News & Updates

  • 27 May 2021 7:39 AM | AIMHI Admin (Administrator)

    HealthAffairs Source Article | Comments Courtesy of Matt Zavadsky

    EMS providers have theorized that decreased 911 calls, and increased patient transport declination rates for patients experiencing cardiac-related symptoms may have led to increases in out-of-hospital-cardiac arrest (OHCA) cases and deaths.

    A study just released in Health Affairs seems to support this theory.

    Previously released data from the Academy of International Mobile Healthcare Integration (AIMHI) revealed concerning trends reported by member agencies from:

    • Fort Worth, TX: Metropolitan Area EMS Authority (MedStar)
    • Richmond, VA:   Richmond Ambulance Authority
    • Fort Wayne, IN: Three Rivers Ambulance Authority
    • Solano, CA:         Medic Ambulance Service
    • Davenport, IA:   Medic EMS


    EMS providers and other healthcare experts continue to encourage people to not delay seeking medical care for potentially serious medical complaints.


    Excerpts from the study and full study link:


    Worse Cardiac Arrest Outcomes During The COVID-19 Pandemic In Boston Can Be Attributed To Patient Reluctance To Seek Care

    Christopher Sun, Sophia Dyer, James Salvia, Laura Segal, and Retsef Levi

    PUBLISHED: MAY 26, 2021



    The indirect effects of COVID-19 pose substantial immediate and long-term public health challenges. During the pandemic, patient avoidance and reluctance in seeking emergency care via EMS significantly increased compared with historical baselines. The avoidance of care and resulting possible treatment postponement likely played a critical role in the excess out-of-hospital cardiac arrests observed during the same time. The sustained changes in patients’ care-seeking behaviors and excess OHCA deaths after the initial COVID-19 wave may foreshadow the harmful long-term indirect effects of COVID-19 on health care systems. Ensuring that patients seek timely care during and after the pandemic is essential, to reduce potentially avoidable excess cardiovascular disease deaths.



    Delays in seeking emergency care stemming from patient reluctance may explain the rise in cases of out-of-hospital cardiac arrest and associated poor health outcomes during the COVID-19 pandemic.


    In this study we used emergency medical services (EMS) call data from the Boston, Massachusetts, area to describe the association between patients’ reluctance to call EMS for cardiac-related care and both excess out-of-hospital cardiac arrest incidence and related outcomes during the pandemic. During the initial COVID-19 wave, cardiac-related EMS calls decreased (−27.2 percent), calls with hospital transportation refusal increased (+32.5 percent), and out-of-hospital cardiac arrest incidence increased (+35.5 percent) compared with historical baselines. After the initial wave, although cardiac-related calls remained lower (−17.2 percent), out-of-hospital cardiac arrest incidence remained elevated (+24.8 percent) despite fewer COVID-19 infections and relaxed public health advisories. Throughout Boston’s fourteen neighborhoods, out-of-hospital cardiac arrest incidence was significantly associated with decreased cardiac-related calls, but not with COVID-19 infection rates. These findings suggest that patients were reluctant to obtain emergency care. Efforts are needed to ensure that patients seek timely care both during and after the pandemic to reduce potentially avoidable excess cardiovascular disease deaths.


    Change In Characteristics And Outcomes:

    Beyond increased OHCA incidence, worse OHCA outcomes may also demonstrate the repercussions of patient reluctance and COVID-19. While assessing these relationships, OHCA patient and response characteristics with confounding effects on OHCA outcomes must also be examined. Accordingly, both the changes in OHCA outcomes and cofounding patient and response characteristics were assessed during and after the initial COVID-19 wave, relative to the historical baselines.



    This study supports the hypothesis that treatment delays resulting from increased patient reluctance to obtain urgent care contributed to the increased absolute and relative volume of non–nursing home out-of-hospital cardiac arrest incidence and death during the COVID-19 pandemic. Specifically, the substantial decrease in cardiac calls and increase in hospital transportation refusals during the pandemic supports the hypothesis of increased patient reluctance to seek EMS and in-hospital care.


