Pandemic Response 

Listening Session

June 2022

Mission Statement

We. support. and. strengthen. fi.re. and. emergency. medical.

services. and. stakeholders. to. prepare. for,. prevent,. mitigate.

and.respond.to.all.hazards.

Table of Contents iii

Table of Contents

Executive Summary...................................................................................................... 1

Workforce............................................................................................................................ 1

Logistics and supply chain................................................................................................ 2

Business operations and continuity................................................................................ 2

Agency funding, grants and reimbursement................................................................. 3

Purpose and Organization .......................................................................................... 5

Issue categories.................................................................................................................. 5

Workforce..................................................................................................................... 5

Logistics and supply chain.......................................................................................... 7

Business operations and continuity......................................................................... 9

Agency funding, grants and reimbursement........................................................... 12

Conclusion..................................................................................................................... 15

Attendees and Organizations..................................................................................... 17

In-person attendees.......................................................................................................... 17

Virtual attendees................................................................................................................ 18

Acronyms....................................................................................................................... 19
iv Pandemic Response Listening Session
Executive Summary 1

Executive Summary

On Oct. 21-22, 2021, the U.S. Fire Administration (USFA) hosted a national-level

pandemic response listening session at the National Emergency Training Center in

Emmitsburg, Maryland.

The 2-day session provided an opportunity for the over 40 national stakeholder

representatives to discuss the challenges and impacts of the ongoing COVID-19

pandemic on fire departments, emergency medical services (EMS), 911 dispatch

telecommunicators and other response agency operations. These discussions

provided insight to the complexity of the pandemic response as participants discussed

their challenges and provided their proposed potential solutions that spanned state,

local, tribal and territorial (SLTT) boundaries.

To aid the discussion, issues were divided into 4 categories:

1. Workforce.

2. Logistics and supply chain.

3. Business operations and continuity.

4. Agency funding, grants and reimbursement.

Many of the participants’ issues and solutions spanned 2 or more categories and

recurred throughout the discussions. Stakeholders identified the following impacts

within each category.

Workforce

The stakeholders conveyed that the COVID-19 pandemic negatively affected the fire

and EMS first-response agency workforce in several ways. The most prominent impact

was the lack of available personnel to fully staff shifts for 911 dispatch and response.

Fewer available personnel resulted in fewer staffed units, leading to longer response

times and diminished incident mitigation capabilities, affecting patient outcomes.

From the beginning, during case escalation and persisting throughout the global

pandemic, the overall capability of emergency response organizations to recruit, train

and retain a first- responder workforce has been greatly diminished. This was due to

public health restrictions; staff who normally worked these nonresponse positions

were assigned back to their response duties, leaving vacant the positions intended to

address roles such as training and recruitment.

Participants shared that responder health and safety were also negatively affected as

continual changes in scientific guidance based on new findings was communicated to

the field. Initially, the science regarding the coronavirus was very broad, being refined

as additional data became available. Frequent changes led to significant confusion and

varied local concurrence. Stakeholders shared that their agencies struggled to decipher

and meet requirements through unclear and inconsistent policy and procedural changes.

Often, new requirements were provided without the necessary guidance or training. New

information from the scientific community needed to be articulated in a manner specific

for first responders to ensure implementation by local response agencies.

According to listening session participants, first responder behavioral health issues

were greatly exacerbated during the pandemic. Health issues were brought on

by increased worry, continual stress, more frequent exposure to post-traumatic
2 Pandemic Response Listening Session

stress triggers, extended work cycles, and family concerns that resulted in personal

struggles. These directly impacted the provision of emergency response services. 

Infection control quickly became a problem due to the initial lack of sufficient and

approved personal protective equipment (PPE).

Logistics and supply chain

Participants shared that the COVID-19 pandemic caused significant logistics and

supply-chain issues for first responder agencies. This situation disrupted agency

operations and negatively affected workforce safety and health. In part, this situation

was due to shortages of appropriate PPE and insufficient distribution and allocation

of materials that were available to responders. When testing and vaccines became

available, there was difficulty in gaining access to them to enable responders who

had been exposed or who had COVID-19 to return to or remain at work. Participants

felt that in some circumstances, EMS was not considered part of the health care

community and therefore not placed in the same primary tier as other health care

providers for distribution of PPE, testing or vaccines.

