on EMS agencies.

The AAA recommends that our members review the HHS OCR Request for Information and submit comments by the February 12, 2019 deadline.  If members have any questions or need assistance in submitting their comments, the AAA is here to help.

OSHA Reminder 2019

OSHA Injury Posting & Reporting of 2018 Injury Data

It is important that employers remember that they must post a copy of their OSHA Form 300A which is a summary of workplace injuries starting February 1, 2018 through April 30, 2018.  The OSHA Form 300A is a summary of all job-related injuries and illnesses that occurred in an employer’s workplace during 2018.  If a company recorded no injuries or illnesses in 2018, the employer must enter “zero” on the total line. The form must be signed and certified by a company executive. The OSHA Form 300A Injury Summary must be displayed in a common area where notices to employees are usually posted.  In addition to posting these reports in the workplace, covered employers should be electronically submitting their 2018 workplace injury data to OSHA via the Injury Tracking Application (ITA).  If members need assistance with the workplace posting or electronic injury reporting submission, contact the AAA.

2019 OSHA Penalty Adjustment

Also, a reminder to employers who are subject to OSHA or to those who operate in a state with an OSHA approved state level plan, the penalty amounts for OSHA violations are increasing effective the publication of the new rates in the Federal Register.  In accordance with the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015, the Department of Labor is required to adjust penalties for inflation each year. New penalties for willful and repeat violations are $132,598 per violation; serious, other-than-serious, and posting requirements are $13,260 per violation; and failure to correct violations is $13,260 for each day the condition continues.  The new penalty details can be found in the OSHA Enforcement Section of their website.

HIPAA Breach Results in Highest Settlement in OCR History

The U.S. Department of Health and Human Services (HHS) Office of Civil Rights (OCR) announced earlier this month that is has entered into the largest settlement agreement in the history of the Department with Anthem, Inc., the largest Blue Cross and Blue Shield health benefit companies in the country.  Anthem, Inc. agreed to pay $16 million to HHS and take substantial corrective action to settle numerous potential violations of both HIPAA Privacy and Security Rules after it exposed protected health information (PHI) for nearly 79 million people.

In March 2015 Anthem filed a breach report with OCR after they discovered that their Information Technology (IT) systems were infiltrated by cyber-attackers who had gained access to their systems after an Anthem employee opened a phishing email.  This email released an undetected continuous persistent threat attack that permitted the cyber-attackers to access their systems from December 2014 through the end of January 2015.  This attack opened access that ultimately resulted in the PHI of nearly 79 million people to be stolen.

OCR’s investigation revealed that Anthem failed to conduct an enterprise-wide risk analysis.  Additionally, OCR determined that Anthem “failed to have sufficient policies and procedures to regularly review IT system activity, identify and respond to suspected or known security incidents, and failed to implement adequate minimum access controls to prevent impermissible access to electronic PHI.”

As part of the settlement, Anthem must comply with a Corrective Action Plan (CAP) for a period or two years.  As part of that CAP, Anthem must conduct an “accurate and thorough risk analysis of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of all ePHI held by Anthem.” This risk assessment must be submitted to OCR for review and approval.  The CAP includes the review, revision, and distribution of all written policies and procedures addressing Information System Activity Review and Access Control for systems containing ePHI.  The CAP requires regular and ongoing reporting to OCR for actions taken under the Plan and for any reportable events.

The day following the Anthem, Inc. settlement press release, OCR and the Office of the National Coordinator for Health Information Technology (ONC) announced that they have strengthened the Security Risk Assessment (SRA) Tool to improve functionality.  The SRA is designed for use by small to medium sized health care providers to help them identify risks and vulnerabilities to ePHI within their practices.  All HIPAA covered entities and business associations are required to conduct an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of ePHI in their organizations.

Ambulance services should conduct a comprehensive Risk Analysis of their systems.  This Risk Analysis should include all provisions and requirements under HIPAA.  While this settlement highlights the significant risks associated with ePHI and IT systems, there remains significant risks to PHI in non-electronic forms as well.  This settlement is a great illustration of how apathy or reduced focus can result in potentially devastating results.

Contact the American Ambulance Association (AAA) with questions or assistance regarding any HIPAA related or other ambulance service compliance issue.

Notice of Proposed Change to OSHA Injury Reporting

Notice of Proposed Change to OSHA Electronic Injury Reporting Regulations

The Occupational Safety and Health Administration (OSHA) announced on July 27, 2018 that it has published a Notice of Proposed Rulemaking (NPRM) that would change the Electronic Injury Reporting Regulations (29 CFR Part 1904) for employers with 250 or more employees. OSHA is proposing this change due to a heightened concern that employee Personally Identifiable Information may be at risk of disclosure through the Freedom of Information Act (FOIA).

Currently, all EMS employers must submit their annual injury and illness data to OSHA through the Injury Tracking Application (ITA). Historically, employers were required to track all workplace injuries and illnesses and maintain records of those incidents in the workplace on the OSHA Form 300, 301, and 300A. Each year, employers are required to post a Summary of Workplace Injuries and Illnesses on the Form 300A from February 1st through April 30th.

In May 2016, OSHA amended the regulations requiring all employers to submit their Form 300A Summary electronically through the Injury Tracking Application (ITA). Employers with 250 or more employees were required to electronically report all injury and illness data from Forms 300, 301, and 300A each year. Initially OSHA believed that the reporting of electronic injury data would encourage employers to focus on workplace safety because the summary of injury data would be published for public use.

