Director's Message: Howard Backer, MD, MPH, FACEP
EMS Training Program Requirements Protect Students
One of the statutory responsibilities we have at the EMS Authority is to ensure that individuals licensed as paramedics or certified as EMTs or AEMTs receive excellent training. We accomplish this in partnership with the local EMS agencies through regulations that detail program standards, management, staff, oversight, and process.
Last month, the Sacramento County EMS Agency withdrew authorization for a paramedic training program that served students in Sacramento, Alameda and San Joaquin counties. The program no longer met all of the regulatory requirements, notably the lack of approval as an educational institution from the State Department of Consumer Affairs, Bureau of Private Postsecondary Education (BPPE). This placed the training and licensure of more than 70 individuals in jeopardy.
Through the work of the local EMS agencies and our EMS Personnel Division, as well as the participation of other authorized training programs in northern California, we have been able to provide information to assist with many of the individual students and allow them to complete the training required to earn their paramedic licensure. Unfortunately, complicated issues of tuition reimbursement will have to be resolved between the students and the program. One of the benefits of BPPE approval is a guarantee of tuition reimbursement, if a program closes before a course is finished.
Upon further review, several other EMT and paramedic training programs in the Sierra-Sacramento Valley, Alameda County and Santa Clara County EMS jurisdictions were found to lack the necessary approvals, and local EMS agencies are evaluating those programs now. In some cases there was a misconception that the training programs were exempt from the requirement to obtain BPPE approval (certain institutions and agencies do have exemptions).
These incidents raise the importance of ensuring that all operating paramedic and EMT training programs meet the statewide training standards in statute and regulation. EMS Authority regulations establish the requirements for EMT and paramedic training programs, which are implemented by the local EMS agencies. California Health and Safety Code Sections 1797.206-208 make the local EMS agency responsible for evaluating, approving and monitoring EMT and paramedic training programs and allow the local EMS agency to place on probation, suspend, or revoke approval of training programs for failure to comply with statute or regulation.
The regulatory requirements for EMT and paramedic training programs are detailed in California Code of Regulations, Title 22, Chapters 2 (EMT), 3 (AEMT) and 4 (Paramedic). The training requirements vary based on the skill level. For example, the program approval requirements for a paramedic training program include:
1) Must be accredited and maintain current accreditation by the Commission on Accreditation of Allied Health Education Programs (CAAHEP), upon the recommendation of the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP). New programs have two years to achieve accreditation. If this requirement isn’t met, the LEMSA will revoke the program’s authorization.
2) Must be an accredited university or college, a military program, a licensed general acute care hospital, an agency of government, or be approved by the State of California, Department of Consumer Affairs, Bureau of Private Postsecondary and Vocational Education.
3) Must have a physician medical director licensed in California who, among other requirements, has two years’ experience in prehospital care in the last five years.
4) Must have a course director who is a physician licensed in California, a registered nurse who has a baccalaureate degree, a paramedic who has a baccalaureate degree, or an individual who holds a baccalaureate degree in a related health field or in education.
These requirements were developed in cooperation with the broad EMS stakeholder community and they exist to protect the individual students as much as to ensure the high quality of EMS training throughout California. We are now working with the local EMS agencies to review training programs and ensure that every training program meets the state requirements, thereby serving the interests of EMS students, and ultimately protecting our patients.
2012 EMS Awards Announced
39 people will be honored for their heroic acts and extraordinary contributions to EMS at a ceremony on December 5th in San Francisco.
Dr. Howard Backer, Director of the California Emergency Medical Services Authority (EMSA), has announced the recipients of California Emergency Medical Services Awards for 2012. Launched in 2007, the annual awards honor and recognize exceptional acts and service by individuals working or volunteering in California's emergency medical system. This year, 39 people will be honored for their heroic acts and extraordinary contributions to EMS.
"Providing emergency medical care in the field, whether on the street, home, office, or store is heroic by its nature, and the people who chose this career deserve recognition," said Backer. "Each year, certain emergency medical technicians, paramedics and system participants stand out for their extraordinary actions. It's important that we acknowledge their contributions toward public safety and for making California's EMS system one of the best in the world."
EMS personnel are trained to provide stabilizing and lifesaving care. These EMS awards are intended to honor and recognize noteworthy or exceptional acts and service while working as EMS certified or licensed personnel, administrators, trainers, or volunteers within the EMS system. The award period represents activities from October 10, 2011 through September 7, 2012 for cumulative service.