Also, listening session participants shared that there were significant preliminary

challenges in acquiring decontamination tools and agents for responders. In addition

to PPE decontamination, all equipment (e.g., litters, defibrillators, oxygen kits and

other durable equipment) as well as vehicles needed to be decontaminated to

protect responders and patients. The guidance for decontamination and reuse of

PPE, equipment and vehicles was continually changing as more information about

COVID-19 became available. This resulted in significant confusion and inconsistency

as leaders struggled to keep pace with the information to update policies, procedures

and training protocols.

Business operations and continuity

Participants shared that the pandemic affected the response capability and continuity of

operations for emergency response agencies nationwide. Many state and federal entities,

such as Centers for Disease Control and Prevention (CDC) and the Federal Emergency

Management Agency (FEMA), did not consider EMS responders as health care providers.

This hindered access to necessary protective items (i.e., PPE, tests, vaccinations) and

other items (i.e., cleaning supplies, personal hygiene items) required for ongoing

operations, further impairing response operations. This limited responders’ ability to

obtain needed protective resources and left them more vulnerable while providing EMS

care in less-controlled environments such as people’s homes and businesses.

They also shared issues procuring routine supplies and medications to maintain

response operations for patients who did not have COVID-19. There were significant

internal and external communication problems due to the unusual national scope of

the pandemic and as the science changed, it required changes to federal and state

guidance. The frequency of updated guidance and the communication of necessary

changes resulted in significant challenges to the revision of agency policies and the

retraining of personnel for safe operations.

Maintaining the needed operational response tempo became difficult with fewer

staff available. State emergency regulation changes, certification and credentialing

requirements, response policies, etc., affected those who responded across state
Executive Summary 3

lines. According to participants, the lack of inclusion of EMS in the federal Emergency

Support Functions (ESFs) as a prehospital provider of health care hindered EMS from

receiving the same federal level of attention as other emergency responder and health

care providers.

Agency funding, grants and reimbursement

Funding issues during the pandemic were significant, with cities seeing tax revenues

decrease, which affected fire and EMS agencies’ existing budgets. This will also likely

have a negative impact on future-year budgets. 

Listening session participants shared that for career and combination (those

departments that include career and volunteer workforce) departments, there were

significant issues with overtime, backfill and hazard pay. All agencies experienced the

need to buy additional, unplanned quantities of PPE and other necessary equipment.

Volunteer and combination fire and EMS organizations that rely on fundraising (e.g.,

barbecues, fish fries, rodeos, carnivals, etc.) experienced canceled fundraising events

due to emergency pandemic public- health regulations. Monetary or in-kind donations

also decreased due to many local business closures or reduced hours of operation.

Although some grant money became available, some small and volunteer agencies

had difficulty applying for funding because they lacked the experience or staff to

complete applications in the designated time period.

Reimbursement for EMS care was not always received or did not adequately cover the

actual cost of response and treatment.
4 Pandemic Response Listening Session
Purpose and Organization 5

Purpose and Organization

The purpose of the organized facilitation was to bring together the national fire and

EMS organizations and allied professions to listen and discuss the challenges and

impacts of the ongoing COVID-19 pandemic on fire departments, EMS, 911 dispatch

telecommunicators and other response agency operations. These discussions

provided an overview of the complexity of the pandemic response, elevating

responder needs during such a national disaster, and provided potential solutions that

spanned SLTT boundaries to better prepare the nation for future pandemic events.

