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NHTSA OEMS COVID-19 Weekly briefings
March 10th, 2020 1600hrs

Welcome and Introductions

53 participants

Update on current activities (subject to change):

  • Risk to US is still low
    • Remain low risk 115K worldwide with 4K deaths
    • 750 in US with 26 deaths
    • Another cruise ship in Oakland CA, being unloaded. Travis AFB & Miramar AFB & Dobbins AFB and Lackland AFB are now designated quarantine centers.
    • CDC recently published their one-page guidance for LE personnel.
    • CDC recently released a definition modification of “person under investigation”.
    • Now a CoronaVirus.GOV web site
    • NHTSA site: https://www.ems.gov/preparedness.html
  • Confirmed cases in US
    • 750 in U.S. with 26 deaths
    • Cases in Virginia, MD and DC. 35 states with confirmed cases.
  • 911 Centers
    • It was asked what type of surveillance is being established by 911 centers. Most responded that they are using their triaging component of their dispatching protocol.

NOTES from the meeting:

Effect on clinical rotation in hospital schedules and the impact on EMS educational programs.

Surge planning needs to take place now. Meet with local health care agencies and coalitions for planning.

Changing crew configurations review and modifications.

PPE: continues to be a legitimate concern for EMS and healthcare in general. From national perspective healthcare only account for 30% of all the national needs for all PPE (for other industries).

CDC Report:

  • Posted update interim guidance for healthcare infection control
    • PPE recommendation is modified. Still recommends eye, gown and glove protection. Face masks, P-95 or R-95s are an acceptable alternative to respirators if supply chain is an issue. Patient with suspected COVID-19 do not have to be placed in an “isolation room with air ventilation structure”, a single room would be adequate. For EMS guidance will be updated shortly.

Cal Health is not permitting reuse of N-95 even though several others have indicated they can be reused as long as they are not obviously contaminated.

NIH papers have shown N-95 masks can be decontaminated with use of ultraviolet technology.

Some agencies are running into uncooperative hospitals concerning the release of patient information relative to COVID-19.

Some agencies report childcare is becoming a problem and is affecting staff shortages.

Guidance was requested for terminating the quarantine period for providers when the suspect patients test negative.

Resources:


March 17th, 2020 1600hrs

Welcome and Introductions

            About 30 – 35 participants

Update on current activities (subject to change):

  • Reviewed CDC current report & update
  • Request was made for ICU bed count being used for COVID-19 admissions to be maintained
  • Request was made for “Crisis Standards of Care” be posted on the EMS.gov website and be produced into a webinar or video
  • NHTSA is working to place all resources for COVID-19 in one easy to find location on their web site, on a COVID-19 landing page
  • Recommendation made for each state, or NASEMSO, to provide any state orders, regulatory modifications, or emergency legislation being implemented, to be placed on the COVID-19 web site
  • Request for clarification to be issued that N-95 is preferred, but regular surgical masks are an acceptable alternative when no N95’s are available
  • NHTSA asked what the experience has been with EMS agencies trying to utilize their regional or state OEMs to attain PPE
  • Some agencies are preparing to utilize rain coats and pants and clean them with a bleach solution after exposure, once their disposable PPE depletes
  • Biggest issue that we are hearing concern from folks about is PPE
    • That is an issue for the entire health care community – as well as many other areas of industry
    • Overall, health care folks account for < 15% of the overall need
    • Health care and first responders (EMS, LE, FD) are being given priority consideration
    • The most effective way for agencies to address their PPE needs at this time is to attempt to order through their established supply chain – will likely not work but has to be attempted
      • Then go through local emergency management to state emergency management – OR – through state EMS office to state emergency management (that will vary state – state)
  • Screening criteria are one of the issues that local areas may want to review
    • With more widespread disease in the community – rather than asking about travel to specific areas of the world or country, it probably makes most sense to ask about symptoms and exposure to potential cases.
    • NHTSA asked participants if their PSAPs were still asking about travel during their caller interrogation. Some responded they have diminished asking about travel, others have not
  • Questions about testing – the process is still stressed but folks are working on making it better
    • Testing is currently limited to folks who have confirmed / high risk exposure
    • There have been issues about getting test results reported back – efficiency varies around the country
      • We are trying to get that addressed at the national level
    • NHTSA asked if first responders are having trouble getting access to testing. Some replied they are having trouble getting testing unless they have signs and symptoms. Others report tremendous variability on how local health departments are handling testing of first responders and how they handle situations when no tests are available regarding the quarantine period. Some reported a seven-day waiting period for test results. Rumor that LabCorp is establishing a test for COVID-19 giving priority to first responders
  • Quarantining is also an issue – currently follow recommendations of the local public health department and CDC
    • there are some areas that are looking at alternative models and we hope to have more information about potential best practices from those areas out soon.
    • NHTSA asked participants how they are handling quarantining of personnel. There were varies responses
  • REPLICA has been activated. http://www.emsreplica.org/replica-and-the-ems-provider/

https://www.emsworld.com/news/12332549/replica-meets-goal-interstate-compact-becomes-official


