Virginia Department of Health Office of Emergency Medical Services Or the National Registry of EMT’S

Virginia Department of Health

Office of Emergency Medical Services

Quarterly Report to the

State EMS Advisory

Board

November 11, 2020 Executive Management, Administration & Finance

1 | P a g e Office of Emergency Medical Services Report to The State EMS Advisory

November 11, 2020

MISSION STATEMENT:

To reduce death and disability resulting from sudden or serious injury and illness in the Commonwealth through planning and development of a comprehensive, coordinated statewide emergency medical services (EMS) system; and provision of other technical assistance and support to enable the EMS community to provide the highest quality emergency medical care possible to those in need. I. Executive Management, Administration & Finance

A. Replica Coordinated Database for Emergency Medical Services (CDEMS) UPDATE

In Virginia, the REPLICA legislation was signed into law on March 1, 2016. This made Virginia the third state to enact the EMS Compact. Virginia Office of EMS Director, Gary Brown, was seated to the Interstate Commission for EMS Personnel Practice at the inaugural meeting on October 11, 2017. Activation of the EMS Compact required the legislation to be enacted by ten state legislatures. This occurred on May 8, 2017 with Georgia becoming the tenth state.

The Commission was tasked with producing the commission rules; which govern REPLICA activities amongst member states. Rules for the Interstate Commission for Emergency Medical Services (EMS) Personnel Practice became effective September 1, 2019. Essential to the EMS Compact is the Coordinated Database for Emergency Medical Services (CDEMS). This multi- state database will allow member states the ability to rapidly share EMS licensure records, discipline, and investigative information between authorized state EMS offices. In addition to licensure data, the database will maintain an individual’s multi-state privilege to practice

2 | P a g e authorization. The National Registry of EMT’s (NREMT) has partnered with the EMS Compact to create and maintain the database.

The Virginia Office of EMS has worked with NREMT and has successfully uploaded ALL Virginia EMS providers into the national database. This is a live connection that updates provider information, enforcement history, and multi-state privilege to practice in real time.

B. Virginia Collaborates with NREMT for EMS Research UPDATE

In 2004, the National Highway Traffic Safety Administration and the Maternal and Child Health Bureau published a national consensus document titled National EMS Research Agenda. One of the top recommendations from this document was:

“A large cadre of career EMS investigators should be developed and supported in the initial stages of their careers. Highly structured training programs with content directed toward EMS research methodologies should be developed.”

Based upon this call, the National Registry of EMTs established a Research Department and founded the EMS Research Fellowship program to address the National Research Agenda’s recommendation. The mission of the National Registry Research Department is to develop and foster EMS-prepared doctoral researchers to function with the highest level of scientific integrity to improve and ensure high quality and innovative National Registry products and processes through evidence and collaboration. It is further the mission to contribute to the body of scientific out-of-hospital knowledge to improve the competency, health, safety and wellness of EMS professionals and the patients they serve.

Since its inception, the National Registry Research Department has conducted numerous studies focusing on the impact of burnout on the EMS workforce, prehospital EMS provider perceptions of errors and safety, factors predicting a negative perception of patient safety in the EMS workplace; just to name a few. Identifying the importance of these national research initiatives at a state level, the Office of EMS has partnered with the National Registry to have a dedicated doctoral fellow in the EMS Research Fellowship utilizing these national research initiatives specifically towards Virginia.

Virginia will actively participate with the National Registry in the determination of future research initiatives and produce Virginia specific research results alongside national results. Further, the National Registry will provide periodic analysis to the Virginia Office of EMS, Virginia Department of Health and the Governor’s EMS Advisory Board. Upon completion of a research topic, formal results will be provided to Virginia stakeholders at the EMS Advisory Board. More information about the National Registry’s completed research projects, visit www.nremt.org.

The first research project being worked on collaboratively with the NREMT is a study on the effect of COVID-19 on the Virginia EMS Workforce as compared to the nation. While this research study is still in beginning stages, Virginia has provided considerable data elements to

3 | P a g e NREMT relative to initial education, success rates, student retention rates, and subsequent affiliation data. As this research progresses, additional information will be provided.

C. Implementation of Project Management Software

Earlier in 2020, OEMS has multiple meetings with the regional EMS councils to discuss methods for enhanced communication and collaboration of regional and statewide projects. As such, staff began to research multiple communications platforms and selected Monday.com. Monday.com as a project management platform allows OEMS and the regional councils to input current projects and work efforts for enhanced visibility while also providing a web-based platform to facilitate communications and collaboration for small and large scale projects alike. Currently, there are over 100 users enrolled in Monday.com between OEMS and the regional councils. While we are still in the early stages of implementing this software, we have had out first live training with Monday.com with more to come.

D. Tim Perkins - Virginia Office of Emergency Medical Services’ Division Director Recognized by the National Organization of State Offices of Rural Health as Virginia’s 2020 “Community Star” Award Winner

On November 19, 2020, Tim Perkins, division director for Community Health and Technical Resources with the Virginia Department of Health, Office of Emergency Medical Services (OEMS) was honored with the prestigious “Community Star” award from the National Organization of State Offices of Rural Health (NOSORH).

Every year, the NOSORH leads National Rural Health Day, an annual celebration that recognizes those who serve the vital health needs of an estimated 57 million people living in rural America, and celebrates Community Star award winners across the nation.

The Community Star Recognition Program’s nominees are selected by their state’s coalition to recognize individuals and organizations that make a positive impact in rural communities. This year, nominations were received from 48 states, a record for this annual awards program.

In Virginia, Tim Perkins was selected as this year’s Community Star award winner. As the Division Director for the OEMS’ Community Health and Technical Resources Division, he is

4 | P a g e responsible for working with rural EMS agencies, rescue squads and Regional EMS Councils throughout the commonwealth to provide a range of education, resources and technical assistance. He advocates for various agencies at the state level and oversees multiple initiatives, including mobile integrated healthcare/community paramedicine, disease management and preventative health care services.

During Perkins’ 14 years at the OEMS, there have been many changes in the provision of emergency care, which have put a strain on rural areas, including agencies that heavily rely on volunteers, an aging workforce, and recruitment and retention challenges. However, Perkins’ continues to be a leader in this field and has met those challenges by focusing his efforts on response and increased telehealth services in rural Virginia.

Perkins is an asset to Virginia’s EMS System and his contributions to rural health and the provision of emergency care is commended. The OEMS is proud to congratulate and recognize Perkins for his outstanding achievements and commitment to protect the health of all people in the commonwealth.

For more information about the Community Star award, please visit: https://www.powerofrural.org/community-stars/. Tim Perkins will appear in the 2020 edition of the book of Community Stars, published on the official National Rural Health Day website, powerofrural.org, on November 19, 2020.

E. State/Regional (Hybrid) EMS Council Reports

As previously stated, the Office of Emergency Medical Services committed to providing updates on the progress of the collaborative partnership(s) and the transition and conversion of applicable Regional EMS Councils that have requested to be a hybrid State/Regional EMS model. We began with a summary of progress and status of the Central Shenandoah EMS Council/State Regional Office. Since that time, two more Regional EMS Council Boards of Directors have unanimously voted and requested to adopt this model in collaboration with the Office of EMS. As such we have a report from each of those Councils as follows: Central Shenandoah EMS Council Please see Appendix A Blue Ridge EMS Council Please see Appendix B Rappahannock EMS Council Please see Appendix C

F. Financial Assistance for Emergency Medical Services (FAEMS) Grant Program, known as the Rescue Squad Assistance Fund (RSAF)

Luke Parker, Grants Manager Linwood Pulling, Grants Specialist

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The deadline for the Fall 2020 cycle of the Rescue Squad Assistance Fund (RSAF) was extended from September 15 to September 16, 2020 to account for scheduled portal maintenance. OEMS received 119 applications requesting $17,145,178.39 in funding. Applicants are categorized by agency type as represented by Figure 1. Funding requests were in the following amounts by agency type:  106 EMS Agencies requesting $16,033,368.73  13 Non-EMS requesting $$1,111,809.66

Figure 1: Total Request by Agency Type

Non-EMS

EMS

94%

The number of applications and total requests increased by approximately 6% and 20%, respectively, compared to the Fall 2019 cycle of RSAF. OEMS received applications from agencies within each of the EMS regions as represented by Figure 2. Funding requests were in the following amounts by EMS region:

 Blue Ridge (BREMS): $442,860.13  Central Shenandoah (CSEMS): $1,453,815.50  Lord Fairfax (LFEMS): $756,192.73

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 Northern Virginia (NVEMS): $607,693.97  Old Dominion (ODEMSA): $3,689,292.20  Peninsulas (PEMS): $1,430,896.25  Rappahannock (REMS): $413,084.80  Southwestern Virginia (SWEMS): $2,344,778.29  Thomas Jefferson (TJEMS): $572,617.17  Tidewater (TEMS): $3,357,396.97  Western Virginia (WVEMS): $2,076,550.38

Figure 2: Total Request By EMS Region

WVEMS $2.1M TEMS $3.4M TJEMS $573K SWVAEMS $2.3M REMS $413K PEMS $1.4M ODEMSA $3.7M NVEMS $608K LFEMS $756K CSEMS $1.4M BREMS $443K 0% 5% 10% 15% 20% 25% Non-EMS EMS

The funds requested for this cycle represent 233 individual items and projects. Vehicles make up approximately half of the total funds requested, followed by monitors and defibrillators at 20%, and all other requests making up the remainder. These requests can be further broken down into the following item type categories:  ALS Equipment: $268,259.92  BLS Equipment: $148,760.25  Chest Compression Devices: $287,192.00

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 Communications Equipment – Mobiles: $12,033.69  Communications Equipment – Pagers: $10,050.00  Communications Equipment – Portables: $16,000.00  Computer Hardware: $185,681.96  Computer Software: $13,900.00  Defibrillator - Automatic External Defibrillator: $3,703,681.87  Load Systems, Cots, and Stretchers: $796,335.64  Other*: $381,407.01  Rescue Equipment – Extrication: $221,036.15  Rescue Equipment - Misc.: $30,005.50  Special Priority - Emergency Medical Dispatch: $92,861.79  Special Priority – Emergency Operations: $200,473.42  Special Priority - Innovative (Special) Projects: $58,248.92  Special Priority – Multi-Jurisdictional / Agency Projects: $685,416.40  Special Priority – Recruitment and Retention: $186, 435.00  Special Training Projects: $30,967.25  Stair Chairs - $23,867.22  Training Equipment: $311,249.78  Vehicle - Quick Response Vehicle: $260,669.89  Vehicle - Rechassis: $240,879.00  Vehicle - Specialty – Other**: $35,917.53  Vehicle - Type I Ambulance: $6,778,285.20  Vehicle - Type II Ambulance: $294,234.00  Vehicle - Type III Ambulance: $1,871,329.00

*The “Other” Category includes climate-control devices, decontamination systems, medical supplies, vehicle part accessories, testing equipment, safety vests, ballistic helmets and vests, ALS pediatric kits, public education supplies, capital improvement projects, and a personnel position.

** The “Vehicle – Specialty – Other” category includes an ATV and a cargo trailer.

8 | P a g e The Financial Assistance Review Committee (FARC) will meet to finalize recommendations for funding to the State Commissioner of Health on December 3, 2020. RSAF Award decisions will be approved by the Commissioner and announced on January 1, 2021 via the EMS Portal, email, and the RSAF web page. Please contact Luke Parker, OEMS Grants Manager, at [email protected] with any questions or concerns regarding the information presented in this report.

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EMS on the National Scene

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II. EMS On the National Scene

National Association of State EMS Officials (NASEMSO) Note: The Virginia Office of EMS is an active participant in the NASEMSO and has leadership roles on the Board of Directors and in each NASEMSO Council. The National Association of State EMS Officials is the lead national organization for EMS, a respected voice for national EMS policy with comprehensive concern and commitment for the development of effective, integrated, community-based, universal and consistent EMS systems. Its members are the leaders of their state and territory EMS systems.

A. NASEMSO Endorses H.B. 8592 – EMS Counts Act of 2020 U.S. Representative Susan Wild (D-PA) was recently joined by Rep. Fred Keller (R-PA) in introducing H.R. 8592, the EMS Counts Act of 2020, bipartisan legislation that would address the chronic miscounting of first responders, particularly firefighters and emergency medical services (EMS) personnel. This legislation will ensure that the federal government is collecting accurate, comprehensive data on the quantity, location, and training of first responders throughout the United States, which is essential to ensuring that communities are able to quickly respond to emergencies, including outbreaks of diseases and natural disasters. The EMS Counts Act of 2020 is endorsed by the National Association of Emergency Medical Technicians (NAEMT), International Association of Fire Chiefs (IAFC), International Association of Fire Fighters (IAFF), American Ambulance Association (AAA), National Association of State EMS Officials (NASEMSO), National Association of EMS Physicians (NAEMSP), National Association of EMS Educators (NAEMSE), International Academy of Emergency Dispatch (IAED), National EMS Management Association (NEMSMA), National Registry of Emergency Medical Technicians (NREMT), and Association of Air Medical Services (AAMS). Text of the legislation is available HERE. B. Gainor Serves as Panelist to Qualcomm C-V2X Virtual Summit Dia Gainor, NASEMSO Executive Director, was a panelist during the Qualcomm “C-V2X Virtual Summit Featuring Road Operator Deployments” held in late September. Qualcomm (a Fortune 500 company) supports automakers and road operators worldwide to demonstrate how cellular-based direct communications provide reliable and high-performing messages to deliver improved driving safety and traffic efficiency. Topics included collision avoidance, roadside work zone safety and warnings, signal pre-emption, and the unique needs of emergency response vehicles in a connected world. The opening overview talk provides an excellent orientation to “Cellular to Vehicle-to-Everything” technology that is already transforming transportation safety and highlights emerging technology and how it will affect the roadway transportation system in

11 | P a g e the US in the future. Gainor’s presentation was “C-V2X Through the Eyes of Emergency Medical Services and Other Emergency Responders”. Videos are available through December 31, 2020. C. NASEMSO STC Updates Pediatric Transport Products NASEMSO recently endorsed the joint position statement “Clinical Care and Restraint of Agitated or Combative Patient by Emergency Medical Services Practitioners” coauthored with the National Association of EMS Physicians, the National EMS Management Association, the National Association of Emergency Medical Technicians, and the American Paramedic Association. The document addresses the use of agency protocols, assessment and treatment, education and credentialing, indications for restraint, prohibited techniques, pharmacological management, reassessment, and more. Download the position statement here.

D. NASEMSO Joins National Orgs in Position Statement on Care of Combative and Agitated Patients NASEMSO’s Safe Transport of Children Committee has released an updated version of the Pediatric Transport Products for Ground Ambulances document. Because there are no federal or industry consensus standards in the U.S. for devices used to secure children in ambulances, the document is for the sole purpose of providing helpful information for EMS services on the products currently available for transporting children in ground ambulances in the US. Read more at https://nasemso.org/wp-content/uploads/Pediatric-Transport-Products-for- Ground-Ambulances_v2.2.pdf.

In related news, NASEMSO continues to solicit funding for a proposal to develop safety standards for pediatric ambulance transport. Read more on this initiative at https://nasemso.org/projects/testing-child-restraint-devices-for-ambulances/. E. NASEMSO Reimagined 2020 Offers Range of Topics NASEMSO joined scores of organizations that presented virtual sessions to its members in lieu of an in face annual meeting. Topics included a 2020 NASEMSO Update, Overviews of the National EMS Assessment and Specialty Systems of Care publications, FirstNet Progress, Remote Inspections and Surveys, NEMSIS, and a visionary look at EMS. An abbreviated business meeting was also held. Through the generosity of our exclusive corporate sponsor, FirstNet Built by AT&T, we were able to offer this programming at no cost to members. More info is available at https://nasemso.org/news-events/events/event/annual-meeting-2020-2/. F. NASEMSO Offers Insight to EMS Fatigue Study Funded by the National Highway Traffic Safety Administration in cooperation with the University of Pittsburgh and supported by a systematic review and meta-analysis of the literature, the project team has launched an experimental study to evaluate important outcomes germane to patient and shift-worker safety, personnel performance, acute fatigue, sleep quality, burnout/stress and indicators of long-term health through an experimental study.

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The study’s two primary outcomes of interest include: [1] sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI); and [2] fatigue as measured by the Chalder Fatigue Questionnaire (CFQ). Data collection has been approved through rigorous processes of the White House Office of Management and Budget (OMB Control Number 2127-0742) and an academically based Institutional Review Board. EMS agency participants will join in a series of ten educational modules with several learning objectives and upon completion of a course evaluation are eligible to receive 2.25 CEH by the Commission on Accreditation for Prehospital Continuing Education (CAPCE.) Fifteen peer reviewed manuscripts, including Effect of fatigue training on safety, fatigue, and sleep in Emergency Medical Services personnel and other shift workers: A systematic review and meta- analysis, were published by Prehospital Emergency Care in 2018 and can be accessed for free through our website at www.emsfatigue.org. We’ve recently updated the timeline graphic and added the learning objectives for the course modules that will be available publicly after the study is completed. In related news, "Should Public Safety Shift Workers Be Allowed to Nap While On Duty?" Free access is available for this news article published by our "Fatigue in EMS" project colleagues at the University of Pittsburgh in the American Journal of Industrial Medicine.

Communications

G. Next Generation 911 (NG911) Roadmap Progress Report The NG911 Roadmap Progress Report, a follow-up resource to the 2019 NG911 Roadmap, tracks and shares progress made at the national level – by a variety of stakeholders – toward a nationwide NG911 system. As 911 leaders and organizers forge ahead in creating interconnecting 911 systems, technical and nontechnical tasks need to be completed at the national level to ensure information sharing and avoid duplication of efforts. This collaborative tool:

 Identifies primary goals and specific national-level tasks that need to be accomplished by the 911 community to achieve full migration to NG911.

 Shares the community’s progress toward completing identified tasks.

 Highlights opportunities where contribution from leaders like you is still needed. If you or your organization has made progress in any of the tasks, please let the program know by emailing [email protected]. Read more here.

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H. FCC Proposes to Modernize Priority Service Rules In a Notice of Proposed Rulemaking adopted last month, the Federal Communications Commission (FCC) seeks to modernize its priority services rules to cover priority treatment of voice, data, and video services for emergency personnel. The Commission also proposed to streamline these rules by removing outdated requirements that may impede the use of Internet Protocol (IP)-based technologies. In addition, the Commission proposed to amend the rules to reflect current administrative responsibilities for the priority services programs while eliminating burdensome and unnecessary administrative requirements. Read more at https://docs.fcc.gov/public/attachments/FCC-20-97A1.pdf. I. FCC Helps First Responders Find 911 Callers in Buildings The Federal Communications Commission (FCC) recently adopted Enhanced 911 rules to require wireless providers to transmit the location of wireless 911 calls, obligating wireless providers to meet an increasingly stringent series of location accuracy benchmarks in accordance with a timetable, including providing the caller’s dispatchable location (such as the street address and apartment number) or coordinate-based vertical (“z-axis”) location. Beginning in January 2022, the Commission will also require wireless providers to provide dispatchable location with wireless 911 calls when it is technically feasible and cost-effective to do so, which will promote consistency in the Commission’s 911 rules across technology platforms. The Commission added a new requirement that nationwide wireless providers deploy z-axis technology nationwide by April 2025, while affording non-nationwide wireless providers an additional year (i.e., until April 2026) to do so within their service areas. Read more at https://docs.fcc.gov/public/attachments/FCC-20-98A1.pdf.

J. FCC Designates 988 as 3-Digit Access to National Suicide Prevention Hotline The Federal Communications Commission (FCC) has adopted rules to establish 988 as the new, nationwide, 3-digit phone number for Americans in crisis to connect with suicide prevention and mental health crisis counselors. The rules require all phone service providers to direct all 988 calls to the existing National Suicide Prevention Lifeline by July 16, 2022. During the transition to 988, Americans who need help should continue to contact the National Suicide Prevention Lifeline by calling 1-800-273-8255 (1-800-273-TALK) and through online chats. Veterans and Service members may reach the Veterans Crisis Line by pressing 1 after dialing, chatting online at www.veteranscrisisline.net, or texting 838255. Read more at here.

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Health and Medical Preparedness

K. New DHS Guide Helps Departments Develop an Active Shooter Program The U.S. Department of Homeland Security's (DHS) Emergency Services Sector Active Shooter Guide walks first responder departments through a four-step process and lists resources to create a program: 1. Awareness. Maintain a sense of organizational awareness of this issue and know where you can find resources (FBI, DHS, etc.). 2. Training. Improve local active shooter planning and preparedness through no-cost online training. The guide provides links to training. 3. Community outreach. Establish collaborative networks within your community. This helps during an actual event and makes it more likely that people will report suspicious activity before an incident to a friendly face within the public safety community. 4. Exercise coordination. Exercise the plan to identify training and planning gaps. This is a great way to build on the previous three steps. Additional information, including guides, videos and templates and are available here.

L. New NASEM Report Recommends National Framework to Strengthen PHE Response Research and funding priorities tend to shift from one disaster to the next, which has resulted in a sparse evidence base and hampers the nation’s ability to respond to public health emergencies in the most effective way, says a new report from the National Academies of Sciences, Engineering, and Medicine. It recommends the creation of a National Public Health Emergency Preparedness and Response (PHEPR) Science Framework — led by the Centers for Disease Control and Prevention (CDC) — to establish a sustained research agenda and the necessary infrastructure to advance understanding of what works and why in disaster preparedness and response. Download the full report and companion resources at https://www.nap.edu/catalog/25650/evidence-based- practice-for-public-health-emergency-preparedness-and-response. M. New GAO Report Highlights Use of MRCs Physicians, nurses, and other providers can volunteer in their communities to help people affected by public health emergencies. These volunteers, known as the Medical Reserve Corps, provide first aid and shelter support during a variety of events—like wildfires, hurricanes, and pandemics—and provided medical aid to migrants at the southern border. They have also assisted with drive-thru testing during the COVID-19 pandemic. In a new report, the U.S. Government Accountability Office (GAO) found that almost all states have a network of health care volunteers—the Medical Reserve Corps—who can augment federal, state, and local

15 | P a g e capabilities in response to public health emergencies, such as those arising from wildfires and hurricanes, and infectious disease outbreaks. Having sufficient, trained personnel, such as these volunteers, is critical to a state's capability to respond and recover from public health emergencies. According to federal data, 48 states and the District of Columbia reported 102,767 health care volunteers in 838 Medical Reserve Corps units as of September 2019, with nurses making up 43 percent. Read “Information on the Use of Medical Reserve Corps Volunteers during Emergencies” here. N. MIT Engineers Develop Reusable Face Mask as Effective as N95 Engineers at the Massachusetts of Technology (MIT) and researchers at the Brigham And Women’s Hospital in Boston have developed the Injection Molded Autoclavable, Scalable, Conformable system-- iMASC, a clear silicone rubber mask that covers the nose and mouth, with a nose bridge and two nylon elastic straps that go around the head. The fit was based on the 3M 1860 respirator, a particular style of N95 mask that's commonly used by healthcare providers. The biggest innovation? While N95 masks are made entirely from a special material that filters out airborne droplets and fluids that could contain the Covid-19 virus, the new MIT mask is made from silicone, with slots for just two small, disposable disks of the N95 material (which serve as filters). That means the masks themselves can be quickly and easily sterilized and reused, and though the small filters must be thrown out, each mask requires much less N95 material. More tests need to be done, and the group is currently working on a second mask design. The iMASC system still requires approval by the FDA and NIOSH. Read more.

Medical Direction

O. Portable, Injectable Clotting Agent Could Treat Trauma Victims on the Front Lines Researchers from the Harvard John A. Paulson School of Engineering and Applied Sciences (SEAS), in collaboration with Massachusetts General Hospital, Beth Israel Deaconess Medical Center, and Case Western Reserve University, report an injectable clotting agent that reduced blood loss by 97 percent in mice models. The freeze-dried agent, which has a physical consistency of cotton candy, can be stored at room temperature for several months and reconstituted in saline before injection. The research is published in Science Advances. Read more at https://medicalxpress.com/news/2020-07-portable-clotting-agent-trauma- victims.html?MvBriefArticleId=27498. P. FDA Approves New Opioid for IV Use in Hospitals The U.S. Food and Drug Administration has approved Olinvyk (oliceridine), an opioid agonist for the management of moderate to severe acute pain in adults, where the pain is severe enough to require an intravenous opioid and for whom alternative treatments are inadequate. For more info on oliceridine, download the powerpoint.

16 | P a g e Q. ILCOR Offer Multiple Updates to Cardiovascular and First Aid Guidelines An overflowing treasure trove of information with free access is now available on line in October Supplements to Circulation from the International Liaison Committee on Resuscitation (ILCOR). According to the American Heart Association, “This 2020 document is the fourth in a series of annual International Liaison Committee on Resuscitation (ILCOR) International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC) Science With Treatment Recommendations (CoSTR) summary publications.” It is noted that the 2020 CoSTRs for BLS and ALS are the most comprehensive updates since 2010. In addition, the “2020 American Heart Association (AHA) and American Red Cross Focused Update for First Aid” incorporates systematic reviews conducted by the First Aid Task Force of the International Liaison Committee on Resuscitation (ILCOR). Systematic reviews conducted by ILCOR provided up-to date science for international use and translated for the North American Guidelines. Overall, the 2020 Guidelines outline 491 recommendations specific to adult, pediatric and neonatal life support, resuscitation education science and systems of care. In addition to the updated and new written guidance, all of the algorithms were updated to reflect the latest science and several major changes were also made to improve the visual training and performance aids. Podcasts on the 2020 Guidelines can be found on the Digital Digest.

All manuscripts can be accessed in the October issue of Circulation:

 2020 International Consensus on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care Science With Treatment Recommendations (on basic life support) Originally published 21 Oct 2020 https://doi.org/10.1161/CIR.0000000000000892 Circulation. 2020;142:S41–S91

 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (for advanced life support) Originally published 21 Oct 2020 https://doi.org/10.1161/CIR.0000000000000893 Circulation. 2020;142:S92–S139

 2020 International Consensus on First Aid Science With Treatment Recommendations Originally published 21 Oct 2020 https://doi.org/10.1161/CIR.0000000000000897 Circulation. 2020;142:S284–S334

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Pediatric Emergency Care

R. HRSA’s National Survey of Children’s Health Each year the Maternal and Child Health Bureau at the Health Resources and Services Administration (HRSA) collects information from parents and caregivers on the physical, emotional, and behavioral health of children ages 0-17 years old in the United States. The survey is meant to be a tool with reliable data for researchers and policymakers on a wide range of factors that can influence children’s health – from the prevalence and impact of special health care needs, to adverse childhood experiences and mental and behavioral health. HRSA also released a new brief on Rural/Urban Differences in Children’s Health using the combined data of the 2017-2018 surveys. Find more here. S. FDA Issues Warning on New Social Media Craze The U.S. Food and Drug Administration (FDA) is warning that taking higher than recommended doses of the common over-the-counter (OTC) allergy medicine diphenhydramine (Benadryl) can lead to serious heart problems, seizures, coma, or even death. The agency has issued a press release on news reports of teenagers ending up in emergency rooms or dying after participating in the “Benadryl Challenge” encouraged in videos posted on the social media application TikTok. Health care professionals should be aware that the “Benadryl Challenge” is occurring among teens and alert their caregivers about it. Encourage teens and caregivers to read and follow the Drug Facts label. In the event of an overdose, health care professionals should attempt to determine whether a patient with a suspected overdose took diphenhydramine. Read more here. T. New CDC Report Provides Insight to Teen Vaping A new report posted in the Morbidity and Mortality Weekly Report recently published by the Centers for Disease Control and Prevention evaluated electronic vaping devices used among high school students. While the study was somewhat limited in number, the CDC observes that “School-based efforts to reduce and prevent tobacco product use are most effective when they are part of a comprehensive approach along with other evidence-based population-level strategies. School-level efforts could include adopting tobacco-free policies (including e- cigarettes) with enforcement measures that include access to resources and treatment for students, rather than punishment; implementing evidence-based curricula not sponsored by tobacco companies; and educating school staff members and parents about the changing product marketplace and known health risks of youth tobacco product use, including e-cigarettes.” Read more. U. P-COSCA Advisory Seeks to Improve Peds Resuscitation In 2018, the International Liaison Committee on Resuscitation (ILCOR) sponsored the COSCA initiative (Core Outcome Set After Cardiac Arrest) to improve consistency in reported outcomes of clinical trials of adult cardiac arrest survivors and has since supported a new P-COSCA

18 | P a g e initiative (Pediatric COSCA). The P-COSCA includes assessment of survival, brain function, cognitive function, physical function, and basic daily life skills. Survival and brain function are assessed at discharge or 30 days (or both if possible) and between 6 and 12 months after arrest. Cognitive function, physical function, and basic daily life skills are assessed between 6 and 12 months after cardiac arrest. Because many children have prearrest comorbidities, the P-COSCA also includes documentation of baseline (ie, prearrest) brain function and calculation of changes after cardiac arrest. Supplementary outcomes of survival, brain function, cognitive function, physical function, and basic daily life skills are assessed at 3 months and beyond 1 year after cardiac arrest if resources are available. To access P-COSCA (Pediatric Core Outcome Set for Cardiac Arrest) in Children: An Advisory Statement From the International Liaison Committee on Resuscitation, go here.

INDUSTRY NEWS

V. Medicare Ground Ambulance Data Collection System: Updated Documents On July 31, CMS posted updated versions of the following Medicare Ground Ambulance Data Collection System resources:

 Medicare Ground Ambulance Data Collection Instrument (PDF): See page 45 for a list of the updates, including additional clarifications to the instructions in several sections of the instrument, technical and editorial clarifications and programming notes

 Frequently Asked Questions (PDF) For more information, see the Ambulances Services Center website. In related news, the renewed ABN deadline has been extended. Due to COVID-19, CMS extended the deadline for using the renewed Advance Beneficiary Notice of Noncoverage (ABN) until January 1, 2021. You may use the renewed form prior to the mandatory deadline. W. Ten States Receive 2020 Top Performing State Awards HRSA’s Federal Office for Rural Health Policy (FORHP) presented ten states with the 2020 Top Performing State Awards as part of the Medicare Beneficiary Quality Improvement Project (MBQIP). These awards reflect state efforts to increase reporting rates and levels of improvement in rural Critical Access Hospitals. The top performers—Virginia, South Carolina, Wisconsin, Idaho, Michigan, Georgia, Nebraska, Massachusetts, Illinois, and Utah—built on their previous achievements through activities that lead to high-quality care for rural residents. States work collaboratively with every Critical Access Hospital and their partners to share best practices and use data to drive quality improvements. HRSA also recognized leaders from Idaho and Wyoming with the MBQIP Spirit Award for making remarkable strides in quality measurement and

19 | P a g e improvement in their communities. Read more at https://www.hrsa.gov/rural-health/rural- hospitals/mbqip. X. NEW!! NQF Rural Telehealth and Healthcare System Readiness Committee The National Quality Forum (NQF) is convening a multi-stakeholder committee to create a measurement framework linking quality of care delivered by telehealth, healthcare system readiness, and health outcomes in a disaster. The new Rural Telehealth and Healthcare System Readiness Committee will build on the 2016-2017 Framework to Support Measure Development for Telehealth and the 2019 Healthcare System Readiness Measurement Framework. The Committee will focus on quality of care provided in rural areas and will discuss, update, and enhance the previously developed telehealth framework to ensure its relevance for person- centered measurement, patient safety, and value-based measurement and to ensure it addresses new as well as ongoing opportunities and challenges, in part due to the COVID-19 pandemic. For more info on the committee or to sign up for project updates, go to http://www.qualityforum.org/ProjectDescription.aspx?projectID=93747. Y. First Ever Hess Toy Ambulance on Sale; Free STEM Curriculum Also Available Of interest to collectors, the 2020 Hess Ambulance and Rescue (the series’ first ever ambulance) is now available for purchase exclusively at HessToyTruck.com for $36.99 with free standard shipping and Energizer® batteries included. More importantly, Hess also has made available for free download the 5th edition of a science, technology, engineering and math (STEM) curriculum guide. Designed by Baylor College of Medicine’s Center for Educational Outreach, the guide provides 7 lessons featuring the 2020 Hess Ambulance and Rescue as a STEM learning tool. Hess’ catalog of free STEM teaching tools is available at https://hesstoytruck.com/stem/#stem-curriculum.

Z. CAMTS Offers New Accreditation Standards on Community Paramedicine Programs The Commission on Accreditation of Medical Transport Systems (CAMTS) is proud to announce the release of the first national accreditation standards for Community Paramedicine Programs. The standards reflect months of work with input from some of the national leaders in community paramedic services. As an accredited Standards Setting Organization through the American National Standards Institute (ANSI), CAMTS follows the ANSI essential elements for establishing new and expanding standards. This includes solicitation and consideration of comments and suggestions for standards development. The draft Community Paramedic Program Accreditation Standards are posted on the CAMTS website (camts.org) and are now open for public comments. An online comment/suggestion form allows for new comments and assures all recommendations are logged and addressed. Feedback is provided to the submitter of each recommended change. The draft standards will be available for comments until April 2021 and the final standards will be released in the fall of 2021, with an implementation date of January 1, 2022. Programs that believe they are in substantial compliance with the standards can apply for the voluntary accreditation at that time.

