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Tag: National Association of EMS Physicians NAEMSP

NAEMSP Survey on Drug Shortages: Impact on Fire Departments and EMS Agencies

NAEMSP is currently conducting a vital survey aimed at understanding the effects of drug shortages on Emergency Medical Services (EMS) agencies. As esteemed leaders in the field of EMS, your insights are invaluable in comprehending the challenges faced by frontline responders due to medication scarcities.

 

In recent years, the healthcare sector has grappled with an increasing number of drug shortages, presenting significant hurdles for EMS agencies and fire departments. These shortages not only disrupt standard protocols but also pose potential risks to patient care and safety. As such, it is imperative to gather comprehensive data to address these issues effectively.

 

Your participation in this survey will contribute to a deeper understanding of the following:

  1. The frequency and severity of drug shortages experienced by EMS agencies and fire departments.
  2. The impact of drug shortages on patient care, treatment protocols, and outcomes.
  3. Strategies employed by EMS agencies and fire departments to mitigate the effects of drug shortages.

By sharing your expertise and experiences, you will play a crucial role in shaping strategies to address drug shortages and enhance emergency medical services nationwide. Your input will inform policymakers, healthcare providers, and stakeholders about the challenges faced on the ground, enabling us to develop targeted solutions to safeguard patient care and optimize resource allocation.

 

Thank you in advance for your participation and commitment to advancing the quality and effectiveness of prehospital patient care.

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NAEMSP | Rest in Peace E. Brooke Lerner, PhD, FAEMS

NAEMSP is deeply saddened by the news that E. Brooke Lerner, PhD, FAEMS has passed away after a courageous battle with cancer. Over the past two decades, Brooke has dedicated her career to the advancement of prehospital care, from spending time in the field as a paramedic to serving on the NAEMSP Board of Directors and joining her alma mater, the University of Buffalo, as a tenured professor and vice chair for research in the Department of Emergency Medicine in the Jacobs School of Medicine and Biomedical Sciences.

 

Said NAEMSP President José G Cabañas MD, MPH, FAEMS: “We pay tribute to the extraordinary legacy ‎of Dr. Brooke Lerner. Her service to our profession and NAEMSP was marked by honor and distinction, ‎including the mentorship of countless clinicians devoted to building effective prehospital systems of ‎care. Brooke’s transformative work played a pivotal role in advancing trauma and pediatric emergency ‎care, leaving behind a body of work that was instrumental in enhancing prehospital care standards. ‎May her enduring legacy serve as an inspiration to all of us, reminding us of the profound impact one ‎person’s selfless dedication can have in elevating the practice of EMS medicine.”‎

 

Throughout her career, Brooke focused on research in a subspecialty with a relatively small literature ‎base, authoring over 135 peer-reviewed publications and completing many federally funded grants to ‎conduct EMS research. Much of her research addressed acute injury care and field/disaster triage, and ‎she led the current national guideline for mass casualty triage.‎

 

Brooke also dedicated much of her time to pediatric emergency care, especially through the federally ‎funded Pediatric Emergency Care Applied Research Network (PECARN), where she led the ‎organization’s only prehospital node and served on its Executive Committee.‎

 

Following her diagnosis, Brooke worked with NAEMSP and the GMR Foundation to establish the E. ‎Brooke Lerner Research Fund with the goal of supporting early career EMS researchers. “I’ve spent my ‎career on improving prehospital care, and I wanted to leave something behind to keep that legacy ‎moving forward,” Brooke said, speaking of the fund shortly after its creation.‎

 

In 2013, Brooke received NAEMSP’s Keith Neely Award, and ten years later, she was recognized with ‎the Ronald D. Stewart Award for her illustrious career in EMS. It would be impossible to recount all the ‎invaluable contributions to emergency medical services made by Brooke Lerner, and more impossible ‎still to describe the impact she made on each person she met. NAEMSP will remember Brooke with the ‎utmost admiration and is profoundly grateful for everything she has done to advance EMS.‎

NAEMSP | Board Nominations Open

 

Dear NAEMSP members,

 

The subspecialty of EMS continues to evolve every day. As a member of NAEMSP, I hope you feel a part of this continued evolution. Our members — you! — work each and every day to advance EMS and improve the lives of our colleagues, patients, and communities.

 

As you may be aware, applications are currently open for the 2024-2026 slate of NAEMSP’s Board of Directors. Four positions are available: three Physician Members-at-Large positions, and one Professional Member-at-Large position. I am writing to encourage you all to consider applying for these open positions and helping us guide the future of NAEMSP and EMS as a whole.

 

The application deadline is September 1 — just a few days away. The link below will take you straight to the application page.

 

I hope to see your application soon!

