EMS Live in Wisconsin Podcast

Successful report tied to core value of patient-centered EMS delivery

>> Click for on-demand playback and listen now!

What started decades ago throughout Milwaukee County EMS as a seemingly well-intended policy to divert ambulances to less crowded hospital emergency departments now represented an opportunity to realign patient-centered EMS delivery within the context of a changing health care landscape. 

According to Milwaukee County EMS Medical Director Dr. Mario Colella, "In the era of diversion, we noticed when one hospital went on diversion other surrounding hospitals soon followed, patient satisfaction diminished and ambulances were forced to drive further away from their communities.  Most importantly, patients that were sick were denied access to the closest emergency care".

With the phased in policy, ambulance diversion officially ended April 1, 2016, in Milwaukee County.  Now, a report has been authored on the outcomes from the policy change.  >> Click to review the report's executive summary.

The podcast was recorded on April 25.  Guests included Milwaukee County Emergency Management Director Christine Westrich, Milwaukee County EMS Medical Director Dr. Mario Colella and Milwaukee County Emergency Management Program Director Ken Sternig.  >> Click for on-demand playback and listen now!

The following questions were discussed:

1. What is the history of Hospital Diversion and why is "non-diversion better?
2. How did Milwaukee County coordinate this among paramedics, hospitals, etc.? 
3. Did you stage the approach or go cold-turkey on the actual operations?
4. Did the data show what you expected -- has there been any fallout or successes?
5. What's next for the Milwaukee County EMS System?

EMS Live in Wisconsin is broadcast live on the phone and via the internet the second and fourth Tuesday every month starting at 9:00 a.m. and typically running 30 minutes. 

State Capitol

Bill now moves to the Senate, to hold public hearing soon.

The Community Paramedicine Bill, >> AB151, received unanimous vote of approval by the full Assembly at the State Capitol on April 4.  Assembly Amendment 1 was adopted and passed.  >> Review Community Paramedicine Bill - Assembly Amendment 1.

During the Assembly's Committee on Health public hearing on March 22, Dana Sechler, EMS director at the Baraboo District Ambulance Service, said "Community EMS fills the "gaps or voids where there is a need.  Their efforts can help hospitals avoid penalties for re-admissions". 

Captain Michael Wright of the Milwaukee Fire Department shared with members of the Assembly's Committee on Health that he helped develop the city's community paramedic program three years ago.  The department, which has about 30 trained paramedics, focuses not only on preventing re-admissions, but also to help those who frequent emergency rooms for their healthcare. The program is funded by the city of Milwaukee.   He said the program was needed because "there's so many gaps."
 
Captain Wright, photo insert, stated during the public hearing, "For eighteen years, I've been responding to people and knowing that they needed more. They weren't getting it from the hospitals, they weren't getting it from the doctors. They couldn't get it from us because we don't have time. The program helps provide that care, he said".

According to PAAW Lobbyist Michael Brozek, "This is a very, very fast tracked piece of legislation...unusually fast."

Minnesota Ambulance Association Lobbyist Buck McAlpin also shared on news about the Assembly's vote, "Very few states have formalized this (Community Paramedicine) into law - a very nice win."  McAlpin was instrumental in Minnesota passing Community Paramedicine legislation in 2011.

Now, the bill heads to the Senate.  The companion bill in the Senate is known as >> SB149.  It was read for the first time before the full Senate on March 29, and then referred to the Committee on Health and Human Services for a public hearing.

State Capitol

Senate to hold first public hearing on Thursday, April 6.

The Community Paramedicine Bill received a public hearing on March 22 and unanimous vote of approval on March 29 from the Assembly's Committee on Health.  Now, the bill goes before the full Assembly at the State Capitol and is scheduled for a vote on Tuesday, April 4.  The bill is known as AB151 and is sponsored by Rep. Amy Loudenbeck.

It is anticipated the Assembly will vote in favor of the Community Paramedicine Bill.  The companion bill in the Senate, known as SB24, is tentatively scheduled for a public hearing in the Senate on Thursday, April 6.  >> Click to download Senate Community Paramedicine Bill SB149.

Recent Podcast on Community Paramedicine

>> Click to listen now.