OSHA is now concerned about disclosure of information on the Form 300 and 301, which contains a great deal of sensitive information, including the employee’s date of birth, injury type, and limited treatment information. There have been several instances in which organizations have sought this sensitive information by invoking the Freedom of Information Act (FOIA). In addition, OSHA stated that collecting this data costs the Department of Labor roughly nine (9) million dollars and places a substantial administrative burden on employers.

The Summary of Proposed Rulemaking is seeking comment on only the change to Part 1904.41 which requires employers with 250 or more employees to submit the data represented on Form 300 and 301. The proposed change would eliminate the requirement for employers with 250 or more employees to submit the information on those form, but they would still be required to report the Form 300A summary data. However, all employers are required to maintain records, and be able to produce the data on Form 300 and 301 for OSHA if requested. This also does not change an employer’s required Form 300A posting requirements from February 1st through April 30th.

OSHA also proposed a change to the regulations seeking to require employers to include the Employer Identification Number (EIN) when they electronically submit their Form 300A data on the ITA annually. This proposed change would allow the Department of Labor to reduce duplicative reporting of information because it would allow them to match data with information submitted through other Department agencies, such as the Bureau of Labor Statistics.

This proposed change would be a win for employers as it significantly reduces a great deal of administrative burden. Employers are encouraged to submit comments to these proposed changes by September 28, 2018. If members have any questions on what their current reporting obligations are under OSHA or how these proposed changes will affect their organizations, please contact Scott Moore at the AAA.

Submit your comments here. 

Confidential support for AAA member organizations

Confidential support for employees of AAA member organizations

As first responders, you regularly bear witness to traumatic events, and you directly experience loss, sadness, and sometimes even frightening violence outside the norm of the human experience. Exposure to trauma can cause emotional reactions for weeks or even months following. If you’re struggling to cope with difficult emotions or dealing with symptoms of an acute stress reaction, the American Ambulance Association can help.

Confidential counseling from LifeWorks—At no cost to you.

LifeWorks is your employee assistance program (EAP) and well-being resource. We’re here for you any time, 24/7, 365 days a year, with expert advice, resources, referrals to counseling, and connections to specialty providers including substance abuse professionals.

  • Toll-free immediate support by phone if you’re in distress.
  • Up to three face-to-face confidential counseling sessions per issue.
  • Counseling live by video to meet clinical needs and preferences.
  • All counselors are experienced therapists with a minimum Master’s degree in psychology, social work, educational counseling, or other social services field.

Onsite CISM Services – Round-the-clock support for critical incidents.

If your ambulance service has experienced an employee death, severe vehicle accident, staff suicide, or other traumatic event, AAA is here to help. Email info@ambulance.org 24/7 to request an onsite CISM counselor at AAA’s expense.

Download the PDF version here

                                                     

Data Privacy

This past January, the AAA hosted a webinar presented by EMS/healthcare Attorneys Matthew Streger, Margaret Keavney, and Rebecca Ragkoski, titled Cybersecurity, Top 10 Considerations in Healthcare and How to Address Them. During this very informative webinar, Matt, Margaret, and Rebecca covered one of the biggest issues facing EMS and other healthcare providers today, data security. If you did not get chance to listen in on this program, it is available on-demand at the AAA website.

As highlighted in their webinar, data security and data breach concerns are one of the most frequently encountered issues facing EMS agencies as healthcare providers but also as employers. Ensuring that patient and employee protected health information (PHI) and personally identifiable information (PII) is adequately protected from access or intrusion is critically important.

Alabama becomes the 50th state to enact data breach requirements for all individuals and businesses in the state. The Society for Human Resource Management (SHRM) provides a great summary of the new breach requirements in several article resources published this week. The National Conference on State Legislatures is a great resource for learning the laws that apply to your organization. Of course, it is recommended that all members engage a law firm that is familiar with data security requirements both at the federal and state level.

It is critically important for EMS agencies to perform a risk analysis for all data systems. This analysis should include all third party hosted web platforms that contain or may contain PHI or PII. EMS leaders should inquire with their IT departments and all EMS leadership to identify where PHI or PII might be found. Be sure to include any incident reporting system utilized by the agency. Often these systems include information about response locations, which can include patient addresses or other PHI. Also found in many incident reporting systems is employee incident and injury data which can include PII. Be sure that these often-overlooked systems meet the security requirements detailed in the applicable federal and state data protection laws.

OSHA Injury Reporting

Last year we notified AAA members that they must begin electronically reporting their workplace injury data to OSHA starting December 1, 2017 for 2016. This is just a reminder to all employers can begin electronically reporting their 2017 workplace injury data through the OSHA Injury Tracking Application (ITA). 2017 Injury Data must be submitted to OSHA no later than July 1, 2018. For employers in states that are covered by OSHA approved state level work injury regulations, OSHA has announced on April 30, 2018 that employers in states that have not completed the adoption of a state rule must also report their 2017 injury data through the OSHA ITA. If any member has not set up their account with OSHA on the ITA, we strongly suggest that you do so immediately. The AAA can assist members who need assistance ensuring they are compliant with this reporting requirement.

Infographic: When to Call an Ambulance

It can be challenging for the public to gauge which situations call for mobile healthcare. Check out our handy “When to Call an Ambulance” infographic for a few easy-to-follow guidelines. (When in doubt, of course please call 9-1-1!)

When to Call an Ambulance Infographic by the American Ambulance Association
When to Call an Ambulance Infographic by the American Ambulance Association

OSHA Electronic Injury Reporting Deadline Is Dec 15

Several months ago, we alerted AAA members that the Occupational Safety and Health Administration (OSHA) had announced that it would further delay the deadline for employers to electronically file injury data until December 1, 2017.  With that deadline quickly approaching, we wanted to make sure that our members were prepared and reporting the data correctly.

