When the National Emergency Medical Services Advisory Council (NEMSAC) met in January, neither coronavirus nor pandemic were on the agenda. Chartered by the Transportation Secretary in April 2007, NEMSAC members representing areas of hospital care, ambulance service, emergency dispatch, medical and agency management, typically convene semiannually.
In conjunction with the Council, the Office of EMS run by the National Highway Traffic Safety Administration issues informed and thoroughly deliberated guidelines to emergency medicine providers. In a time of pandemic and street demonstrations and riots unseen in decades, the occasion was ripe for updates and continued focus.
Here are 4 takeaways from the NEMSAC meeting.
1. Response during civil unrest raises questions
Violence against first responders is nothing new but viral video of George Floyd’s death in Minneapolis produced nationwide unrest unseen since the late 1960s. The Council agreed to an interim advisory in January and revisited the issue at the August meeting with the benefit of all-too fresh experience.
Dr. Jon Krohmer, EMS Office director, said “folks were put in situations that were potentially less stable than day-to-day, semi-stable environment that EMS often operates under,” noting inquiries that led to a briefing packet for public safety agencies.
Based on Council action, look for a national expertise conference on controversial issues like body armor or body-worn cameras within EMS as seen among law enforcement. One member was adamant that EMS providers not carry firearms for self-defense. Several states have passed legislation to permit EMS practitioners to carry weapons on the job.
Councilmember Sean Kaye noted that medics were targeted by law enforcement in trying to provide medical aid, in at least two cities, raising the concept of White Helmets or other Geneva Convention-like marking. He posed supporting people legitimately providing care, noting it will get a lot worse instead of a lot better, anticipating further unrest around the 2020 election. Jonathan Washko, a board member on the National Association of EMTs, pointed to distinguishing between volunteers and government affiliated EMS agencies as “a cautious line” for NEMSAC to respect.
The Council’s Profession Safety Committee will work further on guidance about mitigating violence against EMS practitioners in the meantime, first on a clarifying letter to include use of body cameras. Ultimately, NEMSAC is calling on NHTSA to move with dispatch. Long before this year’s unrest, the National Association of Emergency Medical Technicians 2019 report based on a survey of 37,000 respondents found that two in three providers from a sample of had been physically assaulted in the course of care.
2. Update on the ET3 Emergency Triage, Treat and Transport Model
Brenda Staffan with the Department of Health and Human Services updated the Council on the ET3 payment model developed last year but delayed to this fall by the CMS Innovation Center in April. Alternative destination transport and treatment in-place, in-person, or on-scene via telehealth are key to the model. Organizations like Medicare-enrolled ambulance providers, federally qualified healthcare centers, urgent care, doctors’ offices and others are being sought after to participate in the model, for which a notice of funding opportunity will soon be issued, according to Brenda.
The goal is for a network of medical ambulance suppliers and providers, public safety answering points, payers, alternative destination sites and treatment-in-place qualified healthcare practitioners all working together under the new model. Over 200 such organizations have signed up, ranging from public sector to nonprofit and hospital-based providers across suburban and rural areas.
Under the model, qualified healthcare practitioners would receive a 50% increase in their Medicare reimbursements outside of defined business hours, and after three years, a performance-based payment adjustment could go up 5%.
Data standards from the NEMSIS, or National Emergency Medical Services Information System, are being worked into the ET3 model to determine the technical details to make sure that data submission is a smooth process, Staffan told the Council.
3. Interest in emergency telemedicine
The public was first introduced to telehealth with Gage’s regular calls to Dr. Brackett in the hit television show “Emergency!” The pioneering paramedic phoned in symptoms and Brackett recommended an intervention and transport. The day is coming when a patient or a witness can communicate visually, suggested Washko, who cowrote a paper on modern telehealth – use of video – which found that “video is considered an enhancement by physicians overseeing a community paramedicine response,” suggesting a potential new horizon for emergency medicine.
Krohmer updated the Council on COVID-19 activities with respect to healthcare resiliency and telehealth. Project ECHO clinics have been conducted three days a week on critical care, emergency medicine and related issues since April. To date, 50 sessions have been conducted with over 10,000 viewers. The Office of EMS established an EMS/Prehospital Team “to become more aggressive and start looking at ways that we can use telehealth to provide clinical care” for ingratiating into standard service.
The COVID-19 Healthcare Resilience Task Force is working just as aggressively, according to Krohmer. Guidance was released in April. Read the American College of Emergency Physicians (ACEP)’s Telehealth Section White Paper on progress to date. This infographic explains why one networked provider believes telemedicine is a game changer. Yet, that conclusion is contradicted in a 2019 paper that looked specifically at electronic triage or tele-screening.
4. PPE a persistent concern
Eric Chaney with the EMS Office outlined efforts to track PPE within the data structures that exist as EMS COVID-19 Reporting Tool. “When you see the categories we collected,” Chaney explained, “there were designed by us. They were designed so that the data we take from our system goes directly into the charts and graphs,” he presented. “Our No. 1 priority was to fit into what’s being built.”
“EMS was not even on the chart” with other facilities like hospitals, long-term care and nursing homes, he said. “We have been rolling this out to everybody who will listen.”
EMS agencies are asked to report every seven days for data aggregation Tuesdays and Thursdays to be presented at a federal and state level dashboard. Cases among personnel whether confirmed or suspected, and fatalities to date are also to be accounted for. Resupply needs and logistics fulfillment are seen by select federal staff with visibility into acute stress – defined as less than a three-day supply – of N95 masks, for example.
PPE categories were based on HHS, but beyond that, Chaney is wide open to suggestions for the tool and other products to consider developing. “We heard all along,” Chaney said, “we knew that PPE data was not making it from the agency level into the national reports that were being given at the HHS/FEMA reporting levels,” so the tool aims to fill the gap. “Definitely, I think we have to figure out how to get the word out,” Washko said, noting that 123 reporting agencies represented only about .4% of the national EMS community.
Vincent Robbins, who presided over the plenary sessions, compared NEMSIS and the PPE reporting tool to data collection on ambulance crashes, workplace injury and violence. Data is visible on the site for two weeks; agencies are asked only if they have a shortage presently or within a week. Join the effort.
Additional resources
A white paper was generated rather than building previous work by the Federal Interagency Committee on EMS, a worthy read for those interested in EMS and 911 systems.
Learn more about arming EMS, ET3, treat in place, telehealth and PPE with these resources:
- Treat in place: How EMS models are shaped by reimbursement
- Protecting EMS providers from violence
- Arming the EMS workforce
- Poll Call: Should paramedics be allowed to carry guns on duty?
- Stretching your service’s supply of N95 respirators
- Data company says current rate of COVID-19 N95 usage is ‘unsustainable’
- The expanding use of telemedicine during the COVID-19 pandemic
- ET3 - Emergency Triage, Treat and Transport Model
- The gatekeepers: How EMS will save the U.S. healthcare system