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In related news, CAMTS is also establishing a Community Paramedic Program Accreditation Standards consensus committee that will review and approve any changes. If you are interested in joining this committee, please contact CAMTS at [email protected]. Include your name and contact information and your relationship to community paramedicine programs. The consensus committee will include representatives from providers, program administration, partners, and users. AA. NREMT Launches Monthly Podcast on EMS Competency The National Registry of EMTs has launched a new podcast series, Reinventing Recert, on the NREMT continued competency project. Mark Terry, the Registry’s Chief of Certification will provide listeners insight about the journey of the Continued Competency project and emphasize the importance of the project to the EMS community. The podcast will feature many special guests and serve as a historical record for the successes – and road bumps – of the project. The podcast series launched on October 22 and will be available on a monthly basis for the next year non on Buzzsprout, Spotify, and Apple Podcasts. If you would like more information about the podcast or have questions regarding the content, please reach out to Mark Terry at [email protected]. BB. FirstNet Catalog Offers Range of System Compatible Apps The FirstNet mission is to deploy, operate, maintain, and improve the first high-speed, nationwide wireless broadband network dedicated to public safety. Before choosing or promoting a mobile device application to serve first responder needs, all applications listed in the FirstNet catalog have been scanned for malware and severe security vulnerabilities to better protect the public safety community. Certified apps have passed more stringent security assessment. If it is in the FirstNet Catalog, it is relevant to public safety and the unique needs of first responders. All apps listed in the catalog have been evaluated to ensure sensitive data or important enterprise info will not be compromised. Apps are continuously being added-- readers can view the FirstNet catalog of compatible apps at https://apps.firstnet.att.com/?auth=false. CC. Last Chance to Comment on NFPA 1900/1917 Consolidation Proposal As part of its consolidation plan, the National Fire Protection Association (NFPA) has announced NFPA 1900 (the standard on automotive ambulances) is in a custom cycle due to the Emergency Response and Responder Safety Document Consolidation Plan (consolidation plan) as approved by the NFPA Standards Council. As part of the consolidation plan, NFPA 1900 (combining Standards NFPA 414, NFPA 1901, NFPA 1906, and NFPA 1917) is open for public input with a closing date of November 13, 2020. Find the revised standard at https://www.nfpa.org/codes-and-standards/all-codes-and-standards/list-of-codes-and- standards/detail?code=1900&tab=nextedition.

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Division of Accreditation, Certification

and Education (ACE)

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III. Accreditation, Certification and Education

Committees

A. The Training and Certification Committee (TCC): The Training and Certification Committee meeting scheduled for October 8, 2020 was cancelled due to Executive Order 51 pertaining to COVID-19. Copies of past minutes are available on the Office of EMS Web page here: http://www.vdh.virginia.gov/emergency-medical-services/education- certification/training-certification-committee-standing/.

B. The Medical Direction Committee (MDC): The Medical Direction Committee meeting scheduled for October 7, 2020 was cancelled due to Executive Order 51 pertaining to COVID-19. Copies of past minutes are available from the Office of EMS web page at: http://www.vdh.virginia.gov/emergency-medical-services/education- certification/medical-direction-committee-standing/

Accreditation

All EMS programs that are in need of a site visit having gained accreditation either through Letter of Review or through full accreditation have been granted an extension of expiration until December 31, 2021. No accreditation visits will be scheduled until such time as it is deemed safe due to COVID-19.

A. EMS accreditation program.

1. Emergency Medical Technician (EMT)

a) The following EMT programs are under Letter of Review:

(1) Arlington County Fire Department (2) Fauquier County (3) Hampton Roads Regional EMS Academy (4) Augusta County (5) Rockingham County Dept. of Fire and Rescue (6) Gloucester Volunteer Fire and Rescue (7) Fairfax County Fire and Rescue

23 | P a g e 2. Advanced Emergency Medical Technician (AEMT)

a) The following AEMT programs are under Letter of Review:

(1) Newport News Fire Training (2) Fauquier County (3) Hampton Roads Regional EMS Academy (4) Augusta County (5) Rockingham County Dept. of Fire and Rescue

3. Paramedic – Initial

National accreditation occurs through the Committee on Accreditation of Educational Programs for the EMS Professions (CoAEMSP – www.coaemsp.org).

a) Blue Ridge Community College has been issued their LOR from CoAEMSP and is enrolling students for their first cohort class.

b) Thomas Nelson Community College has completed their first cohort class and are working on submission of their initial report to CoAEMSP.

c) Henrico County Division of Fire has been issued a LOR from CoAEMSP and will be enrolling students for their first cohort class

4. Paramedic – Reaccreditation

National accreditation occurs through the Committee on Accreditation of Educational Programs for the EMS Professions (CoAEMSP – www.coaemsp.org).

a) No current activity. CoAEMSP has suspended all reaccreditation visits due to COVID-19.

C. For more detailed information, please view the Accredited Site Directory found on the OEMS web site at: https://vdhems.vdh.virginia.gov/emsapps/f?p=200:1

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Virginia Certification Online Verification

OEMS offers an online Virginia EMS Provider Certification Lookup which can be used to verify credentials online at the following URL: https://vdhems.vdh.virginia.gov/emsapps/ProviderSearch.html All certification data on this website is real-time, up-to-date, valid and accurate.

Certification Cards No Longer Required for EMS Agency Inspection Requirements

Extension of Certification Expirations

No further extension of certifications has been granted or are anticipated at this time. All providers must meet their continuing education requirements by the last day of their certification expiration month, or the provider will go into reentry per our normal regulatory requirements.

Continuing Education

 All CE is available through online resources, and providers are encouraged to use those resources. https://www.vdh.virginia.gov/emergency-medical-services/education- certification/provider-resources/web-based-continuing-education/

TPAM Policy T-1445 – Course Scheduling

As a reminder, in the May 2020 update to the Training Program Administration Manual, we made it possible for Cardiopulmonary Resuscitation (CPR) to be a pre or co-requisite for initial certification programs. If CPR is offered as a co-requisite, the student must obtain a valid CPR card by the end date of the course as announced to the Office. Failure to obtain CPR by the end date of the course or marking a student as “Pass” for the course without a valid CPR card is not permitted and will be considered a violation of this policy.

Field and Clinical Requirements for EMT and Advanced EMT Programs (T-1445)

State and regional Medical Directors have reiterated, as late as August 12, 2020, the importance of students in initial certification programs successfully completing and meeting all field and clinical requirements as specified for all certification programs. Educators and Program Directors conducting initial certification programs during COVID-19 are expected to seek out all possibilities to ensure students are able to meet all field and clinical requirements until at least June 30, 2021. If an educator or Program Director has exhausted all possibilities for field and clinical sites for their students and they are unable to secure sites due to COVID-19 limitations or restrictions, then the educator or Program Director shall:

1. Secure an attestation statement from each site indicating that they will not allow access to their facility for your students due to COVID-19 limitations or restrictions.

25 | P a g e a. The attestation statement must include signatures (physical or electronic) from the educator, the field or clinical site representative and the program Medical Director. b. A sample attestation statement is attached.

2. Once attestation statements have been received for all sites, the educator or Program Director can then allow field and/or clinical competencies to be conducted with the students using programmed patients and/or advanced simulation scenarios until you are comfortable that the student is satisfactorily competent.

a. Field and/or clinical competency stations should limit the number of people in contact with one another in compliance with social distancing guidelines. b. Screening of all students and staff is required before ANY in-person meetings with them using form TR-900 – Student Screening Log. Maintain the screening log along with TR-06 – Course Roster. c. Maintain social distancing requirements of six (6) feet of separation to the best of your ability. d. ANY face-to-face field and/or clinical competency stations sessions that require being less than six (6) feet apart shall use adequate PPE to ensure all involved are protected to the highest degree possible.

3. Attestation statements are required to be maintained by the educator with their course files.

Certification Testing Changes – State and National Registry

BLS Certification Testing

 Cognitive Exams – The National Registry has implemented cognitive examination testing through the Pearson OnVUE Testing process which allows remotely proctored cognitive exams to be completed in locations such as their home provided they can meet the security requirements. This process became available on May, 12, 2020.

 Please direct candidates to learn more about Pearson OnVUE Remote Proctored Exams by visiting: https://home.pearsonvue.com/nremt/onvue  Pearson OnVUE remote proctoring will be temporary, however the National Registry is planning to implement a more permanent remote proctoring solution in 2021.  Once a candidate sits for and passes the National Registry Cognitive Exam, they will be issued a full National Registry and Virginia certification.

 Psychomotor Exams – After careful consideration, the Office of EMS Management Team has decided to cancel all further Consolidated Testing at the

26 | P a g e BLS level through June 30, 2021 due to the COVID-19 pandemic. With so many unknown factors in the months ahead and the amount of advanced planning and commitment required to hold a CTS, we determined cancellation to be in the best interest of the health, safety and well-being of all participants. Students will receive guidance from their Course Coordinator as to how their psychomotor skills will be tested in lieu of Consolidated Testing.

ALS Certification Testing

 Advanced EMT Programs

 Pearson OnVUE remote proctoring will be temporary, however the National Registry is planning to implement a more permanent remote proctoring solution in 2021.  Once a candidate sits for and passes the National Registry Cognitive Exam, they will be issued a provisional National Registry and provisional Virginia certification.  The candidate will have to complete and pass their National Registry psychomotor exam before full National Registry and Virginia certification will be issued.  Provisional certifications can be converted to full certification once the COVID-19 threat is mitigated and the student takes and passes their NREMT required psychomotor exam.

 Psychomotor Exams – The Office is working with ALS programs and the National Registry and started conducting ALS psychomotor testing on June 15, 2020 with the appropriate measures in place to meet the requirements of social distancing, temperature checks, wearing of masks and use of manikins in lieu of patients. The ALS Testing Calendar can be found on the OEMS website at: https://www.vdh.virginia.gov/emergency-medical-services/virginia- national-registry-psychomotor-examination-schedule/

 Paramedic Programs

 Cognitive Exams – The National Registry is collaboration with Pearson VUE have increased the availability of Test Centers to reopen as quickly as possible. Paramedic candidates are required to take their cognitive

27 | P a g e exam at a Pearson VUE Test Centers—remote proctoring via Pearson OnVUE is not permitted for paramedic candidates.

 Once a candidate sits for and passes the National Registry Cognitive Exam, they will be issued a provisional National Registry and provisional Virginia certification.  The candidate will have to complete and pass their National Registry psychomotor exam before full National Registry and Virginia certification will be issued.  Provisional certifications can be converted to full certification once the COVID-19 threat is mitigated and the student takes and passes their NREMT required psychomotor exam.

National Registry

 National Registry & Virginia Provisional Certifications – (Advanced EMT and Paramedic ONLY!)

 National Registry will cease issuing provisional certifications on December 31, 2020.

 National Registry & Virginia have restarted the process of scheduling NREMT psychomotor exams.

 For those who were not able to take their NREMT psychomotor exam due to the COVID-19 pandemic, the Board of the National Registry has approved the issuance of a provisional certification. In Virginia, this will only impact the Advanced EMT and Paramedic certification levels. A provisional National Registry certification is issued when a student:

1. completes their certification program according to state or CoAEMSP requirements, and 2. sits for and passes the National Registry cognitive exam.

28 | P a g e 3. When these items are completed, a provisional National Registry certification will be issued with an expiration date of December 31, 2021. The issued certification will clearly indicate the awarding of provisional certification pending completion of the psychomotor exam when successfully completed.

 Provisional certifications can be converted to full certification once the COVID‐ 19 threat is mitigated and the student takes and passes their NREMT required psychomotor exam.

 Virginia has begun accepting and likewise issuing provisional certifications cards when the National Registry transmits these results to us. Please see the sample provisional Virginia certification card. We are providing this sample to you so that you are aware of what we will be issuing during the COVID‐19 pandemic. The sample is highlighted to indicate the changes that will be made to certification cards issued under this provisional authority.

 The issuance of a provisional certification by the Virginia Office of EMS is not reflective that the Office is restricting provider practice. The ability for a provider to practice is solely up to the EMS Agency and the agency’s Operational Medical Director. We are issuing provisional certifications as a means of ensuring that we have a mechanism to track these providers and ensure that they complete their certification process once the COVID‐19 threat is mitigated.

 When being scheduled for work, National Registry strongly urges that no two provisionally certified providers work on the same truck. There should always be a fully certified provider riding with a provisionally certified provider.

 Should a provider who was granted provisional Virginia certification based off of a National Registry provisional certification not fulfill the requirements of their National Registry certification, the Office of EMS will initiate the process of revocation of the provider’s certification in the Commonwealth.

National Registry Cognitive Examinations

 NREMT currently offers two different options for taking the cognitive exams: face-to- face exams at a Pearson VUE Testing Center and remotely proctored exams making use of Pearson OnVUE.

 Candidates, when applying for their cognitive exam have the opportunity to select whether they would like to take their exam face-to-face exams at a Pearson VUE Testing Center or a remotely proctored exam on Pearson OnVUE.  Sample face-to-face exam ATT Letter  Sample Pearson OnVUE ATT Letter.

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 If a candidate decides to change their method of testing from face-to-face to Pearson OnVUE or vice versa, they can do so, however the issuance of a new ATT letter will take at least 24 hours to generate before they can then schedule the examination through the process they have chosen.  Click here for screenshots of how to change your testing method from face-to-face testing to Pearson OnVUE.

National Registry Releases New Certification Schemes

The National Registry’s Board of Directors voted to bring consistency and uniformity to certification schemes, as well as aligning all National Registry levels with the current National EMS Scope of Practice Model. The new policy also addresses the need for a pathway for reentry for AEMTs.

“These certification schemes were passed to clearly communicate requirements for certification in a single policy,” said Mark Terry, Chief Certification Officer. “Additionally, the new policy aligns each level with the National EMS Scope of Practice Model and the National Registry’s Practice Analysis, which identified necessary knowledge, skills and abilities for the profession.” The policy, with the new certification schemes, goes into effect on July 9, 2020. Please see the following links to view the in-depth policies for each National Registry Certification Level

 EMT Certification Level  AEMT Certification Level  Paramedic Certification Level

National Registry Recert 2.0

On October 22, 2020 the Office published a new version of the National Registry Recert 2.0 document which details the steps Virginia EMS Provider’s should follow to recertify their National Registry certification if they are in the March 2021 recertification cycle. This information is highlighted on the main OEMS webpage as well as on the revised Recertifying Your Virginia EMS Credentials webpage.

 https://www.vdh.virginia.gov/emergency-medical-services/education- certification/provider-resources/recertifying-your-virginia-ems-credential/

General Updates

Virginia Course Approval Requests

Another long promised enhancement to the Virginia EMS Portal is finally here. Today we are introducing online submission of EMS Course Requests through the Virginia EMS Portal. Beginning Tuesday, October 27, 2020, the Office of EMS no longer accepts electronic or

30 | P a g e paper submissions of form TR-01 – Course Approval Request. Any paper or electronic forms received from October 27, 2020 forward will be returned to the Education Coordinator / ALS- Coordinator and they will be asked to login to the Virginia EMS Portal to complete their submissions.

The Course Request feature is fully integrated into the Virginia EMS Portal and involves several approval flows/queues for your courses. At any step in the process, it is possible for your EMS Physician or the Office of EMS to deny a course request. You will be notified of the decision of your EMS Physician and/or the Office of EMS via e-mail messages from the EMS Portal.

For most courses, you will need only select the course type and fill in the requisite details and click submit for approval. However, there are occasions when you must submit an attachment as a part of your course approval:

1. All Auxiliary Courses will require that you submit a digital copy of your instructor certification from the parent organization for that program. You will not be able to complete the submission process without an attachment. Attachments can be in the form of: PDF, DOCX, JPG, PNG, TIF. 2. All “custom CE” courses will require that you submit form TR-19 - Custom CE Program Outline (attached). You will not be able to complete the submission process without an attachment. 3. All “VILT” courses will require that you submit form TR-18 - VILT Program Course Schedule and Registration (attached). You will not be able to complete the submission process without an attachment.

Please see the online training for this new module on the following page BEFORE you attempt to complete and submit a course approval the first time.

 https://www.vdh.virginia.gov/emergency-medical-services/virginia-ems-portal-training- videos/

Digital Certification Cards

The Office of EMS introduce digital certification cards to EMS providers, EMS Physicians and EMS Agency Leadership in late October.

Digital certificates make keeping your certification with you easier than ever. The certificates are easy to pull up from a cell phone or computer. Digital certificates also make it a snap for an employer or organization to check and verify your certification levels.

Accessing a digital version of your certification card is as easy as logging into the Virginia EMS Portal. A fact sheet on digital certification cards is attached – APPENDIX D. Providers can now download their certification card directly to their devices and keep it with them in digital format wherever they go!

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Why transition to digital certification?

1. EMS providers lose their certification cards, frequently. With digital certification cards providers never have to worry about replacement cards because providers will always have access to the digital certification for the duration of their certification period. 2. Saving taxpayer money! Certification card stock, the cost of envelopes and postage, manpower to print, fold and stuff cards all cost money! Money which could be better spent on new technology resources, increased funding for the Rescue Squad Assistance Fund, and other benefits to the EMS system as a whole. 3. Instead of faxing or mailing copies of your certification card to your employer or anyone requesting proof of your training, just e-mail them your Virginia EMS Certification card. It’s fast and easy! 4. Be on the cutting edge and go green! Save our valuable natural resources whenever possible.

Concerned about Safety and Security?

Verify any Virginia EMS certification quickly on the Office of EMS website. This website allows for a search by a certificate number, first and last name and/or agency. If you are an employer and your employee has given you his or her Virginia EMS certification, or even just the certification number, you can use it to search for the certificate to validate that it’s valid as well as see when it expires.

This tool makes compliance and HR record keeping a breeze. Just go to the Virginia Office of EMS Digital Certification Verification web page and search for the certificate number you are trying to verify.

 https://vdhems.vdh.virginia.gov/emsapps/f?p=200:3

Once you’ve had a digital certification card, you’ll have a hard time going back to “the way we used to do it.”

Please see the online training for this new module for how to access digital certification cards.

 https://www.vdh.virginia.gov/emergency-medical-services/virginia-ems-portal-training- videos/

Virginia EMS Portal Two-Factor Authentication

Late last week, our IT Team put into production an upgrade for the two-factor authentication used to verify an individual’s identity and allow for on-the-fly password changes.

By default, two-factor authentication now uses SMS to send a 6-digit authentication token to the user’s cellphone which must be entered before the EMS Portal allows a password to be reset. The addition of this new method for two-factor authentication is a much needed

32 | P a g e enhancement to our security and the ability for end-users to make password resets without the need to call or e-mail the OEMS Help Desk.

Virginia CE Requirements

As of today (October 1, 2020), very few providers will be left on the 2012 CE recertification cycle. Therefore, we released an update recertification worksheet which combines BLS and ALS CE hours together on one easy-to-read page.

The revised Recertifying Your Virginia EMS Credentials webpage has been published and can be found at the following link: https://www.vdh.virginia.gov/emergency-medical- services/recertifying-your-virginia-ems-credential/

Also as a part of this redesign, the requirements for Provider’s in Reentry were separated into a new webpage to help distinguish reentry from recertification, which provider’s often confuse. The new EMS Providers in Reentry webpage can be found at: https://www.vdh.virginia.gov/emergency-medical-services/ems-providers-in-reentry/

New Process for Enrolling Foreign Nationals in EMS Programs

 Foreign nationals must reach out to Debbie Akers ([email protected]) with a copy of their Visa for further guidance.  The US State Department may be involved.  OEMS will assign a fictitious SSN which can then be used for completion of the online enrollment process the same as all other providers.

Education Program

Education Coordinator and ALS Coordinator Certification Extensions

 Due to Executive Order 51 et seq., the Virginia Office of EMS will be extending the expiration dates for Education Coordinators and ALS Coordinators with an expiration date of June 30, 2021 through December 31, 2021 until June 30, 2022.  The Education Coordinator Update schedule can be found online at: http://www.vdh.virginia.gov/emergency-medical-services/ems-educator-update- schedule/

Education Coordinator Candidate Program

The Office was able to hold a socially distant Education Coordinator Institute at the end of September in Norfolk, Virginia. At the conclusion of the Institute, the Office was able to certify 22 new EMS educators.

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The Office is hopeful that we will be able to conduct the winter Education Coordinator Institute in late January:

 The deadline for EC Candidates to have completed all requirements in order to be considered eligible for this institute is 5:00 pm December 6, 2020.  Invitations will be sent to eligible candidates via e-mail on the morning of December 8, 2020.  More information can be found at: http://www.vdh.virginia.gov/emergency-medical- services/ems-education-coordinator-requirements/

Education Coordinator Updates

The ACE Division has been able to hold three (3) socially distant Education Coordinator Updates—one in NOVA, one in Norfolk and one in Keswick—after verifying seating capacity and the ability of our host sites to accept “outside guests.”

Due to restrictions in place for COVID-19 and in keeping with the Governor’s Phase Three Guidelines, we require a registration process for all EC Updates until the pandemic is over. EC Updates will look and feel different for the foreseeable future with:

 continued social distancing, and  participants wearing face coverings/masks while indoors in public settings.

The schedule of updates and links to register to attend an update can be found on the OEMS web page at: https://www.vdh.virginia.gov/emergency-medical-services/ems-educator-update- schedule/

PLEASE NOTE: EC Updates are subject to cancellation up to 24 hours before the event is scheduled to take place depending on guidance our Office receives from the Office of the Governor, VDH or the hosting site.

EMS Training Funds

Table. 1 – Virginia EMS Scholarship Program – FY21 (Q1) Certification Level No. Awarded Amount Awarded EMR 0 -- EMT 154 $129,979.00 AEMT 28 $31,599.00 Paramedic 114 $546,324.00 Grand Total 296 $707,902.00

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Psychomotor Test Site Activity

A. BLS Psychomotor Testing has been suspended for the remainder of 2020. A workgroup of the Training and Certification Committee will continue their work, when safe to do so, on changes to the BLS testing through a more comprehensive critical thinking scenario based evaluation rather than the memorization of skill sheets.

Other Activities

 Debbie Akers is serving on the committee to rewrite the Education Standards and Instructional Guidelines. The completion of this project has been delayed and the anticipated release date of the new Education Standards will be March, 2021.

 Debbie Akers is serving on the workgroup who will be looking at Competency Based Education with the National Registry.

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Community Health and Technical Resources (CHaTR)

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IV. Planning and Regional Coordination

CHaTR Website

The CHaTR division has its own section on the Virginia OEMS website at the link below:

http://www.vdh.virginia.gov/emergency-medical-services/chatr/

Regional EMS Councils

The OEMS continues to maintain a Memorandum of Understanding (MOU) with the Regional EMS Councils for the 2021 Fiscal Year. The Regional Councils submitted their FY21 First Quarter reports throughout the month of October, and are under review. OEMS transitioned to a web based reporting application to replace Lotus Notes for the Regional EMS Councils to submit quarterly deliverables.

The OEMS, Dr. Jaberi and the Regional Council Executive Directors met on December 6, 2019 to discuss various aspects of the regional council programs including a planning session to evaluate the current MOUs in place and any possible modifications to future MOUs. A meeting originally scheduled for April of 2020 will be held upon the relaxation of the COVID-19 meeting/gathering limitation policies.

OEMS staff has been holding COVID-19 updates via webinar with regional council staff and board members on a weekly basis since March 13, 2020. These webinars transitioned to biweekly basis on June 26, 2020. In addition, CHaTR staff have assisted in the coordination of Personal Protective Equipment (PPE) distribution to the Regional EMS Councils.

The Blue Ridge and Rappahannock EMS Councils have entered into MOU agreements to become OEMS Regional Offices. OEMS staff has worked with the Board of Directors of those respective councils for implementation throughout 2020. Hiring processes for the Program Managers of both offices took place throughout March and April. The OEMS Program Managers for these Regional Offices are Mary Kathryn Allen at BREMS and Wayne Perry at REMS.

CHaTR staff have attended Board meetings and/or award programs for the Blue Ridge, Central Shenandoah, Lord Fairfax, Northern Virginia, Peninsulas, Southwest Virginia, Thomas Jefferson, Tidewater, and Western Virginia Councils.

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Medevac Program

The medevac program is in the process of transition from the CHaTR division to the Trauma/Critical Care division. This process will be completed in 2020.

The Medevac Committee meetings scheduled for August 6 and November 11, 2020 were cancelled due to the COVID-19 pandemic. The minutes of previous Medevac Committee meetings are available on the OEMS website linked below: http://www.vdh.virginia.gov/emergency-medical-services/advisory-board-committees/medevac- committee/

The amount of data submitted to the Medevac Helicopter EMS application (formerly known as WeatherSafe) continues to grow. In terms of weather turndowns, there were 569 entries into the Helicopter EMS system in Q2 of the 2020 calendar year. 58% of those entries (332 entries) were for interfacility transports, which is consistent with information from previous quarters. The total number of turndowns is a increase from 441 entries in Q2 of 2019. This data continues to demonstrate a commitment to the program and to maintaining the safety of medevac personnel and equipment.

The Committee continues to evaluate the increased use of unmanned aircraft (drones), and the increased presence in the airspace of Virginia. A workgroup continues work to raise awareness among landing zone (LZ) commanders and helipad security personnel.

The Office of EMS has developed a form intended for a health care provider to notify a patient or his/her authorized representative that the health care provider is requesting air medical transport for the patient who may not have an emergency medical condition.

The form can be found via the link below: http://www.vdh.virginia.gov/content/uploads/sites/23/2019/03/Air-Medical-Transport- Authorization-Form.pdf

The CHaTR division manager participates on the NASEMSO Air Medical Committee. OEMS and Medevac stakeholders continue to monitor many developments regarding federal legislation and other documents related to Medevac safety, regulation, and the cost of providing air medical services.

State EMS Plan

The Virginia Office of EMS Strategic and Operational Plan is mandated through The Code of Virginia to be reviewed and revised on a triennial basis.

Review and revision of the State EMS Plan began in early 2019. Committee chairs, OEMS staff, and Regional EMS Council staff have received the current 2016-2019 plan and the guidance documents for the triennial review and revision period. Reports from committees for edits, additions and deletions have been compiled into a draft of the 2020 State EMS Plan. On October 16, 2019, the Legislative and Planning Committee met during a special called planning session.

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During this meeting the committee reviewed and made final edits to the plan and subsequently voted unanimously to approve the draft 2020-2022 State EMS Plan.

The State EMS Plan was unanimously approved by the State EMS Advisory Board at their November 6, 2019 meeting. The Board of Health is required to adopt the plan, however the March 26, 2020 Board meeting was cancelled due to the COVID-19 pandemic. On June 4, 2020, the State Board of Health met and approved the State EMS Plan in a unanimous vote.

The current version (2020-2022) of the State EMS Plan is available for download via the OEMS website at the link below: http://www.vdh.virginia.gov/emergency-medical-services/state-strategic-and-operational-ems- plan/

State Telehealth Plan

During the 2020 session, the Virginia General Assembly passed House Bill 1332, which directs the Board of Health to complete a State Telehealth Plan by January 1st, 2021.

House Bill 1332 expresses the plan must address six provisions summarized as Delivery, Remote Patient Monitoring, Criteria for Use, Integration, Sustainability, and Data Collection. More detailed information regarding the bill language can be found at the links below: https://lis.virginia.gov/cgi-bin/legp604.exe?201+ful+HB1332ER+pdf

https://lis.virginia.gov/cgi-bin/legp604.exe?201+ful+CHAP0729+pdf

The Virginia Department of Health (VDH) has created several workgroups to address the specific provisions of the bill language. The Office of EMS (OEMS) has worked with the Office of Health Equity (OHE) and leadership from the Injury and Violence Prevention Program to coordinate stakeholders to participate in the development of the State Telehealth Plan. Stakeholder workgroup meetings were held virtually in August and September.

The Board of Health was granted a three month extension for the State Telehealth Plan on September 23, 2020, changing the deadline for completion to March 1, 2021. The VDH workgroup is carefully crafting a framework for the State Telehealth Plan and will reconvene stakeholder workgroup meetings once the first draft of the framework has been completed.

State Rural Health Plan

For the past several months, the Office of Rural Health has been developing the first State Rural Health Plan released in over five years. Members from the Office of Rural Health, the Office of Health Equity, and the Office of Emergency Medical Services have collaborated on the document on a weekly basis since May 2020.

The scheduled completion date of the State Rural Health Plan is December 6, 2020. The newest version of the State Rural Health Plan will be available for download at a later time.

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IV. Technical Assistance

EMS Workforce Development Committee

The EMS Workforce Development Committee (WDC) was scheduled to meet in November 2020 in conjunction with the Virginia EMS Symposium. The meeting was cancelled due to the COVID-19 pandemic. Previous WDC minutes are available on the OEMS website, at the link below: http://www.vdh.virginia.gov/emergency-medical-services/advisory-board- committees/workforce-development-committee/

EMS Workforce Development Committee (Continued)

The goals of the WDC include: the EMS Officer program, the Standards of Excellence (SoE) program, the introduction of military personnel and veterans into the Virginia EMS workforce, and supporting the recruitment and retention of the EMS workforce in Virginia.

EMS Officer Program:

Since the initial release of the EMSO1 pilot in 2016, nine (9) courses have been completed. In 2020, plans were in place to hold 8-10 offerings throughout Virginia. In addition, each of these course offerings were opportunities to onboard new instructors to the EMSO1 instructor pool. Due to the COVID-19 pandemic, all course offerings after March 13, 2020 were cancelled. CHaTR staff will be making plans to resume instruction in the future.

The committee is currently finalizing some adjustments to the overall program and are instituting a Train-the-Trainer program. The development of the EMS Officer II program has begun, while the committee also finalizes the full release of EMS Officer 1.

The EMSO1 online education format was formatted to a Learning Management System (LMS) and was first utilized at the 40th Virginia EMS Symposium. The input from the students and

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instructors was extremely positive and is being utilized to make changes to future course offerings.

The EMS Officer section of the VDH/OEMS webpage has been updated to reflect the recent progress with the program, at the link below: http://www.vdh.virginia.gov/emergency-medical-services/agency-leadership-resources/ems- officer-i/

EMS Workforce Development Committee (Continued)

Standards of Excellence (SoE) Program:

The SoE Assessment program is a voluntary self-evaluation process for EMS agencies in Virginia based on eight areas of excellence - areas of critical importance to successful EMS agency management, above the requirements of the Virginia EMS Regulations.

Each area is reviewed using an assessment document that details optimal tasks, procedures, guidelines and best practices necessary to maintain the business of managing a strong, viable and resilient EMS agency.

CHaTR staff is providing technical assistance to agencies wishing to become Agencies of Excellence, however site visits are not currently possible due to the pandemic.

All documents related to the SoE program can be found on the OEMS website at the link below: http://www.vdh.virginia.gov/emergency-medical-services/virginia-standards-of-excellence- program/

EMS Recruitment and Retention

The network is comprised of membership from Virginia, Maryland and West Virginia with over 300 members. The mission of the Virginia Recruitment and Retention Network is “to foster an open and unselfish exchange of information and ideas aimed at improving staffing” for volunteer and career fire and EMS agencies and organizations.

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The Virginia Recruitment and Retention Network met virtually on July 22, 2020, with CHaTR staff participating. The network announced their new website, which offers resources for agencies as well as contact points for individuals interested in Fire and EMS. The network is continuing to add additional content including obtaining member information. The link to the website can be found on the CHaTR Recruitment and Retention page at the link below: https://www.vdh.virginia.gov/emergency-medical-services/chatr/recruitment-retention/

Several changes have been made to the Recruitment and Retention page on the OEMS website to give it a more streamlined appearance. Links to pertinent reference documents are expected to be added to the page in the coming months. The network is strongly encouraged to work with OEMS to provide updated information and resources through the website and social media for recruitment and retention across Virginia.

System Assessments/Miscellaneous Technical Assistance

CHaTR staff assists the Virginia Department of Fire Programs (VDFP) with evaluations of the Fire and EMS systems in localities in Virginia.

The most recent studies were held in Southampton County, September 25-27, 2019, and in Greene County on January 27, 2020. The final reports of those studies have not been released.

Evaluation reports for previously conducted studies can be found via the link below: https://www.vafire.com/about-virginia-department-of-fire-programs/virginia-fire-services- board/virginia-fire-services-board-studies/

ChaTR staff has been requested to conduct an EMS system study in Wise County. That study has been postponed due to the pandemic.

On March 30, 2020, Center for Medicare and Medicaid Services (CMS) released notification to allow for an expansion of the list of allowable destinations for ambulance transports, including any destination that is able to provide treatment to the patient in a manner consistent with state and local Emergency Medical Services (EMS) protocols in use where the services are being furnished.

On April 9, the Virginia Office of Emergency Medical Services (OEMS) distributed guidance in the form of a white paper to both EMS agencies and facilities considered to be allowable destinations for ambulance transports under the CMS guidance.

The white paper includes guidelines for agencies transporting patients to alternative sites, the protocols that outline the transportation options, funding for transportation to an alternate site, as well as further considerations for transportation to an alternate site.

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The white paper can be found at the link below: http://www.vdh.virginia.gov/content/uploads/sites/23/2020/04/EMS-Transport-to-Alternate- Sites-White-Paper.FINAL_.pdf

Mobile Integrated Healthcare/Community Paramedicine (MIH/CP) and Rural EMS

The MIH/CP workgroup that was created in 2015 reconvened on September 19, 2018, with Dr. Allen Yee again serving as chair. The workgroup last met on February 12, 2020. Future meetings have not been scheduled due to the pandemic.

Previous meeting minutes may be viewed at the link below: http://www.vdh.virginia.gov/emergency-medical-services/community-paramedicine-mobile- integrated-healthcare/

The workgroup has created a MIH-CP white paper and a letter of intent for agencies that are performing system evaluations to determine the feasibility of providing MIH-CP service. These documents were unanimously approved by the Medical Direction Committee at their meeting on January 16, 2020.

The white paper and letter of intent were approved by the State EMS Advisory Board at the last meeting on February 7, 2020, but the process has been postponed due to the pandemic.

