Hall Ambulance staff and Central California communities gathered today at the Rabobank Arena in Bakersfield, CA to celebrate the life of Harvey Hall. Hall founded the ambulance service in 1971 and served as its president and CEO for over 45 years until his passing on May 15th of this year. In an impressive showcase of unity, CA private ambulance providers sent strike teams to cover the region’s EMS needs allowing all employees to attend the services.

In addition to founding and leading Hall Ambulance, Hall served four terms as mayor for Bakersfield from 2000 to 2016, making him the longest-serving mayor in the history of the town. He was known for his dedication to community development, education advocacy and business development across the region. During his tenure he initiated efforts to tackle homelessness and city beautification.

He also established the Mayor’s Scholarship Foundation for graduating seniors heading to college and funded it each year with his entire mayoral salary.

Born in Bakersfield, Hall attended Bakersfield High School and Community College, before heading to San Francisco City College. There he studied journalism, Personnel Management and Emergency Medicine. In 1960, he entered the emergency medical services industry where he stayed until the founding of his own company in Bakersfield.

In recognition for his outstanding life achievements in bettering his community, Hall has been previously awarded the Kern Chapter Real Heroes Life of Service Award, Darrel Hildebrand Regional Award of Merit for Distinguished Leadership, the Iron Eyes Cody Award, the Planck Foundation Humanitarian of the Year, the Jim Burke Light and Liberty Award, and the John Brock Community Service Award.

His legacy will long be remembered by his employees, his community, and the California EMS community. He leaves behind his wife and four children.

This week the California Senate Committee on Appropriations voted in favor of a new law (SB-944) to formalize community paramedicine. The law aims to create oversight bodies and a legal pathway for local EMS authorities to build programs in their regions. The committee voted four in favor, with three abstentions, to move the bill to the senate floor. If the California Senate gives a nod to the bill, it will then head to the State Assembly, and finally on to Governor Brown.

Community paramedicine has existed in California for the past three years in the form of thirteen temporary pilot programs. These pilot programs utilized specially-trained, senior paramedics to assist patients in key demographic segments of the prehospital population, such as post-discharge, mental health, frequent EMS users, and hospice. Annual UCSF reviews found an overwhelming majority of the programs to be successful and cost-effective. These findings mirror the results of community paramedicine programs across the country.

A portion of the California pilot sites also reviewed the transport of EMS-originating patients to alternative destinations in lieu of emergency departments. In San Francisco, Paramedics tested the safety of transporting inebriated patients to sobering centers where they could be observed by a registered nurse, sleep, and metabolize the alcohol in their system. These patients typically do not require medical attention after their initial triage yet occupy beds for hours. The program was highly successful, with only one concerning event of hypothermia. This issue was immediately rectified with an updated vital sign and transfer of care policy, and the program continued on without issue.

In a surprising turn, while the California Senate has supported the creation of community paramedicine, a second bill in the State Assembly (AB-1795) aimed to allow alternative destinations for EMS patients was killed in committee. This bill had the support of California hospital executives, medical directors, paramedics and insurers.

It is likely the bill was opposed by nursing labor groups who see paramedic growth as a threat to job roles they prefer filled by nurses. It is also possible the emergency physicians, distinct from medical directors, opposed the bill under the premise of reduce emergency room visits and revenue. Even SB944, the bill remaining alive, was lobbied to include mandatory oversight of all community paramedicine by nursing labor representatives, revealing some of the underlying motives.

While the future of the community paramedicine bill remains uncertain, the fate of the alternative destination is sealed for now. The California legislative environment has been tough on a long-idle paramedic community that is struggling to better serve their populations under antiquated state code. Stay tuned for updates on this important issue.

This past Wednesday in Charlotte, North Carolina, the California Paramedic Foundation and EPIC Medics conferred the 17th annual Nicholas Rosecrans Award to Captain Mike Filson of Chula Vista Fire Department. Captain Filson was honored during the opening keynote ceremony of the EMS Today Conference for his WARN: Water Awareness in Residential Neighborhoods program which has successfully worked to prevent residential drownings.

Captain Filson started the comprehensive prevention program in 2011 after his department saw a string of preventable drownings throughout their community. The WARN system centers on high-quality education to both providers and the public. After successfully implementing the program in his own community, Captain Filson expanded his reach by training over 50 other departments across his region.The program has been highly successful in both its scope and influence.

