The Cambridge (Mass.) EMS system is putting biosurveillance technology to novel use: combating drug abuse. In Massachusetts, overdoses from heroin and prescription drugs such as oxycodone, codeine and methadone increased sixfold from 1990 to 2007, according to the Cambridge Prevention Coalition, a drug abuse prevention agency that’s part of the Department of Human Service Programs. Cambridge was one of 15 cities to receive state funding to evaluate the issue and find ways to reduce the problem.
For help, the Coalition turned to Pro EMS, a private company that provides emergency response in the city in conjunction with the Cambridge Fire Department. About a year ago, Pro EMS began using biosurveillance technology provided by FirstWatch of Encinitas, Calif., to monitor real-time trends in H1N1 and other hazards, as well as to track the geographic distribution of 911 calls to help with deployment decisions. By integrating FirstWatch software with the electronic health record tablet already in use, Pro EMS could give the Coalition real-time alerts about drug overdose situations, as well as trends and patterns. Pro EMS is also helping the Coalition track underage drinking trends and incidents.
Early detection means early intervention and action, says Gisela Rots, director of the Cambridge Prevention Coalition. “Using the FirstWatch system allows us to complete the picture of our data analysis,” she says. “Having real-time data that let us track the number of overdoses, the geographic area, the kind of drug, and other important information helps in achieving our goals, which is to reduce the overdoses and provide help to those users and their families.”
Privacy laws prohibit Pro EMS from sharing names or exact addresses with the Coalition, says Pro EMS CEO Bill Mergendahl, but the company can provide information on the streets in which overdoses occur, as well as the age, gender and other demographic information about addicts. Those data help the Coalition focus its interventions and initiatives where they’re most needed and where they will have the most impact. For example, if the data show a trend in people overdosing on some new combination of drugs, the Coalition can alert the community about the danger, as well as the local shelters and hospitals, Rots says.
Ultimately, reducing drug overdoses could also benefit the EMS system by leading to decreased numbers of overdose-related 911 calls and transports, Mergendahl says. For example, in 2007, for every opioid-related death, there were 47 non-fatal incidents treated at Massachusetts acute care hospitals, according to the Coalition. “It’s extremely important for EMS to be connected with public health issues in the community that we serve, and drug abuse has always been a big one in our area,” he adds.
The landmark health reform legislation signed into law in March includes a measure that has the potential to bring substantial changes to the way Medicare pays for services. The legislation calls for President Obama to appoint an Independent Payment Advisory Board (IPAB), which will have the authority to not only set the Medicare fee schedule, but determine how payments are made and for what. Many major medical groups have raised concern that IPAB will have far too much power.
Currently, Congress sets the fee schedule, and the Medicare Payment Advisory Commission (MedPAC) advises Congress. Yet IPAB’s recommendations will go into effect without congressional approval. While Congress can reject the recommendations, the vote is subject to presidential veto. In that case, Congress would need a supermajority two-thirds vote to block the recommendations—a nearly impossible threshold most of the time.
In January, dozens of major medical organizations, including the American Hospital Association, the Center for Medicare Advocacy and the Association of American Medical Colleges, sent a letter to Senate Majority Leader Harry Reid (D-Nev.) and House Speaker Nancy Pelosi (D-Calif.) calling for Congress to drop IPAB from the bill. Among the concerns: Instead of payment decisions being handled by Congress, they argued, authority would rest with political appointees who answer only to the president.
IPAB, whose 15 members will serve six-year terms and be made up of health care experts and other stakeholders, is one of the primary cost-control measures in the legislation and is mandated to reduce growth in Medicare spending to hit certain targets. Not only is it highly unlikely someone with EMS expertise will get a seat at the table, but under IPAB, it’s unlikely that Medicare reimbursement issues will get resolved, says Tristan North, vice president of governmental affairs for the American Ambulance Association. “[IPAB] will likely be looking at broad ways to reduce overall costs to the Medicare program as well as individual provider cuts,” he says. “So there unfortunately really isn’t an opportunity to address below-cost reimbursement of ambulance services. In general, providers will be facing additional cuts rather than any expansion of services of additional funding.”
To read the letter sent to congressional leaders, visit aha.org/aha_app/whatsnew/index.jsp. Search for “independent” to find the downloadable document.
The Federal Interagency Committee on Emergency Medical Services (FICEMS) held a national EMS and 911 stakeholders meeting on March 17 and 18 in Washington, D.C. The meeting was sponsored by the Department of Homeland Security, Office of Health Affairs. “The meeting was a good opportunity for stakeholders across the EMS spectrum to share the challenges we face. The input will go directly to all the federal agencies that have a piece of EMS,” says Gary Wingrove, a member of the last National EMS Advisory Council and president of the National EMS Management Association. “While consensus was not a goal of this meeting, a lot of issues are now on the table for further discussion and action.”
In a news release, FICEMS said the meeting was a way to improve communication between EMS stakeholders and federal agencies. Participants met in small groups for facilitated discussions with the aim of identifying “action items” for FICEMS to address. A summary of the meeting will be shared with the next National EMS Advisory Council when it is appointed, Wingrove says.
All fire departments and emergency medical services in Salt Lake County, Utah, are slated to be equipped with 12-lead ECGs and Bluetooth technology to transmit the data, thanks in part to grants from the Utah Hospital & Health Systems Association, a hospital trade association. “The hospital association had the foresight to help the fire departments fund a 12-lead program for all of the 911 systems in the Salt Lake City area, and the fire departments embraced the new technology so we can meet or exceed the national standard of care for cardiac patients in this area,” says Salt Lake City Fire Department Deputy Chief Brian Dale.
Salt Lake City, South Salt Lake and West Valley City are among the fire departments that will receive $133,000 in grants to fund the Blue Tooth purchases. With Bluetooth-enabled cell phones on board, the data gathered by the 12-leads are immediately transmitted to the hospital, where an emergency department physician can read the data. If an ST elevation myocardial infarction (STEMI) heart attack is confirmed, the physician will activate the hospital’s cardiac catheterization team, enabling the patient to receive treatment more quickly.
While studies have shown that prompt treatment of STEMI improves the odds of survival, only about 10 percent of EMS providers have 12-leads.