The USFA used professional facilitators from the U.S. Department of Homeland

Security’s (DHS’s)/FEMA’s Alternate Dispute Resolution staff to assist with planning,

design, facilitation and implementation of the meeting. Participants from national

organizations representing the fire service, EMS, 911 and other responder associations

were invited to participate in person or virtually. Additionally, USFA federal partners,

such as Federal Interagency Committee on EMS, U.S. Department of Transportation

(DOT)/National Highway Traffic Safety Administration’s (NHTSA’s) Office of Emergency

Medical Services (OEMS), U.S. Department of Agriculture (USDA)/U.S. Forest Service

(USFS), DHS/FEMA, as well as observers from the research community, attended to

listen and gather national insight from the discussions.

The participants were randomly divided into 3 groups, 2 in person and 1 virtual. Each

group discussed and provided information during breakout sessions on the 4 key

issue categories:

1. Workforce.

2. Logistics and supply chain.

3. Business operations and continuity.

4. Agency funding, grants and reimbursement.

The groups then reconvened after each work session and reported back in a plenary

session that included in-person and virtual participants. Session notes were prepared,

consolidated and used to develop the final report. A spreadsheet was also developed

with all the attendees’ comments from each session. Solutions offered in this report

were captured from attendee comments and are those that attendees believe can be

mitigated by the federal government.

The following section contains data from the 4 key issue categories followed by

suggestions for mitigation.

Issue categories

Workforce

According to participants, workforce issues consist of insufficient staffing, recruitment

and retention, infection testing, infection control, vaccination, quarantine and recovery

from infection, retirements and resignations, and behavioral health impacts. These

issues affect the ability of agencies to have the sufficient staff members to respond

to and provide service in their usual timely and practiced manner.

Emergency responders and other staff members were unavailable for duty because

they were ill, quarantined, or needed family and/or child care services due to child care

facility and school closures and restrictions. Additionally, issues of recruitment and
6 Pandemic Response Listening Session

retention during the pandemic were more difficult because of recruitment program

cancellations due to public-health restrictions and personnel duty changes (from

recruitment duties to emergency response duties) where additional resources were

needed. Some members resigned or retired because they or a family member had

medical comorbidities risks that would increase with COVID-19 or were unwilling to

work under COVID-19 response conditions.

Participants shared that responders were greatly affected by exposure to situations

(multiple deaths, increased call volume, continual donning and doffing of PPE before

and after each call, performing decontamination, etc.) that they had not previously

experienced during their careers. Loss of family members and coworkers increased

responder worry for themselves and others who were ill or quarantined. As the

situation intensified, response agencies implemented mandatory overtime to fill shifts,

intensifying the negative impacts on responder behavioral health.

Participant recommendations:

ĵ Staffing and response issues (insufficient staff, illness, quarantined, resignations/

retirements, family issues, ambulance hospital hold times, decontamination times, etc.).

Potential federal government solutions:

Ý Federal support to obtain more staffing in the times of crisis and develop

contingencies to prepare for staffing revamp in future events.

Ý Federal funding for EMS training locations that can operate safely during the

pandemic, as universities and colleges that traditionally teach this are closed

or strictly virtual.

Ý Federal support to continue and improve use of virtual training.

ĵ Recruitment and retention issues (recruitment activity and training shutdowns,

resignations and retirements due to COVID-19, burnout, movement to better paying

EMS jobs, moving to other career fields, etc.).

Potential local and state oversight solution:

Ý Develop and implement systems to improve interest in becoming a first responder.

ĵ Responder safety and health (including worker’s compensation programs, protection

of responder families from COVID-19, etc.).

Potential federal government solutions:

Ý Federal-established best practices for care and rehabilitation of the workforce,

like CDC’s efforts during AIDS crisis.

Ý Federal-established, national-level follow-on study similar to the national 9/11

follow-on study.

Ý Federal-established central point for clear and consistent information for

responders. Transparency when information is not readily available or if the

guidance is likely to change.

Ý Federal government to update worker compensation guidelines.
Purpose and Organization 7

ĵ Behavioral health issues (worry/stress/burnout, post-traumatic stress, suicide, etc.).

Potential federal government solutions:

Ý Federal collaboration across agencies on mental health and suicide prevention

in the workforce.