Friday March 20, 2020

Welcome and Introductions

  • Welcome to the call – OEMS Staff
  • Introductions
    • NEMSMA (Vince Robbins), IAFC (Gary Ludwig), IAEMSC Peter Dworsky), NHTSA (Dave Bryson, et al)

Update on current activities (subject to change):

  • Current Status of the Disease
    • World Numbers
      • 196,617 confirmed cases. 7,899 confirmed death
    • National Numbers
      • 9,026 confirmed cases. 150+ confirmed deaths
  • Impacts on your departments
    • Have you made changes to the composition of crews?
      • Yes. Crew complement modifications.
    • Have you made changes to your responses?
      • Yes, Modified screening of calls to reduced response. Some agencies considering paramedic implemented treat and release.
  • PPE
    • Supply
      • Depletion is occurring. Agencies are innovating substitutions for PPE.
    • Ordering
      • Receiving less than ordered. Manufacturers are triaging PPE to hospitals.
    • Other sources
      • Agencies creating their own PPE.
    • CDC guidelines
      • Changing often.
  • Screening
    • PSAPs modifying call intake to downplay travel history. Agencies developing beginning of shift crew screening.
  • Testing
    • More tests needed. Need test results back faster. Hospitals reserving tests for their personnel and patients.
  • Quarantining
    • Various rules. No standard to release quarantined crew.
  • Needs or issues – email NHTSA.EMS@dot.gov

 Tuesday March 24, 2020

Welcome and Introductions

Participants: about 50, including multiple federal agencies and national EMS associations

Update on current activities (subject to change):

  • CDC Cases in US https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in- us.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019- ncov%2Fcases-in-us.html

  • FEMA Healthcare Systems Resilience
    § EMS Task Force (being Chaired by Dr. Jon Krohmer of NHTSA OEMS)

    Goals for the Prehospital/ Emergency Medical Services (EMS) Line of Effort

 

Work to ensure the resilience of the Emergency Medical Services (EMS) response capabilities throughout the United States.

o Promote safetyvof the EMS workforce, to include physical and behavioral health, as well as keeping their families safe at home.

o Support planning for alternative workforce strategies.

  • Facilitate improved interface among 911, EMS, public health, health

    care systems and emergency management from the local level to the national level.

    o Identifying and filling any training gaps that need to be filled for Crisis Standards of Care and Innovative protocol adoption.

  • For the EMS system to provide optimal patient care, given the current resources available.

    o Maintaining the logistics to provide necessary resources (workforce, supplies, training and education, reimbursement) to all EMS agencies.

    § NOTE: the task force is adding several representatives of selected national EMS organizations, including NASEMSO.

    The Task Force will be issuing a one-page statement regarding the shortage of PPE. It will attempt to put in perspective (that several healthcare and other industry segments are considered “high priority” as is EMS) the issue and provide guidance that includes 1) continue to order through your regular supplier, 2) then, if not available, through the state OEM. When requesting, agencies must be very specific about what is needed and the current urgency level of need for the PPE.

 

Discussion: COVID-19 surveillance

The role of NEMSIS and National Dashboards
o IAFC: Dashboard focuses on impact of COVID-19 on

EMS agencies
o ESO: Dashboard focuses on EMS clinical activity

being provided for COVID-19 patients o Biospatial

o NEMSIS is working with the states to create and share data collection via a dashboard to provide as real time data as possible. It would include customized set of data elements specific to COVID- 19. Participants were concerned of the time it would take to implement and the cost to EMS agencies to modify the current NEMSIS data set.

o NEMSMA is conducting weekly surveys of members asking key questions on the impact of COVID-19 pandemic on their agencies.

Crisis Standards of Care: What EMS needs to know – Webinar being scheduled for Thursday.

o The three panelists will share their expertise on crisis standards of care from public health, legal, medical and operational perspectives:

o JamesG.Hodge,Jr.,JD,LLM, is the director of the Center for Public Health Law and Policy at Arizona State University and a professor at the Sandra Day O'Connor College of Law. A leading expert in public health emergency law, he has helped draft several model public health regulations and advised public health officials across the country.

Aaron Burnett, MD, FACEP, is the EMS medical director for the State of Minnesota and an associate professor of emergency medicine at the University of Minnesota. As a member of Minnesota's State EMS Regulatory Board, he helped the state put in place recent changes to regulations to help communities and EMS organizations respond to COVID-19.

John L. Hick, MD, serves as deputy chief EMS medical director and medical director for emergency preparedness at Hennepin County Medical Center in Minneapolis. Dr. Hick was a member or co-chair for each of the Institute of Medicine/National Academy of Medicine Crisis Standard of Care publications and has published widely on disaster-related topics.

o The NHTSA Office of EMS will moderate.

o Note: This live webinar will be limited to the first 3,000 people to log in using the link provided. A recording of the webinar will be shared as soon as it is

available, and the webinar will use computer audio only, rather than a phone line.

Needs or issues – email NHTSA.EMS@dot.gov
o COVID-19 resource page on EMS.gov updated twice per week; Please

email suggestions for new resources.

