Excellence in EMS Integration Awards

Washington, DC— Academy of International Mobile Healthcare Integration (AIMHI) announced the winners of the third annual AIMHI Excellence in Integration Awards at Pinnacle last week. Winners not in attendance will receive awards remotely. These prestigious honors celebrate and promote high-performance, high-value EMS, its partners, and leaders.

2021 winners are:

• 2021 AIMHI Excellence in EMS Integration | Texas Health Resources
• 2021 AIMHI Excellence in EMS Integration | Exodus Recovery
• 2021 AIMHI Excellence in EMS Integration | Washoe County, Nevada
• 2021 AIMHI Leadership in Integrated Healthcare | Dr. Janice Knebl, DO, MBA, FACP, MACOI
• 2021 AIMHI Excellence in Education | Pro EMS Refresh 2021
• 2021 AIMHI Excellence in Value Demonstration or Research | Niagara EMS & McMaster University Professor Feng Xie
• 2021 AIMHI Excellence in Value Demonstration or Research | USC & LAFD
• 2021 AIMHI Excellence in EMS Advocacy | US Senator Catherine Cortez Masto
• 2021 AIMHI Excellence in EMS Advocacy | Indiana State Senator Karen Tallian
• 2021 AIMHI Lifetime Achievement Award | Josef Penner
• 2021 AIMHI Lifetime Achievement Award | Jon Swanson

“The 2021 AIMHI Excellence in Integration Award winners represent the very best in mobile integrated healthcare. We are proud to honor these exceptional programs and individuals,” said AIMHI President Chip Decker.

This year’s winners were celebrated at the Pinnacle EMS Conference, those not in attendance will receive their awards remotely.

###

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. 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 members are able to offer unsurpassed service excellence and cost efficiency.

►Download the most recent AIMHI Benchmarking Report at www.aimhi.mobi. 

Jon M. Swanson was raised in central Ohio where he earned his bachelor degree from the Ohio State University in 1970 and later earned his master’s degree from the University of Arkansas in 1980.  He joined the Air Force and entered pilot training in 1971 where he served as a T-38 and C-130 instructor pilot.  During his more than 27 years on active duty he was commander of the 39^th Tactical Airlift Squadron (C-130), the 94^th Intelligence Wing at Ft. Meade, MD and Commandant of the Combat Airlift Delivery School at Little Rock AFB.  His assignments also included lead investigator of a C-130 fatality accident at Jackson Hole WY, UN Truce Observer in Beirut, Lebanon in 1982 and NATO HQ staff officer in Holland.  He completed his career on the Air Mobility Command staff as Chief of Combat Operations retiring in 1998 in the rank of Colonel.

Since joining MEMS in 1998 Mr. Swanson has been trained and certified as an EMT, an Emergency Medical Dispatcher and in Mass Casualty Incident Command.  During his tenure at MEMS he has seen the service area double in size and the run volume triple.  He is a past Secretary/Treasurer and is currently an elected board member of the Arkansas Ambulance Association and serves a state ambulance association liaison to Arkansas General Assembly. 

Under his leadership, MEMS has successfully implemented in-house entry level EMT and paramedic schools which has resulted in a much more diverse work force and improved retention.  He also led the highly successful project to design, deploy and operate the statewide call center for the Arkansas Trauma System which coordinates the movement of seriously injured patients to the closest appropriate hospital across the entire state.  He successfully led the project to amend the state rules and regulations to create a tiered system to use BLS units to respond to lower acuity emergency calls resulting in improved efficiency for the entire system. 

Under his leadership MEMS has provided Law Enforcement First Responder (LEFR) training to over 3,000 state and local law enforcement officers in the use of tourniquets and other life-saving techniques and coordinated grant resources to provide them with tourniquet kits.  This concept was successfully expanded to include similar training and equipment for public schools across the entire state.