Most of the awards will be presented during a luncheon ceremony following the regular meeting of the Commission on Emergency Medical Services December 5th in San Francisco at the Marines’ Memorial Hotel. Clinical Excellence Awards will be presented at the recipients’ home stations.
The award ceremony is sponsored by American Medical Response, BoundTree Medical, Paramedics Plus, and the San Francisco Paramedic Association and will be held at no cost to the State.
Click here for information about the awards and the ceremony. Space is limited. Seats are $31/person. Click here to register. For a full list of award recipients, click here.
CAL-MATs Support the 2012 San Francisco Giants Victory Parade
EMSA’s California Medical Assistance Team (CAL-MAT) was called upon to support the 2012 San Francisco Giants Victory Celebration and Parade. In accordance with California’s Standardized Emergency Management System (SEMS), EMSA deployed a 23 member CAL-MAT with a two member Mission Support Team after it was determined that medical personnel resources were not readily available within the region for this particular event.
The CAL-MAT worked in concert with ROCK MEDICINE personnel, treating 59 patients in Larkin Hall at Civic Center Plaza which served as the primary receiving facility for ambulance traffic along the entire parade route. Medical treatment was needed for wound care, stitching, syncope, claustrophobia, chest pains, and one patient that suffered a severe seizure. In addition to the 59 patients treated, six patients were transferred out to local hospitals for further care. ROCK MEDICINE personnel also practiced Sobering Medicine.
The San Francisco Fire Department deployed staff into the crowds to provide support and assisted with moving injured patients to the Civic Center when needed. The American Red Cross provided minor care at Civic Center Plaza.
The San Mateo County Emergency Medical Services Agency and American Medical Response also deployed an Ambulance Strike Team to support the event with an EMSA Disaster Medical Support Unit (DMSU).
The CAL-MAT was lauded by city officials and the patients who received care were thoroughly satisfied. By deploying a CAL-MAT on short notice, working with local providers and helping to ensure public safety during the momentous Giants Victory Parade, EMSA was able to demonstrate the important role played by Mobile Medical Assets.
AMR Responds to Hurricane Sandy Under Public-Private Partnership Agreement With FEMA
By Jason Sorrick, Director of Communications and Government Relations, American Medical Response
During the initial stages of the Federal Emergency Management Agency’s (FEMA) response to Hurricane Sandy’s destruction, video footage surfaced showing Northern California Strike Team members from American Medical Response (AMR) evacuating a New York hospital. After this footage had aired on national news broadcasts, it left many in California wondering why a private ambulance provider deployed a strike team of Northern California paramedics and EMTs to the east coast, and how did they get there so quickly?
Well, the fact is that AMR is the exclusive contracted ambulance provider for FEMA, and has been since 2007. Under AMR’s FEMA contract, the company is responsible for providing ground and air ambulance service along with para-transit transport to supplement federal and military responses to disasters, acts of terrorism and other public health emergencies that occur anywhere in the continental United States.
On October 26, 2012, as Hurricane Sandy began to approach landfall, AMR’s National Command Center (NATCOM) was activated by FEMA. NATCOM manages coordination and logistics for large-scale EMS deployments, and remains in operation throughout the entire deployment until all resources arrive home safely. Once activated, NATCOM team members began to mobilize regional strike teams and equipment for deployment.
AMR strike team members, which include paramedics, EMTs, emergency dispatchers, supervisors and managers, go through extensive disaster training required by FEMA, and each member volunteers to be part of AMR’s FEMA operations. Many strike team members are veterans of past hurricane deployments going back to Hurricane Katrina, and have experience operating under harsh environments for long periods of time. In addition to trained personnel, AMR also has assigned a cache of vehicles and equipment specifically for FEMA deployments, and has strategically located them throughout the country to be called upon quickly when activated.
NATCOM’s first request for deployment occurred on October 27, 2012, and included 30 members of the NorCal Strike Team (20 paramedics and 10 EMTs). Two subsequent deployments out of California occurred on October 27th and 28th, which included 28 members of the SoCal strike team (16 paramedics and 12 EMTs) and six emergency dispatchers who were assigned to NATCOM. Once crews arrived in the disaster area, they joined up with their ambulances and equipment which were brought in from an AMR depot by strike team members from other parts of the nation.