OSHA announced in July that it will be launching the new electronic Injury Tracking Application (ITA) on August 1, 2017.  The new rules are an effort to “nudge” employers to improve safety in the workplace by publishing employee injury data, as reported by employers.  Electronic data reporting would give job candidates and employees the ability to compare potential employers and their safety records.  Currently, most employers are required to record injuries that occur in the workplace, but this data is not easily available to candidates or OSHA itself.  It is anticipated that employers can expect greater investigative and enforcement actions after electronic injury reporting begins.

Under the Old & New Rules

Every year, ambulance services with 10 or more employees are required to record all workplace injuries that involve medical treatment beyond first aid, days away from work, restricted/transfer of duties, or loss of consciousness.  There are certain injuries that must be reported immediately to OSHA if they occur, workplace fatalities, hospitalization, loss of an eye, or an amputation.  The injury logs must be compiled and kept for five years.  Each year, employers are required to post a summary (Form 300A) of all workplace injuries in the workplace for from February 1 through April 30.

Currently, OSHA does not collect workplace injury information except through complaints from employees, onsite inspections, mandated reports of specific serious injuries, or through data collection from limited “high hazard” industries.  This new rule, will require that injury data reports be reported electronically to OSHA.  Many ambulance services already report this information electronically to the Bureau of Labor Statistics (BLS), who collects data on behalf of the Department of Labor but the employer specific information is not released publicly.  Under these new rules, employer injury data will be published.

Who Do These Rules Effect?

The electronic reporting requirements are based on the size of employer.  For the purposes of determining employer size, employers must count each individual employed at any time during the calendar year as one employee.  This includes full-time, part-time, seasonal, and temporary workers.  All employers with 250 or more employees in industries covered by the recordkeeping regulation must electronically submit to OSHA injury and illness information from OSHA Forms 300, 300A, and 301.  Employers with 20-249 employees must electronically submit information from OSHA Form 300A only.

Important Reporting Note:

The information that must be reported is determined by “Establishment” size.  Often this is confused by employers as being their entire “Firm”, even if they have multiple locations.  It is important to understand that you should be reporting data by Establishment location.  There are times that an Establishment can include more than one location, if they are close in geographic location as defined by OSHA.

For example, if one ambulance service has a headquarters located in one town and a satellite ambulance station located 20 miles away, those would be two “Establishments” under the OSHA Regulations. The employer would assign each of their employees to a specific “establishment” for the purposes of reporting.

In our industry, employees tend to work in multiple locations. For the purposes of ITA reporting, assign each to one. The employer would then count the number of employees (full time, part time, per diem, seasonal) at each location.  After totaling the employee count at each location, determine if their establishment size requires summary reporting or more detailed reporting.  For this year, only the summary data (Form 300A) needs to be reported for each establishment.

An employer could have a total of 400 employees working for their company but only must report the Form 300A information because those employees are evenly distributed amongst their eight separate “Establishments”.

Phase In

The new rules are being phased in by employer size.  In 2017, all employers, with 20 or more employees must report the information from OSHA Form 300A, which is the summary of all injury data by December 1, 2017.  By July 1, 2018, employers with 250 or more employees, will report all injury data from Forms 300, 300A, and 301 and employers with 20-249 employees will only report the data from the Form 300A.  Starting in 2019, all covered employers will have to report their 2018 injury information electronically by March, 2019.  Thereafter, all employers will report injury data electronically by March of each year.

Data Submission

OSHA has launched the Injury Tracking Application on August 1, 2017.  The electronic data submission process involves four steps:

  1. Creating an establishment (employer account);
  2. Adding 300A summary data;
  3. Submitting data to OSHA; and
  4. Reviewing the confirmation email.

The secure website offers three options for data submission. One option will enable users to manually enter data into a web form. Another option will give users the ability to upload a CSV file to process single or multiple establishments at the same time. A third option will allow users of automated recordkeeping systems to transmit data electronically via an application programming interface (API).

OSHA states that the creation of the account in the electronic Injury Tracking Application (ITA) will only take employers about ten minutes.  After creating an account, OSHA predicts that it will take employers about ten minutes to report the data on Form 300A.  For large employers reporting also required to submit Form 300 and 301 information, OSHA is predicting it will take about 10 minutes per incident.

For those who are already reporting injury information to the Bureau of Labor Statistics (BLS) electronically, you will be required to report the information to OSHA also.  OSHA states that it is working on eliminating the duplicate reporting requirements but that until they do, employers will have to input data to both agencies.

Conclusion

Employers only have until this Friday, December 1, 2017 to submit their first set of injury data from 2016.  If AAA members are uncertain if they are tracking and reporting injury data appropriately or believe that they need assistance with this new requirement, be sure to contact the AAA for assistance, we can assist you with this required reporting.

EMS.gov Ambulance Crash Data

NHTSA’s Office of EMS has partnered with a number of organizations, Federal agencies and U.S. Department of Transportation offices to develop resources that help EMS agencies understand ambulance crashes, transport patients safely, report ambulance and equipment defects and build or buy safer ambulances.

Download the ambulance crash infographic►
Visit the site today►

OSHA to Launch Electronic Injury Reporting on August 1, 2017

A few weeks ago, we alerted AAA members that the Occupational Safety and Health Administration (OSHA) had announced that it would further delay the deadline for employers to electronically file injury data.  The new rules, which require electronic injury data reporting were originally to take effect on July 1, 2017.  These rules were delayed until this December 1, 2017.  It was believed the requirements, an Obama administration initiative, might never see the light of day under the new administration.  However, OSHA announced Friday that all employers (ambulance providers) who employ twenty or more employees will be able to begin submitting electronic report injury data starting August 1, 2017.

