Town Hall Recordings (and Resource Documents)
The Effect of Hospital Overcrowding on EMS
9/8/21
Click here to watch a recording of the session.
Many US EMS systems are experiencing unprecedented challenges in providing ambulance availability. Some of this appears directly related to the lingering effects of the pandemic on staffing and, more recently, overwhelmed hospital systems have no place to put our patients leading to extended “wall times” for our crews. NAEMSP is convening a series a Town Halls to bring together a geographically diverse group of EMS leaders to discuss the current state of affairs and approaches they have taken to deal with the crisis. Join us in this timely discussion, bring questions and solutions as you visit with this seasoned group of colleagues.
Presenters:
- Clayton Kazan - Dr. Kazan started in EMS as EMT while an undergraduate at UCLA in 1994. After completing his BS in Biology from UCLA, he received his MD and MS (Clinical Pathology) from Rosalind Franklin University of Medicine and Science in 2001 and completed a transitional internship at the University of Hawaii and his emergency medicine residency at UCLA/Olive View-UCLA in 2005. Dr. Kazan held a variety of EMS leadership positions, and he has spearheaded a number of innovative programs since being named as the Medical Director of the Los Angeles County Fire Department since 2015. In addition, he served on the Clinical Faculty in Emergency Medicine at Harbor-UCLA Medical Center from 2005-2012, and he is currently an Assistant Clinical Professor of Emergency Medicine at the David Geffen School of Medicine at UCLA.
- Joe Holley - Dr. Joe Holley is the Medical Director for the State of TN Department of Emergency Medical Services as well as the Memphis and Shelby County Fire Departments and several municipal and private ambulance services in West Tennessee. He also holds the position of Associate Professor in Emergency Medicine for the University of Tennessee Health Science Center. Dr. Holley received his Medical Degree from the University of Mississippi School of Medicine, followed by internship and residency at University Medical Center in Jackson. Dr. Holley has served on over 30 deployments, including Hurricane Katrina and the Pentagon on 9/11, as the Medical Director of the Tennessee Task Force 1, Urban Search & Rescue Team and serves on the national FEMA Incident Support Team. He is a member of the CAPCE Board of Directors, the National Association of EMS Physicians and a Fellow of the American College of Emergency Physicians. Dr. Holley is board certified in Emergency Medicine and was among the first group of physicians in the nation to earn the designation of Fellow of the Academy of Emergency Medical Services.
- David Miramontes - Dr. David Miramontes started as a volunteer Firefighter-EMT while still in high school and went on to the level of EMT-II, Registered Nurse (he worked a total of ten years as a Registered Nurse in ER and ICU), Mobile Intensive Care Nurse, and then received his BS in Physiology at UC Davis. He attended the Medical College of Ohio and Emergency Medicine Residency at the St Vincent Mercy Medical Center in Toledo Ohio, where he also was a Lifeflight Physician. He served as the Pre-hospital EMS Director at St Vincent Mercy Medical Center and provided medical direction for the City of Toledo Fire Dept. and 18 rural and suburban EMS agencies. He was the Assistant Fire Chief and Medical Director for District of Columbia Fire Department (Wash. DC) from 2011-14 and currently serves at EMS Medical Director for the San Antonio Fire Department.
- Anjni Joiner - Dr. Anjni Joiner is the System Medical Director for Durham County Emergency Medical Services in Durham, NC. She is also an Assistant Professor of Surgery/Emergency Medicine at Duke University. She completed her Emergency Medicine residency at Duke University and an EMS fellowship at Emory University. She is board certified in both Emergency Medicine and Emergency Medical Services and holds a Master of Public Health from the Rollins School of Public Health at Emory University in Global Epidemiology. Her research focuses primarily on emergency care and emergency medical services development in low- and middle-income countries and using artificial intelligence for emergency call center chief complaint categorization and triage.
