Rural/Frontier EMS Agenda

for the Future:

The Future is Now

www.nasemso.org > Committees > Rural EMS > Resources

www.nasemso.org/Projects/RuralEMS/documents/Rural-Frontier-EMS-

Agenda-for-the-Future.pdf

http://www.nasemso.org/

Blueprints for the System of EMS

EMS Agenda for the Future (1996)

The Vision

Emergency medical services (EMS) of the future:

• Community-based health management …

• Fully integrated with the overall health care system…

• Able to identify and modify illness and injury risks..

• Able to provide acute illness and injury care and

follow-up, and …

• Able to contribute to treatment of chronic

conditions and community health monitoring…

3

Rural/Frontier EMS Agenda

• Origin

– National Rural Health Association

– National Organization of State Offices of

Rural Health

– National Association of State EMS Officials

– Office of Rural Health Policy (USDHHS)

http://cpif.communityparamedic.org/www.nasemso.orghttp://cpif.communityparamedic.org/www.nosorh.org

Consensus Process • Iterative writing process

• EMS/rural health organizations and communities alerted/liaisons named

• August, 2003 – October, 2004

• Drafts to editorial board, steering committee, public

• Four public drafts circulated/posted

• National review meeting held

• Fifteen drafts total

Volunteers and

EMS Community Consensus

• Nine person editorial board

• 25 volunteer writers, editors, meeting facilitators

• 65 from EMS/rural health communities participated in

consensus conference

• Additional 150 submitted over 2,000 comments

Editorial/Writing Team

EDITORIAL ADVISORY BOARD Mic Gunderson, National EMS Management Association

Thomas Judge, LifeFlight of Maine

Dr. David Kim, Idaho Emergency Physicians

Carol Miller, Frontier Education Center, New Mexico

Dr. Daniel Patterson, University of South Carolina Rural Health Research Ctr.

Nels Sanddal, REMSTTAC, Montana

Gary Wingrove, Gold Cross/Mayo Medical Transport, Minnesota

Dr. James Upchurch, Indian Health Service

PRINCIPAL INVESTIGATOR and PRIMARY AUTHOR

Kevin McGinnis, MPS, Paramedic, NASEMSO

RESEARCHER

Dr. Richard Narad, California State University

Steering Committee

Dennis Berens, Nebraska Office of Rural Health (Chair) John Barnas, Michigan Office of Rural Health

Dean Cole, Nebraska Office of EMS

Jim Derrick, New Mexico Office of EMS

Marvin Firch, Iowa Office of Rural Health

Caroline Ford, Nevada Office of Rural Health

David Lake, Kansas Office of EMS

Fergus Laughridge, Nevada Office of EMS

Dr. Greg Mears, North Carolina Office of EMS

Jim Prince, Alabama Office of EMS

Chris Tilden, Kansas Office of Rural Health

Evan Mayfield, Federal Office of Rural Health Policy

Eli Briggs, National Rural Health Association

Mary Sheridan, Idaho Office of Rural Health

www.nasemso.org/Projects/RuralEMS/

documents/Rural-Frontier-EMS-

Agenda-for-the-Future.pdf

www.nasemso.org > Committees >

Rural EMS > Resources

October, 2004

http://www.nasemso.org/Projects/RuralEMS/documents/Rural-Frontier-EMS-Agenda-for-the-Future.pdfhttp://www.nasemso.org/Projects/RuralEMS/documents/Rural-Frontier-EMS-Agenda-for-the-Future.pdfhttp://www.nasemso.org/Projects/RuralEMS/documents/Rural-Frontier-EMS-Agenda-for-the-Future.pdfhttp://www.nasemso.org/Projects/RuralEMS/documents/Rural-Frontier-EMS-Agenda-for-the-Future.pdfhttp://www.nasemso.org/Projects/RuralEMS/documents/Rural-Frontier-EMS-Agenda-for-the-Future.pdfhttp://www.nasemso.org/Projects/RuralEMS/documents/Rural-Frontier-EMS-Agenda-for-the-Future.pdfhttp://www.nasemso.org/Projects/RuralEMS/documents/Rural-Frontier-EMS-Agenda-for-the-Future.pdfhttp://www.nasemso.org/Projects/RuralEMS/documents/Rural-Frontier-EMS-Agenda-for-the-Future.pdfhttp://www.nasemso.org/Projects/RuralEMS/documents/Rural-Frontier-EMS-Agenda-for-the-Future.pdfhttp://www.nasemso.org/Projects/RuralEMS/documents/Rural-Frontier-EMS-Agenda-for-the-Future.pdfhttp://www.nasemso.org/Projects/RuralEMS/documents/Rural-Frontier-EMS-Agenda-for-the-Future.pdfhttp://www.nasemso.org/Projects/RuralEMS/documents/Rural-Frontier-EMS-Agenda-for-the-Future.pdfhttp://www.nasemso.org/Projects/RuralEMS/documents/Rural-Frontier-EMS-Agenda-for-the-Future.pdfhttp://www.nasemso.org/Projects/RuralEMS/documents/Rural-Frontier-EMS-Agenda-for-the-Future.pdfhttp://www.nasemso.org/

