News & Updates

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  • 15 Oct 2020 8:50 AM | AIMHI Admin (Administrator)
    Recently, Reno's REMSA launched a tiered response model. The news segment from Aging and Awesome featured below offers a clear explanation about how using a variety of healthcare provider levels for an out-of-hospital medical response is an effective and safe way to help patients access the healthcare they need – which can range from an urgent ambulance transport to the emergency room or access to a telehealth provider.
  • 9 Oct 2020 9:20 AM | AIMHI Admin (Administrator)

    From: Matt Zavadsky, AIMHI Communications Chair

    Participants in the CMMI ET3 Model should have received an email from CMS late yesterday advising that the Implementation Plan template has been uploaded to the portal.

    Accessing the section where the Implementation Plan template can be viewed and downloaded is a little tricky, so here is a brief guide of how to access the document.

    Also, several ET3 Model participants have been asking when the new Participation Agreement might be available.  Interestingly, while accessing this document this morning, I also noticed that the new Participant Agreement has been uploadedwith a due date of 12/15/20.

     Download Instructions

  • 5 Oct 2020 4:28 PM | AIMHI Admin (Administrator)

    From EMS1 | By Chuck Gipson, Medic EMS

    Thinking outside the box can lead to untapped potential from a previously overlooked resource. All of our agencies have a dispatch center of some sort that gets the right resources to the right place at the right time. Right? That call taker is the first person to make contact with the patient after the 911 system is activated. Many times as EMS providers, we forget the care that gets delivered to that patient before the first response vehicle ever arrives on scene.

    Elapsed time is a big factor in the outcomes for stroke patients as a stroke occurs roughly every 40 seconds, 87% of which are thrombolytic in nature.

    Continue reading►

  • 21 Sep 2020 8:25 AM | AIMHI Admin (Administrator)

    Modern Healthcare source article | Comments courtesy of Matt Zavadsky

    Many have expressed concern about the shifting payer mix, as well as the impact of the pandemic on state and local budgets. 

    This will likely be the 2nd wave of the economic storm for healthcare providers.

    In states where EMS agencies enjoy “GEMT” payments, there is even concern about the ability of those programs to continue under the current economic climate.

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    Medicaid payments under threat as COVID pummels state budgets

    MICHAEL BRADY

    September 19, 2020

    https://www.modernhealthcare.com/medicaid/medicaid-payments-under-threat-covid-pummels-state-budgets

    Like many hospitals struggling to cope with the financial fallout of the COVID-19 pandemic, University Medical Center of Southern Nevada has made tough decisions and reevaluated its business strategy to survive.

    The Las Vegas hospital has gotten federal relief funding, but “it’s just not enough” to offset increasing care costs and declining revenue, UMC CEO Mason Van Houweling said. The hospital’s fortunes are deeply intertwined with the state’s tourism-heavy economy, which has been hammered for the past six months as casinos shuttered, and conferences were canceled.

    UMC’s supply budget has more than tripled since the outbreak began, and it recently offered voluntary buyouts to staff members to rein in its growing labor costs. It also curtailed investments in new capital projects over the next five to 10 years, even though its finances were on solid footing before the pandemic hit the U.S. The hospital reported $691 million in operating revenue and a total profit margin of 4.3% in fiscal 2019, according to a Modern Healthcare analysis of CMS cost reports.

    Now reductions to Nevada’s Medicaid program threaten to cut UMC’s finances even closer to the bone. Nevada lawmakers agreed to a 6% across-the-board rate reduction during a special session in July to help close a $1.2 billion budget shortfall, saving the state $53 million, and with the loss of federal matching will cost providers more than $100 million. It’s the largest cut to Medicaid provider rates any state has made since the pandemic began and a massive blow to Nevada’s largest public hospital.

    “The new proposed rate puts us back to 2001 levels,” Van Houweling said.

    With Medicaid enrollment snowballing and tax revenue falling off a cliff thanks to the pandemic, many states are sharply reducing their Medicaid spending to balance their budgets.