OSHA announced Friday that it will be launching the new electronic Injury Tracking Application (ITA) on August 1, 2017.  The new rules are an effort to “nudge” employers to improve safety in the workplace by publishing employee injury data, as reported by employers.  Electronic data reporting would give job candidates and employees the ability to compare potential employers and their safety records.  Currently, most employers are required to record injuries that occur in the workplace, but this data is not easily available to candidates or OSHA itself.  It is anticipated that employers can expect greater investigative and enforcement actions after electronic injury reporting begins.

Under the Old & New Rules

Every year, ambulance services with 10 or more employees are required to record all workplace injuries that involve medical treatment beyond first aid, days away from work, restricted/transfer of duties, or loss of consciousness.  There are certain injuries that must be reported immediately to OSHA if they occur, workplace fatalities, hospitalization, loss of an eye, or an amputation.  The injury logs must be compiled and kept for five years.  Each year, employers are required to post a summary (Form 300A) of all workplace injuries in the workplace for from February 1 through April 30.

Currently, OSHA does not collect workplace injury information except through complaints from employees, onsite inspections, mandated reports of specific serious injuries, or through data collection from limited “high hazard” industries.  This new rule, will require that injury data reports be reported electronically to OSHA.  Many ambulance services already report this information electronically to the Bureau of Labor Statistics (BLS), who collects data on behalf of the Department of Labor but the employer specific information is not released publicly.  Under these new rules, employer injury data will be published.

Who Do These Rules Effect?

The electronic reporting requirements are based on the size of employer.  For the purposes of determining employer size, employers must count each individual employed at any time during the calendar year as one employee.  This includes full-time, part-time, seasonal, and temporary workers.  All employers with 250 or more employees in industries covered by the recordkeeping regulation must electronically submit to OSHA injury and illness information from OSHA Forms 300, 300A, and 301.  Employers with 20-249 employees must electronically submit information from OSHA Form 300A only.

Phase In

The new rules are being phased in by employer size.  In 2017, all employers, with 20 or more employees must report the information from OSHA Form 300A, which is the summary of all injury data by December 1, 2017.  By July 1, 2018, employers with 250 or more employees, will report all injury data from Forms 300, 300A, and 301 and employers with 20-249 employees will only report the data from the Form 300A.  Starting in 2019, all covered employers will have to report their 2018 injury information electronically by March, 2019.  Thereafter, all employers will report injury data electronically by March of each year.

Data Submission

The electronic data submission process involves four steps:

  1. Creating an establishment (employer account);
  2. Adding 300A summary data;
  3. Submitting data to OSHA; and
  4. Reviewing the confirmation email.

The secure website offers three options for data submission. One option will enable users to manually enter data into a web form. Another option will give users the ability to upload a CSV file to process single or multiple establishments at the same time. A third option will allow users of automated recordkeeping systems to transmit data electronically via an application programming interface (API).

OSHA states that the creation of the account in the electronic Injury Tracking Application (ITA) will only take employers about ten minutes.  After creating an account, OSHA predicts that it will take employers about ten minutes to report the data on Form 300A.  For large employers reporting also required to submit Form 300 and 301 information, OSHA is predicting it will take about 10 minutes per incident.

For those who are already reporting injury information to the Bureau of Labor Statistics (BLS) electronically, you will be required to report the information to OSHA also.  OSHA states that it is working on eliminating the duplicate reporting requirements but that until they do, employers will have to input data to both agencies.

Conclusion

The new Injury Tracking Application (ITA) does not launch until August 1, 2017. Employers will have until December 1, 2017 to submit their first set of injury data from 2016.  If AAA members are uncertain if they are tracking and reporting injury data appropriately or believe that they need assistance with this new requirement, be sure to contact the AAA for assistance.  Members should look to the Daily Digest or the AAA website for further announcements regarding this or any employment regulatory change that will impact our members.

EMS Education – A Look Forward

I have always believed EMS parallels the career trajectory of nursing. This is especially true when you look at the infancy of nursing—1750 to 1893—in what was a subservient apprenticeship with no didactic education. “Most nurses working in the States received on-the-job training in hospital diploma schools. Nursing students initially were unpaid, giving hospitals a source of free labor. This created what many nurse historians and policy analysts see as a system that continues to undervalue nursing’s contribution to acute care.” (History Lesson: Nursing Education has evolved over the decades, 2012, para. 5).

We reached a turning point in 1893 when the Columbian Exposition met, and although Ms. Florence Nightingale was unavailable to attend, she did have a paper presented at the exposition. In essence, the paper proved that a well-educated nursing workforce with standards of practice was needed to improve the health care of the United States.

This is exactly where EMS is now. Young enough to have moved through our growing pains of the late ’60s and early ’70s, but lucky enough to be in an age of extensive medical growth where all levels of providers are looking to enhance the care being provided.

So where do we go from here? We can choose to keep the status quo or we can move forward, hopefully, at a much greater speed than our nursing brothers and sisters. We should consider moving away from being governed by the Department of Transportation and the National Highway Traffic Safety Administration. A much more appropriate body is the Department of Health, which gives us the ability to stop thinking of our discipline as transport to the hospital, and more like bringing a hospital-like service to the to the sick and injured.

