RuralFrontier EMS Agenda for the Future http:www'nrharural'orggroupssubEMS'html

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Rural/Frontier EMS Agenda for the Future
http//www.nrharural.org/groups/sub/EMS.html
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Rural/Frontier EMS Agenda

• Emergency Medical Services Systems Act of 1973
• NHTSA EMS Agenda for the Future
• 1996

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Rural/Frontier EMS Agenda

• Origin
• National Organization of State Offices of Rural
  Health
• National Association of State EMS Directors
• National Rural Health Association
• Office of Rural Health Policy (USDHHS)

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Rural/Frontier EMS Agenda

• Goal
• On-line and Print Document
• National Consensus Document
• Local/State/National Makers of Policy and Funding
  Decisions
• Local EMS Service Chiefs
• On-line Literature Compendium
• Maintained by REMSTTAC

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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

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Thanks!
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Volunteers andEMS Community Consensus

• Nine person editorial board
• 14 person steering committee
• 25 volunteer writers, editors, meeting
  facilitators
• 65 from EMS/rural health communities participated
  in consensus conference
• Additional 150 submitted over 2,000 comments

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Rural/Frontier EMS Agenda

• Editorial/Writing Team

EDITORIAL ADVISORY BOARD Mic Gunderson, National
EMS Management AssociationThomas Judge,
LifeFlight of MaineDr. David Kim, Idaho
Emergency PhysiciansCarol Miller, Frontier
Education Center, New MexicoDr. Daniel
Patterson, University of South Carolina Rural
Health Research Ctr. Nels Sanddal, REMSTTAC,
MontanaGary Wingrove, Gold Cross/Mayo Medical
Transport, Minnesota Dr. James Upchurch, Indian
Health Service PRINCIPAL INVESTIGATOR/PRIMARY
AUTHOR Kevin McGinnis, NASEMSD RESEARCHER Dr.
Richard Narad, California State University
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Steering Committee
Dennis Berens, Nebraska Office of Rural Health
(Chair)John Barnas, Michigan Office of Rural
HealthDean Cole, Nebraska Office of EMS Jim
Derrick, New Mexico Office of EMSMarvin Firch,
Iowa Office of Rural Health Caroline Ford,
Nevada Office of Rural HealthDavid Lake, Kansas
Office of EMS Fergus Laughridge, Nevada Office
of EMSDr. Greg Mears, North Carolina Office of
EMS Jim Prince,  Alabama Office of EMSChris
Tilden, Kansas Office of Rural HealthEvan
Mayfield, Federal Office of Rural Health
PolicyEli Briggs, National Rural Health
Association Mary Sheridan, Idaho Office of Rural
Health
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You!
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The Vision

• The rural/frontier emergency medical
• service (EMS) system of the future will
• assure a rapid response with basic and
• advanced levels of care as appropriate
• to each emergency, and will serve as
• a formal community resource for
• prevention, evaluation, care, triage,
• referral and advice. Its foundation will
• be a dynamic mix of volunteer and paid
• professionals at all levels, for and
• determined by its community.

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The Vision

• basic and advanced levels of care as appropriate
  to each emergency
• formal community resource for prevention,
  evaluation, care, triage, referral and advice
• mix of volunteer and paid professionals
• determined by its community.

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Major Themes
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Themes

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

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Themes

• Informed self-determination
• Objective community EMS evaluation
• Public informed
• Evaluation results
• Options/standards
• Costs
• Community determines type/level local
  investment in EMS

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Themes

• Paramedic Paradox
• Integration EMS-based community health services
  (community paramedicine)
• To assure ALS present in community when needed
• Using EMS providers to fill health care services
  gaps
• Assures these providers skills maintained
• Other solutions to service survival and ALS
  provision
• Regionalization/cooperatives
• Effective mix of volunteer/paid staff
• Alternative means of bringing ALS to scene

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Themes

• Money (Federal/State/Regional/Local)
• Recruitment/retention
• Infrastructure
• Training
• Data collection
• Research
• Medical direction
• Adequate reimbursement

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Themes

• Volunteers
• Management/direction of services as modern
  clinical and business operations to assure
  existence
• Management and leadership training for service
  chiefs and medical directors
• Medical directors trained supported adequately

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• Integration of Health Services
• EMS Research
• Legislation and Regulation
• System Finance
• Human Resources
• Medical Oversight
• Education Systems
• Public Education
• Prevention
• Public Access
• Communication Systems
• Clinical Care and Transportation
  Decisions/Resources
• Information Systems
• Evaluation

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Rural Access to Emergency Services Act of 2005
(RAES Act)

• S.1108
• H.R.2525
• Addresses Recommendations

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Recommendations

• Integration of Health Services
• Encourage EMS-based community health service
  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.

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• Research
• Fund and implement the recommendations of the
  NHTSA EMS Research Agenda for the Future but
  address the needs and challenges of
  rural/frontier EMS systems research.
• Enable local research
• Enable multi-center research

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• Legislation and Regulation
• Authorize and fund a restructured Federal
  Interagency Committee on EMS to provide
  national leadership.
• Adequately fund the state EMS lead agency to
  enable it to carry out its designated
  responsibilities.
• Create the opportunity forstate-level public
  policy to delineate the roles, support and
  treatment of EMS volunteers, while fulfilling
  public expectation on level and type of EMS
  provided.

