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| MIEMSS Executive Director’s Update |
Maryland’s EMS Response to Hurricane Katrina. There were multiple Emergency Management Assistance Compact (EMAC) requests from Louisiana that were supported by Maryland. Clay Stamp was the advance Maryland expert sent to size up the situation and integrate the incoming EMS, fire and health professional assets into the New Orleans area. Maryland’s EMS response has been composed of volunteer, career and commercial EMS Operational Programs with Basic and Advanced Life Support ambulances. DHMH managed a request for physicians and nurses through the EMAC and MEMA. They deployed over 65 nurses and physicians along with members of the Maryland Defense Force and the Maryland National Guard Medical Battalion. MIEMSS continues to monitor the situation and will maintain our State’s EMS support in Louisiana as long as necessary. Maryland EMS Board Appointments. Five new EMS Board appointments have been made by Governor Robert L. Ehrlich, Jr. The new EMS Board members have been selected and began their service at the September meeting. The new members are: Career Firefighter/EMS Provider: Scott Graham, NREMT-P, Battalion Chief, Emergency Physician: Jeffery Fillmore, MD Emergency Nurse: Mary Alice Vanhoy, RN, NREMT-P Volunteer Firefighter/EMS Provider: Eugene Worthington, EMT-B, Past President, MSFA Public-at-Large: Sally Showalter, RN The following out-going EMS Board members were presented proclamations from Governor Ehrlich in honor of their dedicated service and many contributions to the citizens of Maryland and the Maryland EMS community: Chief John R. Frazier J. Andrew Sumner, MD Dorothy W. Dyott, RN Richard L. Yinger John M. Murphy EMS Work Force Committee. MIEMSS has established an EMS Work Force Committee in an effort to maximize obtaining and retaining EMS providers within Maryland. The group began its work with a meeting in May, 2004. The committee began the development of a survey that would identify various issues and assist the committee in obtaining their objectives. A meeting was held at MIEMSS in January, 2005 to gain a better understanding of issues directly related to concerns of the minority EMS community. The information gathered from those meetings has been compiled into a report. MIEMSS has completed the draft of the final report for the committee to review and is in the process of collecting feedback. The next meeting will be held at MIEMSS in Room 212 on Wednesday, September 21, 2005 at 1:00 PM. Maryland EMS Plan. MIEMSS is currently in the process of updating the Maryland EMS Plan. This procedure will include input from the general public as well as the fire, EMS, and rescue communities. A copy of the draft Plan is available from the MIEMSS web page. Each region will host an open forum for participation from all interested parties. The following schedule has been organized to gather the information: Region I: October 20, 2005 – 7:30 PM Eastern Garrett County Volunteer Fire and Rescue Department 401 Finzel Road Finzel, Maryland Region II: September 20, 2005 – 7:30 PM Robinwood Medical Center, Silver Section Suite 142 Medical Campus Road Hagerstown, MD 21740 Region III: September 28, 2005 – 2:00 PM Reisterstown Vol. Fire Co. 108 Main Street Reisterstown, MD 21136 Region IV: October 18, 2005 – 1:30 PM Easton Volunteer Fire Department Aurora Park Drive Easton, Maryland 21601 Region V: September 22, 2005 – 2:00 PM Branchville VFD 4905 Branchville Road College Park, MD 20740 National Scope of Practice (SOP) Model Draft. The National Association of State EMS Directors (NASEMSD) and the National Council of State EMS Training Coordinators (NCSEMSTC) have completed a national project to develop the National EMS Scope of Practice Model. The two organizations encourage interested individuals and organizations to visit http://www.emsscopeofpractice.org/ to view the final draft product, the result of over two years of concerted effort. The project, jointly funded by the National Highway Traffic Safety Administration (NHTSA) of the U.S. Department of Transportation and the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services, was developed by a task force of 14 national associations. NREMT Computer Adaptive Testing (CAT) Update. As discussions continue at the ALS committee, SEMSAC and EMS Board, the NREMT is proposing transitioning its pencil-and-paper exams to computer based testing starting in January 2007. The implementation of computer based testing strengthens the NREMT’s commitment to serving the EMS community and providing a valid and reliable exam process. It also provides numerous benefits to candidates, educators, and others in the EMS community as well as the American public, including:
