News & Updates

In cooperation with the American Ambulance Association, we and others have created a running compilation of local and national news stories relating to EMS delivery. To date, over 1,500 news stories have been chronicled, with 56% highlighting the EMS staffing crisis, and 38% highlighting the funding crisis.

Click below for an up to date list of these news stories, with links to the source documents.

EMS Media Log Through 1-8-24 Read Only.xlsx

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  • 22 Feb 2024 5:18 PM | Matt Zavadsky (Administrator)

    While Rural communities are at the tip of this spear – many of these same issues are happening in urban and suburban areas as well.

    NAEMT is working on a project to try and create a Critical Access Ambulance Provider designation that would function with the same eligibility and reimbursement model and Critical Access Hospitals.

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    Rural emergency hospital model exposes ambulance service gaps

    ALEX KACIK

    February 22, 2024

    https://www.modernhealthcare.com/providers/cms-rural-emergency-hospital-model-ambulance-services-anson-general

    Anson General Hospital needed to transfer a pediatric patient to a specialist at Cook Children’s Medical Center in Fort Worth, Texas, but the only ambulance in Anson wasn’t available.

    If it had made the 340-mile round trip during a night of heavy rain on Feb. 10, no ambulance would have been available to handle 911 calls. As a result, Anson General had to keep the patient overnight in the emergency department.

    The next morning, the ambulance transported the child 25 miles to the airport in Abilene, where Cook Children’s had dispatched a plane for him.

    “We are the only hospital left in Jones County, since the other two hospitals closed," said Anna Doan, chief nursing officer at Anson General. “Those communities bring us patients on a daily basis. When a patient has more acute needs and needs to be transferred to a tertiary facility, the problem arises: How are we going to get them there?”

    It doesn't take much to upend emergency transportation services in rural communities, which have been plagued for years by limited ambulance networks.

    Many hospitals used to operate ambulance services, but that dynamic has shifted as rural hospitals finances have deteriorated. Rural hospitals often rely on one or two ambulances, oftentimes operated by volunteers, to transfer patients and handle 911 calls. A new hospital designation—rural emergency hospital—threatens to derail the fragile system.

    Twenty hospitals have converted to rural emergency hospitals about a year since the federal program was implemented. Hospitals forgo their inpatient beds, among other trade-offs, in exchange for a 5% increase in Medicare outpatient reimbursement and an average facility fee payment of more than $3.2 million a year.

    More hospitals are expected to convert, potentially requiring more ambulance transfers of patients to hospitals with inpatient beds. Since Anson General converted in March, on average it has transferred roughly 20 patients a month, versus 15 previously.

    “The rural emergency hospital legislation was notably missing considerations about ambulance services,” said Gary Wingrove, president of the Paramedic Foundation, a nonprofit research and advocacy group and a member of a federal advisory committee on ground ambulance and patient billing. “That is a big unintended consequence.”

    Ambulance services are typically fueled by a tenuous stream of subsidies from local jurisdictions and providers. When funding falls through, communities can lose emergency transportation services, potentially overloading area hospitals and causing delays in patient care. The situation has prompted pushes from local, state and federal policymakers to overhaul the reimbursement model.

    According to the latest Medicare cost report data, only 18% of rural hospitals bill Medicare for ambulance services, meaning that communities largely lean on volunteer-run and third-party contractors, according to a data analysis by consultancy the Chartis Center for Rural Health.

    Jones County, where Anson General is located, is reviewing a contract expiring in March for the city’s sole ambulance.

    “Not having a 911 service would be detrimental to the community. People could lose their lives,” Doan said. “It could have a big impact on patient care, changing the patient flow in ERs and how long transfers take.”

    Other rural communities could face similar predicaments since many towns are grappling with declining populations, worsening socioeconomic conditions and Medicare reimbursement cuts, particularly as more people age into the program, Anson General Interim CEO Ted Matthews said. 

    It costs roughly $1 million a year to fund an ambulance service, research shows. Roughly 4.5 million people live in an ambulance desert, defined as an area where a dispatch station is at least 25 miles away, according to a report published in May by the Maine Rural Health Research Center, which is associated with University of Southern Maine.

    The cost is prohibitive for many hospitals, cities and counties. In those areas, ambulance services are operated by volunteers and owned by third-party contractors.

    “We’re expecting the people who are going to decide whether you live or die to be volunteers,” Wingrove said. “That just doesn’t work.”

    Only one of the ambulances covering Friend, Nebraska, operates 24/7. The other two volunteer-run ambulances have limited hours and select routes.

    In July, Warren Memorial in Friend had a complex bariatric patient who needed to be transferred to a larger hospital in Lincoln, Nebraska. Administrators called 12 different transport companies and none would take him. Their vehicles lacked the specialized equipment to shuttle an obese patient.

    “He ended up staying here all night when he could’ve gotten better treatment in Lincoln,” said Jared Chaffin, chief financial officer and interim co-CEO of Friend Community Healthcare System, which operates Warren Memorial. While care was delayed, the patient ended up OK, Chaffin added.

    Administrators at Warren Memorial, which converted to a rural emergency hospital this month, are worried about the impact to the area's transportation network since the hospital no longer has inpatient capacity.

    Not everyone expects the rural emergency hospital program to strain transportation services. Most of the hospitals that convert were not admitting many emergent patients, said Eric Shell, board chair with the consultancy Stroudwater Associates who specializes in rural healthcare. Even if they did, most of the hospitals would be able to treat those patients under observation, as permitted by the rural emergency hospital program, as long as the average annual length of stay for observation patients remains below 24 hours, he said.

    That's the case at Santa Rosa, New Mexico-based Guadalupe County Hospital, which converted in September. The hospital hasn’t seen an increase in transfers since it already had relatively few admissions, and those who had been admitted were treated as observation patients, Administrator Christina Campos said.

    Still, regardless of the impact of the rural emergency hospital program, a more sustainable funding model is needed for emergency transportation services, experts said.

    Some industry observers are pushing for cost-based reimbursement for ambulance operators, similar to the critical access hospital model. As part of the No Surprises Act, legislation implemented in 2022 intended to shield patients from surprise bills, the federal government appointed an advisory committee on ground ambulance and patient billing. Ground ambulances are exempted from the law.

    That committee will soon publish a report that supports a cost-based payment model for ambulance services, said the Paramedic Foundation’s Wingrove, a member of the committee.

    “It is a misnomer to think you can pay for an ambulance service through reimbursement alone. The math simply isn’t there,” said Andy Gienapp, deputy executive director of the National Association of Emergency Medical Services Officials.

    “This problem has been a festering wound for decades now.”


  • 14 Feb 2024 12:50 PM | Matt Zavadsky (Administrator)

    Excellent Op-Ed by a well experienced fire service leader!

    Important quotes from his Op-Ed:

    • As EMS has been pulled into filling the gaps, it’s become clear that it’s not sustainable or effective in that role. Meanwhile, its ability to respond effectively to life-threatening emergencies has been strained.
    • Recognizing that it’s hard to improve something you don’t measure, the LAFD has been a leader in EMS research. One example was an evaluation of more than 33,000 calls for abdominal pain over a three-year period to see how many turned out to be life-threatening emergencies. The answer, astoundingly, was just seven.
    • Los Angeles is not alone; the staggering growth of nonemergency calls has plagued services around the country. A 2021 study of nearly 6 million 911 calls involving nearly 1,200 U.S. agencies found that while 86% of the responses sent crews racing with lights and sirens on, less than 7% resulted in a potentially lifesaving intervention.
    • Above all, any large-scale solution will require systemwide primary care access for 911 callers. The ultimate goal — one our modern EMS system has largely lost sight of — is to help people get the most appropriate and effective care.