During his tenure he has been at the helm through a number of major incidents that demonstrated MEMS’s capabilities under pressure including the crash of American Airlines 1420, the major tornadoes that struck downtown Little Rock in 1999 and Mayflower/Vilonia in 2014, the safe and efficient transfer of patients from the old Baptist Hospital in North Little Rock to the new Spring Hill Hospital, the reception of hundreds hospital patients evacuated to Little Rock in the face of Hurricanes Katrina and Gustav, the evacuation of patients from an area hospital suddenly at risk of flooding, the response to a mass shooting in downtown Little Rock in 2017 with 25 victims and numerous mass casualty events throughout the MEMS service area as well as supporting neighboring communities when needed.  

During his tenure as the MEMS Executive Director the system has completed well over a million and a half transports.  Throughout he has constantly focused on steadily improving the quality of care and patient outcomes, the recruitment and retention of the best people in the industry, the importance of establishing effective partnerships with both the medical community as well as the area first responders, ethical conduct at every level of the organization and diligent attention on safety for patients, employees and the public at large.

Joe Penner is the Executive Director of Medic, the paramedic service for the Charlotte, N.C., area. He's a fellow and board certified in healthcare management by the American College of Healthcare Executives, board member of the American Ambulance Association, board member of the Commission on Accreditation of Ambulance Services, board member for AIMHI, and the chair for the Housing Advisory Board of Charlotte—Mecklenburg.

AIMHI honors Joe for his decades of service to EMS. His leadership and dedication have shaped the careers of countless mobile healthcare professionals.

Advocacy in Integrated Healthcare Award: Recognizing an elected or appointed legislator or regulator from any level of government who has made significant impact on the integration or advancement of EMS.

The Crawfordsville Fire Department would like to recognize Senator Karen Tallian (D4) as this year’s EMS External Award for her exemplary efforts in authoring SB 498 (Community Paramedicine reimbursement). Sen. Tallian is an accomplished public servant from Northwest Indiana, who has brought a wealth of knowledge and experience to the Statehouse for our public safety professionals.

Senate Bill 498 elevates EMS professionals to a provider status with Medicaid, and professionalizes EMS by allowing Community Paramedicine to be financially self-sustainable through reimbursement for services rendered. Actions taken in this bill removes EMS from the stigma of ambulance drivers and transportation agencies, allowing our industry of clinicians to provide patient-centered preventative care.

Sen. Tallian demonstrated great vision and leadership assuring the support needed for the passage of this bill by immediately reaching out to the subject matter experts at local fire departments currently engaged in providing Community Paramedicine for direction. Additionally the Professional Fire Fighters Union of Indiana (PFFUI), and the Indiana State EMS Association was engaged by Sen. Tallian later assisting with bi-partisan support from both legislative houses which resulted in a 47-0 & 97-0 passage of SB 498.

Senate Bill 498 elevates EMS professionals to a provider status with Medicaid, and professionalizes EMS by allowing Community Paramedicine to be financially self-sustainable through reimbursement for services rendered. Actions taken in this bill removes EMS from the stigma of ambulance drivers and transportation agencies, allowing our industry of clinicians to provide patient centered preventative care.

Advocacy in Integrated Healthcare Award: Recognizing an elected or appointed legislator or regulator from any level of government who has made significant impact on the integration or advancement of EMS.

Description of Initiatives & Impacts

Senator Cortez-Masto has a track record of supporting and proposing legislation that addresses disparities in health care and works to improve the health care system. Cortez-Masto represents Nevada - a state in which nearly 10 percent of the population lives in rural or frontier areas - 87 percent of the land mass of Nevada is rural or frontier land. Nevertheless, Senator Cortez-Masto is a tireless advocate for the belief that all Americans have the right to affordable, quality health care.    

In response to provider shortages in rural communities that could affect the health care coverage of nearly 8,000 Nevadans, Cortez Masto cosponsored the Marketplace Certainty Act to stabilize the health care markets, lower premiums for consumers and prevent insurers from leaving rural counties. Senator Cortez-Masto visited REMSA Health in August 2019 to learn more about its partnership with Northern Nye County (an AIMHI Excellence in EMS award-winning partnership) to provide community paramedics and telehealth services in an area otherwise unserved by 24/7 health care. During her visit it was obvious that the Senator has a deep understanding of the complexities of the health care system, as well as how the out-of-hospital health care provided by ambulance transport and mobile health care organizations fit into that landscape - in an urban and rural environment.    

