EMS agencies, providers, collaborators, and other stakeholders are encouraged to be active advocates for the creation of sound EMS regulatory policies. AN ESSENTIAL SERVICE The first of these principles is that states should consider defining EMS as an “essential service.” 36 While it may seem fundamental, in most states this is not the case. Therefore there is no requirement for any government agency to plan for or ensure sustainable EMS systems. This hurts innovation as there is no incentive for municipalities to consider new delivery methods. It has hurt EMS since its inception and is a significant factor in our over- dependence on volunteer providers. PENNSYLVANIA OVERCOMES LEGAL BARRIERS TO EMS PUBLIC HEALTH INNOVATIONS In the early 2000s, Pennsylvania EMS leaders looked into using paramedics to distribute vaccines to the public. Intramuscular injections had been within the paramedic scope of practice since the 1985 EMS Act, and these leaders saw EMS as a very effective potential distribution system. Compared to Departments of Health, EMS has access to the necessary manpower and can organize vaccination drives relatively easily. Like Departments of Health, they also know their communities well. Unfortunately, the Pennsylvania EMS Act did not include vaccinations on the list of medications EMS providers were permitted to administer, and EMS could not distribute vaccines under the EMS Act unless the Secretary of Health declared a mass immunization emergency. In response, EMS leaders found that under the Medical Practice Act, physicians can designate technicians as extensions of their medical practices. EMS medical directors were able to designate off-duty EMS providers to distribute immunizations, and a paramedic-
RIGHT PLACE, RIGHT TIME The second of these principles is that state statutes and regulations should be silent about the practice locations and transport destinations of patients assessed and managed by EMS providers (EMTs, AEMTs and paramedics). Many states limit the role of EMS to certain practice settings such as the out-of-hospital environment or, more commonly, to the initial treatment and stabilization of patients during an emergency. This has the unfavorable effect of potentially (depending on interpretation) preventing EMS from providing follow-up care after an emergency or hospitalization, proactively engaging patients who are at high risk or have a The success of this proof-of-concept was useful during the response to the H1N1 influenza epidemic. The Secretary of Health declared a mass immunization emergency, and EMS partnered with the Department of Health to distribute seven million vaccines. Paramedics were trained with a statewide online module on administering H1N1 vaccinations and the plan for distributing the vaccines around the state. The state government then approached local EMS chiefs to organize the distribution to their local communities. EMS chiefs were able to identify buildings that would support a vaccination drive, provide the staffing, and raise interest in the community. Pennsylvania rewrote the EMS Act in 2009 to allow paramedics to give vaccines. The act also defined the role of EMS more broadly as an essential public service with responsibilities beyond emergency response and transport. The efforts of EMS leaders to move Pennsylvania towards using EMS to distribute vaccines provide an example of how seemingly impossible legal barriers to innovation can be overcome to allow EMS to better serve communities. led pneumovax drive showed that these drives could effectively distribute vaccines to communities.
36 Van Milligan M, Mitchell III JP, Tucker J, Arkedis J, Caravalho D. “An Analysis of Prehospital Emergency Medical Services as an Essential Service and as a Public Good in Economic Theory.” (Report No. DOT HS 811 999a). (Washington, DC: National Highway Traffic Safety Administration; May 2014).
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CHAPTER 2
MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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