Ditch NHTSA, Task Force Says, and Move EMS Under DHS

Ditch NHTSA, Task Force Says, and Move EMS Under DHS

“The time is ripe for EMS to move to a more suitable federal agency.”

That’s the conclusion of a recently released report that supports the idea—recently broached and seemingly increasingly popular—of moving federal oversight of emergency medical services from under the Department of Transportation’s National Highway Traffic Safety Administration (NHTSA) to a new home in the Department of Homeland Security (DHS).

The notion, already being promoted by one high-profile national task force (www.projectusemsa.org), received another boost in May with the release of a report compiled by a task force of the Homeland Security Policy Institute (HSPI) at George Washington University. The publication, Back to the Future: An Agenda for Federal Leadership of Emergency Medical Services, cites EMS as a “missing piece of the preparedness puzzle” that needs reevaluation at the federal level.

The authors’ conclusion: “While DOT might have been the appropriate home for EMS in the federal government during the early years of EMS, when its focus was on transporting automobile accident victims, EMS has long outgrown such vestigial ties.”

Like the Project USEMSA group, the HSPI group calls for the creation of a U.S. EMS Administration under DHS. Such an administration, it says, would lead national EMS policy; be the providers’ voice in the federal government; examine responder safety issues; collect and disseminate data; serve as a central clearinghouse for information, funding and standards; manage national training programs; and conduct research.

The task force behind the report brought together numerous top EMS leaders. It was cochaired by HSPI Director Frank Cilluffo, Deputy Director Daniel Kaniewski and Paul Maniscalco, an assistant professor at GWU and a veteran of the landmark Gilmore Commission. Other representatives included field providers, educators and chief officers from a range of agencies and institutions.

While creating an EMS Administration under DHS has its promoters, support for the idea is not universal. In response to the HSPI report, Advocates for EMS issued a statement supporting an EMS office under DHS, with a strengthened FICEMS (the Federal Interagency Committee on EMS) serving to coordinate the EMS activities of various federal agencies and offices.

NHTSA, notes Advocates, “has a productive history as a lead federal EMS coordinating agency since the late 1960s.” The Advocates opinion represented the National Association of State EMS Directors, the National Association of EMS Physicians and the National Association of EMS Educators.

For the full HSPI report, see https://homelandsecurity.gwu.edu/newsroom.htm. For the Advocates response, see www.advocatesforems.org/Library/upload/GW_Report_Response.pdf.

For more on the issue of where EMS best belongs in the post-9/11 era, watch future issues of EMS.

—John Erich, Associate Editor

We welcome your thoughts on this topic. Go to www.emsmagazine.com to complete a brief survey, or e-mail emseditor@aol.com.

Second Draft of Scope of Practice Model Out

Having absorbed comments on a first draft, task force members charged with crafting the National EMS Scope of Practice Model produced a second draft of the document in April.

The Model’s second draft includes what principal investigator Dan Manz terms a few “significant themes.” Among these are the proposed retention of an EMT level with skills similar to those specified in the U.S. DOT’s 1994 EMT-B National Standard Curriculum; inclusion of an “Advanced EMT” level between EMT-B and EMT-P; addressing implementation issues specific to the model; and clarifying the purpose of the model and its relation to current state-approved scopes of practice and licensure levels for EMS providers.

Further discussion/development of the Advanced Practice Paramedic level broached in the first draft has been shelved pending a NHTSA forum on the idea.

See the second draft at www.emsscopeofpractice.org.

—NASEMSD, NCSEMSTC

Emergency Orgs Unveil Data Messaging Project

An array of emergency response organizations have banded together to launch the National Emergency Alerting and Response Systems (NEARS) Initiative, a nonprofit effort to demonstrate an effective approach to interagency messaging. Participants plan to demonstrate and deploy interoperable emergency data messaging using commercial information technologies and a shared electronic directory of agencies called the EPAD (Emergency Pro-vider Access Directory). Agencies will register with the EPAD to receive emergency messages based on their geography, incident interest and agency type.

Current NEARS partners include representatives from EMS, fire, law enforcement, 9-1-1/dispatching, emergency management, emergency medicine, public health, the private sector and the media. The National Association of EMTs supports the project because “it’s important to improve our communications capability to get critical data in and out of emergency operations,” says Will Chapleau, chair of the organization’s PHTLS Division. For more: www.comcare.org/nears.

—ComCARE Alliance

Grant Program to Provide EMS Billing Software

Dyna-Linc, a national developer of EMS billing software, has announced a software grant program available to publicly funded EMS departments that perform fewer than 1,200 EMS runs a year.

Applications for the program will be accepted through June. The grant package will include licensed EMS Management Billing Software, two days of training and a six-month service contract that will include all updates and unlimited technical support.