    As positive cardiac outcomes are dependent on timely treatment after symptom onset,1214 these prolonged delays could explain the significantly increased rates of OHCA incidence and poor outcomes. In fact, these treatment delays may play a larger role in increasing OHCA incidence compared with the direct impact of COVID-19 infection.5,26 


    The Poisson regression analysis indicated that OHCA incidence was strongly associated with increased reluctance to call EMS and the initial COVID-19 wave period, during which barriers of obtaining care were abundant (for example, infection fears, financial instability, and stay-at-home advisories), but not with neighborhood-level COVID-19 infection rates.


    Importantly, patients’ reluctance to seek emergency care and OHCA incidence remained elevated despite the low COVID-19 infection rates and relaxed public health advisories after the initial COVID-19 wave. This not only suggests the greater impact of patient reluctance on excess OHCA incidence compared with COVID-19 infections but also raises concerns regarding the potential long-term indirect effects of COVID-19. Lasting changes in patients’ care-seeking behaviors that worsen the underuse of EMS could result in increased mortality rates for acute conditions.912


    The increased EMS avoidance and hospital transportation refusals during the pandemic were likely driven by patients’ reluctance to obtain care as opposed to unneeded medical attention. The decreased cardiac call volume and higher proportion of OHCAs among all cardiac calls suggests that at least some of the patients were only calling EMS during extreme emergencies. There is also evidence that some patients acted against explicit medical advice and refused transportation to a hospital after calling EMSAt least some of these patients experienced OHCA less than seven days after their initial EMS call, indicating that these refusals occurred despite worsening conditions. Moreover, historically, transportation refusals represent a reluctance to obtain necessary care, as approximately one in five patients refusing transportation received subsequent care at an emergency department within forty-eight hours after their refusal.27,28 Increases in refusal rates during the pandemic may similarly indicate higher patient reluctance to obtain care.

  • 26 May 2021 11:51 AM | AIMHI Admin (Administrator)

    Modern Health Source Articles |Comments Courtesy of Matt Zavadsky

    There are 2 important articles in Modern Healthcare this morning.  Combining them for you to cut out at least one more email for all of you.. 


    The first details an effort by Congress to make some telehealth waivers permanent.  This could be of big interest to EMS agencies and their partners, especially in geography that makes video telemedicine difficult. 


    The bigger impact of the proposal may be the removal of the restriction that the patient be IN a healthcare facility.  This could potentially have 2 impacts on EMS.  1) It could enhance our ability to do things like telehealth enabled patient navigation from a 911 scene, especially in areas with challenging cell coverage; and 2) as CMS further evaluates the expansion of ‘Hospital at Home’ models, EMS could be part of the assessment team for routine or episodic needs of the patient ‘hospitalized’ at home.  One of the CMS PHE waivers specifically allows mobile healthcare paramedics to provide assessments and care to patients that we in this model of care/reimbursement.


    The 2nd article is the data/outcome/utilization of the Medicare preauthorization program for repetitive, non-emergency patients.  Interesting finding, and as result, the program is rollout out country-wide I the fall 2021.


    Interesting times for sure!



    Congress wants permanent Medicare coverage of audio-only telehealth


    May 24, 2021


    Medicare would permanently cover audio-only telehealth visits under a new bill introduced Monday by two members of Congress.


    The bill, introduced by Rep. Jason Smith (R-Mo.) and Josh Gottheimer (D-N.J.), would also remove a requirement that patients receive telehealth services at a health facility for it to be covered by Medicare.


    CMS temporarily waived dozens of limitations on telehealth coverage during the COVID-19 pandemic, but the old restrictions will resume after public health emergency unless Congress acts.


    Providers and members of Congress have argued the waivers should be made permanent, especially to benefit patients who live in rural areas where patients may not have internet access for video calls.


