|Director’s Message: Howard Backer, MD, MPH, FACEP
How Legislation and Policy Change Impacts Your EMS PracticeEach year, there is state legislation that impacts your EMS practice in California. Some of the proposed legislation is passed and becomes law, usually after much discussion and changes in the original language. Other measures never make it out of the legislature or if they are sent forward, they may not be signed by the governor. Many new laws subsequently require regulations to describe details of implementation. Regulations must be based on the law and are created with stakeholder and public input; they do not involve the legislature. We have many different regulations that clarify portions of The EMS Act and the EMS System and Prehospital Emergency Medical Care Personnel Act. Current EMS laws and regulations can be found on EMSA’s website.Naloxone and Other EMT Scope of Practice IssuesSB 1438 (Pavley, Chapter 491, Statutes of 2014) This bill expanded the basic scope of practice for all EMT certifications through required training in the administration of naloxone hydrochloride, currently an optional skill. The regulations that control scope of practice for EMTs was amended this year to include the administration of naloxone hydrochloride as a mandatory training topic in the training and scope of practice for all EMTs.Paramedics and Advanced EMTs already have naloxone in their basic scopes of practice, but EMSA was required to develop training and standards for all prehospital emergency medical care personnel in the administration of naloxone hydrochloride and other opioid antagonists.
While the EMT regulations were opened for changes, several other amendments were added to the EMT training and scope of practice, including:
- Further expand the scope of practice and required training for EMTs in the administration of epinephrine by auto-injector and the use of a glucometer at the discretion of the LEMSA.
- Add basic tactical casualty care (TCC) principles to the required course content.
- Increase the required course hours from 160 to 174 to include naloxone, epinephrine, glucometer training, and tactical casualty care.
Public Safety First Aid
In response to legislation allowing law enforcement to carry and use naloxone, and legislation for coordinated training for tactical medicine, changes were made to regulations governing first aid practice for our law enforcement and other public safety colleagues. The revised regulations clarify which skills public safety personnel are authorized to perform following training and demonstrated competency, and add optional skills that may be approved by the local EMS agency medical director:
- Nasopharyngeal airway training was added to the list of optional skills.
- Tourniquets and hemostatic dressings were added to training clarifying tactical training elements within the proposed course content.
- Including training in Automated External Defibrillators as a part of CPR training.
AB 1598 (Rodriguez, Chapter 668, Statutes of 2014) This bill requires fire, law enforcement, and emergency medical services agencies to jointly establish standard operating procedures and coordinated training programs for active shooter incidents. A workgroup coordinated by EMSA had already been setting training standards and is functioning to meet some requirements of this law. All EMS and law enforcement personnel will receive a minimum of four hours and recommended level of eight hours training in civilian tactical casualty care. Additional training for BLS and ALS personnel is available, consisting of 16-80 hours, depending on the level of skill and engagement in the tactical team.
AB 1129 (Burke, Chapter 377, Statutes of 2015) This bill requires all emergency medical care providers to use an electronic health record system (ePCR) when collecting and submitting data to a local EMS agency. The electronic patient care record must export data in a format that is compliant with the current versions of the California Emergency Medical Services Information System (CEMSIS) and the National Emergency Medical Services Information System (NEMSIS) standards; include those data elements required by the local EMS agency; and use an electronic health record system that can be integrated with the local EMS agency’s data system. By last estimate, about 75% of EMS provider agencies were using an ePCR. This law means that all providers currently using hand forms will need to convert in the next year to an electronic system—almost all of which are based on a tablet or laptop. Moreover, the mandate includes any public safety agency that is providing EMS care. Providers currently using an ePCR that was locally developed or from a small vendor may need to change systems, since the vendor/developer is unlikely to meet the compliance standards, which require testing and use a completely different data dictionary. Agencies at all levels will see benefits in system analysis and performance improvement from this conversion to an all-electronic system that produces higher quality and more compatible data.