In total, AMR and its disaster response team network providers deployed over 380 ambulances into the New York City and Long Island area, with the first strike teams fully operational by October 27, 2012, and all teams operating by October 28, 2012. The initial assignment for AMR crews was to transport critical patients from hospitals and elder care facilities to safe locations, and operate as first responders freeing up fire services to perform fire suppression and recovery. AMR is also providing the following services in the disaster area:
• Emergency communications
• Incident management teams
• Patient triage (evaluation)
• Medical liaison
• Disaster planning
• Emergency and non-emergency dispatching
• Disaster resource tracking
• Base camp operations for responders
The initial deployment for California personnel was 14 days, which has since been extended by FEMA. The first week was obviously quite demanding for AMR strike team members, given the urgent need to move critical patients, including children, and the difficulties posed by operating in highly dense and urban areas. However, AMR crews continue to operate at full capacity, backfilling 9-1-1 ambulance services and performing welfare checks. Although some areas have seen some reprieve from harsh conditions, the weather continues to be a hurdle, with snow and colder temperatures settling into the New York region.
Orange County Physician Appointed to State Commission on EMS
Kristi L. Koenig, MD, of Orange County, has been appointed to the
Commission on Emergency Medical Services by California Assembly Speaker John A. Pérez.
Koenig is a professor of emergency medicine at the University of California, Irvine, director of UC Irvine’s Center for Disaster Medical Sciences, and director of Public Health Preparedness. She is also director of the university’s International EMS & Disaster Medical Sciences Fellowship. As a representative of the California Medical Association, Koenig served on the commission in 1998.
An internationally recognized expert and widely published in the fields of homeland security,
disaster and emergency medicine, emergency management, and emergency medical services, Koenig and UC Irvine colleague Dr. Carl H. Schultz published Koenig & Schultz's Disaster Medicine: Comprehensive Principles & Practices in 2010. The book is the definitive reference in preparing for disasters and is intended for anyone who manages or trains people involved in disaster response, including public health officials, paramedics, hospital staff and medical school students.
Prior to joining the University of California, Koenig held a five-year appointment from the Secretary of the Department of Veterans Affairs as the national director of the federal Emergency Management Strategic Healthcare Group. As principal emergency medicine advisor to the Under Secretary for Health, she led emergency management for the nation’s largest integrated healthcare system.
Koenig began her career in EMS during medical school at New York’s Mount Sinai School of Medicine when she studied the city’s EMS delivery system and collected real -time data during ride-alongs with the Harlem paramedics on Friday and Saturday nights.
The proposed paramedic regulations were submitted to the Office of Administrative Law (OAL) and were disapproved due to procedural issues. EMSA was given a 120-day extension to fix the issues identified by OAL. EMSA has used this opportunity to make non-substantive language clean-up in the 3rd and 4th public comment periods. The 4th public comment period for the paramedic regulations began on October 25th and ended on November 8, 2012. These regulations will be taken up during the December Commission on EMS meeting for approval. The rulemaking packet will then be resubmitted to OAL for approval.
New AEMT regulations became effective September 12, 2012. They are available here.
Stroke and STEMI draft regulations are currently in the pre-public comment period, which goes from October 25 to December 21st, 2012. The draft regulations and comment forms can be found here. Once the comment periods for these draft regulations closes, the EMS Authority will review any comments received and work with the Stroke/STEMI task force to make changes.
15th Annual EMS For Children Educational Forum
By Farid Nasr, MD, Specialty Care System Programs, California EMS Authority
One of the ongoing projects within the EMSC program is to hold an annual educational forum. This event contributes to the EMSC program’s success by providing a forum for the dissemination of EMSC goals, objectives, and training for EMS providers and nurses. For the past Fifteen years the goals of the conference have been to provide an opportunity for EMTs, paramedics, and nurses to learn about vital children’s issues and the new trends in Emergency Medicine. The conference provides resources on current EMSC techniques, assessments, events, and injury prevention. It also provides research information and resources and is an excellent opportunity for networking amongst prehospital care personnel.