In mid-March 2020, REMSA Health was contacted by Senator Cortez-Masto’s office to arrange a meeting in which she could speak with administrative and operational leaders to learn more about REMSA Health’s immediate needs in response to the COVID-19 pandemic. REMSA Health’s leadership and the Senator’s team spoke again a few months later, as well.    

Senator Cortez-Masto remains supportive of the Affordable Care Act, from which, REMSA Health received a healthcare innovation award to test out new payment models that improve care quality and access while delivering savings to the health care system.    

https://www.cortezmasto.senate.gov/news/press-releases/cortez-masto-aca-brought-lifesaving-innovation-to-washoe-county-repealing-the-law-could-take-us-backward

A recent example of the Senator’s commitment to broadening the position of mobile healthcare was her support of S. 149 - a bill that she, along with Senator Bill Cassidy, M.D. (R-LA), introduced allowing the removal of a barrier that prevented ground ambulance service organizations from being reimbursed for health care services they provide. This bill addressed a specific situation (a community-wide protocol restricting the transport of the patient) during an unprecedented event (a global pandemic). While it doesn’t support all out-of-hospital health care organizations in terms of reimbursement, it does bring into focus the idea that ambulance transport agencies and mobile health care organizations are uniquely positioned to navigate patients to the right level of care - a key component in the overarching goal of stabilizing health care. In a February 2021 article in EMS World, Cortez Masto is quoted as saying, “Nevada’s ambulance organizations are going above and beyond to keep low-risk patients out of the hospital during the coronavirus pandemic. Instead of being rewarded for this innovative, lifesaving work, they’re being penalized by an outdated payment system. I’m proud to introduce legislation that would ensure that ambulance providers are properly paid for all services delivered to Medicare beneficiaries, regardless of whether those patients are transported to the hospital or other healthcare facility.”   

The Senator was honored by the American Ambulance Association as Legislator of the Year in 2021.

Bio

CATHERINE CORTEZ MASTO -  Senator from Nevada; born in Las Vegas, Nev., March 29, 1964; B.A., University of Nevada, 1986; J.D., Gonzaga University School of Law, 1990; admitted to the Nevada bar in 1990; assistant county manager, Clark County, Nev.; chief of staff to Nevada governor Bob Miller; federal prosecutor; attorney general of Nevada 2007-2015; executive vice chancellor for the Nevada System of Higher Education; elected as a Democrat to the United States Senate in 2016 for the term ending January 3, 2023; chair, Democratic Senatorial Campaign Committee (2019-2021).

University of Southern California & Los Angeles Fire Department

Excellence in Value Demonstration or Research: This award recognizes an EMS or non-EMS organization that created and implemented an analysis of data and/or research project to demonstrate the value impact of the services provided by the organization.

Description
Dr. Stephen Sanko and Dr. Marc Eckstein helped create numerous approaches to mobile integrated healthcare, and have published on the implementation, safety and efficacy, and role during COVID of advanced practice providers and community paramedics in 9-1-1 response. Their peer-reviewed publications in the Journal of Emergency Medical Services, Prehospital Emergency Care, and the New England Journal/Catalyst Innovations in Care Delivery are frequently cited by other medical directors and MIH task forces as justification for exploring and implementing novel MIH approaches.

Dr. Sanko is Assistant Medical Director overseeing strategic development and providing medical oversight for the Los Angeles Fire Department Mobile Integrated Healthcare Unit. Dr. Marc Eckstein is the EMS Bureau Commander and Medical Director of the Los Angeles Fire Department. LAFD is the second largest municipal EMS provider agency in the United States. Since 2015, its mobile integrated healthcare responders have attended over 7000 9-1-1 patients, and worked closely with alternate destinations and patient liaisons to track patient outcomes.