As with all of its endeavors, the National Registry’s primary interest is the safety of the American public. With computer based testing, we will be able to verify, with increased accuracy, that every EMT who passes the NREMT exam possesses the necessary skills and knowledge to competently provide entry-level, pre-hospital emergency medical care. The NREMT has entered into an agreement with Pearson VUE to provide computer based test delivery of the NREMT exam. Pearson VUE is a provider of innovative electronic testing solutions that enhance the performance, reliability and security of high-stakes testing programs throughout the world. As currently proposed, Maryland ALS providers will have access to 8 testing centers both in Maryland and in cities surrounding the State. Additionally, MIEMSS has requested additional sites in the metro Baltimore and Western Maryland to accommodate the higher volume of students concentrated there. The exam and registration fee will increase for a CRT from $45 to $100, and an EMT-P from $50 to $110. The increase exam fees are due to the higher cost associated with conducting computer based testing. Removal of EMT-A Reference. Certification of new EMT-As ended in July 1996, and the EMT-A was phased out over the next several years. References to the “EMT-A” have been eliminated from the Title 30 regulations, and the reference “EMT-A” is expected to be removed from Education Article 13-516 in 2006. AED Regulations. The EMS Board is in the process of revising the AED regulations to conform with the changes to the AED statute found in House Bill 1054 passed in the most recent legislative session. Title 30 Regulations. The EMS Board has proposed some amendments to COMAR Title 30 to correct statutory references and to make some substantive amendments which are needed in certain areas. The proposed amendments have been reviewed by SEMSAC, JAC, and MSFA and appear in the Maryland Register on August 19th for comment. Seal of Excellence – Voluntary Ambulance Inspection Program (VAIP). A statewide committee chaired by Roger Simonds, has been meeting to update the Voluntary Ambulance Inspection Program (VAIP) - Seal of Excellence. The committee's membership includes: urban and rural jurisdictions; ALS and BLS providers; and representatives of the MSFA. Utilizing feedback from the past two years of inspections, changes in the Maryland Medical Protocols, and a desire to streamline and simplify the inspection process, the committee has completed its final draft. This draft was presented to and approved by the State and Regional Medical Directors in July. The MSFA EMS and Executive Committees have also approved the draft document. A major change will be a reduction in the drug inventory to provide maximum ALS care for one patient, as opposed to the previously required inventory for two patients. Bystander Care Grant. The MIEMSS Region I Office has been awarded a grant from the Maryland Highway Safety Office through the Frostburg State University Safe Communities Office regarding the implementation of the Bystander Care Program. The grant will pilot the Bystander Care Program in five Maryland rural counties; Carroll, Washington, Frederick, Garrett, and Alleghany. This effort will train persons that frequently travel the highways in scene safety and initial basic first aid procedures. Doug Beitzel, EMTP has been hired as the Bystander Care Coordinator and is updating the course curriculum with the help of Dr. Richard Alcorta and the Maryland Highway Safety Office. The program has been taught as a pilot course to a focus group. The curriculum has been revised with the group’s feedback. The rollout will begin in Garrett and Allegany Counties early this fall. FRED The Prince Georges Health Department was awarded the $6.9 million UASI Grant which will help to incorporate Patient Tracking and the CHATS into FRED. The RFP for the work is expected in the fall. This will also integrate similar programs in Virginia and the District of Columbia. Delaware is now actively using FRED. Pennsylvania continues to use the system. A new comprehensive update is now being planned and steps are being taken to directly link FRED data with EMMA and Web EOC. Field Operations. MIEMSS continues to work with partners and stakeholders in the evaluation of the WMD Plan and the development of a current Health and Medical Preparedness Plan. Additionally, MIEMSS has been engaged in the development of a Health and Medical Surge Capacity Plan for the National Capital Region, as well as for the State. The GEMAC Health and Medical Committee has been very active recently. The EMS Disaster focus group has been re-energized and has identified 10 goals to achieve over the next several months. This includes drafting an EMS Mutual Aid Plan. A Planning Technical