“EMS is a critical component of the nation’s healthcare system. Indeed, regardless of where they live, work or travel, people across the US rely on a sufficient, stable and well-trained workforce of EMS providers for help in everyday emergencies, large-scale incidents and natural disasters alike.” (“Education,” 2015, para. 1)

To get there, our education needs to reflect growth, and evidence-based medicine should be the law of the land. If this is proven to be effective, then let’s adopt it. If not, let’s stop teaching the worthless skills of yesterday, just as we have seen with the near extinction of the Long Spine Board. Let’s increase the minimum requirements for every level of provider. Let’s give Paramedics an associate’s degree, a diagnosis’s language, and a licensure, not a certification. Let’s all take the reins of our chosen career paths and have better continuing education that is challenging and accessible, and not an alphabet soup of certifications.

Yes, these are my musings about the future of EMS education. I know places that are very progressive in this country exist. I know there are protocol driven areas too. So let’s stop the segregation and become a health care group with a real mission, an everyday purpose. A place where we act as a group, not as individuals. A place where we treat our patients with the skill, compassion, and talent I know exists. Are you ready to join me?

Scott F. McConnell is Vice President of EMS Education for OnCourse Learning and one of the Founders of Distance CME. Since its inception in 2010, more than 10,000 learners worldwide have relied on Distance CME to recertify their credentials. Scott is a true believer in sharing not only his perspectives and experiences but also those of other providers in educational settings

References

Education. (2015). Retrieved from https://www.ems.gov/education.html

History Lesson: Nursing Education has evolved over the decades. (2012, November 12th, 2012). History Lesson: Nursing Education has evolved over the decades Blog post. Retrieved from https://www.nurse.com/blog/2012/11/12/history-lesson-nursing-education-has-evolved-over-the-decades-

 

Electronic Injury and Illness Rules Delayed

As reported to members in late May, the United States Department of Labor (DOL) announced that Occupational Safety & Health Administration (OSHA) will further delay the implementation of the new Electronic Injury and Illness Rules that were scheduled to go into effect on July 1, 2017. The DOL announced today that they were further delaying the implementation until December 1, 2017. The DOL has stated that the delay is intended to give the agency “further review and consider the rule.”  We will continue to keep members posted of any pending changes to this or any DOL change.

NHTSA and NASEMSO Host Panel on EMS Practices

The National Association of State EMS Officials (NASEMSO) and the National Highway Transportation Safety Administration (NHTSA) hosted a series of meetings for subject matter experts to discuss revisions to the National EMS Scope of Practice model. The experts reviewed the model’s practices, examined education and training procedures, and discussed what certification level, if any, is needed for specific treatments that are now widely-used among EMS professionals. The panel focused on five specific procedures that are commonly practiced: hemorrhage control, Naloxone use, CPAP use, therapeutic hypothermia in cardiac arrest, and pharmacological pain management.

Over the next several months, the panel will continue to examine information and recommend changes to the Scope of Practice model, with final recommendations tentatively set to be submitted in August 2018. For more information, please visit NASEMSO’s website.

 

 

REPLICA Compact Enacted

REPLICA Meets Goal, Interstate Compact Becomes Official

May 8, 2017
For Immediate Release
Contact:
Sue Prentiss
603-381-9195
prentiss@emsreplica.org

May 8, 2017 (Falls Church, VA). With the 10th member state enactment, the Recognition of
Emergency Medical Services Licensure Interstate Compact (REPLICA) has become official.
Governor Nathan Deal of Georgia signed Senate Bill 109 on today activating the nation’s first EMS
licensure compact. States that have passed REPLICA to date include: Colorado, Texas, Kansas,
Virginia, Tennessee, Idaho, Utah, Mississippi, Wyoming and Georgia.

Released in 2014, REPLICA’s model legislation creates a formal pathway for the licensed individual
to provide pre-hospital care across state lines under authorized circumstances. According to Keith
Wages, president of the National Association of State EMS Officials (NASEMSO), “REPLICA
represents a collective, nationwide effort to address the problems faced by responders when needing
to cross state borders in the line of their duties.” Wages highlighted the compact’s abilities to
“increase access to healthcare, reduce regulatory barriers for EMS responders, and place an
umbrella of quality over cross border practice not previously seen in the EMS profession.” Wages
also noted that the partnership with the National Registry of Emergency Medical Technicians
(NREMT) has been essential during the advocacy and implementation phases. “We are grateful for
their continued support and contributions.”

Through funding provided by the Department of Homeland Security (DHS), NASEMSO led 23 EMS,
fire, law enforcement organizations and associations as well as key federal partners in the design and
drafting of REPLICA. The National Registry of EMTs (NREMT) currently provides funding to finalize
the development of the Commission.

The compact calls for establishment of an Interstate Commission with each state that has passed
REPLICA holding a seat, as well as a national EMS personnel coordinated database. Member states
will be able to rapidly share personnel licensure information, develop policy focused only on cross
border EMS practice, and hold EMS personnel originating in other states accountable in an
unprecedented way. The National Registry of EMT’s (NREMT) has committed to the development
and hosting of the coordinated database.

Twelve national associations and organizations support REPLICA. Three states have REPLICA bills
under consideration in their legislative sessions. Learn more at www.emsreplica.org.

###

Maintaining Compliance Within an EMS Service

Maintaining compliance within an EMS service can be a daunting task, especially given the number of regulations that we must follow.

One way to look at EMS is if a trucking company married a hospital.

There are rules and regulations to abide by for an entire fleet of vehicles, from safe operation guidelines all the way down to the use and color of lights. Then there are requirements for a group of healthcare providers, which include necessary certifications such as CPR and knowledge of pertinent life-saving skills.

