News & Updates

In cooperation with the American Ambulance Associationwe and others have created a running compilation of local and national news stories relating to EMS delivery, powered by EMSIntel.org. Since January 2021, 3,203 news reports have been chronicled, with 39% highlighting the EMS staffing crisis, and 43% highlighting the funding crisis. Combined reports of staffing and/or funding account for 81.5% of the media reports! 274 reports cite EMS system closures/takeovers, or agencies departing communities, and 96.1% of the news articles reference staffing challenges, funding issues and response times.


Click below for an up to date list of these news stories, with links to the source documents.

Media Log Rolling Totals 6-30-25.xlsx

  • 9 Jan 2025 8:31 AM | Matt Zavadsky (Administrator)

    This is one approach…

    The referenced HB 1365 was enacted in April 2023 – wonder how many communities have acted to fund EMS under the law?

    ------------- 

    North Dakota lawmakers consider bill to prevent abrupt ambulance service closures

    By: Michael Achterling 

    January 8, 2025 

    https://northdakotamonitor.com/2025/01/08/north-dakota-lawmakers-consider-bill-to-prevent-abrupt-ambulance-service-closures/

    A bill addressing distressed ambulance services aims to give North Dakota communities a safety net before EMS companies abruptly close.

    Senate Bill 2033 would require ambulance services that are failing to meet state or federal regulations or are at risk of closing within 60 days to comply with a new program administered through the Department of Health and Human Services.

    A survey sent to North Dakota ambulance service providers showed about 30 may close in the next five years, Adam Parker, chair of the advocacy committee for the North Dakota EMS Association, told the Senate Human Services Committee Wednesday. 

    “When an ambulance fails, that jeopardizes the community, as well as stresses the neighbors,” Parker said. 

    The program would lay out procedures for HHS to create an improvement plan with the struggling ambulance services and inform local medical directors and local subdivisions of the issues. It also creates a coordinator position under HHS to manage the program, expected to cost about $210,000 during the 2025-27 biennium and $218,000 in the 2027-29 budget.

    The program would require both HHS and the ambulance provider to sign off on an improvement plan that would be presented to local residents before going into effect.

    Rep. Robin Weisz, R-Hurdsfield, testified in favor of the bill.

    “It’s a tool to make sure we don’t all of a sudden reach a crisis situation,” Weisz said. 

    He added he would advocate for additional funding for rural ambulance services, though the bill does not include that funding.

    “For someone in a rural area, when I do something stupid, which I do occasionally … I want somebody to show up,” Weisz said. “I don’t want to sit there and wait for 30 minutes hoping somebody comes while I’m bleeding out, or whatever. And I want somebody who knows what they are doing.”

    Committee members voted 5-1 to give the bill a “do pass” recommendation.

    “There hasn’t been a process to require some communication and I think that’s sometimes just critical,” said Sen. Judy Lee, R-West Fargo, chair of the Senate Human Services Committee.

    During the 2023 legislative session, House Bill 1365 created districts for rural ambulance services with an oversight board that would be in charge of crafting an EMS plan for its area and raising local taxes to cover the costs of the service. But, Parker said that bill didn’t address potential closures.

    Parker said the goal of the new bill is to force a dialog between the provider and the state and to come up with a plan to leave reliable emergency services in place. If ambulance service providers fail to respond or participate in the new HHS program, the state could revoke its EMS license.

    The sole member of the committee to vote against the bill, Sen. David Clemens, R-West Fargo, said he didn’t think the state should be involved in another program at HHS when the issue could be best resolved at the local level.

    “If people are becoming concerned about their ambulance service then I think it’s their responsibility to go to their county, county commissioners, and say, ‘Look, we’ve got to have this fixed,’ and I think they are capable of fixing it,” Clemens said.

    The bill will now move to the Senate Appropriations Committee to be considered as a part of the larger HHS budget.

  • 8 Jan 2025 10:56 AM | Matt Zavadsky (Administrator)

    Enhancing Fire Response: How Medical Dispatchers Elevate Care and Service for the Community

    January 2, 2025

    By Shannon Popovich, JD, CMCP

    https://www.jems.com/exclusives/medical-dispatchers-elevate-care-and-service/

    As the exclusive ground emergency medical services provider for Washoe County, Nevada, REMSA Health has provided emergency medical services for the community for more than 38 years. As the community has expanded and evolved, REMSA Health has enhanced its services to provide the best care for patients when they need it most––and our philosophy is that care starts with the call.

    REMSA Health’s Regional Emergency Communications Center answered nearly 94,000 emergency calls in 2023. As trained EMTs or paramedics, our center’s 24 full-time medical dispatchers are truly the “first” first responders and are highly skilled in providing critical and life-saving care over the phone while collecting information for the clinical care providers who will arrive on the scene.

    In 2021, our dispatch team’s role expanded and we began dispatching fire and medical resources for Truckee Meadows Fire Protection District (TMFPD) through a public-private partnership. REMSA Health dispatches approximately 1,800 fire-related emergency calls for TMFPD annually.

    Doubling the Dispatcher’s Skillset – Pursuing Accreditation for Emergency Fire Dispatch

    In 2024, the Communications Center team earned the designation of Emergency Fire Dispatch (EFD) Accredited Center of Excellence (ACE) from the International Academies of Emergency Dispatch (IAED) further expanding REMSA Health dispatchers’ advanced skillset.

    Pursuing accreditation for EFD bolstered our dispatch team’s skillset and strengthened our partnership with TMFPD. During the accreditation process, we worked through approximately 300 fire response configurations. Our dispatchers identified areas for improvement and created a training plan to address knowledge gaps.