SB 19 (Wolk, Chapter 504, Statutes of 2015) This bill enacts the California POLST (Physicians Orders for Life-Sustaining Treatment) eRegistry Pilot Act. The bill requires EMSA, in consultation with stakeholders to develop and operate an electronic registry system on a pilot basis for the purpose of collecting POLST information received from a physician or other designated provider and making it available rapidly to providers with a need to know. The goal is to develop and test means of providing DNR information from POLST forms (the bright pink form) to EMS providers in the field, emergency department providers, acute care and long-term care facilities. Access from the field will be through a web-based link that can be accessed from a mobile platform. This will be one of the many benefits of new initiatives in health information exchange that will support your decision-making in the field.
AB 1223 (O’Donnell, Chapter 379, Statutes of 2015) This bill requires EMSA to develop a statewide standard methodology for the calculation and reporting by a local EMS agency of ambulance patient offload time, and authorizes a local EMS agency to adopt policies and procedures relating to ambulance patient offload time. This is a necessary step to begin to address the problem of wall time. Several local EMS agencies now track this measure but each use slightly different measures. Standardizing the measurement and encouraging other EMS agencies to collect and report the data will allow us to influence policy at the state level to begin to impact this burden on EMS providers.
Sacramento may seem remote and irrelevant to your day-to-day practice, but nothing could be further from the truth. The laws, regulations, and policy that are developed here directly impact our entire state EMS system. Let me assure you that EMSA is working with your local EMS agencies and provider organizations to move our system forward and help you as providers, as well as to improve care in the field and ultimate outcomes for our patients.
|Paramedic Licensure Unit to Begin Same-Day Service
As part of EMSA’s continuing efforts to provide exceptional customer service, the paramedic licensure unit is pleased to begin offering same-day paramedic licensure service. Licensure applicants who come into our office with a completed paramedic license application packet can receive their licensure card while they wait!
Same-Day Counter Services Include:
- Initial in-state & out-of-state applications
- Challenge applications
- Renewal applications (not flagged for audit)
- Reinstatement renewals (not flagged for audit)
- Duplicate cards
Same-Day Counter Service Hours:
- Tuesdays from 9:00 a.m. to 11:30 a.m.
- Thursdays from 1:00 p.m. to 3:30 p.m.
(Holiday exclusions apply)
Same-day counter service is not a guarantee that an applicant’s license will be approved; license approval is contingent upon staff review of the content contained in the application packet.
Questions? Contact the paramedic licensure unit at (916) 323-9875 or by e-mail.
Paramedic Licensure Unit Welcomes New Employees
Robin R Robinson joined the paramedic licensure unit in July 2015. Robin is responsible for providing technical assistance to paramedics interested in applying for initial in-state, initial out-of-state, and reinstatement California paramedic licenses. In addition, Robin processes paramedic applications, licensure verification/reciprocity requests, and oversees all aspects of the state licensing match system with the Department of Child Support Services. She also participates in the development of website content and other assigned projects.
Robin comes to the paramedic licensure unit from EMSA’s executive office, where she had served for eight years as the executive assistant to the director and chief deputy director. Robin holds a baccalaureate degree in management from St. Mary’s College and an associate of arts degree in communication from Los Angeles City College. Robin is a published author (currently working on a second book), a performer, has done voice-overs and enjoys painting and reading in her spare time.
Kim Lew, formerly with EMSA’s systems division, joined the paramedic licensure unit in August 2015. Kim has been with EMSA for just over two years. Kim is responsible for providing technical assistance to, and the monitoring of, statewide paramedic training and continuing education programs, processing and overseeing California approved NREMT proctor contractual activities, and assisting physicians, physician assistants, nurses, and MICNs to become licensed paramedics in California. She also provides administrative support and analytical services to management in areas related to regulation, policy/procedure, budget, forms, and web content development.
Kim brings extensive public service experience to EMSA; over the past twenty years, she has been an EMT, firefighter, CPR/first aid instructor, 911 dispatcher, deputy sheriff, and code enforcement officer. She holds a baccalaureate in organizational leadership with an emphasis on social services and an associate of science degree in public administration. Kim enjoys spending time with her husband and two teenagers (a son and a daughter). They like to travel, snow ski, play paintball/airsoft, and do just about anything adventurous outdoors.