This EMS Live in Wisconsin podcast was recorded on Tuesday, March 28, and was dedicated to Community Paramedicine.  Guests included Minnesota Ambulance Association Legislative Lobbyist Buck McAlpin and PAAW President Patrick Ryan.  >> Download the podcast at http://tobtr.com/9900319.

Community Paramedic Training Program - Offered by the University of Wisconsin - Milwaukee

Using the North Central EMS Curriculum, a Community Paramedic Program is offered through the University of Wisconsin - Milwaukee.  The program provides all required content for the Community Paramedic including:

For more information >> click here or contact Dr. Kim Litwack, Program Director at 414-229-4189 or email litwack@uwm.edu.

State Legislation

Following a public hearing on March 22 at the State Capitol, the Assembly's Committee on Health called an executive session to vote on AB151, the Community Paramedicine Bill.  The executive session is scheduled for Wednesday, March 29 starting at 11:00 a.m. in room 328 Northwest at the State Capitol.  >> Click for the meeting agenda.

The Wisconsin Department of Administration (DOA) recently released a report detailing the fiscal impact to the Department of Health (DHS) in adding an endorsement for Community EMT and Community Paramedic.  According to the report, to implement the endorsement, provide training and maintain the standard of 60 days or less to process licenses, operation plans and protocols, DHS would require one additional full-time coordinator at $80,300 GPR.  In addition, there are two minor one-time setup fees totaling $7,500.  >> Click to review the DOA fiscal estimate.

The Community Paramedicine / Mobile Integrated Healthcare Bill is sponsored by Rep. Amy Loudenbeck.  >> Click for the Community Paramedicine Bill (AB151).

According to PAAW President Patrick Ryan, "PAAW, along with State stakeholders have worked long and hard to get this important legislation to this point. We are optimistic about support throughout the state for the establishment of a framework for the development of Community Paramedic programs across the state".

For current insights into what EMS Today conference attendees had to recently share about Community Paramedicine and Mobile Integrated Healthcare program ideas, click here.

Upcoming Podcast on Community Paramedicine - Tuesday, March 28 at 9:00 a.m.

The next EMS Live in Wisconsin podcast on Tuesday, March 28, is dedicated to Community Paramedicine.  Guests include Minnesota Ambulance Association Legislative Lobbyist Buck McAlpin and PAAW President Patrick Ryan.  Listen live by calling 646-929-1081, or on the internet at this link >> http://tobtr.com/9900319.  The program is broadcast live from 9:00 to 9:30 a.m.

Minnesota is a leading state in Community Paramedicine, with its bill signed into law in 2011.  McAlpin was instrumental in the bill passing in Minnesota, and has consulted with PAAW and other ambulance services in Wisconsin intending to deliver Community Paramedicine in the badger state.  McAlpin's employer, North Memorial Medical Center, Brooklyn Park, Minnesota, offered a two-day class in September 2015 for Wisconsin's ambulance services and other healthcare providers to review their operation and stats, to meet those delivering out-of-hospital Community Paramedicine care, and help these organizations begin to lay the groundwork for Community Paramedicine in their own community.

Western Wisconsin EMS News

More than 20 St. Croix EMS emergency medical technicians could lose their jobs if the city of Hudson decides to transfer the service to the Hudson Hospital and HealthPartners.  City commissioners emphasized negotiations are still ongoing and no decision has been made.

Lakeview Vice President of Ancillary Services Nathan Pulscher, one of HealthPartners’ representatives at the meeting, said the Hudson Hospital would use the two-paramedic model that other HealthPartners organizations do, as it has found the model to be successful. Under this model, Hudson Hospital would offer all current St. Croix EMS paramedics employment, but the model has no role for current EMTs.

St. Croix EMS employs 24 EMTs and 12 paramedics, though some employees in both positions already work for HealthPartners as well.

Pulscher said HealthPartners and Hudson Hospital would be willing to talk about supporting current EMTs in being trained as paramedics.

Currently the hospital and city have not landed on an answer for who will serve as first responders to the community if the transfer is approved.

Council Member Tom McCormick said the city is dedicated to public safety in the community. Services would still be based in Hudson.