- Paul Pepe - For over four decades, Dr. Paul Pepe has continued to pioneer many of our patient care advances in resuscitation medicine, EMS systems design and public health emergencies. A critical care clinician-scientist, he brought vanguard clinical/research expertise to EMS in 1970s as an on-scene “street doctor” for the Seattle Fire Department. Later, as the first Physician Director of EMS for Houston, TX (1980s, early 90s), he helped to forge the EMS subspecialty within the house of medicine and also stewarded dramatically-increased survival rates for both cardiac arrest and critical trauma, all facilitated by many landmark research initiatives. After serving as Commonwealth Emergency Medical Director for Pennsylvania (late 1990s), he became the Chief Medical Director for Dallas County (TX) Public Safety when recruited, in 2000, to also become Professor and Chair of Emergency Medicine at the University of Texas Southwestern Medical School and Parkland Emergency-Trauma Center.
Today, he not only continues to serve as Dallas County Medical Director, but also as Medical Director for Research, Education & Special Operations for numerous south Florida public safety agencies (Broward, Palm Beach and Polk counties). Among many dozens of notable accomplishments, Dr. Paul Pepe co-founded the National Association of EMS Physicians in 1984 and became its first President-Elect. He later organized the Metropolitan EMS Medical Directors Global Alliance (aka “Eagles”) and also helped to co-found and organize the NIH Resuscitation Outcomes Consortium. Still receiving numerous awards for multi-disciplinary scientific achievements over the past year, he also facilitated boots-on-the-ground accurate and rapid informational exchange across the globe through his unparalleled network of 9-1-1 system leaders. In turn, he was named the 2020 NAEMT EMS Medical Director of the Year.
- Veer Vithalani - Veer Vithalani, MD, FACEP, FAEMS, is the System Medical Director for the Metropolitan Area EMS Authority and the Chief Medical Officer for MedStar Mobile Healthcare. He is also an Emergency Physician at John Peter Smith Hospital and Texas Health Resources Harris Methodist Fort Worth. Board Certified in both Emergency & EMS Medicine; he is a Fellow of the American College of Emergency Physicians and the National Association of EMS Physicians. He is active in organized medicine, as the President of the Texas Chapter of the National Association of EMS Physicians, Board Member for the Tarrant County Medical Society, and past Chair of the EMS & Trauma Committee for the Texas Medical Association.
- James Augustine - James Augustine, MD, FACEP, is an emergency physician and a Clinical Professor in the Department of Emergency Medicine at Wright State University in Dayton, Ohio. He is Chair Emeritus of the National Clinical Governance Board of US Acute Care Solutions, based in Canton, Ohio. He is a proud member of NAEMSP.
Dr. Augustine currently serves as the Medical Director role with Georgia fire services in the cities of Morrow, Forest Park, Hapeville, Riverdale, and South Fulton. He is an Associate Medical Director for North Collier Fire Rescue in Naples, Florida. He is also Medical Director for Washington Township Fire Rescue near Dayton, Ohio. He served as Medical Director for Atlanta Fire Rescue, and later as Assistant Fire Chief and Medical Director for the District of Columbia Fire EMS Department.
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Navigating Current Recommendations and Practice in the COVID-19 Era
12/4/20
Click here to watch a recording of the session.
Moderator: NAEMSP President David K. Tan, MD, EMT-T, FAAEM, FAEMS
Presenters:
- Alexander Isakov, MD, MPH, FAEMS - Alexander Isakov, MD, MPH, FAEMS, is a Professor of Emergency Medicine at Emory University School of Medicine. He is certified by the American Board of Emergency Medicine in both emergency medicine and emergency medical services (EMS). Dr. Isakov is the director of the Section of Prehospital and Disaster Medicine whose faculty provides medical oversight for 911 communications centers, and ground and air EMS responders in metropolitan Atlanta. He is also the executive director of the Emory Office of Critical Event Preparedness and Response (CEPAR), which serves as the center for Emory enterprise-wide planning for and coordinated response to catastrophic events. Dr. Isakov has provided leadership in emergency medical services and disaster preparedness locally and nationally. He serves as the medical director for the Sandy Springs Fire Department and Air Life Georgia. He is the founding medical director for the Emory-Grady EMS Biosafety Transport Program. He is the EMS lead for the National Emerging Special Pathogens Training and Education Center (NETEC) and is a designated Subject Matter Expert for the Assistant Secretary for Preparedness and Response, Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE). Dr. Isakov is also on the American College of Emergency Physicians Epidemic Expert Panel and is a member of the EMS sub-board for the American Board of Emergency Medicine. He previously served on the National Association of EMS Physicians board of directors and the Technical Expert Panel for NHTSA’s EMS Agenda 2050.