Patrick Sanders joined the paramedic licensure unit in September 2015. Patrick is responsible for scanning licensure documents, uploading documents into the central registry, processing mail, filing, and other licensure support tasks. Patrick previously worked in a temporary position for Covered California as a service center representative. He is excited to have found a permanent state position here at EMSA.
Prior to state employment, Patrick worked for a software company. Patrick is an only child and is very family-oriented. He enjoys music and frequently attends music events and festivals. He likes trying new things and is very adventurous. His career goal is to work with disadvantaged youth.
Tiffany Pierce joined the paramedic licensure unit in August, 2015. Tiffany is a temporary employee responsible for various clerical tasks, including document imaging and uploading documents into the central registry. Tiffany’s career goal is to become a full-time employee at the EMSA.
Tiffany has proudly served in the military as a Marine and is the daughter of an EMSA employee in the disaster medical services unit. Tiffany graduated from a criminal justice academy in high school and enjoys contributing to public service related activities. She is experienced in training and providing care for dogs and volunteers at a local animal shelter.
Kani Jeyarajah joined the paramedic licensure unit in August 2015. Kani is a temporary employee responsible for various clerical tasks, including document imaging and uploading documents into the central registry. Kani’s career goal is to become a full-time employee at the EMSA.
Kani is married with three children, ages eight, eleven, and thirteen. Kani enjoys caring for her family and taking her children to soccer games.
New Laws for 2016
Childhood Nutrition Training:
Governor Brown signed AB 290 (Alejo, Chapter 734, Statutes of 2013) which, for licenses issued on or after January 1, 2016, requires a director or teacher of each day care center and family day care home who receives health and safety training to also have at least one hour of childhood nutrition training as part of preventive health practices courses.
EMSA has been working with training programs to ensure their course curriculum is updated and is compliant with this new requirement. Find a list of approved training programs here.
Governor Brown signed SB 658 (Hill, Chapter 264, Statutes of 2015), which provides an explicit civil liability shield for a physician and surgeon or other health care professional that is involved in the selection, placement, or installation of an AED. EMSA is in the process of revising regulations to be consistent with the revised statute.
Epinephrine Auto-Injectors Regulations:
Governor Brown signed SB 669 (Huff, Chapter 725, Statutes of 2013), which authorizes an off-duty prehospital emergency medical care person or lay rescuer to use an epinephrine auto-injector to render emergency care to another person after receiving certification through an approved training program.
Regulations pursuant to this bill became effective January 1, 2016 and EMSA is now accepting applications for training program approval. Visit our webpage for additional information.
POLST Form Revisions:
Governor Brown signed AB 637 (Campos, Chapter 217, Statutes of 2015), which authorizes the signature of a nurse practitioner or a physician assistant acting under the supervision of the physician and within the scope of practice authorized by law to create a valid POLST form.
The new POLST form is available for download here. Forms completed prior to January 1, 2016 and signed by the patient/decision maker and a physician will remain valid.
3rd Annual Health Information Exchange in EMS Summit
You are invited to sponsor or participate in the 3rd California Health Information Exchange in Emergency Medical Services Statewide Summit being held at the Hyatt Regency Orange County April 19-20, 2016. This is an opportunity to connect with approximately 200 local EMS agency representatives, EMS providers, hospital administrators, and health information organizations statewide who are actively working to establish health information exchange in the EMS arena. Attendees will hear from influential policymakers and industry leaders on topics such as:
- Sustainability of health information exchange infrastructure
- Health information exchange progress and policy direction nationwide
- Electronic Patient Care Record innovation to facilitate HIE in EMS
- National EMS Information System evolution and integration with HIE efforts
- Consumable Data and Data Governance standards development
- Physicians Order for Life Sustaining Treatment (POLST) eRegistry development and interconnectivity
Space is limited and tickets do sell out quickly. For event tickets, sponsorship opportunities, or general questions, contact Adam Davis via e-mail or at (916) 431-3659. Visit the HIE in EMS blog, here.
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