CHaTR staff is also working with the VDH Office of Health Equity (OHE) to perform assessments of EMS systems that have Critical Access Hospitals (CAH) in their service areas. Due to the pandemic, those visits have been postponed.

The CHaTR division manager participates on the NASEMSO CP-MIH workgroup, the Joint Committee on Rural Emergency Care (JCREC), and is a member of the Virginia Rural Health Association (VRHA) Board of Directors.

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Division of EMS Emergency Operations

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V. Division of Emergency Operations

Division of Emergency Operations Staff Members Office Number for Staff Members 804-888-9100

Karen Owens Emergency Operations Manager, Staff Support – Provider Health and Safety Committee [email protected]

Sam Burnette Emergency Services Coordinator, Staff Support – Trauma System Emergency Preparedness and Response Committee [email protected]

Rich Troshak Emergency Operations Specialist, Staff Support - Communications Committee [email protected]

Caron Nazario Emergency Planner, Staff Support - Emergency Management Committee [email protected]

Vincent Valeriano Epidemiologist [email protected]

● COVID-19 Response

The Division of Emergency Operations continues to work closely with other OEMS staff, VDH partners, and other local, regional, and state partners to coordinate response, develop and share plans, update information, and provide guidance to the EMS agencies across the state in conjunction with the response to the Coronavirus (COVID-19) outbreak.

The following is a list of activities that the division staff have conducted in support of COVID-19 response:

o Vaccination Planning

Karen Owens participated in the VDH Vaccination seminar and tabletop exercise during this quarter. The events were an opportunity to review the VDH COVID vaccination plan, discuss the roles of the various stakeholders, and provide recommendations for changes to strengthen the plan. Additionally, Karen participated in a conference call with Director Gary Brown and members of VDH to discuss the role

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of EMS in the vaccination process and the requirements that exist for EMS providers to serve as vaccinators.

o Virginia Department of Health Partner Calls

Division of Emergency Operations staff have been participating in weekly VDH Partner teleconferences held by the Virginia Department of Health Office of Emergency Preparedness (OEP) held each Friday morning. This weekly call brings VDH partners and stakeholders together to discuss how VDH is responding to and assisting with the COVID 19 crisis in Virginia.

o Healthcare Committee Karen Owens continues to represent the Office of EMS and the EMS community on teleconferences of the Healthcare Committee for COVID response planning. In her position as EMS Subcommittee Chair, Karen continues to assist in developing the role for EMS in the ongoing response.

o Ongoing Meetings

Karen Owens, and other members of the Office of EMS staff continue to work with other VDH partners, and stakeholders to answer questions, gather information, and provide resources for response and recovery planning related to COVID response. This includes, but is not limited to, antigen testing, PPE availability, and testing resources.

● Hurricane Response Activities

Members of the Division of Emergency Operations maintained situational awareness and status review for various weather related events during this quarter. With an active hurricane season, Emergency Operations staff monitored potential impacts to Virginia, shared preparedness information, and ensures that Virginia EMS resources were ready to respond within the state or into other states, should requests be received.

● Virginia Emergency Support Team (VEST)

During this quarter, members of the Division of Emergency Operations, participated in various meetings and trainings designed to strengthen the capabilities of staff during VEST activations. This includes, but is not limited to Microsoft Teams Training, weekly VEST training events, review of the Commonwealth of Virginia Emergency Operations Plan and the Recovery Plan. These activities ensure that Emergency Support Function (ESF) – 8, as well as other VDEM partners are best prepared to respond in emergency and non-emergency large- scale incidents.

● Virginia Hospital Alerting & Status System (VHASS)

Sam Burnette and Karen Owens have been participating in monthly virtual training on the Virginia Hospital and Healthcare Association’s (VHHA) Virginia Hospital Alerting and

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Status System hosted by the Central Virginia Healthcare Coalition (CVHC). This recurring event provides refresher training and update information on the system that provides hospital bed availability information to incident commanders to transport patients to the appropriate medical facility during large-scale events or mass casualty incidents.

Training

● Geographic Information System (GIS) Training

Members of the Division of Emergency Operations attended GIS training on August 24, 2020. The training provided an opportunity to explore the features of ArcGIS and research methods for use of GIS in EMS response.

● Rescue Task Force for Incident Commanders

On September 9, 2020, Karen Owens and Sam Burnette participated in a webinar hosted by the International Public Safety Association (IPSA) entitled “Rescue Task Force for Incident Commanders”. The webinar presented a panel of trainers that designed and implemented 10 weeks of integrated, live scenario training on the Rescue Task Force (RTF) tactic to police, fire, EMS, and 911 dispatchers, specifically to the commanders and supervisors.

 US Secret Service – Mass Attacks in Public Spaces Report

Caron Nazario and Sam Burnette participated in a webinar hosted by the United State Secret Service National Threat Assessment Center (NTAC) on September 15, 2020. NTAC presented the findings from the Mass Attacks in Public Spaces – 2019 (MAPS-2019). NTAC researchers studied the tactics, backgrounds, and pre-attack behaviors of the attack perpetrators to identify and affirm recommended best practices in threat assessment and prevention.

 FEMA Continuity Program Managers Course

Sam Burnette participated in a virtual delivery of the FEMA Continuity Program Managers Course offered on September 22-25, 2020. The course provides information to help Continuity Program Managers to understand their roles and responsibilities and provides resources to help develop viable continuity of operations plans. By completing this course, Sam has completed the requirements of the FEMA Continuity Excellence Series – Level I Professional Continuity Practitioner program.

Caron Nazario participated in the Emergency Management Institute (EMI) Continuity of Operation (COOP) Planning Course held September 21- 25, 2020. This course thoroughly covered components of Continuity of Operations development and planning. This course illustrated how continuity planning is relevant and crucial to all localities, agencies, and organizations (regardless of size). This course provided knowledge, skills, and tools necessary

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to develop and implement continuity plans according to established Homeland Security continuity requirements and guidance.

● Mass Casualty Incident Management Train the Trainer

On September 29 and 30, Sam Burnette delivered two instructor training programs in Loudoun County for the OEMS Mass Casualty Incident Management I and II courses. Loudoun County is requiring all operational personnel; both volunteer and career, to complete these courses by 2022. Providing these train-the-trainer courses will allow Loudoun County to meet the challenge of delivering these classes to their approximately 800 volunteers and 700 career personnel.

● Mass Casualty Incident Management Training Course

On October 27, 2020, Sam Burnette assisted with a Mass Casualty Incident Management I and II course held at Fort Lee. Fort Lee Fire and Emergency Services hosted this training, which was attended by their own staff and members from surrounding jurisdictions to include Prince George, Hopewell, and Dinwiddie. Over 50 EMS providers were trained with many participants representing multiple agencies in area through their volunteer and/or part-time employment.

● Analysis of Mass Casualty Incident Management Course Deliveries

Sam Burnette conducted an analysis on the number of MCIM courses delivered and submitted to the Division of Emergency Operations for certificates of completion across the Commonwealth of Virginia since June 1, 2019. Based on courses submitted for certificates, there were 20 MCIM I courses delivered to 297 students; 4 MCIM II courses with 37 students; and 42 MCIM I and II courses with 630 students. These statistics only include courses, which are submitted to the Division of Emergency Operations for course certificates. The intention of this study was to help OEMS focus training resources on the areas of the state needing additional MCIM training.

Communications/Emergency Medical Dispatch

● Regional Virginia Department of Emergency Management (VDEM) Teleconferences

Rich Troshak continues to participate in multiple regional 911 Center/Public Safety Answering Point (PSAP) teleconferences hosted by VDEM 911/GIS Services Bureau. Rich continues to coordinate with the 911/PSAP community on the pending updates to telephone cardiopulmonary resuscitation (CPR) and emergency medical dispatch (EMD) requirements passed by the 2020 General Assembly as well as the OEMS EMD Accreditation program.

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● National Emergency Communications Program (NECP)

Throughout this quarter, Sam Burnette and/or Rich Troshak attended monthly virtual meetings held by FEMA’s National Emergency Communications Program (NECP). Presentation titles included “Lifecycle Planning for Emergency Communications”, “Exercise! Exercise! Exercise! How to turn evaluations into real world communications improvements” and “Funding Your Emergency Communications Capabilities”. Understanding this information helps OEMS understand the needs and challenges encountered by emergency communications centers across the Commonwealth.

● FirstNet Virginia Update

FirstNet hosted a virtual update specifically for updating the rollout of FirstNet in Virginia. Sam Burnette and Rich Troshak attended the event on August 18, 2020. Tom Crabbs, the then Virginia Statewide Interoperability Coordinator (SWIC), provided an overview of how FirstNet is being used in the Virginia. AT&T provided an update on the FirstNet network being deployed across the Commonwealth. Participation in these types of events, help OEMS locate and evaluate opportunities for improving EMS communications in Virginia.

● L3Harris Mission Critical Alliance Roundtable

On August 18, 2020, Sam Burnette participated in an L3Harris hosted virtual roundtable discussion with fifteen of L3Harris’ strategic partners to discuss future collaborative efforts involving L3Harris equipment. A few of the participating companies included Tait, Cradlepoint, and FirstNet. OEMS utilizing equipment and services from these vendors. The event provided information on how these products will continue to be integrated along with L3Harris radio systems. Presently, OEMS has a cache of L3Harris / Tait radio equipment in its communications equipment cache.

● State of 911 Webinar

Sam Burnette and Rich Troshak attended a 911.gov hosted webinar on September 8, 2020. This event, part of an ongoing series, was entitled “NG911 Interstate Playbooks: Case Studies in Collaboration, Coordination, and Joint Purchasing”. A portion of the presentation included discussion on the Metropolitan Washington Council of Government’s NG911 project, which includes localities in Northern Virginia. Information from this webinar can be utilized to provide guidance to 911/Public Safety Answering Points on potential funding resources for increasing or enhancing their emergency communications infrastructure.

● VDEM 911/GIS Bureau Updates

Rich Troshak and Sam Burnette attended a VDEM hosted virtual event on September 19, 2020. Some of the information included the 911/GIS Bureau organizational structure, the FY22 PSAP Grant Program, Statewide NG911 deployment projects, as well as the Virginia Base Mapping Program (VBMP) orthoimagery program.

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Sam Burnette attended a follow-up webinar entitled “VBMP Orthoimagery – Flight Year 2021 and Beyond” on October 26, 2020. This VDEM hosted webinar provided detailed information on the next iteration of the Virginia Base Mapping Program, which will include three years of the vendor – Surdex- planning flights over the Commonwealth of Virginia to collect photography and other electronic data for mapping the entire state. This information will be useful in a variety of non-emergency and emergency applications by state and local agencies.

 Opioid Response with Poison Control Centers and Public Safety Answering Points (PSAP)

During this quarter Karen Owens brought together representatives from various public safety agencies, poison control centers, and the Office of the Secretary of Health and Human Services to discuss the roles of Poison Control Centers and PSAPs in acute and non-acute opioid emergencies. The task force, which was developed in response to a letter from the Joint Commission on Health Care, focuses on actions that may improve the capability of the above resources to respond to acute and non-acute opioid events.

Emergency Operations Planning

 National Preparedness Month Activities

Caron Nazario participated in National Preparedness Month awareness activities, which included distribution of preparedness materials to OEM staff members. National Preparedness Month is recognized to promote family and community planning throughout the year.

October is also Earthquake Preparedness Month. Caron shared materials on earthquake awareness and preparedness activities to include recommending participation in the International ShakeOut Day/Drill held on October 15, 2020. The purpose of the ShakeOut is to help people and organizations be better prepared for major earthquakes and to practice how to protect themselves when they do happen.

 Central Virginia Emergency Management Alliance (CVEMA) Monthly Meeting

Sam Burnette and/or Caron Nazario attended the CVEMA Monthly meetings via a virtual platform throughout the quarter. Discussions include training and mitigation grants for the region as well as training program delivery in the COVID environment. The meetings are attended by emergency management officials from local and state government organizations.

 Project ECHO (Extension for Community Health Outcomes)

Sam Burnette has routinely participated in weekly Project ECHO - EMS Response to COVID 19 webinars hosted by the University of New Mexico. Each week presenters from various EMS agencies from across the United States share valuable lessons learned information from their COVID 19 response. These webinars began to include response to

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civil unrest as events began occurring throughout the nation.

 Complex Coordinated Terrorist Attack (CCTA) Workgroup

On September 17, 2020, and October 30, 2020, Sam Burnette participated on a Virginia Department of Emergency Management (VDEM) hosted workgroup responsible for the creation/updating of a complex coordinated terrorist attack annex for the Commonwealth of Virginia Emergency Operations Plan (COVEOP).

 Central Virginia Emergency Management Alliance (CVEMA)

Caron Nazario participated in the Fiscal Year 2021 Hazard Mitigation Plan review on October 7, 2020. This plan review focused on hazard mitigation for the Richmond and Tri-Cities regions. It entailed updating organizational charts and decision-making matrices, funding mechanisms and opportunities and key process steps.

 Mass Casualty Incident Committee – Old Dominion EMS Alliance

On October 23, 2020, Sam Burnette participated in a virtual meeting of the Old Dominion EMS Alliance (ODEMSA) Mass Casualty Incident (MCI) Committee. The purpose of the committee is the establishment of mass casualty incident guidelines, oversight, and emergency planning for EMS agencies and providers within the region.

Health and Safety

 SafeHaven and Medical Society of Virginia (MSV)

Karen Owens and Vince Valeriano joined Director Gary Brown on a conference call with the Medical Society of Virginia (MSV). The conference call provided the MSV members an opportunity to share information on the SafeHaven program. The program is an opportunity for licensed medical professionals to seek mental health assistance without the normal stigma associated with such an action in the workplace. The program allows for individuals and their families to receive mental health assistance through a variety of options.

 First Responders Against Human Trafficking Website In an ongoing effort to raise awareness and combat human trafficking, Vincent Valeriano completed the redesign of OEMS’s anti-human trafficking webpage (https://www.vdh. virginia.gov/emergency-medical-services/fraht/). The new layout aims to centralize relevant resources that equip providers to better identify and help victims of human trafficking.

 Public Safety Exposure Workgroup

As a part of the 20202 General Assembly legislation, the Office of EMS is tasked with

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developing processes associated with prevention of and response to public safety exposures to decedent blood. During this quarter, the workgroup met to discuss the education and training opportunities, the process for blood collection, and other resources available to all of public safety on this topic.

 Department of Human Resources Management Safety Training

Caron Nazario participated in the DHRM- Safety Responsibilities of Managers and Supervisors on September 10, 2020. This course gave participants strategies and techniques to ensure their safety programs are constantly improving. It also reviewed best practices for personnel in management or supervisory positions on how they can help the lead the safety effort in their agency or at their facility. This course emphasized that successful safety systems have management’s support that not only comes in the form of financial funding but more importantly, by taking an active role in the safety program.

Caron also participated in the DHRM- “Office Safety: It’s a Jungle in There!” on October 15, 2020. This course was developed as the result of surveys conducted to identify hazards throughout COV state offices. This course was designed to give Commonwealth of Virginia employees strategies and solutions to create a safe office work environment. This course illustrated the cost of safety and mitigation efforts versus the cost and impacts of dealing with work related injuries.

 Health and Safety Infographics During this quarter, Vincent Valeriano released three new infographics surrounding provider health and safety that were shared on the OEMS webpage and social media:

o August – Fuel Like A Hero o https://www.vdh.virginia.gov/content/uploads/sites/23/2020/08/Nutrition- Infographic.pdf

o September – #BeThe1To Save a Life: National Suicide Prevention Awareness Month o https://www.vdh.virginia.gov/content/uploads/sites/23/2020/09/Suicid-Prevention- Awareness-Month.pdf

o October – Violence is Never Okay o https://www.vdh.virginia.gov/content/uploads/sites/23/2020/09/September-2020- Violence-is-Never-Okay-.pdf

 Health and Safety Webinars Vincent Valeriano attended multiple webinars focused on provider health and safety. They include: o Survive, Thrive and Matter in 2020: The ResponderStrong Tool

This year has been one massive stress test. More than ever, providers face novel challenges in their lives as responders and as humans. This webinar discussed the ResponderStrong tool (https://you.responderstrong.org/), a free responder wellness tool

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designed to support LEO, EMS, Fire, Dispatch, and ER Staff, along with their families, in surviving and thriving no matter what life throws at them.

o International Public Safety Association: Surviving the Service, First Responder Health Risks

Public safety service comes with specific and unique occupational health risks that are much different from most professions. This presentation by Chief Todd LeDuc, Editor of “Surviving the Fire Service,” examined the unique health risks that first responders face and what they can do to manage those risks to have long and healthy careers and enjoy a successful retirement. The presentation focused on case experiences of first responder health issues and the role of prevention and early detection.

o NHTSA Office of EMS: Living Well and Leveraging Adversity and Stress Over the Long Haul

Due to the challenges of everyday EMS work and the added difficulties of extraordinary events, adversity and stress are unavoidable aspects of serving as EMS clinicians. This webinar discussed ways to cultivate resilience, recognize and manage stress, and turn adversity into an opportunity for personal growth. Leaders, veterans, and resilience experts Mike Washington and Dr. John Becknell discussed self- awareness, self-care, and specific actions, practices, and wisdom for living well.

 The State of EMS Provider Mental Health

Vincent Valeriano presented the 2019 Virginia EMS Provider Mental Health Survey results to the Virginia Department of Health’s Injury and Violence Prevention Collaborative Network and the Suicide Prevention Inter-Agency Group. The presentation discussed background issues surrounding EMS provider mental health, the Make the Call campaign, the survey results, and what OEMS is doing to address this issue.

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Division of Public Information and Education

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VI. Division of Public Information and Education

Public Relations

Beginning in January 2020, Public Relations staff, along with VDH/OEMS staff began assisting with COVID-19 pandemic response efforts. Due to these emergency response efforts, the marketing and promotion of regularly scheduled events was postponed or cancelled in order to focus on the Governor’s emergency declaration for this pandemic. This emergency response effort is ongoing. Public Outreach via Marketing Mediums Via Virginia EMS Blog The OEMS continues to share important updates and information via the Virginia EMS Blog. This blog replaces the EMS Bulletin, which was an online newsletter that went out twice a year. This blog allows OEMS shares information in a more timely, concise and in a web-friendly format. It also offers more interactive features so readers can comment or ask questions through the blog. Via Social Media Outlets We continue to keep OEMS’ Twitter and Facebook pages active, educational and relevant by posting daily and/or weekly updates that provide important announcements and health-related topics to increase awareness and promote the mission of OEMS and VDH. Some of the subjects that were featured from July - September are as follows:

 July – Holiday office closures, NHTSA Park.Look.Lock, Keep the Fire Burning July health and safety bulletin, EMS Virtual Learning Center, VA C.O.P.E.S. warmline and HHS and FEMA best practices for the preservation of personal protective equipment.

 August – Isaias storm preparedness, COVIDWISE app, Rescue Squad Assistance Fund E- GIFT fall application cycle, Rescue Squad Assistance Fund, Fuel Like A Hero August health and safety bulletin, EMS Strong Virtual 5K hosted by the Southwest Virginia EMS Council, Fall 2020 Cycle of Nasal Naloxone for EMS Agencies, EMS databases emergency system update, Richmond EMT is an American Girl doll, Bruce Edwards obituary and self-dispatch during emergencies guidance.

 September – National Preparedness Month, holiday office closures, RSAF online grant application system down/application deadline extension, National Suicide Prevention Awareness Month, September 11 memorial, September health and safety bulletin on preventing and responding to workplace violence and Virginia Office of Health Equity’s primary care needs assessment survey.

Via GovDelivery Email Listserv (July - September)

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 9/2/20 National Innovative Practices in EMS Post Overdose Response Survey

Customer Service Feedback Form (Ongoing)

 PR Assistant provides monthly reports to EMS management regarding OEMS Customer Service Feedback Form.

 PR Assistant also provides biweekly attention notices (when necessary) to OEMS Director and Assistant Director concerning responses that may require immediate attention. Social Media and Website Statistics

As of November 10, 2020, the OEMS Facebook page had 8,200 likes, which is an increase of 109 new likes since August 3, 2020. As of November 10, 2020, the OEMS Twitter page had 5284 followers, which is a decrease of 7 followers since August 3, 2020.

Figure 1: This graph shows the total organic reach* of users who saw content from the OEMS Facebook page, July - September. Each point represents the total reach of organic users in the 7- day period ending with that day. Our most popular Facebook post was posted on August 22, 2020. This post garnered 6,868 people reached and 769 engagements (including post likes, reactions, comments, shares and post clicks.)

*Total Reach activity is the number of people who had any content from our Facebook Page or about our Facebook Page enter their screen. Organic reach is the number of unique people who saw our post in the newsfeed or on our page, including people who saw it from a story shared by a friend when they liked it, commented on it, shared our post, answered a question or responded to an event. Also includes page mentions and check-ins. Viral reach is counted as part of organic reach. Organic reach is not paid for advertising.

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Figure 2: This graph shows the total organic impressions* over a 91-day period on the OEMS Twitter page, July - September. During this 91 day period, you earned 250 impressions per day. The most popular tweet received 1,949 organic impressions. *Impressions are defined as the number of times a user saw a tweet on Twitter. Organic impressions refer to impressions that are not promoted through paid advertising.

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Figure 3: This table represents the top five most downloaded items on the OEMS website from July – September.

July 1. RSAF Award List (128) 2. Authorized Durable DNR Form and Instructions (120) 3. Virginia EMS Scholarship Program Quick Guide (87) 4. EMT Performance (74) 5. Creating an Account for CentreLearn for EMSAT (54) August 1. Virginia EMS Scholarship Program Quick Guide (163) 2. Authorized Durable DNR Form and Instructions (108) 3. EMT Performance (98) 4. Creating an Account for CentreLearn for EMSAT (85) 5. Transport Vehicle Checklist (81) September 1. Authorized Durable DNR Form and Instructions (96) 2. EMT Performance (84) 3. TR-06 – Course Roster (84) 4. TR-01 – Course Approval Request Form (74) 5. Creating an Account for CentreLearn for EMSAT (70)

Figure 4: This table identifies the total number of unique pageviews, the average time on the homepage and the average bounce rate for the OEMS website from July - September 2020.

Unique Average Time on Page Bounce Rate Pageviews (minutes: seconds) (Average for view)

July 7,083 00:36 26%

August 8,019 00:32 25.22%

September 8,764 00:40 23.15%

Google Analytics Terms:

A unique pageview aggregates pageviews that are generated by the same user during the same session. A unique pageview represents the number of sessions during which that page was viewed one or more times.

The average time on page is a type of visitor report that provides data on the average amount of time that visitors spend on a webpage. This analytic pertains to the OEMS homepage.

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A bounce rate is the percentage/number of visitors or single page web sessions. It is the number of visits in which a person leaves the website from the landing page without browsing any further. This data gives better insight into how visitors are interacting with a website.

If the success of a site depends on users viewing more than one page, then a high bounce rate is undesirable. For example, if your homepage is the gateway to the rest of your site (e.g., news articles, additional information, etc.) and a high percentage of users are viewing only your home page, then a high bounce rate is undesirable.

The OEMS website is setup in this way; our homepage is a gateway to the rest of our information, so ideally users should spend a short amount of time on the homepage before bouncing to other OEMS webpages for additional information. Generally speaking, a bounce rate in the range of 26 to 40 percent is excellent and anything under 60 percent is good.

Governor’s EMS Awards Program

 PR Assistant attended the virtual Traffic Incident Management (TIM) Awards selection committee meeting on August 17, 2020 at 10 a.m. She also assisted with the TIM awards grading process.  PR Assistant prepared the Governor’s EMS Award Nomination digital packet for the Governor’s EMS Awards Nomination Committee members for review and grading  PR Assistant organized the Governor’s EMS Awards Nomination Committee meeting, held virtually on September 18, 2020 at 10 a.m.  PR Assistant placed order for the Governor’s EMS Award pyramids.  PR Coordinator prepared the Decision Memo for awards certificates to be printed by the Governor’s Office.  PR Coordinator prepared the Decision Memo for recognition video/virtual awards ceremony.

OEMS Communications

The PR Coordinator and PR Assistant are responsible for the following internal and external communications at OEMS:

 On a daily basis, the PR Assistant monitors and provides assistance to the emails received through the EMS Tech Assist account and forwards messages to their respective divisions.  The PR Assistant is the CommonHealth Coordinator at OEMS, and as such, she sends out weekly CommonHealth Wellnotes to the OEMS staff and coordinates events within the office.  The PR Coordinator designs certificates of recognition and resolutions for designated EMS personnel on behalf of the Office of EMS and State EMS Advisory Board.

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 Upon request, the PR Coordinator creates certificates for free Symposium registrations to be used at designated events.  Upon request, the PR Coordinator and PR Assistant provide assistance for the preparation of responses to constituent requests.  The PR Coordinator and PR Assistant respond to community requests by sending out letters, additional information, EMS items, etc.  The PR Coordinator and PR Assistant provide reviews and edits of internal/external documents as requested.  The PR Coordinator and PR Assistant update OEMS website with content and documents upon request from office Division Directors and Program Managers.  The PR Coordinator is responsible for monitoring social media activity and requests received from the public. She forwards questions to respective OEMS division managers and provides responses to the inquiries through social media. The PR Assistant provides back-up to all social media for OEMS and VDH.  The PR Coordinator is responsible for coordinating and submitting weekly OEMS reports to be used in the report to the Secretary of Health and Human Resources. The PR Assistant provides back-up assistance.  The PR Coordinator assists with FOIA requests as needed.  When applicable, the PR Assistant submits new OEMS hire bios and pictures to be included on the New Employees webpage on the VDH intranet.

VDH Communications Office

VDH Communications Tasks – The PR Coordinator and PR Assistant are responsible for covering the following VDH Communications Office tasks from July - September:

 July – September – The PR Coordinator is responsible for working with the Communications Office to assist with coverage for media alerts, VDH in the News, weekly Commissioner’s message, media assistance, team editor, VDH social media, Shutterstock agency-wide image requests and other duties upon request.

o In response to the COVID-19 pandemic, the PR Coordinator was temporarily reassigned to the role of Assistant Director for the Office of Communications. This role will last March-March 2020. As such, in this role she is responsible for approving time off requests, monthly financial approvals (sign-off on employee leave/pay forms), assisting with the Joint Information Center (JIC) duties and weekend/afterhours JIC coverage, leading VDH Communications/JIC team meetings, creating daily VDH communications report, media response, writing/sending/posting press releases, coordinating press conferences, attending

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leadership meetings, assisting with VDH COVID-19 website updates and social media posts, assisting as lead PIO on VDH ICS Vaccine Unit workgroup, submitting RAPs, assisting marketing contractors with access to VDH social media advertising sites, etc.

. In response to the COVID-19 pandemic, the PR Assistant has been helping with the following tasks: Logging media inquiries into the VDH Media Alert Generator, monitoring the VDH web feedback submissions, assisted the VDH testing team with sending notices out to local physicians regarding area COVID-19 test sites and replying to general inquiries, assisting with posting and sharing OEMS COVID-19 information and updates.

o The PR Assistant is responsible for sending VDH media alerts, updating the VDH New Employees photos for the VDH intranet, replying to website feedback via the VDH website, coordinating and sending the Commissioner’s clinician letters. The following Clinician Letters were sent from July - September: . Face Coverings and Precautions During COVID-19 – September 18 . COVID-19 Update for Virginia – September 14 . COVID-19 Long-Term Care Update for Virginia – September 9 . COVID-19 Update for Virginia – August 7 . Acute Flaccid Myelitis – August 4 . COVID-19 Update for Virginia – July 13

o The PR Assistant also serves as secondary backup for VDH social media, listserv emails and assisting with website feedback.

 VDH Communications Conference Calls (Ongoing) - The PR Coordinator and PR Assistant participate in bi-weekly conference calls and polycoms for the VDH Communications team.

o PR Coordinator and PR Assistant participate in monthly Agencywide Communications Workgroup. The PR Assistant serves on the Policies and Procedures Workgroup sub-committee and the PR Coordinator serves on the Social Media sub-committee.

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Regulation and Compliance Division

While a declared state of emergency does provide for the commonsense relaxation of regulatory enforcement; it does not indicate a complete abandonment of the ideal of regulatory compliance.

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VII. Regulation and Compliance

The Division of Regulation and Compliance Enforcement performs the following tasks:

 Licensure & Permitting

o EMS Agencies and vehicles

 Regulatory Compliance enforcement of:

o EMS Agencies

o EMS Vehicles

o EMS Personnel

o EMS Physicians

o RSAF Grant Verification

o Regional EMS Councils

o Virginia EMS Education

o Complaint\Compliance Investigations

o Drug Diversion Investigations

o LCR Database Portal Management

 EMS Physician (Operational Medical Director) Endorsements

 Background Investigation Unit

o Determine eligibility for EMS certification and/or affiliation in Virginia

 EMS Regulation Variance/Exemption application determinations

 EMS Psychomotor Examination Accommodation Request determinations

 Creation and/or Revision of EMS Regulation(s)

o Utilizing the Virginia Division of Legislative Services, Regulatory Town Hall, and Department of Planning and Budget as required

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 Provide Virginia General Assembly legislative session representation for the Office of EMS

o Provide written and verbal consultation regarding proposed legislation being debated or considered, that involves or impacts the delivery of EMS in the Commonwealth of Virginia

 Virginia EMS Regulation & Compliance Enforcement Educational Resource

o Educational programs provided on request and during most EMS conferences throughout the Commonwealth of Virginia

 Provide support to all Committees of and for the State EMS Advisory Board

 Provide EMS regulatory and compliance consultation services for EMS agencies and localities within the Commonwealth of Virginia

 Represent the Virginia Office of EMS, Regulation & Compliance Enforcement Division on national boards and/or committees

The following is a summary of the Division’s activities for the third quarter, 2020:

EMS Agency/Provider Compliance

2020 2020 2020 2020

1st 2nd 3rd 4th 2020 2019 2018 Enforcement Quarter Quarter Quarter Quarter Totals Totals Totals

Citations 9 8 3 20 33 14 EMS Agency 2 2 2 6 13 9 EMS Provider 7 6 1 14 20 5

Verbal Warning 1 1 2 4 8 10 EMS Agency 0 0 0 0 4 8 EMS Provider 1 1 2 4 4 2

Correction Order 1 0 3 4 5 5 EMS Agency 0 0 0 0 1 4

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EMS Provider 1 0 3 4 4 1

Suspension 4 6 9 19 24 40 EMS Agency 0 0 0 0 0 0 EMS Provider 4 6 9 19 24 40 Revocation 0 0 0 0 2 0 EMS Agency 0 0 0 0 0 0 EMS Provider 0 0 0 0 2 0 Compliance Cases Investigations 89 203 160 Opened 26 37 26 Investigations 95 * 91 Closed 31 46 18

Drug Diversions 1 3 1 5 6 12

Variances 18 17 14 49 110 54 Approved 9 10 4 23 56 33 Denied 9 7 9 25 54 20

Note: Not all investigations reveal regulatory non-compliance or result in enforcement action(s). Therefore, the number of enforcement actions will not equal the total number of compliance cases. Complaints could be unfounded or resolved utilizing guided compliance.

Quarterly IFFC = Informal Fact Finding Conferences appeal hearing update

Currently the Regulation & Compliance Enforcement Division has 9 IFFC hearings pending. Seven (7) of the nine (9) pending hearings are scheduled for November 10th & 12th, 2020 to be held at the Office of EMS in Glen Allen, VA.

There were no Administrative Processes Act - Informal Fact Finding Conferences (hearings) this quarter due to Covid-19 restrictions and lack of an available Administrative Law Judge.

Both Cam Crittenden, R.N., and Ron Passmore, NRP, have completed classes at the National Judicial College to obtain non-attorney, Administrative Law Judge (hearing officer) credentials and will begin hearing IFFC’s for the Office of EMS. Ms. Crittenden will be the sole hearing officer for all Regulation & Compliance Enforcement Division cases.

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Quarterly EMS Agency & Vehicle Licensure Activity Licensure 2020 2020 2020 2020 2019 2018 Total Total 1st 2nd 3rd 4th Quarter Quarter Quarter Quarter

Total Agencies 584 578 578 587 607 New Agency 5 0 2 7 6 New Vehicles 90 62 17 239 4,243* Inspections 657 141 1017 2819 3,729* Agencies 43 0 95 330 288 Inspected Vehicles 532 135 904 2153 3,097 Inspected Unscheduled 82 6 18 336 389 “Spot” Inspections *Note: Statistical data unavailable or incomplete at the time of this report. Data will be included as it becomes available.

Background Investigation Unit

The Office of EMS began conducting criminal history background checks utilizing the FBI fingerprinting process through the Central Criminal Record Exchange (CCRE) of the Virginia State Police on July 1, 2014. A dedicated section with relevant information about this process is on the OEMS web site at: http://www.vdh.virginia.gov/emergency-medical-services/regulations- compliance/criminal-history-record/ .

Background 2020 2020 2020 2020 2020 2019 Total 2018 Total Checks 1st 2nd 3rd 4th Total Quarter Quarter Quarter Quarter Processed 1,602 728 1977 4,307 7,613 7,318 Eligible 1,558 706 1954 4,218 6,973 6,578

Non-Eligible 15 17 11 43 47 48

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Review 29 103 12 144 Not Not Criminal Available Available history Outstanding 9 0 0 Not Not Not Waiting for Cumulative Cumulative Cumulative results Rejected 20 5 12 37 391 Not Fingerprint Available cards Jurisdiction 424 346 227 997 2,432 1,344 Ordinance

EMS Physician Endorsement

Operational 2020 2020 2020 2020 2020 2019 2018 Medical 1st 2nd 3rd 4th Total Total Total Directors Quarter Quarter Quarter Quarter Year End # of OMD’s Endorsed 221 225 211 220 * New OMD’s 5 3 6 14 >3 * Re-Endorsed 5 0 6 11 41 * (5yr) Conditional 3 0 6 9 23 * (1yr) Expired 1 0 0 1 19 * Endorsement

The 2020 OMD workshops schedule resumed on October 30, 2020 and was the first virtually held workshop. Please visit the Virginia Office of EMS website, Regulation & Compliance Enforcement, EMS Medical Director sub-tab for the posted schedule for the remainder of 2020.