 

Warmly,

JerrieLynn Kind

Executive Director, NAEMSP

Apply for NAEMSP’s Board of Directors

March 15 | NAEMSP/AAA Town Hall

NAEMSP/AAA Town Hall:
The Future of Healthcare Policy After the COVID 19 Public Health Emergency: What does it mean for Emergency Medical Services?

March 15th  //  12-1pm ET

The COVID-19 pandemic has had a significant impact on the healthcare system and has highlighted the need for healthcare reform. As the world moves forward from the pandemic, it is likely that the future of healthcare will be shaped by the need for cost containment while continuing to shift the healthcare delivery system to a more value-based care model.

For the past three years, we have seen new innovative approaches to healthcare delivery including the rapid adoption of telemedicine, and it is expected that this trend will continue in the post-pandemic world. Reimbursement reform continues to be an important issue for Emergency Medical Services (EMS) systems, as it affects their ability to provide high-quality care to patients. Despite the disruption that we have seen for the last three years, the EMS industry has continued to push forward with new innovative approaches to service delivery including the expansion of community paramedicine programs and the implementation of alternative programs like the Emergency Triage, Treat, and Transport (ET3) model. During this session, the panelists will discuss the current healthcare landscape, including what innovative programs may be here to stay and what it means for EMS Systems.

Moderator

Jose G. Cabañas, MD, MPH, FAEMS
President, NAEMSP

Panelists

Jonathan Oberlander, PhD
Professor & Chair of Social Medicine and Professor of Health Policy & Management
University of North Carolina – Chapel Hill

Paul Hinchey, MD, MBA, FAEMS
COO for University Hospitals in Cleveland, Ohio

Larry McMillan, MHA
Chief Compliance Officer & ET3 Project Lead, Wake County EMS

Randy Strozyk, MBA
President, American Ambulance Association

Lekshmi Kumar, MD, MPH, FAEMS
Medical Director, Grady EMS

Melissa Kroll, MD
Washington University, St. Louis

Lights & Siren Vehicle Operations on Emergency Medical Services (EMS) Responses

Joint Statement on Lights & Siren Vehicle Operations on Emergency Medical Services (EMS) Responses

February 14, 2022

Douglas F. Kupas, Matt Zavadsky, Brooke Burton, Shawn Baird, Jeff J. Clawson, Chip Decker, Peter Dworsky, Bruce Evans, Dave Finger, Jeffrey M. Goodloe, Brian LaCroix, Gary G. Ludwig, Michael McEvoy, David K. Tan, Kyle L. Thornton, Kevin Smith, Bryan R. Wilson

Download PDF Position Statement

The National Association of EMS Physicians and the then National Association of State EMS Directors created a position statement on emergency medical vehicle use of lights and siren in 1994 (1). This document updates and replaces this previous statement and is now a joint position statement with the Academy of International Mobile Healthcare Integration, American Ambulance Association, American College of Emergency Physicians, Center for Patient Safety, International Academies of Emergency Dispatch, International Association of EMS Chiefs, International Association of Fire Chiefs, National Association of EMS Physicians, National Association of Emergency Medical Technicians, National Association of State EMS Officials, National EMS Management Association, National EMS Quality Alliance, National Volunteer Fire Council and Paramedic Chiefs of Canada.

In 2009, there were 1,579 ambulance crash injuries (2), and most EMS vehicle crashes occur when driving with lights and siren (L&S) (3). When compared with other similar-sized vehicles, ambulance crashes are more often at intersections, more often at traffic signals, and more often with multiple injuries, including 84% involving three or more people (4).

From 1996 to 2012, there were 137 civilian fatalities and 228 civilian injuries resulting from fire service vehicle incidents and 64 civilian fatalities and 217 civilian injuries resulting from ambulance incidents. According to the

U.S. Fire Administration (USFA), 179 firefighters died as the result of vehicle crashes from 2004 to 2013 (5). The National EMS Memorial Service reports that approximately 97 EMS practitioners were killed in ambulance collisions from 1993 to 2010 in the United States (6).

Traffic-related fatality rates for law enforcement officers, firefighters, and EMS practitioners are estimated to be 2.5 to 4.8 times higher than the national average among all occupations (7). In a recent survey of 675 EMS practitioners, 7.7% reported being involved in an EMS vehicle crash, with 100% of those occurring in clear weather and while using L&S. 80% reported a broadside strike as the type of MVC (8). Additionally, one survey found estimates of approximately four “wake effect” collisions (defined as collisions caused by, but not involving the L&S operating emergency vehicle) for every crash involving an emergency vehicle (9).