    Tip of the hat to Kolby Miller at Medstar, Inc. in Michigan for finding this….

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    Opinion: Why that ambulance racing through L.A. traffic may not be going to a life-or-death emergency

    BY JON NEVIN

    FEB. 14, 2024

    https://www.latimes.com/opinion/story/2024-02-14/ems-ambulance-emergency-medical-service-fire-healthcare-los-angeles-california

    The lights and sirens of emergency medical services are pervasive in the United States. Not only are our screens saturated with them, but it’s hard to go far in any large city without seeing an ambulance race by.

    The public often assumes that the vehicle is on its way to a life-or-death emergency. But those who have worked in EMS know that is overwhelmingly not the case.

    What started in the 1960s as an answer to rapidly increasing carnage on the nation’s freeways has evolved into a complex subspecialty of American healthcare. Early research on the field demonstrated that prompt emergency medical care benefits a small subset of patients, namely those who suffer cardiac arrest and certain kinds of severe trauma. The hugely successful marketing of the 911 system also drove the expansion of EMS.

    Between 1980 and 2010, while the U.S. population increased 36%, the country’s fire departments experienced a 267% explosion in EMS runs. The number of life-threatening emergencies obviously didn’t grow that rapidly, so what happened?

    The EMS system got too good at its job — not the job of saving lives so much as the job of showing up in a matter of minutes at any time, day or night, for anyone who dials those three numbers. As affordable access to healthcare continued to erode, 911 was a reliably, readily available substitute.

    In its fifth decade, the modern EMS system doesn’t look much like it did when it was formed. In most cities, it’s become a catchall for everything that can fall through the cracks in our healthcare networks: communities with poor primary care access, homeless populations, and people with mental illnesses and substance abuse problems, to name a few.

    All these people need and deserve access to healthcare. The trouble is that EMS systems were not designed to handle this volume or breadth of patients. While emergency medical services are less expensive than byzantine hospital systems, they are by no means cheap.

    EMS is a labor- and equipment-intensive industry that struggles to recruit personnel, collect insurance reimbursement and, more recently, transfer patients to emergency rooms in a timely fashion. As a result, its ability to respond to any rapid increase in demand for care is very limited.

    Take the Los Angeles Fire Department, which responded to nearly half a million calls for service in 2022 — a 10.3% increase from 2018 — for a ratio of 1 response per 7.8 residents. To accomplish this feat, the department staffs approximately 150 ambulances per day out of its 106 fire stations. While that sounds like a lot of resources, the truth is that it’s only enough to cover 0.004% of the population at any given time. This is just one example of the vulnerability of our overburdened EMS system.

    Further exacerbating the difficulties in providing EMS coverage, use patterns are notoriously uneven; certain neighborhoods rarely use the system, while others rely on it for most of their healthcare. But it can’t just be removed from neighborhoods that don’t use it much.

    Unhoused people are an extreme example of these divergent patterns. They represent only 0.8% of the population but account for 10.2% of the city’s EMS calls, using the service at 14 times the rate of housed residents.

    Recognizing that it’s hard to improve something you don’t measure, the LAFD has been a leader in EMS research. One example was an evaluation of more than 33,000 calls for abdominal pain over a three-year period to see how many turned out to be life-threatening emergencies. The answer, astoundingly, was just seven.

    Los Angeles is not alone; the staggering growth of nonemergency calls has plagued services around the country. A 2021 study of nearly 6 million 911 calls involving nearly 1,200 U.S. agencies found that while 86% of the responses sent crews racing with lights and sirens on, less than 7% resulted in a potentially lifesaving intervention.

    The repercussions of inadequate healthcare run rampant in EMS calls and emergency departments. Only 8% of Americans 35 and older receive all recommended preventive services and screenings, and 1 in 8 of those ages 12 to 65 doesn’t have health insurance. Complications from diabetes, uncontrolled hypertension, obesity and alcohol use overwhelm the healthcare system in volume and cost. According to the Centers for Disease Control and Prevention, 90% of U.S. healthcare spending goes to treat chronic conditions.

    As EMS has been pulled into filling the gaps, it’s become clear that it’s not sustainable or effective in that role. Meanwhile, its ability to respond effectively to life-threatening emergencies has been strained.

    Many local leaders are aware of this and looking for answers. The strategies they have deployed include referring nonemergency calls to nurse hotlines, employing alternative transportation to sobering facilities and urgent care clinics, and bringing mental health practitioners to patients. Much effort has been expended trying to discourage nonemergency 911 calls with minimal success.

    It’s become apparent that the answer isn’t dissuading the public from calling 911 as much as it is changing what happens when the calls come in. One stumbling block has been accurately identifying non-life-threatening conditions. EMS systems have generally opted to err steeply on the side of tolerating nonemergency calls to avoid liability. Refining dispatch algorithms and integrating physician and nurse assessment may help alleviate the impulse to just send an ambulance.

    Ultimately it will be necessary to view 911 centers as healthcare hubs and ambulance transport as just one spoke for delivering it. The ability to triage patients as an emergency room does and send the appropriate response — whether an ambulance, taxi or mobile laboratory — may help conserve resources.

    Above all, any large-scale solution will require systemwide primary care access for 911 callers. The ultimate goal — one our modern EMS system has largely lost sight of — is to help people get the most appropriate and effective care.

    Jon Nevin is a battalion chief for a Southern California fire department and a longtime emergency medical services practitioner and researcher.


  • 14 Feb 2024 12:49 PM | Matt Zavadsky (Administrator)

    Notable quotes from these two articles on the same study released yesterday…

    • “EMS systems in the United States have traditionally relied upon operational measures, like response times, to measure performance of the system. However, this study highlights how patient care and experience are not solely determined by how fast an ambulance can arrive at the patient’s side,”
    • Over half of all EMS agencies failed to meet multiple performance measures, and only one in 10 dispatches followed the exact safety guidelines set, according to the study published Tuesday in Prehospital Emergency Care.
    • The rate of injuries in EMS workers is almost 15 times higher when ambulances use lights and sirens compared to when they don’t.
    • Researchers looked at how many patients who were transported using lights and sirens received interventions at the hospital, and only 4.5% of patients got this type of intervention.
    • The rest received interventions from EMS workers before arriving at the hospital, so the researchers recommended more research was needed to justify the use of lights and sirens in patients who need hospital intervention.

    You can view a PDF of the study here.

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    Quality of Care for Patients Who Call 911 Varies Greatly Across the United States, Study Finds

    Mount Sinai research could lead to more consistency and safety measures

    February 14, 2024

    https://www.mountsinai.org/about/newsroom/2024/quality-of-care-for-patients-who-call-911-varies-greatly-across-the-united-states-study-finds

    Emergency medical service (EMS) systems are not consistently providing optimal care based on new national standards of quality to patients who call 911, according to a new study from the Icahn School of Medicine of Mount Sinai.