Advisory Group (TAG) has been established and will be working with the Governor's Office of Homeland Security on implementation of HSPD 8 in Maryland. The Hospital Focus group has requested that a PPE/Decontamination TAG be established to address standard procedures on when and how patients should be decontaminated. The Surge TAG has begun its investigation into how the health care system can be expanded in order to accommodate extreme stress on that system. The advanced placements of federally owned nerve agent antidote caches are now deployed across the State. MIEMSS and DHMH have coordinated with certain hospitals and other agencies to completed placement. Specific information concerning CHEMPACK can be obtained by contacting Mr. Clay Stamp. If these cashes are required for an incident, contact EMRC/SYSCOM to access them. MIEMSS continues to support the disbursement of federal funding for EMS preparedness through the HRSA Bio-Terrorism Cooperative Agreement Funding for EMS. MIEMSS is presently working with DHMH for FY2004 funding. From FY 2004, $480,000 will be available for EMS preparedness which will be directed to local EMS agencies. MIEMSS, in partnership with DHMH, has initiated a Preparedness Networking Process between public health, EMS, and hospitals to enhance communication, share ideas, and identify planning opportunities. This process includes a series of regional terrorism forums, adding public health representation to regional EMS councils and monthly coordination calls. Emergency Medical Services for Children Program (EMSC). For the 2005-2006 "Right Care When It Counts" Program, Maryland EMSC will be accepting nominations throughout the year and sending certificates and patches to all children and youth nominated. All nominations are due by April 3, 2006 at which time a committee will select those nominees to represent the program during EMS Week. The bilingual Public Service Announcements and posters remain available on the MIEMSS webpage. ( www.miemss.org/EMSCwww/PrevProg.html ). Through the EMSC Partnership Grant, four Injury Prevention projects were awarded this July to programs that promote prevention and preparedness in the community. The Maryland RISK WATCH Champion Team leadership met in June
and the special education workgroup met in July to plan for 2005-2006
school year. The joint display with the Fire Prevention Committee at the
MSFA Convention in June was well received by both children and parents.
Many communities plan to return home and develop partnerships with not
only schools but also day care and after school recreation programs. The
team has made a commitment to continue with the implementation of RISK
WATCH for a third year. MIEMSS and the State Fire Marshal
Office will continue to lead the Team and will be expanding
the state effort to include an advisory committee made up of advocates and
teachers with a focus on the Natural Disaster modules. Family
Preparedness materials are being developed for both RISK WATCH
and Red Cross Masters of Disasters curricula. RISK WATCH schools
continue to receive support from the Maryland State Fireman's
Association Fire Prevention Committee, Maryland SAFE KIDS Coalitions
and the Maryland Chapter of
the American Trauma Society. Cecil County is the newest
member of the state team. The MIEMSS EMSC Program Child Passenger Safety (CPS) Hospital Assessment grant has resurveyed the hospitals to determine changes in practice and educational needs. The revised Prescription for Your Child's Safety pad is available on the website and available for use in primary and emergent care facilities. The CPS webpage includes: Posters on Occupant Protection that address all ages and are available in English & Spanish (double sided), training CD-ROMs for health care providers, Best Practices for Health Care Facilities workbook, and Proper Occupant Protection DVD and video ( http://www.miemss.org/EMSCwww/CPSHome.htm). The EMSC Program has completed a CD ROM resource on Child Victimization recognition and made it available to all the approved training centers. The Maryland Enhanced PEPP training resources with the release of the 2nd Edition of the American Academy of Pediatric program will be completed this fall after the instructor materials are published and the staff participated in the national roll outs with the AAP. Car seat extrication and securing car seats in ambulances will be included in the 2nd Edition PEPP. The PEMAC Education Subcommittee is working with the BLS Subcommittee of SEMSAC on an instructor resources CD over the next year. A feedback survey on the Trach Care CDROM will be posted on the website for both instructors and participants to complete. Yellow Alert For the first in several years, 2004 showed a downward trend of yellow alert utilization in