This year’s educational forum was a complete success with over 160 people in attendance. Topics included:
- Ambulance Occupant Safety and Safe Transportation of Children
- Animal Bites
- Youth Sport Injury and Trauma
- Legal Aspects and Case Review
- Neonates in the Field and Case Review
- Blast injuries
The vision for the annual EMSC Educational Forum is to increase attendance which will in turn train more and more EMS personnel on current EMSC skills and applications. California’s EMS for Children program will continue to be a highly important program which strives to ensure that acutely ill and injured children have access to high quality, coordinated, and comprehensive emergency and critical care services appropriate for children’s special needs and that pediatric services are well integrated into an EMS system.
EMSA Inspects CHP Aircraft
This past September, the EMS Authority completed its biennial inspection and EMS classification of helicopters operated by the California Highway Patrol (CHP).
The EMS Authority functions as the classifying agency for aircraft operated by statewide public safety agencies in accordance with the California Code of Regulations Prehospital EMS Aircraft regulations.
Staff from the EMS Authority and CHP Office of Air Operations are required to perform on-site inspections of helicopters operated by the CHP. The on-site inspections take place at the CHP’s Northern, Valley, Golden Gate, Central, Coastal, Border and Inland divisions where the aircraft are based.
These on-site inspections include a review of medical equipment carried in the aircraft in addition to reviewing records related to training and medical equipment maintenance. Upon completion of inspection, the helicopters inspected by the EMS Authority are classified as ALS Air Rescue for use within the State of California EMS System.
The EMS Authority enjoys a cooperative, productive relationship with the CHP as we both strive to provide patients with the highest quality of air ambulance service and ensure safe working conditions for EMS personnel.
EMSA Welcomes New Employees
Lisa Witchey is the new Staff Services Manager-I in the Personnel Standards Unit. Lisa comes to EMSA from a long career with the State Compensation Insurance Fund where she served as a community educator, training coordinator and supervisor of a workers compensation claims benefit and investigation unit
Lisa will be leading the Personnel Standards Unit staff which approves and monitors first aid, CPR, and preventive health training programs for licensed childcare providers, as well as revisions of various chapters of regulations and the EMT certification program.
In her free time, Lisa enjoys running, hiking, traveling and having fun family adventures.
Eric Fu is the newest member of the Response Personnel Unit, serving as the Staff Information Systems Analyst. He collaborates with vendors and works with EMSA staff to provide support to the technology system during non-emergency periods and during emergency operations. Before joining EMSA, Eric worked as a system administrator in the Department of Developmental Services (DDS).
Eric loves the outdoors. During his off hours, he enjoys spending time in the wilderness, hiking and camping under the stars with his wife and a dog named Beijing.
Dana Ferry joins the Disaster Medical Services Division as a Health Program Specialist I in our Plans and Training Unit. Dana comes to us from Department of Public Health, Emergency Preparedness Office and before that from the Department of Rehabilitation where she has a background in Budgets, Exercises and Project Management.
Before joining the State of California, she was an Officer in the U.S. Navy where she primarily served as an Ordnance Officer in support of Operation Iraqi Freedom and as an Exercise Planner for the U.S Coast Guard.
In her free time, Dana enjoys traveling and photography and looks forward to planning her next big trip, where ever that may be.
Teri Harness has worked for the State of California for 29 years and has a strong policy background. Teri will function as the Assistant Division Chief for EMS Systems. She will be working with staff to support all of the programs within EMS Systems.
She comes to us from the Department of Child Support Services where her duties included regulation development, legislative analysis, and policy interpretation for local child support agencies.
In her spare time, Teri enjoys traveling with her husband, spending time with her only child – her cat Coco, and the occasional karaoke night with her family.
EMSA also welcomes Nina Tonnu. Nina is a Legal Assistant in EMSA's Legal Department.
Nina is currently a Communication Studies major at Sacramento State. In her free time she enjoys reading, gardening, exploring local eateries, and spending time with friends.
EMSA also welcomes Lauran Capps. Before joining EMSA, Lauran worked for the Department of Corrections and Rehabilitation (CDCR) at Folsom State Prison. Prior to CDCR, Lauran was a medical assistant at a local family practice medical office. She is currently working as an Office Technician in the Disaster Medical Services Division.
While not at work, Lauran attends Folsom Lake College where she is studying to earn her associates degree. During high school, Lauran participated in the ROP (regional occupational program) program where she received her medical assisting certificate.
In her free time, Lauran enjoys volunteering at an alzheimer’s home, attending music concerts, spending time with family, friends, and playing her guitar.