- Jon R. Krohmer, MD, FACEP, FAEMS - Jon R. Krohmer, M.D., FACEP, FAEMS is the Director of the NHTSA Office of EMS in the Department of Transportation. He also served as the NHTSA Acting Associate Administrator for Research and Program Development from October 2018 to January 2020. Prior to NHTSA, he was the Assistant Director of the ICE Health Service Corps at the Department of Homeland Security. Previously, he was the principal deputy assistant secretary for DHS Office of Health Affairs and DHS deputy chief medical officer. He began serving in that position as a member of the Senior Executive Service (SES) with DHS in September 2006 and served as the acting assistant secretary for health affairs and chief medical officer from August 2008 to August 2009. Dr. Krohmer was an attending physician and director of emergency medical services (EMS), emergency medicine residency and Department of Emergency Medicine at the Spectrum Health Butterworth Campus in Grand Rapids, MI, associate professor of emergency medicine at the College of Human Medicine at Michigan State University and EMS medical director of Kent County Emergency Medical Services and was the medical director for the West Michigan Metropolitan Medical Response System. Dr. Krohmer received his undergraduate degree at Ferris State College, School of Pharmacy in Big Rapids, Mich., and is a graduate of the University of Michigan Medical School in Ann Arbor, Mich. He completed his emergency medicine residency and EMS Fellowship at Wright State University in Dayton, Ohio. He is board certified in emergency medicine and emergency medical services.
- Stephen Y. Liang, MD, MPHS, FACEP - Stephen Y. Liang, MD, MPHS, FACEP, is an Associate Professor of Medicine at Washington University School of Medicine in the Department of Emergency Medicine and Division of Infectious Diseases, Department of Medicine. Dr. Liang works as an emergency physician and infectious disease specialist at Barnes-Jewish Hospital and is interested in infection prevention and infectious disease challenges in emergency care settings, including emergency medical services. He is the primary consultant to the High Consequence Pathogen transport program for AMR in St. Louis and has deployed numerous times with the federal Urban Search & Rescue system as a Medical Team Manager with Missouri Taskforce-1.
Key take-aways:
- When EMS clinicians ask, “Are you getting the vaccine, Doc?” what they are really asking: “Is the vaccine safe?” Knowing how mRNA vaccines are different from traditional vaccines, debunking myths, and providing guidance and reassurance on what to expect after receiving a vaccine will be an important role of the Medical Director.
- Field practitioners will look to the Medical Director for guidance managing the constant change in COVID mitigation guidelines and risk assessment. The CDC website can help separate fact from fiction when it comes to the latest “rumors.”
- Pre-hospital steroid use in suspected COVID patients is probably not yet ready for prime time, and initial pre-hospital efforts should be at optimizing oxygenation and managing other immediate life threats.
- Leaders should not assume that personnel are donning and doffing PPE appropriately. Especially as PPE fatigue increases, care should be taken to provide refreshers and friendly reminders at regular intervals.
- Proper PPE use, including while performing aerosol-generating procedures, remains a mainstay of defense even in a post-vaccine era for the foreseeable future.
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COVID-19 and Public Health Intersection in EMS
11/9/20
Click here to watch a recording of the session.