Resources:

  • Visit https://www.ems.gov/projects/coronavirus_covid-19_resources.html

  • Visit https://www.hhs.gov/sites/default/files/covid-19-hipaa-and-first-responders- 508.pdf regarding HIPAA issue of civil rights related to the COVID-19 pandemic

  • COVID-19 cost recovery for Fire and EMS departments o https://www.usfa.fema.gov/current_events/031820.html

  • Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States, (CDC 2007)

    • https://www.cdc.gov/flu/pandemic-resources/pdf/community_mitigation- sm.pdf
  • Open discussion:

    PPE shortage:

    Reported by numerous participants as widespread and on the verge of complete depletion throughout the EMS industry.

    A participant reported that he was approached by two separate Chinese companies offering to sell his agency N95 masks. Guidance was requested on who approves foreign masks and when they will become available.

    A participant stated his agency is collecting used N95 mask after use and storing for potential decontamination and reuse later if shortage continues.

    Personnel shortage:
    Ventilator shortage increasing interhospital transports:
    Medication shortages (Ventilator/airway sedation drugs, hydration IV fluids, and others):


Friday, March 27th, 2020

Welcome and Introductions

  • Thank you for joining
  • Reminder the purpose of these calls is to bring together folks from organizations with similar areas of focus to attempt to identify similar issues
  • Roll call – IAFC, NEMSMA & IAEMSC
  • Also remember the general EMS stakeholder calls Tuesdays at 1600 EDT if you also want to participate in those calls

Update on current activities (subject to change):

  • FEMA is leading the planning and response now. Three task forces have been set-up (prehospital, hospital and out of hospital) and Jon is the lead for Prehosp and Kate Elkins is his deputy. These calls help get them data they need and in turn allows the TF to help you and your members. Let’s keep working together.
  • We believe the biggest issue we’re still facing is with PPE. A one-pager is being drafted and coming from the PHTF very soon for you. It’ll be critical for folks to fill out the forms accurately and completely with data and not just say, “I need 5,000 N95s because I’m an ambulance service.”
    • Healthcare and first responders (EMS,LE,FD) are being given priority consideration by the Federal Government as these groups are all clearly stated in the DHS Critical Infrastructure document driving FEMA right now.
    • We all need to accept the fact there’s not enough resources and we have to work together to make necessary modifications to keep our folks safe.
    • As Rick Patrick shared with some of you on a call earlier today:
      • Local level department makes requests through local Emer Mgmt agency (or whatever structure exists in a given state)
      • Then goes to state Emer Mgmt Agency -> then to FEMA region -> then to FEMA NRCC in DC who hands off medical requests to HHS (Fire/EMS is Tier 1 high priority along with hospitals, NHs and others).
        Disaster declaration in a State is also relevant (go to fema.gov and search for disaster declarations, DR or EM for each state will pop up, not every state has DR declaration, if EM 75/25 cost split).
    • Vince Robbins: Some hot spot agencies have depleted their PPE
    • Dave Mitchell: wide disparity in testing and testing turn around time...CO is 10-11 day turn arounds
  • Quarantining and Testing - the process is still stressed but folks are working on making it better. There’s also an algorithm (one-pager) coming very soon for you on exposure, evaluating personnel and then quarantining, isolating and/or testing when appropriate and indicated.
    • Vince Robbins: first responders are being denied tests and test are being reserved for pts, physicians and nurses. One pager should address diversity of guidelines...confusing
    • Testing capacity is not adequate
  • Needs or issues – email NHTSA.EMS@dot.gov – These get reviewed by the PHTF – direct to the top, folks.

Resources:
What are your top priority needs for Federal grant funding that is now, or may be, available to you?

  • Hiring individuals at high pay rates (reimbursement is inadequate)=>payroll; PPE disinfection equipment and ambulance decontamination equipment; stimulus funds to ambulance manufacturer for integrating disinfection systems into ambulances
  • Money to support first responders under quarantine=>would encourage employees under quarantine;
    Workers compensation needs will be high in the future
  • Education and training of staff => education system shut down
  • Permanent ongoing plan for pandemics

EMS.gov has been loaded with great resources from Feds, your groups and other sources and it gets updated twice per week. Please keep everything you think is good coming to the NHTSA.EMS@dot.gov address so we can post it for all to see and use.

What else do you need?


What else have you done we need to know about?

  • Local PH is not doing contact tracing until you have positive COVID-19 results...this approach will wipe out local EMS agencies. Provide a contact tracing questionnaire for local EMS agencies.
  • Vince Robbins: We need a single place for EMS=> NHTSA
  • Develop an EMS version of NWCG to support interstate EMS assistance (maybe attached to Medical Reserve Corps)

Tuesday, March 31st, 2020

Participants: About 50
Welcome and Introductions
Update on current activities (subject to change):

 