The remaining 2 workshops for 2020 will be held virtually on November 13th & December 11th. Register by clicking the link under EMS Medical Director Course Info on the EMS Medical Director subtab under the Regulation & Compliance Enforcement Division section, of the OEMS website.

Dr. Lindbeck is updating the on-line OMD training program that is utilized as a pre-requisite for physician interested in becoming an endorsed EMS Physician in Virginia.

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One Portal login for all OMD roles is finally here! All EMS Physician OEMS processes are paperless and in real time online now! Apply for initial and re-endorsement, approve EMS courses, variances, agency affiliations, symposium submissions, and print your own state card via your online OEMS portal account.

Tutorial videos are available on the EMS Medical Directors subtab under Regulation & Compliance Enforcement Division section of the OEMS website.

Regulatory Process Update

OEMS Regulation & Compliance Division continue to work with key EMS stakeholder groups to review suggested revisions to all sections of the current EMS Regulations (Chapter 31).

 Stage 1 - A Notice of Intended Regulatory Action (NOIRA) posted in the Virginia Register of Regulations (Vol. 33 Issue 19) on May 15, 2017. The deadline for public comment was June 14, 2017. No public comments were submitted. OEMS Staff is working to complete the required documentation for the next step for the “Proposed” EMS Regulations.

 The approved first draft of “Proposed” EMS Regulations (Chapter 32) has been manually entered into the RIS as project 5100

 The required Town Hall (TH-02) form is complete which details all changes in regulatory language from Chapter 31 to 32 by comparison. This form was submitted to the Regulatory Town Hall on January 25, 2019.

 The decision was made to hold this draft (Chapter 32) and include regulatory language of what will be required for agencies to become licensed as a Mobile Integrated Healthcare-Community Paramedicine and/or Critical Care Transport agency. Chapter 32 language must also be consistent and compliant with REPLICA language.

 Stage 2 - Submission of the completed TH-02 document on January 25, 2019 for project 5100 (Chapter 32) will be presented to the VDH – Board of Health once final edits are complete; to initiate the Executive Branch Review process which requires the Office of Attorney General, Department of Planning and Budget including an Economic Impact Analysis, Cabinet Secretary, and Governor of Virginia to review; then posted for a 60 day public comment period on the Virginia Regulatory Town Hall.

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 Following the 60 day comment period, all comments will be considered (adopted) and final regulatory language will be revised

 Stage 3 – Submission of the completed (TH-03) document for project 5100 as the final regulatory package via the Town Hall to again receive a repeat Executive Branch review and final public comment period before adoption into law.

Additional Regulation & Compliance Enforcement Division Work Activity

 The Regulation and Compliance Enforcement Division bi-monthly staff meeting(s) resumed on August 12th through 14th in South Hill VA and October 14th through 16th at the Office of EMS. Social distancing and masks were required during these meetings.

 Division staff were released to resume field operations on August 1st 2020 with required social distancing, face masks, and hand hygiene.

o Division mission is to complete all EMS agency & vehicle inspections that were due in 2020 by December 31, 2020. This will return all agencies to their routine bi-annual inspection schedule . This will require the Field Investigators to complete 10 months’ worth of agency & vehicle inspections within a 5-month period. o Field Investigators are also actively conducting 65 compliance investigations and have 77 pending new vehicle temporary permits to inspect.

 Division Field Investigators have assisted the OEMS Grants Manager and the RSAF program by performing reviews of submitted grant requests. Field Investigators currently have 130 RSAF grant awards to inspect for purchase compliance verification.

 2020 Agency Data Compliance Initiative Launched on January 1, 2020

o Per 12VAC5-31-560-C All licensed EMS agencies are required to submit Patient Care Records with the required minimum data set on a schedule established by the Office of EMS as authorized in §32.1-116.1 of the Code of Virginia. o Field Investigators continue to work with their agencies regarding data compliance during this quarter, in support of Trauma & Critical Care Divisions data compliance mission.

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o The most current compliance report as well as contact information for resources to assist each EMS agency in becoming compliant are provided on the OEMS website under Regulation & Compliance Enforcement tab, then click the Data Compliance Report sub-tab.

 Regulation & Compliance Enforcement Division website updates:

 New Sub-Tab EMS Medical Directors – all OMD information has been relocated on the Office of EMS website to the Regulation & Compliance Enforcement Division section under its own EMS Medical Directors sub-tab.

o EMS Physician Portal User Guide Tutorial video is available

o On-line EMS Medical Director Initial Course is also being updated

o Application process for OMD Endorsement or Re-Endorsement is now online (paperless)!

o OMD Workshops (required for continuing endorsement) are currently being held virtually on November 13th & December 11th 2020.

. Register for one of these workshops by visiting the EMS Medical Director subtab on the OEMS website under the Regulation & Compliance Enforcement Division section.

o Many other links, documents, course information, and related links are available for OMD’s on this page

o Relaxation of EMS Regulations during declared State of Emergency (SOE).

. While a declared SOE does provide for the commonsense relaxation of regulatory enforcement; it does not indicate a complete abandonment of the ideal of regulatory compliance.

. Covid-19 related requests for EMS Agency regulatory variances are being tracked by the Regulation & Compliance Division.

 All agencies that requested and were granted Covid-19 variances have concluded their requested period of variance and have returned to standard regulatory compliance.

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Regulation and Compliance Enforcement Division Structure Profile

Ronald D. Passmore, NRP

Division Director, Regulation and Compliance Enforcement Phone: (804) 888-9131 Fax: (804) 371-3108

Oversees the Division of Regulation and Compliance Enforcement, focus is on the following broad areas:

 EMS Physician initial and re-endorsement  EMS agency initial and re-licensure  EMS vehicles permitting and renewal  EMS regulations development and enforcement  Variances and Exemptions processing for provider, agencies and entities  OEMS policy advisor to Executive Management  Provide technical assistance & guidance to all committees of and the state EMS Advisory Board  OEMS Staff Liaison to the Rules and Regulations Committee  Manages Operations Education Track for Virginia EMS Symposium  Technical assistance to local governments, EMS agencies and providers  Background investigations on EMS certified personnel and EMS students  Regulatory enforcement, complaint processing  National issues involving licensure and regulations

Marybeth Mizell Senior Administrative Assistant, Physician Endorsement & Background Investigation Unit Phone: (804) 888-9130 Fax: (804) 371-3108

Provides direct administrative support to the Division Manager while managing all Virginia endorsed EMS physicians, to include all applications for OMD endorsement and re-endorsement, and provides technical support assistance to field team administrative assistants.

Update and maintain listing of all Virginia endorsed EMS Physicians Provides staff support to the Rules and Regulations and Transportation committees

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Kathryn “Katie” Hodges Shirley Peoples Administrative Assistant, Administrative Assistant, Background Investigations Regulation & Compliance Team Support Phone: (804) 888-9133 Phone: (804) 888-9125 Fax: (804) 371-3409 Fax: (804) 371-3409

Provides support to field team and coordinates background investigation activities to include:

 Receiving and processing results of all fingerprint based background investigations  Notification to agencies regarding member eligibility status per background investigations  Assist Field Investigators (Program Representatives) with all administrative tasks  Assist customers by navigating requests to the appropriate resource for resolution

OEMS Program Representatives (Field Investigators)

Provides field support to EMS agencies, local government, facilities and interested parties in the development of EMS to include the following:

 EMS agency initial and renewal licensure by inspections  EMS vehicle initial and renewal permits and spot inspections  EMS regulation development and compliance enforcement  EMS complaint investigations  Verify awarded EMS grants to eligible recipients from RSAF program  Liaison and OEMS representative at various local and regional meetings with organizations to include but not limited to local governments (county, city, town), regional EMS Councils, VDEM, VDFP, OCME, federal/state and local law enforcement agencies, etc…  Subject matter experts on the delivery of EMS within the Commonwealth  Facilitator for matters related to OEMS through the various Office of EMS programs

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Sr. Supervisor, Jimmy Burch, NRP ([email protected]) – Virginia - East Wayne Berry, NRP ([email protected]) – Coastal Steve McNeer, EMT-I ([email protected]) – Central Doug Layton, EMT-P ([email protected]) – Shenandoah

Supervisor, Paul Fleenor, NRP ([email protected]) – Virginia - West Ron Kendrick, EMT-I ([email protected]) – Appalachia Scotty Williams, EMT-P ([email protected]) – Highlands Len Mascaro, NRP ([email protected]) – Northern Virginia

The Regulation and Compliance Team of professionals provide the Commonwealth of Virginia with more than 153 years of combined experience specific to EMS regulations and compliance enforcement; in addition, this team of twelve has more than 322 years of combined experience with the delivery of Emergency Medical Services as clinical providers and EMS administrators.

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Division of Trauma and Critical Care

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VIII. Division of Trauma and Critical Care

● Patient Care Informatics

A major focus of Division leadership has been the creation and posting of the Request for Proposal for a statewide EMS EPCR, state data repository, and trauma registry system. We were able to incorporate lessons learned from the last contract period to be very specific in our needs for today, and to allow for strategic growth over the contract period. As we have previously shared with the Advisory Board and our EMS Agencies, OEMS/VDH does not “own” any parts of the EMS patient medical record- that ownership remains with the individual EMS agency. The COV makes it clear that OEMS only has ownership of the data elements specified in the data dictionary.

To move the EMS medical record “closer” to our agencies and to continue our ongoing collaboration with our Regional Councils, the Western EMS Council will be the contract holder for the next award and OEMS will manage the system operations (just as we do now). A copy of the RFP for Board review is attached as an Appendix E.

We had a Pre-Proposal Conference on Friday, November 6, 2020, and had close to 50 attendees. The conference generated close to 70 additional questions from the interested parties. To say we are excited to see what these vendors have to offer Virginia would be an understatement!!

In this quarter, the Informatics team addressed over 500 general support tickets, emails, and phone calls. The ongoing zip code cleanup project is about 75% complete. We continue monitoring the data import and export processes to ensure information is received and distributed properly. The monitoring of the reporting database continues as well. While the reporting system works properly the majority of the time, this monitoring did discover an issue in August. The problem was identified within two hours of its occurrence. Once identified, the vendor (ImageTrend) was notified and corrective actions were taken. As a result of our monitoring processes, the reporting database was back to normal within an hour of vendor notification and no adverse effects were reported.

In regards to support, the majority of reported issues during the quarter were related to general user account issues such as locked accounts or forgotten credentials. In an attempt to mitigate these types of issues, the informatics team is reviewing these in- depth to develop additional educational resources. Our goal will be to provide users

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with a better understanding of user account functionality so they can avoid any interruption of access. We are also going to work with individual EMS agencies to ensure they have enough administrator-level access to address locked account issues locally.

● Virginia Elite Updates

o OIM and VITA are working together to move our data that is currently housed in the CESC to another environment that will utilize a cloud infrastructure. There may be intermittent system unavailability but those instances will be communicated to EMS and our Hospitals with as much advance notice as possible. We are hoping that once the move is completed our end users will notice an improvement in system performance.

The Informatics team participated in this move by developing multiple test plans and time evaluation spreadsheets as well as facilitating all external communication. By working together, the servers were swapped using a staggered process, which ensured no downtime occurred. The test plans were used before and after the move to ensure the system functioned properly. Time measurements were taken before and after to see if any performance improvement was found. All information was given to VITA for evaluation.

o Based on feedback from the epidemiology team and a software issue introduced by a 3rd party vendor, we have added additional monitoring processes. We now run daily checks looking for issues with how the Primary Role of the Unit is documented and to ensure the use of destination code 102, designated to identify Out of state hospitals – not listed, is used correctly. When questionable issues are found, those are communicated to the primary contact at the agency with a request they review the issue and make any needed updates. We are evaluating available options to see what additional functionality can be added to reduce these issues.

o We continue to receive monthly updates to the Virginia Elite system. The updates this quarter were all related to software fixes, so no new functionality was added.

● EMS Data Submission and Data Quality

o Overall data quality improved to approximately 98% during this quarter. The improvement is directly related to the new “Checker” program, which is described in

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the next section. The number of agencies missing a portion of the required demographics data is approximately 200. During the next quarter, the Informatics team is going to start reviewing all demographic data items to provide agencies with a comprehensive list of items missing items.

o One of the major changes related to data quality improvement was the implementation of a “Checker” program by ImageTrend. The purpose of this program is to scan all records exported by agencies using an ImageTrend system, block the submission of non-compliant (data that is not aligned with Virginia’s minimum dataset requirements), and notify the sending agency of the issue so they can proactively take corrective action. Once this program was implemented, the number of non-compliant values submitted steadily dropped from a high of around 14,000 at the beginning of the quarter down to just over 2,000 by the end of the quarter. We are reviewing these remaining items to see what additional changes can be adopted to reduce this even more.

o OEMS has established a scoring system that reflects whether an agency is submitting/recording information correctly. Based on this score, called “Incident Validity Score,” the agencies are classified as I) Excellent, II) Good, or III) Poor. The staff works monthly with EMS agencies and the Regulation and Compliance Division to improve the quality of the data submitted to the Elite system.

o The latest Data Quality Report and Data Submission Compliance Reports are on the Knowledgebase: Knowledgebase - Data Submission Report

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Table 1: Number of Virginia EMS Agencies Classified by Average Incident Validity Score, July 2020 – September 2020

Validity Score Scale July August September Excellent (98-100) 454 455 454 Good (95-97.99) 53 46 36 Poor (< 95) 41 37 39 Failed to Submit 45 55 66

Validity Score Scale July Augu Septem st ber

Excellent (98-100) 454 455 454

Good (95-97.99) 53 46 36

Poor (< 95) 41 37 39

Failed to Submit 45 55 66

● Virginia Trauma Registry

o During this quarter, additional work was done on updating and removing obsolete validation rules based on NTDB standards in the Virginia State Trauma Registry (VSTR) system. The Administrative Procedure document was completed and copies were sent to all of the registry contacts we have on file for both hospitals and trauma centers.

o The submission issues that had been affecting the timeliness of trauma center submissions were corrected by facility vendors and ImageTrend this quarter. Now that trauma centers can properly submit records, we will be able to produce accurate Trauma Center quality reports at the end of each quarter beginning at the end of the 3rd quarter.

o One of our team members (Barry Reeves) participated in the Association of Virginia Trauma Registry (AVaTR) meeting. During the meeting, they created a

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rough draft of the Trauma registry resource manual. They also went over any updates/announcements throughout Virginia.

● Biospatial Implementation

o In this quarter, the Informatics team distributed emails to VDH EPI and all EMS agencies informing them about the Biospatial platform. The number of agencies that responded and expressed interest was less than 15% of the total agencies contacted. We are in the process of “enhancing” our messaging about Biospatial functionality and will be sending out additional emails.

o For those agencies that did respond, multiple training webinars were provided by Biospatial personnel highlighting the various ways Biospatial can be used. Additional training assistance was provided by Informatics team members. User accounts, once approved, were setup when requested.

o Our team continues to monitor the daily export of EMS data to Biospatial, ensuring information is provided promptly. Soon, trauma centers will be able to take advantage of the benefits Biospatial has to offer.

o The use of the various dashboards has greatly improved how we monitor performance measures for agencies throughout the state. Now, the COVID-19 dashboard is a great tool we use daily to monitor our current climate. It helps us get a handle on areas where COVID-19 numbers increased substantially over other areas. Below is the COVID-19 Dashboard for Q3 2020. Multiple views and layers can be customized in this interactive program

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● EMS Epidemiology o Team Updates:

We are happy to share that our Epidemiology team is back to full strength. The OEMS Epidemiology Program Manager, Jessica Rosner, wrapped up her 8-month COVID-19 response assignment on October 15, 2020. While serving as the VDH COVID-19 Community Mitigation Team Co-Lead, Jessica was involved in a variety of projects. Specifically, Jessica worked with the Governor’s Office on the development of Virginia phase guidance and executive orders, served as a VDH subject matter expert for collaborations with the Department of Labor and Industry (DOLI) on the Virginia Emergency Temporary Standard, and acted as a member of the VDH DOLI steering committee. She also assisted with maintaining VDH COVID-19 business website materials, responded to constituent emails and FOIA requests, and partnered with business representatives and other internal and external partners to develop and maintain COVID-19 community mitigation guidance documents and reopening plans.

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o Meeting Attendance and Training Participation:

The OEMS Epidemiology Program Manager participated in an Injury and Violence Prevention Collaborative Network meeting on September 9, 2020. During the meeting, the OEMS Emergency Operations Epidemiologist presented data from the 2019 Virginia EMS mental health survey.

The OEMS Epidemiology Program Manager attended training sessions on both Biospatial and performance management systems in July 2020.

In November 2020, the Division of Trauma and Critical Care provided EMS council regions with training on the Virginia Pre-Hospital Information Bridge (VPHIB). Representatives from various EMS council regions attended the training. The training session was recorded and was provided to synchronous participants and to those who were unable to attend the live session. The main training topics included:

● Introduction to the VPHIB reporting system

● Finding information in the Knowledgebase

● Validation rules while reporting an incident

● Data quality reporting

● Creating and running reports in Report Writer

● Creating custom data elements in Report Writer

● Saving, sharing, and exporting reports from Report Writer

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● EMS Calls Summary:

Virginia EMS agencies received/responded to 394,389 transport calls in the third quarter of 2020 (reported as of 10/15/2020). Summaries of the calls by incident disposition, sex, age, and EMS council regions are tabulated below (Tables 1-4).

Table 1: EMS Calls by Incident Disposition, Third Quarter 2020, Virginia

Incident Disposition EMS Calls Patient Treated, Transported by this EMS Unit 262,993 Canceled 45,547 Assist 27,574 Patient Refused Evaluation/Care (Without Transport) 21,055 Patient Treated, Released (AMA) 13,365 Standby 6,106 Patient Evaluated, No Treatment/Transport Required 5,504 Patient Treated, Transferred Care to Another Unit 4,836 Patient Dead at Scene 3,879 Patient Treated, Released (per protocol) 1,569 Patient Refused Evaluation/Care (With Transport) 998 Patient Treated, Transported by Law Enforcement 561 Patient Treated, Transported by Private Vehicle 261 Transport Non-Patient, Organ, etc. 131 Blank 10 Total 394,389

Table 2: EMS Calls by Patient Sex, Third Quarter 2020, Virginia

Patient Sex EMS Calls Female 166,827 Male 152,592 Not Recorded 13,131 Not Applicable 7,087 Blank 2,720 Unknown (Unable to Determine) 248 Total* 342,605 *Note: Total does not include canceled EMS calls, standbys, or transport of non- patients, organs, etc.

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Table 3: EMS Calls by Patient Age Group, Third Quarter 2020, Virginia

Patient Age Group (Years) EMS Calls Under 15 9,824 15 – 29 32,409 30 – 44 38,493 45 – 59 57,484 60 – 74 88,505 75 and Above 92,761 Blank 23,129 Total* 342,605 *Note: Total does not include canceled EMS calls, standbys, or transports of non- patients, organs, etc.

Table 4: EMS Calls by EMS Council Region, Third Quarter 2020, Virginia

EMS Council Region EMS Calls Blue Ridge 13,439 Central Shenandoah 15,121 Lord Fairfax 11,207 Northern 70,098 Old Dominion 80,995 Out of State/Other 402 Peninsulas 37,523 Rappahannock 19,017 Southwest 28,225 Thomas Jefferson 12,285 Tidewater 62,794 Western 43,283 Total 394,389

● Opioid Usage and Naloxone Administration: Virginia EMS providers administer Naloxone (Narcan) to patients with opioid overdoses. A total of 3,830 Naloxone administrations for 2,733 incident overdose cases were reported from July - September 2020. Of the Naloxone doses administered, an improved response was documented for 2,047 of the doses; the 2,047 doses were provided for 1,673 incident overdose cases. Comparing the number of incident

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overdose cases (N=2,733) and the incidents with improved responses (n=1,482), 54.2% of the overdose cases had a positive response to Naloxone administration documented.

Figure 1: Naloxone Administrations by Patient Sex, Third Quarter 2020, Virginia

Figure 2: Naloxone Administrations by Patient Age Group, Third Quarter 2020, Virginia

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Table 5: Naloxone Administrations by EMS Council Region, Third Quarter 2020, Virginia

EMS Council Region Naloxone Administrations Blue Ridge 78 Central Shenandoah 65 Lord Fairfax 191 Northern 541 Old Dominion 1,043 Out of State/Other 4 Peninsulas 378 Rappahannock 247 Southwest 129 Thomas Jefferson 62 Tidewater 716 Western 376 Total 3,830

● Causes of Injury

o Trauma Incidents:

Of the total EMS calls (394,389) reported in the third quarter of 2020, 22,732 calls were trauma-related (5.8% of the EMS call volume).

Table 6: Injury Types by Abbreviated Injury Scale Body Region, Third Quarter 2020, Virginia

Injury Types Counts of Incidents Injury – Lower Extremities 5,228 Injury – Unspecified 4,793 Injury – Head 4,181 Injury – Upper Extremities 3,576 Injury – Face 1,598 Injury – Spine 1,355 Injury – Neck 867 Injury – Thorax 595 Injury – Abdomen 495 Multiple Injuries 44

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Table 7: Top Ten Hospital Destinations for Injury Calls, Third Quarter 2020, Virginia

Destination Hospital For Trauma Incidents Counts of Incidents Fairfax Hospital 1,214 Roanoke Memorial Hospital 931 VCU Health Systems 923 Norfolk General Hospital 817 Riverside Regional Medical Center 719 Chippenham Hospital 707 UVA Health System 658 Virginia Beach General Hospital 635 Northern Virginia Medical Center 590 Mary Washington Hospital 534

Table 8: Causes of Injury, Third Quarter 2020, Virginia

Causes of Injury Counts of Incidents Falls, slips/trips 8,231 Unspecified 7,375 MVC-related 4,297 Blunt force trauma 934 Sharp object-related 583 Non-motorized transport 366 Firearm 335 Machine-related 152 Animal-related 139 Burn, smoke inhalation, electrocution, explosion 96 Self-harm 86 Recreational 62 Abuse 28 Overexertion/strain 10 Asphyxiation 9 Toxic chemical-related 9 Environmental/weather-related 6 Human bite 6 Aircraft 4 Drowning 4

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● Ad Hoc Reports:

OEMS completed a total of 12 data and/or data analysis requests in the third quarter of 2020. Two specific requests are discussed below.

● Report on the administration of controlled substances within the Blue Ridge EMS Council Region:

o A report on the administration of Ketamine, Fentanyl, Morphine, Versed, Succinylcholine, Rocuronium, and Etomidate between January and September of 2020 was requested. The report highlighted the number of times these medications were administered and the percent change by month for the Blue Ridge EMS Council Region.

Table 9. Number of Controlled Substance Medication Administrations and Percent Change from Prior Month, Blue Ridge EMS Council Region, January – September 2020

Month Medication Administrations Percent Change January 253 0 % February 276 9.1 % March 265 -4.0 % April 148 -44.2 % May 189 27.7 % June 257 36.0 % July 247 -3.9 % August 196 -20.6 % September 140 -28.6 % ● Report on pediatric EMS calls in Old Dominion EMS Council Region:

o Information on pediatric EMS calls was requested for the Old Dominion EMS Council Region. The date range included was January 1, 2019, to July 31, 2020.

● A total of 14,291 pediatric calls occurred in 2019, equating to an average of 39.2 calls per day.

● A total of 6,302 pediatric calls occurred between January 1, 2020, and July 31, 2020, equating to an average of 29.6 calls per day.

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Table 10: Number and Percent of Pediatric Responses by Reported Level of Care, Old Dominion EMS Council Region, January 2019 – July 2020

Response Level of Care Number of Patients Percent of total ALS 15,985 77.6% BLS 4,133 20.1% Specialty Critical Care 475 2.3%

Trauma and Critical Care

● Trauma System Status

On March 12, 2020, Governor Ralph Northam declared a state of emergency in the Commonwealth of Virginia in response to the continued spread of the novel Coronavirus Disease known as COVID-19. The White House also declared COVID-19 a national emergency.

Under these emergency declarations, the ongoing COVID-19 pandemic and at the direction of State Health Commissioner Dr. M. Norman Oliver, MD, MA, the Virginia Office of Emergency Medical Services (OEMS) suspended all triennial trauma center verification visits scheduled to take place during 2020 (provisional trauma centers were excluded from the one-year extension.)

● A trauma site visit was conducted at Chippenham Hospital as they were operating under a provisional designation as a Level I center. One-year provisional visits are modified in nature; however, multiple efforts were made to ensure the safety of hospital staff and site review staff. There was no large opening conference and as the team had toured the facility a year ago, that was eliminated from the agenda as well. An unintended benefit was to allow the team a greater amount of uninterrupted time to spend on medical records and policy and process review. The team recommended to the State Health Commissioner that Chippenham receive full designation as a Level I trauma center and after reviewing the team report, the Health Commissioner agreed and conferred full designation.

● Division staff is working with the Office of Information Management (OIM) to create a trauma center portal (similar to the EMS portal) which will allow a secure electronic platform to upload trauma center designation application documents, and to store previous triennial visit application documents for quick review and reference. There will be a section that will house and maintain site reviewer documents (such as CV’s and W9’s) and a central site review scheduling document for the reviewers. The portal will include automatic notices to centers and will be tied directly to the current

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trauma designation criteria and the application checklist. We are still in the early phases, however, are hoping to pilot it with a center by the end of the first quarter of 2021.

● Trauma Fund

o The annual FY2020 Trauma Fund Report to the General Assembly has been posted to the OEMS website. As feared, and predicted, FY 2021 revenues have declined drastically as a result of the last General Assembly’s removal of driver's license suspension for non-driving-related offenses (2019 Budget Bill included Amendment No. 33 Item 3-6.03 – Adjustments and Modifications to Fees Driver’s License Reinstatement Fee. This amendment eliminates the driver’s license reinstatement fee transfer to the Trauma Fund and eliminates the loss of driving privileges for individuals who have only failed to pay fines, court costs, forfeitures, restitution, or penalties assessed against them).

If collections continue at the same rate as of today, the fund is predicted to contain approximately four million dollars at next year's payout. OEMS and Division leaders have met with the VHHA to share out concerns and to offer advice and guidance on alternate sources of revenue. The Trauma Fund is in jeopardy--this is a system issue and will be an ongoing topic of communication throughout the year.

o Highlights from the Report:

Table 1. Trauma Center Funding by Trauma Center FY2020

FY2020 Trauma Center Funding Amount

Level I Carillon Medical Center - Roanoke $780,583.85

INOVA Health Care Services (Inova Fairfax Hospital) $1,512,890.07

Sentara Norfolk General $1,597,641.60

University of Virginia $1,753,902.24

VCU Health Systems $3,528,387.46

Children’s Hospital of the King’s Daughters $246,914.04

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Chippenham Hospital (Provisional Level I Designation) **

Level II AHA Training Center c/o CENTRA Health Inc. (Lynchburg) $521,032.28

Mary Washington Hospital Inc. (Fredericksburg) $419,065.59

Riverside Regional Medical Center (Newport News) $1,267,905.17

Valley Health Systems (Winchester) $731,586.87

Henrico Doctors Hospital, Forest $421,714.08

Reston Hospital Center $840,174.77

Level III

Johnston Willis Hospital $225,726.16

Carillion New River Valley Medical Center $188,647.36

Lewis Gale Hospital Montgomery Inc. $182,026.15

Southside Regional Medical Center $301,207.99

Sentara Virginia Beach General $507,789.86

Inova Loudoun Hospital $195,268.58

TOTAL $15,222,464.12

Table 2. Utilization of Trauma Center Funds by Category for CY 2019

Total Funds Percentag Category Used e Support an administrative infrastructure $6,579,790 53.0% Support higher staffing levels $3,758,050 30.0% Support extensive trauma-related training of staff $704,234 6.0% Support injury prevention/community outreach $633,993 5.0% Support a trauma-specific comprehensive PI $351,278 3.0% program Support for trauma-related research $238,192 2.0% Support for outreach programs $108,649 0.08% Procure trauma-specific patient care equipment $50,217 0.04%

Totals $12,424,405 99.1%

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Table 3. Comparative Analysis of Trauma Center Fund Amounts per Center

Trauma Center FY17 FY18 FY19 FY20 Level I Carilion Medical Center - Roanoke $ 1,202,947.09 $ 1,267,100.73 $ 1,423,380.04 $780,583.85 INOVA Health Care Services $ 1,442,391.28 $ 1,237,360.38 $ 993,201.75 $1,512,890.07 (Inova Fairfax Hospital) $ $ 1,064,671.58 $ 1,132,932.81 $1,597,641.60 Sentara Norfolk General 928,548.22 University of Virginia $ 1,030,857.23 $ 1,107,951.59 $ 1,300,530.85 $1,753,902.24 VCU Health Systems $ 2,391,097.13 $ 2,317,908.77 $ 2,569,048.07 $3,528,387.46 Children’s Hospital of the King’s * * $ 176,604.37 $246,914.04 Daughters Level II AHA Training Center c/o CENTRA $ $ $ $521,032.28 Health Inc. (Lynchburg) 263,312.17 386,779.29 396,693.50 Mary Washington Hospital Inc. $ $ $ $419,065.59 (Fredericksburg) 412,861.90 389,418.12 400,624.67 Riverside Regional Medical Center $ $ $ $1,267,905.17 (Newport News) 557,190.24 525,023.86 755,476.62 $ $ $ $731,586.87 Valley Health Systems (Winchester) 307,020.57 445,401.39 571,345.47 Chippenham and Johnston Willis $ $ $ Hospitals (Chippenham Medical ** 229,772.19 491,186.59 461,732.25 Center) $ $ * $421,714.08 Henrico Doctors Hospital, Forest 233,336.52 425,368.89 $ $ * $840,174.77 Reston Hospital Center 172,667.50 351,485.00 Level III Chippenham and Johnston Willis $ $ $ $225,726.16 Hospitals (Johnston Willis Hospital) 106,063.38 168,511.45 177,007.41 Carilion New River Valley Medical $ $ $ $188,647.36 Center 111,833.52 174,758.07 140,469.67 $ $ $ $182,026.15 Montgomery Regional Hospital Inc. 111,559.14 172,367.66 130,816.11 Petersburg Hospital Company Inc. $ $ $ (Southside Regional Medical $301,207.99 127,506.01 200,900.07 189,958.10 Center) $ $ $ $507,789.86 Sentara VA Beach General 422,481.57 445,030.24 334,777.51 INOVA Health Care Services $ * * $195,268.58 (Inova Loudoun Hospital) 148,309.74

$ $ $ $15,222,464.12 TOTAL 9,781,565.00 10,664,250.48 12,079,762.80 Notes: *Not a Designated Trauma Center during that FY **No disbursement due to Provisional status Source: VDH OEMS

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● Division of Trauma and Critical Care Staffing

o The Trauma and Critical Care Program Manager Position is open for recruitment until 11/13/2020. To date, there are eight applicants with several of them meeting the minimum requirements of the role.

o We reported out in the second-quarter report that OEMS received preliminary approval to create a statewide performance improvement specialist position to work with our Epidemiologists, Regional Council partners, Trauma, and Stroke system stakeholders to design programs to improve health outcomes for our citizens. Unfortunately, it appears that we not be allocated an FTE for this role. We will continue to work with our VDH leadership in the hopes we will receive the FTE in the future.

● NASEMSO

o The Trauma Managers Council held their annual meeting virtually this year and by and large it was a success. There was great participation from those states’ that normally don’t allow their Trauma Managers to travel. It was no surprise that most of the conversations surrounded conducting operations during a global pandemic. Multiple states budgets have been impacted significantly and their Program Managers are uncertain if they will be able to continue their services.

● Trauma Triage

o The American College of Surgeons and NHTSA has announced that the 2011 Field Triage Guidelines are undergoing revision and they are seeking input on the current guidelines from all stakeholders at all levels and in all roles. They are specifically looking for insight into the perceived strengths and challenges of the current guidelines and they have developed an EMS Stakeholder Feedback Tool. They have sent out a request that leadership from key partner organizations use the tool to provide feedback and to forward the tool to their membership. The deadline to submit comments is January 15, 2021, and the survey should take approximately 15 minutes to complete. Please share the link with your stakeholders: EMS Stakeholder Feedback Tool

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● Virginia State Trauma Registry Data

o We are sharing the Trauma Registry Administrative Procedure document again so that you can share it with your constituents. The revised procedure will go into effect on January 1, 2021. We have been sending out quality and compliance reports and working with each facility to bring them to an acceptable standard. The reports are posted on the OEMS Knowledgebase Below are the reports for none and trauma designated hospitals. The non-designated hospitals are required to report data in the month following the patient’s discharge or transfer from their facility. The designated centers are required to report data 60 days after the last day of the previous quarter. Please See Appendix F

Virginia State Trauma Registry Administrative Procedure

Authority and Purpose

The Code of Virginia § 32.1-116.1(C) states “All licensed hospitals which render emergency medical services shall participate in the Virginia Statewide Trauma Registry by making available to the Commissioner or his designees abstracts of the records of all patients admitted to the institutions with diagnoses related to trauma. The abstracts shall be submitted in the format prescribed by the Department and shall include the minimum data set prescribed by the Board.”

Pursuant to the above named Code section, the Office of EMS has developed the following procedure for the administration of submissions to the Virginia Statewide Trauma Registry (VSTR).