    "This method of healthcare delivery should serve as a bridge to provide better care and remain a permanent option for patients who will not gain access to broadband and technology overnight," Smith said.


    The bill is supported by the Medical Group Management Association (MGMA), Healthcare Leadership Council, and others.


    Before COVID-19, Medicare's coverage of telehealth services was fairly limited. CMS waived dozens of restrictions, making it easier for patients to use telehealth during the pandemic when they were avoiding healthcare facilities.


    Congress is now working to decide which waivers should be made permanent, but some lawmakers have concerns about potential fraud, waste and cost.


    MedPAC has cautioned Congress to temporarily allow targeted telehealth expansion for a few more years to gather more data on costs and outcomes.




    CMS: Prior authorization slashed ambulance transportation by 70%


    May 24, 2021


    Prior authorization dramatically lowered the use of regular, non-emergency ambulance transportation among Medicare beneficiaries without affecting quality or beneficiaries' access to care, according to a government report on Monday.


    Those are the results of a CMS Center for Medicare and Medicaid Innovation experiment to test whether requiring ambulance service providers to get pre-approval for such services would reduce their use among Medicare beneficiaries with End-stage Renal Disease or pressure ulcers.


    Researchers found that prior authorization reduced unnecessary use and spending by more than 70%, lowering total Medicare spending by 2.4%. The findings suggest that expanding prior authorization for regular non-emergency ambulance transportation could save Medicare even more money without affecting beneficiaries' health.


    "That said, we believe these savings would be smaller than those estimated in this report. Given that CMS initially chose model states with particularly high baseline rates of RSNAT use, the findings here may not generalize to states that have more moderate rates of RSNAT use," the report said.


    CMS announced that it plans to expand the program nationwide in September. But it won't add new states until the pandemic is under control.


    According to CMMI, prior authorization reduced Medicare spending among the original states far more than the ones added by Congress. For each quarter, spending in New Jersey, Pennsylvania and South Carolina dropped by $481 per beneficiary compared to just $112 per beneficiary in the congressionally-mandated states.


    The agency has been testing prior authorization for repetitive, scheduled, non-emergency ambulance transportation for its Medicare beneficiaries in several states since 2014 to address concerns about improper payments for those services.



    A study of the impact on prior authorization for repetitive scheduled non-emergent ambulance transport (RSNAT services) found a Medicare model reduced both usage and Medicare expenditures.


  • 24 May 2021 10:39 AM | AIMHI Admin (Administrator)

    CNN Source Article | Comments courtesy of Matt Zavadsky

    Sadly, this scenario is accentuated in rural communities.  But, it’s also a growing challenge in most all EMS agencies, rural, suburban and urban.

    NAEMT, the American Ambulance Association, the International Association of Fire Chiefs, and the International Association of Fire Fighters are collaborating on a number of initiatives to try and help with the major economic challenges facing our nations EMS agencies. 


    Rural ambulance crews are running out of money and volunteers. In some places, the fallout could be nobody responding to a 911 call

    By Lucy Kafanov, CNN

    Sat May 22, 2021

    Worland, Wyoming (CNN)  America's rural ambulance services, often sustained by volunteers, are fighting for their survival -- a crisis hastened by the impact of Covid-19.

    More than one-third of all rural EMS are in danger of closing, according to Alan Morgan, CEO of the National Rural Health Association. "The pandemic has further stretched the resources of our nation's rural EMS."


    In Wyoming, the problem is especially dire. It may have the smallest population in America, but when it comes to land, Wyoming is the ninth-largest.


    In Washakie County, which lies in Wyoming's southern Bighorn Basin, it means a tradeoff for the nearly 8,000 residents living here: While there is vast open space, the nearest major trauma hospital is more than 2.5 hours away.