Blueprints for the Rural System of EMS

10

Rural & Frontier EMS Agenda

• Where we are

• Where we want to be

• How we get there

• Recommendations – 120 +

• A story: Western Mountains Ambulance and Rescue

Integration of Health Services Human Resources Prevention

EMS Research & Evaluation Medical Oversight Public Access/Communications

Legislation/Regulation Education Systems Clinical Care & Transp. Decis. & Resources

System Finance Pub. Info. Educ. & Relations Information Systems

Major Themes

Recommendations

Results

Themes

• “Paramedic Paradox”

• Integration: Community Paramedicine

– To assure ALS present in community when needed

– Using EMS providers to fill health care services gaps

– Assures these providers’ skills maintained

Recommendations

Integration of Health Services

• Encourage community paramedicine program

development through the funding of pilots,

cataloguing of existing successful practices,

exploration of opportunities for expanded EMS

scopes of practice, and on-going

reimbursement for the provision of such

services.

Recommendations

Prevention

• Make prevention one of the EMS-based

community health service roles of adequately

staffed rural/frontier EMS provider agencies.

• Develop and fund community health advocacy

roles and prevention programs for rural/frontier

EMS personnel that are mutually beneficial.

Results • Wow!

• At least 110 CP or MIH programs in US

• 45/49 (92%) of states/territories report activity

• CMS Innovation grants

• Community Health Workers

• Minnesota: (North Memorial) Medicaid ACO

• $1.2 million EMS/CP savings share

• Third party payers

• ACOs/health system contracts on rise

• Performance measures project

• EMS 3.0

• CMS Rules Section 440.130 Change for Medicaid

45 CFR Parts 155 and 156 [CMS–2334–F] RIN 0938–AR04 Medicaid and Children’s Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Final rule. SUMMARY: This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act).

PART 440—SERVICES: GENERAL PROVISIONS ■ 35. Section 440.130 is amended by revising paragraph (c) to read as follows: § 440.130 Diagnostic, screening, preventive, and rehabilitative services. * * * * * (c) Preventive services means services recommended by a physician or other licensed practitioner of the healing arts acting within the scope of authorized practice under State law to— (1) Prevent disease, disability, and other health conditions or their progression; (2) Prolong life; and (3) Promote physical and mental health and efficiency.

Themes

• Volunteers vs. “volunteers” vs. paid staff

• Recruitment and retention

• Management/direction of services as modern clinical and

business operations to assure existence

– Management and leadership training

– Billing, budgeting and financial management

– Reporting requirements

Recommendations

Human Resources

• Extend federal and state rural health manpower recruitment and retention planning leadership, technical assistance and funding specifically and categorically to rural/frontier/tribal EMS and implement through state EMS offices, state offices of rural health or other appropriate entities.

• Analyze, at the state EMS agency level, rural/frontier workforce recruitment and retention efforts and develop statewide plans for improvement.

• A national EMS service leadership and service management training model should be developed

Results

• Recruitment and Retention Efforts

BUT: Leadership Training Support Issues

Themes

• Disconnect between what public expects and what rural/frontier EMS delivers – Maine Survey: 87% expect Advanced Life Support (ALS)

• Informed self-determination – Objective community EMS evaluation

– Public informed • Evaluation results

• Options/standards

• Costs

– Community determines type/level & local investment in EMS

Recommendations

Public Information, Education and Relations

• Develop a national template for community

EMS system assessment and informed self-

determination processes…

• Fund processes for community EMS system

assessment and informed self-determination.