Description of Data & Methodology

In January 2017, the Dr Sanko and Dr Eckstein co-authored a peer-reviewed description of the implementation of the LAFD Nurse Practitioner Response Unit (NPRU) for the Journal of Emergency Medical Services. A precursor to the later Advanced Practice Response Unit (APRU), this NRPU combined the skills of a Nurse Practitioner with emergency experience and a firefighter/paramedic to offer treatment-in-place and alternative destination transport in downtown and South Los Angeles. It also provided the first published narrative reflections on the unique nature of this new model of care delivery from the perspective of the team member.

In 2019, Sanko and Eckstein co-authored a report for Prehospital Emergency Care describing the first year of the Advanced Practice Response Unit Program. This included a description of services provided, provider impressions, patient dispositions/outcomes, and the impact on other non-MIH 9-1-1 resources. Importantly, it provided one of the earliest assessments of safety and efficacy for 9-1-1 mobile integrated healthcare in a large US city.

In February 2021, Sanko and Eckstein published a peer-reviewed report in the New England Journal of Medicine/Catalyist Innovations in Care Delivery on the importance of MIH in confronting the COVID-19 pandemic in Los Angeles. In addition to demonstrating how multiple strategies can interact and complement eachother in 9-1-1 MIH, this paper also provided one of the first descriptions of per-incident cost savings through MIH-care compared to standard EMS care.

The authors have presented numerous other abstracts at national conferences on both NPRU, APRU, community paramedicine and 9-1-1 telemedicine use in EMS.

Supporting Links
https://www.jems.com/mobile-integrated-healthcare/nurse-practitioner-response-unit-launched-in-los-angeles/     

https://www.tandfonline.com/doi/pdf/10.1080/10903127.2019.1666199?needAccess=true

https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0383

Advanced Practice Providers in the Field Implementation of the Los Angeles Fire Department Advanced Provider Response Unit.pdf

Excellence in Public Information or Education: This award recognizes an EMS or non-EMS organization that has developed and implemented an effective public information or education campaign designed to encourage patients, members, or the public to develop or maintain healthy lifestyles, or to more effectively utilize healthcare resources.

Executive Summary

Refresh 2021, the free, online CAPCE Accredited NCCR program has delivered a much-needed free education program to the nation in the height of the pandemic.  As of April 1, a total of 26,660 medical professionals from 103 countries enrolled in Refresh 2021 (95% from the USA).  The Learning Management System platform has delivered (currently) over HALF A MILLION class hours and 11,000 providers have completed the required 30 hours of class to receive their NCCR certificate of completion.  We fully expect the remaining enrollees to complete the class and receive their CAPCE credit.  In terms of costs, research identified that the 30-hour NCCR program was being offered by online education vendors at between $150 – 200.  At a modest $150 comparator, Refresh 2021 has provided 4 MILLION DOLLARS worth of free education to our providers in their moment of need.

Narrative

With the advent of the COVID pandemic and the requirement to maintain currency and paramedic certification it became very clear, very quickly that the nations EMTs and paramedics, may well run into difficulty and expense in re-certifying.  A collection of the nation’s top educators grouped together to create 30 hours of CAPCE certified, online education free to all that participated.  The program is known as Refresh2021.  The program is hosted online and administrated by Prodigy EMS, who also process all the CAPCE credit and associated certification in line with the National Continued Competency Program (NCCP).

The National Continued Competency Program (NCCP) was constructed using a methodology similar to that of the American Board of Medical Specialties requirements and streamlines the recertification process into three strategic categories of continuing education: National, Local, and Individual. Refresh 2021  provided a complete free package of continuing education to meet local operational needs.

The project was the brainchild of Tom Bouthillet, Battalion Chief of EMS at Hilton Head Island Fire Rescue who noted ‘NREMT waived the limits on distributive education limits for this recertification season due to COVID-19. That means we have a unique opportunity to crowdsource a spectacular educational experience for EMTs and Paramedics around the world’ To move the project along and to provide guidance and technical expertise, a project board consisting of Drs’ Peter Antevy, Paul Pepe, Kelly Bouthillet, Remle Crowe, and EMS Thought leaders James DiClemente (Pro EMS), Keith Griffiths, Brian LaCroix, Rob Lawrence (Pro EMS), and Mike Taigman. 