    On a recent drive from Cody -- the closest town with an airport -- the land stretched endlessly while cattle and wildlife outnumbered people. The sole reminders of civilization were the occasional oil rigs pumping silently in the distance.


    But for the residents, speedy access to emergency medical services -- paramedics and an ambulance -- can be a matter of survival.


    It's a fact Luke Sypherd knows all too well. For the past three years, he has overseen Washakie County's volunteer ambulance service. But on May 1, the organization was forced to dissolve.


    "We just saw that we didn't have the personnel to continue," Sypherd said. "It was an ongoing problem made worse by Covid with fewer people interested in volunteering with EMS during a pandemic and patients afraid of getting taken to a hospital."


  • 13 May 2021 4:17 PM | AIMHI Admin (Administrator)


    Media Contact:

    Jenny Abercrombie

    FirstWatch and the Academy of International Mobile Healthcare Integration (AIMHI) Partner to Fund the Jack Stout Archive at The National EMS Museum

    Online Collection will Showcase the Late EMS Visionary’s Legacy

    Carlsbad, Calif.—FirstWatch, a technology and quality improvement company serving public safety and healthcare organizations, has partnered with the Academy of International Mobile Healthcare Integration to preserve the written legacy of the late EMS visionary Jack Stout. The partnership will fund an online archive hosted by The National EMS Museum, making more than 100 of Stout’s articles and essays available to the public. Many of them appeared in JEMS, the Journal of Emergency Medical Services, beginning with his pivotal series introducing the concepts of high-performance EMS in the May 1980 edition.

    As EMS Week approaches with the theme of, “This is EMS: Caring for our Communities,”

    Keith Griffiths, the founding editor of JEMS and now a partner with the RedFlash Group, noted that

    Stout is known for creating efficiency in EMS systems. However, his philosophy was very much about doing what was best for the patient and their community, according to their priorities and policies.  Griffiths worked with Stout on dozens of his articles and columns. “He was a brilliant communicator and storyteller,” he said, “taking abstract concepts and making them come alive with clear, down-to-earth prose that still resonates today.”

    Known as the “Father of High-Performance EMS and System Status Management,” Stout developed his concepts in the 1970s to improve EMS systems by making them more efficient and focused on patient care. An economist by trade, he found that applying the science, concepts, and economics used in manufacturing provided the framework for standing up high-quality EMS systems that could afford to provide effective and reliable prehospital care.

    Stout’s son, FirstWatch Founder and President, Todd Stout, has granted The National EMS Museum the rights to provide access to all of his father’s articles in a format that’s fully searchable. “Teaming up with AIMHI was the natural and obvious choice to enable The National EMS Museum to ensure my father’s work, which is still so timely today, is available for future generations to learn from,” he said. “We appreciate that JEMS provided a good home for his ideas for more than a decade.”

    The National EMS Museum will digitally transcribe and catalog the documents as part of itsdigital library and research archives—part of the virtual museum program created and maintained by volunteers. Many of the articles are already available in the museum’s online Jack Stout Archive. Additional material will be added in future months.

    “We’re delighted to preserve and share these historical and transformative articles,” said Kristy Van Hoven, the museum’s director.

    “AIMHI is proud to partner with FirstWatch to contribute to the creation of the Jack Stout rchive,” said Chip Decker, president of AIMHI and CEO of the Richmond Ambulance Authority. “His legacy lives on as many of our member organizations were formed around the high-performance principles and practices of Jack’s work—which is increasingly valuable in today’s economically-challenged EMS landscape.”

    The principles established by Stout led to the creation (by him, Jay Fitch, and others) of nationally recognized and award-winning high-performance EMS systems including the Three Rivers Ambulance Authority (TRAA) in Fort Wayne, Indiana; the Richmond Ambulance Authority (RAA) in Richmond, Virginia; Metropolitan EMS (MEMS) in Little Rock, Arkansas; the Regional EMS Authority (REMSA) in Reno, Nevada; the EMS Authority (EMSA) in Tulsa and Oklahoma City, Oklahoma; the Sunstar system in Pinellas County, Florida; and MEDIC in Charlotte, North Carolina. 

