News & Updates

Inside Sources source article | Comments courtesy of Matt Zavadsky

Very insightful OpEd from national and international EMS leaders – Note the “About the Authors” section below...

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Will an Ambulance Be Available When You Call?

September 10, 2020

by Brian Maguire, et. al

https://www.insidesources.com/will-an-ambulance-be-available-when-you-call/

 

Our emergency medical services professionals have been devastated by the pandemic.

 

By August 3, 35 emergency medical technicians and paramedics had died from the coronavirus nationwide, and the rate of COVID-19-fatalities for medics was about four times higher than the rate for firefighters.

 

Thousands of medics have been afflicted, many will never be able to return to their jobs. Now, across the country, many medics are retiring and resigning, and EMS agencies are struggling to staff ambulances.

 

Immediate action is needed to save the EMS system.

 

Since the start of the pandemic, EMS medics have endured overwhelming call volumes and worked endless overtime shifts caring for critically ill patients.

 

Insufficient supplies of personal protective equipment such as masks, gloves and gowns exposed the medics, their patients, their co-workers and their families to heightened risks of infection. Many medics slept in their cars to avoid returning home and potentially infecting their families. Three New York City medics committed suicide since April.

 

Before the pandemic, EMS agencies in the United States responded to more than 40 million calls for assistance each year. In addition to crashes and heart attacks, EMS is often the healthcare provider of last resort for people of color, the poor and the disenfranchised. Medics may be the only healthcare providers in many rural communities.

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Comments Courtesy of Matt Zavadsky

Nice to see healthcare workers in healthcare facilities and First Responders in the 1^st priority group for COVID-19 vaccine allocation!

Read the full DRAFT briefing here.

Public Listening Session of the Committee on Equitable Allocation of Vaccine for the Novel Coronavirus being held from 12:00-5:00pm ET.  You can register to listen to the hearing at the link below:

https://www.eventbrite.com/e/equitable-allocation-of-covid-19-vaccine-public-listening-session-tickets-118114225829

Written public comment is open until September 4, 2020 (11:59 pm ET); submit written comment here.

The National Association of Emergency Medical Technicians, American Ambulance Association, Congressional Fire Services Institute, International Association of Fire Chiefs, International Association of Fire Fighters, National Fire Protection Association, and National Volunteer Fire Council collaborated on a letter to the White House and several key members of Congress advocating for high priority vaccine allocation for First Responders on July 13, 2020.  View the letter here.

ESO Source Data | Comments Courtesy of Matt Zavadsky

Interesting information in the ESO Mid-Year Index, COVID-19 Special Edition!  Thanks to ESO for providing this!

Lots of PPE usage info, and general response characteristics below...

You can access the full Index here.

Many EMS agencies, including us here at MedStar have been reporting similar trends in data.

Thanks to ESO for providing this!

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TOTAL 911 CALLS DROPPED…FOR A BIT

Overall, we noticed a decrease in total 911 call volume since early January 2020 by as much as 18% through the end of April. Motor Vehicle Crash calls in particular experienced a significant drop, down by 40%. However, starting in May through the end of July, we see a steady upward trend.

 

NON-TRANSPORTS JUMPED…FOR A BIT

Coupled with 911 call volume dropping, non-transports increased – by as much as 33% in April 2020.

 

CARDIAC ARREST SPIKES

Substantial increases in the number of out-of-hospital cardiac arrests have been observed, particularly in regions with increased COVID-19 cases. As a whole, in April 2020, EMS responses for cardiac arrests spiked by 36% compared to the prior year.

 

OPIOID OVERDOSE CALLS ARE UP

Between January 1, 2020 and July 31, 2020, opioid overdose responses jumped 30%. The numbers increased in particular in May and June by approximately 41% and 53% respectively.

NEJM Catalyst Source | Comments Courtesy of Matt Zavadsky

Very well-done commentary from NEJM Catalyst. 

 

While not specifically mentioned, our “EMS” brethren, payers and other healthcare system partners should take note of the ways “EMS” can be a partner in “Leveraging alternative care pathways and care sites, such as telehealth, home-based care, and community-based care, can also help keep patients out of the ED and provide alternatives to low-value and wasteful care. ED visits and hospitalizations are frequently preventable and, once there, patients often receive unnecessary imaging and lab tests.”

 

Tip of the hat to Chris Hanson from TMF for finding and forwarding this commentary!

