EMS agencies and personnel – Private and public EMS agencies and emergency response personnel providing all levels of care. EMS advisory committees or boards – Local and state agencies responsible for the overall planning and coordination of EMS (e.g., State Disaster Medical Advisory Committee [SDMAC]). EMS policy and regulatory agencies – Agencies that create, direct, and enforce the financial, regulatory, and licensing policies for EMS and certify or license EMS personnel and ambulances. Policy and regulatory agencies will vary by state, but may include state EMS authorities, governor's councils, and other committees. Professional organizations and associations – Local, state and national organizations and associations representing EMS agencies and personnel. Purpose This document provides communities with a framework for responding to medical surge by employing the previously identified four strategies for expanding EMS system capacity during an emergency. The EMS Framework aims to guide communities in building the foundation necessary to implement these strategies during an emergency, as well as how to train, educate, and communicate with EMS personnel, patients, and the media about the strategies. The configuration of EMS systems varies considerably nationwide by community size, demographics, geography, and legal authority. (4, 7) Communities also vary in their level of medical surge planning and the involvement of EMS in this planning. This document contains guidance from EMS and public health SMEs and aims to facilitate community collaboration with local and state EMS agencies—ideally through healthcare coalitions—to develop medical surge plans. The EMS Framework does not provide standard protocols or guidelines intended for adoption by all EMS agencies. Format With the exception of Chapter Two – Setting the Stage: A Foundation for Expanding EMS System Capacity, the chapters in this document are organized in a standard format. Chapter Two describes the groundwork needed to initiate planning for expanding EMS system capacity during medical surge. A key takeaway is the recommendation for establishing or enhancing healthcare coalitions to include EMS. Chapter Two also discusses hazard vulnerability analysis (HVA) and needs assessment, triggers, reimbursement mechanisms, performance management, education and training, and stakeholder communication.
Tier 2: Other Key Community Planning Partners Partner Partner Hospitals Hospital EDs Federally Qualified Health Centers/ free clinics Outpatient/retail clinics Hospital outpatient centers Local physician groups Urgent care centers Public works Behavioral health providers Insurance providers/ third party payers/Centers for Medicare and Medicaid Services (CMS) Billing companies/administrators Other Long-term care facilities Other Tier 3: Other Potential Partners for EMS to Engage Partner Partner Elected officials (e.g., National Governor's Association, Association of City and County Managers) State and local regulatory agencies and legislatures Companies familiar with the logistics of distribution (e.g., UPS, FedEx) Professional EMS Member Organizations (e.g., National Association of State Emergency Medical Services Officials [NASEMSO], National EMS Management Association [NEMSMA]) NGOs, civic groups, and community groups that represent vulnerable populations Volunteer organizations Legal experts Ethicists Other Other
Author or Organization Title and Description Available at Utah Hospitals and Health Systems Association for the Utah Department of Health Utah Pandemic Influenza Hospital and ICU Triage Guidelines Guidelines and algorithms intended to guide the allocation of patient care resources during an influenza pandemic or other public health emergency, when demand for services dramatically exceeds supply. (Prehospital settings, EMS, page 2) Appendices: Committee on Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations; Institute of Medicine Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response Table 6-1. Potential EMS Response Adaptations Under Conventional, Contingency, and Crisis Conditions A Note on Training EMS Personnel to Perform Modified Treatment and Transport Implementing modified treatment and transport strategies represents a change in traditional EMS practice. Providing education and training to perform modified treatment and transport in advance of an actual incident is recommended. This change in traditional practice to incorporate more complex decision making requires more education and training. Education on the actual protocols for where to transport can be just-in-time. Providers must be trained and retrained, and their knowledge/skills must be validated on a regular basis. As many EMS experts have argued, strategies for expanding EMS systems capacity will be most successful if at least some activities are integrated into daily operations.