    The accreditation process also involved REMSA Health’s clinical quality department. Our quality assurance coordinators, who already hold specialized emergency medical dispatch (EMD) and EMD Quality Assurance Coordinator certifications, also took EFD Quality Assurance Coordinator courses to perfect their EFD call-response skills. Our quality assurance coordinators were required to earn their EFD quality certification.

    Serving a geographically-challenging area

    Washoe County is a beautiful place to live and recreate where residents enjoy views of the Sierra Nevada mountains, trees and foliage that change with the seasons and several accessible outdoor activities. While the landscape is breathtaking, it is incredibly varied and it can be challenging.

    The county spans several elevations, experiences varying weather patterns and includes densely populated areas dotted by expanses of public lands with open terrain and rugged landscapes, creating obstacles for first responders when fighting fires. Our dispatchers have to be at the top of their game to dispatch fire calls that can come from any corner of our diverse county.

    Additionally, our region of northern Nevada is susceptible to wildland fires that occur in remote areas, as well as in proximity to residential developments. To ensure readiness, our team collaborates with the TMFPD’s wildland division to prepare for fire season.

    All team members complete an annual two-part training that educates them on what to expect during a wildfire, who to call, what resources are available to dispatch to the scene and how to understand weather predictions.

    The wildfire training provided a critical base of knowledge for our dispatchers ahead of 2024’s wildfire season. Our dispatchers proved ready for wildland season with the recent Davis Fire that burned nearly 6,000 acres across southern portions of Washoe County and neighboring areas.

    As our TMFPD partners and other co-response agencies worked to contain the fire, our Communications Center continued to answer and triage calls across the county. While working at our highest proficiency to serve the firefighters during a growing wildland fire, we also continue to provide exceptional care to new incoming medical and fire calls.

    As fires grow, so do our call volumes. Additional staffing in the communications center is needed during these large incidents to support the influx of calls, as well as continue to support the day-to-day 911 calls and run communications for the fire’s incident command.

    Our dispatchers intake calls about the wildfire and communicate pertinent updates from the community to the responders on scene to ensure they are responding to all the hot spots and protecting residential structures.

    Continuous Training and Improvement for Fire Dispatch

    REMSA Health’s dispatchers are required to understand fire dispatching terminology, firefighting tactics and fire response configurations. This extensive and specialized training ensures they have a comprehensive understanding of what’s happening on the scene, how to anticipate the needs of the responders and are equipped to efficiently support firefighters.

    Additionally, new dispatchers are required to be EMD- and EFD-certified and undergo a 16-week immersion-style training program to further enhance their medical, fire, and ambulance dispatch knowledge.

    Our dispatchers are also required to complete fire ride-alongs so they can visualize what the firefighters do at the station, enroute to a call, while onscene, and after the call is complete. This gives them the chance to fully understand what happens in the field and to build relationships with the responders.

    We give our dispatchers several opportunities to “hear it, learn it, do it,” utilizing simulations in a collaborative educational environment so trainees can make mistakes and correct them before they begin answering live 9-1-1 calls.

    REMSA Health works with fire department leaders to conduct After Action Reviews for complex fire calls. The reviews outline successes and points of improvement, providing essential feedback for continuous improvement and maintaining high quality dispatch standards.

    Becoming dually accredited to effectively dispatch for medical and fire emergencies was a years-long process for our Communications Center team. But the endeavor is worthwhile as we continue to streamline our community’s resources and work to ensure the closest most appropriate and available resource is sent to the scene.

    Accreditation also ensures we continue to surpass the standard of medical and fire dispatching due to the 3rd party review of our performance.

    The fire dispatch training, accreditation and commitment to continuous improvement has advanced our team’s dedication to excellence and has built a respectful, productive relationship with our co-responder agencies that benefits the citizens we serve.

    About the Author

    Shannon Popovich is the director of REMSA Health’s Regional Emergency Communications Center.

     


  • 1 Jan 2025 8:58 PM | Matt Zavadsky (Administrator)

    Interesting to have this ‘quantified’, although not terribly groundbreaking…

    Somewhat surprised that only 7-8% of the respondents indicated they were likely to LEAVE EMS in 12 months? Thought it would have been higher than that…

    Notable finding that EMTs and paramedics with associate or bachelor’s degrees indicated higher propensity of leaving the profession.

    --------------------------

    Factors Associated With Emergency Medical Clinicians Leaving EMS

    Christopher B. Gage, Christine B. Cooke, Jonathan R. Powell, Jacob C. Kamholz, Jordan D. Kurth, Shea van den Bergh & Ashish R. Panchal

    Received 05 Oct 2024, Accepted 18 Nov 2024, Published online: 13 Dec 2024

    PREHOSPITAL EMERGENCY CARE https://doi.org/10.1080/10903127.2024.2436047

    https://www.tandfonline.com/doi/full/10.1080/10903127.2024.2436047#d1e255

    Abstract -

    Objectives:

    Many United States (U.S.) communities face challenges with Emergency Medical Services (EMS) workforce turnover. The demands created by the pandemic have worsened the stressors EMS clinicians face, possibly changing the drivers of workforce turnover. Our study aims to understand the factors associated with Emergency Medical Technicians (EMTs) and paramedics’ likelihood of leaving EMS.

    Methods:

    We conducted a cross-sectional analysis of nationally registered civilian EMTs and paramedics ages 18–85 from October 2021 to April 2022. After recertifying their National EMS certification, respondents were invited to complete a survey regarding their primary role, additional jobs, and the likelihood of leaving EMS in the next 12 months. If likely to leave, reasons for leaving were collected and evaluated for the top reasons. Multivariable logistic regression modeling (OR, 95% CI) was used to describe the odds of being likely to leave in 12 months, adjusted for age, agency type, education level, primary role, and job satisfaction.

