Tag: Massachusetts

2016 AMBY Best Use of Technology: Trinity EMS & Firstwatch, Opioid Epidemic Project

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. 

Trinity EMS & FirstWatch Opioid Epidemic Project Awarded a 2016 AMBY for Best Use of Technology

Trinity EMS & FirstWatch | Massachusetts

amby-congrats-trinity-ems-with-firstwatchMassachusetts has seen a massive increase in opiate overdoses and deaths. In 2013 there were 918 opiate related deaths in Massachusetts. Massachusetts had 1531 deaths in the first six months of 2016. Many of the communities Trinity EMS serves are on the front lines of this issue. Their EMT’s and paramedics are helping to revive patients every day from an opiate overdose. Understanding the scope of an issue is a critical first step to solving an issue. They started using their PCR data to help frame the issue for their communities. They began tracking the demographics such as age and gender of the patients, time of day and day of the week, and location within the communities. They also monitor the volume to identify spikes in volume in individual communities and system wide. Trinity reported data monthly, one month behind to the health department, public safety partners, methadone clinics, hospitals and city governments. This data was well received. Other services contacted them for help in developing their tracking and reporting. They added FirstWatch to their program to speed up the notifications. Monthly reporting is still valuable. Instant reporting is even better. FirstWatch allows their communities to be notified within an hour of an opiate overdose. Public health and public safety now have this intelligence right away.

The goal was to gather and present data in a cross discipline format for aid with better understanding on the situation. First responders, law enforcement, public health, EMS, and district attorneys, and the press have received and used their data. Trinity wanted to show:

  • The profile of the patients we are seeing
  • The frequency of the patients
  • The location and time of the overdoses
  • The severity of the patients. (Our volume of overdoses have leveled off, the acuity of the patents is still increasing)
  • Our monthly report is a key performance indicator as to the opiate issue at the street level in our communities
  • Our needle pick up data indicated where outdoor intravenous drug use is happening
  • Many of the overdose calls to the 911 centers are not communicated as being overdoses; “fall”, “respiratory”, “unconscious” are common chief complaints at dispatch. This data would not have been collected and reported using chief complaint as a filter

When it became clear the opiate issue was becoming a wide spread crisis Trinity started working the issue. They knew their best area to provide data from was PCRs. They came up with a set of data points they thought would help. They attended many meetings and public events. During those forums dozens of additional questions and theories came forward. Trinity took and implemented all that they had data for. (Example. There was question about social benefits and opiate use. They are able to show on an ongoing basis that there is no correlation between opiate overdoses and the 1st and 15th of the month.)

Before 2015, Trinity reported opiate overdoses usually annually only when requested. Starting in 2015 they reported monthly. They wanted to provide data even quicker. Trinity had seen FirstWatch a few years before. They felt the speed and automation FirstWatch could provide was a critical improvement. The intelligence gathered with knowing in live time of opiate overdoses can’t be overstated. The automation allows that intelligence to be gathered no matter the day or time.

Trinity started working with FirstWatch in December 2015. In May 2016, Trinity put FirstWatch directly into the hands of public health, public safety and public schools. Each discipline has a HIPAA compliant login with access to data specific to their mission. They worked very closely with FirstWatch so they could understand the capabilities within the system. They brought the idea and FirstWatch brought the execution and focus. The FirstWatch platform is amazingly powerful for Trinity, to provide live access is amazing. In June 2016, Trinity participated in a Middlesex County District Attorney opiate task force meeting. Trinity had earlier in the meeting done a 20 minute presentation on the opiate crisis in our city. This provided the 70 people in attendance a fresh look at the data. Towards the end of the meeting conference to alert families and friends of addicts to watch their loved ones, and scheduled “emergency” Narcan administration training for the community. During DA Ryan’s presentation, Trinity received a FirstWatch alert for a 39 year old female opiate overdose from 30 minutes before. Three minutes later they received another alert for a 41 year old female that suffered a fatal opiate overdose. They were able to share that with the group and drive home the DA’s message.