Results

• Accreditation processes proliferate

• Third party service evaluations spread

– Some with informed self-determination

– Community health needs assessment

• Need for standardization of process

• Funding for processes

Recommendations

Public Access & Communication Systems

• Conduct comprehensive state EMS communications needs assessments upon

which to base federal, state, and local investment... in telecommunications

interoperability and Intelligent Transportation Systems (ITS)…

• EMS leaders should continue to communicate with state and federal agencies

to integrate Automatic Crash Notification… and health event advice lines

into…public access and EMS resource deployment.

• States should establish formal plans for ….. satellite, and/or cellular networks…

• Concept of substituting technology for manpower and training

21st Century EMS Communications Systems: “Brick” to the Tricorder & FirstNet!

October 16, 2015 26

Kevin McGinnis, MPS, EMT-P Communications Technology Advisor National Association of State EMS Officials National Association of EMS Physicians National Association of EMTs National Association of EMS Educators National EMS Management Association

Pre-1970 to 2014

EMS Frequencies VHF – 155.xxx MHz

UHF – 463.xxx/468.xxx MHz

– (10 “MED Channels”)

Telephone

700/800 MHz

No broadband to support existing treatment/diagnostic technologies

or information sharing

Larry Goldsmith, NREMT-I; Lemmon, South Dakota:

“In over 20 years of EMS, I do not recall that I have ever spoken directly with a dispatcher through the radio system.”

Beginning in 2006, the public safety community fought hard to convince Congress that it needed a dedicated, reliable and interoperable network to provide advanced data communications capabilities nationwide …fulfilling the last remaining recommendation of the 9/11 Commission.

Middle Class Tax Relief and Job Creation Act February 22, 2012

8/14/2013 © First Responder Network Authority

29

FirstNet will be the first high-speed, broadband and data network dedicated to public safety.

FIRSTNET

8/14/2013 © First Responder Network Authority 30

Implementing the Vision

July 28-30, 2015

“Recommendation: Congress should

support pending legislation which

provides for the expedited and

increased assignment of radio

spectrum for public safety

purposes….”

Middle Class Tax Relief and Job Creation Act of 2012

“The First Responder Network Authority shall hold the

single public safety wireless license and take all actions

necessary to ensure the building, deployment, and

operation of the nationwide public safety broadband

network”

2004 2011

2.22.12 FirstNet becomes law PL 112-96

GOVERNANCE

THE LAW FUNDING

$7B authorized to build the FirstNet network. Funded by spectrum

auctions through 2022.

The FirstNet Board has 15 members, including those with telecommunications and public safety backgrounds. Each Governor appoints 1 Single Point of Contact (SPOC) and governing body to represent the State’s interests to FirstNet.

40 member Public Safety Advisory Committee (PSAC) advises FirstNet on public safety intergovernmental matters.

BAND CLASS (BC) 14 20MHz of bandwidth has been dedicated

to public safety in the prime upper

700MHz frequency range.

BC 12

AT&

T

AT&

TD

ish

AT&

T

Ve

rizon

PS

Bro

adb

and

PS N

arrow

ban

d

Ve

rizon

PS

Bro

adb

and

PS N

arrow

ban

d

6 MHz 12 MHz 12 MHz 6 MHz 12 MHz 11 MHz 10 MHz 6 MHz 11 MHz 10 MHz 6 MHz

BC 13 BC 14BC 13 BC 14

BC 17

BC 29BC 12

BC 17

1 MHz Guard Bands

LMR LMR

DOWNLINK DOWNLINKDOWNLINKDOWNLINK UPLINK UPLINKUPLINK DLUL

31

A RAN

Core Network

FirstNet

RAN

Distributed Core

Network EPC

Evolved Packet

Core network

SDP Service Delivery

Platform

FirstNet “3-in-1” Nationwide Network Concept

N RAN

Core Network

FirstNet

RAN

Satellite

Core Network

Satellite

Core Network

Operator A

Terrestrial Mobile Systems Mobile Satellite Systems Deployable Systems

System On

Wheels

Cell On

Wheels

Operator A Operator N Operator N

… …

FirstNet

1 2

5

4

3

Early Builder/Public Safety LTE Deployments

Project SMLA KLCP Sites Key Learnings On-Air

1. LA-RICS Yes Yes 231 Quality of Service, priority/pre-emption 3Q15

2. NM Yes Yes 9 Hosted core, int’l border spectrum management, Federal partnerships 2Q15

3. NJ Yes Yes 31 Deployable assets, training exercises, NOC notification 2Q15

4. ADCOM Yes In-Progress 18 FirstNet test support, BC 14 device testing NOW

5. TX Yes In-Progress 14 KLCP nearly complete (5 KLCs including core transition, data analytics, and extended modes)

NOW

“FirstNet will provide technical support to these projects and will

share any lessons learned with the broader public safety community to enable the

successful implementation of FirstNet’s nationwide

deployment."