Not only does maintaining compliance keep vehicles and equipment running smoothly, but it can offer employees valuable peace of mind and keep everyone focused on the same goals of providing the best care possible.

I like to consider compliance an investment in common sense.

Employees know what is expected of them at all times, and they know what type of support their employer will provide to keep their skills sharp. In turn, an EMS service gains from being in good standing with regulators and from an engaged, confident workforce.

The benefits of a strong culture of compliance are immense. An organization that lives and breathes compliance can help ensure a smooth-running operation that features top-notch communication and quality providers who offer excellent care.

Journey to Compliance

These six key ways ensure compliance will serve as a roadmap to a strong culture in your organization:

  1. Start from the top: Backing from leadership ensures a strong culture of compliance. For certification and education compliance to stick, it starts with the attitudes of upper management, such as the board of directors, chiefs, officers, and day-to-day operations staff. Leaders must actively support all compliance efforts, including regular compliance-related reports, approving policies and having a general knowledge of the rules that govern EMS providers. Without the right tone from the top, an EMS service’s compliance efforts are usually undermined and ultimately fail. This results in issues with governing bodies, payers, scheduling and staffing.
  2. Commit to resources: Having the right personnel and systems in place are both vital to creating a strong compliance culture. The organization’s compliance staff should have experience in directing compliance efforts and supporting the evaluation of compliance-related risks. When it comes to certifications and education, compliance is always black and white. Knowing how to evaluate and respond to operational issues is important to maintaining compliance and successfully operating an EMS service. Systems that provide information to assist the service in complying with its obligations are a necessity.
  3. Have the write stuff: Developing written policies and procedures for compliance programs and internal controls is essential to adequately address regulatory requirements and an EMS service’s specific risks. Having these policies and procedures in writing sets the expectation of what is required of both managers and employees. Assessing risks before drafting these programs will help identify key areas where controls are needed. A compliance program should include how a service’s policies can be implemented from an operational perspective. This will include internal controls and standard operating procedures.
  4. Provide education: Providing the training for your EMS employees gives them peace of mind that they will be in compliance and acknowledges that the service values them.
  5. Test the system: Subjecting procedures to an independent review and audit ensures the compliance system is working correctly. This review provides an evaluation of where the EMS service’s compliance efforts stand. It also offers an opportunity to correct deficiencies before an outside regulatory audit is performed.
  6. Communicate more: Communication is vital to all organizations, but it can be the most difficult piece of the puzzle to achieve. With compliance-related responsibilities, sharing information is very helpful and, in some cases, required. Communicating expectations within EMS training programs is imperative. Reporting compliance efforts and noting any deficiencies should be a part of a communication strategy, especially if your state has an active medical director and/or board of EMS.

2016 AMBY Best Public Relations Campaign: EMSA, CPR Education Program

Congratulations to the 2016 AMBY Award Winners

Each year, the American Ambulance Association honors best practices, ingenuity, and innovation from EMS providers across the country with our AMBY Awards. 

EMSA CPR Education Program Awarded a 2016 AMBY for Best Public Relations Campaign

Emergency Medical Services Authority (EMSA) | Tulsa, Oklahoma

amby-congrats-emsaEMSA, the Emergency Medical Services Authority, is Oklahoma’s largest provider of pre-hospital emergency medical care. We provide ambulance service to more than 1.1 million residents in central and northeast Oklahoma. EMSA was established in Tulsa in 1977 and later expanded to include Bixby, Jenks and Sand Springs. EMSA began providing service to Oklahoma City in 1990. EMSA is the ambulance provider in 16 cities across the state. As a public trust authority of the City of Tulsa and City of Oklahoma City governments, EMSA is charged with ensuring the highest quality of emergency medical service at the best possible price. There are several entities that work together in the EMSA system, including the Cities of Oklahoma City and Tulsa, the medical director, and the contracted ambulance provider. EMSA oversees all business aspects including ambulances and other capital equipment, maintaining patient records, billing and more. The medical director conducts routine audits and testing of all medics practicing in the system, writes seamless protocols to ensure the continuity of care between first responders and transport medics, researches new treatment modalities and evaluates complaints. EMSA is committed to training and building awareness about CPR in EMSA’s 16 service areas. The program includes a variety of year-round opportunities to learn Hands-Only CPR(TM), as well as leveraging various opportunities to promote CPR education through traditional earned media, digital advertising, and social media. Also, EMSA medics were part of a national challenge to train as many local citizens as possible in Hands-Only CPR, called World CPR Day.

The CPR Education Program had one ultimate goal which was to increase the number of Oklahoma citizens who can effectively do CPR statewide (mostly Hands-Only CPR). The secondary goal was to connect the message of health care expertise and community involvement with EMSA, as an organization, by providing non-emergency interactions with EMSA medics and promoting CPR-related stories in earned media and digital platforms. Two measurable objectives were identified for the CPR Education Program.

Primary Objective

The first objective was to train more than 2,000 Oklahomans on how to conduct Hands-Only CPR on World CPR Day and 10,000 at the Tulsa State Fair and Oklahoma City State Fair. The second specific objective was to utilize earned media, social media, events and public figures to educate the community that EMSA is their CPR resource for training.

For many years EMSA, along with its 16 partnering first-responder agencies, achieved a heart attack survival rate six times higher than the national average. Recognizing that bystander response times were integrated into this health outcome, EMSA noted an opportunity to magnify and improve these successful numbers. The heart attack survival rate results are based on patients in cardiac arrest who received some form of bystander CPR and were found in a shockable rhythm (an ECG rhythm that is treatable using defibrillation) on first EMS contact.