This procedure is divided into two parts: Submission Compliance and Data Quality.

Part 1: Submission Compliance

Data from the patient medical record must be submitted to the VSTR on any patient who presented for initial treatment of an injury within 14 days of sustaining the injury and met one of the following criteria:

● Was admitted to a hospital for treatment of his/her injury;

OR ● Was transferred from a hospital or free-standing emergency department (FSED) for treatment of his/her injury;

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OR ● Who died at a hospital or FSED from his/her injury.

See Appendix A for the full inclusion/exclusion criteria.

Hospitals that are designated trauma centers and those that are not designated trauma centers report on different schedules.

Designated Trauma Centers

Submissions are made quarterly, with submissions due two months after the end of the quarter in which the patient was discharged:

Discharge Date Submission Deadline January, February, March May 31 April, May, June August 31 July, August, September November 30 October, November, December February 28

Non-Designated Hospitals

Submissions are made monthly, with submission due by the last day of the month following the patient’s discharge.

For Non-Trauma Center Hospitals

1. On the first business day after the end of a submission period, OEMS staff will generate a report of the total number of records submitted by each hospital for that submission period. If your facility did not have any records meeting the reporting criteria, your facility must contact the Office of EMS via email stating so. Hospitals without submissions will be deemed non- compliant. 2. OEMS staff will contact the data submission contact and the director for each non-compliant facility. Contact will be by e-mail with the ‘Request read receipt’ function activated.

● The data submission contact of the non-compliant hospital will be informed of the timeframe in which no data was submitted.

● The hospital will have 30 days from the date of contact to submit data that is up to 90 days in arrears.

● The hospital will have 60 days from the date of contact to submit data that is in arrears by 90 days or greater.

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3. If the data submission contact does not respond within one week, OEMS will contact the Chief Nursing Officer (CNO) of the facility. The CNO will be informed of the contact attempts made in #2 (above).

● The hospital will have 30 days from the date of contact to submit data that is up to 90 days in arrears.

● The hospital will have 60 days from the date of contact to submit data that is in arrears by 90 days or greater.

4. If the CNO does not respond within one week, OEMS will contact the Chief Executive Officer (CEO) of the facility. The CEO will be informed of the contact attempts made in #2 and #3 (above).

● The hospital will have 30 days from the date of contact to submit data that is up to 90 days in arrears. The hospital will have 60 days from the date of contact to submit data that is in arrears by 90 days or greater.

5. If the records are not submitted by the deadline established in #4 (above), the hospital will be listed on the OEMS website as “Non-Compliant with Code of Virginia § 32.1-116.1.”

● The non-compliance website posting will remain until the records in arrears are received, at which time the posting will be withdrawn.

For Trauma Centers

1. On the first business day after the end of a submission period, OEMS staff will generate a report of the total number of records submitted by each trauma center for that submission period. Trauma centers without submissions will be deemed non-compliant.

2. OEMS staff will contact the Trauma Registrar and the Trauma Program Manager (trauma program staff) for each non-compliant facility. Contact will be by e-mail with the ‘Request read receipt’ function activated.

● The trauma program staff of the non-compliant hospital will be informed of the timeframe in which no data was submitted.

● A deadline will be established to begin the submission of records in arrears.

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● The hospital will have 30 days from the date of contact to submit data that is in arrears.

3. If the trauma program staff does not respond within one week, OEMS will contact the Chief Nursing Officer (CNO) of the facility. The CNO will be informed of the contact attempts made in #2 (above).

● The hospital will have 30 days from the date of contact to submit data that is in arrears.

4. If the CNO does not respond within one week, OEMS will contact the Chief Executive Officer (CEO) of the facility. The CEO will be informed of the contact attempts made in #2 and #3 (above).

● The hospital will have 30 days from the date of contact to submit data that is in arrears.

5. If the records are not submitted by the deadline established in #4 (above):

● The Commissioner of Health will be informed of the Trauma Center’s lack of compliance with the Code of Virginia and the data submission requirements of the Virginia Trauma Center Designation Manual.

● The Commissioner, at his/her discretion, may alter or withdraw the hospital’s designation as a Trauma Center.

● The hospital will be listed on the OEMS website as “Non-Compliant with Code of Virginia § 32.1-116.1.”

● The non-compliance website posting will remain until the records in arrears are received, at which time the posting will be withdrawn.

Part 2: Data Quality

The purpose of the Virginia Statewide Trauma Registry is to provide a database of patients injured in Virginia and admitted to hospitals in Virginia or surrounding states. Trauma registries are an integral part of the operations of a trauma center. The quality of trauma registry data is of great importance to the overall success of trauma programs for performance improvement, research, injury prevention, resource utilization, and the creation of state standards and benchmarks.

A key element in the performance improvement process is having accurate data portraying trauma patient injury, severity, the process of care, outcome measures, type of trauma, and cause of injury. The trauma registry functions as the information resource driving this process. Thorough reporting, therefore, is critical.

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Data quality will be assessed by the following:

● VSTR will have validations placed to prevent logic errors at the time of data entry or submission. Examples of logic errors are records with patient discharge date preceding patient arrival date, or records of patients with negative ages.

o Records with logic errors will be rejected.

● The number of blank fields will be divided by the total number of data elements to obtain a percentage of missing data. This number will be subtracted from 100 to determine the percentage of complete data. Scoring will be placed in a Red-Yellow- Green (RYG) scorecard format with the following values:

▪ Green: 98 – 100%, Acceptable

▪ Yellow: 95 – 97.9%, Below Average

▪ Red: <95%, Poor

o The data submission contact person or the trauma registrar for each facility with red or yellow scores will be contacted by OEMS staff and will be informed of the poor or below average quality of their submission. A deadline will be established to begin the submission of updated records.

o The facility will have 30 days from the date of contact to correct the blank field errors and resubmit the data.

o The RYG scorecard will be posted to the OEMS website 15 days after the data quality assessment is performed.

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Sample Monthy VSTR Data Quality Report

Average Submissions Validity December January February March up to date? score OEMS 2019 2020 2020 2020 April 2020 May (last 12 last 6 Hospital Name ID Validation Validation Validation Validation Validation Validition months) months Gretna Medical Center 218 99.85 97.91 99.91 100.00 99.833333 97.38 Yes 99.15 Halifax Regional Hospital 21 94.83 99.20 97.94 98.40 100 100.00 Yes 98.40 Failed to Hanover Emergency Center 217 100.00 100.00 100.00 100.00 99.666667 submit No 99.93 Failed to Failed to Harbour View Health Center 201 97.17 91.20 100.00 74.25 submit submit No 90.65 Haymarket Medical Center ED 216 93.27 99.93 98.13 99.94 100 100.00 Yes 98.54 Henrico Doctors' Hospital - Parham 26 99.44 100.00 100.00 100.00 99.85 99.89 Yes 99.86 Independence Hospital 24 100.00 100.00 100.00 99.17 100 100.00 Yes 99.86 Inova Alexandria Hospital 1 98.57 95.21 97.34 95.09 97.7 100.00 Yes 97.32 Failed to Inova Emergency Room - Fairfax 202 100.00 100.00 98.33 100.00 100 submit No 99.67 Inova Emergency Room - Leesburg 203 99.08 97.29 98.21 100.00 100 100.00 Yes 99.10

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VIRGINIA EMS for CHILDREN (EMSC) PROGRAM

November EMS for Children Committee--CANCELLED

Due to safety reasons and circumstances surrounding the COVID-19 pandemic, the EMS for Children Committee of the EMS Advisory Board had to cancel their scheduled November 2020 meeting. As soon as the next meeting can be scheduled, all will promptly be notified of the time and place.

Annual Survey of Virginia EMS Agencies Begins in January

In partnership with the University of Utah, the National EMSC Data Analysis Resource Center is preparing a new EMS for Children Survey. This survey will launch to Virginia EMS agencies on January 6, 2021. The questions will focus on HRSA’s Performance Measure’s 2 and 3.

EMSC 02 recommends that EMS agencies and Emergency Departments appoint a pediatric emergency care coordinator to provide pediatric leadership for the organization. The goal is that 90% of EMS agencies in Virginia have a designated individual by 2026. EMSC 03 recommends that EMS providers are required to physically demonstrate the correct use of pediatric-specific equipment. The goal is that 90% of agencies will have such a process in place by 2026.

The OEMS epidemiologists are in the process of updating NEDARC’s Contact List Management System to reflect EMS Agency Leadership (as documented in the LCR Database) as the primary point of contact for the survey.

We will send out reminders before, and during, the survey period.

Volunteers Needed for EMSC Projects:

If you have passion and/or expertise concerning pediatric emergency care issues, the Virginia EMSC Program can use your assistance. Consider helping us with the following topics:

 Workgroup to develop recommended EMS agency protocols for restraining children during ambulance transport.

 Workgroup to support the development of EMS Agency Pediatric Champions.

 Workgroup to develop recommended evidence-based pediatric protocols.

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 Best practices in creating a recognition program for hospital emergency departments who have demonstrated a specific readiness level in caring for children (medical).

 Pediatric medication dosing safety.

 Templates for and examples of written hospital emergency transfer guidelines and agreements (that specifically refer to pediatric patients).

 Including children in hospital disaster plans and practices.

 Local family reunification strategies and resources.

EMSC Program-Funded Child Restraint Systems Are Still Available

A small number of “ACR-4” child restraint systems funded by the federal EMSC State Partnership Grant are still available for distribution to Virginia EMS agencies with need. Contact David Edwards at [email protected] or (800) 888-9144 to discuss this if your agency is not currently using a pediatric restraint system or device. Once current supplies are exhausted, agencies still in need will be kept on a waiting list to be prioritized for the next child restraints procurement.

Every child transported by ambulance in Virginia should be appropriately restrained. Agencies should adopt safety policies and procedures requiring the use of child restraints by their providers. A Virginia EMSC Program workgroup will develop a model set of recommended policies and procedures that can be offered to Virginia providers. If you have interest in serving on this group, please contact David Edwards at [email protected] or (800) 888- 9144.

(Funding for the child restraint systems was through the EMSC State Partnership Grant [H33MC07871] via the Health Resources & Services Administration [HRSA] and administered by the Maternal and Child Health Bureau [MCHB] Division of Child, Adolescent and Family Health.)

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STILL POSTPONED--National Pediatric Readiness Assessment (Hospital ED’s)

The National Pediatric Readiness (NPRP) Assessment originally set to begin in Summer of 2020 is still on hold due to the continuously evolving COVID-19 situation. We will provide more detail on the timing of the NPRP Assessment as details emerge--visit www.pedsready.org to stay up on assessment details.

Regional Pediatric Disaster Preparedness:

The Virginia EMSC Program continues as a partner in projects with several regional hospital coalitions in developing Pediatric Annexes to augment existing regional disaster and mass casualty plans. The groups focused on identifying and addressing gaps in preparedness related to the pediatric population.

PEPP and ENPC Course Funding Assistance

The Virginia EMSC Program continues to offer support for Pediatric Education for Prehospital Professionals (PEPP) and/or Emergency Nurses Pediatric Course (ENPC) courses in regions that have difficulty in accessing pediatric training. Please let us know if you are trying to set up a course(s) and need some form of support for instructors, fees, or materials in order to get these courses out there. We need to provide more of these courses in Virginia—ask us for help, please.

Suggestions/Questions

Please submit suggestions or questions related to the Virginia EMSC Program to David P. Edwards via email ([email protected]), or by calling 804-888-9144 (direct line). The EMS for Children (EMSC) Program is a part of the Division of Trauma and Critical Care, within the Virginia Office of Emergency Medical Services (OEMS).

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The Virginia EMSC Program receives significant funding for programmatic support through the EMSC State Partnership Grant (H33MC07871) awarded by the U.S. Department of Health and Human Services (HHS) via the Health Resources & Services Administration (HRSA), and administered by the Maternal and Child Health Bureau (MCHB) Division of Child, Adolescent and Family Health.

Respectfully Submitted

OEMS Staff

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Appendix

Central Shenandoah EMS (CSEMS) Regional Office

I. Regional Infrastructure A. Regional Office ■ The Central Shenandoah EMS Regional Office headquarters is located at 2312 W Beverley St., Staunton, VA. With approximately 5,600 square feet of operating space, the facility offers administrative offices for staff, an intern suite for VDH interns, 3 shared office space for visiting OEMS employees, two classrooms, and six breakout rooms for small group training and simulation. The office is open from 9:00 am - 5:00 pm Monday through Friday. The COVID-19 pandemic has impacted the staffing model, as employees have been permitted to telework more frequently. In the event regional activities and staffing does not permit open facilities, notices are provided via social media and email distribution lists. Under COVID-19 restrictions, all visitors and staff are screened prior to entering the facility, including temperature screening. The same process is used when the training center is open after hours. Routine cleaning and disinfecting of all high touch areas has been in place, using an electronic log that automatically notifies staff when cleaning is required. Visitor IDs are provided to all visitors upon signing in, assisting in limiting the total number of occupants in the building to 15. Additionally, signage has been placed strategically to remind occupants to frequently wash their hands, maintain social distancing, and wear face coverings. Currently, most meetings are being held virtually, while providing equipped conference rooms with limited capacity for people who need access to web conferencing technology. B. Continuity of Operations ■ Regional staff have been working with the Central Shenandoah Health District to revise continuity of operation plans, mutually. As a state office, the CSEMS facility will soon have access to the Commonwealth of Virginia Network, offering the capability for Virginia Department of Health (VDH) employees to access networks. This creates opportunities for shared continuity plans that take advantage of the common resources between facilities. Plans to test continuity plans were being planned for Spring 2020, but have been delayed due to the pandemic response for both organizations. The unforeseen nature of the pandemic has prompted additional revisions to incorporate telework capabilities. Office space,

conference rooms, and classrooms are now available in the VDH central scheduling calendar, and can be accessed and requested by VDH employees statewide. C. Staffing ■ As of September 30, 2020, the regional EMS office is staffed by one employee of the VDH, Daniel Linkins (Regional Director), and one Central Shenandoah EMS Council, Inc. (CSEMSC) employee, Laurie Cook. ● The CSEMSC Administrative Coordinator, Dawn Varner resigned in September, 2020. This position will not be replaced under the new hybrid model. ● The OEMS Technical Resource Specialist, Brandon Havens, resigned in September 2020. ■ Positions in the process of review for recruitment include temporary contract positions for performance improvement and technical resource assistance, and three full-time employees as follows: ● EM031 - Program Coordinator (Technical Resource Specialist) ● EM032 - Regional Health Emergency Coordinator (Performance Improvement Specialist) ● Not yet classified - Administrative Coordinator ■ CSEMSC employs part-time instructors for the American Heart Association Community Training Center, which funds the non-profit organization and provides community outreach to support improved health and emergency response. D. Organizational Information ■ The Central Shenandoah Regional Office is a hybrid model, intended to operate as a collaborative partnership between the Office of EMS and the Regional EMS Council. Managed by VDH-OEMS staff, the regional office serves as an access point for technical assistance, regional coordination and planning, and agency support. CSEMSC is overseen by a 15-member board of directors. Board meeting minutes available online at www.csems.org. E. Committee Meetings ■ CSEMSC coordinates regional planning through standing committees and workgroups. The COVID-19 pandemic has limited most meetings to virtual format, and some projects have been postponed until the staffing transition is complete. The committees below met during the first quarter of FY2021. ● Medical Control Review Committee 9/15/2020 ● Pharmacy Committee 7/15/2020 F. State Committee Responsibilities ■ Due to the COVID-19 Pandemic, state committee meetings have been canceled. However, the regional director has participated in bi-weekly virtual meetings with the Medical Direction Committee to discuss pandemic response and pressing issues that may impact Virginia’s EMS

system. OEMS division staff present a bi-weekly update for Regional Council Directors bi-weekly on Fridays (recordings posted on the OEMS website). A separate meeting is held bi-weekly on Wednesdays with Regional Council Directors to collaborate and unify processes across the state. II. Regional Medical Direction A. CSEMSC maintains a contract with Dr. Asher Brand, an experienced Emergency Medicine physician who began his career as an EMS provider. Dr. Brand is very active in the EMS system, and is available to providers, agency leaders, and regional staff 24 hours a day. He participates in regional and agency meetings, hosts provider briefings as needed, and assures that protocols and practices are current with the latest science. He chairs the Medical Control Review committee, and actively participates in regular workgroup meetings. Information on current workgroups is available at https://www.csems.org/agencies/performance- improvement/ B. Regional Protocols ■ Beginning in October, 2019, a regional protocol workgroup has worked tirelessly on a complete rewrite of the regional protocols. To make the document flexible for real-time updates, a new digital format will be utilized. The protocols were finalized in June 2020, and education is being developed for a rollout with implementation scheduled in late Fall 2020. Due to delays in onboarding staffing for the CSEMS office, the education has taken longer to develop than originally anticipated. Additionally, there is an expected delay with the release of the 2020 AHA guidelines, which will require revisions to the resuscitation protocols. C. Regional EMS Supplies Restocking Program ■ The regional pharmacy committee met on 7/15/2020, but did not make changes to the current restocking plan. D. Regional Medication Exchange Program ■ The regional pharmacy committee met on 7/15/2020, and approved changes to the medication list consistent with the new protocol revisions. Documents are available on the CSEMS website for review. A preview of an online reporting form was provided to the committee, which will simplify the reporting and tracking of incidents. The committee also discussed potential changes with the anticipated release of new DEA regulations. Note: A Notice of Proposed Rulemaking was subsequently filed on 10/2/2020. III. Regional Planning A. Regional EMS Plan ■ Development of the regional EMS plan is still in progress, pending onboarding of staff to coordinate the completion project. Components of the plan include MCI/WMD/Pandemic response, collaboration with local health districts, performance improvement, triage, and hospital diversion and surge planning, which are already in development.

B. Participation in agency planning ■ CSEMS regional staff attend meetings across the region in support of EMS operations. In these meetings, CSEMS is able to provide regular updates to agencies regarding state and regional initiatives. Staff is informed on local practices in order to improve coordination of regional resources. Staff attended the following meetings during the first quarter of FY2021. ● Northwest Region Healthcare Coalition (Brandon Havens) - 7/9/2020 ● Staunton-Augusta-Waynesboro LEPC virtual Meeting (Daniel Linkins) - 7/15 ● Fairfield Rescue Squad Award Banquet (Daniel Linkins & Brandon Havens) - 7/18/2020 ○ Daniel Linkins conducted the Officers’ Installation ● Sentara Rockingham Memorial Hospital EMS Task Force (Daniel Linkins) - 9/13/2020 ● Rockbridge Emergency Rescue Group meeting (Daniel Linkins) - 8/26/2020 IV. Regional Coordination A. Regional Information & Referral - ■ CSEMS maintains a website to provide information to the region’s more than 1,700 EMS providers and more than 50 instructors within the 57 licensed EMS agencies. Information is updated regularly at www.csems.org. The website is currently transitioning to the VDH-OEMS website using a phased approach to minimize service interruptions to the site. ■ Because nearly all regional, state, and national conferences are canceled, CSEMS looked for opportunities to provide access to vendor exhibit halls that were no longer available. Vendors were contacted and information posted on the CSEMS website inviting any vendor to demonstrate products at the CSEMS headquarters. Exhibit participants were screened prior to entry, and a maximum of 4 people were permitted at a time. This enabled vendors to demonstrate products in a manner that was safe and effective. Participants were required to schedule appointments in advance. Participating vendors included: ● Gaumard Scientific - 7/24/2020 ● CAE Healthcare - 8/28/2020 ● Z-Medica Quikclot - 8/28/2020 ● Nasiff - Cardiocard Virtual Demo - 9/10/2020 ● Laerdal Medical - 9/25/2020 B. Regional Performance Improvement Program ■ CSEMS is in the process of developing a comprehensive Continuous Quality Improvement program. The Medical Control Review Committee identified a key list of topics for review, and plans are being developed to address these needs. Recruitment is in progress for a Performance

Improvement Specialist, which will lead these projects. During this quarter, the Trauma Performance Improvement workgroup met on 8/11/2020 to discuss metrics for trauma triage. Key areas will include: ● Mistriage incidence and causes ● Temperature management of trauma patients ● Outcomes in the use of TXA in trauma patients ● Airway management C. Trauma Triage Planning ■ The 2020 Protocol revision reviewed and revised the Trauma Triage plan in accordance with best practices and available resources in the region. This plan will continue regular revisions as a part of the performance improvement plan. D. Rescue Squad Assistance Fund ■ During the Fall 2020 RSAF cycle, eleven agencies submitted grant applications, requesting a total of 33 items. ● 33 Cardiac Monitors were requested at a cost of $521,529.98, of which $328,342.93 was requested from RSAF funds. ● 7 Patient moving devices (stretchers, stair chairs, etc.) were requested at a total cost of $121,972.52, of which $91,959.51 was requested from RSAF funds. ● 3 Ambulances were requested at a total cost of $749,500.00, of which $599,600.00 were requested from RSAF funds. ● 7 Other items, including CAD devices, automated CPR devices, etc. were requested at a total of $60,813.00, of which $30,406.50 was requested from RSAF funds. ■ CSEMS staff assisted the REMS and BREMS offices in implementing an electronic tool for summarizing committee grades for RSAF virtual grading processes. This technology duplicates the portal grading process used by the Financial Aid Review Committee for use by regional committees. E. Critical Incident Stress Management Program ■ No CISM responses were requested during this quarter. A reorganizational meeting was scheduled for October 2020 to revise policies and discuss future goals of the team. F. Regional EMS Awards ■ The Regional Awards Selection Committee met on 7/23/2020 to review nominations. Due to the pandemic, the nomination period was extended to June 30, 2020, with submissions due to OEMS by July 31, 2020. Because COVID-19 precautions prevented the ability to safely conduct the traditional awards ceremony, CSEMS organized an “Award Patrol” to conduct multiple small ceremonies throughout the region. These ceremonies were a surprise to the award recipients, and were conducted via Facebook Live. A press release was distributed online celebrating this

year’s award winners. Winners of the regional award for each category will be nominated for the Governor’s EMS award, where applicable. G. Education ■ CSEMSC is an authorized training center for the American Heart Association (AHA) under the direction of Laurie Cook and, most recently, the National Association of EMTs (NAEMT) under the direction of Daniel Linkins. Class capacity has been reduced to provide more than six feet of physical distance between students. Students are provided their own manikins (1:1 ratio) for all classes, and masks are required during classes. Enhanced disinfecting and sanitation practices have been implemented in accordance with AHA and CDC guidelines. Courses have not yet begun for the NAEMT Training Center. AHA Training Center activity is listed below for the first quarter of FY21:

V. Special Projects A. Multiple projects have been underway at the CSEMS regional office: ■ Graphics with the new CSEMS Regional EMS Office logo were installed at key locations throughout the building and at the entrances, along with the organizational mission statement. ■ Much needed paint was applied throughout the facility. ■ The parking lot spaces were widened from approximately 8 feet to more than 9 feet, with wider spaces to accommodate emergency vehicles and improve accessibility. ■ Safety barriers were installed on the reception desk to provide safety for staff during screening and transactions with visitors. B. OEMS implemented Monday.com across the state and regional offices, as well as all Regional EMS Councils. This technology improves communications and

tracking of projects through cross-functional teams. CSEMS staff have assisted in the implementation and training of users across the state. C. On 8/12/2020, the CSEMSC Board of Directors signed an agreement as the fiscal agent to implement the BlackBoard Learning Management System for all Virginia EMS educators, through a contract modification with the Virginia Office of EMS. This program will enhance virtual education by adding consistency and efficiency. D. CSEMS continues to deliver Personal Protective Equipment to agencies that experience delays in delivery of supplies. EMS Agency Superusers received access to a password-protected request form. Software calculates a distribution allowance based on average call volume, staffing levels, and number of units operating at peak system times. Local Emergency Managers are automatically notified with each agency distribution, in order to improve coordination of PPE between OEMS and VDEM processes. At least 3 other Regional EMS Councils are utilizing this system, for which CSEMS continues to provide technology support. E. Regional Office Directors for CSEMS, BREMS, and REMS continue to meet regularly to develop a Best Practices document for transitioning a Regional Council to a Regional Hybrid Office of EMS. This is expected to be completed by December, 2020. F. Network designs are being finalized for the regional office, along with audio/visual enhancements to improve virtual meeting coordination, educational programs, and workflow management.

Appendix

B .

Blue Ridge EMS (BREMS) Regional Office

I. Participation in Local, Regional and State EMS Activities BREMS/OEMS Staff participate in local/regional activities in support of agency operations as a regional system. Our regular monthly and quarterly meetings have been conference calls. BREMS coordinates efforts with the Centra hospital system to continue emergency management conference calls. Regional Medical Director, Dr. Wendy Wilcoxson, provided information updates for EMS. The bi-weekly, monthly, and quarterly calls help to identify goals and objectives necessary to meet regiona l needs. The BREMS region encompasses a committed and engaged group of EMS Leadership, EMS providers, EMS agencies, and physician medical directors. The following activities were attended by BREMS leadership: A. Local and Regional virtual conference calls during the 1st quarter FY 20: Regiona l EMS Council Director’s Group Weekly conference calls during the quarter: • 7/1/2020-MDC Bi-weekly Call • 7/1/2020- Regiona l Director’s Group (RDG) Call • 7/6/2020- Regional Offices and Regulation/Compliance Discussion • 7/6/2020- BREMS positions conference call • 7/7/2020- BREMS Staff Meeting • 7/8/2020- RDG call • 7/13/2020- Technical Resource Support by Regional Offices Discussion • 7/15/2020- MDC Bi-Weekly COVID-19 Conference Call • 7/15/2020- RDG Call • 7/22/2020- RDG Call • 7/22/2020- VHAC State Meeting • 7/22/2020- COVID-19 Healthcare Coordinator’s Meeting • 7/24/2020- OEMS Quarterly Report Due • 7/24/2020- Went to Richmond State Office • 7/27/2020- Regional OEMS Director Information Sharing • 7/28/2020- EMX32 Position Recruitment Interview • 7/29/2020- Meet with BOD Treasurer • 7/29/2020- RDG Call • 7/29/2020- MDC Bi-Weekly COVID-19 Conference Call

. • 7/30/2020- Meet with BOD Treasurer • 8/3/2020- Regional OEMS Director Information Sharing • 8/5/2020- Google Meet with Dr. Jaberi • 8/6/2020- VHAC Meeting • 8/10/2020- Regional OEMS Director Information Sharing • 8/11/2020- G Suite Discussion • 8/12/2020- MDC Bi-Weekly COVID-19 Conference Call • 8/12/2020- RDG Call • 8/12/2020- Goals completed for Cornerstone • 8/13/2020- Meet with BOD Treasurer • 8/17/2020- Regional OEMS Director Information Sharing • 8/19/2020- Virginia Biospatia l Training • 8/19/2020- BREMS Staff Meeting • 8/24/2020- Regional OEMS Director Information Sharing • 8/25/2020- STEMI and Chest Pain Regional Discussion • 8/26/2020- MDC Bi-Weekly COVID-19 Conference Call • 8/26/2020- Director’s Call • 8/26/2020- COVID-19 Healthcare Coordinator Call • 8/28/2020- Regional Medical Directors Meeting • 8/31/2020- Meet with BOD Treasurer • 9/2/2020- BREMS Staff Meeting • 9/4/2020- MK travel to Charlottesville to meet OEMS • 9/7/2020- Regional OEMS Director Information Sharing • 9/9/2020- MDC BI-Weekly COVID-19 Conference Call • 9/9/2020- RDG Director’s Call • 9/14/2020- Regional OEMS Director Information Sharing • 9/16/2020- BREMS Staff Meeting • 9/16/2020- VHAC Steering Committee Call • 9/17/2020- BREMS BOD Meeting • 9/21/2020- Regional OEMS Director Informatio n Sharing • 9/23/2020- RDG Call • 9/23/2020- MDC BI-Weekly COVID-19 Conference Call • 9/24/2020- Staff meeting • 9/28/2020- Regional OEMS Director Information Sharing

Hospital System (Centra) and BREMS conference calls during the quarter: ● 7/2/2020- Chest Pain Council Meeting ● 7/8/2020- VHAC Steering Committee Call ● 7/13/2020- VOAD Conference Call Meeting ● 8/5/2020- A-Fib Committee Meeting

. ● 9/1/2020- EMS Stroke Education Meeting ● 9/3/2020- Chest Pain Council Meeting B. State Virtual conference calls during the 1st quarter: Divis io n Directors Meeting conference calls ● July 2nd, 9th, 16th, 23rd, 30th ● August 6th ,13th, 20th, 27th ● September 3rd, 10th, 17th, 24th OEMS & Regiona l EMS Council Update conference calls ● July 3rd, 10th, 17th, 24th, ● August 7th, 14th, 21st, 28th ● September 4th, 18th II. Consolidated Testing Services A. Due to COVID-19, all CTS practical exams were canceled for July, August, and September of 2020.

III. Regional EMS Council Meetings, Operations and State Regional Office Transition Progress A. To fulfill regional responsibilities of the BREMS Council, the following meetings were conducted in the 1st quarter of FY20: September 17th- BREMS Board of Director’s Meeting October 13th- BREMS Board of Director’s Grant Review (first in person meeting). Multiple meetings between BREMS staff and Regional Medical Director on protocol review for CQI benchmarks and the Advanced Paramedic Program. These meetings included communication on COVID-19 regional protocols and policies. CQI Plan to be updated and approved by the Regional CQI meeting October 13, 2020. B. BREMS/OEMS State Regional Office Transition Update The Department of General Services (DGS) Division of Real Estate Services (DRES) has forwarded the request for proposals (RFP) to their real estate broker (Divaris) to secure a new location for the BREMS office. Work continues on the development, advertisement and recruitment for a Performance Improvement Specialist position in the BREMS office. Reclassification of the position into the correct working classification. The EWP has been approved by the BREMS Board of Directors. OEMS and BREMS staff have been working collaboratively on the following: ● Vehicles and their maintenance.

. ● Worked together to fill the Regional Medical Director position- filled on August 17th, 2020 by Dr. Wendy Wilcoxson. ● New Employee Training for the Regional Medical Director. ● Equipment distribution for the Regional Medical Director (laptop, and cell phone). ● RFP status of the BREMS office. ● Status of BREMS Performance Improvement Specialist position Ann Wilson, Administrative Assistant, staffs the front desk. She continues to manage all equipment check outs, financial records for the BREMS Council, payroll, and is the primary point of contact for office supplies, Council equipment inventory, equipment rental scheduling, Council purchasing, and vendor relations. She takes care of the daily office logistics for BREMS. Jenn Kersey, BREMS Field Coordinator communicates, in conjunction with the Program Director, with EMS agencies, hospital administration, EMS regional leadership, EMS providers, and other regional stakeholders. The Field Coordinator updates the website information, manages customer relations, and CTS testing. The Performance Improvement Program (CQI- Continuous Quality Improvement) is the largest portion of the Field Coordinator’s job. She works with the Regional OMDs and the CQI Committee on protocol development, PI policies, and benchmarks. Sean Regan, Part Time Training Coordinator for BREMS, works with the Advanced Paramedic Program (APP), Handtevy Program, Regional Heartcode Recertification Program, and all educational trainings offered in the BREMS region. Mary Kathryn Allen, Program Director, manages office operations, coordinates with OEMS leadership, handles interactions with other regional EMS councils, coordinates all regional drug box developments/issues, and provides program support for all committee meetings. Mary Kathryn also works directly with EMS regional leadership, hospital leadership, and other regional stakeholders. C. Professional Development Mary Kathryn began working on mandatory VDH new employee orientation training this quarter. IV. Education & Projects A. BREMS coordinates regional education training and serve as a resource for other EMS Programs and Educators in the region. This quarter presented some challenges because of COVID-19 for education in the BREMS region.

. All APP candidates are currently completing a 40-hour internship with our current APP providers. We have worked on an APP CQI program and will begin this process in December 2020. B. Under the direction of Dr. Wendy Wilcoxson, BREMS is working on the following education/training projects; Ultrasound- currently working on protocols for the implementation of POCUS in cardiac arrest patients and lung trauma patients. Handtevy- the app and handbooks are complete. All EMS agencies have been contacted to set up teaching dates. Meeting with Peter O'Brien and Christian Butcher to consider how to broaden the ECMO program to the counties; currently successful in Lynchburg. BREMS has reached out to the local health department in regards to the vaccination plan from VDH. BREMS working with Penny Hall (COO for this VDH District) to figure out how EMS can support vaccinating and potentially testing for COVID. Penny is a 25-year EMS veteran and very excited to work with BREMS. BREMS is working with Lynchburg FD on a project for Bipap. On track to begin trainer education in January, and provider rollout in February. BREMS has begun a new Regional CQI program based on protocol-driven benchmarks and related data points. BREMS has met with a few local jurisdic tio ns for an agency based CQI program that leverages Regional dashboard. Drafts for both in progress. Bedford and Campbell would like a generic model that could be used for their agencies as well. BREMS is working with Doug Layton, OEMS Field Representative on this. Protocol review/revision continues. BREMS has reached out to Cam Crittenden for information and we are working on a new format that is a more dynamic model. BREMS is working on the Monday.com platform.

V. COVID-19 Operations A. Operation Change Dates due to COVID-19: BREMS COVID-19 Pandemic Procedure Protocols, in place since March 13, 2020. Principles in Airway Management (part of the bulk document originally sent out) – in place since March 13, 2020. CDC Guidelines (part of the bulk document originally sent out) – still in place since March 13, 2020.