    The study demonstrates that EMS performance on key clinical and patient safety measures varies widely across urban and rural communities. The findings, published in the February 13 issue of Prehospital Emergency Care, identify opportunities that could lead to improved care during 911 responses and improved outcomes for patients across the United States.

    “EMS systems in the United States have traditionally relied upon operational measures, like response times, to measure performance of the system. However, this study highlights how patient care and experience are not solely determined by how fast an ambulance can arrive at the patient’s side,” explains lead author Michael Redlener, MD, Associate Professor of Emergency Medicine at Icahn Mount Sinai. “While fast response times are essential for rare, critical incidents—like when a patient’s heart stops beating or someone chokes—the vast majority of patients benefit from condition-specific clinical care in the early stages of a medical emergency. It is essential for EMS systems, government officials, and the public to know about the quality and safety of care that is occurring and find ways to improve it.” 

    This is the first study to use specific safety and clinical quality measures to assess patient care across the entire 911 system in the United States.

    The research team reviewed all 911 responses in the United States for the year 2019, more than 26 million responses from 9,679 EMS agencies. They assessed specific quality measures in each call outlined by the National EMS Quality Alliance – a nonprofit organization that was formed to develop and endorse evidence-based quality measures for EMS and healthcare partners that improve the experience and outcomes of patients and care providers. This includes the treatment of low blood sugar, seizures, stroke, pain, and trauma, as well as medication safety and transport safety. Some of the notable findings were:

    • Pain for trauma patients improved in only 16 percent of cases after treatment by EMS.
    • 39 percent of children with wheezing or asthma attacks did not receive breathing treatments during their EMS call, even though earlier treatment can lead to earlier relief of distressing symptoms.
    • Nearly one-third of patients with suspected stroke did not have a stroke assessment documented, potentially delaying or missing time-sensitive treatment.

    The researchers also analyzed performance of all EMS agencies, looking at agency size and location—urban, suburban, and rural. They discovered substantial differences in agencies that primarily responded in rural communities compared to urban and suburban areas. Agencies with responses in mostly rural areas were less likely to treat low blood sugar or improve pain for trauma patients, and more likely to use lights and sirens unnecessarily when compared to EMS systems in urban and suburban communities.

    Previous studies have shown that when lights and sirens are used during EMS transport there is a higher likelihood of accidents, injury, and death, so unnecessary use may be more dangerous. Dr. Redlener says the difference between the highest- and lowest-performing agencies on these key measures is notable.

    “This work is not about blaming bad EMS services, but about uncovering opportunities to improve patient care,” Dr. Redlener adds. “We have to move away from solely looking at response times and start looking at performance that directly impacts the people we are meant to treat.”

    ---------------------

    Rural EMS Patients Face Worse Health Care—And Too Many Sirens, Study Finds

    Arianna Johnson

    Forbes Staff

    February 13, 2024

    https://www.forbes.com/sites/ariannajohnson/2024/02/13/rural-ems-patients-face-worse-health-care-and-too-many-sirens-study-finds/?sh=31bf67665bbb

    Emergency medical services in rural areas are less likely to reduce pain in trauma patients provide proper care to kids with asthma attacks, and are more likely to use lights and sirens unnecessarily, according to a study published Tuesday, adding to previous research that found rural health systems struggle more compared to urban and suburban areas.

    KEY FACTS

    The team of researchers from the Icahn School of Medicine of Mount Sinai looked at all the 911 dispatches in the U.S. in 2019—which consisted of over 6 million responses from 9,679 EMS agencies—and graded EMS agencies based on some of the National EMS Quality Alliance’s performance measures, like effectiveness of pain management and taking trauma patients to trauma centers.

    Over half of all EMS agencies failed to meet multiple performance measures, and only one in 10 dispatches followed the exact safety guidelines set, according to the study published Tuesday in Prehospital Emergency Care.

    EMS agencies with responses in mostly rural areas were on average more than 25% more likely to use lights and sirens unnecessarily when responding to calls, and 5% less likely to improve trauma patients’ pain and treat low blood sugar compared to agencies in suburban and urban areas.

    Almost 40% of children who suffered asthma attacks or breathing problems from all communities didn’t receive treatment from EMS, but those in rural areas received it at a rate of about 10% less, according to Tuesday’s study.

    Almost a third of patients in all communities suspected of a stroke didn’t receive a stroke assessment, which the researchers believe could have delayed or completely stopped the patients from receiving timely treatment.

    SURPRISING FACT

    The national average from the time of a 911 call to arrival on scene is seven minutes, but that time doubles to 14 minutes in rural areas, and around one in 10 encounters take 30 minutes, according to a 2017 JAMA study.

    CRUCIAL QUOTE

    “While fast response times are essential for rare, critical incidents—like when a patient’s heart stops beating or someone chokes—the vast majority of patients benefit from condition-specific clinical care in the early stages of a medical emergency,” lead author Michael Redlener, an associate professor for the Icahn School of Medicine of Mount Sinai, said in a statement.

    KEY BACKGROUND

    Rural communities have worse or struggling medical systems because they’re often isolated from bigger cities, and they tend to have a shortage in doctors, according to the National Institutes of Health. EMS agencies in isolated areas respond to more critical, life-threatening calls that require more timely response times than suburban and urban EMS providers, mainly because rural areas are poorer, older and sicker.

    Large geographic areas with scattered populations, longer travel distances and challenging weather conditions and terrain are all factors into longer dispatch times in rural communities, the federally funded Rural Health Information Hub says.

    Another factor at play is the closure of hospitals in rural areas. There were 136 rural hospital closures between 2010 and 2021, with a historic 19 in 2020 alone—the most of any year in the past decade—according to a 2022 report from the American Hospital Association. Hospital closures means still-standing hospitals have an increased coverage area: rural ambulance travel times increase 76% in the year directly following a closure, a 2019 University of Kentucky study found.

    TANGENT

    The use of sirens and flashing lights by ambulance vehicles has been a long-debated topic within the medical community.

    Lights and sirens are meant to decrease response and transport times, and research suggests they cause a “modest” reduction in EMS response time between 1.7 to 3.6 minutes, and reduce transport time between 0.7 to 3.8 minutes.

    However, some argue they do more harm than good. The risk of crash more than doubles when emergency vehicles use lights and sirens while transporting a patient, according to the National Safety Council.

    The rate of injuries in EMS workers is almost 15 times higher when ambulances use lights and sirens compared to when they don’t.

    Researchers looked at how many patients who were transported using lights and sirens received interventions at the hospital, and only 4.5% of patients got this type of intervention.

    The rest received interventions from EMS workers before arriving at the hospital, so the researchers recommended more research was needed to justify the use of lights and sirens in patients who need hospital intervention.


  • 13 Feb 2024 8:39 AM | AIMHI Admin (Administrator)

    Washington, DC—Today the Academy of International Mobile Healthcare Integration (AIMHI) announced the winners of the 2024 AIMHI Excellence in Integration Awards, which will be celebrated at the American Ambulance Association Annual Conference & Trade Show in Nashville on April 24.  These prestigious honors celebrate and promote high-performance, high-value EMS, its partners, and leaders.

