Highlights from the December FICEMS Meeting

On December 7, 2022, the Federal Interagency Committee on EMS (FICEMS) met virtually to discuss topics such as improving post-crash care, helping prehospital workers move across state lines, and speeding up the routing of wireless 9-1-1 calls, among others.

FICEMS was established in 2005 “to ensure coordination among federal agencies supporting local, regional, state, tribal, and territorial EMS and 9-1-1 systems,” according to ems.gov. “FICEMS was also created to improve the delivery of emergency medical services (EMS) throughout the nation."

EMS World attended the December meeting and provides the following highlights.

Improving Post-Crash Care

Ann Carlson, acting administrator of the National Highway Traffic Safety Administration (NHTSA), presented first, sharing with committee members that improving post-crash care has become a priority for her agency.

“Sadly, we know that 40% of people who succumbed to their crash injuries initially survived the crash, meaning that timely quality EMS care is absolutely vital to saving lives,” said Carlson. “That's why supporting improvements to post-crash care is a top priority for DOT, for NHTSA and for our Office of EMS.”

To make this happen, NHTSA has asked the National EMS Advisory Council (NEMSAC) how to improve post-crash care. In its response, NEMSAC “highlighted the importance of collaboration among highway safety officials, EMS, 9-1-1 and trauma systems,” Carlson said. “They also encouraged adopting best practices including those for NEMSIS [the National Emergency Medical Services Information System], emergency medical dispatch, and field trauma triage. And finally, they expressed support for continuous quality improvement programs and other initiatives.”

“We'll be taking a close look at NEMSAC's advice,” she concluded. “I appreciate that NEMSAC emphasized the importance of collaboration.”

Continuing Pandemic-Inspired Waivers

During the COVID-19 crisis, the Centers for Medicare & Medicaid Services (CMS) provided health care authorities with extra flexibility to respond to the pandemic by issuing waivers under Section 1135 of the Social Security Act. Today, CMS continues to issue these waivers to help cope with the effects of the pandemic, according to Capt. Skip Payne, director for emergency preparedness and response operations for CMS.

CMS is also assessing “the appropriateness of continuing those flexibilities beyond the public health emergency and to identify those flexibilities that should potentially be made permanent,” he said.

In instances in which CMS has seen no need to continue with specific waivers, “we have issued updated regulations and program guidance,” said Payne. “We [continue to] work with providers to ensure they receive adequate notice and direction before the changes take place.”

Caregivers Operating Across State Lines

In a move that could provide additional prehospital caregiver support to U.S. communities in need, the Department of Homeland Security (DHS) is working to make it easier for these professionals to work elsewhere in the country.

To enable this change, “DHS is preparing for a federated portability of medical licensure, effectively authorizing and privileging our prehospital providers to practice across state lines in accordance with our respective mission and duties that the department's assigned,” said Cameron Hamilton, DHS’ director of EMS. “These, used in accordance with national protocols established under a singular scope of practice or commonly accepted scopes of practice for each specialty skill, are another effort that we use at DHS to standardize our practices and efforts.”

U.S. Fire Administration Adding EMS Branch

In a bid to better align its activities with its mission statement—"the U.S. Fire Administration is to support and strengthen fire and emergency medical services (EMS) and stakeholders to prepare for, prevent, mitigate and respond to all hazards”—the USFA will convene a formal EMS branch early in 2023. As part of this change, “The National Fire Programs Division will be retitled as (the) National Fire and EMS Programs Division,” said Rick Patrick, division director.

Patrick added that the USFA has been “conducting a complete EMS gap analysis that has been underway now for a little over six months. This is a contract being done to better understand what is missing within the realm of our mission and statutory scope as charged by Congress as it relates to emergency medical services. And from there we will work to build out what our strategic plan and engagement will be going forward.”

Improving Wireless 9-1-1 Call Routing

The Federal Communications Commission (FCC) is taking action to speed up the correct routing of wireless 9-1-1 calls to reduce the number of calls that are rerouted before getting to the 9-1-1 centers closest to the callers.

“The thing that has changed in this environment is the technology that is now available to route wireless 9-1-1 calls that was not available when wireless 9-1-1 started,” said David Furth, deputy bureau chief of the FCC’s Public Safety & Homeland Security Bureau. “Let's say I make a 9-1-1 call in Maryland and it is received by a cell tower in Virginia. There's now technology that would tell the carrier that I'm in Maryland, [so] they can route that call to the correct PSAP in Maryland.”

Given that this technology now exists, the FCC is considering issuing a Notice of Proposed Rulemaking at its December 21, 2022 meeting. This proposed rule, which would be opened for public comment, “would require wireless carriers and text providers to use what we call location-based routing, which is routing based on location of the caller to route 9-1-1 calls,” Furth said. “We think this has the potential to ultimately result in millions of fewer calls needing to be transferred and those calls would go to the correct PSAP in the first instance. Barring the unexpected, we expect that the proposal (to issue the Notice of Proposed Rulemaking) will be adopted.”

For more information visit www.ems.gov/ficems.html.