Administration and Leadership, Ambulances & Vehicle Ops, Communications & Dispatch, News, Training

New OnStar Program Assists First Responders

Issue 12 and Volume 36.

Advancements in telematics technology and a dedicated call center staff allow OnStar to deliver emergency services to subscribers in a variety of ways. The first is automatic crash response. Using built-in vehicle sensors, OnStar’s embedded system notifies an OnStar advisor if the vehicle is involved in a moderate to severe crash.

The advisor will then speak to the vehicle occupants to confirm that emergency assistance is required. If the occupant confirms needing emergency assistance or is hurt and can’t respond, the advisor will contact the appropriate public safety answering point (PSAP) and provide the vehicle’s description, exact GPS location and subscriber information.

The second way OnStar delivers emergency services is through a subscriber’s 24/7 priority access to an emergency advisor, accessible by pushing the red emergency button on their rearview mirror. The third way is through an OnStar Good Samaritan call. A Good Samaritan call is when an OnStar subscriber reports other emergencies external to their vehicle, such as road hazards, crashes or wildfires.

EMS providers know that every second that goes by between a patient’s injury and receiving medical attention is crucial to their well-being. OnStar emergency advisors now provide a service called First Assist, commonly referred to in the emergency responder community as emergency medical dispatch (EMD) for all emergencies.

Additional Training
EMD calls are supported by OnStar-certified emergency advisors. To become an emergency advisor, a candidate must have significant experience at an OnStar call center handling non-emergency calls and have demonstrated such traits as the ability to multi-task, make quick decisions and stay calm under pressure. Advisors are then required to complete approximately three months of training, which includes an OnStar emergency training course, CPR training and specialized training by the International Academy of Emergency Dispatch and National Academies of Emergency Dispatch. The culmination of the program is EMD certification. These advisors also receive continued EMD and OnStar-specific education to maintain their certification.

Through this training and certification, OnStar emergency advisors can offer critical guidance during emergencies, ranging from explaining how to treat injuries sustained after a car crash to assisting in the birth of a child. After determining the nature of the situation, advisors can provide timely instructions, which may result in potentially lifesaving actions. This assistance is given before first responders arrive on scene. While one advisor is providing guidance to the patient(s), another advisor is contacting the local PSAP to provide the appropriate information. Here’s how the process works:

An advisor receives a call from the vehicle, either through automatic crash response or by pressing an emergency button.

The advisor evaluates the nature of the emergency and determines whether EMD is needed.

If EMD is needed, the advisor will conference in a partner (another emergency advisor) to perform EMD while they contact the local 9-1-1 center.

The original advisor speaking to the 9-1-1 dispatcher will verify jurisdiction and provide the vehicle location and a description of the incident. This advisor may also connect the 9-1-1 dispatcher to the patient or provide updates on the EMD information that has been obtained so far.

The advisors will coordinate with each other and the 9-1-1 center to obtain any additional information necessary to facilitate the appropriate dispatch of help to the caller.

This process heavily relies on emergency first responders because OnStar acts as the intermediary only until EMS providers arrive on scene. Because OnStar emergency advisors now have the proper training to give pre-arrival instructions, however, they can calm panicked drivers before EMS arrival.

This new service was established to complement a PSAP’s use of EMD or to have the medical protocol available when centers aren’t EMD equipped. Since its inception this past year, OnStar EMD has been used to help a customer in an Oregon desert treat a poisonous rattlesnake bite, to comfort and direct a woman who just delivered a baby in the vehicle and to aid a camper having serious heart and breathing problems.

OnStar-equipped vehicles can also replay data to an advisor who will help determine the nature of the patient’s injuries. This system, known as Injury Severity Predition, is an algorithm that takes into account specific crash information to determine whether there’s a high probability of severe injury after a crash. This information is then relayed through an advisor directly to the 9-1-1 center with juridiction to determine what level of response is needed for each situation.
—Cathy McCormick

MSDS Info in Your Phone
Emergency personnel can easily decipher technical terms and abbreviations encountered on material safety data sheets (MSDS) and chemical container labels with the new MSDS Apptionary, an iPhone and iPad app that puts more than 1,000 reader-friendly MSDS-related definitions at your finger tips. Embedded within the definitions are scores of telephone numbers and website links that will instantly connect users to reliable and authoritative sources for hazard, environmental and regulatory information. You can download a copy for $1.99 at the iTunes store.

What You Said
We asked our Facebook fans to tell us their top tips for driving in the snow. Below are our two favorite tips. To read the complete story, visit
1. Slow down, watch the idiots, and remember this: You are worth nothing if you don’t arrive. —Matthew Swart
2. Go slow, drive safe and go home at the end of your shift … It’s the patients’ emergency, not yours. —Adam Willemssen
To follow us on Facebook, visit!/jemsfans. Also, check out “Deadly Driving” for more information.

Pro Bono
Blowing the Whistle

The federal government is stepping up its anti-fraud and abuse initiatives with increased audits, enforcement and new tools to root out fraud in our healthcare system. The number of whistleblower lawsuits is on the rise. The Medicare Fraud Hotline, Senior Medicare Patrols and encouragement of whistleblower lawsuits are just a few weapons the government is using in its fraud fighting arsenal to encourage citizens to report suspected Medicare and Medicaid fraud.

The Federal False Claims Act (FCA) whistleblower provision gives whistleblowers a “cut,” much like what plaintiff lawyers get in a successful personal injury case. A whistleblower who turns an EMS agency in for alleged Medicare fraud stands to gain up to 30% of the civil damage award or settlement amount if the allegations are true.