both Regions III and V. This may be the result of hospital policies that no longer allow declaration of yellow alert as a means of alleviating crowded, busy emergency departments. MIEMSS is now monitoring EMS return to service times however, which increased in 2004 showing that hospital inpatient throughput efficiency must remain the focus even as yellow alert utilization trends may continue to decrease. These increased return to service times for EMS providers are a serious concern to the state EMS system and the communities we serve. MIEMSS is continuing to work with hospitals on recognizing the problem of extended emergency department wait times for EMS providers. Solutions exist within the hospitals but MIEMSS and workgroups within the regions are working to enforce existing policies as a means to managing alerts. Policies are being reviewed for needed revisions and will be submitted to the Regional Councils, State EMS Advisory Council and EMS Board for approval. Data will continue to be collected an analyzed in order to monitor the status of alerts in Maryland. MIEMSS will continue to share the data with EMS jurisdictions and hospitals on an ongoing basis. Geriatric Emergency Medical Services Advisory Committee (GEMSAC) The last meeting was held on September 7, 2005 at MIEMSS. The group discussed the nursing home EMS triage initiative, as well as GEMSAC information to be included on the MIEMSS web page. The group also reviewed a video on Elder Abuse, which was produced by the MIEMSS Media Services. The next meeting is scheduled for December 7, 2005 at MIEMSS. Rural Access to Emergency Devices Grant Program. MIEMSS has been awarded $ 139,269 for the fourth and final year of the current Rural AED (RAED) Grant Program. The FY ‘05 project period begins September 1, 2005. All eligible jurisdictions will again be allowed to participate. The funds may be used for the purchase and placement of AEDs with public safety and appropriate public access locations and a portion of the funds may be used for training. Maryland's eligible rural jurisdictions will have received a total of $703,534. AED Program. Currently, there are 506 approved layperson AED facilities in Maryland with a total of 1050 sites. A list of approved facilities is available on the MIEMSS website. As of November 2004, there were 66 reported cardiac arrests in the layperson AED program with a 24.2 % return of spontaneous circulation at EMS arrival. HB 1054 included amendments to the current AED statute. Changes involve removal of individual use restrictions; broadening options for medical direction to include an individual sponsoring physician or a Regional Council AED Committee; and removing the minimum age limit for an individual using an AED. HB 1054 passed during the session and became effective July 1, 2005. Montgomery County passed a law effective January 1, 2005 requiring all commercial fitness and health clubs to have AEDs by July 1, 2005. Facilities are required to register with MIEMSS. MIEMSS anticipates approximately 100 fitness centers to register, however few have done so to date. Primary Stroke Center Designation. JCAHO has certified 3 hospitals in Maryland as Primary Stroke Centers however, the hospitals have not been designated by MIEMSS. Designation regulations must be finalized in order to allow bypass of the nearest facility and transport to a stroke center by EMS providers. MIEMSS has developed a draft set of regulations and will meet with representatives from each EMS region to review the draft. Representatives form each hospital in Maryland will be invited to a meeting in late August to and given an opportunity to express any concerns with the proposed regulations. MIEMSS is anticipating finalization of the designation regulations this fall with the program being fully implemented in the spring of 2006. EMAIS. EMAIS is now “live” in 15 jurisdictions - Allegany, Annapolis City, APG, Calvert, Cecil, Charles, Dorchester, Frederick, Garrett, Harford, Kent, Queen Anne's, Somerset, Talbot, and Washington counties. MSP implementation was delayed until revisions in the software can be made that meet the specific needs of aviation. Caroline County will begin training this month and St. Mary’s County will begin EMAIS training in October, with a scheduled implementation date of November 1, 2005. MIEMSS continues to move forward with additional reports for the EMAIS Online Report System. MIEMSS is working with jurisdictions on designing the next set of reports due out this August. Protocols. The 2005 Protocol update has been completed and the new protocols became effective on July 1, 2005. . This year’s version is a complete reprint and includes a spreadsheet with an itemized list of revisions/additions. The new pocket protocols have been printed