    Results:

    A total of 29,671 (response rate-25.9%) EMTs and paramedics were included in the analysis, with 7.1% and 7.9%, respectively, reporting they were likely to leave EMS in 12 months. The EMTs likely to leave were younger (median age 32 vs. 37) and had fewer years with main EMS job (median 3 vs. 4) than paramedics. A lower proportion of EMTs were male (68.8% vs. 78.6%) and non-Hispanic White (79.8% vs. 87.6%). The EMTs were less likely full-time (65.6% vs. 87.5%) and held fewer EMS jobs (23.4% vs. 32.3%). The EMTs and paramedics reported stress as the most significant reason for leaving (27.9% and 38.8%, respectively), followed by COVID-19 (12.9% and19.3%) and education (18.3% and 6.4%). Those dissatisfied had significantly higher odds of leaving (11.91 and 13.46, respectively). The EMTs and paramedics in hospitals (OR = 2.32, OR = 2.37), private (OR = 2.72, OR = 2.38), and government non-fire (OR = 2.22, OR = 1.98) agencies were likelier to leave than fire agencies.

    Conclusion:

    Although increased stress and pandemic-related factors are most common reasons reported for being likely to leave EMS, job dissatisfaction was the most impactful factor. A better understanding of factors that drive job satisfaction needs evaluation to develop strategies to enhance retention.

    Other interesting findings:

    Associates With Leaving EMS in 12 Months

    Age was a significant predictor of leaving for EMTs (OR = 0.96, 95% CI [0.95–0.96]) and paramedics (0.97, 0.97–0.98) (Table 3). Education level was also significant, with EMTs holding an associate degree (1.45, 1.11–1.90) and a bachelor’s degree or higher (2.13, 1.70–2.66) showing higher odds ratio of leaving. Paramedics with bachelor’s degrees or higher exhibited a higher odds ratio of leaving (1.58, 1.20–2.06).

    Job satisfaction was the most significant predictor of leaving for EMTs and paramedics. Those unsatisfied with their EMS job had dramatically higher odds ratios of leaving (EMT 11.49, 9.61–11.74; paramedic 13.48, 11.64–15.61) than those satisfied.


  • 1 Jan 2025 8:11 PM | Matt Zavadsky (Administrator)

    Likely as a result of the recent Boston Globe report on failing EMS systems, Winthrop is moving forward with evidence-based EMS system redesign changes such as emergency medical dispatch (EMD) response prioritization and certifying first response firefighters as EMTs.

    Community and EMS leaders should critically evaluate their EMS delivery models, using national evidence-based, scientific studies and local data to challenge traditional myths about EMS delivery that may no longer be true.

    -------------------------- 

    Winthrop to revamp emergency response procedures in wake of patient deaths

    By Jason Laughlin Globe Staff

    December 31, 2024

    https://www.bostonglobe.com/2024/12/31/metro/winthrop-toddler-ambulance-emergency-massachusetts-als-bls/

    Winthrop is revamping its emergency response services following at least three deaths, including a toddler’s, that have been linked to ambulance shortages and overworked emergency crews.

    The town is making the changes after a Boston Globe story earlier this month detailed statewide problems with emergency response that have left patients without critically needed care.

    Winthrop Fire Chief Scott Wiley and town manager Anthony Marino declined to comment, citing the possibility of civil litigation. But earlier in December they released a statement describing changes in how the community prepares for and responds to emergency calls.

    Those include paramedic training for some firefighters and a reevaluation of how ambulance services prioritize calls for help.

    “No one should experience delayed paramedic service in Winthrop or anywhere else due to the unavailability of ambulances or emergency medicine,” the town officials said in their joint statement released Dec. 6.

    Almost a year ago, Yuna Feeley, a Winthrop 2-year-old, went into cardiac arrest at home. The fire department responded to a 9-1-1 call from the child’s mother, but Action Ambulance, the private company that provides service to Winthrop, didn’t have a vehicle available to transport Yuna to the hospital. A backup company didn’t have the staff needed to get an ambulance on the road. Wiley, the fire chief, drove the child to Mass. General in Boston himself, but she died at the hospital.

    The girl might have been saved had an ambulance stocked with the medications and equipment designed to provide advanced life support been available, experts have said.

    The Globe’s reporting identified two other Winthrop patients over the past three years who died while being cared for by paramedics from Action Ambulance.

    In another incident in Western Massachusetts, a state investigation determined an Action Ambulance paramedic misdiagnosed a patient and administered medications that caused the person to go into cardiac arrest.

    The deaths underscore critical shortcomings plaguing emergency response services statewide. There’s little to no regional coordination to ensure coverage when a community’s primary ambulance

    providers are occupied with other calls, and no central authority evaluating whether a region has the number of ambulances it needs. In addition, staffing shortages can keep needed vehicles out of circulation or lead to a lack of experienced personnel responding to serious emergencies.

    Winthrop, which says it has 31 firefighters and officers, requires all firefighters to be certified as Emergency Medical Technicians. Several are now training as paramedics, who undergo additional education and can provide more advanced life saving care, according to the town’s statement. It also is consulting with a software vendor that can track the locations of fire and EMS vehicles and provide information about their status and availability.

    “We believe that technology can assist communities in being as efficient and responsive as possible in the delivery of all services, emergency and non-emergency,” the town manager and fire chief said in their statement.