SMLA: Spectrum Manager Lease Agreement KLCP: Key Learning Conditions Plan

February 27, 2015 33

FirstNet Will Change the Practice and System of Rural EMS

The Current State Mission Critical Non-Mission Critical

Land Mobile Radio Public Safety

System/Spectrum

Voice

The Near-Term Vision The Long-Term Vision

FirstNet will provide emergency responders with the first nationwide, high-speed,

wireless broadband network dedicated to public safety

35

Vision for Public Safety (Long-Term)

Mobile Data Terminal –

Commercial LTE Device

Data

Smart Phone –

Commercial LTE Device

Voice Data Data Data Voice

February 19, 2015

≠ 30+30+50+40 Minutes

Trauma, Heart Attack, Stroke…..

THE GOLDEN HOUR Time Dependent Life Threatening Conditions

MERCY

HOSP.

CITY TRAUMA CTR.

LIFE FLIGHT

UNITED AMB.

CITY FIRE/RESCUEMVC

CARDIAC

DIABETIC

EMSREMS

RIDGEWAY HOSP.

JONES MEM. HOSP.

(DIVERT)

RIDGEWAY EMSVERNON FD

VOLUNTEER

AMBULANCE

NEW SHARON FD

1ST RESPONDERS

RIDGEWAY FD

EXTRICATION/HAZ MAT

MVC

2 Patients/45MPH

1001 Hendrix Highway (Nash/Oak Sts.)

Toyota Prius/Object/Head On

++Airbags ++Belts

++Severity

Ridgeway EMS 1

MVC

Other Medical

Alarms

EMS INFORMATION NEEDS

Injury Severity Predictor Allows Early Launch of Resources

8/14/2013 © First Responder Network Authority 39

EMS Drone for Scene “Preview”

October 16, 2015 41

MERCY

HOSP.

CITY TRAUMA CTR.

LIFE FLIGHT

UNITED AMB.

CITY FIRE/RESCUEMVC

CARDIAC

DIABETIC

EMSREMS

DOTREMS

RIDGEWAY HOSP.

JONES MEM. HOSP.

(DIVERT)

RIDGEWAY EMSVERNON FD

VOLUNTEER

AMBULANCE

NEW SHARON FD

1ST RESPONDERS

RIDGEWAY FD

EXTRICATION/HAZ MAT

MVC

Ames St. to Clark St. to Old

Highway (E); 15.2 Mi.s;

#3945 Old Highway

Ridgeway EMS 1

MVC

ROAD CLEARANCE

Lights + /Cars ++ETA: 10 Min’s.

ETA: 12 Min’s.

Team On Alert for Pt:+

ED On Alert for Pt: +

Team On Alert for Pt:+

Parallel Processing

EMS INFORMATION NEEDS

At the Scene…

8/14/2013 © First Responder Network Authority 43

Other Technologies

– 2 Way Video (Virtual

MD/Community Paramedicine)

– Portable Ultra Sound (Video &

Images)

Other Drone Uses

Other Predicted Technologies

– http://www.npstc.org/ems.jsp “Documents”

− EMS Based Routine Patient Monitoring

− Automated Dispatching Based on Monitored Patients

and Vehicles

− Audio/Video/Data Interfaces with “I’ve fallen” Systems

− Access to Searchable Patient Records/Images/Data

− Real-Time Vehicle Extrication Hazards Alerting Based

on AACN Including Video/Images as Necessary

− Syndromic Surveillance and Quick Alerting to Specific

Populations

− Physician Mediated Interface Between EMS Dispatch,

EMS Crews and Nurse Call Centers

http://www.npstc.org/ems.jsp

Rural/Frontier EMS Agenda:

Where to From Here? • Initial Review for National Rural EMS Conference

• Solicitation of Author/Editor Panel & Review Committee

• Development of Review Plan

– Prioritize Original Recommendations (and Pare Down!)

• Seek Association & Federal Partner Support as Needed

• Conduct Review & Release Paper