    On June 24, FirstWatch will host a special edition of Conversations That Matter—a series of thought-provoking discussions in EMS—to answer the question, “Who Was Jack and Why Do His Ideas Still Resonate?” Facilitators Mike Taigman and Rob Lawrence will be joined by Kristy Van Hoven, Todd Stout, Keith Griffiths, and Jon Washko, a “Stoutian” disciple and highly respected consultant and EMS system expert, to explore why Stout’s ideas remain critically relevant for today’s EMS leader and key to the design of EMS systems of the future. Register for the session now here.  


    About FirstWatch

    FirstWatch helps public safety and healthcare professionals serve their communities through the use of technology and the science of quality improvement. Drawing on deep experience in emergency services, the FirstWatch team develops software and personalized solutions to help organizations continuously improve at what they do. Founded in 1998, and based in Carlsbad, Calif., FirstWatch has partnered with more than 500 communities across North America to improve outcomes, efficiency, safety, and operations. Learn more at:

    About the Academy of International Mobile Healthcare Integration (AIMHI)

    The Academy of International Mobile Healthcare Integration (AIMHI) represents high performance emergency medical and mobile healthcare providers in the U.S. and abroad. AIMHI, formerly known as the Coalition of Advanced Emergency Medical Services (CAEMS), changed its name in March 2015 to better reflect its members’ dedication to promoting high performance ambulance and mobile integrated healthcare systems working diligently to performance and technological advancements. Member organizations are high performance systems that employ business practices from both the public and private sectors. By combining industry innovation with close government oversight, AIMHI affiliates are able to offer unsurpassed service excellence and cost efficiency. Learn more at:

    About The National EMS Museum

    The National EMS Museum is dedicated to preserving and commemorating the history of EMS in the U.S. By collecting historic equipment, books, articles and tools of the trade, the museum showcases how EMS has developed over the last 150 years. Through the study of the past, the museum strives to inspire EMS practitioners and leaders of today to develop new tools and procedures to provide better and more effective emergency care to patients and communities. Learn more at:

  • 6 May 2021 10:40 AM | AIMHI Admin (Administrator)

    From Matt Zavadsky

    For those who may not have heard yet, today, CMS released the waiver on Medicare treatment-in-place for ground ambulance services for the Public Health Emergency.

    Several EMS Association leaders were invited to meet with CMS today as they announced the waiver.

    This provides reimbursement to ambulance services for 911 responses to patients who are not brought to local hospitals due to a community-wide protocol designed to preserve health system capacity.

    Typically, ambulance agencies are only reimbursed if they transport a patient to an emergency room.

    Highlights of the waiver include:

    • Medicare reimbursement for patients treated in place due to a community-wide EMS protocol.
    • For dates of service starting March 1, 2020 and lasting through the end of calendar year in which the PHE ends.
    • Can be billed through May 5, 2022.
    • ALS and BLS base reimbursement eligible, depending on level of service provided.
    • Does not require the use of telemedicine.

    This waiver recognizes the value of the critical role EMS professionals play in the healthcare system.

    THANK YOU to the members and leadership of the National Association of Emergency Medical Technicians, American Ambulance Association, International Association of Fire Chiefs and International Association of Fire Fighters who collaborated to get this important legislation passed.

    Thanks also to the Members of Congress for voting for this waiver, and the staff at CMS who have been very supportive of this initiative.

  • 4 May 2021 10:24 AM | AIMHI Admin (Administrator)

    ABC Source | Comments Courtesy of Matt Zavadsky

    Very well done by ABC News!
  • 30 Apr 2021 9:28 AM | AIMHI Admin (Administrator)

    NYT Source Article | Comments Courtesy of Matt Zavadsky

    A GREAT, but troubling article in the NYT about the plight of rural EMS agencies.  Excellent reporting and insight!