    Winthrop officials are also discussing with Action Ambulance how to update the way the company prioritizes its calls for service and are working to introduce paramedic supervisor “chase vehicles,” which would support ambulance crews or determine the level of care a patient needs before an ambulance arrives.

    “These are challenges we are working to overcome every day, and we look forward to working with our community partners and local and state governments on meaningful solutions for all residents,” Mike Woronka, Action Ambulance’s chief executive, said in a statement Friday.

    While having fire personnel trained as EMTs and paramedics may help, it wouldn’t eliminate the need for ambulances and the lifesaving tools they carry, said Matt Zavadsky, a national EMS consultant with the Pennsylvania-based PWW Advisory Group.

    Along with ensuring there are enough emergency vehicles in a region, what is most needed is a sophisticated system to ensure the best trained personnel are available for the most serious emergencies.

    EMTs are trained to respond to most calls, but paramedics are invaluable when a patient needs an immediate medical response.

    They are in short supply, Zavadsky said.

    “Paramedics are very expensive and for the majority of calls they’re not necessary,” he said.

    Patients requiring advanced life support account for just 30 percent of all ambulance calls, Zavadsky said, and calls that require an immediate, potentially life-saving response are even less common.

    When one of those calls comes in, it can be critically important that a paramedic is among the responders.

    “A person who called 9-1-1 because they twisted their ankle is different than a 65-year-old male with a history of cardiac problems complaining of chest pains,” he said.

    The first call can be handled by EMTs. The second, though, needs a fast response and the patient would likely benefit from the presence of a paramedic. Software is available, Zavadsky said, to help

    emergency responders prioritize those two calls, and ensure an ambulance with a paramedic isn’t tied up with a broken bone while somewhere else a patient is having a heart attack.

    “Doing the two things combined, adding basic life support ambulances and triaging calls, will in essence dramatically improve this process,” Zavadsky said.


  • 27 Dec 2024 1:15 PM | Matt Zavadsky (Administrator)

    In this special crossover episode of Inside EMS and EMS One Stop, host Rob Lawrence is joined by Matt Zavadsky of PWW Advisory Group and Rodney Dyche of PatientCare EMS for an in-depth look at the biggest EMS stories of 2024.

    From critical staffing shortages to groundbreaking changes in system design, the trio tackles how the EMS landscape has evolved and what lies ahead for 2025.

    ------------------------------------- 

    This lively discussion explores how data from the EMS Media Log has illuminated topics like tiered response models, legislative battles for better funding, and solutions to ambulance thefts and ambulance patient offload time (APOT) delays. Packed with insightful quotes, actionable strategies, and the latest data, this episode is a must-listen for EMS professionals striving to shape a better future for their communities.

    A key tool driving this discussion is the EMS Media Log, maintained collaboratively by the American Ambulance Association (AAA) and the Academy of International Mobile Healthcare Integration (AIMHI). This log aggregates EMS-related news stories from local, regional and national outlets across the U.S.


    https://www.ems1.com/ems-advocacy/ambulance-thefts-bed-delays-response-times-tackling-tough-ems-issues  

  • 23 Dec 2024 6:16 AM | Matt Zavadsky (Administrator)

    Over the weekend, Congress passed, and the President signed a Continuing Resolution (CR), to fund the federal government through March 2025. The CR included several healthcare provisions of interest to EMS.

    These provisions only carry through March, 2025, so please stay engaged with your national associations as they work diligently to make continue these important provisions beyond March 2025!

    Full text of the CR is available here.

    EMS Interest Items Included in the CR:


    Provider Payment Policies:

    • Extends ambulance add-on payments through March 31, 2025
    • Extends increased payments for low-volume hospitals through March 31, 2025

     
    Telehealth Flexibilities:

    • Extends Medicare telehealth geographic and originating site flexibilities through March 31, 2025
    • Continues expanded practitioner eligibility for telehealth services through March 31, 2025
    Extends audio-only telehealth services through March 31, 2025


    ------------------------------------------- 

    Congress votes to keep government open, abandons health package
    Michael McAuliff
    December 20, 2024
     
    https://www.modernhealthcare.com/politics-policy/spending-bill-house-healthcare-package
     
    Congress overcame two failures in the House and advanced a last-minute measure to keep government funded into next year on Saturday, but abandoned a set of ambitious health policies promised just days ago.
     
    The bill that debuted on the eve of a federal shutdown after a week of turmoil will have limited effects on the healthcare system. The health provisions mostly consist of short-term delays of Medicare and Medicaid payment cuts set to kick in Jan. 1 and brief extensions of several programs. President Joe Biden endorsed the measure.
     
    Telehealth and hospital-at-home providers will remain eligible for Medicare reimbursement until March 31 under the bill. Those authorities would have extended for two years and five years, respectively, under the bipartisan deal House Speaker Mike Johnson (R-La.) announced Tuesday but scrapped after President-elect Donald Trump came out against it.
     
    The new measure will postpone scheduled cuts to Medicaid disproportionate share payments for safety-net hospitals and extend special Medicare reimbursements for low-volume hospitals and Medicare-dependent hospitals until April 1. It sustains funding for community health centers and pandemic preparedness programs until March 31.

  • 20 Dec 2024 11:24 AM | Matt Zavadsky (Administrator)

    The EMSIntel.org log is beginning to show a growing number of news reports like this.

    Financial issues in many communities across the country requiring tough decisions regarding EMS delivery.

    Thankfully, some communities are using evidence-based research published in peer-review journals and local data to reimagine EMS delivery based on science.

    Tip of the hat to Bill Schneiderman for sharing this news report.