  • CDC Cases in US https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in- us.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019- ncov%2Fcases-in-us.html
  • FEMA Healthcare Systems Resilience
    • EMS Task Force
  • CMS Guidance: https://www.cms.gov/files/document/covid-ambulances.pdf
    •  AAA reported on CMS’s new emergency guidelines. Allows reimbursement for transport to healthcare facilities other than a hospital, but not for releasing patient at home. Also allows for waiver of patient’s signature. It does not change PCS’s requirements, such as for interfacility transports. It mentions suspension of audits and preauthorization requirements. Lastly speaks to telehealth services. Clearly articulates that ambulance services cannot directly bill for telehealth, but a physician could enter into a contract with an ambulance service sand bill that way. This is retroactive to March 1, 2020.
  • Licensing & Recognition:
    • 19 states are in the compact (REPLICA became operational March16,2020) and utilizing it. Other states are independently waiving and easing regulations surrounding provider licensure for external practitioners and agencies as well as in-state providers. They are also easing crew complement and expiration deadlines and requirements.
    • NREMT has implemented a “ProvisionalCertification”. It certifies individuals who have passed all elements of testing except psychomotor examination and expires 12/31/2021. It is up to each state to determine if any restrictions on scope of practice should be placed on such “Provisionally” Certified individuals.
  • NEMSIS update:
    • NHTSA reported NEMSIS is sending out a secondary request for those states who have not yet responded concerning releasing of County level data of flu-like symptoms.
    • Working with Palateer to attain realtime information about PPE and availability.
  • Crisis Standards of Care (CSC) discussion:
    • Webinar was held last week on this topic through the EMS Task Force.
    • Some localities have implemented Treat and Release at home.
    • Some agencies are reporting that hospitals have requested any aerosoling treatment be terminated prior to transfer to the hospital.
    • IAEMSC reports agencies are checking with their legal counsel to assess administrative risk for Treat and Release.
    • NAEMT suggests all should use caution with calling Treat and Release Crisis Standard of Care since it is actually a best practice now.
    • Some indicated that some dispatch centers may be setting in place protocol that stops an EMS response for non-emergent COVID-19 suspected patients.
    • Discussion around MPDS Card 36; Pandemic response.
    • Agencies are implementing restriction on non-patient riders in ambulances
  • Needs or issues – email NHTSA.EMS@dot.gov :
    • COVID-19 resource page on EMS.gov updated twice per week; Please email suggestions for new resources.

Resources:

  • Visit https://www.ems.gov/projects/coronavirus_covid-19_resources.html
  • HHS/OCR guidance to EMS on HIPAA https://www.hhs.gov/sites/default/files/covid-19-hipaa-and-first-responders-508.pdf
  • COVID-19 cost recovery for Fire and EMS departments
    • https://www.usfa.fema.gov/current_events/031820.html
  • Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States, (CDC 2007)
    • https://www.cdc.gov/flu/pandemic-resources/pdf/community_mitigation- sm.pdf

Open discussion:

  • First EMS practitioner, Israel Torentino of New Jersey, died today of the coronavirus. He was an EMT for both St. Claire’s Hospital and the Passaic Fire Department. Source of disease contraction unsubstantiated, but Fire Chief claimed it was LODD.
  • NEMSMA reported members have indicated the following issues of concern regarding the pandemic:
    • Shortage & depletion of PPE supplies (especially N95 respirators)
      • Decontamination of disposable PPE?
    • Lack of testing accessibility for personnel
    • Confusion/Conflict of return to work clearance protocol
      • If patient tests negative
      • If provider tests negative (a second test after 24 hours?)
    • Shortage of EMS practitioners
      • Due to quarantine
      • Due to lack of childcare
    • Concern over shortage of drugs (NNS, D5W, sedatives and paralytics [ventilator patients])
    • Concern over shortage of ventilators (transport ambulances)
    • Concern over decontamination of ambulances
    • Concern over future reduction in new graduates to hire, due to impact on training programs.

Results from NEMSMA’s third survey has been released.

The issue that research should be thought about now regarding EMS’ response to this pandemic, was brought up.


Friday April 3rd, 2020

Participants: Vince Robbins, NEMSMA; Rob Brown, IAFC; IAEMSC

Welcome and Introductions

Update on current activities (subject to change):

  • CDC Cases in US
  • FEMA Healthcare Systems Resilience
    • EMS Task Force update
  • Licensure discussion – Interstate Licensure Compact and NASEMSO
  • NEMSIS update
    • Two separate efforts on going; 1) Flu like symptoms and 2) working with a
      vendor regarding PPE status.
  • Crisis Standards of Care discussion
    • Webinar was held. Concern over ventilator patients being transported to facilities that don’t have ventilators.
  • Needs or issues – email NHTSA.EMS@dot.gov
    • COVID-19 resource page on EMS.gov updated twice per week; Please email suggestions for new resources.
    • EMS agencies looking for regular broadcasts or info sheets issued by EMS.gov to keep industry updated with facts.

Resources:

Open discussion:

NEMSMA reported member concern:

  • Shortage & depletion of PPE supplies (especially N95 respirators)
    • Decontamination of disposable PPE?
  • Lack of testing accessibility for personnel
  • Confusion/Conflict of return to work clearance protocol
    • If patient tests negative
    • If provider tests negative (a second test after 24 hours?)
  • Shortage of EMS practitioners
    • Due to quarantine
    • Due to lack of childcare
  • Concern over shortage of drugs (NNS, D5W, sedatives and paralytics [ventilator patients])
  • Concern over shortage of ventilators (transport ambulances)
  • Concern over decontamination of ambulances
  • Concern over future reduction in new graduates to hire, due to impact on training programs
  • Need for “single source of truth”, EMS.gov