    This year's winners are:

    Excellence in EMS Integration
    • Ascension St. John Bed Delay Initiative
      Ascension St. John Medical Center's aggressive bed delay mitigation strategy, which significantly reduced EMS waiting times and improved unit hour production, earns it the AIMHI Excellence in EMS Integration Award. This initiative showcases the hospital's dedication to enhancing the efficiency of EMS services by ensuring the rapid transfer of care from EMS to hospital staff, thereby drastically reducing bed delays. Ascension St. John's proactive approach, including a goal for EMS transfer of care within 5 minutes, not only enhanced operational efficiency but also boosted EMS crew morale, fostering a stronger partnership between EMS and hospital staff. This achievement underscores Ascension St. John's leadership and innovation in healthcare, setting a new standard for hospital and EMS collaboration.
    • Honorable Mention: Niagara Consumption & Treatment Services (CTS) site 
      Niagara's Consumption & Treatment Services (CTS) site, a safe space for individuals struggling with substance use, received an honorable mention this year. This initiative, in partnership with Positive Living Niagara, combines supervised drug consumption with immediate medical intervention by EMS paramedics in case of overdose, alongside offering a range of support services. This holistic approach not only saves lives but also connects individuals to crucial health and social services, demonstrating a successful model of integrated healthcare that addresses both immediate and long-term needs of those with substance use disorders.
    • Honorable Mention: AmeriHealth Caritas Ambulance Value Based Program 
      AmeriHealth Caritas, a leader in healthcare solutions for low-income and chronically ill populations, has been recognized with an honorable mention for its innovative Ambulance Value-Based Program in partnership with Acadian Ambulance. This groundbreaking initiative focuses on enhancing clinical quality, performance, and patient outcomes through a value-based care agreement. This agreement incentivizes ambulance services to achieve shared savings linked to patient outcomes, particularly following treat-in-place encounters, and rewards efforts towards meeting quality measure benchmarks. Through this partnership, AmeriHealth Caritas and Acadian Ambulance have demonstrated a commitment to improving patient care and outcomes for Medicaid members in Louisiana, highlighting the power of collaboration in advancing healthcare.

    Excellence in Public Information or Education

    • Mecklenburg EMS Agency's Response Configuration Community Outreach

      The Mecklenburg EMS Agency, also known as Medic, has been honored as the winner of the Excellence in Public Information or Education Award for its exemplary Response Configuration Community Outreach program. Launched on April 17, 2023, this initiative redefined Medic's approach to responding to calls, optimizing resource allocation, and setting new benchmarks for response times, particularly for non-emergent situations. To ensure the success of this transformative change, Medic formed a multi-agency project team, collaborating closely with local fire departments, police departments, and community organizations. This team embarked on an ambitious communication campaign, engaging in public feedback sessions across Mecklenburg County, leveraging local media, and generating significant social media engagement. The creation of dedicated landing pages for both the public and internal staff facilitated transparent communication and feedback, contributing to the project's success. Medic's comprehensive strategy not only secured broad stakeholder buy-in but also effectively managed public perception, ensuring a smooth transition to the new response configuration. This campaign underscores Medic's commitment to public education and its role as a leader in EMS service delivery, demonstrating the profound impact of effective communication and community engagement in healthcare.

    Excellence in Value Demonstration or Research
    • Mecklenburg EMS Agency's Response Configuration
      The Mecklenburg EMS Agency (Medic) stands out as the recipient of the Excellence in Value Demonstration or Research Award, thanks to its pioneering Response Configuration program. This initiative, launched in April 2023, strategically enhanced Medic's response protocols to emergency calls, leading to significant operational improvements. Notably, within six months, comprehensive data analysis highlighted that the new configuration had no negative effects on patient outcomes, optimized resource allocation, and led to a substantial 70% reduction in the use of lights and sirens during responses. Additionally, it achieved a 78% decrease in Medic-involved traffic incidents, significantly enhancing safety for both the community and emergency responders. These impressive outcomes not only demonstrate Medic's innovative approach to EMS but also underscore its unwavering commitment to improving patient care, safety, and efficiency within the greater Charlotte area.
    • Honorable Mention: AAA/AIMHI EMS News Tracker (Rob Lawrence & Rodney Dyche)

      The American Ambulance Association/AIMHI EMS News Tracker, spearheaded by Rob Lawrence and Rodney Dyche, receives an honorable mention in the category of Excellence in Value Demonstration or Research. Since its inception in 2021, this invaluable resource has meticulously cataloged local and national news stories pertinent to the EMS community. By offering a filterable database complete with direct links to each news report, the News Tracker has become an essential tool for publications, presentations, and national webinars, showcasing the significant challenges and impacts facing EMS across the nation.

    Advocacy in Integrated Healthcare Award
    • Rep Mike Carey (OH-15)

      Representative Mike Carey of Ohio’s 15th Congressional District is celebrated for his staunch advocacy on behalf of EMS, particularly in championing improved reimbursement and innovative patient care models. Since his tenure began in November 2021, Carey has leveraged his positions on influential committees to advocate for policies that support EMS providers and ensure they are fairly compensated for their critical services. His commitment to EMS advancement reflects his broader dedication to public service.

    • Senator Peter Welch (VT)
      Senator Peter Welch of Vermont is honored with the Leadership in Integrated Healthcare Award for his groundbreaking work on the Emergency Medical Services Reimbursement for On-Scene Care and Support Act (EMS ROCS). This legislation, a significant milestone for the integration of EMS into the healthcare system, proposes that the Medicare program reimburse EMS providers when they render care on-scene, even if the patient opts against transport to an emergency department. Welch's initiative addresses a critical gap in healthcare delivery by ensuring EMS providers are supported financially for the essential services they offer, regardless of patient transport decisions. His efforts highlight a profound commitment to enhancing patient care, supporting EMS providers, and advancing the integration of EMS services into the broader healthcare ecosystem.
    EMS Leadership Award
    • Benjamin Swig of Acadian Health
      Benjamin Swig's visionary leadership at Acadian Health has been instrumental in transforming healthcare through innovative initiatives such as the Mobile Healthcare Division and value-based care agreements. His efforts in integrating EMS into broader healthcare delivery systems, from home healthcare innovations to partnerships for advanced medical solutions, demonstrate an exceptional commitment to improving patient care, efficiency, and outcomes. Swig's strategic initiatives have had a profound impact on the EMS and healthcare industries, making him a deserving recipient of the Leadership in Integrated Healthcare Award.
    • Jason Schaak of West Allis Fire Department
      Assistant Chief Jason Schaak of the West Allis Fire Department's Bureau of Mobile Integrated Health is recognized for his exceptional leadership in advancing community healthcare. By focusing on proactive and individualized care for residents heavily reliant on EMS, Schaak's work with the community paramedic program exemplifies innovative healthcare delivery that bridges gaps, reduces unnecessary hospital stays, and improves patient outcomes. His dedication to creating sustainable healthcare models and his impact on reducing overdose rates and improving the quality of life for community members underscore his significant contributions to integrated healthcare.

    Lifetime Achievement Award

    • Dan Swayze, DrPH, MBA, MEMS

      Dan Swayze is honored with the Lifetime Achievement Award for his pioneering role in community paramedicine and his enduring impact on the EMS and healthcare industries. With over three decades of dedicated service, his leadership in developing the first MIH/CP program and integrating it into health plans has paved the way for innovative care models that significantly reduce acute care utilization. Swayze's contributions to education, program development, and advocacy have not only shaped the future of EMS but have also improved patient care and outcomes across the healthcare continuum.

