News & Updates

KFF Source | Guardian Source | Comments Courtesy of Matt Zavadsky

This is an excellent, interactive database of healthcare workers who have succumbed to COVID-19, including Medical First Responders. 

13 of the 167 profiled workers are EMS providers.

You’ll see 2 different counts.  According to the Q & A in the database explaining the difference, “This is an ongoing project. The larger figure refers to the number of reported cases our journalists have identified.  The second, smaller figure, refers to the number of deaths we have confirmed and reported on by interviewing family members, employers and medical examiners. Those are the figures we have added to our database. We are adding new stories weekly.”

If you know a healthcare worker who has died from Covid-19, share their story with KHN/Guardian by filling out this form.

New Interactive Database by KFF's Kaiser Health News and Guardian US Reveals More Than 900 Health Care Workers Have Died in the Fight Against COVID-19 in the U.S.

Many Were Unable to Access Adequate Personal Protective Equipment, and People of Color Account for a Disproportionate Share of Deaths Among Those Profiled So Far

August 11, 2020

A new interactive database from KFF’s Kaiser Health News (KHN) and Guardian US reveals that many of the more than 900 U.S. health care workers who have died in the fight against COVID-19 worked in facilities with shortages of protective equipment such as gowns, masks, gloves and face shields. People of color and nurses account for a disproportionate share of deaths among those profiled so far.

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Prehospital Emergency Care Source | Comments Courtesy of Matt Zavadsky

Nice research project from very well-respected researchers published in Prehospital Emergency Care. 

The good news is, there appears to be a trend to reduce RLS responses, but still lots of agencies still doing it routinely for all calls.  The 2020 EMS Trend Report from Fitch & Associates/EMS1.com revealed:

And:

“Lights and sirens. Fire department-based respondents continue to report the highest rates of using lights and sirens for every call (25%, compared to a 15% average in other agency types). Based on published research questioning the efficacy of responding lights and responses to all 911 calls, and the inherent dangers, this points to a policy and training opportunity to improve patient, provider and community safety.”

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Using Red Lights and Sirens for Emergency Ambulance Response: How Often Are Potentially Life-Saving Interventions Performed?

Jeffrey L. Jarvis, MD; Vaughn Hamilton, MA, EMT-P; Mike Taigman, MA & Lawrence H. Brown, PhD

Published online: 07 Aug 2020

 

https://doi.org/10.1080/10903127.2020.1797963

 

Abstract

 

Background

Emergency Medical Services (EMS) often respond to 911 calls using red lights and sirens (RLS). RLS is associated with increased collisions and increased injuries to EMS personnel. While some patients might benefit from time savings, there is little evidence to guide targeted RLS response strategies.

 

Objective

To describe the frequency and nature of 911 calls that result in potentially life-saving interventions (PLSI) during the call.

 

Methods

Using data from ESO (Austin, Texas, USA), a national provider of EMS electronic health records, we analyzed all 911 calls in 2018. We abstracted the use of RLS, call nature, and interventions performed. A liberal definition of PLSI was developed a priori through a consensus process and included both interventions, medications, and critical hospital notifications. We calculated the proportion of calls with RLS response and with PLSI performed, both overall and stratified by call nature.

 

Results

There were 5,977,612 calls from 1,187 agencies included in the analysis. The majority (85.8%) of calls utilized RLS, yet few (6.9%) resulted in PLSI. When stratified by call nature, cardiac arrest calls had the highest frequency PLSI (45.0%); followed by diabetic problems (37.0%). Glucose was the most frequently given PLSI, n = 69,036. When including multiple administrations to the same patient, epinephrine was given most commonly PLSI, n = 157,282 administrations).

 

Conclusion

In this large national dataset, RLS responses were very common (86%) yet potentially life-saving interventions were infrequent (6.9%). These data suggest a methodology to help EMS leaders craft targeted RLS response strategies.

CMS.gov Source | Comments Courtesy of Matt Zavadsky

his could be a beneficial innovation expansion for EMS agencies.  Many have leveraged the expansion of telehealth benefits to partner with telehealth providers to provide patient navigation services during emergency calls.

CMS has indicated their belief in the past that some waivers initiated to mitigate the impact of the pandemic may be harder to unwind than they were to initiate – this may be an example of that belief.