    ----------------------------- 

    Costly EMS tax might hit Fort Lauderdale
    By Susannah Bryan South Florida Sun Sentinel
    December 19, 2024
     
    https://www.sun-sentinel.com/2024/12/18/costly-ems-tax-might-be-coming-down-the-pike-in-fort-lauderdale/
     
    Fort Lauderdale might start charging a new tax that would bring in tens of millions to help cover the cost of ocean rescue and emergency medical services.
     
    The tax would come to $456.78 for a home with a taxable value of $590,000, according to current estimates. The higher the value of the home or commercial property, the higher the tax.
     
    Commissioners got details about the possible new tax from an outside consultant on Tuesday.
     
    If Fort Lauderdale moves forward with the plan, the tax would show up on property tax bills as soon as 2026.
     
    The tax would apply not only to single-family homes, but to all properties currently taxed in Fort Lauderdale, said Peter Napoli, a senior manager with Stantec Consulting.
     
    Napoli had a dire warning for the commission, saying the city can expect a growing shortfall over the coming years if drastic measures are not taken.
     
    The city will face a deficit of $4.7 million in 2026; a deficit of $35.4 million in 2027; $39.4 million in 2028; $52.9 million in 2029; and $45.3 million in 2030, Napoli said. Emergency reserves would be depleted by 2029, he added.
     
    Commissioner Ben Sorensen said he was alarmed by the news.
     
    “We’re going to be in trouble if we don’t increase revenue or significantly reduce spending,” he said.
     
    Mayor Dean Trantalis said an Emergency Medical Services tax would help close the gap, but he sees no reason to move forward with a new tax at this time.
     
    “I’ve seen these (projections) for years and they’re always jaw dropping,” he said. “And at the end of the day, we seem to find a way to close the gap.”
     
    Fort Lauderdale Fire Rescue has a $127.4 million budget.
     
    Here’s how the budget breaks down:

    • The cost of fire/first responders is $68.5 million.
    • Costs related to Emergency Medical Services come to $52.9 million.
    • And Ocean Rescue costs an additional $5.9 million.

     
    Fort Lauderdale homeowners already pay a yearly fire fee of $328.
     
    Unlike the fire fee, the EMS tax would be tied to the value of their property.

    Collecting an EMS tax rate of $68 per $100,000 in assessed value would bring in nearly $75 million over the next 10 years, Napoli said. Increasing the EMS tax to $86 per $100,000 in assessed value by 2033 would bring in close to $95 million.
     
    “You can adopt the EMS tax rate at full cost recovery in the first year,” Napoli said. “Or you can phase it in, ramp it up over a four-year period or five-year period.”
     
    Here’s the cost breakdown if the EMS tax were phased in:

    • 25% cost recovery in Year 1: $101.64 for a home with a taxable value of $590,000
    • 50% cost recovery in Year 2: $208.57
    • 75% cost recovery in Year 3: $322.67
    • 100% cost recovery in Year 4: $454.83.
     
    After hearing the presentation, Trantalis said he and the commission needed time to vet the idea with the community.
     
    “According to your chart, this is not going to creep up on us until 2027,” he told the consultant. “We don’t really have to do anything now. I see a projected deficit of only $4.7 million in 2026. It’s something we can consider down the road. I think it might be important to reach out to the community and see what the appetite is for this.”
     
    Acting City Manager Susan Grant suggested the commission move forward with a new ordinance to get the framework in place, even if they decide to wait on collecting the new tax.
     
    “That way we’d be prepared based on what budget numbers look like,” Grant said. “Set up the framework and we wouldn’t have to decide until June or July.”
     
    Vice Mayor Steve Glassman and Commission John Herbst both agreed.
     
    “I think to set up the structure is not a bad idea,” Glassman said.
     
    The mayor’s response: “I don’t want to scare anybody either.”
     
    Herbst chimed in.
     
    “I concur that establishing a structure right now doesn’t necessarily obligate us to fund anything,” he said. “And it puts the infrastructure in place so if we do decide we want to move forward we’re not hamstrung by timing considerations.”
     
    Herbst suggested the commission continue the discussion at their annual goal-setting session in January.
     
    “I do think we should come to some consensus in January before we get too much further down the road,” Herbst said.
     
    Grant said she’d direct staff to begin working on an ordinance so the commission can be poised to move forward with the new tax if that’s the route they decide to take.


  • 19 Dec 2024 5:39 PM | Matt Zavadsky (Administrator)

    This is CMS’ first report on the GADCS data that was reported by selected ground ambulance organizations In Year 1 and Year 2.

    The full report, as well as the codebook that accompanies the report which describes the structure and contents of the Medicare Ground Ambulance Data Collection System (GADCS) Year 1 and Year 2 analytic file used to conduct the analyses described throughout the report, can be found here.

    ------------------------------------- 

    Notable Highlights of a Preliminary Review of the Report

    • Among 4,529 selected organizations actively billing Medicare in 2023, 95 percent (n = 4,321) started the GADCS process, and, of those, 3,694 selected organizations, or 85 percent, completed reporting as of July 15, 2024.
    • Over half—56 percent—of transports were at the basic life support (BLS) level.
    • Advanced life support, level 1 (ALS1) services accounted for an additional 42 percent of transports.
    • Advanced life support, level 2 (ALS2) and Specialty Care Transport (SCT) services combined accounted for 3 percent of total transports.
    • The Unadjusted Mean Cost Per Transport across all NPIs was $2,673.
    • The Unadjusted Mean Revenue Per Transport across all NPIs was $1,147.




  • 10 Dec 2024 6:42 AM | Matt Zavadsky (Administrator)

    A Victory for the Ambulance Industry - Federal Appeals Court Vacates VA Rule That Would Have Reduced Ambulance Payments.