    Continue reading>

  • 18 Sep 2020 9:26 AM | AIMHI Admin (Administrator)

    From APA PsycNet | Comments Courtesy of Matt Zavadsky

    Very interesting findings – Summary statements:

     

    First responders have a unique position as first-line response to COVID-19 patients, which results in an increased likelihood for exposure to the virus. Because of this position, mental health problems, such as anxiety, depression, insomnia, and stress, have been revealed in this population.

     

    During the COVID-19 pandemic, health care workers and first responders described experiencing stigma in their communities. Amid this crisis, a qualitative phenomenological study was conducted to understand the experiences of first responders during the pandemic; this is the first study of its kind to review the effects of stigma on first responders in any pandemic. This study used a convenience sampling of first responders (e.g., physicians, nurses, paramedics, police officers, firefighters, etc.) who discussed their personal experiences during the pandemic.

    Solutions to this problem could include real-time and urgent information being conveyed to the public while being mindful of untoward exposure to the media (Garfin et al., 2020). The goal is to reduce hysteria and mitigate the transmission of misinformation.

     

    Conclusion

    Facing stigma is often invisible, in that the effects are not often recognized; despite the inability to see it, experiencing stigma can be dangerous to health while also diminishing the value of a person through discrimination and loss of status by being devalued, rejected, and excluded (Link et al., 2006). The compounding adverse mental health effects in an essential population used to fight the pandemic turns an already challenging situation dire.

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    Stigma on First Responders During COVID-19

    Tara Rava Zolnikov email the author, Frances Furio

    Zolnikov, T. R., & Furio, F. (2020).

     

    http://dx.doi.org/10.1037/sah0000270

     

    Abstract

    During the pandemic, first responders were at an increased risk of being stigmatized because of their direct exposure to COVID-19; stigmatization is an undesirable stereotype that can contribute to a myriad of adverse effects, including, but not limited to, anxiety, depression, devaluing, rejection, stress, health problems, exposure to risks, and limiting protective factors. The objectives of this research were to understand stigma on first responders during the COVID-19 pandemic as well as the consequences of stigma on first responder’s mental health. A qualitative phenomenological study used semistructured interviews to understand the experiences of first responders during the pandemic. This study included a convenience sampling of 31 first responders (e.g., physicians, nurses, paramedics, police officers, firefighters, etc.) located worldwide. First responders reported feelings of isolation, lack of support and understanding by family or friends, decreased or forced removal in immediate social interaction (e.g., within family and friend circles), sentiments of being infected or dirty, increased feelings of sadness and anxiety, and reluctance to ask for help or get treatment (e.g., self-approval of being isolated). By answering these research questions, this information highlighted additional challenges that may be faced by first responders aside from being a frontline worker during a pandemic, which is equally stressful. By understanding the role of stigma, public health practitioners during pandemics or emergency situations can seek to diminish it.

     

    On March 11, 2020, the World Health Organization (2020) characterized the newly emerging respiratory illness, coronavirus 2019 (COVID-19), as a global pandemic. COVID-19 had rapidly spread across the world, creating a surge of cases in countries like Italy, Iran, South Korea, and the United States. Pandemics and disease outbreaks pose significant threats to human health as well as contribute to adverse mental health effects because of drastic life changes along with the inability to predict daily events (Pike, Tomaney, & Dawley, 2010). Anxiety, stress, and fear felt by people during the coronavirus pandemic was real and overwhelming, resulting in strong emotional reactions in adults and children (Centers for Disease Control and Prevention, 2019). The culmination of these reactions could be directed at first responders, who were at the forefront of treating people affected by the disease and sequentially considered the most exposed population (Adhanom Ghebreyesus, 2020; Ehrlich, McKenney, & Elkbuli, 2020).

     

    During the pandemic, first responders were at an increased risk of being stigmatized (Adhanom Ghebreyesus, 2020; Ehrlich et al., 2020), which is an undesirable stereotype that reduces an accepted person to a tainted one (Goffman, 1963). Stigma has several components, including stereotyping, discrimination, labeling, status loss, and separation (Link & Phelan, 2001). Stigmatization can negatively impact individuals faced with it, especially if stigma has become internalized (Drapalski et al., 2013). Stigmatization is problematic and can contribute to a myriad of adverse effects, including, but not limited to, anxiety, devaluing, rejection, exposure to risks, and limiting protective factors (Link & Phelan, 2006). Stigma has been shown to increase stress among the individuals who experience it (Major & O’Brien, 2005) as well as depression (Benoit, McCarthy, & Jansson, 2015). Stigma can impact an individual’s self-esteem and their overall achievements (Major et al., 2005). Studies have shown that low self-worth and negative health outcomes are both potential outcomes of stigma (Benoit et al., 2015).