Host:
- Lekshmi Kumar, MD, MPH - Dr. Kumar completed her ER residency at Mayo Clinic Rochester MN, EMS fellowship at Emory and MPH at Rollins school of Public Health. ER attending at Emory University Hospital and has been medical director for both ambulance and fire based systems for the past 8 years. Currently Medical director for Grady EMS that is a hospital-based EMS system, a component of Grady Health System and provides 911 services to the City of Atlanta in addition to 16 counties across Georgia with an approximate annual call volume of 130,000 within the City of Atlanta.H
Presenters:
- Chelsea White, MD, NRP, FAEMS, FACEP - Dr. White is an emergency physician in the Department of Emergency Medicine at University of New Mexico, USA. He is the Director of the UNM Center for Rural and Tribal EMS as well as the soon-to-be immediate past Director of the UNM EMS Fellowship. He currently serves as EMS Medical Director for Cibola (sih-BOW-la) County Fire and Emergency Medical Services, Pueblo of Acoma (AAH-co-mah) EMS/Fire Department, Pueblo of Isleta EMS, Pueblo of Laguna Fire Rescue, Pine Hill Emergency Medical Services, and the TóHajiilee (to-HA-juh-lay) Field Office of Navajo Nation EMS. He is the President of the New Mexico Chapter of the NAEMSP.
- Ray Barishansky, MPH, MS - Mr. Barishansky is the Deputy Secretary for Health Preparedness and Community Protection at the Pennsylvania Department of Health. From 2012 to 2015, he served as the Director of the Office of Emergency Medical Services for the Connecticut Department of Public Health. Prior to that, he served as the Chief of Public Health Emergency Preparedness and Response for the Prince George's County (MD) Health Department from 2008 to 2012. Mr. Barishansky is currently enrolled in a Doctoral Program in Public Health (DrPH) at the Fairbanks School of Public Health at Indiana University. He holds a Bachelor of Arts degree from Touro College, a Master of Public Health degree from New York Medical College and a Master of Science in Homeland Security Studies from Long Island University. He is a graduate of the Senior Executives in State and Local Government program held at the John F. Kennedy School of Government at Harvard University (2006) and has also earned a Certified Public Manager (CPM) certification through Arizona State University. Mr. Barishansky has authored articles in such publications as EMS Magazine, the Journal of Emergency Medical Services (JEMS), EMS Insider, Domestic Preparedness Journal, the Journal of Homeland Security and Emergency Management, Emergency Management Magazine, and the Crisis Response Journal (UK). He is a nationally recognized speaker and has made presentations at various EMS and Public Health conferences.
- Justin Stewart, AAS Paramedic, ME - Justin Stewart is the Training Officer for Rockingham County EMS. Justin has taken Rockingham County EMS to the tip of the spear in prehospital patient care in the country. He has accomplished this with revolutionary partnerships with Social Services and Health Departments. One example of this is integrating paramedics with the Department of Health and Social Services, working hand in hand with social workers, mental health providers, and substance abuse peer support specialists. Justin is inspired by his wife of twenty-six years, Sarah, and their six daughters, one of which he lost to cancer in 2011. Justin likes to spend time with his family in his free time and is active in his church.
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Economic Impact of COVID-19
9/8/2020
Click here to download a recording of the session - Access password: S*9q!FKs
Moderator: NAEMSP Secretary/Treasurer José G. Cabañas, MD, MPH, FAEMS
Participants:
- J. Stephen Lee. Steve manages the PPG office in downtown Pittsburgh and works with clients to develop, implement and monitor tailored financial solutions. He also serves as the firm's Chief Investment Officer, overseeing the firm's investment research, portfolio construction and portfolio management. Steve joined the team in 2012 when Pittsburgh-based H.L. Zeve Associates merged with JFS. Before the merger, Steve worked as a Lead Advisor for H.L. Zeve since 1994. Prior to this, Steve lived in New Orleans, LA, where he owned and operated an oil and gas exploration and production company, managing funds from private and corporate investors. He received a Bachelor's Degree in Geological Sciences from Brown University and earned his Master's Degree in Business Administration (MBA) from the University of Pittsburgh Katz School of Business.
- Ronald W. Yost. Ron works with clients to develop, implement and monitor tailored financial solutions at our PPG office in downtown Pittsburgh. He is also a member of the firm's Business Development team. Ron joined the team in 2012 when Pittsburgh-based H.L. Zeve Associates merged with JFS. Before the merger, Ron worked as Vice President for H.L. Zeve since 2004. Prior to this, Ron was Vice President and Manager of Charles Schwab's Monroeville office where he oversaw a staff of six and was responsible for firm assets of approximately $700 million.