Ý Federal government to expand research on COVID-19 responder behavioral

health impacts.

Ý Federal government to enact a national 9/11-type follow-on study.

Ý Federal government to expand support for the professions that need more

training with mental health, etc.

Ý Federal agencies to collaborate across workforces on mental health and suicide

prevention. EMS and 911 workforce need to be considered essential and need

federal funding to do research and gather information about its workforce.

A public health methodology might be needed and not just for line-of-duty

deaths, but include all injuries and occupational hazards.

ĵ Infection control and PPE issues (insufficient quantities, changing guidance for

decontamination and reuse, periodic policy changes based on science changes, etc.).

Potential federal government solutions:

Ý Federal agencies as well as national standards bodies streamline and improve

vehicle decontamination standards; mattresses, crevices, plywood were not

designed with infection control in mind.

Ý Federal government support of research concerning ventilation in the back

of ambulances.

Ý Federal government to update and maintain the Strategic National Stockpile (SNS).

Ý Federal government oversight of supply chain shortages around the globe

and provide suggestions on how to obtain goods or to start manufacturing

more goods.

Ý Federal government guidance on decontamination and reuse.

Ý Federal agencies to provide consistent decontamination messaging.

Ý Federal government to establish a guideline for uniform training and PPE protocols.

Logistics and supply chain

Participants shared that logistics and supply chain issues had a significantly negative

impact on agency operations and workforce safety and health. The depletion of the

SNS and movement of many of the pandemic critical items to offshore suppliers and

manufacturing over the years had negative impacts on first responders.

Shortages of appropriate PPE, distribution/allocation of PPE, testing and vaccine

access, procurement of decontamination equipment and agents, guidance changes for
8 Pandemic Response Listening Session

PPE decontamination and reuse, etc., affected responders and agencies in a negative

manner. In many circumstances, EMS was not considered part of health care; they

were not placed in the same high tier for distribution of PPE, testing, and vaccines as

other health care providers. This situation affected responder health and safety as

well as response operations.

Participant recommendations:

ĵ Issues concerning obtaining PPE (offshore manufacture, supply chain issues, EMS

personnel not in high enough tier to have priority, etc.).

Potential federal government solutions:

Ý Federal government to enact the Defense Production Act sooner for more than

just ventilators and masks to an expanded use.

Ý Federal government to provide oversight to educate and inform on which

goods are experiencing shortages and recommendations on how to procure

goods or begin manufacturing goods.

Ý Federal government to leverage onshore production of critical supplies needed

for pandemic response.

Ý Federal government to advocate for EMS needs to be made essential in all states.

Ý Federal government to develop and implement plans to eliminate competition

for supplies between private sector, federal agencies, states, local, tribal, and

territorial agencies.

Ý Federal agencies revise the level of priorities to ensure first responders are

given tier 1 prioritization (first responders are given the same prioritization as

health care workers) for PPE, vaccines, testing, etc.

Ý Federal agencies ensure the supply chain is recreated, maintained, restored,

stock rotated, and products are sent out in an orderly manner. Manage SNS

supplies; if they are expiring, send them to organizations that need them.

ĵ Decontamination and reuse of PPE issues (changing science and guidance, access

to decontamination systems, shortages, etc.).

Potential federal government solutions:

Ý Federal agencies develop and provide clear information, messaging and training

on the different decontamination levels. There could be training for some

decontamination levels.

Ý Federal government to provide 1 agency to take the lead on messaging.

Ý Federal agencies along with national standards bodies improve vehicle standards

for decontamination.

ĵ Address issues around access to COVID-19 tests and vaccines for responders (EMS

is not considered part of the health care system nationwide; not the same level as

doctors, nurses, etc., in matters such as national shortages, distribution issues,

ESFs, planning and response, etc.).
Purpose and Organization 9

Potential federal government solutions:

Ý Federal agencies predefine who is an essential employee or a critical

infrastructure worker; first responders should be at a higher level of

prioritization; EMS needs to become an essential service.