Tuesday, April 7th, 2020

About 30 participants

Welcome and Introductions

Update on current activities (subject to change):

  • CDC Cases in US https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
  • FEMA Healthcare Systems Resilience
    • EMS Task Force:Formed to attempt to address the needs of the healthcare system for COVID-19. Multiple subgroups within the task force focused on specific areas of the healthcare system.
  • Licensure discussion
    •  Interstate Licensure Compact (REPLICA) and NASEMSO: Compact when line in March. There appears to be developing a need to shift personnel from hot-spot to hot-spot. No automated credentialing system operating yet, so states will be using a paper documentation process. Tracking is not functioning yet, but it appears many personnel are crossing state lines daily to help other areas in need.
    • States that are not currently in REPLICA appear to be eyeing what’s happening have now expressed interest in joining.
    • NREMTs: Have been working on ways to get candidates to finish and test for credentialing. Each state has handle licensure differently during this pandemic. NREMT has extended its certification until the end of June. It is difficult to determine state by state which testing centers are open and which are closed or curtailed. Looking at remote testing and proctoring. NREMT has authorized provisional certification (passed the cognitive exam but not the psychomotor test).
    • NASEMSO: Continue to upload documents for emergency licensure processes and procedures, organized by state. NASEMSO is part of the FEMA Healthcare Systems Resilience EMS Task Force and found there are states using EMS professionals as COVID-19 specimen collectors. NASEMSO is attempting to collect all waivers and procedure changes instituted by each state.
    • Some state Medicaid Offices are implementing changes to permit reimbursement of EMS when transport does not take place.
    • CMS is moving more slowly on Treat in Place and other no-transport patient care for EMS, but at this time believe they have exhausted all their legal waiver remedies and can’t do much more.
    • What about reimbursement for EMS services provided by out of state practitioners and agencies that are not licensed in the activity state?
  • NEMSIS update
    • Is working actively with about half the states to increase LIL and PPE surveillance and coalesce the information. A dashboard will be published so with that information.
  • Crisis Standards of Care discussion
    • NYC and NY state have adopted CSC for cardiac arrest cases.
    • LA also has issued CSC protocols for Cardiac Arrest.
    • Is the expanding scope of practice being adopted throughout the U.S. is a CSC?
    • Participants were asked to share any and all CSC policies being implemented around the country.
    • Airway management discussion.
  • Needs or issues – email NHTSA.EMS@dot.gov
    • COVID-19 resource page on EMS.gov updated twice per week; Please
      email suggestions for new resources.

Resources:

  • Visit https://www.ems.gov/projects/coronavirus_covid-19_resources.html

Open discussion:

  •  Participants expressed the need to make sure legislation working through the congress for EMS reimbursement covers all service providers.
  • Some resources posted on the CDC web site are arduous to read through and interpret for EMS centric agencies.
  • Could the GSA develop an EMS portal for agencies to search for supplies that are needed.
  • NVFC reports that some jurisdictions have issued guidelines that non-EMS public safety agencies not permit their staff to work/volunteer for EMS organizations, for fear of them contracting COVID-19. This is contributing to EMS personnel shortages, especially for rural areas

Friday, April 10th, 2020

Update on current activities (subject to change):

  •  CDC Cases in US https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
  • FEMA Healthcare Systems Resilience
    • EMS Task Force update
      • No updates or comments.
  • Discussion of financial challenges
    • Participants confirmed that several agencies, particularly private providers,
      are either laying staff off (on their non-emergency transport operations) or
      announcing they will be closing the company.
    • Costs pertaining to personnel have increased substantially, mainly
      associated with quarantined staff.
    • PPE costs have increased significantly, as much as 10 times. Normal
      supply chain has been disrupted and agencies are searching anywhere
      they can find supplies.
    • Discussion about long term costs that will become permanent for
      operations, such as vehicle decontamination and local PPE supply reserves.
  • Data collection
    • IAFC and others have dashboards on their web sites and are collecting
      data actively.
  • NEMSIS update
    • No update report
  • Needs or issues – email NHTSA.EMS@dot.gov
    • COVID-19 resource page on EMS.gov updated twice per week; Please
      email suggestions for new resources.
    • One item through the clearance process; mental/behavioral health
      document adopted for EMS.

Resources:
Open discussion:


Tuesday, April 14th, 2020

EMS Stakeholder Call re: COVID-19

Welcome and Introductions (Dr. Krohmer)

Elaine Chao, Secretary of the Department of Transportation, gave introductory remarks. She thanked the EMS industry for their efforts everyday regarding the COVID-19 pandemic. She extended her appreciation to Dr. Jon Krohmer and the office OF NHTSA-OEMS.

James Owens, Acting Director of the NHTSA then gave additional introductory remarks. He also thanked the EMS industry and the Office of EMS and Dr. Krohmer.

