Safety First: First Federal Summit addresses the need for ambulance research & data


 
 

From the January 2009 Issue | Monday, January 5, 2009


Safety First

First Federal Summit addresses the need for ambulance research & data

More than 150 individuals and organizations participated Nov. 7 (in person or via Webinar) in the first Ambulance Transport Safety Summit sponsored by the EMS Transport Safety Subcommittee of the Transportation Research Board, one of six major divisions of the National Academy of Sciences/National Research Council. The meeting focused on the availability of ambulance-crash data (or lack of such data) and on vehicle design and operations, human factors, ergonomics and safety standards for ambulance services.

EMS Transport Safety Subcommittee ChairNadine Levick, MD, MPH, an emergency physician, academic and interdisciplinary researcher, chaired the four-hour meeting. Nineteen leaders from EMS, public-health research, government, fire service and private provider agencies participated in panel discussions.

One theme that arose throughout the meeting was the lack of ambulance-safety research and data. Researchers identified only 40 papers published over the past 30 years that deal specifically with ambulance safety, although highway incidents killed 39% of the U.S. EMS personnel who_ve died in the line of duty. Levick noted that the National Transportation Safety Board initially declined to gather data specific to ground ambulance crashes but reversed that stance in October.

A panel on human factors and ergonomics included an ergonomist, a paramedic expert on emergency-vehicle visibility and an ambulance service director who discussed the value of driver-monitoring equipment for identifying and correcting poor driving. The panel stressed that designers of ergonomically safe ambulances must consider specific requirements for patient-compartment access and egress from rear and side doors, the loading and unloading of stretchers and how personnel access equipment during transport.

Ralph Grzebieta, PhD, an Australian road-safety research leader, advocated a "safe systems approach," including safe vehicle design, road design and driving habits. He stressed that the side-facing seats and protruding cabinets in today_s ambulances are inherently dangerous. An ambulance manufacturer_s representative noted that the latest federal KKK standard for ambulancesdoes allow for front- or rear-facing seating instead of a squad bench.

Levick noted that federal KKK standards don_t require dynamic ambulance testing and federal motor vehicle standards specifically exempt ambulances. In fact, the U.S. currently has more safety standards for moving cattle than for moving patients.

Eileen Frazer, executive director of the Commission on Accreditation of Medical Transport Systems (CAMTS), said that both CAMTS and the Commission on Accreditation of Ambulance Services would release new standards in 2009 that include safety issues for the first time.

In the closing address, Arthur Cooper, MD, director of pediatric surgical services and the regional trauma center at Columbia University in New York City, said there_s little data readily available on ambulance crashes, no epidemiology to determine what elements negatively affect ambulance transport safety and no idea of the true costs of ambulance-safety issues to EMS personnel and patients.

Summit panelists agreed on the need to develop consensus definitions to help compile ambulance crash data and create a database as the foundation for a National Clearing House for EMS Transport Safety Resources and Research. They also agreed federal agencies should work together to provide comprehensive information and design solutions for safer ambulances, and the EMS community should develop an EMS Transport Safety Agenda for the Future.

For PowerPoint presentations and an audio recording of Summit proceedings, visitwww.objectivesafety.net. ƒGlenn Luedtke

Quick Takes

New Jersey Proposes EMS Standards

The New Jersey EMS Council has drafted legislation that would put all EMS under state health department control, require communities to make provisions for EMS (as they must for fire and police services), establish response times and mandate at least two EMTs on every emergency ambulance. Currently, only hospital-based services may provide ALS in the state, with most BLS provided by volunteer services that have fought state control. A 2007 study mandated by the legislature recommended 55 changes. "The failure of New Jersey_s EMS system is not about to happen, it has already begun, quietly worsening each year," said the report on the study_s findings. According to the Newark Star-Ledger, legislators promise public hearings in early 2009 before they introduce and vote on a formal bill.