“We want to have a successful EMS system,” McCormick said.

McCormick said the city has approved retention bonuses for most EMS staff that would provide incentive for workers to stay on and ensure the service can continue to operate up until the transfer point, if the transfer is approved.

Source: Hudson Star-Observer

Standby for Tones Blog

They only moved here a month ago, she says. It’s quite dark outside and you can’t tell it’s foggy unless you catch a glimpse of the misty haze in the glow of the passing small town streetlights. From another part of the state, they loved the topography of the bluffs that line the mighty Mississippi in our driftless region. The coulees stretch fingers up among the gentle swells of the bluffs, and in the warmer months the surface of the water is glassy and rippling, in turns. They knew exactly where they wanted to move when they retired, and just under a month ago they made my region of Wisconsin their permanent home. When she speaks of the views she enjoys from their new home, her face lights up and she beams. The joy is incongruous in its juxtaposition next to the ecchymosis evident on her eyelid and surrounding tissues which occlude her vision on one side.

The Badgers played awhile back and lost the game to the Gators in the last 4 seconds. She and her hubby haven’t really met anyone here yet, so they enjoyed a couple beers at home. Unused to the unfamiliar home, she stumbled in the dusk afterward and lost her footing. A retired healthcare provider, she chalked up her subsequent pain and stiffness as just a result of tumbling down some stairs. Time went by, the sun rose, she began to admit that it was more than pain and stiffness. Listening to her history of the events, I’m struck by her strength. The paperwork accompanying her lists a fracture as well as an anteriorly displaced shoulder dislocation – in the same upper extremity as the ecchymosis. A reduction attempted was unsuccessful due to some myoclonus and trismus evidenced after administration of etomidate. I’m currently transporting her to a larger facility for further care.

>> Click to read more of the story...

Texas Legislation Introduced

Texas lawmakers introduced legislation last week to allow the state’s first responders to carry a handgun while on duty, KXAN reported.

The proposed legislation would make it possible for firefighters and Emergency Medical Services personnel who have firearms permits to carry their guns during normal shifts.

“You never really know what you’re getting into,” said Capt. Rick Rutledge, of the Austin-Travis County EMS. “There are certainly risks.”

House Bill 435 also allows for volunteer emergency workers to carry guns. The bill, according to the station, will not require any further training for those who are already licensed to carry firearms.

“You have to assume it’s like a driver’s license,” said State Rep. Dan Flynn, a Republican. “You know how to drive before you get a license; you know how to shoot a gun before you get a license.”

Still, Rutledge questions if the bill will really help the state’s first responders to remain safe.

“Protecting that weapon, limiting liability, knowing when to use and not use that. It is a specialized area and a course of training that we haven’t had,” Rutledge said.

Chris Barron, the executive director of the State Firefighters’ and Fire Marshals’ Association of Texas, echoed the sentiment: “We are not trained in law enforcement.”

Flynn told KXAN that “hostility towards first responders” is the reason for the bill.

“What we’re finding out is often, someone will set up an attack, they’ll set up a fire just to go after people that they don’t like,” he said.

National EMS News

Members will engage the national EMS community in creating a vision for the future 

What could be the role of EMS in our nation's healthcare, public health, and public safety systems in three decades? What do we have to do now to make that happen? EMS Agenda 2050, a two-year project with a mission to write a new Agenda for the Future, has selected 10 members to serve as the Technical Expert Panel (TEP), which will work with the EMS community to answer these and other questions.

The panel will take ideas and suggestions from the EMS, public safety, and healthcare communities, as well as the general public, to create a path for a comprehensive system of emergency care integrated with the broader healthcare continuum.

The 10 TEP members bring to the project diverse backgrounds and perspectives, including experience at local, state and national levels, a history of innovative thinking and a passion for making a difference in the lives of patients and providers.