numbers of acutely ill patients require transport, EMS providers must be reserved to fulfill their primary role of acute stabilization and transport. Retired healthcare providers or volunteers may need to support vaccination efforts in the absence of EMS. Pharmaceutical Distribution EMS Subject Matter Expert Tip Discussions about rapid implementation of patient interventions will be more productive if healthcare coalitions and planning teams prioritize the safety of healthcare responders, including EMS providers. A critical point to make is that those on which the burden of disaster response falls should be provided the supplies and equipment necessary to protect themselves, before supplies are allocated to the general public. Supplies and equipment could include vaccines, prophylactic medications, and PPE needed to protect responders from illness and injury. Some disaster experts recommend also prioritizing delivery to responder's families to alleviate mental burden on responders and allow them to focus on their disaster response functions. EMS providers operating under written protocols and supervision routinely dispense a variety of pharmaceuticals to patients. In many states, EMS providers also can assist patients by administering drugs prescribed by the patients' healthcare provider. During mass medical surge, communities may need to rapidly dispense prophylactic medications to the general public or to certain populations at increased risk for illness (such as pregnant women, children, geriatric or disabled patients, or individuals living a certain distance from a disaster site). Experts recommend that communities limit discussions on the role of EMS in delivering patient interventions to tasks that can be performed within utilizing existing EMS resources. For example, using EMS providers to deliver prophylactic pharmaceuticals to every home in a community (e.g., "postal service model") would take EMS providers away from vital treatment and transport functions. However, EMS personnel may be able to deliver prophylactic medications to family members or those living with a patient who is being treated by EMS (e.g., targeted antiviral prophylaxis). EMS experts recommend that healthcare coalitions share with EMS partners any existing plans for receiving, distributing, and dispensing SNS assets and plans for mass immunization or prophylaxis. When all partners are knowledgeable about current planning efforts, they can better discuss feasible options for EMS integration. Communities will need to examine the legal regulations governing prescriptive authority and EMS providers' license to dispense certain medications. Some disaster experts propose modifying requirements that each patient have an individual prescription to authorize the widespread administration of vaccines and drugs without prescriptions. (71)
Lincoln Professor of Health Law and Ethics Sandra Day O'Conner College of Law Arizona State University, and Network for Public Health Law Kenneth Knipper, FF, EMT Chairman of Emergency Medical Services/Rescue Section National Volunteer Fire Council Kenneth Miller, MD, PhD Medical Director Emergency Medical Services Section Orange County Fire Authority, and Orange County Health Care Agency Mickey Moore, AAS, EMT-P Deputy Director Georgia Office of Emergency Medical Services Paul Patrick Director Bureau of Emergency Medical Services and Preparedness Utah Department of Health, and National Association of State Emergency Medical Services Officials Severo Rodriguez, MS, NREMT-P, LP, AEMCA Executive Director National Registry of Emergency Medical Technicians Gregory Scott, MBA Operations Research Analyst Research and Analytics International Academies of Emergency Dispatch Anthony Sequoyah President Emergency Medical Services National Native American Emergency Medical Services Association Umair Shah, MD, MPH Executive Director Harris County Public Health and Environmental Services Robin Shivley, EMT Director Emergency Medical Services Michigan Department of Community Health John Sinclair Fire Chief Kittitas Valley Fire Rescue, and International Association of Fire Chiefs Jennifer Sinibaldi, MPH Director Public Health Preparedness Association of State and Territorial Health Officials Peter Taillac, MD Medical Director Bureau of Emergency Medical Services and Preparedness Utah Department of Health, and University of Utah Division of Emergency Medicine Ronald Thackery Senior Vice President Professional Services American Ambulance Association David Thomson, MD, MPA, MS, FACEP, CMTE
Clinical Professor Department of Emergency Medicine East Carolina University, and Association of Air Medical Services Kimberly Torris, MHA, LP Deputy Director of Emergency Medical Services Emergency Medical Services and Trauma Systems Oregon Health Authority Stephen Vetrano, DO, FACOEP, FACEP, EMT(I) Emergency Physician American College of Osteopathic Emergency Physicians John Walsh, MA Assistant Professor Vanderbilt University, and Assistant Director National Center for Emergency Preparedness International Association of Emergency Managers Lynn White, MS, CCRP National Director Resuscitation and Accountable Care American Medical Response, and National Association of Emergency Medical Services Physicians Timothy Wiedrich, MS Section Chief Emergency Preparedness and Response North Dakota Department of Health Arthur Yancey II, MD, MPH Associate Professor Emory University, and Medical Director Grady Emergency Medical Services National Association of Emergency Medical Services Physicians
Federal Government Participants Greg Burel Director Division of Strategic National Stockpile Office of Public Health Preparedness and Response Centers for Disease Control and Prevention Lisa Dillard Lead Public Health Advisor Program Preparedness Branch Division of Strategic National Stockpile Centers for Disease Control and Prevention Christopher Handley, MS Management and Program Analyst Commander Navy Installations Command Operating Forces (N30) U.S. Navy David Hunter, MPH, MSW LCDR, U.S. Public Health Service Public Health Analyst Office of Public Health Preparedness and Response Centers for Disease Control and Prevention Gregg Margolis, PhD, NREMT-P Director Assistant Secretary for Preparedness and Response U.S. Department of Health and Human Services Patrick Nonnenmacher Emergency Coordinator Office of State, Tribal, Local, and Territorial Support Centers for Disease Control and Prevention Georgina Peacock, MD, MPH Medical Officer National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention Scott Sasserƚ, MD Associate Professor Emory University Angela Schwartz, MBA Associate Director Policy, Planning, and Evaluation Office of Public Health Preparedness and Response Centers for Disease Control and Prevention David Sugerman, MD, MPH, FACEP CDR, U.S. Public Health Service Medical Officer Division of Unintentional Injury Prevention National Center for Injury Prevention and Control Centers for Disease Control and Prevention Todd Talbert, MA Associate Director Division of State and Local Readiness Office of Public Health Preparedness and Response Centers for Disease Control and Prevention Richard Wild, MD, JD, MBA, FACEP Chief Medical Officer