Very quickly, a host of household EMS names signed on to provide content, safe in the knowledge that it will offer a free, CAPCE credit gaining, training program for those that have been on the front lines for the majority of 2020, enduring not only response to COVID but also natural disasters from Hurricanes and wildland fires and bouts of response to civil disorder.

The power of social media has played a part in promoting Refresh2021. Because of the fact that Prodigy EMS is a Learning Management System (LMS) that was offering free content, and therefore directly competing against the offerings of other EMS trade LMS systems, a limited opportunity existed for widespread trade news publicity. However, Refresh and Prodigy developed a social media campaign and with the targeted use of key EMS media influencers, crowd sourced the applicants for the program.  A twitter ‘teaser’ campaign (@Refresh2021) began in mid-November prior to the launch and has continued since.

Refresh 2021, the free, online CAPCE Accredited NCCR program has delivered a much-needed free education program to the nation in the height of the pandemic.  As of April 1, a total of 26,660 medical professionals from 103 countries enrolled in Refresh 2021 (95% from the USA).  The Learning Management System platform has delivered (currently) over HALF A MILLION class hours and 11,000 providers have completed the required 30 hours of class to receive their NCCR certificate of completion.  We fully expect the remaining enrollees to complete the class and receive their CAPCE credit.  In terms of costs, research identified that the 30-hour NCCR program was being offered by online education vendors at between $150 – 200.  At a modest $150 comparator, Refresh 2021 has provided 4 MILLION DOLLARS worth of free education to our providers in their moment of need.

Registration for Refresh 2021 is open for all of calendar year 2021 and the landing page and registration can be accessed here: https://link.prodigyems.com/refresh2021

Organization Overview
Professional Ambulance Service (Pro EMS) has proudly served the City of Cambridge, Massachusetts since 1969, providing emergency medical services in cooperation with the Cambridge Fire, Police and Emergency Communications Departments. In addition to serving the City of Cambridge, Pro EMS provides emergency medical services to Harvard University and the Massachusetts Institute of Technology. Pro EMS partners with Emerson Hospital, located just north and west of Cambridge, to provide advanced life support (ALS) services to the eight communities of the Central Middlesex Emergency Response Association (CMERA).

Pro EMS was the first ambulance service in Massachusetts to be accredited by the Commission on Accreditation of Ambulance Services (CAAS), and recognized as an Accredited Center of Excellence (ACE) by the International Academies of Emergency Dispatch. Pro EMS is only one of 32 systems in the United States that has received both accreditations which are considered the “gold standard” for ambulance services, certifying distinction for quality patient care and ambulance operations.

Visit http://proems.com for further information.

Pro EMS's Training and Education division is known as Prodigy EMS  Recognizing a considerable deficit in e-Learning targeting the pre-hospital setting, Pro EMS Center for MEDICS set out to create an in-house system for high quality education, delivery, and tracking.  After several internal iterations, PRODIGY was launched in late 2016. The Prodigy platform offers live classes, real cases and engaging content delivered by Subject Matter Experts in meaningful real-life applications. The extensive course offerings reflect not only the recertification requirements set forth by the NREMT, but also courses focused on occupational health and safety, compliance, best practices, and lectures from professional pre-hospital conferences.

Date of Implementation: 12/15/2020

Description of Outcomes / Utilization / Change
At the time of drafting, 11,000 medical providers have completed their NREMT, NCCR required recertification.  as 2021 continues, this number will grow.

Budget:

The underlying principle of this program was that it was, and is, free to the user / student.

The Refresh 2021 program costs have been totally absorbed by the core team of Pro EMS / Prodigy EMS.  We estimate about 10 hours per week of management and administration time goes into technical support and social media generation.

The value of the education product offered for FREE is currently estimated to be $4 million.