Dr. Krohmer then made the following comments:

  • The EMS Task Force has established a series of webinars & conference calls on COVID-19 and patient care, weekly in coordination with e ECHO project. They include a focus on specialty areas ICU, ED & EMS.
  • He commented on the modeling programs and what they are predicting. Several models are being used and reported out to the state emergency operating centers.
  • Access to testing modalities are much better and continuing to ramp up.
  • PPE inventory has improved but there remains much more needed.
    Currently being prioritized. It is expected that the supply chain will be at a
    nominal level soon.
  • Would like to discuss the physical & mental health wellness of
    practitioners. Participants reported this is beginning to surface as an issue as the pandemic continues to grow and colleague are concerned. It was reported that efforts to distract staff from the pandemic between assignments was helpful. Therapy dogs visiting stations was reported as helpful. Limiting access to the news was also reported as helpful to staff’s mental health.

Roll Call

Vince Robbins, NEMSMA

Representatives from NAEMT, NREMT, IAFC, IAFF, IAEMSC, NFPA, NANA, NASEMSO, AAA, Falk, GMR, NAEMSP, ACS, NVFC, APCO, ACEP, several federal agencies

Update on current activities (subject to change):

  • CDC Cases in US https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
  • FEMA Healthcare Systems Resilience
    • EMS Task Force
      • Capt. Redd, chair of the Task Force, commented they were aware of the PPE shortage and have focused on ways to extend the life use of existing equipment and supplies.
      • He also indicated they are attempting to incentivize the use of telemedicine to-treat-at-a-distance (TAAD) potential COVID-19 patients.
  • NEMSIS update
    • No update was given
  • Crisis Standards of Care discussion
    • No update was given
  • Needs or issues – email NHTSA.EMS@dot.gov
    • COVID-19 resource page on EMS.gov updated twice per week; Please
      email suggestions for new resources.

Resources:

  • Visit https://www.ems.gov/projects/coronavirus_covid-19_resources.html

Open discussion:


Tuesday, April 21, 2020

Roll Call

NEMSMA, IAEMSC, NAEMT, NREMT, NASEMSO, AAA, IAFC, IAFF, Falck, GMR, NVFC, NASNA, COMPACT, AIMHI, Eagles, APCO, NFPA, USFA, EMSC, NHTSA, CDC-NIOSH, CMS, Jon Krohmer

Welcome and Introductions

Update on current activities (subject to change):

  • CDC Cases in UShttps://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
  • FEMA Healthcare Resilience Task Force
    • EMS Team
      • Continues to continue documents based on input from stakeholder calls to help providers with responding to the pandemic.
      • The approval process for these documents is evolving and getting faster.
      • Documents are being placed on numerous government web sites for widest distribution.
      • EMS.GOV is being updated three times a week.
      • NHTSA/OEMS meeting regularly with the EMS Educators discussing pandemic on training and certification process and numbers. Paper reviewing this impact will be published shortly.
      • CSC document is progressing well and near FEMA clearance.
  • Medication Shortages
    • Sedative used with ventilators, versed, and other analgesics
  • PPE Shortages
    • Battell decon system for N95 being distributed. Hydrogen peroxide based decon chambers. https://www.battelle.org
  • Reimbursement
    • EMS services financially straining under reduced volume and no reimbursement for not transporting to the hospital.
  • Discussion: Fraudulent PPE
  • NEMSIS update
    • No report
  • Crisis Standards of Care discussion
  • Needs or issues – email NHTSA.EMS@dot.gov
    • COVID-19 resource page on EMS.gov updated twice per week; Please email suggestions for new resources.

Resources:

Open discussion:    


Thursday, April 23, 2020

EMS Education System Impacts due to COVID-19

Collaborate to explore opportunities and use a systems approach to remove barriers for EMS clinician throughput - go to school, pass the test, get a license, maintain the license – to keep the pipeline flowing and support system surge capacity.

Roll Call
NEMSMA, NAEMSE, NREMT, CoAEMSP, NASEMSO, AAA, IAFC, CAPCE, NHTSA, Other federal agencies, COMPACT, NAEMT, ACS, NCDMPH

Pandemic Updates

 CDC Cases in US https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
IAFC COVID-19 Fire and EMS Impact dashboard


White Paper Update

 In progress. Following final draft, it will be run through the approval process. Consideration needs to be given to EMS students as essential students that need to be given priority during the reopening process because clinical skills labs and psychomotor skills testing are necessarily in-person, face-to-face.

Education

Several surveys have been issued by various groups and they are awaiting the final results. Some early returns are that most programs have gone on-line with didactic education and a minority have closed altogether temporarily. Some (minority) programs report continuing with in-field internships and in-person clinical education. Unaware of any program that is preparing to completely reopen.

Need designation that EMS education programs are essential and permit them to operate.

Testing and Certification

NREMT: Progressing with open testing centers (Pearson). May 1st is expected to be a key date for re-opening testing. Working with multiple states to open testing. Remote proctoring has been designed and will be rolled out, expected to be mid-May.

Recertification

Many states have delayed recertification requirements and deadlines. NREMT established June 30th deadline as its 2020 extension deadline.

Licensure

NREMT instituted provisional certifications. NASEMSO: No new issues to report. COMPACT: No new issues to report.

Service Impact

Anticipated reduction in workforce in the pipeline is unchanged.