The company’s EMS Management Billing Software is HIPAA-compliant and comes ready for Medicare, Medicaid and private insurance claims. It can also bill patients and third parties. Direct electronic submission capabilities are standard.

To apply, go to www.dynalinc.com/ems managementgrant.asp.

—Dyna-Linc, Inc.

Second Draft of Scope of Practice Model Out

Having absorbed comments on a first draft from interested EMS providers and organizations, task force members charged with crafting the National EMS Scope of Practice Model produced a second draft of the document in April.

The Model’s second draft includes what principal investigator Dan Manz terms a few “significant themes.” Among these are the proposed retention of an EMT level with skills similar to those specified in the U.S. DOT’s 1994 EMT-B National Standard Curriculum; inclusion of an “Advanced EMT” level between EMT-B and EMT-P; addressing implementation issues specific to the model; and clarifying the purpose of the model and its relation to current state-approved scopes of practice and licensure levels for EMS providers.

Further discussion/development of the Advanced Practice Paramedic level broached in the first draft has been shelved pending a NHTSA forum on the idea.

The task force is a project of the National Association of State EMS Directors (NASEMSD) and the National Council of State EMS Training Coordi-nators (NCSEMSTC). See the second draft at www.emsscopeofpractice.org.

—NASEMSD, NCSEMSTC

Emergency Orgs Unveil Data Messaging Project

An array of emergency response organizations have banded together to launch the National Emergency Alerting and Response Systems (NEARS) Initiative, a nonprofit effort to demonstrate an effective approach to interagency messaging.

Participants plan to demonstrate and deploy interoperable emergency data messaging using commercial information technologies and a shared electronic directory of agencies called the EPAD (Emergency Pro-vider Access Directory). Agencies will register with the EPAD to receive emergency messages based on their geography, incident interest and agency type.

Current NEARS partners include representatives from EMS, fire, law enforcement, 9-1-1/dispatching, emergency management, emergency medicine, public health, the private sector and the media. The National Association of EMTs supports the project because “it’s important to improve our communications capability to get critical data in and out of emergency operations,” says Will Chapleau, chair of the organization’s PHTLS Division.

For more: www.comcare.org/nears.

—ComCARE Alliance

AOL Signs On to NENA’s Next-Gen E9-1-1 Effort

Internet giant America Online an-nounced in April that it has become a program partner in the National Emergency Number Association’s (NENA’s) Next Generation E9-1-1 Program.

As part of the program, AOL will participate in its Operational/Educational Roundtable, an effort to develop and im-plement operational standards, policies and procedures for emergency services. AOL will also work with NENA to develop a public-awareness campaign aimed at educating consumers about E9-1-1.

In related news, the company has introduced its AOL Internet Phone Service, an enhanced Voice over IP (VoIP) service that will be available to AOL members. It includes full E9-1-1 calling coverage in all of the markets targeted for initial rollout of the service.

For more on AOL: www.aol.com. For more on NENA and the Next Generation E9-1-1 Program: www.nena.org.

—America Online

Medical Groups Press for Funding for EMSC

The American College of Emergency Physicians (ACEP), American Academy of Pediatrics and American College of Surgeons came together in April to urge Congress to reauthorize funding for the Emergency Medical Services for Children (EMSC) program.

EMSC, the organizations say, saves lives and improves the care of children in the nation’s emergency departments by promoting a nationwide exchange of critical knowledge and collaboration by those passionate about pediatric care.

“EMSC,” said ACEP President Robert Suter, DO, “has driven key improvements in emergency medical services to children. Emergency physicians believe strongly that Congress should reauthorize this program.”

A bill to do that, S. 760, was under consideration by the Senate’s Committee on Health, Education, Labor and Pensions at press time. It seeks $23 million for the program for fiscal 2006.

—ACEP

L.A. Fire Departments Roll Out 12-Lead EKGs

Using a $3 million grant from the Annenberg Foundation, the two major Los Angeles fire departments have launched a new paramedic-based 12-lead EKG system they say will speed and improve the diagnosis and treatment of heart attack patients.

The new system will replace a system of 4-lead EKGs that was used previously. Using the 12-leads (previously available only in hospitals), medics in the field will now be able to determine in two minutes if a patient is experiencing an acute heart attack.

The upgrade involves a partnership between the L.A. City Fire Department, the L.A. County Fire Department and the American Heart Association. More than 170 paramedic units (103 city and 159 county) will be converted. More than seven million people count on the departments for emergency response.

—L.A. County Fire Department

Newspaper Profiles Deadly Teen Drivers

A USA Today examination of all of 2003’s deadly automobile crashes involving teenage drivers yielded some conclusions about who is at highest risk, the newspaper reported in March. Such information may allow EMS providers to better target their public-safety educational efforts.