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COMMENTARY

 

Building A Better Health Care System Post-Covid-19: Steps for Reducing Low-Value and Wasteful Care

The upheaval in the provision of routine health care caused by the Covid-19 pandemic offers an unprecedented opportunity to reduce low-value care significantly with concurrent efforts from providers and health systems, payers, policymakers, employers, and patients.

 

By Corinna Sorenson, Ph.D., MHSA, MPH, Mark Japinga, MPA, Hannah Crook & Mark McClellan, MD, Ph.D.

August 21, 2020

 

https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0368?query=CON&cid=DM97604_Catalyst_Non_Subscriber&bid=247526681

 

Summary

The Covid-19 pandemic has disrupted the provision of routine care, forcing providers and patients to postpone many services and adopt virtual and non-contact strategies. These changes present an unprecedented opportunity to re-evaluate the necessity of services our health system provides, embracing and enhancing the ones that provide the most value and finally reducing or eliminating those that provide little or no benefit. Immediate action is essential as reopening occurs; force of habit and financial stresses may otherwise counteract some positive recent changes and move the health care system back toward business as usual. We suggest aligned strategies for providers and health systems, payers, policymakers, employers, and patients that can help seize this opportunity to build a better health system.

 

In just months, the coronavirus (Covid-19) pandemic upended significant portions of the U.S. health care system.1 Postponed elective procedures and services for non-emergency care significantly reduced overall health care utilization,2 and the rapid shift to telehealth dramatically altered care delivery. Recent months have also exposed long-standing flaws of our health care system, marked by fragmentation, inefficiencies, high rates of chronic illness, and glaring health disparities.

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Axios Source Article | Comments courtesy of Matt Zavadsky

Recall the conversations we’ve been having about whether “EMS” is public safety or healthcare? 

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• Whenever the first coronavirus vaccine makes it across the finish line, there won't be enough to go around. So experts say two rounds of rationing will be necessary — one to divvy up the available doses around the world, and then another to decide who gets first crack at the U.S.' limited supply.  Most Americans are OK with a domestic priority system but don't think the U.S. should share a vaccine internationally if it's the first country to develop one, according to a new Harris poll shared exclusively with Axios.

  By the numbers: 69% of respondents in the Harris survey said they’d support a priority system for distributing a vaccine within the U.S., while just 31% said they’d prefer a first-come, first-served approach.

• 66% said that if the U.S. develops a vaccine, it should only be made available abroad after all U.S. orders have been filled; just 34% said it should be made available overseas immediately.

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KFF Source | Guardian Source | Comments Courtesy of Matt Zavadsky

This is an excellent, interactive database of healthcare workers who have succumbed to COVID-19, including Medical First Responders. 

13 of the 167 profiled workers are EMS providers.

You’ll see 2 different counts.  According to the Q & A in the database explaining the difference, “This is an ongoing project. The larger figure refers to the number of reported cases our journalists have identified.  The second, smaller figure, refers to the number of deaths we have confirmed and reported on by interviewing family members, employers and medical examiners. Those are the figures we have added to our database. We are adding new stories weekly.”

If you know a healthcare worker who has died from Covid-19, share their story with KHN/Guardian by filling out this form.

New Interactive Database by KFF's Kaiser Health News and Guardian US Reveals More Than 900 Health Care Workers Have Died in the Fight Against COVID-19 in the U.S.

Many Were Unable to Access Adequate Personal Protective Equipment, and People of Color Account for a Disproportionate Share of Deaths Among Those Profiled So Far

August 11, 2020

A new interactive database from KFF’s Kaiser Health News (KHN) and Guardian US reveals that many of the more than 900 U.S. health care workers who have died in the fight against COVID-19 worked in facilities with shortages of protective equipment such as gowns, masks, gloves and face shields. People of color and nurses account for a disproportionate share of deaths among those profiled so far.

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Prehospital Emergency Care Source | Comments Courtesy of Matt Zavadsky

Nice research project from very well-respected researchers published in Prehospital Emergency Care. 

The good news is, there appears to be a trend to reduce RLS responses, but still lots of agencies still doing it routinely for all calls.  The 2020 EMS Trend Report from Fitch & Associates/EMS1.com revealed:

And:

“Lights and sirens. Fire department-based respondents continue to report the highest rates of using lights and sirens for every call (25%, compared to a 15% average in other agency types). Based on published research questioning the efficacy of responding lights and responses to all 911 calls, and the inherent dangers, this points to a policy and training opportunity to improve patient, provider and community safety.”