BREMS Drug Box Decon & Mitigation Directive – Original on March 13th; Updated on March 31st, and still in place. BREMS Employee/Provider Health Guidance & Exposure Mitigation – in place since March 31, 2020. BREMS Pandemic Airway Management & Respiratory Considerations Procedure –in place since April 8, 2020. BREMS EMS Transport Unit Decon –in place since April 14, 2020. BREMS N95 Decontamination Method –in place since May 12, 2020. BREMS participates in hospital Emergency Management Meetings related to COVID operations. BREMS worked with Centra to provide COVID positive patient information to EMS agencies. This has allowed EMS to be notified sooner of positive patients to help identify needs in agency employee/provider health guidance and exposure mitigation during COVID. BREMS has been working with EMS agencies, the hospitals, and the local health department in regards to COVID positive patient notifications, and PPE distribution. BREMS is continuing with ongoing COVID support to region; new BREMS update pending on vaccine efforts.

B. BREMS Protocol Update Dates: March 13th April 8 th May 12th June 29th

C. BREMS closed offices and moved operations to telework. Visitors to be accepted by appointment only. Staffing maximum of 2 personnel in the building, operating only for PPE distribution and other essential services. Staffing the office 3-4 times a week and those hours are given to the EMS agencies weekly allowing appointments to be made for drop offs, PPE pickups, etc. D. BREMS participated in the Regional EMS Council Director’s Group (RDG) bi- weekly conference calls. E. BREMS participated in the OEMS/Regional EMS Council bi-weekly conference calls.

. F. Most of the regional EMS council meetings/quarterly meetings were held via conference calls. October 13th is the first Board of Director’s meeting and Performance Improvement committee meeting held in person while adhering to social distancing guidelines.

Appendix

C .

Rappahannock EMS (REMS) Regional Office

I. Participation in Regional Activities REMS/OEMS staff participates in various regiona l meetings and activities in support of agency operations as a regional system. Participatio n in jurisdictional and/or hospital and system meetings enables the regional office to stay informed about issues experienced by EMS agencies, in order to better align regional goals and objectives with the needs of the agencies. These meetings also provide an opportunity for REMS/OEMS staff to provide important informational updates to agency leadership and other healthcare providers. The REMS region, which includes Planning Districts 9 and 16, is comprised of an engaged community of both EMS providers and agency leaders. A. The following regional meetings/activities were attended by REMS/OEMS staff during this reporting period: ■ 07/01/2020 Meeting with Mary Washington Healthcare ■ 07/06/2020 VDH Regulation and Compliance Division overview ■ 07/09/2020 Northwest Regional Healthcare Coalition Meeting ■ 07/11/2020 Technical Resources Support Conference Call ■ 07/12/2020 Community Service Volunteer Intake Interview ■ 07/13/2020 Technical Resources Support Conference Call ■ 07/29/2020 Regional Awards Ceremony ■ 07/31/2020 Regional Fire Chiefs and EMS Chiefs Meeting ■ 08/04/2020 Chamber of Commerce Department of Labor Webinar ■ 08/04/2020 Virginia Governor’s School Intern interview ■ 08/11/2020 IT webinar on Google Suite use for Regional Councils ■ 08/12/2020 Preceptor training and approval for City of Fredericksburg ■ 08/13/2020 Northwest Regional Healthcare Coalition Meeting ■ 08/14/2020 Rappahannock United Way meeting ■ 08/28/2020 Conference call with VCU: Geriatric Education partnership ■ 09/01/2020 GoToMeeting Training for Staff ■ 09/03/2020 GoToMeeting Training for Staff ■ 09/08/2020 Collaboration with CSEMS Regional Council on G-Suites ■ 09/09/2020 Conference call with VCU: Geriatric Education partnership ■ 09/10/2020 Northwest Regional Healthcare Coalition Meeting ■ 09/19/2020 Train the Trainer Session for 2020 Protocol Rollout

. B. The REMS is integrated with the Northwest Regional Healthcare Coalition (NWRHC) and attended several meetings during this reporting period. ■ The coalition announced winning a COVID-19 support grant which has led to a discussion about temporary isolation, single-room temporary isolation, and portable structures that are available for decontamination through various vendors. ■ BOD representatives from PD9 were routed an invitation through the REMS Council to participate in a survey of the COVID-19 impact on operations to contribute data to this project. ■ The REMS Council has also accepted an invitation from NWRHC to participate in development of a regiona l healthcare coalition preparedness plan for Northern Virginia. ■ The REMS Council participated in a Pediatric Surge Annex training through the NWRHC in June; subsequent to that event the coalition drafted a pediatric patient surge plan and an After Action Report on a pediatric mass fatality drill was presented to the BOD for review.

C. The REMS Council also participated in weekly conference calls with EMS agency leadership and management related to COVID-19 operations; REMS provides updates and information from other meetings to ensure timely and accurate distribution of information to the end-user agency-level operations.

II. Regional Council Meetings and EMS Operations A. The REMS Council has held weekly staff meetings since the declaration of the pandemic and the activation of the COOP in order to ensure understanding of changing procedures and to promote prompt sharing of staff projects and needs.

B. In addition, in order to fulfill contract and regional EMS Plan responsibilities of the REMS Council, the following meetings were conducted in the FY21 Q1 term: ■ 07/01/2020 Heudia meeting on AccessMeCare application for MIH-CP ■ 07/07/2020 Heudia meeting on AccessMeCare application for MIH-CP ■ 07/08/2020 REMS Incident and Threat Mitigation Committee Meeting ■ 07/09/2020 REMS Regional Pharmacy Committee Meeting ■ 07/09/2020 REMS Regional PI Committee Meeting ■ 07/14/2020 Heudia meeting on AccessMeCare application for MIH-CP ■ 07/15/2020 REMS Protocol Sub-Committee Meeting ■ 07/21/2020 Heudia meeting on AccessMeCare application for MIH-CP ■ 07/24/2020 REMS Regional Medical Direction Committee Meeting

. ■ 07/27/2020 REMS Regional Awards Nominating Committee Meeting ■ 07/28/2020 AccessMeCare Focus Group Meeting for MIH-CP ■ 07/29/2020 AccessMeCare Focus Group Meeting for MIH-CP ■ 08/04/2020 AccessMeCare Focus Group Meeting for MIH-CP ■ 08/10/2020 REMS Protocol Sub-Committee Meeting ■ 08/11/2020 Heudia meeting on AccessMeCare application for MIH-CP ■ 08/18/2020 Heudia meeting on AccessMeCare application for MIH-CP ■ 08/25/2020 Heudia meeting on AccessMeCare application for MIH-CP ■ 08/27/2020 REMS Protocol Sub-Committee Meeting ■ 09/02/2020 REMS Regional Heart and Stroke Committee meeting ■ 09/03/2020 REMS Protocol Sub-Committee Meeting ■ 09/08/2020 Heudia meeting on AccessMeCare application for MIH-CP ■ 09/08/2020 Guidelines and Training Committee Meeting ■ 09/09/2020 REMS Council Strategic Planning discussion ■ 09/14/2020 REMS Protocol Sub-Committee Meeting ■ 09/15/2020 Heudia meeting on AccessMeCare application for MIH-CP ■ 09/16/2020 REMS Council Strategic Planning Committee meeting ■ 09/16/2020 REMS Council MIH-CP Program and Stakeholder meeting ■ 09/30/2020 Meeting with Regional OMD ■ The REMS/OEMS staff continued to respond to requests for PPE from area EMS providers and distributed items from the remaining SNS and OEMS deliver ie s. ■ The REMS Council is tasked with reviewing and processing the release documentation for ALS providers seeking to practice in the region. Once the documentation packet is approved, the Regional Education Coordinator (REC) schedules an in-person meeting with the candidate to administer a written test, provide an ID badge, obtain OMD validation, and finalize the documentation. ● On July 1, the REC conducted an ALS Release for Caroline County (Fort AP Hill) ● On July 8, an ALS Release for King George County ● On July 22, an ALS Release for King George County ● On July 23, an ALS Release for Stafford County ● On July 29, the REC conducted an ALS Release for Caroline County (Fort AP Hill) ● On August 5, an ALS Release for Westmoreland County (Colonia l Beach Rescue Squad) ● On August 14, an ALS Release for the City of Fredericksburg

. ● The ALS Release sub-committee also proposed and update to the regional program to include AEMT preceptors; this was approved by the BOD. The sub-committee has also held a special training session to train three AEMT preceptors for an agency in Orange County. ■ The REMS Council was contacted by an EMS agency in the City of Fredericksburg requesting assistance gathering data on pelvic binder use; they are evaluating the need for training. They have been partnered with another agency in the region to create and distribute a provider survey. ■ The REMS Council is partnered with the Virginia Center on Agency, Geriatric Education Center at VCU. There are plans to provide EMS providers throughout the region with education on POST, DDNR, and end-of-life decision-mak ing. ■ The Heart and Stroke committee created a 10-question survey as part of a needs assessment to gather data on public awareness of CPR; the survey was created and distributed through the REMS Council. ■ The REMS council received, and relayed to the regional EMS agencies and providers, a health and safety warning about Methanol-contaminated hand sanitizer. The link to the list of contaminated products https://www.fda.gov/drugs/drug-safety-and-availability/fda-updates-hand- sanitizers-methanol#products was also shared with the BOD at their regular meeting. The staff also shared a safety notice where Philips released a recall and failure notice for the HeartStart MRx Monitor/Defibrillator related to the operation of the Therapy Selector Switch.

C. Critical Incident Street Management / Mental and Psychological Health ■ The REMS Council maintains an active state accredited CISM team (multi-disciplinary 39-member team) and provides on-going support of the region’s EMS operations through education, defusing, debriefing, psychological 1st aid and Stress First Aid. ● For this quarter, the CISM team was activated 11 times and provided defusing and debriefing services to both individuals and groups related to prolonged/complicated incidents and public- safety-involved incidents such as fatal MVC, infant death by drowning, and fatal fires. ● The REMS Council was also proactive in providing mental health awareness, chronic fatigue management, and other educational 4

. offerings through direct offerings and social media. Free seminars on topics such as cumulative trauma and psychological first aid are made available to the regional EMS system, training is offered to recruit schools and initial certification courses, and support is provided for grieving providers at funerals for providers, etc. ● Monthly training and meetings remain virtual/online given the complications with the pandemic. ICISF is also conducting training and instructor courses in a virtual environment. D. Mobile Integrated Health / Community Paramedic ■ The REMS Council, at the request of EMS agencies, has been working on a Mobile Integrated Healthcare/Community Paramedic (MIH-CP) program for many months. ■ The MIH-CP project continues to move forward. Under a partnership with a healthcare software organization, Heudia, there were several focus group meetings to design a digital platform and app for sharing community health resources. ■ In addition, Heudia is analyzing call data from approximately 50,000 de- identified events looking for patterns or actionable areas surrounding mental health, substance use, youth violence/injury, primary care/preventable incidents, and age-related incidents. The current project is partially funded through a grant from the Community Relief Fund of the Community Foundation. ■ During this reporting cycle, based on recent MIH-CP meetings and discussions, the Regional Systems Coordinator (RSC) identified statewide initiatives from the Governor’s office, which could align the MIH-CP initative with current public health strategic planning in Virginia.

E. Consolidated Testing Services ■ Due to COVID-19, all CTS practical exams were canceled for July (07/23), August (08/20), and September (09/10). ■ All registrations were reversed in the system and refunds were issued for payments. F. Regional Council Operations ■ The REMS Council was selected as a scientific sample of business across the United States and submits monthly payroll and performance data to the US Department of Labor Bureau of Labor Statistics. ■ The REMS Council BOD meetings occur bi-monthly and they met at the Port Royal Fire Department in Caroline County on August 19. The BOD was provided a copy of the NAEMT annual report, including the National

. Report on Violence against EMS Practitioners. Some additional topics on the agenda for discussion included: ● There was a COVID-19 response and vaccination discussion facilitated by Dr. Joe. Saitta, the COVID-19 commander for the Rappahannock Area Health District. ● A brief summary of the legislative actions that had occurred since the last meeting was provided, including appropriation discussions for Phase 4, the US Senate action to include LODD benefits for first responder deaths related to COVID-19 if they meet certain reporting criteria, as well as the fact that H.R. 1309 (Workplace Violence), which was passed in the House of Representatives on November 21, 2019, is now currently pending action in the Senate. ● Several action items were on the agenda as well: ○ The BOD approved a change in the by-laws to allow for quarterly meetings instead of bi-monthly as well as virtua l/o n-line participation ○ The regional Performance Improvement Plan was approved ○ Another action item for the BOD meeting was the updated 2020 Regional Patient Care protocols, which received approval. ■ The REMS Council applied for a CARES Act Local Government grant through Stafford County; the application was not awarded funding. ■ The REMS Council is transitioning to a cloud environment and is now utilizing Google-suite for digital file management; the office also moved to GoToMeeting as the new meeting platform for virtual meetings. ■ The REMS Council staff provides regular assistance to providers in the region answering questions on re-certification requirements and providing infor mation on educational offerings. Additional specific assistance was provided by scanning and submitting validated CEU for providers. ■ REMS Council staff also provided assistance to Orange County for an agency who was searching for instructors to provide PEPP. ■ The Regional EMS Director was re-appointed as a member of the Rappahannock Community College Board Emergency Medical Services Citizens’ Advisory Committee for the 2020-21 academic year.

. ■ The REMS Council staff tracks their work time electronically. This allows leadership to track certain projects’ time allocation in an online platform and see where work time is spent. The staff spends a large amount of their time providing customer service to individuals and agencies in the regional EMS system. Although predominantly serving EMS providers, approximately 25% of their time goes to non-EMS individuals. These examples of time spent are for 1Q FY21.

Customer Project Topics

400

350

300

250

200

150

100

0 General EMS MIH-CP OEMS Customer ALS Board of Marketing Services Operations Contract Service Release Directors

This chart depicts the time allocations for various projects that staff support. General Services includes projects such as distributing health and safety information on social media or promoting community health and safety. General Services includes items such as education on heat and cold exposure, Stop the Bleed, or drug overdose awareness. Some projects, such as MIH-CP are broken out and tracked specifically.

EMS Operations include projects specific to EMS operations such as regional contracts for medication restocking, regional planning for response to MCI and pandemics, or work on CLIA waivers or OMD contracts. Some specific projects, such as the regional release of ALS providers, is broken out and specifically tracked.

. The REMS Council provides work products Staff Work Product Origin General Public, to various different REMS / ROEMS, 11% Regional EMS customers, whether it be 15% System, 42% a request from a locality or EMS agency, a need identified for the general public health and welfare, or something related to the operations of the Regional OEMS. One major component of work time allocation is OEMS, 32% for contract deliverable items through the OEMS Contract.

Locality Customer Allocations This chart

Colonial Beach Caroline County depicts a 20% 14% breakdown of the time spent working with a Stafford County specific locality 5% rather than the general regional Spotsylvania EMS system. City of County This allocation 1% Fredericksburg 31% changes throughout the year as needs of Orange County agencies and 14% jurisdictions ebb

King George and flow. County Fauquier County 11% 4%

G. REMS/OEMS Hybrid Office Restructuring Update ■ The REMS Regional EMS Director position was filled at the end of May. The conversation continues regarding the other positions and when they may be available for advertising and filling. The remaining staff at the council continued to be supervised by the Regional Director. ■ Fiscal and general operations continue with the Regional EMS Director administering the budget, processing bills and invoices, and performing payroll and HR duties for the REMS Council staff. Updates and meetings are held with the BOD President and Treasurer as needed. ■ Until a new building is located, the REMS Council continues to occupy property belonging to MWH. However, the obligation for maintenance on the building and grounds remains the responsibility of the occupants. The staff works to maintain the grounds and provides most of the building maintenance, including painting, replacing damaged ceiling tiles, replacing used bulbs, carpet cleaning, maintenance of landscape and grounds such as removal of leaves and debris, removal of overgrowth, and maintaining the signage and markings of the parking lot. ■ The building – more than 8,500 square feet – also includes a very large training and simulation center. Organization and maintenance of training center facilities and equipment also remains a responsibility of the staff. ■ The staff maintains a website to provide updated information and resources; the office manager currently posts and manages the site until there can be a transition to the VDH website ■ The REMS Council continues to use the regional director’s group IT infrastructure and will likely transition to VDH network once the new building site is located.

H. COVID-19 Operations ■ REMS activated the COOP in April of 2020 and imple me nted modified staffing, moving each employee to telework. Staff organized rotating schedules to minimize the number of personnel in the office while still meeting needs of the customer. ■ Meetings and discussions are held with the regional OMD, Dr. White, as needed and the temporary infectious disease (COVID-19-specific) patient management protocol was cancelled August 1. ■ One additional shipment of PPE was received from OEMS and items have been made available to EMS agencies in need of PPE. A digital request

. form is available for agency super-users and a digital spreadsheet has been shared with OEMS to track distribution of PPE. ■ REMS Council leadership has been actively engaged with agency leadership from Stafford County. Prince William County, Fauquier County, MCB Quantico, City of Fredericksburg, Caroline County, King George County, and Spotsylvania County regarding the specific needs and alternative operations plans during weekly and monthly conference calls. ■ The 9-1-1 for Kids Program remains on hold due to closure and/or alternative schedules of the schools. Stop the Bleed and Hands-Only CPR programs have also come to a halt due to COVID-19 pandemic. ■ With Executive Order 55, the REMS Council office closed and moved operations remotely. ● Visitors are accepted by appointment only. ● Staff works in the building individually and responds as needed to requests for PPE distribution and other essential services. ● All council and committee meetings occurred virtually, using Adobe Connect software platform.

III. State, National, and International Activity A. Committee and group activity related to the state EMS Advisory Board meeting in Richmond for August was cancelled. However, REMS/OEMS staff participated in the following statewide meetings and discussions: ■ 07/10/2020 Image Trend Conference ■ 07/17/2020 VDH Cornerstone Training Session ■ 07/22/2020 Virginia Heart Attack Coalition (VHAC) Meeting ■ 08/05/2020 VDH Division Director’s Meeting with Dr. Jaberi ■ 08/19/2020 Virginia Biospatial training class ■ 08/20/2020 ECHO conference: Emergency Department clinical rounds

B. REMS Leadership joined weekly division manager meetings with OEMS staff to provide updates on progress and share information between the regional office and central office operations.

C. REMS Leadership participated in weekly VDH partner’s meetings to follow updates and information pertinent to EMS operations in the region.

D. REMS Leadership also shared weekly updates on programs and services in meetings with the regional director’s group; conversations were had on various

. topics related to regiona l EMS operations and COVID-19 issues occurring in the other ten council regions.

E. As a fairly new Regional Office of EMS (ROEMS) entity, the REMS Leadership also connected with the Regional EMS Directors from the other two ROEMS in weekly meetings to identify strategic planning needs, establish operational goals, and review best practices.

F. Participation by REMS/OEMS Staff also occurred in the following National and International Meetings: ■ 07/14/2020 HeartSafe Community Champion National Conference Call ■ 07/15/2020 Highway Safety Operations in a COVID-19 environment ■ 08/06/2020 USSS Webinar of Mass Attacks in Public Spaces ■ 08/11/2020 HeartSafe Community Champion National Conference Call ■ 08/18/2020 National EMS Advisory Council meeting ■ 08/19/2020 National EMS Advisory Council meeting ■ 09/01/2020 NAEMT Disaster Preparedness Committee meeting ■ 09/01/2020 ECHO conference on Death of Healthcare Clinicians ■ 09/08/2020 HeartSafe Community Champion National Conference Call ■ 09/14/2020 NAEMT Board of Director’s Meeting ■ 09/22/2020 NAEMT EMS Transformation Committee Meeting ■ 09/28/2020 NAEMT EMS Workforce Committee Meeting

G. Council staff shared information published through the Centers for Disease Control to assist retirement community environments in controlling the spread of COVID-19 as well as the National Registry 2021 Fee schedule and testing updates.

H. Information from the NEMSAC and FICEMS meetings was shared on social media.

I. Researchers at University of Washington’s Baker Lab are using computer models to predict the structure of proteins important to COVID-19 and produce new mini- proteins as potential therapeutics and diagnostics. Understanding the demands of computational power to accurately model the structure of proteins and design new ones the REMS Council, in support of this effort, through the regional director’s group, is contributing a portion of computing resources to a distributed computing network currently consisting of 3,288,889 computers worldwide.

. J. AAR and debriefing information from the USSS National Threat Assessment Center on mass attacks in public spaces was shared with the REMS BOD at their August 2020 meeting.

Appendix

Digital Certification Card Fact Sheet1

A Virginia Office of Emergency Medical Services (heretofore referred to as the Virginia Office of EMS) digital certification card (sample attached) is the electronic form of a Virginia Office of EMS printed certification card. “Digital” is defined as “composed of data in the form of especially binary digits. E.g. “digital images”.2 The term “certification” means verification that on the indicated completion date the participant named on the Virginia Office of EMS certification card demonstrated achievement of the required knowledge and hands‐on skill performance objectives to the satisfaction of a qualified and currently authorized Virginia Office of EMS provider. Certification (or recertification) in a Virginia Office of EMS training program is documented by the legitimate issuance of a correctly completed Virginia Office of EMS print or digital certification card.

Virginia Office of EMS does not offer or endorse online‐only initial emergency medical services certification training programs. Virginia Office of EMS training is competency‐based and certification requires evaluation and verification of a participant’s cognitive and psychomotor skills as required by the National Registry of EMT’s. Online‐only initial EMS certification training does not meet the standards of the Virginia Department of Health Office of Emergency Medical Services or the National Registry of EMT’s.

Relevant Facts Concerning Electronic Records

1. The Federal Occupational Safety and Health Administration (OSHA) have permitted electronic recordkeeping of employee safety training records since 1997.3 2. Just as with paper documents, electronic documents are a record. Regarding its own records management program, OSHA has stated “The electronic data may be considered a copy of a hard copy or paper record. If a hard copy or paper record is not maintained, then the electronic copy is the record copy”.4 3. Since 2001 U.S. Federal courts have accepted electronic records (legal filings) over the Internet via the Public Access to Court Electronic Records (PACER) system. 4. Amendments to the Federal Rules of Civil Procedure require civil litigants to preserve and produce any electronically stored information as it can play an important role as evidence.5 There is no doubt that electronic records have the same legal force as those produced in other formats (such as paper). 5. U.S. Food and Drug Administration (FDA) regulations permit electronic records and electronic signatures as equivalent to paper records and handwritten signatures executed on paper. FDA regulations are intended to permit the widest possible use of electronic technology, compatible with FDA's responsibility to protect the public health.6 6. Web content is rendered in two basic forms ‐ dynamic and static. Dynamic web content consists of information that is rendered differently based on specific user input and is managed in a database associated with a server. Static content consists of information in the form of documents that are rendered identically each time they are accessed. Both static and dynamic web content are considered a permanent record and meet the requirements of the U.S. National Archives and Records Administration (NARA) Electronic Records Management (ERM) E‐Gov Initiative.7 a. Virginia Office of EMS Digital Certification Cards are both static and dynamic. Each document is rendered identically in static format (PDF) and is based on the providers dynamic certification records in the Virginia EMS Portal. b. Every Digital Certification Card is a true and accurate record of the original information received by the Virginia Office of EMS on the date the record was downloaded and is uniquely tracked in the Virginia EMS Portal electronic content management system.

Page 1 of 3

7. The United States Federal Government Paperwork Elimination Act (GPEA) uses reliability, authenticity, integrity, and usability to describe the characteristics of trustworthy records.8 The Virginia Office of EMS follows best practice guidelines regarding reliability, authenticity, integrity, and usability. Consequently, a Virginia Office of EMS Digital Certification Card(s): a. Reliably identifies the certified Virginia Office of EMS Education Coordinator and the National Registry of EMT’s as the record source and provides evidence that the Virginia Office of EMS certified Education Coordinator documented achievement of the participant’s knowledge in cognitive and psychomotor performance according to the program standard. b. Authentically establishes what it purports to be. The Virginia Office of EMS business practices and electronic content management system controls the creation, transmission, receipt, and maintenance of the Digital Certification Card. The transaction is tied electronically to the Virginia Office of EMS Portal. c. Integrity is supported by Virginia Office of EMS rules and regulations, standards, business practices, and electronic content management system that prohibit alteration. d. Usability ensures that it can be located, retrieved, presented, and directly connected to the provider’s certification records and certified Education Coordinator who coordinated the program. The link to the Digital Certification Card remains permanently active.

About the Virginia Office of EMS

Virginia Office of EMS (OEMS) is responsible for planning and coordinating an effective and efficient statewide EMS system. Our programs and services are designed to assure quality prehospital patient care, from when the call is received by the 911 center to the delivery of the patient to the trauma center or hospital.

If you have questions please contact us at 804‐888‐9100.

Disclaimer: Governmental entities may or may not be authorized, empowered, or required by law to accept electronic records. This Fact Sheet cannot address all the possible implications, applications, or exceptions to acceptance of electronic records, including Digital Certification Cards.

1 Last reviewed/updated: October 26, 2020. 2 https://www.merriam‐webster.com/dictionary/digital 3 https://www.osha.gov/laws‐regs/standardinterpretations/1997‐08‐14 4 https://www.osha.gov/enforcement/directives/adm‐03‐01‐004 5 http://www.gpo.gov/fdsys/pkg/USCODE‐2010‐title28/html/USCODE‐2010‐title28‐app‐federalru‐dup1‐rule34.htm 6 http://www.fda.gov/RegulatoryInformation/Guidances/ucm125067.htm 7 http://www.archives.gov/records‐mgmt/initiatives/web‐content‐records.html 8 http://www.gpo.gov/fdsys/pkg/PLAW‐105publ277/pdf/PLAW‐105publ277.pdf

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Unique font State seal with kerning for QR code takes you micro printing document to the OEMS Digital for document security. Certification security. Verification web page. Director of OEMS Provider signature with continuing micro printing education QR for documentPage 3 of 3 code. security. Appendix

REQUEST FOR PROPOSALS (RFP)

Issue Date: October 9th, 2020 RFP No. WVEMS/OEMS300920

Title: Virginia Emergency Medical Services Electronic Patient Care Reporting System

Issuing Entity: Western Virginia EMS Council On behalf of the Virginia Office of EMS / Virginia EMS System 1944 Peters Creek Road, NW Roanoke, VA 24017-1613 Attn: Alicia Rice ([email protected])

PERIOD OF PERFORMANCE: From July 1, 2021 through June 30, 2024. (*Renewable)

Sealed Proposals Will Be Received Until November 20th, 2020 at 5:00 P.M. For Furnishing the Goods/Services Described Herein.

All Inquiries for Information Should Be Directed To: Alicia Rice at [email protected]

IF PROPOSALS ARE MAILED, SEND DIRECTLY TO ISSUING AGENCY SHOWN ABOVE. IF PROPOSALS ARE HAND DELIVERED, THEN DELIVER TO ADDRESS ABOVE. IF PROPOSALS ARE SUBMITTED ELECTRONICALLY, THEN SEND TO EMAIL ADDRESS ABOVE.

In compliance with this Request for Proposals (RFP) and all conditions imposed in this RFP, the undersigned firm hereby offers and agrees to furnish all goods and services in accordance with the attached signed proposal or as mutually agreed upon by subsequent negotiation, and the undersigned firm hereby certifies that all information provided below and in any schedule attached hereto is true, correct, and complete.

Virginia Contractor License No. (if applicable)

DSBSD-certified Small Business No. (if applicable)

Class: Specialty Codes:

Name and Address of Firm: Date:

By: (Signature in Ink) Name:

eVA Vendor ID or DUNS Number Title :

Phone: Fax:

Email:

1 of 40 Note: This public body does not discriminate against faith-based organizations in accordance with the Code of Virginia, § 2.2-4343.1 or against a bidder or offeror because of race, religion, color, sex, national origin, age, disability, sexual orientation, gender identity, political affiliation, or veteran status or any other basis prohibited by state law relating to discrimination in employment. Faith- based organizations may request that the issuing agency not include subparagraph 1.e in General Terms and Condition C. Such a request shall be in writing and explain why an exception should be made in that invitation to bid or request for proposal.

RFP# WVEMS/OEMS300920 2 of 40 TABLE OF CONTENTS FOR RFP# WVEMS/OEMS300920

Table of Contents

I. PURPOSE ...... 5 II. BACKGROUND ...... 5 III. STATEMENT OF NEEDS ...... 5 IV. FUNCTIONAL AND TECHNICAL REQUIREMENTS ...... 7 V. PROPOSAL PREPARATION AND SUBMISSION INSTRUCTIONS ...... 7 A. GENERAL INSTRUCTIONS...... 7 B. SPECIFIC REQUIREMENTS ...... 9 VI. PRE-PROPOSAL OPTIONAL CONFERENCE...... 10 VII. GENERAL TERMS AND CONDITIONS...... 10 A. APPLICABLE LAWS AND COURTS ...... 10 B. ANTI-DISCRIMINATION...... 10 C. ETHICS IN PUBLIC CONTRACTING ...... 11 D. IMMIGRATION REFORM AND CONTROL ACT OF 1986 ...... 11 E. DEBARMENT STATUS...... 11 F. ANTITRUST ...... 11 G. MANDATORY USE OF FORM AND TERMS AND CONDITIONS FOR RFPS ...... 12 H. CLARIFICATION OF TERMS...... 12 I. PAYMENT ...... 12 J. QUALIFICATIONS OF OFFERORS ...... 13 K. TESTING AND INSPECTION ...... 13 L. ASSIGNMENT OF CONTRACT...... 13 M. CHANGES TO THE CONTRACT ...... 13 N. DEFAULT ...... 14 O. TAXES ...... 14 P. ANNOUNCEMENT OF AWARD...... 14 Q. DRUG-FREE WORKPLACE...... 14 R. NONDISCRIMINATION OF CONTRACTORS ...... 14 S. AVAILABILITY OF FUNDS...... 15 T. BID PRICE CURRENCY...... 15 U. AUTHORIZATION TO CONDUCT BUSINESS IN THE COMMONWEALTH ...... 15 VIII. SPECIAL TERMS AND CONDITIONS ...... 15 A. AWARD TO MULTIPLE OFFERORS ...... 15 B. AUDIT ...... 15 C. CANCELLATION OF CONTRACT ...... 16 D. RENEWAL OF CONTRACT ...... 16 E. PROPOSAL ACCEPTANCE PERIOD ...... 16 F. CONFIDENTIALITY OF PERSONALLY IDENTIFIABLE INFORMATION ...... 16 G. PRIME CONTRACTOR RESPONSIBILITIES...... 16 H. QUANTITIES...... 16 I. BEST AND FINAL OFFER (BAFO) ...... 16

RFP# WVEMS/OEMS300920 3 of 40 J. REFERENCES ...... 17 K. SUBCONTRACTS ...... 17 L. STATE CORPORATION COMMISSION IDENTIFICATION NUMBER ...... 17 M. IDENTIFICATION OF PROPOSAL ENVELOPE ...... 17 IX. METHOD OF PAYMENT ...... 17 EXHIBIT A - PROPOSED PLAN AND METHODOLOGY ...... 19 EXHIB IT B - REFERENCES ...... 20 EXHIBIT C - PRICING SCHEDULE ...... 21 A. CORE PRODUCT FEATURES AND CAPABILITIES...... 21 B. ANCILLARY PRODUCT FEATURES AND CAPABILITIES ...... 22 EXHIBIT D – FUNCTIONAL AND TECHNICAL REQUIREMENTS ...... 23 A. CUSTOMIZABLE OFF-THE-SHELF (COTS) PRODUCT ...... 24 B. ELECTRONIC PATIENT CARE REPORT (EPCR)...... 24 C. ACCESSIBILITY...... 25 D. EMS HOSPITAL DASHBOARD ...... 25 E. QUALITY ASSURANCE (QA) / QUALITY IMPROVEMENT (QI) MONITORING ...... 26 F. DATA QUALITY / VALIDATION ...... 26 G. DATA ANALYTICS & REPORTING TOOL ...... 28 H. STATE TRAUMA REGISTRY (STR)...... 29 I. ADDITIONAL FEATURES / CAPABILITIES...... 30 J. ADMINISTRATION TOOL ...... 31 K. TECHNICAL REQUIREMENTS ...... 31 I. STATE EMS DATA REPOSITORY ...... 31 ii. SECURITY...... 33 iii. GENERAL...... 34 L. CUSTOMIZATION ...... 35 i. INCIDENT LIST VIEWS ...... 35 ii. FORMS MANAGER...... 35 M. IMPLEMENTATION ASSISTANCE ...... 36 i. GENERAL...... 36 ii. SYSTEM SETUP ...... 36 iii. SCHEMATRON SETUP ...... 37 iv. EXTERNAL ACCESS SETUP ...... 38 N. ADMINISTRATIVE & END USER TRAINING ...... 38 O. TECHNICAL SUPPORT & SYSTEM MAINTENANCE...... 39 P. COMPLIANCE ...... 40

RFP# WVEMS/OEMS300920 4 of 40 I. PURPOSE:

The purpose of the Request for Proposal (RFP) is to solicit sealed proposals to establish a contract(s) through competitive negotiation for cloud based electronic patient care software (ePCR) by the PURCHASING AGENCY which is the Western Virginia Emergency Medical Services Council (WVEMS) on behalf of the Virginia Office of Emergency Medical Services (OEMS) and the Virginia Emergency Medical Services (EMS) agencies.

The initial contract will be a three (3) year period beginning July 1, 2021 – June 30, 2024 with additional renewals possible at the agency’s discretion.

Offeror’s proposal must clearly identify their ability to meet the proposed offering (fully, partially, or not at all).

II. BACKGROUND:

The Virginia OEMS, Virginia EMS agencies and Virginia Hospitals require, under the authority of the Code of Virginia, and electronic patient medical record and patient registry program. This program provides all 660+ EMS agencies the ability to meet this code obligation of submission of the prescribed data elements to the OEMS within 12 hours of patient care delivery and allows 110 hospitals the ability to submit inpatient trauma data. Historically this has been provided by physical servers housed and maintained by the Virginia Department of Health OEMS. As such, future offerings must be made available via a cloud platform.