    “The AIMHI Excellence in Integration Award winners represent the very best in mobile integrated healthcare and its partners. We are proud to honor these exceptional programs and individuals for their contributions to public health,” said AIMHI President Chip Decker.

    Those not in attendance will receive their awards locally.

    ###

    Academy of International Mobile Healthcare Integration (AIMHI)

    The Academy of International Mobile Healthcare Integration (AIMHI) represents high performance emergency medical and mobile healthcare providers in the U.S. and abroad. Member organizations are high-performance systems that employ business practices from both the public and private sectors. By combining industry innovation with close government oversight, AIMHI members are able to offer unsurpassed service excellence and cost efficiency.


  • 12 Feb 2024 7:26 AM | Matt Zavadsky (Administrator)

    While this article focuses on hospitals, the same issues face EMS agencies.

    Medicare historically has reimbursed less than the cost of providing the level of EMS care local community’s desire. An increasing Medicare payer mix and decreasing commercial payer mix places further economic pressures on EMS agencies.

    The article highlights service level changes hospitals are implementing to decrease costs, while maintaining focus on patient outcomes. So too, EMS agencies, and their communities, should identify service level changes that reduce costs, while maintaining patient outcomes.

    Notable quotes from the article:

    The aging of the baby boomers means Medicare enrollment growth is expected to exceed that of other major payers, at 7.8% annually from 2025 to 2031, the Centers for Medicare and Medicaid Services estimates. Yet many health systems are unprepared to manage the wave of Medicare beneficiaries.

    Providers that don't take measures to avoid high-cost care will see their margins erode, especially as Medicare and Medicare Advantage reimbursement rates wane and as the number of relatively more lucrative commercially insured patient population declines, experts said.

    ------------------------

    Medicare is booming, and providers are bracing themselves

    ALEX KACIK

    February 12, 2024

    https://www.modernhealthcare.com/providers/medicare-medicaid-surge-tampa-general-hospital-memorial-hermann

    Tampa General Hospital decreased sepsis mortality rates by nearly 10%, reduced emergency department utilization by close to two-thirds and slashed more than $1 million in costs over a two-year period.

    The hospital set up a command center that uses predictive, artificial intelligence-backed analytics that flags potential early indicators of diseases like sepsis and tracks a patient's treatment. Catching the warning signs earlier and standardizing care have helped keep patients out of the hospital, improve outcomes and reduce expenses.

    The command center is one of Tampa General's multi-year efforts aimed at better controlling the cost of care and improving quality for the influx of patients aging into the Medicare program.

    “We need to manage a new world order [as payer mix shifts] from commercial insurance to Medicare,” said John Couris, president and CEO of Tampa General. “We’ve been anticipating this and working for the last few years to take friction out of the patient experience.”

    The aging of the baby boomers means Medicare enrollment growth is expected to exceed that of other major payers, at 7.8% annually from 2025 to 2031, the Centers for Medicare and Medicaid Services estimates. Yet many health systems are unprepared to manage the wave of Medicare beneficiaries.

    Providers that don't take measures to avoid high-cost care will see their margins erode, especially as Medicare and Medicare Advantage reimbursement rates wane and as the number of relatively more lucrative commercially insured patient population declines, experts said.

    “This shift puts hospitals and health systems into an immense financial compression,” said Thom Bales, a principal at consultancy PwC. “The simplest recourse is to go back and renegotiate contracts with private payers, and that isn’t sustainable.”

    Medicare patients make up about half of health systems’ inpatient care. That share has stayed relatively constant from 2006 to 2022, inching up from 47.7% of hospitals’ annual inpatient hospital days to 49.2% during that time, according to American Hospital Association data.

    As hospitals’ patient mix skews more toward Medicare, hospitals have treated fewer commercially insured patients. Commercially insured and self-pay patients as a percentage of annual inpatient hospital days has dropped from 33.4% in 2006 to 27.8% in 2022, according to AHA data. The patient mix delta between Medicare and private insurance is expected to widen over the next several years.

    AHA is pushing back against policies, such as site-neutral payments that would equalize Medicare reimbursement for some low-acuity care provided at hospital outpatient departments, ambulatory surgical centers and physician offices, under the premise that Medicare payments do not cover the care costs. Melinda Hatton, general counsel and secretary at the association, cited a recent AHA analysis that concluded Medicare paid hospitals 82 cents for every dollar they spent caring for Medicare patients in 2022.

    “An aging population will continue to exacerbate these challenges,” Hatton said. 

    Hospital margins, in large part, hinge on care for the commercially insured. The decline in the commercially insured patient population, combined with commercial insurers’ cuts to Medicare Advantage and continued contraction in Medicare payments, have caused providers to restructure their workforce and operations, particularly in rural and low-income communities. 

    “If you are in a geographic market full of people who are aging and where young people are moving away, you have a problem,” said Jeff Goldsmith, president of consultancy Healthcare Futures. “Ultimately, it’s a public policy problem.” 

    Hospitals and health systems can better manage the changes through wrap-around care models that help patients manage housing, transportation, nutrition and other social needs, taking on financial risk through alternative payment models, directing more care to outpatient facilities, consolidating certain services and delegating less complex care and administrative work to lower-level staff, industry observers said.

    Some health systems are trying to proactively head off expensive, resource-intensive care by improving the patient experience and adding outpatient sites.

    For example, at Tampa General, the hospital implemented a nurse navigator program in June 2019. The navigators help patients book follow-up appointments, answer clinical questions, explain medication, facilitate transportation and connect them with support services such as nutrition and housing programs. As a result, the number of care referrals booked jumped 80% from 2022 to 2023, Tampa General's data shows.

    Meanwhile, the health system continues to add small clinics and urgent care centers across Florida. Healthcare providers cannot expect patients to come to sprawling outpatient hubs, Couris said. 

    “When you are trying to break even on Medicare, you can’t necessarily afford a $100 million outpatient center,” he said. “The economics of healthcare are shifting, and we have to shift with it.”

    Outpatient expansion and managing Medicare patients are top of mind for HCA Healthcare too. The Nashville, Tennessee-based hospital chain bought 41 urgent care centers in Texas from FastMed in 2023, and has a "large development pipeline" of outpatient facilities in 2024 and 2025, executives said during a Jan. 30 earnings call.

    HCA CEO Sam Hazen has noted the importance of controlling spending and care coordination, particularly among its Medicare population. Medicare admissions grew 2.1% in 2021, 3.4% in 2022 and 4% in 2023, he said on the call.

    Memorial Hermann tripled its urgent care footprint in 2023. The nonprofit health system based in Houston, in partnership with GoHealth, has opened 30 urgent care centers, which have helped free up capacity at its Memorial Hermann's emergency departments, Chief Financial Officer Alec King said. 

    Also, Memorial Hermann has been consolidating services such as obstetrics and neurology into hospitals that specialize in those areas. Taking low-volume services out of certain hospitals and putting them into a centralized location has improved quality and reduced costs, King said.

    "It is not efficient for every hospital to be a center of excellence for every service," he said.

    Health systems across the country are considering consolidating services, said Michael Corbett, director of healthcare consulting at LBMC. "Nearly every conversation we’ve had with clients is focused on consolidation of services," he said.