Ý Federal agencies must recognize EMS as part of health care and not just

transport for ESFs; recognize EMS as first touch of health care in planning and

response.

Ý Federal agencies define, identify and vet critical infrastructure employees

before a critical event.

Business operations and continuity

According to participants, there are a variety of reasons why the pandemic interrupted

the response and continuity of operations for emergency response agencies.

Participants shared that EMS responders were not considered health care providers

and not in the same tier as hospital, other health care providers or emergency

responders. In addition to shortages, the decision to keep prehospital health care in a

lower tier for access to required protective items affected the procurement of needed

PPE, testing and vaccinations, etc., impairing the health and safety of emergency

responders. This circumstance limited responders’ ability to obtain necessary medical

resources and left them vulnerable while providing EMS care in less-controlled

environments, i.e., people’s homes, businesses, etc.

Other important issues shared by the participants included procuring supplies and

items to maintain response operations; communications issues and weaknesses both

internally and externally; keeping up with the continuing federal and state guidance

revisions as the science adapted; ongoing agency policy changes and revisions; and

distributing the latest information to all the necessary personnel to address reacting

to and addressing the mis- and disinformation.

Maintaining the needed operational response tempo became difficult due to staff

shortages. Additional time was needed to decontaminate ambulances and crew

members and mitigate hours-long ambulance holds due to no available hospital beds.

Mutual-aid support was not available as each jurisdiction was experiencing similar

issues, and agencies refused to provide out-of-area services.

Personnel who responded across state lines were negatively impacted by state-to-state

emergency regulation changes that included inconsistencies in certification requirements

and response policies. The proper inclusion of EMS in the ESFs as a prehospital provider

of health care and not just transportation, or some other type of support service, would

have helped give EMS the same level of federal attention as other health care entities.

The services could have been better planned for, supported and utilized.

Participant recommendations:

ĵ Field EMS operations issues (existing and situational matters that impeded EMS

operations such as staffing shortages, increased demand for services, dispatch

issues, lack of PPE, at-hospital ambulance wait times, etc.).

Potential federal government solutions:

Ý FEMA should reinforce the need for adherence to the National Incident

Management System (NIMS) and the National Response Framework (NRF),

responders need to be educated about NIMS.
10 Pandemic Response Listening Session

Ý Update FEMA’s NRF and FEMA’s ESFs to include lead federal agency for each

component (EMS).

Ý Federal government to develop evidence-based strategies. Responders

immediately transitioned from traditional to crisis standards of care without

proper understanding of what this entailed; many available options were found

through trial and error causing infections and errors. Uniform standards and

vetted practices are needed proactively. (USFA and the NHTSA’s OEMS are both

currently developing pandemic after-action reports based on the COVID-19

response.)

Ý Federal government to lead a national assessment of true resource capabilities

of fire and EMS, i.e., number of stations, number of volunteer organizations, etc.

Ý Federal government to develop policies to eliminate competition between

federal, state and local agencies. The federal level sets the recommendation

under the advisement from state and local levels. The state and local levels

then administer the recommendations.

ĵ Define, identify and vet critical infrastructure employees.

Potential federal government solutions:

Ý Federal government to lead a national assessment of true resource capabilities

of fire and EMS, i.e., number of stations, number of volunteer organizations, etc.

Ý Federal government to define the agency that provides leadership and outreach

for EMS.

ĵ Maintain continuity of operations.

Potential federal government solutions:

Ý Federal government to review and update the ESFs considering the pandemic.

Ý Federal government to update the NRF and ESFs to include a lead federal

agency for each component, such as EMS.

Ý Federal government to define, identify and vet critical infrastructure employees.

Potential local and state government agencies solutions:

Ý Local and state government to define, identify and vet critical infrastructure

employees.

ĵ Internal and external information dissemination issues (receiving and developing/

disseminating information from/to multiple sources in an ever-changing environment).

Potential federal government solutions:

Ý Federal government to develop a collaborative effort/national approach for

setting and resetting public expectations.