William Chao is a new Special Investigator in EMSA’s Personnel Division. Prior to joining EMSA, William worked at Department of Corrections and Rehabilitation, Parole Region III.
William enjoys spending time with his wife and children in his free time.
Michael Jacobs is EMSA's new Senior Staff Counsel. Michael comes to EMSA with many years of legal experience gained while working as an Administrative Law Judge for the State. Michael has also been a Park Ranger and a WIld Land Fire Fighter.
Michael enjoys travel, listening to music, hiking and biking in the great outdoors.
Each quarter EMSA recognizes one employee who exemplifies the Authority’s principles and values, which are:
- Treat customers with respect and in a courteous and professional manner;
- Establish a partnership with constituents that will promote an enthusiastic business relationship;
- Continue to improve the way work is done by inviting customers to make suggestions;
- Contribute innovative, timely, and quality work;
- Look upon failures as challenges that provide an opportunity to learn and improve;
- Contribute to a climate of trust, respect, and concern;
- Strive to develop the full potential of every employee; and;
- Make the EMS Authority an enjoyable and creative place to work.
This quarter, the EMS Authority Employee of the Quarter Committee is proud to bestow this recognition upon Ms. Reba Anderson.
Reba is recognized as an expert meeting planner makes sure that the EMS Commission’s quarterly meetings occur seamlessly. She is always standing by to step in and fix a problem, often before anyone else notices it. Ever the smiling face and cheerful personality, Reba is well-respected by her peers and by the many EMS stakeholders she interacts with.
In addition to meeting planning, Reba is the department travel coordinator and has shepherded the Authority through the difficult transition from paper-based travel claims to a web-based electronic system with patience and grace. Everyone who travels on EMSA business, whether an employee or a stakeholder, receives Reba’s excellent care and assistance whenever needed.
Reba’s incredible efficiency and skill are combined with a genuine desire to be of assistance. As stated in her nomination, Reba is the type of person who knows you need something, just by looking at you, and will help you get it. Reba is one of the Authority’s longest serving employees and one who keeps the wheels turning for all of the programs.
Congratulations Reba and thank you for all that you do.
EMS-N-Action Photo Contest
You think you’ve seen it all? Show us! EMSA needs your photos of California’s EMS system in action. Send us pictures of yourself, your partner, your station, your rig, your training, yourself in action (but use models… not real patients). Submit your best shots (keeping HIPPA and propriety in mind) and your photos could be featured on the cover of the next EMS Law Book, on our website, and even on the hallowed halls of EMSA.
The theme of the contest is EMS in action. Photos submitted for the competition should be dynamic, action-oriented, and illustrate some aspect of California EMS personnel in action. As you’re selecting photos to send think compassion, professionalism, diversity, excellent patient care, equipment, heroism, and team work. Make them inspirational, educational, fun, artistic, or just interesting.
At the end of the contest, selected photos will be displayed on EMSA’s public Facebook page and our friends will vote for the best ones. In addition, winning photographs will be featured on the cover of the 2013 California EMS Law Book. More importantly, this is an opportunity to showcase the dedication and professionalism of EMS personnel throughout California!
To submit a photo into the contest, please follow these instructions: (1) Send your high-resolution (1 MB+) photo in either JPG, GIF, BMP or TIFF format to firstname.lastname@example.org. Hard copy photos (at least 4x6 in size please) may be mailed to: EMS Authority Photo Contest, Attn.: Adam Willoughby, 10901 Gold Center Drive # 400, Rancho Cordova, CA 95670; (2) Include with the submission the photographer’s name, occupation, mailing address, email address and phone number; (3) Include with the submission the date and location (city) the photo was taken as well as a brief (no more than one paragraph) description/explanation of the photo.
To participate in this contest, all photos submitted must have been taken in California. In accordance with privacy laws, photos must not allow for identification of patients in any way unless you have obtained a release from the patient, which you must include with your submission. By submitting a photo to this contest, you affirm that you are either the author of the image or have permission from the author to use the image and that by doing so you grant to the EMS Authority a non-exclusive royalty-free license to use the image in its publications and on its website and social media. Any submission from you that is used by the EMS Authority will be credited to you, unless you direct that a different credit be used. The deadline to submit photos for this year’s competition is 5:00 p.m. on Friday, December 7th, 2012. Call (916) 431-3715 with any questions.