    Providers are focused on boosting efficiency of specialty care given that most healthcare dollars flow toward a subsection of high-needs patients. The costliest 5% of Medicare beneficiaries accounted for nearly half of 2020 Medicare fee-for-service spending, according to a July report from the Medicare Payment Advisory Commission.

    Cancer diagnosis and treatment has garnered attention from the federal government because of the disproportionate expense burden on the Medicare program. The Centers for Medicare and Medicaid Services on Nov. 2 created new billing codes for cancer patient navigation services as part of President Joe Biden’s Cancer Moonshot Initiative.

    In addition, the Center for Medicare and Medicaid Innovation in July launched a risk-based payment model called the Enhancing Oncology Model. Participating physician group practices can earn a performance-based payment, or owe CMS a performance-based recoupment, if total expenses over a six-month period exceed a certain threshold.

    “A lot of our [health system] clients are seeing an increase in Medicare and Medicare Advantage patients and looking at value-based care as one way to potentially break even,” said Rick Kes, a healthcare senior analyst at accounting firm RSM. “This is the tip of the iceberg of Medicare because of the demographic shift of people aging into the program.”

    Still, some are taking a wait-in-see approach to Medicare care management strategies, he noted.

    “Some health systems are so big that they have some opportunity to weather these financial challenges for some time,” Kes said. “Others do not have that luxury.”


  • 6 Feb 2024 10:05 PM | Matt Zavadsky (Administrator)

    EMS agencies, like the rest of the healthcare system, face significant challenges with the ongoing, increasing drug shortage of essential medications.

    Thought you all might like to see the recommendations communicated today from the American Hospital Association….

    ------------------------------

    Source:

    https://www.aha.org/testimony/2024-02-06-aha-comments-house-committee-ways-and-means-examining-chronic-drug-shortages-united-states

     

    Statement of the American Hospital Association for the 
    Committee on Ways and Means of the U.S. House of Representatives 
    “Examining Chronic Drug Shortages in the United States” 
    February 6, 2024

    On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, and our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the American Hospital Association (AHA) thanks you for the opportunity to submit comments to the House Committee on Ways and Means regarding the important topic of drug shortages in the United States.

    America’s hospitals and health systems have long been concerned about shortages of a wide range of drugs used to treat patients. Of particular concern to hospitals are the cascading impact of drug shortages on patients and the heightened stress on scarce hospital resources. Shortages can adversely affect patient care by causing delays in treatment, increasing the risk of medication errors and requiring the use of less effective alternative treatments. As a result, diseases that are curable or manageable for most patients, such as childhood leukemia, may not be able to be treated effectively.

    When a drug is in shortage, hospitals must find an alternative drug to provide their patients. This process of finding and procuring an alternative drug can result in significant costs to the hospital. An analysis published in 2019 estimated that drug shortages result in at least $359 million annually in additional labor costs to hospitals.1 This comes on top of the estimated $200 million annually that hospitals and health systems spend paying higher prices to acquire alternative therapies.2 Due to the increased cost and necessity of treating patients in a timely manner, especially in cases of cancer and other serious illness, it is important to ensure the pharmaceutical supply chain is protected and priority drugs are identified and given special attention so that continual access is ensured for patients.

    However, it has become increasingly clear that our national pharmaceutical supply chain is fragile; this fragility poses significant risk to the patients and communities served by America’s hospitals and health systems. Various businesses make up the pharmaceutical supply chain, including suppliers, manufacturers, distributors and group purchasing organizations. A disruption anywhere in the chain can create prolonged difficulties in pharmaceutical supply acquisition for providers, which can directly affect their ability to treat patients.

    Exacerbating these difficulties is the “lean” or “just-in-time” framework of supply chain operations. There is effectively little buffer when disruptions occur. Distributors, manufacturers and health care providers have pursued this just-in-time supply chain approach with the goal of more affordable health care by lowering costs; however, during large scale emergencies and other disruptions in supply, the risks and added costs of such a strategy is clear — when those disruptions occur, providers often have little or no notice and can be left scrambling to acquire products necessary to care for the sick and injured.

    A 2019 report from the Food and Drug Administration’s (FDA) Drug Shortages Task Force found there are three major root causes for drug shortages.3

    1. Lack of incentives to produce low margin drugs. Manufacturers of older generic drugs, in particular, face intense price competition, uncertain revenue streams and high investment requirements, all of which limit their ability to invest in resilience.
       
    2. The market cannot identify and preferentially buy from those with better quality management practices. All manufacturers must meet regulatory requirements for adherence to the FDA’s Current Good Manufacturing Practices (CGMP), which set expectations for company processes to be allowed to do business in the U.S. marketplace. Some companies do more than simply conform to these requirements. They take additional steps intended to ensure a reliable supply of the drugs manufactured at their facilities. Currently, purchasers, including hospitals and health systems, have only limited information to assess the state of quality management of any specific drug manufacturing facility and have little information linking the drug products they buy with the facilities where they were manufactured. The lack of information does not enable the market to reward drug manufacturers for mature quality management, back-up manufacturing capabilities or risk management plans, nor does it penalize manufacturers that fail to invest in modernization of their equipment and facilities to ensure a reliable supply.
       
    3. Logistical and regulatory challenges make it difficult for the market to recover after a disruption. Over the past two decades, the drug supply chain has become longer, more complex and more fragmented as companies have located more production overseas and increased the use of contract manufacturers. Although typical markets would respond to a shortage by increasing production, the complexity of the supply chain, and logistical and regulatory challenges, can limit the ability of drug manufacturers to do so. When companies wish to increase production, they may have to obtain approvals from multiple different national regulatory bodies and/or find a new source of active pharmaceutical ingredients (APIs). If a new manufacturer wants to enter the U.S. market and start selling a drug in shortage, the manufacturer must first develop and file an application with the FDA and await its approval.

    To mitigate these challenges, strengthening the supply chain is crucial. A focus on increasing manufacturing redundancy, diversifying where raw materials are sourced and where products are manufactured, and “fattening” the overall supply chain will provide significant improvements. It will allow the supply chain to withstand expected and unexpected fluctuations in the supply of, and demand for, pharmaceutical products and protect it against future public health emergencies and natural disasters.

    Supply chain issues can adversely impact patient care by delaying treatment, worsening patients’ health outcomes or requiring patients to switch to non-optimal treatment regimens. Congress should act to strengthen the ability of the pharmaceutical supply chain to respond when there is an emergency that creates a sudden rise in demand for medications or a significant disturbance in the supply chain that threatens the availability of critical medications. We recommend that Congress consider providing additional authorities to the FDA to mitigate and prevent drug shortages, such as by developing and disseminating manufacturing quality ratings that could enable hospitals and Group Purchasing Organizations (GPOs) to choose to do business with more reliable manufacturers, sending a market-based signal to support a reliable supply chain, and expanding the agency’s authority to require manufacturers to notify the agency about unusual spikes in demand of essential medications. Congress could also consider expanding the authority of the FDA to require manufacturers doing business in the U.S. to have an emergency response plan that anticipates likely disruptions in the manufacture of critical drugs, describes what steps would be taken to rapidly restore production and to run drills practicing putting those steps in place. These could be embedded in the CGMP requirements.

