National Association of State Emergency Medical Services Officials (NASEMSO)

SCOHTS Annual MeetingApril 28-30, 2010

Dia Gainor, Chief, Idaho EMS BureauChair of HITS Committee

National organization representing all state and territorial EMS offices.

All states have lead EMS agency, most often housed within the Department of Health or Department of Public Safety - In some states an independent agency/board.

State EMS agencies are generally responsible for oversight of ambulances and EMS personnel (paramedics, EMTs, first responders) and a variety of other regulatory and grant programs.

NASEMSO – Who are we?

HITS Committee purpose: Engage NASEMSO on highway safety issues

relevant to EMS. Collaborate with highway safety partners

(nationally and at state level) to promote their understanding of EMS and to identify opportunities for cooperative efforts to reduce injuries and save lives.

NASEMSO Highway Incident and Traffic Systems (HITS) Committee

Foster relationships with highway safety colleagues in SCOHTS.

Explore ways to join efforts to pursue common priorities.

Describe our new Highway Mass Casualty Readiness Project, a joint effort between EMS and highway safety representatives.

Why are we here?

Two-part project conceptualized in response to Mexican Hat, Utah, motor coach crash.

Funded by NHTSA, Office of EMS. Multi-disciplinary work group designing two

new tools to assess EMS capabilities by region and segments of highways.

Kick-off meeting held April 27-28, preceding SCOHTS meeting.

NASEMSO Highway Mass Casualty Readiness Project

NASEMSO Hwy Mass Casualty Readiness Project: Work Group

Dia Gainor, CHAIR Chief, Idaho EMS Bureau

Mary Hedges, Prog Advsr, NASEMSO Jolene Whitney, Deputy Dir

Utah Bureau of EMS Richard “ Chip” Cooper

EMS Bureau, NH Dept of Safety Kelly Hardy, Hwy Safety Prog Mgr

AASHTO Bob Pollack, Safety Data Mgr

Ofc of Safety, FHWA, Wash., DC

Susan McHenry Ofc of EMS, NHTSA

Katherine Burke Moore, Ex Dir MN EMS Regulatory Board

Dennis Blair , Director Alabama EMS Office

Loren Hill, Consultant, OTC MN Dept. of Public Safety

Mark Bush, Operations Prog Mgr AASHTO

George Kennedy , MD NM EMS Medical Director

Tom Martin, Op. Prog Coord I-95 Corridor Coalition

Dan Mack, Asst Fire Chief Miami, OH

Robert Oenning WA State 9-1-1 Director

John Saunders, Dir, Hwy Sfty Srvcs, VA Dept Motor Vehicles

Bill Castagno, EMS Chief, UMDNJ University Hospital, Newark NJ

Tom Judge, Executive Director LifeFlight of Maine, Bangor, ME

Cynthia Wright-Johnson MD Institute for EMS Systems

Jeff Salomone, MD Emory Univ, Atlanta, GA

Charter bus with 53 passengers overturned on rural highway near Mexican Hat, Utah, in January 2008.

Crash not reported for 36 minutes. 1st EMS Unit reached scene 1 hour after

crash. Victims still being transported more than 4

hours after crash. 9 killed and 43 seriously injured. No “Golden Hour” advantage.

Mexican Hat Motor Coach Crash

50 of 53 occupants were ejected

Motor coach , post-crash

Mexican Hat crash demonstrated importance of ready access to features taken for granted in emergency response situations, e.g.,

Communications access (ability to call 9-1-1) Quick EMS response Advanced Life Support (ALS) level of care Access to trauma centers

None were available in this sparsely populated area. Given the limitations, emergency response performed exceedingly well.

Mass casualty incidents on rural stretches of highway pose challenges

San Juan County’s 8 ambulances - all volunteer, Basic Life Support (BLS)

Kayenta Navajo Nation- 4 BLS ambulances Moab-Grand County EMS- 3 ALS

ambulances Mesa County Colorado – 2 ambulances Durango, Colorado – 2 ambulances Air ambulances grounded due to weather Closest hospital - 75 miles Closest Level 1 Trauma Center- 190 miles

EMS Response & Transport

NTSB recommendations to AASHTO & NASEMSO

In letter dated 5/29/2009:

Work with the Federal Highway Administration (FHWA) to develop and implement criteria based on traffic patterns, passenger volumes and bus types that can be used to assess the risks of rural travel by large bus types. (NTSB Safety Recommendation H-09-08)

“Develop a plan that can be used by the States and public safety answering points to pursue funding for enhancements of wireless communications coverage that can facilitate prompt accident notification and emergency response along high risk rural roads, as identified under SAFETEA-LU criteria, and along rural roads having substantial large bus traffic. (H-09-04)”

 

NTSB Recommendation to NHTSA/OEMS for FICEMS

(Federal Interagency Committee on EMS)

“Evaluate the system of emergency care response to large-scale transportation-related rural accidents and, once that evaluation is completed, develop guidelines for emergency medical service response and provide those guidelines to the States. (H-09-5)”

NTSB Recommendation to NHTSA/OEMS for FICEMS

(Federal Interagency Committee on EMS)

Evaluation tool to assess degree of optimum preparedness for responding to mass casualty events.

To be used by local, regional or state EMS agencies for self-evaluating readiness to respond.

Assessment results can influence EMS and highway safety programmatic decisions.

Can be used as scorecard, establishing benchmarks and progress made.

Part 1: Event Response & Readiness Assessment (ERRA)

Benchmark: The location of persons calling into 9-1-1can always be identified.

Indicator: The entire state is covered by Enhanced (“E”) 9-1-1(location of caller displayed).

Scoring: 0 = Not known 1 = No E 9-1-1 2 = Partial E 9-1-1 coverage3 = Half of state covered by E 9-1-14 = Most of state covered by E 9-1-15 = Entire state covered by E 9-1-1

ERRA Example for State

MIECE (pronounced “mice”) Emergency Care Inventory, modeled after

MIRE Working Matrix of Data Elements Use of defined characteristics of emergency

care system To display resource availability and system

capacity by segments of highway

Part 2: Model Inventory of Emergency Care Elements (MIECE)

Data Element: Ground Ambulance Definition: EMS vehicle that travels by

ground, capable of transporting patient on cot, staffed by one or more persons trained to a minimum of EMT level

Priority: 1 Ease of Data Collection: E (Easy)

MIECE Example

1st Edition of Integration and Response Capability Assessment – ERRA

1st scorecard of state level assessment findings

Draft Matrix of Emergency Care Inventory – MIECE

A Proof of Concept for MIECE

Highway Mass Casualty Readiness Project: Deliverables in 2011

Questions?Where do we go from here?