    On December 9, 2024, the United States Court of Appeals for the Federal Circuit granted, in its entirety, the petition of four ambulance service providers in two different states to vacate the Veteran Administration’s rulemaking, which would have significantly reduced ambulance service reimbursement. In a unanimous decision by a three-judge panel, the appeals court determined that the VA overstepped its statutory authority and invalidated the new regulatory change.
     
    The VA’s final rule, published on February 16, 2023, established a new payment methodology for special modes of transportation, including ambulance services. Under this rule, in the absence of a contract between the VA and the provider, the VA attempted to significantly reduce the rates it currently paid to the “lesser of” the provider’s actual charge or the Medicare Fee Schedule amount for all ambulance transports - including those to and from places other than VA facilities.  If implemented, this rule would have significantly reduced payment for emergency and non-emergency ambulance services for our veterans nationwide.  
     
    The Ambulance Association of Pennsylvania (AAP) and the South Dakota Ambulance Association (SDAA) jointly submitted a “friend of the court” brief in support of the ambulance services that challenged the VA’s final rule. One Texas ambulance service, MedStar Mobile Healthcare, and three Pennsylvania ambulance services, Valley Ambulance Authority, Quaker Valley Ambulance Authority, and AMED Authority, were the petitioners in this case.
     
    The ambulance services and associations presented policy-based arguments on the imminent negative impact that the rule would impose on ambulance providers and contended that the rule contradicted the clear, unambiguous language of the existing statutory framework, thus exceeding the authority granted to the VA by Congress. The Court agreed.
     
    “The Court’s decision marks a significant victory for ambulance providers nationwide, ensuring that they can continue to deliver vital services to our veterans, especially in our rural states, like Pennsylvania and South Dakota, where large numbers of veterans live,” said Brian Hambek, President of the SDAA. 
     
    “This favorable ruling was achieved due to the effective advocacy of these ambulance services that petitioned the court, and our two state associations,” said Heather Harris, Executive Director of the AAP. “We successfully underscored the rule’s inconsistencies with existing law, its potential harm to ambulance services nationwide, and, most importantly, the negative impact that the payment reductions would have on access to needed ambulance service for our military veterans,” said Gary Watters, President of the AAP.  
     
    The VA had asked in the last few weeks for the Court to delay its decision or to render the petition moot since the VA had now extended the delay to implement the rule to 2029. But the Court did not agree with the VA’s attempt to reduce payment rates by regulation, and instead issued a ruling in favor of the ambulance industry “on the merits” of the case, thus officially tossing out the VA’s impending regulatory change as unlawful


    The attorneys of Page, Wolfberg & Wirth, LLC, prepared the friend of the court brief on behalf of the AAP and the SDAA.

  • 5 Dec 2024 12:01 PM | Matt Zavadsky (Administrator)

    A very comprehensive news report from the Boston Globe that highlights the many challenges across the country for beleaguered EMS agencies, regardless of provider type.

    No highlights on this one - it's all an important read!

    A PDF version of the story can be accessed below:

    Boston Globe Report - Where were all the ambulances.pdf

    ---------------- 

    When a Winthrop toddler stopped breathing, where were all the ambulances?

    A Globe investigation reveals a broken EMS system that has become dangerous, and in some cases deadly.

    By Adam Piore, Globe Staff

    December 5, 2024

    https://www.bostonglobe.com/2024/12/05/metro/when-winthrop-toddler-stopped-breathing-where-were-all-ambulances/

    About 15 minutes after her 2-year-old daughter went into cardiac arrest, Andrea Feeley realized an ambulance was not coming to save her.

    Just before 10:30 a.m. that January morning, Feeley was kneeling in front of the couch trying to entice her curly-haired little girl, Yuna, to take a drink of Pedialyte when she suddenly went limp and stopped breathing. Yuna had been sent home from day care two days earlier with a low-grade fever, but until that morning Feeley had no reason to believe she was seriously ill.

    Feeley’s son called 911. Within minutes, town firefighters converged on Feeley’s tidy, two-story clapboard home in Winthrop and took over chest compressions and CPR on the toddler. It was immediately clear she needed the kind of advanced life support that trained paramedics could provide.

    “Better step up that ambulance,” Captain Dan Flynn radioed.

    But there was a problem. Action Ambulance Service, the private company that provides ambulance service to Winthrop, did not have an ambulance available to respond to the call, the dispatcher said.

    “Is she breathing yet?” Feeley kept asking. “Is she breathing?”

    Finally, as the minutes ticked away, and no one showed up, Fire Chief Scott Wiley gathered up Yuna, still wearing her “CoComelon” pajamas, carried her outside to his Chevy Tahoe, and drove her to Mass. General. But it was too late. A team of doctors and a chaplain soon found Feeley sitting in a private waiting room and delivered the news: Yuna was dead.

    What happened the morning of Yuna’s death was the result of a broken EMS system across Massachusetts that means there isn’t always an ambulance or ambulance staff immediately available when patients critically need care, a Globe investigation found.

    When one city’s ambulances are tied up, as in Yuna’s case, other towns are supposed to provide ambulances to cover for them. But there is no central or regionalized system to track the location of

    ambulances in real time, and no one evaluating whether the number of ambulances on the road is sufficient.

    For ambulances that are in operation, chronic staffing shortages mean sometimes badly needed ambulances that are supposed to be in the field stay parked in garages, unused.

    And when the ambulances are staffed, in some cases the same overworked EMTs and paramedics are sent out over and over again during long shifts that can result in serious mistakes, interviews and documents reviewed by the Globe suggest. Numerous ambulance staffers said that double and triple shifts are not uncommon.