     

    During the COVID-19 pandemic, health care workers and first responders described experiencing stigma in their communities. Amid this crisis, a qualitative phenomenological study was conducted to understand the experiences of first responders during the pandemic; this is the first study of its kind to review the effects of stigma on first responders in any pandemic. This study used a convenience sampling of first responders (e.g., physicians, nurses, paramedics, police officers, firefighters, etc.) who discussed their personal experiences during the pandemic.

     

    Highlighted topics of discussion focused on treatment, stigma, feelings, and mental health. The expectation of this research was to upend aspects related to adverse mental health in a vital working population during the pandemic.

    Method

     

    A qualitative study was conducted to understand and explore the experiences of health care workers and first responders during the COVID-19 pandemic. This study used a descriptive phenomenological approach, which has been continuously described as a valuable research tool and strategy to understand the lived experiences of participants related to a phenomenon (Neubauer, Witkop, & Varpio, 2019; Marques & McCall, 2005; Husserl, 1980); the aim of this type of research is to identify the common themes, factors, or components related to a phenomenon to better understand the perspectives of those who have experienced it (Marques & McCall, 2005). A phenomenological study looks at both what was experienced and how it was experienced (Neubauer et al., 2019). This method was utilized for this study because first responder experiences offer a unique perspective during the pandemic, although they are not authorities on pandemic stigma, in general.

     

    Health care workers and first responders were selected as the target population. This selection was due to the fact that these individuals have a unique position within this pandemic because they are likely the population most exposed to COVID-19 during this time. Inclusion criteria for this study was: above the age of 18 years, health care worker or first responder, and worked during the COVID-19 pandemic. Participants were recruited through convenience sampling, which used the Facebook platform; participants were then screened, selected, and interviewed via Zoom (per social distancing recommendations by the Centers for Disease Control and Prevention) in a private setting and format, during which questions reviewed challenges faced during the pandemic. After interviews, the data were then analyzed via hand coding, in which themes emerged and presented themselves through repetition. Themes were then made into a codebook, which were used to review all quotes related to the subject matter that directly correlated to answering the research questions. This thematic analysis followed the Moustakas (1994)–modified Van Kaam (1966) method.

     

    All qualitative research must provide measures to ensure validity of the data in the research. In this case, the researchers established trustworthiness through credibility, multiple participant perspectives, peer debriefing and review, reflexive journaling, and field notes. Credibility was gained through triangulation of sources and member checking. Multiple participant perspectives were sought when female and males of various ages in different parts of the world working in different occupations were all included to participate in the interviews. Peer debriefing and review occurred before and after developing interview questions and analyzing themes in the data. Reflexive journaling and field notes occurred in a diary, which was used to report on questions related participant reactions and impressions of each interview. That said, limitations in all research exists. Limitations of this study included the possibility of nontransferable results to other first responders in the world, researcher personal bias (e.g., mental health researcher), and research participant bias.

     

    The study protocol and ethics review were approved by California Southern University. All participants signed informed consent prior to the commencement of the interviews and audio recording. Codes were immediately assigned to every participant to ensure deidentified data collection.

     

    Results

    Participants’ answers concluded various challenges related to treatment, stigma, feelings, and mental health. Participants described factors that were associated with stigma, including feelings of isolation, lack of support and understanding by family or friends, decreased or forced removal of immediate social interaction (e.g., within family and friend circles), sentiments of being infected or dirty, increased feelings of sadness and anxiety, and reluctance to ask for help or get treatment (e.g., self-approval of being isolated).