Paramedics for the Elimination of Preventable Injury in Children, or EPIC Medics, was founded by Paul Maxwell in 1997 after he too experienced a series of tragic child drownings. EPIC Medics soon realized the power of paramedic-driven public health campaigns, which flips traditional 911 on its head by using providers to eliminate emergencies before they ever happen. Paul and his team then created the Nicholas Rosecrans Award, named after the young child whose drowning spurred EPIC Medics, to encourage providers to create equally powerful programs in their own communities.  Lynn Artz, Nicholas’ mother, personally attends each annual event to thank organizers for their work.

Captain Filson’s WARN program and EPIC Medics’ start share a common theme of pediatric drowning prevention, however the Nicholas Rosecrans Award has recognized diverse initiatives over the last two decades.  Prior winners have worked on everything from auto-safety to provider-injury prevention. The award is supported by our generous partners: NHTSA, JEMS, Laerdal and Redflash Group. We thank these partners for their continued support and passion for EMS-driven public health.

Would you like to start a campaign in your own community? Having an impact in your community does not always require inventing an entirely new initiative. We can work with you to identify the issues your community faces and introduce you to previous campaigns that may align with your needs. Are you already leading a successful prevention initiative in your community? Contact us today so that we can recognize your work.

On January 17, 2018 representatives from the California Paramedic Foundation attended the EMS Agenda 2050 event in Los Angeles, California, an important gathering of EMS-focused professionals & participants that are shaping the agenda for the future of EMS. The EMS2050 project is incredibly important to its many federal sponsors including the National Highway Traffic Safety Administration, Homeland Security and the Department of Health.  The goal of this large undertaking is to create a united vision for the next thirty years of EMS system advancement.  The mandate given to participants was “dream big and think deep” on ideas that are fundamental to facilitating change to the next generation of prehospital delivery of care.

EMS 2050 has proven to be a very successful forum in productively bringing together a wide variety of clinicians, administrators, educators, providers and community members on an even playing field. Participants of the recent Los Angeles event enjoyed expressing their views with an equally-valued voice.  Creativity was free to flow in the venue allowing the removal of often hindering boundaries due to the politics, economics or liability issues that tend to pervade our current systems.  The discussion centered on a primary driver for newly-envisioned systems through the simple yet profound idea of “people-centered” processes & practices.  “Patients” are not the only “people” to be considered in our practice of paramedicine.  A broader circle of engagement is proposed that includes family members, community members and practitioners.  Six essential characteristics form the structural framework supporting this “people-centered” principle. Paramedicine for the future intends to be:

• Safe & Effective
• Reliable & Prepared
• Sustainable & Efficient
• Integrated & Seamless
• Socially Equitable
• Adaptable & Innovative

Our CPF representatives, alongside other practicing paramedics, shared our unique, impactful perspectives from the field and received invaluable input from other stakeholders.  Together, all attendees made meaningful contributions in this very important process.  The insights and ideas will be compiled by the RedFlash group, host of the EMS Agenda 2050 event, and will be carried forward to several more gatherings in 2018 planned across the United States.  Ultimately, the consesus gathered will be distilled into solid practices helping drive the future of Paramedicine.

The fundamental vision of the CPF is to foster opportunities for paramedics to be active and integral in the process of advancing our industry– Paramedicine.  We believe that the paramedics who engaged in the latest EMS2050 event along-side medical directors, nurses, fire chiefs and others is a great example of turning that vision in to action.  We look forward to the exciting next steps that EMS2050 will take as it  enhances patient care and our profession. 

 Check out their plans and share your ideas at emsagenda2050.org.

Last month Dr. Howard Backer, Director of the California EMS Authority, notified all California EMS regions that pediatric endotracheal intubation, or pediatric ETI, will be removed from the paramedic scope of practice.   Endotracheal intubation is regarded as the standard of care in airway management, utilized in events such as cardiac arrest and respiratory failure.  The decision follows the recommendation of the Scope of Practice Committee, a group of Medical Directors who periodically review the basic and optional scopes of California Paramedics and EMTs.

The Scope of Practice Committee is a part of the larger EMS Medical Directors Association of California, or EMDAC.  This body is comprised of physicians who lead the 33 Local EMS Authorities, or LEMSAs, across the state.  The organization acts in an advisory role to the EMS Authority.

On September 12th, 2017, the Scope of Practice Committee, and EMDAC as a whole, convened to review the skill of Pediatric Intubation.  It appears the committee had already begun to review the advanced airway procedure over the preceding year.  They planned to create an in-depth review of the procedure and the training programs that support it.  They also continued to approve optional scopes which included pediatric ETI in that period.  “It was my belief that data would show the procedure was not causing adverse patient outcome, rather that is was neutral,” states Dr. Kenneth Miller, chairman of the Scope Committee and Director of Santa Clara EMS.   Dr. Miller attempted to begin an effort to track intubation data and review training procedures in his own EMS region, but had not completed these efforts prior to a decision being rendered by the committee.