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Urban EMS Considerations in the COVID-19 Era
8/12/2020
Click here to download a recording of the session - Access password: V3oNdLn$
Moderator: NAEMSP President David K. Tan, MD, EMT-T, FAAEM, FAEMS
Participants:
- Marianne Gausche-Hill, FACEP, FFAP, FAEMS. Dr. Gausche-Hill is the Medical Director for Los Angeles County Emergency Medical Services (EMS) Agency, Professor of Clinical Emergency Medicine and Pediatrics at the David Geffen School of Medicine at UCLA and serves as Clinical Faculty at Harbor-UCLA Medical Center in Torrance, CA. The LA County EMS Agency receives over 700,000 911 calls a year, has over 70 receiving centers with multiple specialty centers including stroke, STEMI, Trauma, and pediatric. She is nationally and internationally known for her work as an EMS researcher and educator, and for her leadership in the field of EMS and pediatric emergency medicine. She is best known for her study of pre-hospital airway management for children published in JAMA 2000 and her work on the National Pediatric Readiness Project published in JAMA- Pediatrics in 2015. She has won numerous national awards for her leadership in emergency medicine, pediatric emergency medicine and EMS. Dr. Gausche-Hill currently serves as a senior editor for the textbook, Rosen's Emergency Medicine: Concepts and Clinical Practice, and serves on the American Board of Emergency Medicine Board of Directors.
- Drew Harrell, MD, FAEMS, Dr. Harrell is an Associate Professor of Emergency Medicine and EMS in the Division of EMS, Disaster, and Austere Medicine, Department of Emergency Medicine at the University of New Mexico School of Medicine. He is board-certified in both Emergency Medicine and Emergency Medical Services practice and has been a practicing EMS physician in New Mexico for over 10 years. He started in EMS in 1991 when he first took a Wilderness EMT class and, in a prior career, worked as both a nationally registered paramedic and wildland firefighter throughout the western US. He currently provides EMS Physician field response and medical direction through the UNM EMS Medical Direction Consortium program in Albuquerque for the multiple EMS partner agencies of the EMS Consortium. Drew currently serves as the operational EMS Medical Director for the following agencies: Grand Canyon National Park Emergency Services, Bernalillo County Sheriff's Department, the New Mexico State Police and State Search and Rescue, and the Albuquerque Police Dept. Special Operations Division TEMS team. Additionally, he provides operational TEMS medical support as a Reserve Deputy with the Bernalillo County Sheriff's Department Special Weapons and Tactics Team and is also the educational program Medical Director for the US Air Force Pararescue paramedic training program through the UNM EMS Academy. His areas of interest include pre-hospital EMS practice and education, tactical and austere medical care, and EMS medical direction.
- Lekshmi Kumar, MD, MPG, Dr. Kumar completed ER residency at Mayo Clinic Rochester MN, EMS fellowship at Emory and MPH at Rollins school of Public Health. She was an ER attending at Emory University Hospital and has been medical director for both ambulance and fire based systems for the past eight years. She is currently Medical Director for Grady EMS that is a hospital-based EMS system, a component of Grady Health System and provides 911 services to the City of Atlanta in addition to 16 counties across Georgia with an approximate annual call volume of 130,000 within the City of Atlanta.
Key take-aways:
- As emergency care of the COVID-19 patient matured, death rates fell in spite of an increase in overall cases. This underscores the importance of continually building upon lessons learned.
- The idea that PPE usage is effective if used properly and consistently is supported by the ongoing data. Therefore, many EMS systems have begun to relax restrictions on “aerosol generating procedures” as long as clinicians don and doff their PPE appropriately.
- Urban EMS services cannot be expected to know, let alone follow, dozens of different “protocols” for facility entry during this pandemic. Coordination, at a system level, of EMS resources and response is essential.