     

    Participants

    A total of 31 health care workers and first responders were interviewed for this study. The mean age was 36.129 years, with a range between 23 and 57 years. In relation to gender, 18 participants identified as female, and 13 participants identified as male. Participants were located worldwide, including the United States (28), Kenya (one), Ireland (one), and Canada (one). Ethnicities included African/Kenyan, Arab/Palestinian, Caucasian, Caucasian/Russian, Caucasian/Iranian, and Caucasian/Irish. Of these, 18 of the participants were married, and 13 of the participants were single. Sixteen of the participants had children, with an average of 2.25 children per subject, a median of 2.5 children, and a range of one to four children.

     

    The education levels of participants included high school (one), some college (four), associate degrees (six), bachelor degrees (13), graduate degrees (three), and medical school educations (four). All participants worked within roles as health care workers or first responders during the COVID-19 pandemic; there were physicians/doctors (three), nurses (14), a nurse tech, a behavioral therapist, an orthodontist, a dialysis technician, a technician in medical surgery, a data specialist, a paramedic, firefighters and paramedics (three), a firefighter and emergency medical technician, and police officers (three).

    Continue Reading►

  • 16 Sep 2020 9:44 AM | AIMHI Admin (Administrator)

    Inside Sources source article | Comments courtesy of Matt Zavadsky

    Very insightful OpEd from national and international EMS leaders – Note the “About the Authors” section below...

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    Will an Ambulance Be Available When You Call?

    September 10, 2020

    by Brian Maguire, et. al


    https://www.insidesources.com/will-an-ambulance-be-available-when-you-call/

     

    Our emergency medical services professionals have been devastated by the pandemic.

     

    By August 3, 35 emergency medical technicians and paramedics had died from the coronavirus nationwide, and the rate of COVID-19-fatalities for medics was about four times higher than the rate for firefighters.

     

    Thousands of medics have been afflicted, many will never be able to return to their jobs. Now, across the country, many medics are retiring and resigning, and EMS agencies are struggling to staff ambulances.

     

    Immediate action is needed to save the EMS system.

     

    Since the start of the pandemic, EMS medics have endured overwhelming call volumes and worked endless overtime shifts caring for critically ill patients.

     

    Insufficient supplies of personal protective equipment such as masks, gloves and gowns exposed the medics, their patients, their co-workers and their families to heightened risks of infection. Many medics slept in their cars to avoid returning home and potentially infecting their families. Three New York City medics committed suicide since April.

     

    Before the pandemic, EMS agencies in the United States responded to more than 40 million calls for assistance each year. In addition to crashes and heart attacks, EMS is often the healthcare provider of last resort for people of color, the poor and the disenfranchised. Medics may be the only healthcare providers in many rural communities.

    continue reading►

  • 2 Sep 2020 5:07 PM | AIMHI Admin (Administrator)

    Comments Courtesy of Matt Zavadsky

    Nice to see healthcare workers in healthcare facilities and First Responders in the 1st priority group for COVID-19 vaccine allocation!

    Read the full DRAFT briefing here.

    Public Listening Session of the Committee on Equitable Allocation of Vaccine for the Novel Coronavirus being held from 12:00-5:00pm ET.  You can register to listen to the hearing at the link below:

    https://www.eventbrite.com/e/equitable-allocation-of-covid-19-vaccine-public-listening-session-tickets-118114225829

    Written public comment is open until September 4, 2020 (11:59 pm ET); submit written comment here.

    The National Association of Emergency Medical Technicians, American Ambulance Association, Congressional Fire Services Institute, International Association of Fire Chiefs, International Association of Fire Fighters, National Fire Protection Association, and National Volunteer Fire Council collaborated on a letter to the White House and several key members of Congress advocating for high priority vaccine allocation for First Responders on July 13, 2020.  View the letter here.


  • 31 Aug 2020 10:02 AM | AIMHI Admin (Administrator)

    ESO Source Data | Comments Courtesy of Matt Zavadsky

    Interesting information in the ESO Mid-Year Index, COVID-19 Special Edition!  Thanks to ESO for providing this!

    Lots of PPE usage info, and general response characteristics below...

    You can access the full Index here.

    Many EMS agencies, including us here at MedStar have been reporting similar trends in data.

    Thanks to ESO for providing this!

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    TOTAL 911 CALLS DROPPED…FOR A BIT

    Overall, we noticed a decrease in total 911 call volume since early January 2020 by as much as 18% through the end of April. Motor Vehicle Crash calls in particular experienced a significant drop, down by 40%. However, starting in May through the end of July, we see a steady upward trend.