Dr. Donofrio, Associate EMS Fellowship Director at UCSD and EMS Medical Director at Rady Children’s Hospital of San Diego, made a presentation at the September meeting that strongly encouraged the membership to vote on the topic.  Her presentation condemned the skill in the areas of initial training, ongoing training, patient risk, and patient outcomes.  The summary also suggested that failed pediatric intubation is a potential contributing factor to paramedic PTSD and that the mental health of EMS providers should be weighed when creating policy.

Utilizing data from studies dating back to the 1980’s, the presentation argued that pediatric intubation is a problematic skill.  Cited research raised important concerns with serious complications, such as incidents of unrecognized esophageal intubation.  However, the implementation of end tidal CO2 capnography in most California EMS services occurred in the mid to late range of these studies referenced.  It is unclear if those issues would still be present in any modern EMS system where the technology is in play. The topic of paramedic initial and ongoing training confounds the issue further.   Medical directors defending the move argue that protocol decisions must be made with consideration to the lowest trained and minimally performing paramedics, since there is no advanced paramedic differentiation that could recognize these higher skill procedures.

According to those present during the meeting, the bulk of the discussion was somewhat narrow– centering on the presentation and its selection of data and studies. There was at least some concern voiced that there was no current data available to accurately reflect the state of the skill.  The California EMSA acknowledges that it does not track any data regarding pediatric intubation, shining a light on the difficult position in which medical directors are placed.   They must make important decisions on how emergency medical services are provided to the public, often with limited data.

Dr. Marianne Gausche-Hill, Medical Director for the Los Angeles authority and President of EMDAC, appears to have been one of the most ardent supporters for the reduction in paramedic scope.  Los Angeles paramedics currently do not have the ability to intubate pediatric patients, as the optional skill is not requested by her administration.  Dr. Gausche-Hill authored one of the preeminent studies on prehospital airway management, completed in 2000.  The study found no difference in outcome of BVM vs ET intubation when performed in an urban environment.  This research was a foundational part of Dr. Donofrio’s presentation.

EMS providers are no strangers to change.  Longboard spinal immobilization, a simple but mainstay trauma treatment, is the latest procedure being phased out across the country after studies showed detriment to patients.  While the stakes are higher with airway procedures, paramedics argue intubation is still accepted as the standard of care in emergency medicine, and that it is only paramedic training and utilization of the procedure that is in question.  In San Diego, an effort to implement a rapid sequence induction (RSI) protocol revealed the difficulty faced when implementing a sufficient and ongoing training program for a protocol with low utilization levels.  That program was ultimately cancelled.  The medical director behind the program stated the results were frustrating. The program was intended to show the benefits of prehospital RSI, but instead the study reflected a significant training and skill retention hurdle.  A similar frustration, and some fear, appear to have played a role in the EMDAC decision.

In review of this decision and the process by which it was reached, one of the most noticeable features is the very apparent lack of paramedic involvement.  This decision is a top down move by the oversight body.  Whether this is due to a lack of involvement by paramedics, or a lack of desire for paramedic involvement by their medical directors, is debatable.  Individuals close to the issue say it is most likely a mixture.  Paramedics are now voicing concern that the oversight body is taking a stance of scope limitation in place of educational advancement.

For now the committee has spoken and the California EMS Authority will uphold their recommendation.  Outside of a reversal by the state authority or a request by the EMS Commission, the policy change will move forward.  In its wake, EMDAC will now begin to look at policies to introduce perilarygeal airways in the absence of pediatric endotracheal intubation, as multiple medical directors attempt to give paramedics advanced options over simple bag-valve-masks.  EMDAC will be reviewing these options at their next quarterly meeting this December.

Join our newsletter for updates as this topic develops.

EPIC Medics, of the California Paramedic Foundation, is happy to announce we are now accepting nominations for the 2018 Nicholas Rosecrans Award.

The Nicholas Rosecrans Award honors emergency responders who have gone beyond treating injuries– they prevent injury before it happens.  The award recognizes these providers for their demonstrated leadership, commitment and innovation in this mission.

EPIC Medics was founded with the intent to stop preventable injury in children. Its efforts have successfully prevented untold amounts of injury in the community.  It is the hope of the organization and its partners’ JEMS, Redflash Group, Laerdal, and Safe Kids Coalition that others across the nation may be inspired to do just the same.

Winners are honored at the annual EMS Today Conference where they are nationally recognized.  They also receive a spotlight profile in JEMS to celebrate their work.

2018 Nicholas Rosecrans Award Nomination Form

To learn more about EPIC Medics click here.