- While the overwhelming “tsunami” of anticipated EMS calls thankfully did not materialize, the preparatory steps—including treat-in-place protocols, alternative destination sites, and dispatch screening and triage modifications—should be examined for implementation in a post-COVID world in the context of quality medical oversight and increased CMS flexibilities for payment.
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EMS Education Considerations in the COVID-19 Era
7/28/20
Click here to download a recording of the session - Access password: ^Hs3G68T
Moderator: NAEMSP President David K. Tan, MD, EMT-T, FAAEM, FAEMS
Participants:
- Maia Dorsett, MD, PhD, FAEMS, medical director of EMS Education Programs for Monroe Community College in Rochester, New York and the Monroe-Livingston Associate Regional Medical Director for Education and Quality
- Joshua Stilley, MD, medical director for University of Missouri Ambulance, University of Missouri EMS Education and the National EMS Education Standards Update Committee
- Anthony Liu, BS, AEMT, student at Austin Community College's Paramedic program and Advanced EMT for the Hays County EMS in Texas
- Ginger Locke, BA, NRP, Associate Professor of EMS Professions at Austin Community College and creator of the Medic Mindset podcast
Key take-aways:
- Boxes “checked” does not equal material learned. In light of reduced clinical time and patient contacts, medical directors must find innovative ways to determine student competency such as replacing mere number of hours or patient contacts with individual learner demonstration of competencies in managing key chief complaints and skills.
- Seeking other clinical facilities in more rural areas eager to have students has been a solution for many programs, and letting clinical sites know the school will provide student PPE assuages many initial concerns for PPE shortages.
- Program weaknesses have been uncovered because of the COVID-19 crisis. Use this time to specifically address those weaknesses not only for the current pandemic but for the next one surely on the horizon.
- Simulation is here to stay, and schools must be willing to accept that it is time-intensive and needs dedicated support in order to be done correctly.
- Physician medical directors must be ardent advocates of their students and not only develop but maintain and cultivate relationships with key hospitals, agencies and other clinical partners to support the learner’s educational experience.
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Air Ambulance Transport during COVID-19 (originally named HEMS Considerations in the COVID-19 Era)
7/7/20
Click here to download a recording of the session - Access password: 0J&f@C?=
Moderator: NAEMSP President David K. Tan, MD, EMT-T, FAAEM, FAEMS
Participants:
- Leslie Osborn, MD
- Angela Cornelius, MD, FACEP
- Ray Bennett, BSN, RN
Key take-aways:
- Using dedicated aircraft for known COVID-positive patients may help reduce down time for decontamination keeping more aircraft in service.
- Temporary use of scrubs instead of flight suits may be appropriate in some circumstances when considerations include crew fatigue, turnaround time for decontamination, and laundering logistics.
- HEPA filtration in aircraft may filter circulated air, but it does not always filter the air between you and the person in front of you. Continued use of appropriate PPE is essential, and crews cannot depend solely on HEPA filters within certain aircraft.
- There continues to be a paucity of data regarding aerosol-generating procedures and their use within rotor-wing or fixed-wing airframes, but current practice is to limit AGPs similar to ground ambulance services.
- Certain PPE configurations can make headset communication almost impossible. Services must find the right PPE to fit with their night vision equipment, helmets, and/or microphones as applicable and fit-test with these unique configurations at altitude when possible.
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Quality Improvement in EMS in the COVID-19 Era
6/26/20
Click here to download a recording of the session - Access password: 1O@BPa4^
Moderator: NAEMSP President David K. Tan, MD, EMT-T, FAAEM, FAEMS
Participants:
- Remle Crowe, PhD, NREMT, research scientist, ESO; faculty member, NAEMSP Quality and Safety Course
- Tim Burns, NRP, Montgomery County
- Scott Dorsey, MS, Chief of Strategic Analysis and Improvement
- Stephanie Ashford, Ed.S., NRP, paramedic training officer, St. Charles County, Missouri; faculty, NAEMSP Quality and Safety Course
Key take-aways
- Data is meaningless until one can turn it into useful information and put it into context, and that context is often provided in the form of control charts. (See the links in our Follow-up Forum for online resources to make your own control charts!)