    Specifically, the AHA recommends that Congress enact legislation including:

    1. Diversifying manufacturing sites as well as sources of critical raw materials to ensure supply chain sustainability. Currently, the U.S. relies heavily on both China and India for the API and key starting materials (KSMs) necessary to manufacture pharmaceutical products. Further, many manufacturers of these products utilize manufacturing facilities located in both China and India. The overwhelming reliance on a limited number of countries for these pharmaceutical products necessary to care for patients in the U.S. raises serious concerns and poses significant risks to patients and burden on health care workers should a disruption occur. Congress should encourage redundancy in the supply chain through policy initiatives focused on spurring diverse sites of production, including where possible, onshore or near shore manufacturing of critical API and KSMs.
       
    2. Increasing end-user inventories and incentivizing additional cushion. The current just-in-time approach to supply chain logistics functions creates a hazard that becomes a reality during a significant supply chain disruption or emergent need to surge care delivery. Steps need to be taken to “feed” the supply chain with the goal of ensuring enough product is available, or capable of being made available, when demand increases. For example, supporting an increase in end-user inventory of critical medications as well as supplies held across the existing manufacturing and distribution infrastructure in the U.S. will help add necessary capacity to deal with interruptions in the availability of a critical drug. These actions may decrease the need for large national and state stockpiles, which can be difficult to manage and maintain, and present significant operating costs, product expiration and waste issues.
       
    3. Requiring the FDA to develop ratings of the quality management processes of drug manufacturers which are predictive of supply chain and manufacturing vulnerabilities and make these quality ratings publicly available.
       
    4. Requiring drug manufacturers to disclose to the FDA the locations where their products are manufactured, including contract manufacturer locations, as well as the locations from which they source KSMs, API and excipients used in their finished products, in order illuminate the extent of vulnerability for a product and to allow the development of targeted supply strengthening measures.
       
    5. Requiring drug manufacturers to notify the FDA of unusual spikes in demand of essential drugs to allow the agency to take steps to mitigate or prevent any impacts on availability and prevent potential shortages.
       
    6. Requiring the FDA to identify those essential drugs, including their KSM, API and excipients and component parts, that should have increased domestic manufacturing capacity to improve the resilience of the U.S. drug and device supply chain and make recommendations to incentivize their production.

    The AHA has been supportive of several bills that have sought to address supply chain issues which we believe will help address the issue of drug shortages. For example, this year, the AHA supported the Mapping America’s Pharmaceutical Supply (MAPS) Act (H.R. 6992) in the House, which would require the Department of Health and Human Services to update its essential medicines list and create a database to help predict vulnerabilities in the U.S. pharmaceutical supply chain.4

    We thank you for the opportunity to submit comments the House Committee on Ways and Means regarding drug shortages and look forward to continuing to work with you on this important issue.


  • 26 Jan 2024 4:31 PM | Matt Zavadsky (Administrator)

    Interesting issue – Many communities have not only done away with dual-paramedic units, but also any paramedics, opting for tiered ALS/BLS deployment models, when quality Emergency Medical Dispatch is used to appropriately triage calls, based on patient condition, since BLS care is appropriate for a large % of EMS requests.

    ------------------

    ‘Extremely unsafe’ lack of ambulance service in Multnomah County is unacceptable, Portland fire chief says

    Jan. 25, 2024

    By Austin De Dios | The Oregonian/OregonLive

    https://www.oregonlive.com/crime/2024/01/extremely-unsafe-multnomah-county-ambulance-services-unacceptable-says-portland-fire-chief.html

    Interim Portland Fire Chief Ryan Gillespie is the latest official imploring Multnomah County commissioners and health officials to address dangerously slow ambulance response times by changing the staffing model the county imposes on its ambulance provider.

    “The shortage of ambulances is putting the community’s lives in jeopardy and it is also putting our firefighters’ lives in danger,” Gillespie wrote to Dr. John Jui, the county’s medical director, and Aaron Monnig, its health office operations manager, in a letter dated Jan. 23.

    Gillespie joins Multnomah County Commissioner Sharon Meieran, an emergency room doctor, and Portland Commissioner Rene Gonzalez, who oversees the Fire Bureau, in demanding that county officials pilot a program to staff ambulances with an EMT and a paramedic, instead of two paramedics, as they do now. Meieran submitted a proposal to change the staffing requirement Dec. 14.

    Multnomah County has contracted with American Medical Response to send ambulances to emergency medical calls since 1995 but is unique among public agencies in requiring two paramedics per ambulance. AMR officials have said that dropping the requirement would allow them to put more vehicles on the road and respond to more emergencies faster.

    County officials recognize the growing problem of slow response times. In November it fined AMR over $500,000 for failing to meet 911 response time requirements spelled out in its contract with the county, which include arriving within eight minutes for emergency calls. But those same officials disagree about whether a shift to EMT staffing would solve the issue.

    Multnomah County health officials have insisted ambulances need two paramedics because that has helped the county maintain one of the highest cardiac arrest survival rates in the country, according to a November statement.

    Refusing to pilot this model “is irresponsible at best,” Gillespie wrote.

    During the snowstorm that pounded the city last week, Gillespie said that a firefighter broke several bones while battling a blaze. But no ambulances were available at the time, so firefighters transported the firefighter themselves, Gillespie wrote. That’s not something they can do for everyone.

    In the early morning hours of New Year’s Eve, firefighters responded to a call of someone with chest pain. No ambulance was available to respond, a status known as “Level 0,” and firefighters worked with TriMet staff to take the man to the hospital on a bus, as first reported by KOIN 6. The driver, Joe Wiggins, and other TriMet employees won praise in a TriMet board meeting Wednesday, but the man could have died had the situation been more dire.

    The problem requires immediate action, Gillespie said.

    “This is extremely unsafe for the patients and for the firefighters providing medical care as these vehicles are not licensed, nor set up to transport critical patients,” Gillespie wrote.

    Shane Dixon Kavanaugh contributed to this story.


  • 25 Jan 2024 11:36 PM | Matt Zavadsky (Administrator)

    Nice to see a community seeking proposals for evidence-based innovation in their EMS system!

    ------------------------

    Change Sought for County Ambulance Response System

    By Larry Altman

    January 25, 2024

    https://www.independentnews.com/news/regional_and_ca/change-sought-for-county-ambulance-response-system/article_bdb20e9a-bb2c-11ee-af73-a38bde2b440e.html

    REGIONAL — Alameda County officials have opened the bidding process for a new ambulance service contract, asking prospective providers to create a system that would make it unnecessary to transport all patients to emergency rooms.

    The idea, said Lauri McFadden, emergency medical services (EMS) director for the county, is to eliminate the “one size fits all approach,” where every patient who calls 911 is taken to a hospital, even if that is not required.

    McFadden called the idea a “significant shift in how we’re approaching 911 ambulance response.” Residents in Livermore, Pleasanton, Dublin and Sunol all receive ambulance service through the county’s contract, currently with Falck Northern California.

    “The new system is designed to deliver the right care at the right place based on the patient’s acuity, which can mean that in some low-acuity cases patients will receive medical and other treatment at places other than the county’s emergency rooms,” McFadden told The Independent. “The county hopes this will help reduce the impact of the time ambulances must wait between calls.”

    McFadden said the new approach will enable health professionals to provide necessary care, whether in a hospital emergency room, at the scene, or by connecting the patient to other care outside the emergency response system.