and are available at MIEMSS. Individuals or EMS organizations who wish to purchase pocket protocols for their companies may do so at the MIEMSS Office of Licensure and Certification for $1 per copy. If you need additional protocols (regular or pocket) please contact that office at (410) 706-3666 to make arrangements for delivery or pick-up. Pilot Protocol Patient Initiated Refusal of Care. A draft of the Patient Initiated Refusal of Care pilot program has been developed by the Region III Medical Quality Improvement Committee (MQIC). In an effort to address the leading cause of EMS provider litigation and improve patient care, the MQIC conducted a MAIS review, a survey of EMS providers, and also conducted a literature search. This process revealed that within Region III, the percent of refusal/ no transport was nearly 17%. The literature revealed that most programs have around a 12 % refusal rate; yet in one study, where paramedic level assessment and medical consultation was required for all refusals the refusal rate was only 3%. The MSFA EMS Subcommittee was given a draft of the pilot program for comment. Currently there are two counties, Anne Arundel and Howard Counties that would like to pilot this program. The MQIC is in the process of developing an educational program for the refusal protocol in an attempt to streamline the process of accessing potential patients for essential high acuity risk item signs and symptoms. Once the refusal package is complete, it will be sent to the EMS Board for approval as a Pilot Program. Patient Plan of Care Form. A law passed in 2004 authorizing the use of a new “Patient’s Plan of Care” (PPOC) form in health care facilities. The Attorney General’s Office is responsible for issuing the form and has adopted regulations to govern its use. The regulations are effective October 1, 2005. The PPOC form is a standardized way of summarizing and communicating a patient’s key preferences regarding end of life care. The use of the PPOC form is not mandatory but the forms will be available to nursing home and other patients. EMS providers may encounter these forms. However, it is important to note that the PPOC form is not a physician’s order. It cannot serve as an EMS/DNR Order. There is no change in the requirements, protocols, or documentation regarding emergency medical services. A copy of the form is attached. EMS Provider Influenza Vaccine Survey. MIEMSS is currently surveying the State’s jurisdictions regarding plans for influenza vaccines for the upcoming flu season. EMS and the local Health Departments are working together to ensure a smooth process. MIEMSS encourages all EMS providers to receive the vaccine. Nursing Home EMS Triage Guidelines. These guidelines recognize the frequency of hospitalizations from long term care facilities and provide guidance to long term care clinicians on making transportation decisions. They have been developed with expert guidance from EMS physicians, providers, long term care physicians, and the nursing home industry. These are intended to serve as a decision support tool to be jointly implemented with an educational program on structure and function of Maryland’s EMS system as it applies to interfacility transport. A draft document is currently being reviewed by stakeholders from the involved disciplines. Dialogue is ongoing with DHMH and the Office of Health Care Quality to facilitate effective implementation. EMS Continuing Education Programs There are several continuing education programs available in the upcoming months: Peninsula Regional Medical Center Trauma Conference (September 23, 2005) Clarion Hotel, Ocean City, Maryland. Contact Lisa Hohl, RN - 410-543-7328 Mid-Atlantic Life Safety Conference (September 27, 2005) Office of the State Fire Marshal - Johns Hopkins Applied Physics Lab. 1-800-525-3125 PYRAMID 2005 (October 14 - October 16, 2005) Holiday Inn Select - Solomon's Island, Maryland. Contact the Region V Office – 1-877-498-5551 Special Topics in Trauma Care (November 15, 2005) R Adams Cowley Shock Trauma Center – Baltimore, Maryland. Contact – 410-328-6257 Winterfest ’06 (January 27 – 29, 2006) Tilghman Island, Maryland. Contact Talbot County EMS - 410-820-8311 EMS Today (March 21- 25, 2006) Baltimore Convention Center – Baltimore, Maryland. Contact JEMS at http://www.emstodayconference.com/ or 1-800-266-5367 Public Education and Life Safety Conference (March 25, 2006) MFRI , College Park, MD EMS Care ’06 (April 29- 30, 2006 with pre-conference April 27 - 28) Maritime Institute for Technology and Graduate Studies (MITAGS) Linthicum, Maryland. Contact MIEMSS Region III Office – 410-706-3996 Please check with your MIEMSS regional office, the Maryland EMS News, or the MIEMSS web page about additional registration information. |