- One doesn’t necessarily need a Ph.D. to turn data into information, but educating oneself to the fundamentals of Information Science will be important to avoid early frustration. Great resource books and courses are on our Follow-up Forum.
- Data points must be defined. These definitions don’t have to be perfect, but they must be consistent in order to make meaningful comparisons.
- Avoid the urge to make sweeping changes in your system. Enact and examine small tests of change first.
- COVID-19 surveillance has demonstrated that QA and CQI principles can help drive clinical protocols, but can also sustain Human Resources priorities by illustrating PPE utilization and effectiveness.
- A QA program needs more than just “buy-in” from administrators. It needs support. Win that support by finding out what is important to your leadership and demonstrate your value by being the source of actionable intelligence that would help them with their responsibilities.
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NAEMSP Town Hall: Rural and Tribal EMS Considerations in the COVID-19 Era
6/11/20
Click here to download a recording of the session - Access password: 2w^#t9W2
Moderator: NAEMSP President David K. Tan, MD, EMT-T, FAAEM, FAEMS
Participants:
- Jenna White, MD, EMS physician; associate professor of Emergency Medicine, University of New Mexico in Albuquerque, NM.
- Julie Houle, MD, MHA, emergency physician in northern Minnesota.
- Joy Crook, MD, associate professor and vice chair, clinical affairs, Department of Emergency Medicine, University of New Mexico; New Mexico State EMS Medical Director; Medical Director for AMR in Central New Mexico; member of the Secretary of Health's Medical Advisory Team during the Covid pandemic.
- Allen Lewis, MPA, CEMSO, Paramedic: Fire Chief, Virginia Fire Department, Virginia, Minnesota; adjunct professor, College of Safety and Emergency Services, Columbia Southern University
Key take-aways:
- Workforce protection is even more critical in rural/tribal agencies, as there is little to no redundancies in staffing with limited mutual aid options.
- Public health messaging in rural and tribal areas is challenging not only due to geographic expanse but often a lack of electricity, much less Wi-Fi or technology.
- Rural and tribal EMS providers are a valuable avenue for public health messaging, as they are known and trusted by the patients and also speak their language, know their customs, and engender their confidence.
- Cultural norms of multi-generational housing among tribal nations necessitated development of isolation facilities when family members became ill.
- Isolation facilities may be staffed with medical personnel furloughed from other institutions.
- Rural EMS must move to a system where services are rendered to those who need it as opposed only to whoever is paying for it.
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NAEMSP Town Hall: Mental Wellbeing in the COVID-19 Era 5/28/20
Click here to download the recording of the session - Access password: 8D$%.N2U
Moderator: NAEMSP President David K. Tan, MD, EMT-T, FAAEM, FAEMS
Participants:
- Ann Marie Farina, AAS, BA
- Elizabeth Donnelly, PhD, MSW, MPH, NREMT, Associate Professor, School of Social Work, University of Windsor
- Lauren Maloney, MD, NRP, FP-C, NCEE, EMS, Fellow, Stony Brook University Hospital; Adjunct Assistant Professor of Biomedical Engineering, Stony Brook University; Associate Medical Director, SBU Paramedic Program; faculty, SBU Institute for Engineering-Driven Medicine
- Chief Randy Mellow, Chief, Peterborough County/City Paramedics; President, The Paramedic Chiefs of Canada; member, Canadian Institute for Public Safety Research and Treatment - Public Safety Steering Committee.
Key take-aways:
- It is just as okay to be okay as it is to be “not okay” during a crisis.
- Coping with stressors can range from a simple “buddy check” to formal counseling and everything in between but everyone must recognize the need for assistance in themselves, as well as others, and seek or provide the necessary support.
- Setting up a local support and response program for “routine” incidents will garner trust and get personnel accustomed to reaping the benefits of such a system, which will truly reveal its worth when a major catastrophe hits; involve key administrators and stakeholders early in the inception phase.
- Communication styles and strategies during a major event must be adjusted to avoid secondary traumas from ineffective or harmful attempts at conveying information.