Additionally, this contract would provide the option for EMS agencies and/or jurisdictions and hospitals to purchase off the contract based upon the pre-negotiated pricing.

III. STATEMENT OF NEEDS:

The PURCHASING AGENT realizes that the size and scope of this request may limit the number of vendors capable of providing substantially all of the needs for this RFP. Therefore, more than one (1) contract may be awarded as a result of this RFP. The contractor(s) shall furnish all labor, materials, etc. to provide ePCR services and software to the PURCHASING AGENT.

The contractor(s) shall make available ePCR services and software meeting the following:

CORE PRODUCT FEATURES AND CAPABILITIES

Core Product Features and Capabilities will be included in the contract for PURCHASING AGENT, as well as EMS agency utilization. These product components will be included in the contract value annually for the PURCHASING AGENT. Offeror will also provide core product services to EMS agencies seeking to purchase independently at contract prices.

1. Customizable off-the-shelf (COTS) product 2. EMS Electronic Patient Care Reporting (ePCR) 3. State Electronic Medical Record (EMR) 4. State EMS Registry (data repository)

5. EMS Hospital Dashboard 6. EMS-Hospital record integration

RFP# WVEMS/OEMS300920 5 of 40 7. State Trauma Registry (STR) 8. EMS-STR record integration 9. Quality Assurance (QA) / Quality Improvement (QI) Monitoring 10. Line of Duty Injury / Death Reporting Module 11. EMS Provider Mental Health and Wellness Monitoring 12. Ability to create and manage Alerts 13. EMS Billing integration

14. Data Analytics and Reporting Tool (sophisticated / advanced) a. Ability to perform keyword searches in narratives b. Ability to convert one-to many fields to separate columns instead of becoming multiple rows of data for the same patient c. Ability to export raw data quickly and easily into a delimited file that can be read by statistical software (e.g. SPSS, SAS, Tableau) d. Ability to perform unstructured text analysis e. Automatic/integrated audit reporting (track failed submissions and failure to resubmit records) f. Automated/integrated data quality reports that allow for blocking of custom/nonstandard data submissions g. Integration capabilities. External application API integrations to products such as Oracle to both push and pull data.

15. Cloud-based SQL server 16. Web-based system with Offline capable 17. PC, tablet, and smart-phone compatible 18. Runs on Windows, Mac, Android, and iOS

19. Transition Assistance 20. System and Server Setup 21. External Access Setup 22. Implementation Assistance 23. Administrator, Internal and External End-User Training 24. Enhanced Support for period after Go-Live 25. Ongoing Technical Support and System Maintenance

26. NEMSIS v3.4 Compliant Software for State Systems 27. NEMSIS v3.4 Compliant Software for EMS Agencies 28. NEMSIS v3.5 Compliance actively being pursued

29. See EXHIBIT D for Functional and Technical Specifications

ANCILLARY PRODUCT FEATURES AND CAPABILITIES

Ancillary product features and capabilities will be included as line item options in the contract for PURCHASING AGENT as well as EMS agency utilization. These product components will be optionally included on an item-by-item basis in the contract value annually for the PURCHASING AGENT as identified and selected by the PURCHASING AGENT. Offeror will also provide ancillary product services to EMS agencies seeking to purchase independently at contract prices on an item-by-item basis.

1. Additional Registries (e.g. Stroke, Cardiac Arrest) 2. Fire Services Reporting System 3. Fire Inspections Module

RFP# WVEMS/OEMS300920 6 of 40 4. Patient Tracking Tool (Emergency Preparedness) 5. Inventory Management 6. Vehicle Maintenance Management 7. Computer Aided Dispatch (CAD) integration 8. Licensure/Certification and Inspections 9. Public-facing, de-identified self-service database 10. Ability to link a patient’s previous EMS encounter to the current EMS call so that the provider can see pertinent medical history, etc. 11. Machine learning capabilities and predictive analytics, with the ability to make result-based recommendations 12. Collection of metadata elements (e.g. GPS data, temperature, speed) 13. Further software enhancement, such as: a. Live audio recording/dictation/speech-to-text b. Integration with mobile technologies (e.g. smart watch integration) c. Integration with medical devices (e.g. cardiac monitor, vital signs monitor, etc.) 14. Federal Risk and Authorization Management Program (FedRAMP) Compliant

Offeror’s proposal must explain their abilities to meet the identified core and ancillary products either fully, partially, or not at all. In the event core and/or ancillary products are available through Offeror’s cooperative agreement or integration with another vendor; these instances must be specifically identified, vendor agreement provided, and if cost will be included in the Offeror’s proposal or if the PURCHASING AGENT will have to contract independently.

IV. FUNCTIONAL AND TECHNICAL REQUIREMENTS:

Offerors are to indicate their capability of fulfilling each requirement listed in EXHIBIT D. Each Offeror’s responses will be reviewed and compared across Offerors to determine the best solution for the PURCHASING AGENT and Virginia EMS agencies.

V. PROPOSAL PREPARATION AND SUBMISSION INSTRUCTIONS:

a. GENERAL INSTRUCTIONS:

i. RFP RESPONSE:

To be considered for selection, Offerors must submit a complete response to this RFP. One (1) copy of each proposal shall be submitted in accordance with instructions on the first page of this RFP, preferably by email.

Offerors that submit a proposal which contains Proprietary and/or Confidential information must also submit one (1) copy in which Proprietary and/or Confidential information is REDACTED. Submit one (1) cd disk (or file, if submitting electronically) containing the REDACTED file and one (1) containing a copy of the proposal (flash drives will not be accepted). Designating the Purpose, Scope, Specifications, Terms and Conditions, Price and/or anything other than specific data, figures, and/or paragraphs that constitute trade secret or proprietary information as Proprietary and/or Confidential is not acceptable.

Proposals sent electronically shall be submitted to:

Alicia Rice ([email protected]) Subject: “Proposal in response to RFP # WVEMS/OEMS300920”

RFP# WVEMS/OEMS300920 7 of 40 Proposals in physical form shall be submitted to:

Western Virginia EMS Council, Inc. 1944 Peters Creek Road, NW Roanoke, VA 24017-1613 Attn: Alicia Rice

ii. PROPOSAL PREPARATION

1. Proposals shall be signed by an authorized representative of the Offeror. All information requested should be submitted. Failure to submit all information requested may result in the Purchasing Agency requiring prompt submission of missing information and/or giving a lowered evaluation of the proposal. Proposals which are substantially incomplete or lack key information may be rejected by the Purchasing Agency. Mandatory requirements are those required by law or regulation or are such that they cannot be waived and are not subject to negotiation. 2. Proposals should be prepared simply and economically, providing a straightforward, concise description of capabilities to satisfy the requirements of the RFP. Emphasis should be placed on completeness and clarity of content. 3. Proposals should be organized in the order in which the requirements are presented in the RFP. All pages of the proposal should be numbered. Each paragraph in the proposal should reference the paragraph number of the corresponding section of the RFP. It is also helpful to cite the paragraph number, sub letter, and repeat the text of the requirement as it appears in the RFP. If a response covers more than one (1) page, the paragraph number and sub letter should be repeated at the top of the next page. The proposal should contain a table of contents which cross- references the RFP requirements. Information which the Offeror desires to present that does not fall within any of the requirements of the RFP should be inserted at an appropriate place or be attached at the end of the proposal and designated as additional material. Proposals that are not organized in this manner risk elimination from consideration if the evaluators are unable to find where the RFP requirements are specifically addressed. 4. As used in this RFP, the terms "must", "shall", "should" and “may” identify the criticality of requirements. "Must" and "shall" identify requirements whose absence will have a major negative impact on the suitability of the proposed solution. Items labeled as "should" or “may” are highly desirable, although their absence will not have a large impact and would be useful but are not necessary. Depending on the overall response to the RFP, some individual "must" and "shall" items may not be fully satisfied, but it is the intent to satisfy most, if not all, "must" and "shall" requirements. The inability of an Offeror to satisfy a "must" or "shall" requirement does not automatically remove that Offeror from consideration; however, it may seriously affect the overall rating of the Offerors’ proposal. 5. If submitting physically, the proposal should be contained in a single 3 ring binder. All documentation submitted with the proposal should be contained in that single binder.

RFP# WVEMS/OEMS300920 8 of 40 6. Ownership of all data, materials, and documentation originated and prepared for the Purchasing Agent and End User (Virginia Department of Health Office of EMS) pursuant to the RFP shall belong exclusively to the End User and be subject to public inspection in accordance with the Virginia Freedom of Information Act. Trade secrets or proprietary information submitted by an Offeror shall not be subject to public disclosure under the Virginia Freedom of Information Act; however, the Offeror must invoke the protections of § 2.2-4342F of the Code of Virginia, in writing, either before or at the time the data or other material is submitted. The written notice must specifically identify the data or materials to be protected and state the reasons why protection is necessary. The proprietary or trade secret material submitted must be identified by some distinct method such as highlighting or underlining and must indicate only the specific words, figures, or paragraphs that constitute trade secret or proprietary information. The classification of an entire proposal document, line item prices, and/or total proposal prices as proprietary or trade secrets is not acceptable and will result in rejection of the proposal. 7. The signed proposal, if provided in physical form, must be in an envelope/package addressed as directed on page one (1) of this solicitation. If a proposal is not identified as required, the Offeror takes the risk that the envelope may be inadvertently opened and the information compromised, which may cause the proposal to be disqualified. Proposals may be hand delivered to the designated location in the office issuing the solicitation. No other correspondence or other proposal should be placed in the envelope. If proposal is submitted by email, electronic signature will be accepted. LATE PROPOSALS WILL NOT BE ACCEPTED.

b. SPECIFIC REQUIREMENTS

Proposals should be as thorough and detailed as possible so that the Purchasing Agent and End User may properly evaluate your capabilities to provide the required goods/services.

Completeness of Proposal

Offeror should display a thorough understanding of the requirements, familiarity with the content of this proposal, submittal of all required documentation and the overall quality of response.

Offerors are required to submit the following as a complete proposal:

1. Return the RFP cover sheet and all addenda acknowledgments, if any, signed and filled out as required.

2. The following Exhibits must be submitted with the proposal, along with any accompanying documentation:

EXHIBIT A – Proposed Plan and Methodology EXHIBIT B – References EXHIBIT C – Pricing Schedule EXHIBIT D – Functional and Technical Requirements

RFP# WVEMS/OEMS300920 9 of 40 VI. PRE-PROPOSAL OPTIONAL CONFERENCE:

An optional pre-proposal conference will be held if any Offeror expresses interest. A request must be submitted by email prior to October 30th, 2020.

A roll call of audio conference participants will be taken at the beginning of the conference to ensure all participant attendance is recorded. The purpose of this conference is to allow potential Offerors an opportunity to present questions and obtain clarification relative to any facet of this solicitation.

Submit all inquiries concerning this RFP in writing by email, subject “Questions on RFP #WVEMS/OEMS300920”, to: Alicia Rice ([email protected])

To ensure timely and adequate consideration of proposals, Offerors are to limit all contact, whether verbal or written, pertaining to this RFP to Alicia Rice for the duration of this proposal process.

VII. GENERAL TERMS AND CONDITIONS

a. APPLICABLE LAWS AND COURTS: This solicitation and any resulting contract shall be governed in all respects by the laws of the Commonwealth of Virginia, without regard to its choice of law provisions, and any litigation with respect thereto shall be brought in the circuit courts of the Commonwealth.

b. ANTI-DISCRIMINATION: By submitting their (bids/proposals), (bidders/offerors) certify to the Commonwealth that they will conform to the provisions of the Federal Civil Rights Act of 1964, as amended, as well as the Virginia Fair Employment Contracting Act of 1975, as amended, where applicable, the Virginians With Disabilities Act, the Americans With Disabilities Act and § 2.2-4311 of the Virginia Public Procurement Act (VPPA). If the award is made to a faith-based organization, the organization shall not discriminate against any recipient of goods, services, or disbursements made pursuant to the contract on the basis of the recipient's religion, religious belief, refusal to participate in a religious practice, or on the basis of race, age, color, gender, or national origin and shall be subject to the same rules as other organizations that contract with public bodies to account for the use of the funds provided; however, if the faith-based organization segregates public funds into separate accounts, only the accounts and programs funded with public funds shall be subject to audit by the public body. (Code of Virginia, §2.2-4343.1E).

In every contract over $10,000 the provisions in 1. and 2. below apply:

1. During the performance of this contract, the contractor agrees as follows:

a. The contractor will not discriminate against any employee or applicant for employment because of race, religion, color, sex, national origin, age, disability, or any other basis prohibited by state law relating to discrimination in employment, except where there is a bona fide occupational qualification reasonably necessary to the normal operation of the contractor. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices setting forth the provisions of this nondiscrimination clause.

RFP# WVEMS/OEMS300920 10 of 40 b. The contractor, in all solicitations or advertisements for employees placed by or on behalf of the contractor, will state that such contractor is an equal opportunity employer. c. Notices, advertisements, and solicitations placed in accordance with federal law, rule or regulation shall be deemed sufficient for the purpose of meeting the requirements of this section. d. The requirements of these provisions 1. and 2. are a material part of the contract. If the Contractor violates one (1) of these provisions, the Commonwealth may terminate the affected part of this contract for breach, or at its option, the whole contract. Violation of one (1) of these provisions may also result in debarment from State contracting regardless of whether the specific contract is terminated. e. In accordance with Executive Order 61 (2017), a prohibition on discrimination by the contractor, in its employment practices, subcontracting practices, and delivery of goods or services, on the basis of race, sex, color, national origin, religion, sexual orientation, gender identity, age, political affiliation, disability, or veteran status, is hereby incorporated in this contract.

2. The contractor will include the provisions of 1. above in every subcontract or purchase order over $10,000, so that the provisions will be binding upon each subcontractor or vendor.

c. ETHICS IN PUBLIC CONTRACTING: By submitting their proposals Offerors certify that their proposals are made without collusion or fraud and that they have not offered or received any kickbacks or inducements from any other Offeror, supplier, manufacturer or subcontractor in connection with their bid and that they have not conferred on any public employee having official responsibility for this procurement transaction any payment, loan, subscription, advance, deposit of money, services or anything of more than nominal value, present or promised, unless consideration of substantially equal or greater value was exchanged.

d. IMMIGRATION REFORM AND CONTROL ACT OF 1986: Applicable for all contracts over $10,000: By entering into a written contract, the Contractor certifies that the Contractor does not, and shall not during the performance of the contract for goods and services, knowingly employ an unauthorized alien as defined in the federal Immigration Reform and Control Act of 1986.

e. DEBARMENT STATUS: By participating in this procurement, the vendor certifies that they are not currently debarred by the Commonwealth of Virginia from submitting a response for the type of goods and/or services covered by this solicitation. Vendor further certifies that they are not debarred from filling any order or accepting any resulting order, or that they are an agent of any person or entity that is currently debarred by the Commonwealth of Virginia.

If a vendor is created or used for the purpose of circumventing a debarment decision against another vendor, the non- debarred vendor will be debarred for the same time period as the debarred vendor.

f. ANTITRUST: By entering into a contract, the contractor conveys, sells, assigns, and transfers to the Commonwealth of Virginia all rights, title and interest in and to all causes of action it may now have or hereafter acquire under the antitrust laws of the United States and the Commonwealth of Virginia, relating to the particular goods or services purchased or acquired by the Commonwealth of Virginia under said contract.

RFP# WVEMS/OEMS300920 11 of 40 g. MANDATORY USE OF FORM AND TERMS AND CONDITIONS FOR RFPs: Failure to submit a bid on the official form provided for that purpose shall be a cause for rejection of the bid. Modification of or additions to any portion of the Invitation for Bids may be cause for rejection of the bid; however, the Purchasing Agent reserves the right to decide, on a case by case basis, in its sole discretion, whether to reject such a bid as nonresponsive. As a precondition to its acceptance, the Purchasing Agent may, in its sole discretion, request that the Offeror withdraw or modify nonresponsive portions of a bid which do not affect quality, quantity, price, or delivery. No modification of or addition to the provisions of the contract shall be effective unless reduced to writing and signed by the parties.

h. CLARIFICATION OF TERMS: If any prospective Offeror has questions about the specifications or other solicitation documents, the prospective Offeror should contact the buyer whose name appears on the face of the solicitation no later than five (5) working days before the due date. Any revisions to the solicitation will be made only by addendum issued by the buyer.

i. PAYMENT: 1. To Prime Contractor: a. Invoices for items ordered, delivered, and accepted shall be submitted by the contractor directly to the payment address shown on the purchase order/contract. All invoices shall show the state contract number and/or purchase order number; social security number (for individual contractors) or the federal employer identification number (for proprietorships, partnerships, and corporations). b. Any payment terms requiring payment in less than 30 days will be regarded as requiring payment 30 days after invoice or delivery, whichever occurs last. This shall not affect offers of discounts for payment in less than 30 days, however. c. All goods or services provided under this contract or purchase order, that are to be paid for with public funds, shall be billed by the contractor at the contract price, regardless of which public agency is being billed. d. The following shall be deemed to be the date of payment: the date of postmark in all cases where payment is made by mail, or when offset proceedings have been instituted as authorized under the Virginia Debt Collection Act. e. Unreasonable Charges. Under certain emergency procurements and for most time and material purchases, final job costs cannot be accurately determined at the time orders are placed. In such cases, contractors should be put on notice that final payment in full is contingent on a determination of reasonableness with respect to all invoiced charges. Charges which appear to be unreasonable will be resolved in accordance with Code of Virginia, § 2.2-4363 and -4364. Upon determining that invoiced charges are not reasonable, the Purchasing Agent shall notify the contractor of defects or improprieties in invoices within fifteen (15) days as required in Code of Virginia, § 2.2-4351.,. The provisions of this section do not relieve an agency of its prompt payment obligations with respect to those charges which are not in dispute (Code of Virginia, § 2.2- 4363). 2. To Subcontractors: a. Within seven (7) days of the contractor’s receipt of payment from the Purchasing Agent, a contractor awarded a contract under this solicitation is here by obligated: 1. To pay the subcontractor(s) for the proportionate share of the payment received for work performed by the subcontractor(s) under the contract; or 2. To notify the agency and the subcontractor(s), in writing, of the contractor’s intention to withhold payment and the reason.

RFP# WVEMS/OEMS300920 12 of 40 b. The contractor is obligated to pay the subcontractor(s) interest at the rate of one percent (1%) per month (unless otherwise provided under the terms of the contract) on all amounts owed by the contractor that remain unpaid seven (7) days following receipt of payment from the Purchasing Agent, except for amounts withheld as stated above. The date of mailing of any payment by U. S. Mail is deemed to be payment to the addressee. These provisions apply to each sub-tier contractor performing under the primary contract. A contractor’s obligation to pay an interest charge to a subcontractor may not be construed to be an obligation of the Purchasing Agent.

j. QUALIFICATIONS OF OFFERORS The Purchasing Agent may make such reasonable investigations as deemed proper and necessary to determine the ability of the Offeror to perform the services/furnish the goods and the Offeror shall furnish to the Purchasing Agent and End User all such information and data for this purpose as may be requested. The Purchasing Agent reserves the right to inspect Offeror’s physical facilities prior to award to satisfy questions regarding the Offeror’s capabilities. The Purchasing Agent further reserves the right to reject any bid if the evidence submitted by, or investigations of, such Offeror fails to satisfy the Purchasing Agent and End User that such Offeror is properly qualified to carry out the obligations of the contract and to provide the services and/or furnish the goods contemplated therein.

k. TESTING AND INSPECTION: The Purchasing Agent and End User reserves the right to conduct any test/inspection it may deem advisable to assure goods and services conform to the specifications.

l. ASSIGNMENT OF CONTRACT: A contract shall not be assignable by the contractor in whole or in part without the written consent of the Purchasing Agent and End User.

m. CHANGES TO THE CONTRACT: Changes can be made to the contract in any of the following ways: i. The parties may agree in writing to modify the terms, conditions, or scope of the contract. Any additional goods or services to be provided shall be of a sort that is ancillary to the contract goods or services, or within the same broad product or service categories as were included in the contract award. Any increase or decrease in the price of the contract resulting from such modification shall be agreed to by the parties as a part of their written agreement to modify the scope of the contract. ii. The Purchasing Agency may order changes within the general scope of the contract at any time by written notice to the contractor. Changes within the scope of the contract include, but are not limited to, things such as services to be performed, the method of packing or shipment, and the place of delivery or installation. The contractor shall comply with the notice upon receipt, unless the contractor intends to claim an adjustment to compensation, schedule, or other contractual impact that would be caused by complying with such notice, in which case the contractor shall, in writing, promptly notify the Purchasing Agent of the adjustment to be sought, and before proceeding to comply with the notice, shall await the Purchasing Agent's written decision affirming, modifying, or revoking the prior written notice. If the Purchasing Agent decides to issue a notice that requires an adjustment to compensation, the contractor shall be compensated for any additional costs incurred as the result of such order and shall give the Purchasing Agent a credit for any savings. Said compensation shall be determined by one (1) of the following methods:

RFP# WVEMS/OEMS300920 13 of 40 1. By mutual agreement between the parties in writing; or 2. By agreeing upon a unit price or using a unit price set forth in the contract, if the work to be done can be expressed in units, and the contractor accounts for the number of units of work performed, subject to the Purchasing Agent’s right to audit the contractor’s records and/or to determine the correct number of units independently; or 3. By ordering the contractor to proceed with the work and keep a record of all costs incurred and savings realized. A markup for overhead and profit may be allowed if provided by the contract. The same markup shall be used for determining a decrease in price as the result of savings realized. The contractor shall present the Purchasing Agent with all vouchers and records of expenses incurred and savings realized. The Purchasing Agent shall have the right to audit the records of the contractor as it deems necessary to determine costs or savings. Any claim for an adjustment in price under this provision must be asserted by written notice to the Purchasing Agent within thirty (30) days from the date of receipt of the written order from the Purchasing Agent.

n. DEFAULT: In case of failure to deliver goods or services in accordance with the contract terms and conditions, the Purchasing Agent and End User, after due oral or written notice, may procure them from other sources and hold the contractor responsible for any resulting additional purchase and administrative costs. This remedy shall be in addition to any other remedies which the Purchasing Agent may have.

o. TAXES: Sales to the Purchasing Agent are normally exempt from State sales tax. State sales and use tax certificates of exemption will be issued upon request.

p. ANNOUNCEMENT OF AWARD: Upon the award or the announcement of the decision to award a contract as a result of this solicitation, the Purchasing Agency will notify the awardee(s) electronically and in writing.

q. DRUG-FREE WORKPLACE: Applicable for all contracts over $10,000: During the performance of this contract, the contractor agrees to (i) provide a drug-free workplace for the contractor's employees; (ii) post in conspicuous places, available to employees and applicants for employment, a statement notifying employees that the unlawful manufacture, sale, distribution, dispensation, possession, or use of a controlled substance or marijuana is prohibited in the contractor's workplace and specifying the actions that will be taken against employees for violations of such prohibition; (iii) state in all solicitations or advertisements for employees placed by or on behalf of the contractor that the contractor maintains a drug- free workplace; and (iv) include the provisions of the foregoing clauses in every subcontract or purchase order of over $10,000, so that the provisions will be binding upon each subcontractor or vendor.

For the purposes of this section, “drug-free workplace” means a site for the performance of work done in connection with a specific contract awarded to a contractor, the employees of whom are prohibited from engaging in the unlawful manufacture, sale, distribution, dispensation, possession or use of any controlled substance or marijuana during the performance of the contract.

r. NONDISCRIMINATION OF CONTRACTORS: A bidder, offeror, or contractor shall not be discriminated against in the solicitation or award of this contract because of race, religion, color, sex, national origin, age, disability, faith-based organizational status, any other basis prohibited by state law relating to discrimination in employment or because the bidder or

RFP# WVEMS/OEMS300920 14 of 40 offeror employs ex-offenders unless the state agency, department or institution has made a written determination that employing ex-offenders on the specific contract is not in its best interest. If the award of this contract is made to a faith-based organization and an individual, who applies for or receives goods, services, or disbursements provided pursuant to this contract objects to the religious character of the faith-based organization from which the individual receives or would receive the goods, services, or disbursements, the public body shall offer the individual, within a reasonable period of time after the date of his objection, access to equivalent goods, services, or disbursements from an alternative provider.

s. AVAILABILITY OF FUNDS: It is understood and agreed between the parties herein that the agency shall be bound hereunder only to the extent that the legislature has appropriated funds that are legally available or may hereafter become legally available for the purpose of this agreement.

t. BID PRICE CURRENCY: Unless stated otherwise in the solicitation, Offerors shall state bid/offer prices in US dollars.

u. AUTHORIZATION TO CONDUCT BUSINESS IN THE COMMONWEALTH: A contractor organized as a stock or nonstock corporation, limited liability company, business trust, or limited partnership or registered as a registered limited liability partnership shall be authorized to transact business in the Commonwealth as a domestic or foreign business entity if so required by Title 13.1 or Title 50 of the Code of Virginia or as otherwise required by law. Any business entity described above that enters into a contract with a public body pursuant to the Virginia Public Procurement Act shall not allow its existence to lapse or its certificate of authority or registration to transact business in the Commonwealth, if so required under Title 13.1 or Title 50, to be revoked or cancelled at any time during the term of the contract. A public body may void any contract with a business entity if the business entity fails to remain in compliance with the provisions of this section.

VIII. SPECIAL TERMS AND CONDITIONS:

a. AWARD TO MULTIPLE OFFERORS: Selection may be made of two or more Offerors deemed to be fully qualified and best suited among those submitting proposals on the basis of the evaluation factors included in the Request for Proposals, including price, if so stated in the Request for Proposals. Negotiations shall be conducted with the Offerors so selected. Price shall be considered but will not be the sole determining factor. After negotiations have been conducted with each Offeror so selected, the agency shall select the Offeror which, in its opinion, has made the best proposal, and shall award the contract to that Offeror. The Purchasing Agent and End User reserves the right to make multiple awards as a result of this solicitation. The Purchasing Agent and End User may cancel this Request for Proposals or reject proposals at any time prior to an award, and is not required to furnish a statement of the reasons why a particular proposal was not deemed to be the most advantageous (Code of Virginia, § 2.2-4359D). Should the Purchasing Agent and End User determine in writing and in its sole discretion that only one (1) Offeror is fully qualified, or that one (1) Offeror is clearly more highly qualified than the others under consideration, a contract may be negotiated and awarded to that Offeror. The award document will be a contract incorporating by reference all the requirements, terms and conditions of the solicitation and the contractor’s proposal as negotiated.

b. AUDIT: The contractor shall retain all books, records, and other documents relative to this contract for five (5) years after final payment, or until audited by the Purchasing Agent or End User, whichever is sooner. The Purchasing Agent or End User, its authorized agents,

RFP# WVEMS/OEMS300920 15 of 40 and/or auditors shall have full access to and the right to examine any of said materials during said period.

c. CANCELLATION OF CONTRACT: The Purchasing Agency reserves the right to cancel and terminate any resulting contract, in part or in whole, without penalty, upon 60 days written notice to the contractor. In the event the initial contract period is for more than 12 months, the resulting contract may also be terminated by the contractor, without penalty, after the initial 12 months of the contract period upon 60 days written notice to the other party. Any contract cancellation notice shall not relieve the contractor of the obligation to deliver and/or perform on all outstanding orders issued prior to the effective date of cancellation.

d. RENEWAL OF CONTRACT: This contract may be renewed by the Purchasing Agent and End User for additional periods at the Purchasing Agent and End User’s discretion under the terms and conditions of the original contract. Price increases may be negotiated only at the time of renewal.

The initial contract will be a three (3) year period beginning July 1, 2021 – June 30, 2024 with additional renewals possible at the agency’s discretion.

e. PROPOSAL ACCEPTANCE PERIOD: Any proposal in response to this solicitation shall be valid for 120 days. At the end of the days the proposal may be withdrawn at the written request of the Offeror. If the proposal is not withdrawn at that time it remains in effect until an award is made or the solicitation is canceled.

f. CONFIDENTIALITY OF PERSONALLY IDENTIFIABLE INFORMATION: The contractor assures that information and data obtained as to personal facts and circumstances related to patients or clients will be collected and held confidential, during and following the term of this agreement, and unless disclosure is required pursuant to court order, subpoena or other regulatory authority, will not be divulged without the individual’s and the agency’s written consent and only in accordance with federal law or the Code of Virginia. Contractors who utilize, access, or store personally identifiable information as part of the performance of a contract are required to safeguard this information and immediately notify the agency of any breach or suspected breach in the security of such information. Contractors shall allow the agency to both participate in the investigation of incidents and exercise control over decisions regarding external reporting. Contractors and their employees working on this project may be required to sign a confidentiality statement.

g. PRIME CONTRACTOR RESPONSIBILITIES: The contractor shall be responsible for completely supervising and directing the work under this contract and all subcontractors that he may utilize, using his best skill and attention. Subcontractors who perform work under this contract shall be responsible to the prime contractor. The contractor agrees that he is as fully responsible for the acts and omissions of his subcontractors and of persons employed by them as he is for the acts and omissions of his own employees.

h. QUANTITIES: Quantities set forth in this solicitation are estimates only, and the contractor shall supply at bid prices actual quantities as ordered, regardless of whether such total quantities are more or less than those shown.

i. BEST AND FINAL OFFER (BAFO): At the conclusion of negotiations, the Offeror(s) may be asked to submit in writing, a Best and Final Offer (BAFO). After the BAFO is submitted, no further negotiations shall be conducted with the Offeror(s). The Offeror’s proposal will be rescored to combine and include the information contained in the BAFO. The decision to award will be based on the final evaluation including the BAFO.

RFP# WVEMS/OEMS300920 16 of 40 j. REFERENCES: Offerors shall provide a list of at least three (3) references (EXHIBIT B) where similar goods and/or services have been provided. State-level OEMS references are preferred. Each reference shall include the name of the organization, the complete mailing address, the name of the contact person, and telephone number.

k. SUBCONTRACTS: No portion of the work shall be subcontracted without prior written consent of the Purchasing Agency. In the event that the contractor desires to subcontract some part of the work specified herein, the contractor shall furnish the Purchasing Agency the names, qualifications, and experience of their proposed subcontractors. The contractor shall, however, remain fully liable and responsible for the work to be done by its subcontractor(s) and shall assure compliance with all requirements of the contract.

l. STATE CORPORATION COMMISSION IDENTIFICATION NUMBER: Pursuant to Code of Virginia, §2.2-4311.2 subsection B, a Offeror organized or authorized to transact business in the Commonwealth pursuant to Title 13.1 or Title 50 is required to include in its bid or proposal the identification number issued to it by the State Corporation Commission (SCC). Any Offeror that is not required to be authorized to transact business in the Commonwealth as a foreign business entity under Title 13.1 or Title 50 or as otherwise required by law is required to include in its bid or proposal a statement describing why the Offeror is not required to be so authorized. Indicate the above information on the SCC Form provided. Contractor agrees that the process by which compliance with Titles 13.1 and 50 is checked during the solicitation stage (including without limitation the SCC Form provided) is streamlined and not definitive, and the Commonwealth’s use and acceptance of such form, or its acceptance of Contractor’s statement describing why the Offeror was not legally required to be authorized to transact business in the Commonwealth, shall not be conclusive of the issue and shall not be relied upon by the Contractor as demonstrating compliance.

m. IDENTIFICATION OF PROPOSAL ENVELOPE: If a special envelope is not furnished, or if return in the special envelope is not possible, the signed proposal should be returned in a separate envelope or package, sealed, and identified as follows:

From: Name of Offeror Due Date Time

Street or Box Number RFP No.

City, State, Zip Code RFP Title

DSBSD-certified Micro Business or Small Business No.

Name of Contract/Purchase Officer or Buyer

IX. METHOD OF PAYMENT:

The Contractor will be paid monthly in arrears for services rendered upon receipt of a valid invoice by the Purchasing Agent. The Purchasing Agent will pay the Contractor, after review and approval of the End User, for actual expenditures as a result of services performed under the terms of this Agreement, consistent with approved budget. A valid invoice shall be submitted to the Purchasing Agent by the tenth (or designated date) of the month following the month of service.

RFP# WVEMS/OEMS300920 17 of 40 All invoices from the Contractor shall identify, at a minimum, the following:

a. Contract Number b. Invoice Date c. Services Date d. Detailed Description of Service e. Quantity f. Unit Price g. Total Cost

PRICING SCHEDULE:

Offerors must include a detailed proposed pricing with the Pricing Schedule (EXHIBIT C) with their proposals showing all costs, separated by Core vs. Ancillary Product Features and Capabilities, including services, costs for materials, and equipment costs if applicable including delivery. Additionally, Offeror must include the detailed proposed pricing using their own pricing schedule. Offeror shall either include an Order Sheet or specify the preferred method for ordering when submitting the Pricing Schedule (EXHBIT C) with their proposal.

EXHIBITS:

EXHIBIT A – Proposed Plan and Methodology EXHIBIT B – References EXHIBIT C – Pricing Schedule EXHIBIT D – Functional and Technical Requirements

RFP# WVEMS/OEMS300920 18 of 40 EXHIBIT A - PROPOSED PLAN AND METHODOLOGY

Offerors shall provide a narrative statement and supporting information including, but not limited to the following:

1. Provide a brief overview of their organization/agency that includes specific strengths, accomplishments or characteristics that demonstrate the organization’s suitability for being able to provide a data system to meet the needs outlined in this RFP. Please indicate why you feel Offeror’s product is innovative in the field of EMS Electronic Patient Medical Records.