In nearly three-quarters of the crashes examined, the drivers were male, and 16-year-olds proved to be far more dangerous behind the wheel than older teens, the paper said. Citing information from the Insurance Institute for Highway Safety (IIHS), it reported that the rate of involvement in fatal crashes among 16-year-olds was almost five times that of drivers 20 or older. According to the IIHS, rules that restrict 16-year-olds from unsupervised driving may save lives.

NHTSA chief Jeff Runge told USA Today that safety advocates have failed to adequately publicize what’s known about why teens die in crashes. Other factors that increase risk include having other teens in the car, driving after dark and using unsuitably large or small vehicles.

—USA Today

TOPOFF 3 Poses Chem, Bio Scenarios in CT, NJ

A chemical attack in Connecticut and a biological release in New Jersey were the big scenarios challenging participants in the TOPOFF 3 terrorism-response drill held in April.

The $16 million drill, which also involved responders in Canada and the U.K., posed the threats of concurrent mustard gas and plague attacks in an effort to stretch and test local, state and federal response capabilities. It was designed to gauge four critical objective areas: incident management (procedures for joint response to and management of a terrorist event), intelligence/investigation (the handling of critical intelligence), public information (coordination of media relations and public warning) and evaluation (identifying best practices and lessons learned).

New Jersey authorities were particularly tested, as they were simultaneously faced with responding to actual flooding of the Delaware River.

Final reports on what went wrong, what went right and what was learned were expected within several months.

—Staff

Research Consortium Seeks More Data, Quicker

A number of EMS systems and hospitals throughout North America have banded together in an effort to facilitate the quality and quantity of certain prehospital research.

The Resuscitation Outcomes Consortium (ROC) will focus on research in the areas of CPR and traumatic injury. By using regional centers in a number of metro areas, the ROC hopes to accumulate more data faster than could be gathered by any trial at a single site.

Data will be contributed by EMS systems and hospitals in such areas as San Diego, Seattle, Dallas, Pittsburgh, Milwaukee and Portland, as well as major cities in Canada.

“With 10 study sites in North America,” Tom Aufderheide, MD, principal investigator at the Milwaukee site, told MERGINET, “the consortium is designed to generate relatively high numbers of study patients in a relatively short period of time.” This will produce results, he hopes, that “should be generalizable to other EMS systems.”

—www.MERGINET.com

Slow Responses Cost Provider Its Contract

Following a year of controversy surroundings its response times, the EMS provider for Ft. Worth, TX, will be replaced.

According to Area Metropolitan Ambu-lance Authority records, Rural/Metro was assessed more than $987,000 in penalties for missing response-time goals in the year that ended in February. On April 18, the company withdrew from its $12 million contract to provide EMS to Ft. Worth and 13 neighboring cities.

As of April 30, the Authority, also known as MedStar, was to take over ambulance services while it seeks proposals for a new contractor, a process that will likely take until late 2006. All Rural/Metro employees were to be offered continued employment.

Rural/Metro attributed its difficulties to staffing shortages and population growth, among other factors. Under its contract, the company had to meet a predetermined response time on at least 90% of its calls. It had hired 21 new paramedics and raised starting salaries, but ultimately decided to seek an end to the contract.

—Ft. Worth Star-Telegram

Interfacility Transport Successes Sought

A working group charged with addressing 10 major interfacility transport issues identified at a 2002 NHTSA meeting on the subject is seeking case studies that demonstrate effective approaches to the issues.

The nine issues include definitions; cost, reimbursement and funding; integration of transport services into existing healthcare systems; research needs; provider education; liability; medical direction; human resources/staffing; and legislation/regulation.

The goal of the project is the development of consensus guidance regarding methods for delivering and administering interfacility transport services. Examples of programs that have addressed the above issues positively will be compiled into a “best practices” section in the group’s finished product.

More-detailed descriptions of the issue areas can be found at www.nhtsa.dot.gov. Call 202/366-2705 with any questions.

—www.MERGINET.com

Neb. Vols Burned When Tank Refilling Goes Awry

Two volunteer rescue squad members from Ashland, NE, received burns when an oxygen-tank refilling malfunction led to a flash fire at their station in April.

The victims, members of the Ashland Emergency Medical Service team, had returned from a call and were reportedly refilling their oxygen tanks. According to TheOmahaChannel.com, “There was some kind of malfunction, and oxygen released from the tank started a fire.”

The two were taken to a burn center in Lincoln. One received burns to his hands, face and upper torso, but his injuries were not considered life-threatening. The other received minor burns and was treated and released.

The team will now replace its bottles instead of refilling them, the site reported.

—KETV/The Omaha Channel