The City Governments, Public Health, Police and Fire Departments in Trinity’s communities were eager to learn about the data they were able to collect, and their data began to become focal points at press conferences and city council meetings. News agencies began contacting Trinity to help paint the picture of the epidemic in feature stories. In sharing the mapping aspect of Firstwatch they hope that these agencies can further understand the epidemic and develop plans to combat it. Trinity has become the de facto subject matter experts of the opiate crisis.

Congratulations to Trinity EMS and FirstWatch for their selection as 2016 AMBY Winners.

 

Cataldo Ambulance’s Ron Quaranto on Mobile Integrated Health

As a current mobile integrated health provider, we recognize the values of an MIH program which most importantly provides quality patient care to those in need, often in the comfort of their own homes. This is often done under the direction of the patient’s primary care physician in conjunction with the patient’s healthcare team. This allows for the patient to maintain their quality of life while receiving the medical attention they need—and ultimately reducing the healthcare expenses of hospitalization.

Ron Quaranto
COO, Cataldo Ambulance Service

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.

Massachusetts Passes the Pay Equity Act

This past week the Massachusetts State Legislature unanimously passed, and Governor Baker signed into law the Pay Equity Act, making Massachusetts the first state in the nation to have legislation that prohibits employers from asking candidates about their salary history at their current or prior jobs.  Instead, the hiring manager needs to offer the candidate a wage based upon the value of the work being performed rather than being based on the candidate’s current earnings.

The new law, which takes effect on August 1, 2017, seeks to strengthen protections provided under federal equal pay laws.  The provisions of the Massachusetts law are that employers may not discriminate on the basis of gender as it relates to wages for “comparable work.”  The law also prohibits employers from restricting employee’s right to discuss wages with co-workers.  This provision echoes other federal laws that protect some employees when discussing wages.  The intent is that wage transparency will help reduce pay disparities amongst those in similar jobs.

The Massachusetts law encourages employers to perform wage analyses for positions within their organizations.  Further, if disparities are found, employers may be able to mitigate potential damages by showing that the assessment was performed and that they took steps to eliminate any disparities.  Also, the law prevents employers from lowering wages when disparities are discovered, requiring the lower wage to be adjusted.  Lastly, the new legislation provides a more detailed definition of “comparable work” which has been somewhat vague in similar legislation and is not clearly defined in the Federal Equal Pay Act.  Of note, the law does allow wage variations based upon seniority, a bona fide merit based system, or education that is reasonably related to the job function.

Nationally, the Equal Pay Act which was passed in 1963 already provides protections against pay disparities between women and men.  However, national statistics show that women still earn 79 cents for every dollar earned by a male in the same or comparable position.  Nearly every state in the country with the exception of Mississippi and Alabama have state legislation regarding equal pay and fewer states with provisions that provide for wage transparency.  With this new legislation, Massachusetts is certainly raising the bar for employers and it is likely that other states or federal legislation will follow.

The significance of the Massachusetts law is that it prohibits inquiries into past wage earnings.  It is common for employers to inquire about prior work history on an employment application or during the hiring process.  Those inquiries almost always include questions about current or past wages.  Many hiring managers use this as the basis for determining what wage they will offer the candidate even if their scale for the position was above that amount.  Starting August 1, 2016, Massachusetts employers will be prohibited from inquiring about current or past wages prior to making a job offer that includes a pay rate.  This will reduce the likelihood that the future employer will perpetuate any possible prior earning disparities.

The new law does not become effective until August 1, 2017, giving employers plenty of time to prepare.  Employers who have not already done so, should begin analyzing the different positions within their organizations in an effort to identify possible wage disparities.  The AAA has resources available to any member who is seeking to understand their obligations under this, or any other, state or federal law.

“Save Lives, Not Seconds” member editorial

Don’t miss the fantastic member-written editorial, Save lives, not seconds, in Wednesday’s Boston Globe. Submitted by Cataldo Ambulance’s Tom Kimball, it gets to the heart of many issues with using response times as the only performance metric. (Emphasis below is ours.)