Coming Soon:Guidelines for Safely Transporting Kids

The National Highway Traffic Safety Administration launched a two-year project in November to develop recommendations for safely transporting children in ground ambulances. The NHTSA EMS Office and NHTSA Occupant Protection Division are jointly sponsoring the project. Maryn Consulting, an IT/human resources consulting firm, will work with national experts to create the guidelines. For more information, contact NHTSA EMS Specialist Dave Bryson atdave.bryson@dot.gov.

Defibrillators

Add Features

ZOLL and Masimo issued a joint announcement Nov. 13 that Masimo Rainbow SET pulse CO-oximetry would be integrated into all ZOLL E Series defibrillators, allowing the non-invasive and continuous measurement of carbon monoxide (SpCO) and methemoglobin (SpMet) in the blood. This will provide "the advanced clinical intelligence that today_s EMS and fire professionals need to accurately diagnose and treat victims of carbon monoxide poisoning," says ZOLL CEO Richard A. Packer. Also, Physio-Control is awaiting U.S. Food and Drug Administration 510(k) clearance to release its new LifePak 15, which incorporates Masimo_s Rainbow technology for SpCO and SpMet monitoring. "We can_t project when that might happen," says Physio-Control spokeswoman Ann Devine.

Action Alert

Help Build an EMS Caucus in Congress

Ambulance services nationwide are struggling with a broad array of reimbursement and regulatory issues, and federal lawmakers can help. But members of Congress need education on EMS issues and a focused push to address EMS concerns and get more federal funding and other resources for ambulance services and EMS personnel.

To gain more Congressional clout, Advocates for EMS (AEMS), an entity created in 2003 by a coalition of national organizations to educate Congress on EMS issues, has recruited several members of the U.S. House of Representatives to start a Congressional EMS Caucus. Reps. Dutch Ruppersberger, D-Maryland, Charles Boustany, R-Louisiana, and Tim Walz, D-Minnesota, have agreed to lead the new caucus. It will focus on issues that affect the day-to-day operations of EMS providers throughout the country, including improving Medicare and Medicaid reimbursement, getting more federal resources for EMS disaster preparedness, research, the National Emergency Medical Services Information System and addressing EMS workforce issues.

But AEMS needs your help to recruit your members of Congress into the EMS Caucus. Congress is in recess until after the Jan. 20 presidential inauguration, making this the ideal time to visit your representative_s local office to introduce yourself and your issuesƒespecially to newly elected members of Congressƒand ask them to join the caucus. Lawmakers welcome constituent visitsƒespecially by uniformed public safety officers.

If you prefer to write a letter, AEMS makes it easy: Visitwww.advocatesforems.organd click on "Take Action" for all the tools you need.

PRO BONO

Signature Rules ChangeƒAgain!

In Jan. 1, 2009ƒexactly one year to the day after Medicare implemented new regulations for beneficiary signatures necessary to submit a claim for ambulance servicesƒthe regulations have changed again. Although the 2008 changes were significant, the 2009 regulations don_t represent a major modification to the previous rules.

Under the 2008 regulations, all claims submitted to Medicare must have the patient_s signature, but if the patient is physically or mentally incapable of signing, an authorized signer can sign on their behalf. Authorized signers include the patient_s legal guardian, a relative or other person who receives Social Security benefits on the patient_s behalf or arranges for the patient_s treatment or exercises responsibility for their affairs or a representative of an agency or institution that has furnished care, services or assistance to the patient (other than a representative of the ambulance service submitting the claim).

The 2008 regulations also allowed ambulance services to submit claims for emergency ambulance transport services even when they can_t obtain the signature of the patient or authorized signer. To use this "emergency exception," the ambulance service must obtain three forms of documentation before the claim can be submitted to Medicare: a signed statement by an EMS crew member that the patient was unable to sign and no authorized signer was available or willing to sign; documentation with the date and time the patient was transported, along with the name and location of the receiving facility; and a signed statement from a representative of the receiving facility documenting receipt of the patient, or some other secondary form of verification on a facility record showing receipt of the patient from the ambulance service.