There is an interesting Health Affairs Blog on this topic here: https://www.healthaffairs.org/do/10.1377/hblog20200715.454789/full/

NAEMT, AAA, IAFC and other national EMS associations have been working together closely to try and introduce legislative language that authorizes CMS to pay for Treatment in Place (TIP) into upcoming COVID relief Bills.  Language to that effect would be a perfect fit for the expansion of telehealth services.

Even without CMS action, many payers and even state Medicaid offices are, or are moving toward paying for TIP services.

Expansion of the telehealth coverage benefit may also have an impact on the CMMI ET3 model, since it was planned as part of the model that telehealth expansion to patient’s residences, or other non-healthcare points of origin would be available to ET3 partner providers.  However, now it is available to all providers.

EMS should keep a close eye on these developments to see how permanent expansions of telehealth services can complement and advance the EMS Transformation, and be ready to provide comments and communications through the rule making processes.

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Trump Administration Proposes to Expand Telehealth Benefits Permanently for Medicare Beneficiaries Beyond the COVID-19 Public Health Emergency and Advances Access to Care in Rural Areas

Aug 03, 2020

 

https://www.cms.gov/newsroom/press-releases/trump-administration-proposes-expand-telehealth-benefits-permanently-medicare-beneficiaries-beyond

 

The Centers for Medicare & Medicaid Services (CMS) is proposing changes to expand telehealth permanently, consistent with the Executive Order on Improving Rural and Telehealth Access that President Trump signed today. The Executive Order and proposed rule advance our efforts to improve access and convenience of care for Medicare beneficiaries, particularly those living in rural areas. Additionally, the proposed rule implements a multi-year effort to reduce clinician burden under our Patients Over Paperwork initiative and to ensure appropriate reimbursement for time spent with patients. This proposed rule also takes steps to implement President Trump’s Executive Order on Protecting and Improving Medicare for our Nation’s Seniors and continues our commitment to ensure that the Medicare program is sustainable for future generations. 

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Kaiser Health News source | Comments courtesy of Matt Zavadsky

This is the next in the 1-2-3…. Punch for patients and area healthcare providers.  We’ve mentioned before that the volume loss, coupled with the looming changes in the payer mix, will continue to have a big impact on healthcare systems, including EMS agencies.

Everyone should be keeping a close eye on this in your local communities!

Most notable quote of the article – (the same could be said about EMS agencies):

“Hawkins said federal relief money will be directed to health care providers in the coming months. Long term, however, he said this is unsustainable for Texas hospitals. If unaddressed, this financial burden on hospitals could lead to future cuts and possibly closures, he warned.

If state lawmakers don’t start addressing the state’s coverage issues soon, Hawkins predicted, it will become a significant issue during the state’s upcoming legislative session early next year.”

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In Texas, More People Are Losing Their Health Insurance as COVID Cases Climb

By Ashley Lopez, KUT

JULY 28, 2020

 

https://khn.org/news/in-texas-more-people-are-losing-their-health-insurance-as-covid-cases-climb/

 

Steve Alvarez started feeling sick around Father’s Day weekend this year. His symptoms started as mild, but developed into a fever, chills and shortness of breath he couldn’t shake.

 

“Just when I started to get to feeling better and I would have a couple of good days,” Alvarez said. “I felt like I’d backtrack and I was just really run down. This thing lingered and lingered.”

 

Alvarez, a Tejano musician who lives in the San Antonio area, said he eventually got a free COVID-19 test provided by the city of San Antonio. A week later, he found out he tested positive for the coronavirus.

 

Alvarez and his wife — who also became infected — never ended up in the hospital, and they feel fine now. But, he said, there were some scary days — he knows a lot of people who got sick with COVID-19. A friend around his age — mid- to late 40s — has been in an ICU and on a ventilator for weeks now.

 

But it was not just their health that worried Alvarez. Financial fears loomed large, too.

 

“We thought if something happens and this starts getting much worse, we need to start thinking about how we are going to deal with it, how we are going to pay for it,” he said. “It was just abject terror as to what was going to happen and what we were going to do.”

 

Money is tight because the pandemic shut down most of his musical gigs. Alvarez also lost his health insurance a year ago when he was laid off from his day job in construction safety. While he was sick with the coronavirus he paid for remote doctor visits, some prescriptions and over-the-counter medicine all out-of-pocket, he said.

 

“I use discount cards for those prescriptions as much as possible,” Alvarez said. “If something is not generic, that’s just absolutely too expensive, I have to consider doing without it.”