- See the NAEMSP COVID-19 Resource Page and discussion forum for a printout of helpful resources.
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NAEMSP Town Hall: Emerging Critical Care Concepts in the Management of COVID-19
5/14/20
Click here to download the recording of the the session - Access Password: 9k$66D=0
Moderator: NAEMSP President David K. Tan, MD, EMT-T, FAAEM, FAEMS
Participants:
- Jacob B. Keeperman, M.D., EMT, FAEMS, Department of Anesthesiology, Division of Critical Care Medicine; Department of Emergency Medicine, Division of EMS, Washington University School of Medicine, St. Louis, MO
- Amjad Musleh, M.D., Department of Anesthesiology, Division of Critical Care Medicine; Department of Emergency Medicine, Division of EMS, Washington University School of Medicine, St. Louis, MO
- Christopher Palmer, M.D., EMT, Department of Anesthesiology, Division of Critical Care Medicine; Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO
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Chapter Insights Surrounding COVID-19
4/30/20
Click here to download the recording of the the session - Access Password: 2l#0Do82
Moderator: NAEMSP President David K. Tan, MD, EMT-T, FAAEM, FAEMS
Participants:
- Josef Schenker, MD, FAEMS: NAEMSP New York Chapter President
- Joslyn Joseph, DO, EMT: NAEMSP New Jersey Chapter President
- Jeff Williams, MD, FAEMS: NAEMSP North Carolina Chapter President
- Joseph Zalkin: NAEMSP North Carolina Chapter Executive Director
- Jeff Jarvis, MD, EMT-P, FAEMS: NAEMSP Texas Chapter President
Key take-aways
- Crisis Standards of Care should be crafted before a crisis occurs.
- State chapters should be a resource to government officials when it comes to addressing clinical aspects of public policy.
- Including non-NAEMSP members in chapter-sponsored advocacy activities and educational efforts can demonstrate value to stakeholders and provide an avenue to recruit new members.
- The COVID crisis has revealed the utility of telehealth in medical control applications in addition to mobile integrated healthcare.
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EMS Legal Issues Regarding COVID-19
4/16/20
Click here to download recording of session - Access Password: H0#84+48
NAEMSP President, Dr. David K. Tan, spoke with our guests, attorneys Matthew Streger and Margaret Keavney.
Key take-aways:
- Be sure to consider local or state waivers of existing law when crafting Crisis Standards of Care
- If allowing crews to not transport suspected COVID patients who are well-appearing with acceptable vital signs, perhaps in a shared decision-making model, consider crafting an “acknowledgement form” that includes patient education rather than a “refusal form” since the patient is not really “refusing” your care or transport
- CMS has issued temporary regulatory waivers to include expanding the list of allowable destinations for ambulance transport during the Public Health Emergency (PHE) for the COVID-19 pandemic
- Police departments and dispatch agencies are generally not considered a “covered entity” and, therefore, are not required to comply with the HIPAA Privacy Rule
- COVID status may be reported to a law enforcement official to prevent or lessen a serious and/or imminent threat to the health or safety of an individual or to the public
- The Ryan White Act was expanded to include COVID-19 reporting
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Protecting Your Providers: Seattle’s COVID-19 Experience
Watch now. (Access Password: 4lG38G)
Moderator: NAEMSP President David K. Tan, MD, EMT-T, FAAEM, FAEMS
Participants:
- Thomas Rea, MD, MPH, is the Medical Program Director for King County EMS and a Professor of Medicine at the University of Washington.
- Michael Sayre, MD, is the Medical Director for Seattle Fire Department and a Professor of Emergency Medicine at the University of Washington.
Key take-aways:
- PPE works! Greater risk to EMS may actually be off-duty or if not practicing social distancing and basic infection control procedures while at work.
- At this time, PPE is a limited resource, so agencies must risk stratify its use to conserve appropriately until supplies become stable.
- The “Scout” procedure is an added layer of screening to augment the EMD/Dispatch pre-screen as well as another avenue to conserve PPE
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