Secondary Objective

The American Heart Association Research The American Heart Association conducts numerous studies on the impact of bystander CPR. These studies prove that during cardiac arrest a person’s survival chance increases significantly with immediate CPR, that CPR can be taught in a very short amount of time, and that compression-only CPR is effective for saving lives. When paramedics arrive on-scene, a patient who is in cardiac arrest and is found in a shockable rhythm (an ECG rhythm that is treatable using defibrillation) is more likely to survive if they receive some form of bystander CPR. The impact of bystander CPR has improved significantly in the past decade. In 2010, the AMR bystander CPR rate was 21.4 percent and in 2014 it increased to 40.8 percent.

Every five years, EMSA conducts a citizen survey to review the perception of services. The most recent report (2012) shows 80 percent of people who use EMSA have a positive impression. Additionally, the public responds extremely favorably to medics and paramedics; however, most people don’t meet a medic until they’re experiencing a medical emergency. Utilizing this information EMSA expanded its public events to put medics in front of potential patients more regularly — before they experience an emergency. Although the CPR Campaign primarily focuses on health-outcomes related to cardiac arrest, a secondary benefit is providing one-on-one opportunities for the general public to spend with EMSA medics, allowing those without ambulance-experience to see first-hand the caring and compassionate men and women who work at EMSA.

In order to build community awareness around the health impact of knowing CPR, EMSA focused on two general audiences: the first included citizens of EMSA’s service area without Hands-Only CPR training, the second group was the opinion leaders. The opinion leaders with the highest stakes for improving health outcomes on a statewide basis were determined to be elected officials.

EMSA has conducted CPR training throughout the community for decades. EMSA also partners with other CPR-certification agencies to increase access to CPR education. For the past three years, EMSA has organized an annual special event to train a large number of citizens in Hands-Only CPR and also communicate the importance of learning CPR. In addition, EMSA provides stand-by ambulances at the Oklahoma State Tulsa State fair annually; during the fair EMSA utilizes an informational booth space to provide citizens with an opportunity to learn CPR.

The CPR Education Program consisted of three key areas. The first was participation in large-scale events that provide an opportunity for training a large number of people (World CPR Day and the two State Fairs). These larger events would be used as a catalyst. The second area was building awareness that EMSA offers CPR training, both Hands-Only and traditional CPR, to the general public within their service area. The final area was recruiting a prominent Oklahoman to participate in a CPR training in order to maximize attention to the importance of CPR training for all individuals. All of the focus areas, and the message that CPR saves lives, were promoted through traditional earned media, advertising, and social engagement.

Large-Scale Training Events

World CPR Day is organized on a national level by AMR and on a local level by EMSA. Each year the EMSA communications team strategically identifies partnership events and organizations to bring Hands-Only CPR in front of Tulsa and Oklahoma City-area citizens. There are many options annually because the wide audience-base includes all individuals in EMSA’s service area without Hands-Only CPR training. EMSA hosted CPR trainings throughout coverage areas utilizing ongoing events at businesses and organizations, such as the business board meetings. Some trainings were private and others were public events. Utilizing earned media and social media, World CPR Day was heavily promoted and resulted in strong participation. Reviewing the World CPR date and community events we noticed the two largest events that could incorporate CPR training were the Big 12 Baseball tournament and the Dallas Cowboys Mobile Museum. These two events were slated to attract large crowds of active Tulsans ideal for learning Hands-Only CPR. EMSA worked alongside the Tulsa Regional Chamber to coordinate a training site at Fan Fest, the fair-like celebration that runs concurrently during the Big 12 Baseball Tournaments. EMSA also had the Dallas Cowboys mobile museum for their evening sessions at LaFortune Park. In addition to the large public trainings, EMSA hosted smaller CPR trainings throughout our coverage areas utilizing ongoing events at area businesses and organizations, such as the Jenks Chamber of Commerce Board Meeting. The largest private training was at Roosevelt Middle School in Oklahoma City where EMSA trained more than 600 students. The Tulsa and Oklahoma City State Fairs provide easy-access to large groups of Oklahoma residents who are eager to learn CPR in order to save a life. Although the location and interaction opportunities are optimal, medics do use key message points, such as “It’s most likely a loved one’s life you’ll save,” to encourage passers-by to participate in the training. Thousands of individuals learned Hands-Only CPR at the state fairs last year. CPR Training Requests EMSA generally receives 30 requests per year to train small groups on how to perform CPR. These are businesses and organizations, as well as teams and non-profits. During the CPR Education Program, EMSA promoted CPR training through all owned mediums including its website and social channels. After promoting World CPR Day and the importance of learning Hands-Only CPR, EMSA inquiries for trainings increased by almost 25 percent. Most of the new requests came from government officials or civic-related organizations, which are targeted groups because their circle of influence is generally larger than other groups.

Training High-Profile Oklahoman in Hands-Only CPR

EMSA individuals researched prominent Oklahomans to find who fit with EMSA’s mission and goals. We needed individuals that would create a buzz online and in traditional media. After considering various famous individuals we determined that elected officials were the most inclined to be concerned with the overall health and well-being of Oklahomans. We set our goals high, and invited the Governor to learn Hands-Only CPR. Additionally, we sent requests to various local elected officials to offer a CPR class during a City Council meeting. We were pleased that Oklahoma’s Governor Mary Fallin, the Tulsa City Council and Oklahoma City Council accepted our invitations, and in three separate events, they learned the steps to save a life through CPR. The events created a stir in local newspapers and TV while also creating engagement online through our EMSA social channels and other digital news sources. Promotion EMSA promoted World CPR Day, CPR trainings, and the elected-officials training events throughout the year. Additionally, EMSA hosted several in-studio CPR demonstrations at Oklahoma City and Tulsa media stations. Another media component was promoting feature stories on patients that survive because of CPR. The final promotional component was a digital ad campaign that are PSAs about the three C’s of CPR: check, call, and compress.