For EMS, the purpose of using L&S is to improve patient outcomes by decreasing the time to care at the scene or to arrival at a hospital for additional care, but only a small percentage of medical emergencies have better outcomes from L&S use. Over a dozen studies show that the average time saved with L&S response or transport ranges from 42 seconds to 3.8 minutes. Alternatively, L&S response increases the chance of an EMS vehicle crash by 50% and almost triples the chance of crash during patient transport (11). Emergency vehicle crashes cause delays to care and injuries to patients, EMS practitioners, and the public. These crashes also increase emergency vehicle resource use through the need for additional vehicle responses, have long-lasting effects on the reputation of an emergency organization, and increases stress and anxiety among emergency services personnel.

Despite these alarming statistics, L&S continue to be used in 74% of EMS responses, and 21.6% of EMS transports, with a wide variation in L&S use among agencies and among census districts in the United States (10).

Although L&S response is currently common to medical calls, few (6.9%) of these result in a potentially lifesaving intervention by emergency practitioners (12). Some agencies have used an evidence-based or quality improvement approach to reduce their use of L&S during responses to medical calls to 20-33%, without any discernable harmful effect on patient outcome. Additionally, many EMS agencies transport very few patients to the hospital with L&S.

Emergency medical dispatch (EMD) protocols have been proven to safely and effectively categorize requests for medical response by types of call and level of medical acuity and urgency. Emergency response agencies have successfully used these EMD categorizations to prioritize the calls that justify a L&S response. Physician medical oversight, formal quality improvement programs, and collaboration with responding emergency services agencies to understand outcomes is essential to effective, safe, consistent, and high-quality EMD.

The sponsoring organizations of this statement believe that the following principles should guide L&S use during emergency vehicle response to medical calls and initiatives to safely decrease the use of L&S when appropriate:

  • The primary mission of the EMS system is to provide out-of-hospital health care, saving lives and improving patient outcomes, when possible, while promoting safety and health in communities. In selected time-sensitive medical conditions, the difference in response time with L&S may improve the patient’s
  • EMS vehicle operations using L&S pose a significant risk to both EMS practitioners and the public. Therefore, during response to emergencies or transport of patients by EMS, L&S should only be used for situations where the time saved by L&S operations is anticipated to be clinically important to a patient’s outcome. They should not be used when returning to station or posting on stand-by
  • Communication centers should use EMD programs developed, maintained, and approved by national standard-setting organizations with structured call triage and call categorization to identify subsets of calls based upon response resources needed and medical urgency of the call. Active physician medical oversight is critical in developing response configurations and modes for these EMD protocols. These programs should be closely monitored by a formal quality assurance (QA) program for accurate use and response outcomes, with such QA programs being in collaboration with the EMS agency physician medical
  • Responding emergency agencies should use response based EMD categories and other local policies to further identify and operationalize the situations where L&S response or transport are clinically Response agencies should use these dispatch categories to prioritize expected L&S response modes. The EMS agency physician medical director and QA programs must be engaged in developing these agency operational policies/guidelines.
  • Emergency response agency leaderships, including physician medical oversight and QA personnel should monitor the rates of use, appropriateness, EMD protocol compliance, and medical outcomes related to L&S use during response and patient
  • Emergency response assignments based upon approved protocols should be developed at the local/department/agency level. A thorough community risk assessment, including risk reduction analysis, should be conducted, and used in conjunction with local physician medical oversight to develop and establish safe response
  • All emergency vehicle operators should successfully complete a robust initial emergency vehicle driver training program, and all operators should have required regular continuing education on emergency vehicle driving and appropriate L&S
  • Municipal government leaders should be aware of the increased risk of crashes associated with L&S response to the public, emergency responders, and patients. Service agreements with emergency medical response agencies can mitigate this risk by using tiered response time expectations based upon EMD categorization of calls. Quality care metrics, rather than time metrics, should drive these contract
  • Emergency vehicle crashes and near misses should trigger clinical and operational QA reviews. States and provinces should monitor and report on emergency medical vehicle crashes for better understanding of the use and risks of these warning devices.
  • EMS and fire agency leaders should work to understand public perceptions and expectations regarding L&S use. These leaders should work toward improving public education about the risks of L&S use to create safer expectations of the public and government

In most settings, L&S response or transport saves less than a few minutes during an emergency medical response, and there are few time-sensitive medical emergencies where an immediate intervention or treatment in those minutes is lifesaving. These time-sensitive emergencies can usually be identified through utilization of high-quality dispatcher call prioritization using approved EMD protocols. For many medical calls, a prompt response by EMS practitioners without L&S provides high-quality patient care without the risk of L&S-related crashes. EMS care is part of the much broader spectrum of acute health care, and efficiencies in the emergency department, operative, and hospital phases of care can compensate for any minutes lost with non-L&S response or transport.