Resources:

  • https://www.ems.gov/projects/coronavirus_covid-19_resources.html
  • https://www.911.gov/project_coronavirus_covid-19_resources.html
  • https://nasemso.org/resources/covid-19/

Open discussion:


Tuesday, April 28, 2020

EMS Stakeholder Call re: COVID-19

Roll Call

NEMSMA. IAEMSC, NAEMSO, NAEMT, AIMHI, IAED, AAA, NASEMSO, REPLICA, EMSC, Power Phone, NHTSA, NFPA, ACEP, NAEMSP, US Navy, FEMA, IAFC, USFA, NREMT, IAFF, NVFC, Falck, AAMS, NASNA, ENA, APCO, ASPR

Welcome and Introductions

Update on current activities (subject to change):

  • CDC Cases in US https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
  • FEMA Health Care Resiliency Task Force PPE Preservation Working Group
    • John F. Koerner, MPH, CIH (ASPR):
      Presented summary of best practices that have been developed by multiple federal agencies regarding conservative use of PPE during a pandemic. Mantra: Reduce, Reuse, Repurpose PPE, applied through Conventional, Contingency and Crisis levels. Link to the presentation and handouts on this topic: https://www.fema.gov/media-library-data/1587131519031-6501ee8a0ce72004832fa37141c53bc0/PPE_FACTSHEET.pdf
    • Jose Lito Igna, Chief Information Officer:
      Also reviewed Battelle’s, Stryker’s, STERIS (and other) critical care decontamination systems, their distribution around the country and how to access them. Battelle’s program is described here: www.battelle.org/n95
  • FEMA Healthcare Resilience Task Force
    • EMS Team: Six new documents have completed clearance and will
      be posted on EMS.GOV. A behavioral health document is being developed, one on disinfecting fire gear, and others. Putting together other products stakeholders have requested.
  • CMS Update
    • Discussions are ongoing relative to reimbursement issues.
  • NEMSIS update
    • Eric Chaney commented that the data set is updated every 24 hours. Access can be made available to the COVID-19 Dashboard. Image Trend and ESO working on data with Palateer. Incredible reduction in volume has been noted; 30%-40% along with a dramatic increase in cardiac arrests. Looking for ways to assess burden. Additional elements were added to the NEMSIS data base specific to COVID-19.
  • Needs or issues – email NHTSA.EMS@dot.gov
    • COVID-19 resource page on EMS.gov and 911.gov updated twice
      per week; Please email suggestions for new resources.

Resources:

Open discussion:

  • Bruce Evans; Could extractors for cleaning fire gear be used for decontamination of certain PPE? FEMA indicted that they have a technical committee looking at this. But Tyvek suits should not be decontaminated and reused because the process degrades the material too much. USFA has a fact sheet (on their web site) exactly on this topic.
  • Mike McEvoy; In his area they issued a PSA “Don’t die of a heart attack because you’re afraid of catching COVID-19”. EMS activity picked up immediately. This is the link to it: https://youtu.be/MRDhU0hYM_s
  • Vince Robbins; Raised the issue of the increasing incidents of practitioner suicide and requested expedited release of resources on this topic.

EMS Stakeholder Call re: COVID-19
Tuesday, May 5, 2020

Roll Call

NEMSMA, IAEMSC, NAEMT, NASEMSO, AAA, IAFC, IAFF, NVFC, Falck, AAMS, NREMT, NASNA, Power Phone, REPLICA, AIMHI, ACS, NAEMSP, IAED, APCO, NFPA, USAF, EMSC, NIOSH

Welcome and Introductions

Update on current activities (subject to change):

  •  CDC Cases in US https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
  • FEMA Healthcare Resilience Task Force
    • EMS Team: Additional resource documents have attained approval
      and are being distributed. There is a group reviewing current literature and summarizing it. A link will be distributed to this group.
  • NEMSIS update
    • Clay Mann: Reviewed the NEMSIS COVID-19 dashboard now
      available. Excellent digestion of data. Presentation slides will be distributed.
  • National Occupational Research Agenda (NORA) Public Safety Sector – Suzanne Moore (NIOSH)
    • Bi-weekly sustainability update meetings being held. Most recent looking at mental health and decontamination procedures.
  • Needs or issues – email NHTSA.EMS@dot.gov
    • COVID-19 resource page on EMS.gov and 911.gov updated twice per
      week; Please email suggestions for new resources.

Resources:

  • Visit https://www.ems.gov/projects/coronavirus_covid-19_resources.html
  • https://www.911.gov/project_coronavirus_covid-19_resources.html

Open discussion:

From the Management Group’s Meeting today:

  • More EMS resources documents being issued.
  • Collaborating with federal partners and other groups relative to mental health strain on EMS practitioners



EMS Stakeholder Call re: COVID-19
Tuesday, May 12, 2020

Roll Call:

NEMSMA, IAEMSC, NAEMT, NASEMSO, NREMT, AAA, IAFC, IAFF, NVFC, GMR, AIMHI, ACEP, ACS, NAEMSP, IAED, APCO, NFPA, USFA, USN, NHTSA, EMSC, NIOSH, COMPACT

Welcome and Introductions

Update on current activities (subject to change):

  • CDC Cases in US https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
  • FEMA Healthcare Resilience Task Force
    • EMS TeamAdditional documents and guidelines are coming out. One is regarding decontamination of disposable N95 and other PPE, as well as mental health of practitioners. Financial impact on EMS agencies is under review. Education pipeline is also under review.
    • Appear to be increases in EMS calls for in Narcan administrations, suicides, cardiac arrests and pronouncements at home.
  • NEMSIS update
    • EMS Team
      • Trying to capture financial information such as billable cases.
  • National Occupational Research Agenda (NORA) Public Safety Sector – Tyler Quinn (NIOSH)
  • Needs or issues – email NHTSA.EMS@dot.gov
    • COVID-19 resource page on EMS.gov and 911.gov updated twice per
      week; Please email suggestions for new resources.