    This is why organizations like NAEMT, the American Ambulance Association, the International Association of Fire Chiefs and the International Association of Fire Fighters, are working together on federal initiatives to help fund rural EMS systems, such as the SIREN Act and reimbursement for Treatment in Place (TIP).

    If you are not part of these efforts, consider lending your support!


    Rural Ambulance Crews Have Run Out of Money and Volunteers

    Strained by pandemic-era budget cuts, stress and a lack of revenue, at least 10 ambulance companies in Wyoming are in danger of shuttering — some imminently.

    By Ali Watkins

    April 29, 2021

    WORLAND, Wyo. — For three years, Luke Sypherd has run the small volunteer ambulance crew that services Washakie County, Wyo., caring for the county’s 7,800 residents and, when necessary, transporting them 162 miles north to the nearest major trauma center, in Billings, Mont.

    In May, though, the volunteer Washakie County Ambulance Service will be no more.

    “It’s just steadily going downhill,” Mr. Sypherd said. The work is hard, demanding and almost entirely volunteer-based, and the meager revenue from bringing patients in small cities like Worland to medical centers was steeply eroded during much of 2020 when all but the sickest coronavirus patients avoided hospitals.

    Washakie County’s conundrum is reflective of a troubling trend in Wyoming and states like it: The ambulance crews that service much of rural America have run out of money and volunteers, a crisis exacerbated by the demands of the pandemic and a neglected, patchwork 911 system. The problem transcends geography: In rural, upstate New York, crews are struggling to pay bills. In Wisconsin, older volunteers are retiring, and no one is taking their place.

    The situation is particularly acute in Wyoming, where nearly half of the population lives in territory so empty it is still considered the frontier. At least 10 localities in the state are in danger of losing ambulance service, some imminently, according to an analysis reviewed by The New York Times.

    Many of the disappearing ambulances are staffed by volunteers, and some are for-profit ambulance providers that say they are losing money. Still others are local contractors hired by municipalities that, strained by the budget crisis of the pandemic, can no longer afford to pay them. Thousands of Wyoming residents could soon be in a position where there is no one nearby to answer a call for help.


  • 7 Apr 2021 9:05 AM | AIMHI Admin (Administrator)

    Kaiser Source Article | Comments courtesy of Matt Zavadsky

    Leave it to the Kaiser Family Foundation to develop another useful tool to evaluate Emergency Department use across all states, or by state!

    This tool could be very valuable for EMS and healthcare officials to make the case about things like EMS patient navigation from 9-1-1 calls and Mobile Integrated Healthcare (MIH) programs designed to reduce preventable ED visits!

  • 6 Apr 2021 7:37 AM | AIMHI Admin (Administrator)

    Stateline Source Article | Comments Courtesy of Matt Zavadsky

    Nice article from the Pew Charitable Trusts about vaccine efforts….  Might be of help for some agencies participating in local efforts.


    Vaccinating the Vulnerable, One Church at a Time


    April 2, 2021

    By: Christine Vestal

    MedStar Mobile Healthcare, a Fort Worth, Texas, regional emergency medical service, hit what leaders there considered a home run recently, vaccinating 757 people in a single day at Mount Olive Missionary Baptist Church, a predominantly Black church on the city’s east side.

    Meanwhile, a mass vaccination clinic at Texas Motor Speedway in north Fort Worth used 16 drive-thru lanes to vaccinate 10,000 residents per day.

    Both approaches are essential, said Mount Olive Assistant Pastor Louis Stewart. “It’s not an either-or situation.”

    Nationwide, health equity advocates and public health experts agree that to outrun the virus and its variants, states and communities must operate mass vaccination sites for those with the time and transportation to get there, while simultaneously launching hundreds of smaller neighborhood efforts designed to meet the needs of the people who have been most devastated by the virus: low-income communities of color.