Sponsoring Organizations and Representatives:

Academy of International Mobile Healthcare Integration
American Ambulance Association
American College of Emergency Physicians
Center for Patient Safety
International Academies of Emergency Dispatch
International Association of EMS Chiefs
International Association of Fire Chiefs
National Association of EMS Physicians
National Association of Emergency Medical Technicians
National Association of State EMS Officials
National EMS Management Association
National EMS Quality Alliance
National Volunteer Fire Council


References:

  1. Use of warning lights and siren in emergency medical vehicle response and patient transport. Prehosp and Disaster Med. 1994;9(2):133-136.
  2. Grant CC, Merrifield Analysis of ambulance crash data. The Fire Protection Research Foundation. 2011. Quincy, MA.
  3. Kahn CA, Pirallo RG, Kuhn EM. Characteristics of fatal ambulance crashes in the United States: an 11-year retrospective Prehosp Emerg Care. 2001;5(3):261-269.
  4. Ray AF, Kupas DF. Comparison of crashes involving ambulances with those of similar-sized vehicles. Prehosp Emerg Care. 2005;9(4):412-415.
  5. S. Fire Administration. Firefighter fatalities in the United States in 2013. 2014. Emmitsburg, MD.
  6. Maguire Transportation-related injuries and fatalities among emergency medical technicians and paramedics.

Prehosp Disaster Med. 2011;26(5): 346-352.

  1. Maguire BJ, Hunting KL, Smith GS, Levick Occupational fatalities in emergency medical services: A hidden crisis.

Ann Emerg Med, 2002;40: 625-632.

  1. Drucker C, Gerberich SG, Manser MP, Alexander BH, Church TR, Ryan AD, Becic Factors associated with civilian drivers involved in crashes with emergency vehicles. Accident Analysis & Prevention. 2013; 55:116-23.
  2. Clawson JJ, Martin RL, Cady GA, Maio RF. The wake effect: emergency vehicle-related collisions. Prehosp Disaster Med. 1997; 12 (4):274-277.
  3. Kupas DF. Lights and siren use by emergency medical services: Above all, do no harm. National Highway Traffic Safety Administration. 2017. Available online at https://www.ems.gov/pdf/Lights_and_Sirens_Use_by_EMS_May_2017.pdf
  4. Watanabe BL, Patterson GS, Kempema JM, Magailanes O, Brown LH. Is use of warning lights and sirens associated with increased risk of ambulance crashes? A contemporary analysis using national EMS information system (NEMSIS) Ann Emerg Med. 2019;74(1):101-109.
  5. Jarvis JL, Hamilton V, Taigman M, Brown LH. Using red lights and sirens for emergency ambulance response: How often are potentially life-saving interventions performed? Prehosp Emerg Care. 2021; 25(4): 549-555.

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On-Demand | Flipping OFF the Switch on HOT Emergency Medical Vehicle Responses!

Flipping OFF the Switch on HOT Emergency Medical Vehicle Responses!
Recorded July 7, 2021 | 14:00–15:15 pm ET | FREE Webinar

Download Slide Deck | Watch on YouTube

HOT (red light and siren) responses put EMS providers and the public at significant risk. Studies have demonstrated that the time saved during this mode of vehicle operation and that reducing HOT responses enhances safety of personnel, with little to no impact on patient outcomes. Some agencies have ‘dabbled’ with responding COLD (without lights and sirens) to some calls, but perhaps none as dramatic as Niagara Region EMS in Ontario, Canada – who successfully flipped their HOT responses to a mere 10% of their 911 calls! Why did they do it? How did they do it? What has been the community response? What has been the response from their workforce? Has there been any difference in patient outcomes? Join Niagara Region EMS to learn the answers to these questions and more. Panelists from co-hosting associations will participate to share their perspectives on this important EMS safety issue!

Speakers

Kevin Smith, BAppB:ES, CMM III, ACP, CEMC
Chief
Niagara Emergency Medical Services

Jon R. Krohmer, MD, FACEP, FAEMS
Director, Office of EMS
National Highway Traffic Safety Administration
Team Lead, COVID-19 EMS/Prehospital Team

Douglas F. Kupas, MD, EMT-P, FAEMS, FACEP
Medical Director, NAEMT
Medical Director, Geisinger EMS

Matt Zavadsky, MS-HSA, NREMT
Chief Strategic Integration Officer
MedStar Mobile Integrated Healthcare

Bryan R. Wilson, MD, NRP, FAAEM
Assistant Professor of Emergency Medicine
St. Luke’s University Health Network
Medical Director, City of Bethlehem EMS

Robert McClintock
Director of Fire & EMS Operations
Technical Assistance and Information Resources
International Association of Fire Fighters

Mike McEvoy, PhD, NRP, RN, CCRN
Chair – EMS Section Board – International Association of Fire Chiefs
EMS Coordinator – Saratoga County, New York
Chief Medical Officer – West Crescent Fire Department
Professional Development Coordinator – Clifton Park & Halfmoon EMS
Cardiovascular ICU Nurse Clinician – Albany Medical Center

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