    Patients not needing hospitalization could be connected to a care provider on the phone or referred to a service that would deploy mental health providers.

    “Our goal is really to be able to offer the appropriate level of care for each unique call,” McFadden said. 

    According to the county’s “Request for Proposal (RFP)” issued Jan. 11 to open the bidding process for a new ambulance service contract, the EMS system will “appropriately prioritize” lower acuity 911 calls where a life is not threatened. 

    “Not all EMS callers are necessarily patients who require EMS,” the document says. “Many 911 calls involve situations that are not life threatening and do not require an immediate EMS response or indeed any emergency response at all.”

    The change would free up ambulances for true emergencies, it says.

    During the last year, Livermore and Pleasanton officials have criticized Falck Northern California for delays in responding to calls to assist Livermore Pleasanton Fire Department. According to LPFD data, Falck failed to meet expected response times 7.2% of the time on calls requiring a priority response — those with lights and sirens — from May to September.

    Livermore City Manager Marianna Marysheva and Pleasanton City Manager Gerry Beaudin recently wrote a letter to Falck officials to express their concerns and met with them as well.

    The issue of response times is occurring at the same time the county opened the process for other EMS companies to bid for the contract. Falck’s contract expires in 2025. In a statement to The Independent, the city managers did not directly comment on whether they believe the change in policy would improve emergency response times.

    “The cities of Livermore and Pleasanton receive EMS service through a contract with Alameda County,” Marysheva and Beaudin said in a statement. “The county received input from partner cities in the development of the RFP that includes a system redesign for all emergency medical response/transport. The cities are looking forward to service improvements through this new contract. “

    Potential providers have until August to submit their applications. Whoever wins the job, which would be determined by the Board of Supervisors, would take over service between April and July 2026.

    McFadden said in most cases, ambulance providers bill a patient’s insurance for the cost of transport. Not requiring a trip to the emergency room could save the patient money.

    “While cost savings to the consumer may certainly be a byproduct of the RFP, it was not a driving factor in its design.”

    McFadden called the system design change unique in California. She said it was developed through a multiyear process that included public meetings.


  • 17 Jan 2024 9:11 AM | AIMHI Admin (Administrator)

    January 17, 2024 – Irving, TX We didn't need emergency warning devices to get where we were going - a motor vehicle crash without serious injuries. We tried to change lanes and were hit from behind, sideswiped, and pushed across the road. We expected people to yield to us, but the bright flashing lights and sirens contributed to distracting the driver of the car as he was trying to get around us. I still to this day believe we wouldn't have gotten crashed if we were driving without the use of the emergency warning devices.

    The reality is when lights and sirens are on, the risk of crash increases by over 50%.  Weekly, we hear  reports of ambulance crashes that impact providers, patients, and the public.  

    The National EMS Quality Alliance has released Improving Safety in EMS: Reducing the Use of Lights and Siren, a change package with the results, lessons learned, and change strategies developed during the 15-month long Lights and Siren Collaborative It will assist EMS organization in making incremental improvements to use of lights and siren on a local and systematic basis. "The best practices that have emerged from this project will allow every agency, regardless of service model or size, to more safely and effectively respond to 9-1-1 calls.” says Michael Redlener, the President of the NEMSQA Board of Directors.

    "By utilizing less lights and sirens during EMS response and transport, our efforts have shown measurable increases in safety. The EMS community and the general public will surely benefit from the now-proven tactics provided by this partnership,” added Mike Taigman, Improvement Guide with FirstWatch and faculty leading the collaborative.

    More about the Collaborative and participating agencies can be found in the change package and on the NEMSQA website.

    About the National EMS Quality Alliance

    The National EMS Quality Alliance (NEMSQA) is the nation's leader in the development and endorsement of evidence-based quality measures for EMS.  Formed in 2019, NEMSQA is an independent non-profit organization comprised of stakeholders from national EMS organizations, federal agencies, EMS system leaders and providers, EMS quality improvement and data experts as well as those who support prehospital care with the goal to improve EMS systems of care, patient outcomes, provider safety and well-being on a national level.

    NEMSQA
    Sheree Murphy
    smurphy@nemsqa.org
    315-396-4725


  • 3 Jan 2024 3:56 PM | Matt Zavadsky (Administrator)

    AMR Wins Big in Showdown with Santa Barbara County Fire

    Judge Rules in Favor of American Medical Response in Its Ambulance Service Lawsuit Against County

    By Nick Welsh

    Tue Jan 02, 2024

    https://www.independent.com/2024/01/02/amr-wins-big-in-showdown-with-santa-barbara-county-fire/

    In a punishing legal opinion — both in terms of length and detail — Judge Donna Geck ruled that American Medical Response (AMR) ambulances will continue to provide emergency medical response services throughout Santa Barbara County at least until July 16, expressing undisguised skepticism throughout her 33-page opinion at the procedural gyrations undertaken by the County Board of Supervisors to award the lucrative ambulance contract to the County Fire Department instead. 

    Absent Geck’s ruling to approve the temporary injunction, County Fire would have taken over the county’s ambulance service contract as of March 1. As part of her ruling, Geck ordered AMR — which has enjoyed a near total countywide monopoly for more than 41 years — to keep on providing that service at least until July, at which point, a proper trial can be conducted, and the underlying issues hashed out. (That process, it should be noted, could take as long as five years.) 

    Geck’s order qualifies as a judicially ordered “time-out” in a years-long campaign launched by fire chiefs throughout the county to take over the ambulance contract. Because they — unlike AMR — are not a private corporation beholden to stockholders, they have argued, they can field more ambulances at any given time and deliver quicker response times for less money. What AMR transfers back to corporate headquarters by way of profits, they argued, can be plowed back into the community to underwrite such programs as “co-response units” in which public safety personnel team up with mental-health professionals to alleviate the stress and strain imposed on law enforcement. 

    Sadly, for County Fire Chief Mark Hartwig, the fire chiefs who support him, and the four county supervisors who supported them all, none of that was considered by the special panel empowered to review the competing bids submitted by AMR and County Fire. In fact, AMR scored 300 points higher than County Fire. County Fire appealed not once but twice and lost both times.

    The supervisors responded by changing the bidding process to circumvent state laws that apply to exclusive ambulance contracts; they declared the contracts to be “non-exclusive” and enacted an ordinance that enabled them to award multiple contracts based on the “community benefits” promised by the provider. Judge Geck found the verbiage surrounding those benefits to be so amorphous as to be meaningless and said so several times. 

    She also noted that at the end of the day, County Fire ended up with the sole contract. As an exclusive contract awardee, she argued, the state laws — passed in 1980 and 1984 — designed to protect local communities from the downside of market monopoly power should have been observed. That law requires all exclusive ambulance contracts to be reviewed by the local Emergency Services Administration; in this case, Geck concluded, it was not. 

    State Attorney General Rob Bonta had weighed into the case as well, expressing serious concern in a friend-of-the-court brief that key state safeguards had been bypassed. This was the first time, his brief noted, that such an approach had been deployed. Should it succeed in Santa Barbara, his office made clear, it could establish a precedent. In that regard, Bonta is not wrong; statewide and nationally, there’s growing interest by local fire agencies to provide ambulance service. All eyes are, in fact, on Santa Barbara. 


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