EMS EXPO Roundtable Brings Together the Big Guns

     At the EMS EXPO last October in Orlando, EMS Magazine assembled a groundbreaking panel of federal officials to discuss their efforts on behalf of EMS and take questions from attendees.

     Panelists represented the range of federal involvement in the prehospital field:

• John Brasko, EMS/Safety and Health training specialist with the U.S. Fire Administration;
• Drew Dawson, director of NHTSA's Office of EMS;
• Richard Hunt, MD, FACEP, director of the Division of Injury Response in the CDC's National Center for Injury Prevention and Control;
• Jon Krohmer, MD, FACEP, deputy assistant secretary and deputy chief medical officer for the Department of Homeland Security;
• Sally Phillips, RN, PhD, director of the Agency for Healthcare Research and Quality's Public Health Emergency Preparedness Research Program;
• Charlotte Yeh, MD, FACEP, regional administrator for the Centers for Medicare and Medicaid Services (CMS);
• Kevin Yeskey, MD, director of the Office of Preparedness and Emergency Operations (OPEO) and deputy assistant secretary under the Department of Health and Human Services' Assistant Secretary for Preparedness and Response (ASPR).

     Opening remarks were delivered by David Marcozzi, MD, FACEP, director of the new Emergency Care Coordination Center under ASPR/OPEO. The discussion was moderated by Kurt Krumperman, senior vice president of federal affairs and strategic initiatives for Rural/Metro and chair of the American Ambulance Association's Emergency Preparedness Workgroup.

     Each of the panelists outlined their entity's work. Dawson cited a range of priorities for his office, the official lead body for EMS within the federal government, including NEMSIS, 9-1-1 pandemic influenza guidelines, education standards, the EMS Workforce Project, a surveillance system for provider injury and illness, preparedness assessments and data standardization.

     Noting that all disasters have health implications, Krohmer discussed a number of DHS preparedness efforts, including the creation this year of an Office of Health Affairs, headed by acting Assistant Secretary/Chief Medical Officer Jeff Runge, MD, FACEP. Among its duties, this office oversees the Bioshield and BioWatch programs and National Biosurveillance Integration System. A Medical Readiness Division will coordinate contingency planning, first-responder readiness, WMD incident management support and coordination of medical-preparedness grants.

     Yeskey also had a new office to promote, HHS's Office of the Assistant Secretary for Preparedness and Response, of which OPEO is part. The ASPR's office was formerly the Office of Public Health Emergency Preparedness. Its other components include a biomedical research and development arm, an office of public health and a policy/planning office.

     Yeh, citing the statutory basis for the Medicare reimbursement fee schedule, told attendees it wasn't something CMS could change, but that some services weren't availing themselves of all possible reimbursement options. For instance, she noted, Section 1011 of the Medicare Modernization Act authorizes payments for emergency care of undocumented aliens, yet only 450 services have registered to receive them.

     Yeh also promoted the periodic "open-door forums" that let constituents pose questions to CMS personnel. Among these are forums for the ambulance industry, which cover issues concerning payment, billing, coverage and delivery of services. For more, see www.cms.hhs.gov/OpenDoorForums.

Hunt discussed the CDC's efforts in injury prevention and noted the integral role of EMS. The Centers' emphasis on the area is highlighted in its Acute Injury Care Research Agenda, revised in 2005.

     In collaboration with NHTSA, the CDC last year completed a revision of field triage criteria initially published by the American College of Surgeons in 1999. The 2006 update guides providers in choosing transport destinations for severely injured patients (i.e., specialized trauma centers vs. other nonspecialized facilities). For the badly hurt, care at a Level 1 trauma center can reduce the risk of death by up to 25%. For more, see www.cdc.gov/ncipc.

MORE SUPPORT FOR compressions
     Another new study suggests that doing more chest compressions during CPR, and giving fewer rescue breaths, could help save lives. The study, presented in November to an American Heart Association conference, found that those who suffer cardiac arrests outside healthcare settings are twice as likely to survive if given a 50:2 ratio of compressions to breaths. Current AHA guidelines call for a ratio of 30:2. "You need to maximize the number of compressions and minimize the number of breaths," lead author Alex Garza, MD, said of the findings. Garza instituted the 50:2 ratio as EMS medical director in Kansas City, MO, in 2006. Cardiac arrest survival rates subsequently increased by 23%. —Washington Hospital Center/MedStar Health

IAFC, USFA EYE SLEEP DEPRIVATION
     The U.S. Fire Administration and International Association of Fire Chiefs have announced a new report on sleep deprivation among EMS and fire personnel. The Effects of Sleep Deprivation on Fire Fighters and EMS Responders is based on a review of sleep-deprivation literature in other fields and examines their applicability to fire and EMS. It features mitigation strategies and other resources, including a self-guided computer-based training program.

The report and other materials are available at www.iafc.org/sleep.
—USFA

FLU FACTS AVAILABLE
     NHTSA's Office of EMS has posted a pair of documents aimed at guiding systems' response to a potential pandemic influenza outbreak.

The first, EMS Pandemic Influenza Guidelines for Statewide Adoption, is available at www.nhtsa.gov/people/injury/ems/PandemicInfluenzaGuidelines. The second, Preparing for Pandemic Influenza: Recommendations for Protocol Development for 9-1-1 Personnel and Public Safety Answering Points (PSAPs), is at www.nhtsa.gov/people/injury/ems/PandemicInfluenza.

Both documents can also be found at www.pandemicflu.gov/plan/federal. The National Association of State EMS Officials will eventually distribute them on CD-ROM. —NHTSA