    The Globe identified three deaths, including two in Winthrop, that occurred in the months immediately preceding Yuna’s death in which paramedics were subsequently investigated by the state for negligence.

    In at least two of those cases, exhaustion and burnout clearly played a role.

    The Globe reviewed hundreds of pages of documents, including incident reports filed by ambulance companies with the state and follow-up investigations conducted by the Department of Public Health’s Office of Emergency Medical Services, the state agency charged with regulating them. The Globe also analyzed town-by-town ambulance response times, visited ambulance stations to speak with front-line workers, and conducted more than 50 interviews with industry experts, current and former EMTs and paramedics, CEOs, emergency medicine doctors, and others.

    In response to questions from the Globe, Department of Public Health officials said serious incidents and complaints involving ambulances are up across the state.

    “We know that some of these issues are related to the overarching health care landscape, which has become increasingly stressed,” the statement said. “There is a pressing need for more EMTs and paramedics to handle the increasing demand for emergency medical services.”

    ‘A poor patient outcome’

    What happened at the home of Yuna Feeley provides a stark illustration of the potential consequences of this seriously overtaxed system.

    On that January morning when Feeley’s son called 911, both of Action’s Winthrop ambulances were responding to other calls.

    Like all but nine of the state’s 362 municipalities, Winthrop relies on help from neighboring towns through the state’s “mutual aid” system when demand for ambulances exceeds supply.

    When Action’s dispatcher received Feeley’s son’s call, they immediately contacted two ambulance companies in neighboring towns and asked if they could help.

    When those services said their ambulances were busy, the Winthrop dispatcher requested help through the Boston Area Mutual Aid Network, or BAMA, a communication hub for emergency responders in Boston and surrounding communities.

    “The Winthrop & surrounding 911 systems were taxed, and unfortunately there was a poor patient outcome,” an Action Ambulance executive would later write.

    As Wiley tore down the streets of Winthrop into East Boston and hurtled through the Sumner Tunnel at speeds reaching 85 miles an hour and headed toward Mass. General Hospital, two firefighters worked furiously in the back seat to keep Yuna alive. One gently gripped the underside of her jaw and pressed a ventilation bag over her mouth to keep the seal, slowly infusing oxygen into her lungs.

    The other performed chest compressions. They stopped only once, pressing their backs against the SUV windows to avoid touching the little girl as a defibrillator delivered a jolt of electricity to her heart.

    Had paramedics been with the child, they could have given her more advanced emergency care, experts told the Globe. They might have applied drugs such as epinephrine or used more advanced defibrillators with a better chance to shock her heart back into action.

    They could have given her IV fluids to ensure her blood continued to reach her vital organs and supply them with enough nutrients and oxygen to keep them from failing.

    Yuna’s official cause of death is listed as “necrotizing pneumonia in the setting of RSV and strep,” according to an autopsy report Feeley received from the state medical examiner’s office.

    In the wake of Yuna’s death, the Department of Public Health promised a “thorough investigation.” The results, released in May after the Globe submitted a public record request, consist of a four page document, written by an executive with Action Ambulance, the company that runs EMS service in Winthrop, and reviewed and accepted without comment by the Department of Public Health.

    Action Ambulance followed “all appropriate policies and procedures,” the executive concluded.

    But for Feeley, her daughter’s death did not feel like the result of anything that resembled proper protocol.

    After the hospital workers told her Yuna was dead, she was haunted by the feeling that something had gone irrevocably wrong.

    “They asked us if we wanted to go in and say goodbye to her,” Feeley said. “So we did that. But I was not allowed to touch her. That was hard.”

    Not enough ambulances or staff

    The ambulance company best positioned to help Action the morning of Yuna’s death was Cataldo Ambulance, which has an outpost with two ambulances in nearby Revere.

    But Cataldo, like many ambulance companies around the state, had been facing staffing shortages so severe its ambulances sometimes sit in garages because there’s no one available to staff them, said Dennis Cataldo, president and CEO of Cataldo.

    “You can’t staff ambulances without people,” Cataldo, who is also president of the Massachusetts Ambulance Association, said.

    The supply of ambulances in Massachusetts is determined in part by what each local market can support. While some towns run their own EMS services, about 80 percent of the state’s licensed ambulances are operated by private companies that bid for the right to serve each town’s population.

    One notable exception is Boston, which runs a nationally recognized public EMS service through the city health department. It is fully unionized and receives city subsidies that account for more than 25 percent of its budget.

    In most cases, however, the companies’ revenue depends on reimbursements pegged to Medicaid and Medicare rates, which have failed to keep up with rising costs, Cataldo said. That hampers the companies’ ability to staff their ambulances.

    At the time of Yuna’s death, about 15 percent of Cataldo’s positions remained unfilled, about where staffing is today.

    More lives lost

    A review of state investigative documents suggests the staffing shortages have become dangerous. In the two years leading to Yuna’s passing, at least two people in Winthrop were declared dead while receiving treatment from Action Ambulance paramedics, according to state investigative documents contained in the Globe’s public records request.

    In one of the cases, a paramedic on an ambulance was summoned to a marina not far from the Feeley home to treat a patient in cardiac arrest in 2022. She forgot a medicine bag in the ambulance, failed to

    administer potentially life-saving medicine, did not shock the patient’s heart correctly, and misrepresented her actions to a state medical control doctor, the physician charged with exercising clinical oversight, whose permission is needed to cease resuscitative efforts.

    As a result, the control officer prematurely signed off on her request to cease efforts to revive him.