Many cities and towns in Massachusetts still judge the performance of their ambulance services using metrics like response times, which can miss the point. An additional two minutes waiting for an ambulance will rarely make a difference for a trauma patient facing emergency surgery that may take hours.

Patient outcome is a more valuable measure of whether a medical service is doing right by people. In many areas of health care these days, it is the gold standard, a key factor in determining how much insurance companies pay service providers. Changing the terms of ambulance companies’ contracts to make good patient outcomes the goal could greatly improve the quality of medical care across the state — and save lives.

Read the full editorial over at the Boston Globe. 

Spotlight: Sean Kukauskas

Sean Kukauskas
Boston, MA, USA
Director of Ambulance Services, Spaulding Rehabilitation Hospital
Member, AAA Education & Membership Committee

Tell us a little about yourself, please.

I was born and raised in Massachusetts. I have three children, two boys and a daughter. My oldest son, Tyler (20 years old), is in the U.S. Army stationed at Ft. Bliss in Texas. My daughter, Kaylin (19 years old), is a college student, and my youngest son, Sean, is 14 and will be a high school freshman this fall. I am an avid long distance runner. I recently completed my first marathon earlier this year, the 2015 Boston Marathon.

How did you come to work in the industry? How long have you been involved?

Kukauskas, Sean - Spaulding - 2015.07.15 - FamilyAfter high school I joined the U.S. Navy as a mechanical calibration technician for nuclear powered submarines. After getting out of the service, I eventually found myself looking for a solid career. I always had an interest in medicine, so a friend of mine who was an EMT helped me get into EMT school. I have been involved in EMS since then, eventually earning my certification as a Paramedic. I just celebrated my 23rd year in EMS.

I spent the majority of my career working for private fire-based and hospital-based EMS services as a field provider and educator. I have spent the past four years as the Director of Ambulance Services for the Spaulding Rehabilitation Hospital. Spaulding Hospital Ambulance Service is one of the largest hospital based services in Massachusetts. We have 17 vehicles that provide over 16,000 ALS, BLS, and chair car transports annually. Our primary focus is the non-emergent interfacility transportation of patients between the four hospital within the Spaulding Network and our affiliated acute care hospitals.

What do you enjoy most about your job?

As cliché as it sounds, I enjoy making a difference. Whether it is to my patients or for my staff. I like the ever changing envrionment of EMS. Each call, each day, is something new.

What is your biggest professional challenge?

Trying to find that right balance of service and performance while maximizing revenue. At the same time employee engagement and retention are just as importand and challenging.

What is your typical day like?

My typical day starts early to face commuter traffic coming into Boston. Once in my office, I will review the stats from the previous day, respond to emails as needed, and work on the tasks for the day—whatever they may be at that time. I may jump on a truck for the day or for a call. Meetings and then more meetings. At some point during the day I try and get a training run in. Usually I try to finish up some light work at home later in the evening.

How has participation in AAA membership and advocacy helped your organization?

I have found the networking to be invaluable. Chances are someone in in the AAA has encountered a similar situation or issue before. Having a network of colleagues from across the country gives you an avenue to discuss what has worked and what hasn’t.

The AAA helps me grow and improve my department with fresh ideas. The education offerings, the networking opportunities, and reimbursement advocacy all help strengthen our profession. I have been a member of the Education and Membership Committee for the AAA for about two years. I really enjoy working with the other committee members to find and develop new and creative ways to improve the AAA Annual Conference and Tradeshow as well as exploring new opportunities for our members.

Spotlight: Scott Moore

Scott Moore
Somerville, Massachusetts, USA
Scott’s LinkedIn Profile
Director of Human Resources at Cataldo Ambulance Service
Co-Chair, Education & Membership Committee at AAA

Tell us a little about yourself.
I grew up twenty minutes north of Boston, MA. I have a wife, Marianne, and two daughters, Emily (9), and Elise (7). I have been in EMS for 25 years and have worked as a Call Fire-Fighter in my town for the last 10. I have a bachelor’s degree in psychology and a Juris Doctor from Suffolk University Law School.

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