Estimated Reach: Currently, 26,000 EMS personnel have enrolled.  But the program has personnel from 103 countries within that number.  Refresh 2021 is officially a global 'FOMed" activity (Free Online Medical Education)

Supporting Links
https://www.ems1.com/ems-products/education/articles/ems-leaders-doctors-partner-to-provide-free-online-recertification-program-INupGPbWED8RFxQp/

Leadership in Integrated Healthcare Award: This award recognizes an individual who has made significant impact on the integration of EMS, or the advancement of the integration of EMS into the healthcare system.

Description of Initiatives & Impacts

Janice Knebl, DO, MBA, FACP, MACOI

We would like to nominate Dr. Janice Knebl for the AIMHI Leadership in Integrated Healthcare Award. 

Dr. Knebl is a Professor of Geriatrics, and Director of the Center for Geriatrics, at the University of North Texas Health Science Center.  She has been a staunch advocate for promoting the inclusion of EMS in the greater healthcare system through numerous initiative outlined below.

“WE HAIL” GPLI Initiative

Dr. Knebl is a pioneer in the treatment of older adults and has made a lasting impact on geriatric training for osteopathic medical students and health care professionals.  In 2015, Dr. Knebl and her team helped craft the “WE HAIL” program, Workforce Enhancement in Health Aging and Independent Living, with funding from the Health Resources and Services Administration.

Through the “WE HAIL” program, Dr. Knebl created the Geriatric Practice Leadership Institute (GPLI), which prepares interdisciplinary teams of early and mid-career healthcare professionals to become clinical leaders in their organizations using the Age-Friendly Health Systems 4Ms Framework. 

For the past three years, Dr. Knebl has included MedStar Mobile Healthcare in the GPLI program.  Projects completed by the MedStar teams involved in the institute include:

Mitigating Physiological and Environmental Fall Risks in the Mobile Integrated Healthcare Population with Individualized Interventions

• This project led to the development and implementation of a comprehensive fall risk assessment and follow-up for persons over 65 who accessed the 911 for a medical emergency.

Training or Transport: Improving Dementia Caregiver Understanding to Improve Outcomes

• The project developed a comprehensive approach to training EMS providers and other caregivers on how to identify and manage patients suffering from dementia.
• Project outcome was awareness to the issue of lacking health literacy and cultural competency of dementia caregiver and first responder education and support and creating tools that can immediately impact education needs of the clients and public served by both MedStar and the Alzheimer’s Association as well disseminated best practices for use in hospitals and healthcare.

HRSA Fall Risk Assessment/Intervention Study –

Dr. Knebl is also the principle in 5-year study grant from the Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services.  This study addresses issues related to fall prevention and education for EMS providers.  This project includes:

• Education for EMS personnel on the fall risks to assess in the patient’s home setting.
• The implementation of a comprehensive fall-risk screening for all EMS encounters for patients 65 or over.
• Training for EMS personnel on the use of the screening tool.

As an add-on to the study, HRSA offered additional funding for COVID-related needs in the community.  Dr. Knebl reached out to MedStar to collaborate on identification and implementation of service enhancements for the homebound elderly in our community who may be struggling through isolation as a result of the pandemic.  The program included a partnership between Tarrant County Meals on Wheels and MedStar.  Volunteers from Meals on Wheels identified clients that would likely benefit from an in-home assessment by a MedStar Mobile Healthcare Paramedic.  The short-term project provided enhanced assessments and resource referrals for over 110 homebound seniors in our community.

For these and countless other reasons, we feel that Dr. Knebl is very worthy of this award!

Biography

Dr. Knebl is a Professor of Geriatrics, and Director of the Center for Geriatrics, at the University of North Texas Health Science Center.  She has been a staunch advocate for promoting the inclusion of EMS in the greater healthcare system through numerous initiative outlined below.