 

Texas’ uninsured rate has been climbing along with its unemployment rate as COVID cases also surge in the state. Before the pandemic, Texas already had the highest rate and largest number of people without insurance among all states. And 20% of all uninsured children in the U.S. live in Texas.

 

The uninsurance problem has only gotten worse in Texas in 2020. According to recent data from Families USA, a consumer health advocacy group that supported the Affordable Care Act, 29% of Texas adults under 65 don’t have health insurance so far this year.

 

The group found that about 659,000 people in the state became uninsured between February and May as job losses soared. Texas is one of 13 states that has not expanded Medicaid under the ACA.

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San Antonio Express-News Source Article | Comments Courtesy of Matt Zavadsky

Outstanding depiction of the lives of EMS workers on the front lines of the pandemic.  Especially the critical backbone of the inter-facility work EMS providers do!

No highlights – it’s ALL a must read!

Tip of the hat to MedStar’s Ken Simpson for finding this article!

Nice audio/video summary embedded in the link below:

https://www.expressnews.com/coronavirus/article/The-closest-thing-medicine-gets-to-war-24-15427294.php

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Invisible enemies

Ambulance crews respond an average of once an hour to transport COVID-19 patients to hospitals, long-term care facilities or to their homes. For paramedics, it’s a daily battle against two invisible enemies — the virus and burnout.

By Marina Starleaf Riker

Photos by Lisa Krantz

The fluorescent lights in the back of the ambulance glare above paramedic George Lombardo as he leans over to check his patient’s breathing, steadying himself as the vehicle races at 65 mph down the empty highway.

The man is dying from COVID-19. A machine pumps oxygen into his lungs through a breathing tube. His chest rises and falls in a robotic rhythm.

The EMS crew picked up the elderly man at a hospital and is bringing him to hospice care. He had signed a do-not-resuscitate order. If his heart stopped, no one was to intervene.

With six minutes to go, the ambulance veers suddenly into an empty Bill Miller Bar-B-Q parking lot and brakes to a stop.

The man has no pulse.

Lombardo makes a phone call, speaking loudly because his respirator mask muffles his voice. He unfastens the patient’s oxygen mask. It no longer is needed.

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Dallas Observer Source | Comments Courtesy of Matt Zavadsky

Interesting perspective from the reporter, and the American Society of Anesthesiologists…

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Don't Wanna Be Sedated

Sometimes law enforcement officers need assistance restraining people in custody. Sometimes they enlist the help of EMTs and powerful sedatives.

JACOB VAUGHN

JULY 24, 2020 

https://www.dallasobserver.com/news/police-and-emts-use-of-anesthetics-to-control-suspects-debated-11927060

In 2016, Tony Timpa had a run-in with the police. As he stood outside a porn shop on Mockingbird Lane, Timpa called the cops, telling them he was scared, off of his medication and suffering from mental illness. By the end of the night, the 32-year-old Timpa was dead, dying in the custody of the police he had called not long before.

In the time it took the officers to show up, a nearby security guard saw Timpa crossing the street, walking into traffic, and put him in handcuffs until police arrived. When three Dallas Police officers arrived, they switched out his handcuffs and rolled him onto his stomach. One of the cops, Dustin Dillard, held Timpa's face down in the grass with his knee on his back.

This position was held for over 13 minutes. 

When paramedics arrived, they administered Versed, a strong sedative. According to The Dallas Morning News, by the time Timpa was given the sedative, officers on the scene were already questioning whether he was awake.

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The Academy of International Mobile Healthcare Integration honors the legacy of Jack Stout. Jack was an innovative leader, who pioneered the high-performance, high-value EMS systems our members carry on today. His friendship and mentorship will be sorely missed, though his legacy lives on through his son, Todd, and the work of emergency medical services around the world. Our thoughts are with the Stout family during this very sad time. Rest in peace, Jack.

The Standard source article 

Despite being so severely short-staffed, Chief Kevin Smith said paramedics managed to get through the crisis thanks to a substantial reduction in calls for service as well as increased efficiency at Niagara hospital emergency departments that eliminated offload delays in delivering patients to the care of medical staff.

“At one point we had upwards of 70 paramedics required to be self-isolating out of an abundance of precaution. It certainly does take a hit on your human resources,” Smith said.

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Many EMS systems reported similar trends...

Special thanks to Jimmy Pierson of Medic Ambulance for sharing this story…  The referenced study is available in the JAMA hyperlink in the article.