The members of the EMS Agenda 2050 TEP are:

Derek Bergsten, MPA, CFO, CEMSO, MIFIreE, Fire Chief, Rockford Fire Department (Rockford, IL)
Marianne Gausche-Hill, MD, FACEP, FAAP, FAEMS, Medical Director, Los Angeles County EMS Agency (Los Angeles, CA)
Andy Gienapp, MS, NRP, Manager, Wyoming Office of EMS, Wyoming Department of Health (Cheyenne, WY)
Alexander Isakov, MD, MPH, FACEP, FAEMS, Professor of Emergency Medicine, Emory University School of Medicine (Atlanta, GA)
William Leggio, EdD, NRP, Paramedic Program Coordinator and Clinical Faculty, Creighton University (Omaha, NE)
Grace Mandel, MPH, EMT, Project Manager, Baltimore City Department of Health (Baltimore, MD)
Kevin G. Munjal, MD, MPH, MSCR, Assistant Professor, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai (New York, NY)
Kyra Neeley, M.Ed., EMT-P, Lieutenant, Fire Commissioner Liaison, Fire Department of New York EMS (New York, NY)
Ernesto Rodriguez, MA, EMT-P, Chief, Austin-Travis County Emergency Medical Services (Austin, TX)
YiDing Yu, MD, Founder and CEO, Twiage; Instructor, Department of Population Medicine, Harvard Medical School (Boston, MA)

For more information about EMS Agenda 2050, please visit emsagenda2050.org.

Community Awareness

National EMS Week will be celebrated nationwide this year Sunday, May 21 to Saturday, May 27.  Wednesday, May 24 is Emergency Medical Services for Children (EMSC) Day.

The opportunity brings with it local awareness of emergency medical services, and quite often includes community open houses, volunteer recruitment and hiring drives, and opportunities for appreciation, recognition and goodwill.

The 2017 theme is "EMS STRONG:  Always in Service".

National EMS Week was established by the American College of Emergency Physicians (ACEP), and is in partnership with the National Association of EMTs.

Opinion

By Joe Covelli, PAAW Executive Director

We've all attended luncheons, potlucks and parties when co-workers leave their current jobs for something else - an internal promotion, another company, retirement or next adventure.  I usually get mixed emotions at events like this, because it means things will never be the same.  As is customary, you extend well wishes and good luck on their next endeavor.  People, events and circumstances change - and so must we.  Some change is for the better, but other change I wish never happened.

In the past couple of months, I've received emails from two individuals I've admired and  respected for a number of years - not only professionally in EMS, but in their personal character too.  Jim Singer and Dan Williams, two Wisconsin EMS icons in my humble opinion, recently announced their retirements.  They've both dedicated their life's work and careers to EMS - Jim with 31 years of service to Flight For Life, Dan with over 45 years in EMS.  EMS in Wisconsin is in a better place because of their leadership, vision and commitment.

Jim Singer recently announced his retirement, effective March 31, as System Transport Director following a 31-year career at Flight For Life, Milwaukee.

Jim joined Flight For Life in 1986 as a Flight Nurse. He became the Chief Flight Nurse in 1991 and transitioned to his current position in 2001. Under Jim’s tenure, Flight For Life has purchased new aircraft, made significant upgrades to its remaining fleet and added an additional base of operations in the City of Fond du Lac Wisconsin. Flight For Life has completed over 33,000 safe transports since it began operations as the first air medical service in Wisconsin in 1983.

Dan Williams retired as Director at Emergency Services of Door County in Sturgeon Bay, on January 12, 2017. 

In 2013, he announced early retirement as Director at UW Health's MedFlight, Madison, and relocated to Sturgeon Bay.  Soon after his early retirement was announced from MedFlight, Dan was asked to serve again as Director at Emergency Services of Door County - a familiar location to him since he was their director for 30 years.  He's held previous leadership positions with Flight For Life and Paratech Ambulance Service, both in Milwaukee, and for a number of years has provided EMS consulting to many Wisconsin ambulance services.

Dan was instrumental in shaping EMS through his leadership as state of Wisconsin EMS Advisory Board chairman from 1992 to 2005, a Governor appointed position, and as State of Wisconsin EMS section chief. 

Since 1986, Dan has been a lead organizer of the Paramedic Systems of Wisconsin (PSOW), an annual conference for those with ambulance service and EMS leadership responsibilities as administrators, owners, chiefs, officers, directors, managers and medical directors. The September 2017 conference will mark the 30th anniversary for PSOW.