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• System Finance
• Authorize and appropriate sufficient funds for
  CMS to reimburse EMS providersthe cost of
  maintaining full-time response in rural/frontier
  areas
• Implement a series of CMS reforms (including
  rural definition)
• Make federal and state funding programs
  available explicitly and categorically to EMS
  systems and providers including private and
  for-profit agencies.(other legislation)
• Form, and fundrural/frontier EMS operational or
  service-contracting networks.

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• 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

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• Medical Oversight
• Establish statewide networks of EMS medical
  oversight, including medical directors at the
  local, regional, and state levels as appropriate
• Implement at least one full time equivalent
  position of state EMS medical director in every
  state with a job description.
• Adequately compensate EMS medical directors
• Require that EMS medical directors be physicians,
  but
• State-level peer review protection
• Rural/Frontier EMS Medical Directors Course

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• Education Systems
• Address, as part of the implementation process
  for the Emergency Medical Services Education
  Agenda for the Future, the unique needs of
  rural/frontier practice and EMS-based community
  health services.
• Fund at the state and national levels a 14 point
  Rural/Frontier EMS Education and Training
  Initiative.
• National model with local flexibility
• Career mobility
• Education/training access (distance
  learning/mobile labs). Stockpiling of training
  resources.

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• Public Information, Education and Relations
• Develop a national template for community EMS
  system assessment and informed self-determination
  processes(ORHP)
• Fund processes for community EMS system
  assessment and informed self-determination.

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• 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.

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• Public Access
• State EMS offices shouldencourage E-9-1-1 and
  WE-9-1-1 system completion where other approaches
  have failed.
• Integrate Automatic Crash Notificationother ITS
  technology and health event advice lines
  intopublic access and EMS resource deployment.
• Provide formal Emergency Medical Dispatch to
  every caller seeking EMS.
• States should establish formal plans for roadside
  call-box, satellite, and/or cellular networks

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• Communication Systems
• Conduct comprehensive state EMS communications
  needs assessments upon which to base federal,
  state, and local investment in communications
  infrastructure improvement.
• Make EMS eligible for Universal Service Fund
  support.

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• Clinical Care and Transportation
  Decisions/Resources
• Define and require a statewide minimum type and
  level of EMS to be provided to all communities
  including equipment and clinical care standards
• Plan, integrate and regulate, at the state level,
  aeromedical, critical care transport, and other
  statewide or regionwide systems of specialty care
  and transportation
• Create mechanisms for EMS personnel to
  participate in EMS-based community health
  services, non-EMS personnel to participate in EMS
  care, by exploring and integrating new roles and
  scopes of practice for all available providers.

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• Information Systems
• Fund and implement the National EMS Information
  System (NEMSIS)
• Implement EMS information systems at the local,
  regional, state, and national levels
• Reflect the sophistication of each EMS system
  inits EMS information system.
• EMS systems must provide analyzed and descriptive
  information on the service and patient carethey
  provide.
• Encourage multi-system data collection

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• Evaluation
• Federal and state funds should be made available
  to support the development and implementation of
  state EMS evaluation activities.
• Fund the availability of training and toolkits to
  encourage effective local service/system quality
  improvement processes.

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Rural Access to Emergency Services Act of 2005
(RAES Act)

• S.1108
• Kent Conrad (D-ND)
• Pat Roberts (R-KS)
• Tom Harkin (D-IA)
• Ben Nelson (D-NE).
• H.R.2525
• Mark Kennedy (R-MN)
• Earl Pomeroy (D-ND)
• Paul Gillmore (R-OH).

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RAES Act Provisions

• Creates three demonstration projects to allow
  states to innovate ways to integrate EMS systems
  with health care systems
• piloting EMS-based community health services
• creating flexible training models
• assuring the availability and access to quality
  medical direction
• a number of other activities

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RAES Act Provisions

• Expands the work of Medicare's Quality
  Improvement Organizations to include ambulance
  providers
• Creates an ambulance-specific urban/rural
  definition and provides for improved Medicare
  reimbursements needed
• Eliminates isolation test and allows CAHs to
  receive cost-based Medicare reimbursement when
  providing contracting for ambulance service

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RAES Act Provisions

• Assures Medicare beneficiaries emergency
  ambulance coverage by setting the "Prudent
  Layperson" standard as deemed satisfaction of any
  medical necessity requirements
• Adds ambulance services to the definition of
  rural health care provider, which will allow
  them to participate in the telecommunications
  programs supported by the Universal Service Fund

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Take Home Messages

• Use the Agenda as leverage
• Informed self-determination
• EMS-based community health services
• Regional/collective efforts
• New technology
• Use the Agenda to position your service

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Copies

• National Rural Health AssociationPhone (816)
  756-3140
• Printed copies are 15.00 for members of NRHA and
  25.00 for non-members. Bulk purchase discounts
  can be applied. 20 for orders of 10 copies or
  more, 25 for orders of 20 or more. For bulk
  orders call Jeff Sullens at NRHA [phone].
• http//www.nrharural.org/groups/sub/EMS.html

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