Dr. Knebl is currently the Dallas Southwest Osteopathic Physicians’ Endowed Chair in Clinical Geriatrics, Interim Chair of the Department of Internal Medicine & Geriatrics, and Director of the Center for Geriatrics at the University of North Texas Health Science Center (UNTHSC). She is a faculty member at the Texas College of Osteopathic Medicine’s (TCOM) Institute for Healthy Aging and medical director for several local assisted living and memory care centers in the Fort Worth area. A nationally respected leader in treatment, research, and education related to Alzheimer’s and dementia, in 2019 Dr. Knebl received a $3.75 million, five-year grant from the Health Resources Services Administration’s Geriatric Workforce Enhancement Program to fund the UNTHSC Workforce Enhancement in Healthy Aging and Independent Living program. This award-winning program is working to transform clinical training environments for health care professionals and caregivers to better meet the needs of local older adults, many of whom live in rural communities.

Dr. Knebl holds an impressive list of professional appointments. She serves as Board Chair of the National Board of Osteopathic Medical Examiners (NBOME)and sits on the National Quality Forum’s Geriatrics and Palliative Care Standing Committee. She is a former Chair of the Commission on Osteopathic College Accreditation and Alternate Negotiator the U.S. Department of Education to the Negotiated Rulemaking Committee. At UNTHSC, Dr. Knebl holds positions on the TCOM Academy of Medical Educators, the TCOM Curriculum Committee, and the TCOM Executive Committee.

Excellence in EMS Integration Award: This award recognizes a non-EMS organization that has developed and implemented a partnership with EMS organizations that have demonstrated enhancement of patient experience of care, improved patient outcomes, or reduced the cost of healthcare.

Description
In March 2020 as the COVID-19 pandemic arrived in northern Nevada, Washoe County municipal leaders identified the critical and immediate need to launch a resource that would connect residents to accurate information, provide answers to questions and triage callers concerned about possible COVID-19 symptoms. The county already had in place a 24/7 telephone line (311) for residents seeking information about non-emergency government matters. However, that line was quickly overwhelmed and not able to fully meet the needs of the callers.    

Washoe County manager Eric Brown reached out to REMSA Health’s president and CEO, Dean Dow seeking assistance. Recognizing REMSA Health’s experience as a secondary PSAP and its expertise as an internationally accredited medical dispatch center, Washoe County asked REMSA Health to stand-up a 24/7 call center for residents to have their symptoms triaged and  to facilitate testing and contact tracing. The request came on a Saturday and by Thursday - just five days later - the triage line was staffed and active.     

The COVID-19 Community Triage Line is an example of the problem-solving strengths that can develop from a public/private partnership. The Community Triage Line allowed residents to speak to non-medical call center representatives with questions related to symptoms, exposure, social distancing, where to seek testing and care, and other available pandemic-related community resources.    

With Washoe County’s approval, REMSA Health coordinated with the University of Reno, School of Medicine for staffing support. Since the medical school students had to rearrange their clinical and class time due to pandemic-related changes, they were available to assist with staffing while earning field credit for providing pandemic/MCI style triage. It is estimated that the students provided thousands of hours of call center coverage from March through September 2020.     

Washoe County’s Community Triage Line mobilized across several departments at the two agencies. Information Technology pros had to coordinate so that call center decision trees were accurate and that calls could be transferred appropriately if necessary. Clinical and epidemiological staff from REMSA Health and Washoe County respectively, worked together to develop meaningful questions about exposure, symptoms, underlying health conditions and whether the caller needed further patient guidance through REMSA Health’s Nurse Health Line.  Public Information Officers and Joint Information Center representatives worked with regional media, as well as created owned content to promote the triage line as the central spot for all COVID-19 symptom/exposure related information.    

Washoe County’s Community Triage Line is an outstanding example of how the industry-wide characteristics that EMS is known for can support municipalities and government agencies in times of extraordinary need. Mobile healthcare is nimble, responds with intention, is a community’s safety-net provider and is able to provide care and resources in austere environments - including over the phone. EMS is in a constant state of readiness and able to pivot. Expertise in emergency communication and the training to manage mass events sets apart EMS providers from other healthcare or municipal-based organizations. The willingness of Washoe County’s leadership to recognize REMSA Health’s ability to provide a solution in a time of crisis is to be commended. Washoe County was focused on protecting citizens, mitigating the possibility of overwhelming the regional healthcare system and navigating callers to the right resource. In the midst of a global pandemic, Washoe County leaders doubled-down on their value of Quality Public Service - they placed the needs and expectations of the public at the center of their response to COVID-19.    