Ý Federal government to develop a federal collaborative effort/national approach

for community messaging.

Ý Federal government to establish a timely clearance/approval process for all

federal agencies to ensure messaging is delivered within hours and days, not

weeks and months.
Purpose and Organization 11

Ý Federal government to establish 1 federal voice to message and disseminate

information to first responders. Once this is created, begin communication in

steady state to establish trust and understanding before a crisis.

Ý Federal government to establish a single source of vetted, accurate information

for agencies.

ĵ Issues with automatic aid and mutual aid during the pandemic (prior planning or

lack of prior planning, stresses of increased demand, etc.).

Potential local and state agencies solutions:

Ý Local and state governments develop training/protocols to address mutual aid/

automatic aid in planning for pandemics and other public health emergencies.

Ý Advocate for the use of the Interstate EMS Compact — Recognition of EMS

Personnel Licensure Interstate Compact. (Only 21 states are currently on

board with the system.)

ĵ Planning for future COVID-19 tactical operations.

Potential federal government solutions:

Ý Create a federal informational toolkit or a reference guide to share lessons

learned. USFA and OEMS are developing pandemic after-action reports based

on the COVID-19 response.

Ý Create toolkits from the challenges faced early on, keep them up-to-date and

make them available across the board. Example: National Association of State

EMS Officials (NASEMSO) collected some material for USFA’s revised pandemic

continuity of operations report based on the COVID-19 response.

Ý Develop training on establishing vaccination sites and testing facilities. FEMA’s

Emergency Management Institute (EMI) and Center for Domestic Preparedness

(CDP) have similar courses: CDP Mass Antibiotics Dispensing, Train-the-Trainer

MGT-442-1 and EMI Points of Distribution (commodities) IS-0026. These courses

can be used while new courses are developed.

Ý Create a toolkit based on this report for all levels of government, including

information for first responders and the public on how their first responders’

service may change during a pandemic time. 

Ý Identify best practices at the federal level and create reports that can be used

in future events. USFA and OEMS are developing pandemic after-action reports

based on the COVID-19 response.

Ý Create a toolkit to assist departments in creating their own pandemic standard

operating procedures (SOPs). Provide tools to help state, local, territorial and

tribal entities create SOPs and adapt their existing SOPs.

Ý Create evidence-based strategies, etc., to transition from traditional to crisis

standard of care. Provide uniform standards and vetted practices prior to a crisis.

ĵ Developing new plans for future pandemic operations (more strategic, to include

recovery planning, etc.).
12 Pandemic Response Listening Session

Potential federal government solutions:

Ý Identify best practices. Create a toolkit to make these practices available to all

organizations. OEMS is working on a similar project now.

Ý Plan national-level exercises that mirror the many different components working

together during the pandemic.

Ý Review pandemic framework. 

Ý Create a pandemic recovery plan that includes the key players and is clear

across all agencies.

ĵ Apparatus decontamination issues (science changes, access to supplies/equipment,

time and staff needed, policy changes, etc.).

Potential federal government solutions:

Ý Develop policies and training on the science of decontamination that can

be shared with local and state responders. During the pandemic, many

organizations didn’t complete proper decontamination.

Ý Leverage federal government influence to bring about revised vehicle standards

to improve infection control and decontamination.

ĵ Development and dissemination of new COVID-19 SOPs and policies.

Potential federal government solutions: 

Ý Identify best practices and create an educational tool for development of

policy and procedure.

Ý Identify best practices and formulate guidance for future events.

Agency funding, grants and reimbursement

Participants conveyed that cities are experiencing significant funding issues during the

pandemic. Decreases in tax revenue can impact fire and EMS agencies’ existing and

future-year budgets. For career and combination departments, there remain issues of

significant overtime/backfill/hazard pay due to ill or quarantined staff as well as staff

working overtime due to hospital emergency department wait times.