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Using Red Lights and Sirens for Emergency Ambulance Response: How Often Are Potentially Life-Saving Interventions Performed?

Jeffrey L. Jarvis, MD; Vaughn Hamilton, MA, EMT-P; Mike Taigman, MA & Lawrence H. Brown, PhD

Published online: 07 Aug 2020

 

https://doi.org/10.1080/10903127.2020.1797963

 

Abstract

 

Background

Emergency Medical Services (EMS) often respond to 911 calls using red lights and sirens (RLS). RLS is associated with increased collisions and increased injuries to EMS personnel. While some patients might benefit from time savings, there is little evidence to guide targeted RLS response strategies.

 

Objective

To describe the frequency and nature of 911 calls that result in potentially life-saving interventions (PLSI) during the call.

 

Methods

Using data from ESO (Austin, Texas, USA), a national provider of EMS electronic health records, we analyzed all 911 calls in 2018. We abstracted the use of RLS, call nature, and interventions performed. A liberal definition of PLSI was developed a priori through a consensus process and included both interventions, medications, and critical hospital notifications. We calculated the proportion of calls with RLS response and with PLSI performed, both overall and stratified by call nature.

 

Results

There were 5,977,612 calls from 1,187 agencies included in the analysis. The majority (85.8%) of calls utilized RLS, yet few (6.9%) resulted in PLSI. When stratified by call nature, cardiac arrest calls had the highest frequency PLSI (45.0%); followed by diabetic problems (37.0%). Glucose was the most frequently given PLSI, n = 69,036. When including multiple administrations to the same patient, epinephrine was given most commonly PLSI, n = 157,282 administrations).

 

Conclusion

In this large national dataset, RLS responses were very common (86%) yet potentially life-saving interventions were infrequent (6.9%). These data suggest a methodology to help EMS leaders craft targeted RLS response strategies.

CMS.gov Source | Comments Courtesy of Matt Zavadsky

his could be a beneficial innovation expansion for EMS agencies.  Many have leveraged the expansion of telehealth benefits to partner with telehealth providers to provide patient navigation services during emergency calls.

CMS has indicated their belief in the past that some waivers initiated to mitigate the impact of the pandemic may be harder to unwind than they were to initiate – this may be an example of that belief.

There is an interesting Health Affairs Blog on this topic here: https://www.healthaffairs.org/do/10.1377/hblog20200715.454789/full/

NAEMT, AAA, IAFC and other national EMS associations have been working together closely to try and introduce legislative language that authorizes CMS to pay for Treatment in Place (TIP) into upcoming COVID relief Bills.  Language to that effect would be a perfect fit for the expansion of telehealth services.

Even without CMS action, many payers and even state Medicaid offices are, or are moving toward paying for TIP services.

Expansion of the telehealth coverage benefit may also have an impact on the CMMI ET3 model, since it was planned as part of the model that telehealth expansion to patient’s residences, or other non-healthcare points of origin would be available to ET3 partner providers.  However, now it is available to all providers.

EMS should keep a close eye on these developments to see how permanent expansions of telehealth services can complement and advance the EMS Transformation, and be ready to provide comments and communications through the rule making processes.

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Trump Administration Proposes to Expand Telehealth Benefits Permanently for Medicare Beneficiaries Beyond the COVID-19 Public Health Emergency and Advances Access to Care in Rural Areas

Aug 03, 2020

 

https://www.cms.gov/newsroom/press-releases/trump-administration-proposes-expand-telehealth-benefits-permanently-medicare-beneficiaries-beyond

 

The Centers for Medicare & Medicaid Services (CMS) is proposing changes to expand telehealth permanently, consistent with the Executive Order on Improving Rural and Telehealth Access that President Trump signed today. The Executive Order and proposed rule advance our efforts to improve access and convenience of care for Medicare beneficiaries, particularly those living in rural areas. Additionally, the proposed rule implements a multi-year effort to reduce clinician burden under our Patients Over Paperwork initiative and to ensure appropriate reimbursement for time spent with patients. This proposed rule also takes steps to implement President Trump’s Executive Order on Protecting and Improving Medicare for our Nation’s Seniors and continues our commitment to ensure that the Medicare program is sustainable for future generations. 

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Kaiser Health News source | Comments courtesy of Matt Zavadsky

This is the next in the 1-2-3…. Punch for patients and area healthcare providers.  We’ve mentioned before that the volume loss, coupled with the looming changes in the payer mix, will continue to have a big impact on healthcare systems, including EMS agencies.