REMSA Health’s expedient and comprehensive response to the Community Triage Line request demonstrated its agility resulting in Washoe County relying on them for additional pandemic-related mobile healthcare needs including COVID-19 testing for homebound citizens, the safe transport of COVID-19 positive patients between social service agencies, and COVID-19 vaccination of homebound citizens. This is further validation that government bodies and private organizations that share a commitment to innovation and excellence can achieve improved public health outcomes.

Organization Overview
Washoe County is the second most populous county in Nevada and covers more than 6,500 square miles. Narrow and tall along the western edge of the state, there are more than 470,000 residents and during busy special event years, it can welcome up to 5 million visitors a year. There are two incorporated cities within Washoe County - Reno and Sparks, as well as unincorporated county land. Washoe County’s mission is: Working together regionally to provide and sustain a safe, secure and healthy community. Their values are integrity, effective communication and quality public service.

Date of Implementation: March 20, 2020

Number & Demographics of Patients/Members
28,514

Description of Outcomes / Utilization / Change
The Community Triage Line allowed Washoe County to streamline its screening protocols. The phone call volume consistently trended upward and it closely matched the county's daily new cases metric data points indicating that as cases in the county increased, the need for the call center's resources increased.

Supporting Links
https://www.remsahealth.com/news/remsa-and-wchd-announce-covid-19-community-triage-line/

Excellence in EMS Integration Award: This award recognizes a non-EMS organization that has developed and implemented a partnership with EMS organizations that have demonstrated enhancement of patient experience of care, improved patient outcomes, or reduced the cost of healthcare.

Description
Since 2016, Exodus Recovery has served as an alternate destination for 9-1-1 patients with acute mental health exacerbations or isolated alcohol intoxication attended by the Los Angeles Fire Department. Exodus runs several mental health urgent care centers around Los Angeles County offering crisis stabilization services, and runs the only Sobering Center in Southern California - located in Skid Row. Exodus worked closely with the LAFD Mobile Integrated Healthcare Unit to develop protocols and procedures to receive 9-1-1 patients so that they would not have to go to the emergency department. LAFD Advanced Practice Providers and/or alternate destination paramedics have applied medical clearance criteria to identify select patients for transport to Exodus facilities. This has led to thousands of patients being safely navigated to more appropriate care, putting EMS personnel and ambulances back into service more quickly and freeing up ED bed space in the busiest parts of the City of Los Angeles.

Organization Overview
Founded in 1989, Exodus Recovery, Inc. provides high-quality psychiatric and chemical dependency treatment services in collaboration with local hospitals and emergency medical service providers throughout Southern California. For the LA County Department of Mental Health, Exodus has developed and implemented an Integrated Service Agency Program (PARTNERS), an Adult Targeted Case Management Service Program, a Sidekicks Co-Occurring Disorders Program, an AB2034 Program, and an Alcohol and Drug Medi-Cal Contracted Program. Also, through LAC-DMH and the California Mental Health Services Act expansion and transformation, Exodus has developed and implemented additional Full-Service Partnership Programs, Wellness Center Programs, Field Capable Clinical Services Programs and Psychiatric Urgent Care Centers. In San Diego County, Exodus has established and operates two Mental Health Walk-In Assessment Centers, an AB 109 Program and Project Connect, a program contracted with the San Diego Regional Center.

Date of Implementation: May 2016

Number & Demographics of Patients/Members
2544

Description of Outcomes / Utilization / Change
From May 2016 through May 2021, over 2500 patients have been transported by LAFD to Exodus facilities, saving an estimated 25,000 hours in local ED bed time in downtown, East and South Los Angles. Less than 1% of mental health patients and <2.5% of intoxicated patients have required secondary transport to the emergency department.

Supporting Links
The following peer-reviewed journal article provides an overview of the first year of activity in this collaboration.  https://pubmed.ncbi.nlm.nih.gov/31621447/