All agencies were required to purchase additional unplanned quantities of PPE and

other equipment. Volunteer and some combination fire and EMS organizations that

rely on fundraising (e.g., barbecues, fish fries, rodeos, carnivals, etc.) saw a decrease

in revenue due to cutbacks or cessation of events due to emergency pandemic public

health regulations. Funds or in-kind donations to agencies decreased due to many

local business closures.

Although grant money became available, some agencies had difficulty applying

because they lacked the experience or staff. Multiple grants with varying processes to

apply created confusion and redundancy. Reimbursement for EMS care was not always

received or was less than the response and treatment costs. For example, Centers

for Medicare and Medicaid Services (CMS) only considers mileage for reimbursement

of ambulance transport. The CMS pilot Emergency Triage, Treat, and Transport (ET3)
Purpose and Organization 13

Model as currently designed and enacted is insufficient to support all EMS response

agencies and is not permanent.

Participant recommendations:

ĵ Budget issues (insufficient, reprogramming budget funds, decrease in funding due

to less taxes/fees collected, etc.).

Potential federal government solutions:

Ý Better marketing of outreach or information on available grants. The

Coronavirus Aid, Relief, and Economic Security Act and PPE grants helped

smaller departments and covered supply gaps in regions.

Ý Consider an expansion of the Staffing for Adequate Fire and Emergency

Response Grants program.

Ý Streamline the grant submission process. Create one grant system to allow

users to complete information once instead of reentering the same information

into multiple systems.

ĵ Issues with obtaining grants (processes, complexity, tracking, reporting, etc.).

Potential federal government solutions:

Ý Streamline the grant process to get funding to the departments as quickly as

possible.

Ý Identify best practices to formulate grant guidance for the future.

Ý Market the availability of funds to fire, EMS, and 911 departments and explain

how to apply.

ĵ Issues with obtaining reimbursements (processes, complexity, tracking, billing, etc.).

Potential federal government solutions:

Ý Identify EMS as health care providers for the purposes of reimbursement.

Ý Revisit the Government Accountability Office (GAO) Report as it relates to

reimbursement. (GAO-13-6 Oct. 1, 2011: “Ambulance Providers — Costs and

Medicare Margins Varied Widely; Transports of Beneficiaries Have Increased.”

https://www.gao.gov/assets/gao-13-6.pdf)

Ý Simplify the ET3 program and make it available to all areas.

Ý Express the need for speedy reimbursements and waiver acknowledgments.

ĵ Problems receiving donations of cash and durable or consumable goods (some

normally supportive local business closed or lost income and could not provide

items to the responders, etc.).

Potential federal and local/state government solution:

Ý Communicate to public the specifics of what donations are necessary and

where to drop them off.
14 Pandemic Response Listening Session

ĵ Salary, hazard pay and overtime pay impacts (increased overtime costs due to backfill

for ill, quarantined or retired/resigned members, increase in service demand, etc.).

Potential federal government solutions:

Ý Create guidance on receiving funding for and using hazard pay or COVID-19

overtime pay.

Ý Create guidance to dedicate funding for provider pay (e.g., hazard pay instead

of backfilling/overtime).

Ý Create national guidance/consistency concerning handling of hazard pay.
Conclusion 15

Conclusion

The USFA gathered national-level fire, EMS and affiliate group members — in person

and virtually — to listen and discuss responders’ experiences and needs during the

ongoing COVID-19 pandemic. USFA staff and other observers were able to gather

information to develop this listening session document and gain knowledge of

responder agencies’ workforce, logistics and supply chains, business operations and

continuity, funding, grants, and reimbursement needs during the ongoing pandemic.

There were multiple issues brought forth by listening session participants affecting

various areas of fire department and EMS response and 911 dispatch center

capabilities. For example, a lack of appropriate and sufficient PPE put members at risk

for health and safety issues and affected the agency’s ability to respond appropriately

to requests for service. This issue also exacerbated the lack of sufficient staffing due to

illness, quarantine and family care, which impacted career, combination and volunteer

agencies and members. The lack of career personnel led to increased or mandatory

overtime, had a negative impact on budget, and contributed to personnel burnout.

