Kentucky EMS Task Force Meeting - PowerPoint Presentation

1. Kentucky EMS Task Force MeetingChris “Blue” BartleyState Policy and Legislative RepresentativeAugust 16, 2022

2. Kentucky EMS Task Force MeetingTopics to DiscussHistory of EMS and the EMS in the Fire ServiceTrends in EMSEMS Shortage was already occurringShortage Exacerbated by the PandemicFire Departments have been forced to fill the gapsFire-Based EMS synopsisSolutions/Proposals in other States

3. Kentucky EMS Task Force MeetingHistory of EMS and the Fire ServiceNearly 60 years ago, there was no real EMS in the United States. You were likely picked up by a funeral homeLikely transported in a “paddy wagon” with nobody attending to you needs in the backAttendants had little to no experience in medical trainingEMT’s and Paramedics did not existBetter survivability in a combat zone overseas than in the United States due to the immediate treatment and transport to a MASH unit

4. Kentucky EMS Task Force MeetingEMS History and the Fire ServiceWhite Paper released in 1967, “Accidental Death and Disability: The Neglected Disease of Modern Society.”1968, Committee of Highway Traffic Safety Drafts of BLS and ALS training standards Principles of a 9-1-1 system and Recommendation of a national certification agency Dr. Eugene Nagel "Father of Paramedicine” Miami FD (1969)Standards for ambulance design and Equipment were publishedEMS Systems Act of 1973 passedPut EMS under the National Highway Traffic Safety Administration

5. Kentucky EMS Task Force MeetingFire-Based EMS HistoryDr. Nagel worked with Miami FDLexington FD: Began providing EMS and ambulance transports in 1969. EMERGENCY! Credited for raising demand for medics and advanced medical training in the pre-hospital environment

6. Kentucky EMS Task Force MeetingFewer People are Interested in EMS Work1/5 of healthcare workers have quit their jobs- Morning Consult Report 10/4/21EMS like the rest of public safety is seeing a workforce shortage. Recruiting and retention in EMS was already and issue before COVID but the pandemic exacerbated the issueParamedics make a great alternative to nurses. Many have gone to work in the hospitals for much higher pay, benefits and working in a more controlled environment

7. Kentucky EMS Task Force MeetingEMS Trends TodayPrivate For-Profit EMS struggle with recruitment and retainment of employees and are struggling to remain profitableVolunteer-based organizations also struggling to recruit/retainRural areas continue to struggle with providing serviceAbrupt closures have increased during the COVID pandemicWhen EMS organizations close, the fire service have been filling the gapFire departments need increased support as they continue acting as the safety net

8. Kentucky EMS Task Force MeetingEMS TrendsEMS was already trending more towards a Fire-Based system before the pandemicAround 2010-2015, large cities like KC, Philadelphia, and Orlando made the move Smaller communities like: Garner, NC, Belchertown, MASeeing more mergers of counties and districts to maximize services to the citizensSingle role medics and EMT’s are being hired by fire departments to bridge the gap

9. Kentucky EMS Task Force MeetingContinued Trends to Fire-Based EMS “Atlanta officials to launch city-owned ambulance service due to agency’s delays” -EMS1 7/5/22“Uhrichsville, OH FD will take over EMS in the city after a vote in city council to cancel contract with Smith Ambulance.”- The Times-Reporter, New Philadelphia, OH 2/3/20The Villages, FLBlack Jack, MOJefferson County, KY Fire Districts

10. Kentucky EMS Task Force MeetingWhat is Fire-Based EMSFire service is the predominant provider of EMS transport in the United States97% of the 200 most populated communities use fire-based EMSFire-based EMS uses the fire service’s infrastructure to provide EMSNearly all fire fighters have some level of EMS trainingEMS is a component of the fire service’s all-hazards response mission

11. Kentucky EMS Task Force MeetingVersatility of the Fire-Based System

12. Kentucky EMS Task Force MeetingAdvantages of Fire-Based EMSFire departments are government entities and have no profit motive, therefore the priority is the patient/taxpayerMulti-role fire/EMS personnel deployment model is more robust than any other system. It provides seamless transition of care throughout all stages of any emergency response (mitigating fires, medical emergencies, hazardous materials, technical rescues, and community risk reduction programs)EMS is not a distraction from our mission- It is a core service provided by fire fighters and paramedics within the department

13. Kentucky EMS Task Force MeetingAdvantages of Fire-Based EMSResponse time is the absolute priority for medical emergencies. Fire fighters are in the best position to respond quickly and provide vital services on scene. Fire-based EMS systems are strategically positioned to deliver time critical response, effective patient care and scene safetyFire Departments strive to meet the public needs by achieving response time standards established through the National Fire Protection Association (NFPA) of four minutes for basic life support (BLS) and eight minutes for advanced life support (ALS).Fire Departments historically have very low turnover rates. They are long-term workers in their communities and know about community needs including those related to emergency medical response

14. Kentucky EMS Task Force MeetingAdvantages of Fire-Based EMS Use of Emergency Medical Dispatch system through 911 that properly prioritizes calls Continuity of patient care between first responders and ambulanceContinuity of administration (pay and benefits, hiring, training, promotional process)Continuity of Medical DirectionContinuing Quality Assurance/Improvement Unity of CommandContinuity of same medical equipment

15. Kentucky EMS Task Force MeetingEMS Reimbursement SourcesMedicare and Medicaid only reimburses upon transport to an ERNo reimbursement for first response or non-transport apparatusMedicare reimburses approximately 50% of the actual costMedicaid reimburses approximately 10% of the actual costPrivate insurance is inconsistent with payment amounts due to in/out-of-network status of fire departmentsIAFF supports requiring insurers to consider all fire-based EMS as in-network to avoid surprise medical bills for patients

16. Kentucky EMS Task Force MeetingEMS InnovationTreatment in Place (TIP)Allows EMS personnel to provide on-scene treatment without transportIdeal for low acuity emergencies including falls and diabetic issuesSaves patients time and money by avoiding unnecessary ER visitsVery limited Medicaid and private insurance reimbursementsTelehealthUtilize EMS personnel to facilitate telehealth consultation with physiciansNo Medicare, Medicaid, or private insurance reimbursement

17. Kentucky EMS Task Force MeetingEMS Innovation Continued Transportation to Alternative DestinationsAssist patients in accessing urgent care clinics, mental health providers, etc.Some cities exploring Lyft/Uber to assist with non-emergency medical transportation Other InnovationsRe-authorize and increase the ground ambulance add on payments (Usually done for 6-24 months at a time. If extended for several years it would end a band-aid approach and make more permanent adjustments to reimbursements, assisting in planning EMS budgets)Properly count EMS Providers Community Paramedicine

18. Kentucky EMS Task Force MeetingOther Things to ConsiderStakeholder Engagement is vitalThere is a physical/mental toll on EMS workers as well as fire fighters. There will be a need to help these first respondersEMS needs to be categorized as an essential service Funding needs to be available for emergent, urgent and preventative care provided by EMS (telemedicine, alternate destinations, training, recruitment and retention and community paramedicine)Pay, benefits, defined benefit retirements, and work-life balance must be seriously considered for personnel

19. Kentucky EMS Task Force MeetingQUESTIONS?

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