The most significant change in the 2009 regulation is that Medicare has expanded the emergency exception to include non-emergencies as well. Again, three alternate forms of documentation are required when the patient is physically or mentally incapable of signing.

Although the signature rules haven_t changed significantly, the important message remains the same: It_s vital that EMS personnel do everything possible to obtain a signature from the patient or other authorized signer at the time of service. Otherwise, the burdens of obtaining a qualifying signature after the fact can significantly delay an ambulance service_s cash flow.

Pro Bono is written by attorneysDoug WolfbergandSteve WirthPage,Wolfberg & Wirth LLC, a national EMS-industry law firm. Visit the firm_s Web site atwww.pwwemslaw.comfor more EMS law information.

Should Medics Get Bonuses for Improving Performance?

EMTs and paramedics employed by Winona Area Ambulance Service (WAAS), a small hospital-based agency in Minnesota, can earn up to $1,000 extra each year if they collectively meet six performance measures. In 2007, for example, full-time medics took home an extra $900 each for completing patient care reports within three hours; meeting out-of-chute time goals; performing an ECG on every patient with non-traumatic chest pain; assessing and providing appropriate relief for traumatic hip pain; and documenting the time of stroke symptom onset. (Part-timers were paid prorated amounts.) WAAS medics could have earned another $100, but they narrowly missed the target of giving aspirin to at least 98% of the patients with non-traumatic chest pain.

WAAS Medical Director Brett S. Whyte, MD, says WAAS began the incentive program in 2005 after other attempts to improve compliance met with little success. Now, he says that although the EMTs and paramedics no longer

receive a bonus for meeting a specific objective, they usually maintain the improvement because it_s become part of their regular practice.

But Whyte admits not everyone approves of the program. "Somemedics say we should be doing these things anyway," he says.

What do you think? Visitjems.com/jems to let us know.

CONTROVERSY

Should Medics Get Bonuses for Improving Performance?

EMTs and paramedics employed by Winona Area Ambulance Service (WAAS), a small hospital-based agency in Minnesota, can earn up to $1,000 extra each year if they collectively meet six performance measures. In 2007, for example, full-time medics took home an extra $900 each for completing patient care reports within three hours; meeting out-of-chute time goals; performing an ECG on every patient with non-traumatic chest pain; assessing and providing appropriate relief for traumatic hip pain; and documenting the time of stroke symptom onset. (Part-timers were paid prorated amounts.) WAAS medics could have earned another $100, but they narrowly missed the target of giving aspirin to at least 98% of the patients with non-traumatic chest pain.

WAAS Medical Director Brett S. Whyte, MD, says WAAS began the incentive program in 2005 after other attempts to improve compliance met with little success. Now, he says that although the EMTs and paramedics no longerreceive a bonus for meeting a specific objective, they usually maintain the improvement because it_s become part of their regular practice.

But Whyte admits not everyone approves of the program. "Somemedics say we should be doing these things anyway," he says.

What do you think? Visitjems.com/jemsto let us know.

Dangerous

Headphones

In 2007, concerns arose about the potential for iPods to interfere with pacemakers or implantable defibrillators (ICDs). The U.S. Food and Drug Administration checked that out and recently said iPods posed no problems. Butƒsurpriseƒthere_s a problem with some MP3 player headphones! Turns out some headphones can create chaos with a pacemaker or an ICDƒeven if they_re unplugged and in a shirt pocket or hanging around someone_s neck.

William Maisel, MD, a cardiologist at Beth Israel Deaconess Medical Center in Boston, tested eight headphone models on 60 patients and found they interfered with four of 27 pacemakers and 10 of 33 ICDs if they were placed within an inch of the device. Neodymium, a powerful magnetic substance used in some models, could cause heart palpitations or prevent an ICD from firing.

"It_s smart to keep small electronics at least a few inches from implanted medical devices and not let someone wearing headphones lean against your chest if you have [an implanted device]," Maisel told the Associated Press after he presented his findings at the American Heart Association conference in November.JEMS




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