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COVID-19: 'Dramatic' Surge in Out-of-Hospital Cardiac Arrests in NYC

Megan Brooks

June 24, 2020

https://www.medscape.com/viewarticle/932913

The COVID-19 pandemic in New York City led to a surge in out-of-hospital cardiac arrests (OHCAs) that placed a huge burden on first responders, a new analysis demonstrates.

During the height of the pandemic in New York, there was a "dramatic increase in cardiopulmonary arrests, nearly all presented in non-shockable cardiac rhythms (>90% fatality rate) and vulnerable patient populations were most affected," David Prezant, MD, chief medical officer, Fire Department of New York (FDNY), told Medscape Medical News.

In a news release, Prezant noted that "relatively few, if any, patients were tested to confirm the presence of COVID-19," making it impossible to distinguish between cardiac arrests as a result of COVID-19 and those that may have resulted from other health conditions.

"We also can't rule out the possibility that some people may have died from delays in seeking or receiving treatment for non–COVID-19-related conditions. However, the dramatic increase in cardiac arrests compared to the same period in 2019 strongly indicates that the pandemic was directly or indirectly responsible for that surge in cardiac arrests and deaths," said Prezant.

The study was published online June 19 in JAMA Cardiology.

New York City has the largest and busiest EMS system in the US, serving a population of more than 8.4 million people and responding to more than 1.5 million calls every year.

To gauge the impact of COVID-19 on first responders, Prezant and colleagues analyzed data for adults with OHCA who received EMS resuscitation from March 1, when the first case of COVID-19 was diagnosed in NYC, through April 25, when EMS call volume had receded to pre-COVID-19 levels.

Compared with the same period in 2019, the COVID-19 period had an excess of 2653 patients with OHCA who underwent EMS resuscitation attempts (3989 in 2020 vs 1336 in 2019, P < .001), an incidence rate triple that of 2019 (47.5 vs 15.9 per 100,000).

On the worst day – Monday, April 6 – OHCAs peaked at 305 cases, an increase of nearly 10-fold compared with the same day in 2019.

Despite the surge in cases, the median response time of available EMS units to OHCAs increased by only about 1 minute over 2019, a non-significant difference. Although the average time varied, median response time during the COVID period was less than 3 minutes.

A More Vulnerable Group

Compared with 2019, patients suffering OHCA during the pandemic period were older (mean age 72 vs 68 years), less likely to be white (20% white vs 33%) and more likely to have hypertension (54% vs 46%), diabetes (36% vs 26%), physical limitations (57% vs 48%) and cardiac rhythms that don't respond to defibrillator shocks (92% vs 81%).

Compared with 2019, the COVID-19 period had substantial reductions in return of spontaneous circulation (ROSC) (18% vs 35%; P < .001) and sustained ROSC (11% vs 25%; P < .001). The case fatality rate was 90% in the COVID-19 period vs 75% a year earlier.

From JAMA Network Open | Comments Courtesy of Matt Zavadsky

Tip of the hat to Dr. Marshal Isaacs from the UT Southwestern/BioTel system in Dallas for this excellent find!

Might be interesting for other systems to conduct a similar analysis of the pre-hospital system, including dispatch and field encounters.

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Clinical Characteristics of Patients With Coronavirus Disease 2019 (COVID-19) Receiving Emergency Medical Services in King County, Washington

JAMA Netw Open. 2020;3(7):e2014549. doi:10.1001/jamanetworkopen.2020.14549

July 8, 2020

Betty Y. Yang, MD1; Leslie M. Barnard, MPH2; Jamie M. Emert, MPH2; et al

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767993

 

Question  What is the clinical presentation to emergency medical services among persons with coronavirus disease 2019 (COVID-19)?

 

Findings  This cohort study of 124 patients with COVID-19 revealed that most patients with COVID-19 presenting to emergency medical services were older and had multiple chronic health conditions. Initial concern, symptoms, and examination findings were heterogeneous and not consistently characterized as febrile respiratory illness.

 

Meaning  The findings of this study suggest that the conventional description of febrile respiratory illness may not adequately identify COVID-19 in the prehospital emergency setting.

 

Abstract

Importance  The ability to identify patients with coronavirus disease 2019 (COVID-19) in the prehospital emergency setting could inform strategies for infection control and use of personal protective equipment. However, little is known about the presentation of patients with COVID-19 requiring emergency care, particularly those who used 911 emergency medical services (EMS).

 

Objective  To describe patient characteristics and prehospital presentation of patients with COVID-19 cared for by EMS.

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