    In an interview with a state investigator, she said she had been “working a lot of hours” and wasn’t feeling well but “felt she had to stay on the shift because she was the only paramedic on duty.”

    “I knew I should have gone home. . . . I think about this call every day since it happened,” she said.

    She surrendered her license after Action accused her of “gross negligence.”

    A few months later, in March 2023, another Winthrop paramedic pressured an inexperienced EMT to intubate a patient in cardiac arrest, using a technique the EMT was not legally qualified to perform.

    “Just do it,” the paramedic told her, according to a complaint investigation report obtained by the Globe through a public records request. “I want to go to lunch.”

    The paramedic then called a designated medical control doctor to seek permission to cease resuscitation efforts, reporting that the patient’s heart had stopped beating, when in fact there were still

    signs of activity, and lied about the extent of the efforts made to revive him. State investigators later determined this resulted in a “failure to transport a treatable patient.” The state revoked the paramedic’s license until at least 2025.

    In a third incident from 2023, an Action paramedic operating in Western Massachusetts misdiagnosed a patient suffering from sepsis and pneumonia and administered a series of medications that sent him into cardiac arrest, eventually causing him to die of anoxic brain injury, according to a state investigation.

    Michael Woronka, president and chief executive of Action Ambulance Service, said the three deaths identified by the Globe reflect an “error rate” that compares favorably to that of his competitors, since his

    company has tens of thousands of patient interactions a year. “If other services don’t have a similar error rate, then they’re not reporting them because everyone’s going to have an error rate,” Woronka said, adding that it was his company’s own “quality assurance systems” that initially identified and reported the incidents.

    Cataldo, speaking in his role as president of the Massachusetts Ambulance Association, said such deaths are extremely rare.

    The Globe was unable to determine whether the negligence cases and deaths it reviewed were outliers: The deaths were contained in a batch of documents obtained through public records requests submitted in January and February, but the state failed to provide all the requested documents, citing understaffing and a backlog of other requests.

    There are no national standards for an acceptable error rate or any published data on clinical error rates, because most clinical errors are not reported to state regulatory agencies, and are instead handled internally by local agencies and medical directors, said Matt Zavadsky, past president of the national association of EMTs and a nationally recognized expert on EMS.

    Action has been singled out by the state before. In 2017, the state issued the company two consecutive “provisional licenses,” the equivalent of putting the company on probation, citing a failure to properly store and account for controlled substances and a number of equipment code violations, among other problems. But the state later withdrew the provisional licenses as part of a legal settlement after Action sued for $10 million, claiming it had been denied an opportunity to defend itself. To make the case it had been unfairly targeted, Action documented a wide array of violations by its competitors — including an instance in which a competitor fielded an ambulance with passenger side floor boards that had rotted out, providing a view of the concrete passing beneath the vehicle.

    Possible fixes

    In the months leading up to Yuna’s death, there were ample warnings that the state’s EMS system was stressed to the breaking point. Six months prior to her death, the union representing Boston EMS, the largest municipal EMS system in New England, warned that staffing shortages had grown so severe that public safety was at risk. A spokeswoman for Boston EMS said the company has made significant progress in filling staffing shortages in recent months, thanks to an advertising campaign on city buses and federal grants that offer scholarships and helped fund recruitment efforts, among other things.

    Just a month before Yuna’s death, the Board of the Metropolitan Boston Emergency Medical Services Council, an advisory group consisting of hospital medical directors, EMS coordinators, and first responders, signed a letter to Kate Walsh, secretary of health and human services about “the staffing crisis we face.” In a statement to the Globe, a spokesperson for the Executive Office of Health and Human Services acknowledged the shortage of EMTs and paramedics and said the agency had made investments and regulatory changes to address the issue. “We will continue to work with municipalities, ambulance providers and health care facilities on additional improvements to ensure residents receive ambulance service and high-quality medical care when they need it and prevent tragedies like this.”

    Last year, the state allowed staffing of Advanced Life Support level ambulances with a single EMT and a first responder driver, rather than two certified EMTs. And it has invested nearly $60 million across fiscal years 2024 and 2025 in Medicaid reimbursement rates for EMTs.

    But many say it’s not enough.

    One way to address the problem may be through regionalization. Efforts to overhaul the state’s ambulance system have been hampered in part by a “culture of parochialism” that relies on town- and city based services, when a growing number of states, including California, Maryland, and North Carolina, have regionalized, county based services that are better able to track and manage limited resources, said Zavadsky, the EMS expert.

    Smitty Pignatelli, a state representative from the Berkshires, has been lobbying state officials to implement policies that will make it easier for towns to make the politically unpopular decision to raise taxes to pay EMTs and paramedics more competitive wages and add more ambulances.

    Back in Winthrop, Feeley is struggling to come to grips with Yuna’s death. She still sometimes slips into the present tense when talking about her little girl — about her hazel eyes, fair skin, and dirty-blond ringlets. About the astonishing level of joy she could derive from a plastic dinosaur.

    “If an ambulance had come, could they have intubated her?” Feeley wonders. “Could they have given her something? What if there was something on the ambulance that they could have done?”

    Wiley, Winthrop’s fire chief, is also haunted by what might have been.

    “Maybe having an ambulance wouldn’t have made a difference, but it would’ve given her a better shot,” he said from behind his desk a few months after her death.

    ”We’re all parents. Some of us are grandparents. It’s devastating. It’s not supposed to happen. It’s a horrible, horrible thing.”



© 2025 Academy of International Mobile Healthcare Integration | www.aimhi.mobi | hello@aimhi.mobi

Powered by Wild Apricot Membership Software