    To varying degrees, states designed their vaccination campaigns to prioritize vulnerable populations. A new study from the Centers for Disease Control and Prevention uses county-level census data to assess states’ relative success at meeting those goals. Alaska, Montana and Arizona, all states with strong tribal community vaccination programs, were the most successful. At the bottom were Rhode Island, Florida and Idaho.

    Now that age limits for COVID-19 immunization have been dropped in most states, speed and efficiency are more important than ever, public health experts say.

    The federal government is establishing 441 mass vaccination sites across the country with the aim of collectively vaccinating a million people per day. At the same time, vaccine drives organized by state and local health agencies, community health centers, nonprofits and faith-based organizations are proliferating.

    Many of the local efforts are funded in part by nearly $10 billion in federal grants aimed at expanding access to vaccines and better serving communities of color, rural areas, low-income populations and other underserved communities under the Biden administration’s $1.9 trillion American Rescue Plan enacted in March.

    But advocates worry that in the rush to vaccinate the nation’s roughly 250 million adults as quickly as possible, the people most vulnerable to the ravages of the virus will get left behind.

    Black and Hispanic Americans are more likely than White Americans to contract COVID-19 and three times as likely to be hospitalized for the illness. Black and Hispanic people also are at least twice as likely to die from COVID-19 compared with White people, according to the CDC.

    “So far we’re finding the same inequities in vaccine distribution that we find in the health care system as a whole,” said Andi Mullin, director of state and local technical assistance at Boston-based health equity advocate organization Community Catalyst.

    “In nearly every state in the country, White people and wealthier people are getting vaccinated in higher proportions than lower income people and people of color, despite the fact that COVID-19 has had a more devastating impact on these communities,” she said.


  • 5 Apr 2021 7:43 PM | AIMHI Admin (Administrator)

    Harvard Law source | Comments courtesy of Matt Zavadsky

    Very interesting Blog from Mr. Podsiadlo. 

    Lots of highlights, because his opinions may provide some talking points as we chat with public policy officials.

    Tip of the hat to MedStar Operations Director, Chris Cunningham for finding this jewel!


    Pandemic Threatens Future of Emergency Medical Services

    March 17, 2021

    By Benjamin Podsiadlo

    The COVID-19 pandemic has posed persistent, wide-ranging existential threats to effective 911 emergency response.

    The EMS (Emergency Medical Services) system, which sits at the intersection of emergency medicine and public safety, is the out-of-hospital component of the acute care health care system. The EMS mission is targeted at identifying, responding, assessing, treating, and entering suddenly ill and injured patients in the community into the health care system.

    The EMS system’s viability is entirely dependent upon the capacity of its workforce of EMTs, paramedics, and 911 EMS telecommunicators to respond 24/7/365.

    The devastating impacts of the COVID-19 pandemic on EMS include: severe damage to workforce sustainability; grossly insufficient logistical resourcing; and further erosion of cohesive system identity.

    Workforce Sustainability

    The outlook for the EMS workforce’s sustainability is grim. Frontline EMS providers’ wellbeing and livelihood is jeopardized by the pandemic’s persistent economic, mental health, physical health, and social impacts.

    Countless EMTs and paramedics have been infected and sickened by COVID-19. Many have died from coronavirus; the group has the highest COVID-19 mortality rate of all first responders, and one of the highest of health care providers.

    Mental wellness of EMS providers, a longstanding but inadequately addressed concern, reflects extraordinarily high rates of PTSD and suicide during “normal” times. At a baseline, paramedics commit suicide at greater than twice the rate of the general population.

    EMTs are consistently recognized as amongst the lowest-paid essential high-reliability workers in the American workforce by the Bureau of Labor Statistics. The burden upon the nation’s ambulance and EMS response capabilities is now so destabilized by the pandemic that in many cases it has permanently collapsed local EMS provider operations to the point of service disintegration.


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