See measurable outcomes below; additionally review work samples to view social media samples, earned media samples and more.

  • Measurable Objective: train 2,000 attendees how to do Hands-Only CPR on World CPR Day. Result: Trained 2,585 people 1,201 in Tulsa and 1,384 in OKC Measureable Objective: train 10,000 attendees how to do Hands-only CPR at the two Oklahoma State Fairs. Result: Trained more than 10,000 people at the Tulsa State and Oklahoma State Fairs.
  • Measurable Objective: Utilize social media to increase awareness of World CPR Day Result: More than 20,000 unique social media impressions for various social media posts promoting and celebrating World CPR Day.
  • Measurable Objective: Utilize earned media, social media and World CPR Day to educate the community that EMSA is their CPR resource for training.
  • Result: Following World CPR Day EMSA was contacted by several community groups wanting EMSA medics to teach Hands-Only CPR at their monthly meetings. Additionally, EMSA gained a lot of media coverage and social media activity due to the high-visibility leadership participating in Hands-Only CPR.

The overall impact of the ongoing EMSA CPR program continues to increase the number of Oklahoma residents who can perform CPR. This ultimately affects improved health outcomes. Additionally, this campaign provides one-on-one time with medics which produces a familiarity with the ambulance authority that will provide long-term mutually beneficial outcomes.

Congratulations to EMSA for the CPR Education Program’s selection as a 2016 AMBY Winner for Best Public Relations Campaign.

 

2016 AMBY Best Clinical Outcome: Advanced Medical Transport, Race to the Top Program

Congratulations to the 2016 AMBY Award Winners

Each year, the American Ambulance Association honors best practices, ingenuity, and innovation from EMS providers across the country with our AMBY Awards. 

Advanced Medical Transport’s Ramby-congrats-2016-amtace to the Top Program Awarded the 2016 AMBY for Best Clinical Outcome

Advanced Medical Transport (AMT) | Peoria, IL

Advanced Medical Transport (AMT) developed the Race to the Top Program to provide the communities they serve with some of the top cardiac resuscitation rates in the nation. “By concentrating on eight highly-interdependent elements of a world-class emergency cardiac care and response system, we soldier more forces together and win more battles in the war on sudden cardiac arrest,” said AMT’s Josh Bradshaw.

Even before implementing Race to the Top, AMT’s cardiac arrest resuscitation rates were three times the national average.  However, the leadership team felt that they could push the rates higher through a multifaceted outreach program. The project began in in late 2014, with eight specific, measurable, and actionable objectives:

  • Immediate recognition of sudden cardiac arrest;
  • 911 activation, “First-Care” hands-only CPR, GPS to the rescue (PulsePoint);
  • Access to and utilization of AEDs;
  • Pit crew resuscitation by EMS providers;
  • Deployment of Advanced Practice Paramedics;
  • Advanced biomedical tools;
  • Immediate provider feedback; and
  • Community and caregiver recognition.

AMT began the program with a Return of Spontaneous Circulation rate of 27%, and have now reached 45%, well on the way to their near-60% goal. The national average is just 9%.

In December 2014, AMT became the first downstate Illinois EMS agency to report directly to the Cardiac Arrest Registry to Enhance Survival (CARES), a CDC-approved registry provided by Emory University. CARES participation empowers the AMT team to compare Race to the Top’s results with peer cities in North America. This benchmarking is in and of itself another best practice, and helps to drive ever-better results.

AMT’s key objective was to achieve widespread cultural expectations and awareness that saving lives is a community responsibility. “Saving lives is everyone’s responsibility,” says AMT CEO, Andrew Rand, “by working together we can achieve event better results.”

Congratulations to the entire Advanced Medical Transport Team for Race to the Top’s selection as the 2016 AMBY Winner for Best Clinical Outcome.

 

Sept 28 Webinar: Fallon Ambulance on Alternative Destinations

Join Patrick “Sean” Tyler, executive vice president and chief operating officer of Fallon Ambulance Service, on September 28 for Alternative Pathways to Care: The Massachusetts Experience.

Alternative Pathways to Care: The Massachusetts Experience
Speaker: P. Sean Tyler, Fallon Ambulance
September 28 at 2:00 PM ET
$99 for Members | $199 for non-Members
REGISTER NOW►

EMS systems around the US have historically been incentivized by Center for Medicare and Medicaid (CMS), private insurers and other payers to transport all patients encountered through accessing 911 emergency call systems, to an acute care facility emergency department (ED). The reimbursement model for ambulance services in place currently only provides payment for transport of any patient to a state licensed ED according to CMS. The changing healthcare system in the US, through the Affordable Care Act (ACA) 2010, looks to healthcare systems and contractors to provide healthcare at a lower cost. CMS is prescribed, as part of the ACA, to test innovative delivery models to reduce program expenditures…while preserving or enhancing quality of care furnished to individuals.”

This session will review the concepts and programs of implementing a modified system of care whereas trained EMS providers, under the supervision of a physician Medical Director, can transport patients experiencing a psychiatric emergency or require drug abuse services to a destination other than the acute care emergency department. This session also will review existing research papers, conclusions and data available for several existing programs for EMS utilization of permissive alternative destination for behavioral and mental health patients and patients requiring services for drug or alcohol use, in the absence of any acute medical condition.