Volunteer staff responded to an increasing number of calls; this increase in call volume

and the increased time for mutual aid to respond also increased patient access times

and increased the need for care and transportation. Every level of the fire and EMS

services dealt with increased response times, over budget spending, increased patient

load, staff behavioral health issues, excessive overtime, and staff exposure, illness

and burnout.

Agency regulation changes or adoption of potential mitigation efforts provided

in this report may improve the safety and efficacy of emergency response for a

future pandemic or event of national significance. The regulation changes and

implementation of the noted mitigations and proposed solutions may provide for a

more robust EMS system within SLTT agencies and provide a more resilient workforce

and community. It is through the recognition of the issues and solutions discussed

herein that agencies at all levels will be able to develop the plans to prepare for,

respond to and mitigate future large-scale disasters.
16 Pandemic Response Listening Session
Attendees and Organizations 17

Attendees and Organizations

In-person attendees

Augustine, James International Association of Fire Chiefs (IAFC)

Brauer, Brian North American Fire Training Directors (NAFTD)

Brown, Rob IAFC

Cormier, Scott National Association of Emergency Medical Technicians (NAEMT)

Ehrlich, Bob FEMA

Elkins, Katherine DOT/NHTSA/OEMS

Evans, Bruce NAEMT

Gerard, Daniel International Association of EMS Chiefs

Hanifan, Amy Women in Fire

House, Mel NASEMSO

Keiken, Jim NAFTD

Krohmer, Jon DOT/NHTSA/OEMS

McClintock, Robert International Association of Fire Fighters (IAFF)

Miller, Tom National Volunteer Fire Council

Overton, Jerry International Academies of Emergency Dispatchers®

Patterson, Cathie FEMA Grants

Ragone, Michael Global Medical Response/American Medical Response

Sanders, Russ National Fire Protection Association (NFPA)

Seifarth, Bill National Registry of Emergency Medical Technicians

Sinclair, John IAFC

Smith, Hezedean National EMS Management Association (NEMSMA)

Strozyk, Randy American Ambulance Association

Weber, Mario FEMA Office of Policy & Program Analysis
18 Pandemic Response Listening Session

Virtual attendees

Blankenship, Charles NEMSMA

Campbell, Michaela Congressional Fire Service Institute (CFSI)

Chaney, Eric DOT/NHTSA/OEMS

Fortner, James USDA/USFS

Gainor, Dia NASEMSO

Mole, Clary DOT/NHTSA/OEMS

Openshaw, Mark Native American Fire Chiefs Association

Russell, Greg IAFF

Sigrist, Marc Energetics

Statler, Seth NFPA

Stuebing, Ken IAFC

Webb, Bill CFSI

Ziyad, Amy Women in Fire
Acronyms 19

Acronyms

CDC Centers for Disease Control and Prevention

CDP Center for Domestic Preparedness

CFSI Congressional Fire Services Institute

CMS Centers for Medicare and Medicaid Services

DHS U.S. Department of Homeland Security

DOT U.S. Department of Transportation

EMI Emergency Management Institute

EMS emergency medical services

ESF Emergency Support Function

ET3 Emergency Triage, Treat, and Transport

FEMA Federal Emergency Management Agency

GAO Government Accountability Office

IAFC International Association of Fire Chiefs

IAFF International Association of Fire Fighters

NAEMT National Association of Emergency Medical Technicians

NAFTD North American Fire Training Directors

NASEMSO National Association of State EMS Officials

NEMSMA National EMS Management Association

NFPA National Fire Protection Association

NHTSA National Highway Traffic Safety Administration

NIMS National Incident Management System

NRF National Response Framework

OEMS Office of Emergency Medical Services

PPE personal protective equipment

SLTT state, local, tribal and territorial

SNS Strategic National Stockpile

SOP standard operating procedure

USDA U.S. Department of Agriculture
20 Pandemic Response Listening Session

USFA U.S. Fire Administration

USFS U.S. Forest Service

16825 South Seton Ave.

Emmitsburg, MD 21727

usfa.fema.gov