But there are many pitfalls in being a whistleblower: Very few ultimately “win big,” and once the case goes public, it’s often difficult to get employment in the healthcare industry later. It can also be an emotionally agonizing and stressful experience because these civil cases can last many months, and they subject you to the highest level of scrutiny that could tarnish your reputation.

Here are a few points to consider if you’re contemplating blowing the whistle:

Are you sure it’s really fraud? If something troubles you about your agency’s practices, ask questions. What may seem fraudulent to you may not actually be. For example, although you may transport a Medicare recipient who doesn’t meet Medicare’s medical necessity requirements for an ambulance, your billing office may not actually be submitting the claim to Medicare for payment.

Have you followed your agency’s compliance policies? The government recommends all ambulance services have an active compliance plan to prevent and detect potential fraud. The feds prefer internal reporting of concerns to keep these claims from becoming, literally, “federal cases.” The compliance plan should have policies on proper documentation and billing practices, regular compliance training, appointment of a compliance officer and a method to allow all staff members to anonymously report compliance concerns. It’s always best to first follow your internal reporting process before going outside the organization to report your concern.

Have you spoken to the compliance officer? The compliance officer should be trained to act as an ombudsman and “listening ear” for any complaints or concerns about potential illegal activity in the organization. Going to the compliance officer can help ensure prompt investigation of the concern and should be encouraged by your agency.

Have you made an anonymous report? Your agency should have a system that allows you to report your concern anonymously. That helps protect you, your job and your reputation. Many EMS agencies rely on outside professional services with toll-free numbers to encourage bona fide reports of potential fraud. Use this system if you’re concerned about retaliation for reporting compliance concerns.

If all else fails and the internal reporting system is non-existent or ineffective, reporting your concerns to the government may be your only viable option. The FCA and many other laws have anti-retaliation provisions that protect you from termination or adverse action against your job if the action is due to your good faith report of suspected legal violations in your agency. Hopefully, your organization welcomes your legitimate concerns and you won’t have to rely on this legal protection.

Pro Bono is written by attorneys Doug Wolfberg and Steve Wirth of Page, Wolfberg & Wirth LLC, a national EMS-industry law firm. Visit the firm’s website at for more EMS law information.

Quick Takes
Minorities in the FDNY

A federal judge in Brooklyn has appointed a monitor to oversee the Fire Department of New York (FDNY) after ruling that the organization’s recruitment and hiring practices were discriminatory.

City officials vow to fight the ruling, which the FDNY Commissioner Salvatore Cassano said in a hearing would “usurp” some of his authority.

The ruling by judge Nicolas Garaufis came at the end of a suit filed by the Vulcan Society, which represents black firefighters. The group maintained that minorities were at a disadvantage within the FDNY hiring system. Garaufis appointed Mark Cohen, an attorney with the Manhattan law firm Cohen & Gresser, with the task of overseeing changes in the FDNY’s hiring process.

New York City Mayor Michael Bloomberg said the judge was interpreting the law and the city has disagreed with him many times.

“We’re trying to do the right thing,” Bloomberg said on his weekly radio show. “Sometimes if you give equal opportunity, you don’t get equal results.”

The decision to add a monitor hasn’t overturned the FDNY’s hiring process. The next FDNY firefighter exam is set for February. An FDNY spokesman says 60,000 have signed up for the test, with 45,000 expected to actually take it. Forty-nine percent of the applicants for the test are minorities, the spokesman says. For the first time, the FDNY will use a computer-based entry test, rather than a written, the spokesman added.

Garaufis says the city’s efforts to end systematic discrimination have repeatedly failed, thus the need for a monitor. For now, the FDNY is operating under the assumption that it will operate with a monitor in position until the litigation is settled, which could take years.

Already, 1,000 people are signed up to take a promotional exam for a transfer to become firefighters. Those who pass getting priority over those taking the standard FDNY applicant test.

Proper O2 Storage
A shocking explosion of an oxygen tank inside a Maryland ambulance has those of us in the EMS field rethinking how we handle the potentially combustible gas.

In September, a Lifestar Response ambulance caught fire while en route to pick up a patient when the crew reportedly smelled something burning. The quick-thinking staffers inside pulled over and removed the main oxygen tank. Flames quickly engulfed the vehicle, and soon after, the portable tanks inside exploded.

The incident was another reminder of the hidden risks EMS workers face with something they use every day on a routine basis, says Joe Hopple, NREMT-P, the education coordinator of Sussex County (Del.) EMS.

“They’re dangerous, pressurized cylinders,” says Hopple. “They need to secure them and maintain them appropriately.”

Most EMTs and paramedics don’t think much about oxygen, Hopple says. They’re taught how to handle cylinders during their basic training, and for the most part never think about the actual equipment again.

“I think we take it for granted,” he says. “Most EMTs turn on the valve and set their liter flow, and that’s all they think about it.”

The Lifestar ambulance was destroyed in the fire. There were no injuries. Although the tanks weren’t the cause of the blaze, a video of the fire shows the roof being lifted off when the small tanks ignited. The blast was a clear signal of how dangerous the tanks can be.

“With the smaller tanks, we’re very lucky we haven’t seen other incidents,” says Hopple. “I don’t think we have the respect for the power of what’s in those cylinders.”

The National Association of State EMS Officials (NASEMSO) recently reported the results of a national survey of the EMS industry. All 50 states and four of the six territories responded, with the following results.

This article originally appeared in December 2011 JEMS as “Emergency Advisors: A new partner in EMS first response.”