Everyone should be keeping a close eye on this in your local communities!

Most notable quote of the article – (the same could be said about EMS agencies):

“Hawkins said federal relief money will be directed to health care providers in the coming months. Long term, however, he said this is unsustainable for Texas hospitals. If unaddressed, this financial burden on hospitals could lead to future cuts and possibly closures, he warned.

If state lawmakers don’t start addressing the state’s coverage issues soon, Hawkins predicted, it will become a significant issue during the state’s upcoming legislative session early next year.”

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In Texas, More People Are Losing Their Health Insurance as COVID Cases Climb

By Ashley Lopez, KUT

JULY 28, 2020

 

https://khn.org/news/in-texas-more-people-are-losing-their-health-insurance-as-covid-cases-climb/

 

Steve Alvarez started feeling sick around Father’s Day weekend this year. His symptoms started as mild, but developed into a fever, chills and shortness of breath he couldn’t shake.

 

“Just when I started to get to feeling better and I would have a couple of good days,” Alvarez said. “I felt like I’d backtrack and I was just really run down. This thing lingered and lingered.”

 

Alvarez, a Tejano musician who lives in the San Antonio area, said he eventually got a free COVID-19 test provided by the city of San Antonio. A week later, he found out he tested positive for the coronavirus.

 

Alvarez and his wife — who also became infected — never ended up in the hospital, and they feel fine now. But, he said, there were some scary days — he knows a lot of people who got sick with COVID-19. A friend around his age — mid- to late 40s — has been in an ICU and on a ventilator for weeks now.

 

But it was not just their health that worried Alvarez. Financial fears loomed large, too.

 

“We thought if something happens and this starts getting much worse, we need to start thinking about how we are going to deal with it, how we are going to pay for it,” he said. “It was just abject terror as to what was going to happen and what we were going to do.”

 

Money is tight because the pandemic shut down most of his musical gigs. Alvarez also lost his health insurance a year ago when he was laid off from his day job in construction safety. While he was sick with the coronavirus he paid for remote doctor visits, some prescriptions and over-the-counter medicine all out-of-pocket, he said.

 

“I use discount cards for those prescriptions as much as possible,” Alvarez said. “If something is not generic, that’s just absolutely too expensive, I have to consider doing without it.”

 

Texas’ uninsured rate has been climbing along with its unemployment rate as COVID cases also surge in the state. Before the pandemic, Texas already had the highest rate and largest number of people without insurance among all states. And 20% of all uninsured children in the U.S. live in Texas.

 

The uninsurance problem has only gotten worse in Texas in 2020. According to recent data from Families USA, a consumer health advocacy group that supported the Affordable Care Act, 29% of Texas adults under 65 don’t have health insurance so far this year.

 

The group found that about 659,000 people in the state became uninsured between February and May as job losses soared. Texas is one of 13 states that has not expanded Medicaid under the ACA.

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San Antonio Express-News Source Article | Comments Courtesy of Matt Zavadsky

Outstanding depiction of the lives of EMS workers on the front lines of the pandemic.  Especially the critical backbone of the inter-facility work EMS providers do!

No highlights – it’s ALL a must read!

Tip of the hat to MedStar’s Ken Simpson for finding this article!

Nice audio/video summary embedded in the link below:

https://www.expressnews.com/coronavirus/article/The-closest-thing-medicine-gets-to-war-24-15427294.php

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Invisible enemies

Ambulance crews respond an average of once an hour to transport COVID-19 patients to hospitals, long-term care facilities or to their homes. For paramedics, it’s a daily battle against two invisible enemies — the virus and burnout.

By Marina Starleaf Riker

Photos by Lisa Krantz

The fluorescent lights in the back of the ambulance glare above paramedic George Lombardo as he leans over to check his patient’s breathing, steadying himself as the vehicle races at 65 mph down the empty highway.

The man is dying from COVID-19. A machine pumps oxygen into his lungs through a breathing tube. His chest rises and falls in a robotic rhythm.

The EMS crew picked up the elderly man at a hospital and is bringing him to hospice care. He had signed a do-not-resuscitate order. If his heart stopped, no one was to intervene.

With six minutes to go, the ambulance veers suddenly into an empty Bill Miller Bar-B-Q parking lot and brakes to a stop.

The man has no pulse.

Lombardo makes a phone call, speaking loudly because his respirator mask muffles his voice. He unfastens the patient’s oxygen mask. It no longer is needed.

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