     

    NON-TRANSPORTS JUMPED…FOR A BIT

    Coupled with 911 call volume dropping, non-transports increased – by as much as 33% in April 2020.

     

    CARDIAC ARREST SPIKES

    Substantial increases in the number of out-of-hospital cardiac arrests have been observed, particularly in regions with increased COVID-19 cases. As a whole, in April 2020, EMS responses for cardiac arrests spiked by 36% compared to the prior year.

     

    OPIOID OVERDOSE CALLS ARE UP

    Between January 1, 2020 and July 31, 2020, opioid overdose responses jumped 30%. The numbers increased in particular in May and June by approximately 41% and 53% respectively.


  • 27 Aug 2020 5:19 PM | AIMHI Admin (Administrator)

    NEJM Catalyst Source | Comments Courtesy of Matt Zavadsky

    Very well-done commentary from NEJM Catalyst. 

     

    While not specifically mentioned, our “EMS” brethren, payers and other healthcare system partners should take note of the ways “EMS” can be a partner in “Leveraging alternative care pathways and care sites, such as telehealth, home-based care, and community-based care, can also help keep patients out of the ED and provide alternatives to low-value and wasteful care. ED visits and hospitalizations are frequently preventable and, once there, patients often receive unnecessary imaging and lab tests.”

     

    Tip of the hat to Chris Hanson from TMF for finding and forwarding this commentary!

    -------------------

    COMMENTARY

     

    Building A Better Health Care System Post-Covid-19: Steps for Reducing Low-Value and Wasteful Care

    The upheaval in the provision of routine health care caused by the Covid-19 pandemic offers an unprecedented opportunity to reduce low-value care significantly with concurrent efforts from providers and health systems, payers, policymakers, employers, and patients.

     

    By Corinna Sorenson, Ph.D., MHSA, MPH, Mark Japinga, MPA, Hannah Crook & Mark McClellan, MD, Ph.D.

    August 21, 2020

     

    https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0368?query=CON&cid=DM97604_Catalyst_Non_Subscriber&bid=247526681

     

    Summary

    The Covid-19 pandemic has disrupted the provision of routine care, forcing providers and patients to postpone many services and adopt virtual and non-contact strategies. These changes present an unprecedented opportunity to re-evaluate the necessity of services our health system provides, embracing and enhancing the ones that provide the most value and finally reducing or eliminating those that provide little or no benefit. Immediate action is essential as reopening occurs; force of habit and financial stresses may otherwise counteract some positive recent changes and move the health care system back toward business as usual. We suggest aligned strategies for providers and health systems, payers, policymakers, employers, and patients that can help seize this opportunity to build a better health system.

     

    In just months, the coronavirus (Covid-19) pandemic upended significant portions of the U.S. health care system.1 Postponed elective procedures and services for non-emergency care significantly reduced overall health care utilization,2 and the rapid shift to telehealth dramatically altered care delivery. Recent months have also exposed long-standing flaws of our health care system, marked by fragmentation, inefficiencies, high rates of chronic illness, and glaring health disparities.

    Continue Reading►


  • 25 Aug 2020 4:54 PM | AIMHI Admin (Administrator)

    Axios Source Article | Comments courtesy of Matt Zavadsky

    Recall the conversations we’ve been having about whether “EMS” is public safety or healthcare

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    • Whenever the first coronavirus vaccine makes it across the finish line, there won't be enough to go around. So experts say two rounds of rationing will be necessary — one to divvy up the available doses around the world, and then another to decide who gets first crack at the U.S.' limited supply.  Most Americans are OK with a domestic priority system but don't think the U.S. should share a vaccine internationally if it's the first country to develop one, according to a new Harris poll shared exclusively with Axios.

      By the numbers: 69% of respondents in the Harris survey said they’d support a priority system for distributing a vaccine within the U.S., while just 31% said they’d prefer a first-come, first-served approach.

    • 66% said that if the U.S. develops a vaccine, it should only be made available abroad after all U.S. orders have been filled; just 34% said it should be made available overseas immediately.

    Continue Reading►

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