Resources:

Open discussion:


EMS Stakeholder Call re: COVID-19
Tuesday, May 19, 2020

Roll Call

NEMSMA (Vince Robbins), IAFF, AAA, NAEMT, IAEMSC, NASEMSO, NREMT, IAFC, NVFC, Falck, GMR, NASNA, Power Phone, REPLICA, AIMHI, NAEMSP, IAED, NFPA, USFA, USN, NHTSA, EMSC

Welcome and Introductions

Update on current activities (subject to change):

  • CDC Cases in US https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
  • FEMA Healthcare Resilience Task Force
    • EMS Team: Additional guidance documents are out and a few
      more to come. All are or will be posted on EMS.gov. Including one on decontamination of disposable PPE. Several meeting regarding rural community EMS impact of the pandemic and special challenges, especially surge issues. Issues discussed related to counterfeit PPE infiltrating the country. PPE supply chain is still disrupted for EMS, but Task Force has been working on this.
    • Fiscal Impact on EMS of the pandemic: Although this is a critical issue, NHTSA and the FEMA Task Force have been advised it is beyond the scope of their purview/authority upon which they may take action.
  • NEMSIS update
    •  Last week’s presentation is in the clearance process. Similar
      document/research related to behavioral issue and mental health problems EMS cases during the pandemic is underway.
  • Needs or issues – email NHTSA.EMS@dot.gov
    • COVID-19 resource page on EMS.gov and 911.gov updated twice per
      week; Please email suggestions for new resources.

Resources:

Open discussion:

IAEMSC: Seeing some increase in volume related to diminishment of “lockdown/Stay- at-Home”. Asked if anyone else was seeing anything similar.


NHTSA OEMS regular call with:
AAA, IAFF, NAEMT, NFPA, NVFC, IPSDI, NEMSMA & IAEMSC
Tuesday, May 19, 2020

EMS Task Force:
Still working on additional documents foe distribution. One regarding the use of decontamination systems for disposable N95 masks and other PPE was released recently. Working on some items for EMS Week. Also looking at behavioral of EMS practitioners.
Task Force is beginning to lose some members as the effort is winding down.

EMS Education Pipeline:
Nothing new at this time.

Crisis Standards of Care:
Nothing new. Operations seem to be getting back toward normal.

PPE:
Nothing new. Still have shortages and supply chain issues throughout the nation and counterfeit PPE is now infiltrating the system.

Fiscal Impact on EMS of the pandemic:
Although this is a critical issue, NHTSA and the FEMA Task Force have been advised it is beyond the scope of their purview/authority upon which they may take action.

Open Discussion:
One participant indicated the Governor of Texas wants to use EMS personnel to conduct COVID-19 testing of civilians.
One participant advised that wild-fire season has now begun, and discussion ensued regarding the impact of the pandemic on the response to large scale, seasonal fires.


EMS Stakeholder Call re: COVID-19
Tuesday, May 26, 2020

Roll Call

NEMSMA (Vince Robbins), NVFC, NHTSA, FEMA EMS Task Force, IAFC, IAFF, AAA, NFPA, NAEMT,

Welcome and Introductions

Update on current activities (subject to change):

  •  CDC Cases in US https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
  • FEMA Healthcare Resilience Task Force
    • EMS Team:
      • Productive day on Friday, briefed the regional directors of FEMA. Three main areas were reviewed in the briefing. Some FEMA regions thought EMS was in “GREEN” status and doing fine. NHTSA showed the actual data to the directors and correctly informed them of the real condition of EMS around the country.
      • It is very important for individual agencies report up the chain on how effected EMS is.
      • Trying to improve EMS’ access to PPE & Testing.
      • Group within the Task Force is working on Rural EMS challenges.
      • Question was asked about the knowledge level of FEMA regional directors. It was answered that many were former EMS practitioners, but some did not and were not that familiar with the industry.
  • EMS Education Issues
    • White Paper issued
    • Recently federal agencies identified EMS education as “critical infrastructure workers”. This helped get training centers opened for testing and education.
    • Collected survey data indicated didactic education has gone “on-line”, but training labs & psychomotor training continues to require face-to-face education.
  • Crisis Standards of Care
    • No update
  • PPE
    •  No Update
  • Fiscal Impact on EMS
    •  Layoffs seem to be affecting non-EMS personnel so far.
    • IAFC said they would try to develop a dashboard regarding this
  • NEMSIS update
    •  No Update
  • Needs or issues – email NHTSA.EMS@dot.gov
    • COVID-19 resource page on EMS.gov and 911.gov updated twice per week; Please email suggestions for new resources.


Resources:

Open discussion:

Catch up Roll Call