2. Describe and provide evidence of your organization’s readiness to provide the services within the required timeframes referencing previously similar and successful endeavors. Please indicate Offeror’s capability of fulfilling all requirements outlined in the Statement of Needs. If you plan to meet any of the requirements through use of a cooperative agreement or integration with another vendor, which may be through an alliance with another Offeror, this must be specifically identified, vendor agreement provided, and if cost will be included in the Offeror’s proposal or if the PURCHASING AGENT will have to contract independently.

3. Provide a detailed, written response to each of the requirements outlined in the Statement of Need section. A timeline for the creation, testing, data transition, and implementation of the data system should be included as Attachment B. Please indicate how Offeror would respond to change management requests from both the State and the end user.

4. Please provide evidence or reference previous transitions from other ePCR vendors. Please indicate the ePCR vendor(s), timeline(s), method(s) of delivery and/or how Offeror was provided access to the data being transitioned, technical artifacts provided, overall experience, and any other information you deem to be relevant.

This needs to be completed by the Offeror and submitted with proposal.

RFP# WVEMS/OEMS300920 19 of 40 EXHIBIT B - REFERENCES

Offerors shall provide a list of at least three (3) references where similar goods and/or services have been provided. State-level OEMS references are preferable. Each reference shall include the name of the organization, the complete mailing address, the name of the contact person, and telephone number.

1. Qualification: The vendor must have the capability and capacity in all respects to satisfy fully all of the contractual requirements.

2. Vendor’s Primary Contact: Name Phone: ( )

3. Years in Business: Indicate the length of time you have been in business providing this type of good or service: Years: Months:

4. Vendor Information: eVA Vendor ID or DUNS Number:

5. Indicate below a listing of at least four (4) current or recent accounts, either commercial or governmental, that your company is serving, has serviced, or has provided similar good. Include the length of service and the name, address, and telephone number of the point of contact.

A. Company: Contact: Phone: ( ) email: Project: Dates of Service: $ Value:

B. Company: Contact: Phone: ( ) email: Project: Dates of Service: $ Value:

C. Company: Contact: Phone: ( ) email: Project: Dates of Service: $ Value:

D. Company: Contact: Phone: ( ) email: Project: Dates of Service: $ Value:

I certify the accuracy of this information.

Signed: Title: Date:

This needs to be filled out by the Offeror and submitted with proposal. RFP# WVEMS/OEMS300920 20 of 40 EXHIBIT C - PRICING SCHEDULE

Virginia EMS ePCR System - Software, Services, and Support

Offerors must include a detailed proposed pricing with the Pricing Schedule (EXHIBIT C)with their proposals showing all costs, separated by Core vs. Ancillary Product Features and Capabilities, including services, costs for materials, and equipment costs if applicable including delivery. Additionally, Offeror must include the detailed proposed pricing using their own pricing schedule. Offeror shall either include an Order Sheet or specify the preferred method for ordering when submitting the Pricing Schedule (EXHBIT C) with their proposal.

A. CORE PRODUCT FEATURES AND CAPABILITIES

Unit Extended Major Component Item Qty Labor Price Price Core Product Features and Capabilities Configuration / Installation Source Code, Documentation and Content Escrow Software Development / Customization Testing Project Management Training Travel Documentation Other Software/Tools * Data Migration from Current System Year One (1) Maintenance / Support Year Two (2) Avg Annual Maintenance / Support Year Three (3) Avg Annual Maintenance / Support Year One (1) Application Hosting Year Two (2) Application Hosting Year Three (3) Application Hosting Total Price

RFP# WVEMS/OEMS300920 21 of 40 B. ANCILLARY PRODUCT FEATURES AND CAPABILITIES

Unit Extended Major Component Item Qty Labor Price Price Core Product Features and Capabilities

Configuration / Installation

Source Code, Documentation and Content Escrow Software Development / Customization

Testing

Project Management

Training Travel

Documentation

Other Software/Tools *

Data Migration from Current System Year One (1) Maintenance / Support

Year Two (2) Avg Annual Maintenance / Support

Year Three (3) Avg Annual Maintenance / Support

Year One (1) Application Hosting Year Two (2) Application Hosting

Year Three (3) Application Hosting

Total Price

* Please specify how many user licenses your proposal covers, and the environments covered (production, development, QA, training). Include the type of license, and a break-down per functional or technical product if applicable. Your assumptions on the number and cost of licenses included in your proposal should be clearly stated.

This needs to be filled out by the Offeror and submitted with proposal.

RFP# WVEMS/OEMS300920 22 of 40 EXHIBIT D – FUNCTIONAL AND TECHNICAL REQUIREMENTS

Offerors are to indicate their capability of fulfilling each requirement included within this attachment. Each Offeror’s responses will be reviewed and compared across Offerors in order to determine the best solution for the PURCHASING AGENT and Virginia EMS agencies.

Detailed requirements are presented in questionnaire format to facilitate direct responses and establish accountability regarding delivery of the solution by the Offeror(s). Each requirement is designated as:

M – Mandatory - The proposed solution must satisfy this requirement or the Offeror’s solution will not be considered

H – Highly Desirable – PURCHACING AGENT would like this requirement to be satisfied by the proposed solution but Offeror’s solutions that do not include this requirement will still be considered

D – Desirable - It would be advantageous if the proposed solution satisfied this requirement

O – Optional – The proposed solution does not need to satisfy this requirement for consideration

To respond to each requirement, Offeror is asked to enter, in the space provided in COLUMN A, a code that best corresponds to its intended response for the requirement listed. The acceptable codes for COLUMN A are as follows:

Y - "Yes" - Offeror can fully meet the requirement as documented with its current application or proposed solution. If applicable, Offeror should provide in COLUMN B an explanation of how it will fulfill the requirement. Offeror may also use COLUMN B to cross-reference a detailed explanation included in an Exhibit of its proposal.

F - "Yes, Future" - Offeror will be able to fully meet this requirement in the near future (not longer than six (6) months). Offeror should provide a proposed start date and cross-reference any attached documentation in COLUMN B.

P – “Yes, Partner” - Offeror will be able to fully meet this requirement through a cooperative agreement or integration with another vendor. This may include use of alliances with other Offerors. These instances must be specifically identified, vendor agreement provided, and if cost will be included in the Offeror’s proposal or if the PURCHASING AGENT will have to contract independently. Offer should cross-reference any attached documentation in Column B.

N - "No" – Offeror cannot meet the requirement and has no firm plans to be in the position to meet this need within six (6) months.

RFP# WVEMS/OEMS300920 23 of 40 A. CUSTOMIZABLE OFF-THE-SHELF (COTS) PRODUCT

# Level Requirements A B Is your solution a customizable, commercial off-the-shelf (COTS) product? Is any feature / capability of your 1 M solution is based on proprietary technology? Please describe.

B. ELECTRONIC PATIENT CARE REPORT (EPCR)

# Level Requirements A B Does your solution include an Electronic Patient Care 2 M Report (ePCR)? Can your solution be easily navigated, such that a certified paramedic can complete a Patient Care Report, including 3 M Advanced Life Support documentation, within twenty (20) minuets? Does your solution have a GUI that is customizable at the 4 M agency-level, to allow the program to follow the natural progression of EMS incidents? Does your solution allow for multiple methods of incident 5 M reporting within the same incident (e.g. point and click, pull down menus, narratives)? Does your solution include touchscreen technology, 6 M handwriting recognition, and a signature feature? Does your solution provide a means to store and enter 7 O current population data for use with all health-related reporting tools? Does your solution include populated drop-down fields for geographical elements: Country, State, County, City 8 M and ZIP Code? If yes, please specify if users also have the ability to type in free form text and/or update the selected value. Does your solution auto-populate certain fields based on 9 H what a user selects for another (e.g. City, County, State and Country fields populate when ZIP Code is selected)? Does your solution include drop-down fields for any other 10 M elements (e.g. hospital names)? Does your solution, at minimum, support an additional 10 user-defined data elements (e.g. User ID, Password, Card 11 M Code)? If yes, please specify if this is per agency and/or by OEMS? Does your solution collect metadata elements (e.g. GPS 12 D data, temperature, speed)? Does your solution provide anatomical diagrams for 13 M documenting patient care? Does your solution provide the ability to have a paperless 14 M patient care reporting program?

RFP# WVEMS/OEMS300920 24 of 40 Does your solution provide the ability for agencies to 15 M submit data directly to the state? Does your solution contain an integrated method of 16 M communication between system administrators and end users? Does your solution provide a simple way to search for a 17 M record (e.g. one-step lookup, using only an Incident ID)? Does your solution automatically map AIS codes to a 18 D specific body region? Does your solution link a patient’s previous EMS 19 D encounter(s) to current EMS call, so provider can see medical HX, etc.? Does your solution include pre-entry questions to limit 20 D data entry? Will your solution include further software enhancements, such as: Live audio recording/dictation/speech-to-text, 21 D integration with mobile technologies (e.g. smart watch integration), or integration with medical devices (e.g. cardiac monitor)? Does your ePCR solution include any pertinent features / 22 O capabilities, not already addressed above? If yes, please describe. Does your solution offer options for documenting 23 O telehealth visits? If so, provide a breakdown of what elements can be reported.

C. ACCESSIBILITY

# Level Requirements A B Are all features in your solution web-based? If not, please 24 M describe. Is your solution compatible with multiple web browsers 25 M (e.g. MS Internet Explorer, Mozilla's Firefox, Chrome)? Does your solution operate efficiently with all levels and 26 M types of internet connections (e.g. dial up, broadband)? 27 M Is your solution offline capable? 28 M Is your solution PC, tablet, and smart-phone compatible? 29 M Does your solution run on Windows? 30 M Does your solution run on Android? 31 M Does your solution run on iOS? 32 H Does your solution run on Mac?

D. EMS HOSPITAL DASHBOARD

# Level Requirements A B Does your solution include a web-based EMS Hospital 33 M Dashboard? Does your solution enable EMS-Hospital record 34 M integration?

RFP# WVEMS/OEMS300920 25 of 40 Does your solution include a Patient Lookup feature that 35 M allows a hospital to access the ePCR of any patient brought to their facility? Is your solution capable of receiving, processing, and 36 M making the patient records available in real-time? If yes, please describe how you define real-time. Does your solution provide hospital staff the ability to 37 M flag an EMS incident for QA review? Does your solution allow for bi-directional 38 M communication between the EMS agency and receiving hospital? If yes, describe. Does your solution include a way for hospital staff to 39 D report when a patient leaves the hospital? Does your EMS Hospital Dashboard solution include any 40 O pertinent features / capabilities, not already addressed above? If yes, please describe.

E. QUALITY ASSURANCE (QA) / QUALITY IMPROVEMENT (QI) MONITORING

# Level Requirements A B 41 M Does your solution include a QA/QI module? Does your solution provide the ability for a specified 42 M group of users to view the QA/QI Dashboard upon system login? Does your solution include QA/QI functionalities that 43 M interact with individual EMS patient care records? Does your solution allow an agency to design and 44 H redesign their own QA/QI projects? Does your solution allow an agency to customize their 45 M own QA/QI reports? Does your solution provide in-system communication 46 M between administrators, medical directors, and EMS providers? Does your solution allow users to document pertinent 47 M QA/QI information (e.g. actions taken, loop closure)? Does your solution provide the ability to view and 48 M manage QA-flagged patient records marked by hospital staff? Does your QA/QI solution include any pertinent features / 49 O capabilities, not already addressed above? If yes, please describe.

F. DATA QUALITY / VALIDATION

# Level Requirements A B Does your solution include an integrated method to ensure 50 M data submitted by an EMS agency or hospital is valid?

RFP# WVEMS/OEMS300920 26 of 40 Does your solution pass all collected/submitted EMS records (whether from the state provided features, third party vendors, or from non-state licensed users of the 51 M system) through the same data validation processes (e.g. routines processes, validations, XSD, Schematron rules, application specific validation rules, and other data quality monitoring tools)? Does your solution pass all collected/submitted hospital records (whether from the state provided features, third party vendors, or from non-state licensed users of the 52 M system) through the same data validation processes (e.g. routines processes, validations, XSD, Schematron rules, application specific validation rules, and other data quality monitoring tools)? Can your solution generate a detailed State Schematron 53 M File? Does your solution provide the ability to view a list of 54 M validation rules that were not included in the Schematron file, at the time the file was generated? Does your solution provide multiple checks/edits and 55 M edits on data fields to ensure data integrity? Does your solution utilize probabilistic back-end data 56 M linkages to prevent the duplication of pre-hospital EMS data by multiple agencies? Does your solution prevent record duplication in instances where an incomplete ePCR is submitted and then a 57 M subsequent (final) copy is submitted? If yes, please indicate if the record is overwritten. Does your solution provide the ability to generate a 58 M detailed list of all records with data quality rule violations? With your solution, can multiple agencies to 59 O simultaneously edit an ePCR without creating duplicate records? Does your solution provide the ability to prevent submission of “impossible” responses (e.g. year of birth 60 M listed as 2049), such as prompting user to fix it data before they can submit the record? If yes, please describe. With your solution, can audit reports automatically track 61 M failed submissions and the resubmission (or lack of) of the failed/rejected submissions? Does your solution have the ability to automatically 62 M reject/block non-standard or custom codes from submission? Does your solution provide the ability to search for 63 H import/export errors? Does your solution provide the ability to create data 64 D quality reports that can be system generated and emailed to individuals? Does your solution provide the ability to create a system- 65 D generated alert that is emailed to an agency when the agency's data quality falls below a preset level?

RFP# WVEMS/OEMS300920 27 of 40 Is your solution capable of limiting the values of a drop- 66 D down field based on value selected in another field? Does your solution provide the ability to exclude rules 67 M from Schematron publication? Does your solution provide a business-friendly method to 68 M create rules, rather the just code-based? If yes, describe. Does your solution include any pertinent data quality / 69 O validation features and/or capabilities, not already addressed above? If yes, please describe.

G. DATA ANALYTICS & REPORTING TOOL

# Level Requirements A B Does your solution include a Data Analytics and 70 M Reporting Module? Does your solution provide access to source data and 71 M data components? Does your solution access/display EMS data in real- 72 M time? Does your solution provide the ability to perform 73 M transactional (ad-hoc) queries? Does your solution provide the ability to schedule/send 74 M developed reports to end user(s) within system? Does your solution provide the ability to generate a state 75 M data set comparable to NEMSIS v3 State Data Builder? Does your solution provide the ability to develop 76 M customized, canned reports (without coding or having to contact vendor)? Does your solution allow for dynamic statistical 77 M analysis? Does your solution include an analytical tabular and data 78 M cube query tool? Does your solution include configurable application 79 H dashboards? 80 M Does your solution produce drill-down reports? Is your solution capable of multi-year, multi-dimensional 81 M queries? 82 H Does your solution include prebuilt reports? Does your solution include automatic / integrated audit 83 M reporting to track failed submissions and failure to resubmit records? Does your solution include automatic / integrated data 84 M quality reports that allow for blocking of custom/nonstandard data submissions? Does your solution quickly/easily export raw data into a 85 M delimited file that can be read by statistical software (e.g. SPSS, SAS, Tableau)? Does your solution include integration capabilities (e.g. 86 M external application API integrations to products, such as Oracle, to both push and pull info)?

RFP# WVEMS/OEMS300920 28 of 40 Does your solution include machine learning capabilities (e.g. ability for vendor software or external software to 87 D provide recommendations at various levels to State Admins, identification to staff of predictors and classifiers)? Does your solution provide the ability to export any data 88 M parameter to CSV? Does your solution provide the ability to export EMS 89 H data to billing companies? 90 H Does your solution provide the ability to export a map? Does your solution provide the ability to do key word 91 M searches in narratives? Does your solution provide the ability to convert one-to- 92 M many fields to separate columns instead of becoming multiple rows of data for the same patient? Does your solution provide the ability to hide empty 93 D values when printing a report? Does your solution provide the ability to select multiple options within a single dropdown menu? (Example: User 94 H selects several codes within the ICD-10 Codes filter to display on the report) Does your solution provide the ability to copy/share 95 M report designs between agencies using the internal reporting system? Does your solution provide the ability to copy/share 96 H report designs between agencies using different systems? Does your solution provide the ability to select multiple 97 H reports (e.g. QA, Hospital, Billing)? Does your solution provide the ability to hyperlink the 98 M incident ID to the incident record? Does your solution provide the ability to use SQL 99 M (Structured Query Language) as a standard method for requesting information from the system? 100 H Does your solution display data geographically? Does your solution include built-in community 101 H epidemiology reporting? Does your solution include Key Performance Indicators 102 M (KPI) reporting developed from the EMS Compass Initiative?

H. STATE TRAUMA REGISTRY (STR)

# Level Requirements A B Does your solution include a State Trauma Registry 103 M (STR)? 104 M Does your solution enable EMS-STR record integration? 105 Does your solution prevent STR record IDs from M overlapping with EMS Incident record IDs? 106 Does your solution allow users to choose whether AIS D codes are displayed in list format or as separate columns?

RFP# WVEMS/OEMS300920 29 of 40 107 Does your solution clearly indicate what date a hospital should use to populate fields such as ‘Discharge Date’ D (e.g. date that the discharge order was written, date the patient was discharged)? 108 Does your STR solution include any pertinent features / O capabilities, not already addressed above? If yes, please describe.

I. ADDITIONAL FEATURES / CAPABILITIES

# Level Requirements A B Does your solution include a Line of Duty Injuries / 109 M Deaths Reporting Module (similar to the NFIRS’ casualty module)? If yes, describe. Does your solution include a way to capture and report on 110 M Provider Mental Health Capabilities? If yes, describe. Does your solution include a Fire Services Electronic 111 O Reporting System and Fire Inspections module? If yes, describe. Does your solution include any other registries (e.g. 112 D Stroke Registry, Cardiac Arrest Registry)? If yes, describe. Does your solution include a Patient Tracking Tool (aka 113 D Emergency Preparedness)? If yes, describe. Does your solution include an Inventory Management 114 D module? If yes, describe. Does your solution include a Vehicle Maintenance 115 D Management module? If yes, describe. Does your solution include a Licensure/Certification & 116 H Inspections module? If yes, describe. Does your solution include an Alert Manager Module? If yes, describe. Please also indicate if the system provides 117 D users the ability to create custom alerts on any field within the system. Does your solution include Computer Aided Dispatch 118 H (CAD) integration? If yes, describe. Does your solution include EMS Billing Integrations? If 119 H yes, describe. Does your solution provide a public facing de-identifie d 120 D self-service database to allow public users to view data? If yes, describe. Does your solution include any pertinent features / 121 O capabilities, not already addressed elsewhere within this document? If yes, describe.

RFP# WVEMS/OEMS300920 30 of 40 J. ADMINISTRATION TOOL

# Level Requirements A B Does your solution provide a fully functional administration tool for the features application that allows 122 M the OEMS to manage/maintain the application for the statewide EMS community? Does your solution provide an integrated method of 123 M communication between system administrators Features and end users within Virginia? Does your solution allow agencies to create supplemental 124 M questions (and to run reports against any of these items when documented)? Does your solution provide the ability to 125 M activate/inactivate (required/nullable) all active NEMSIS data dictionary elements? Does your solution’s admin tool allow the OEMS to 126 M manage/maintain the app for statewide EMS community?

Does your solution provide the ability to deactivate user 127 M accounts by agency, as well as for the entire system? Does your solution provide the ability to merge multiple 128 M user accounts for a single individual into a single user account? Does your solution provide the ability to post dashboard notices? If yes, does the system provide the ability to 129 M choose if the notice is visible to the entire system (all users), individual agencies, or individual permission groups? Does your solution provide the ability to assign an 130 M expiration date to a dashboard notice, so the notice will auto close? Does your solution provide the ability for agencies to 131 M deactivate facilities they have never transported to? Does your solution provide the ability to define which procedures can be performed per certification level? If 132 M yes, can this be done at the system level and modified by individual agencies? Does your solution provide the ability for the system to email administrators (or any other permission level 133 M group) when their accounts are within 10 to 15 days of locking?

K. TECHNICAL REQUIREMENTS

# Level Requirements A B I. STATE EMS DATA REPOSITORY Does your solution send data quickly, easily, and securely 134 M to a central EMS database for collection and reporting in real time capacity?

RFP# WVEMS/OEMS300920 31 of 40 Is your solution Cloud-based or a Microsoft SQL relational 135 M database? Do your services include the responsibility of maintaining 136 M the application? VDH owns Database. Does your solution provide development and testing 137 M environments? Does your solution provide the ability to operate on both 138 M production servers and querying servers in order to minimize server slow down during peak usage times? Will Microsoft Server and Microsoft SQL be utilized for 139 M the operating systems? Will VDH system administrator have access to the 140 M application, such as the reporting tool and others upon request? Does your Web-based application provide a relational database connectivity that will allow for robust analysis of data including predetermined reports, but also allow for 141 M detailed statistical analysis and querying of data for future or novel areas of interest which would support EMS in improving the delivery of pre-hospital care, improved funding, or resources allocation? Does your solution provide the ability to manage basic 142 M data transactions and queries that are handled by most relational database management systems (RDBMS)? Will your services take EMS, field EMS, trauma registry, licensure/certification, and inspections products and 143 M implement and maintain them with the most current cross- database synchronization features available? Per intent of the state, is your certification and education data from its primary Oracle database synchronized? Will 144 M the state select existing training elements to be synchronized with the via web services? Does your solution provide the OEMS with a list of all tables and their data elements and values for all tables installed on state servers to include service tables, user account tables etc. with the application? Does the list 145 M include all tables, elements, and values with the database and not limited to the NEMSIS elements? Will this include all products/modules purchased? Will this requirement be met upon execution of the contract between the contractor and the OEMS annually? Does the cross-database synchronization link to State/Field 146 M EMS, Hospital, Trauma Registry, Licensure/Certification, and Inspections applications?

RFP# WVEMS/OEMS300920 32 of 40 ii. SECURITY Commonwealth of Virginia, Information Technology Resource Management Standard Section 501-09 (ITRi\4 Standard SEC5O1-09) or its current version. Will the contractor be responsible for utilizing the most current ITRM Standard which can be found on-line at 147 H www.vita.virginia.gov and VDH SEC IT Security Policy VDH SEC Firewall and VPN Policy VDH SEC Security and Architectural Review Policy, and 45 CFR Department of Health and Human Services -Parts 160, 162, and 164 Health Insurance Reform: Security Standards: Final Rule? Will your company provide and keep current contact information for its staff person considered its HIPAA 148 M security officer? Will this person be available to respond to security specific items? Will the application meet or exceed all applicable standards for privacy and security including, but not limited to HIPAA? Will the system be HIPAA compliant in both privacy rules and accepted data formats? Will 149 M HIPAA compliance be maintained by adding future requirements that become part of the HIPAA privacy rule? Also, will procedures for safeguarding the system from unauthorized modification to the application programs and the data be contained in the application? Does your solution provide a complete audit trail of 150 M information for every transaction and specify who has accessed the patient’s record? 151 M Is your solution capable of providing l28-bit encryption? 152 M Is your solution built on current J2EE standards? Does your solution provide the ability to setup permission groups so that a permission group can be customized by 153 D individual users (eliminates the need to maintain many different types of permission groups)? Does your solution provide the ability for a single user to have one set of credentials but access multiple agencies 154 D (Helps when one (1) provider works at two or more agencies)? Does your solution provide the ability to set password 155 D requirements that meet or exceed state security regulations? Does your solution include procedures to prevent 156 M unauthorized modification to the application and underlying data? 157 M Is your solution HIPPA compliant? Does your solution capture a complete list of users that 158 M have accessed a patient's record? Does your solution have an audit trail of information that 159 M is recorded for every transaction? Does your solution have a role-based security permission 160 M for specific modules/features be configured?

RFP# WVEMS/OEMS300920 33 of 40 iii. GENERAL Can the database accommodate NEMSIS v2, v3.3.4, 161 M v3.4.0, and (for the future) v3.5.0 data? Does your solution include audit reports to track system 162 M performance? Will e-response agency identifiers be unique throughout 163 M the entire system, not just unique within an agency? Will unique identifiers be made each time a patient is 164 M transferred in VSTR be required? Will VSTR create a unique system-generated ID field for 165 M all records? Will your solution crash due to browser cache issues 166 M without any warning? Will users have the ability to manually lock user accounts 167 D (can only activate/deactivate)? In remote areas, will your system’s connection to the Internet go up and down causing the software hang up 168 D (Systems needs a way to disable the internet connection without adjusting switches/settings on hardware)? Does your solution limit the number of EMS records that can be printed at one time? Or does it, for example, is there 169 D a cap on the number of records per batch that can be printed? In the Registry, when older forms are no longer used and are inactivated, will records be created using those forms 170 M are no longer available to be viewed? Records should not be form specific. Will adding a lot of filters to a report in your solution 171 D prevent it from being able to run?

172 D Will records have hospital codes that do not match the hospital name entered? Will a warning feature appear if server memory or drive 173 D space limits are within 2% of max (may be more hardware related than software, but it does not hurt to check).? Will an up-to-date, comprehensive list of the data elements 174 D that contain our data (Better yet, do not show us data elements that are not used to hold our data) be composed? Is there a fast and easy way to export raw data into a 175 D delimited file that can be read by statistical software (SPSS, SAS, etc.)? 176 D Are there “Site Down” notifications? Does your solution provide the ability to access a records XML data directly from the audit page of a record (saves 177 D time from having to search individual imports looking for a specific record? Does your solution provide the ability to find unposted records on the cloud and post those when necessary (This 178 D helps when a device is damaged, or the user does something that causes records to be lost from the local device)?

RFP# WVEMS/OEMS300920 34 of 40 Does your solution provide the ability for hospitals to view 179 D EMS records from multiple sources? Does your solution provide the ability to transfer records between agencies with the system and from external 180 M agency (e.g. mutual aid assistance, air medical handoff, agency-to-agency handoff)? Does your solution provide the ability to import CAD 181 M data?

L. CUSTOMIZATION

# Level Requirements A B i. INCIDENT LIST VIEWS Does your solution provide the ability to display different 182 D columns? Does your solution provide the ability to display different 183 D filters? Does your solution provide the ability to add logic to a view so that only specific types of records appear (such 184 D as narrowing down the list of incidents to show only records where Narcan was given)? Does your solution enable users to share a customized 185 D incident list view with individuals, individual agencies, and/or make them available system-wide? ii. FORMS MANAGER Does your solution provide a visual method for form 186 H design? Does your solution provide the ability to set defaults 187 D within a form? Does your solution provide the ability to set visibility 188 D rules on a form? Does your solution provide the ability to relabel fields 189 D that appear on a form? Does your solution provide the ability to copy/share 190 D forms between agencies using the internal system? Does your solution provide the ability to share forms 191 D between agencies using different systems? Does your solution provide the ability to have multiple 192 D forms? Does your solution provide the ability to search for fields 193 D (by name or element)? Does your solution provide the ability to create individual checklist such as (but not limited to) Vehicle checklist to 194 D make sure vehicles are response ready, Supply checklist, Equipment checklist, etc.? Does your solution provide the ability to customize 195 M dropdown field values? Does your solution provide the ability for agencies to set 196 H “Favorite Postal Codes”, so providers do not have to search through all state postal codes?

RFP# WVEMS/OEMS300920 35 of 40 Does your solution provide the ability to define which medications can be given by certification level? If yes, 203 D describe if it can be done at the system-level and modified by individual agencies as needed? Does your solution provide the ability for worksheets (a method of documenting additional items not part of a 204 D state or national standard) to be created at either the system-level or individual agency-level? Does your solution provide the ability to create 205 D worksheets that can be added to the incident form and printed out on the PCR?

M. IMPLEMENTATION ASSISTANCE

# Level Requirements A B i. GENERAL Does your solution provide an implementation plan for 206 M installation, testing and major revisions? Does your solution include standard data migration 207 M services? 208 M Will mapping for other programs be provided? ii. SYSTEM SETUP Does your solution provide the management and execution of all tasks related to setting up your system 209 M (e.g. integration, requirements)? If yes, please provide details. As a part of system setup, does your solution provide a list of data or data file specifications required for any and all initial platform seed loads, historical data loads, pre-populated lists? 210 M

If yes, please provide these items, as well as any other initial data requirements or import files your platform requires or has available. Does your solution provide the importation of EMS Agency information (details can be provided) with 211 M possible import from current database and/or LCR? (Note: Structure of how Agencies are setup: State – Region – County – Agency) Does your solution include system setup for individual 212 M users (e.g. providers)? Does your solution include the setup of permission 213 M groups? Will your system come preloaded with ZIP Codes per 214 M the NEMSIS standard? Does your solution provide the setup of facilities (e.g. 215 M Code, Type, Address, Contact)? Will your solution include system setup for ePCR Entry forms? If yes, will any customization be performed to 216 M ensure everything that Agencies need to collect is represented and flows well?

RFP# WVEMS/OEMS300920 36 of 40 Will your solution include system setup for ePCR Print forms? If yes, will any customization be performed to 217 M ensure everything that Agencies need to have represented is included? Does your solution provide the setup of security 218 M settings (e.g. password length, strength, timeouts)? Does your solution provide the setup of web service 219 M integrations (e.g. imports from agency systems, exports to outside groups such as NEMSIS)? Does your solution provide the setup of all currently 220 M active data set values, per element? Does your solution provide the setup of all required 221 M ICD-10 codes? Does your solution provide the setup of all required 222 M SnoMed codes? Does your solution provide the setup of all required 223 M RxNorm codes? 224 M Does your solution provide the setup of Signatures? Does your solution provide the setup of supplemental 225 H questions currently used by Agencies? Does your solution provide server setup and sizing, 226 M based on current utilization? If yes, please provide details. Does your solution provide custom report set up to 227 H replicate those actively used today? Does your solution provide setup for the EKG import 228 M process? Does your solution include the setup of validation rules, 229 M to mimic what is in place today? Will your solution include the setup of over-system access for all agencies? If yes, please specify what will 230 M and will not be supported (e.g. website links, browser requirements, hardware requirement, printer requirements). iii. SCHEMATRON SETUP Does your solution include Schematron setup? If yes, 231 M please describe what type of assistance this does and does not include. Does your solution include a review of all active 232 M Schematron rules? As a part of the Schematron setup, does your solution include suggesting, implementing, and testing updates 233 M to current rules to increase their effectiveness? If yes, please describe how you have helped clients with this in the past. As a part of the Schematron setup, will your solution help to identify new Schematron rules that can be put in 234 M place, as well as provide the implementation and testing of these new rules? If yes, please describe this process and how you have helped clients in the past.

RFP# WVEMS/OEMS300920 37 of 40 As a part of your solution, will your team write, implement, and test rules to reject records to address any data quality issues that have been identified but do not yet have Schematron rules to reject them?

Examples include (but are not limited to): (1) making

sure that incorrect names or codes (e.g. state, county, country, facilities, scene address) cannot be submitted; 235 M (2) addressing values that are crossed out; (3) preventing handling scene address information to make it more accurate (e.g. prevention of incorrect names and codes.

If yes, please describe if you have assisted other clients with this in the past, specifying if you have addressed the specific data quality issues listed as examples above. iv. EXTERNAL ACCESS SETUP 236 H Does your solution provide CAD import setup? Does your solution provide the setup of external access for hospitals? If yes, provide information about 237 M performing this service in the past (e.g. What was needed? How will it work? Any system requirements?). When setting up external access for hospitals, some may need to make firewall and security adjustments. 238 M Does your solution include IT support to address the technical nature of these types of needs? If yes, provide details. Does your solution provide the setup of billing company integrations to enable (a subset of) individual 239 H agencies to export to their billing company using NEMSIS v3.3.4 and v3.4 standards? Does your solution include setup of the offline incident 240 M creation process, which varies per vendor (e.g. via web site, via stand-alone product that must be installed)?

N. ADMINISTRATIVE & END USER TRAINING

# Level Requirements A B Does your solution provide training of both internal and 241 M external users, structured to the needs of various groups? 242 M Will training be provided by Offeror? 243 M Is onsite and webinar training provided? Does your solution include training materials for each 244 M application? If yes, please provide these materials (preferably links to access each source online). Will a training plan detailing how education will be 245 M provided to all levels of statewide users be provided? Will detailed hands-on training exercise for each 246 M application be provided?

RFP# WVEMS/OEMS300920 38 of 40 Will there be comprehensive online help that includes 247 M built-in instructional videos? Are periodic follow-ups and update training included 248 D when a new release or version of any application is installed?

O. TECHNICAL SUPPORT & SYSTEM MAINTENANCE

# Level Requirements A B Does your solution provide enhanced after go-live 249 M support for a minimum of 30 days (preferably 90 days)? If yes, provide details. Will the contractor provide contact information for emergency 24/7/365 application support? Is this level of support confined to system outages, poor server performance affecting the ePCR, CAD, billing functions 250 M of the application, and data breaches? Will a telephone number or on-call paging system be available, and a live response made within 30 minutes? Is this criterion not dependent upon a trigger from a support product i.e. entering a ticket? Does your solution provide user support provided to state system administrators I coordinators? Does your solution 251 M provide support through advising the process I features available or participate in screen sharing technology to guide state staff as expected? Will your solution provide end user support to Virginia system users on matters relating to application errors, 252 M CAD and billing integrations, and web-services setups? Will other issues be referred to state staff using support contact information? Will maintenance support be included in the new versions, replacement applications, business upgrades, 253 M security updates, and patches that are issued during the term of the contract? Does your solution include an on-line help user guide 254 M that is implemented with the system(s)? Does the application provide easy to use help 255 M tools/dictionaries with a key word search capability (wild card searches are not considered user friendly)? Can Authorized Users perform self-maintenance to keep 256 M their user accounts and profiles up to date? Will responses be prompted to reported issues with 257 M routine updates? 258 D Is there a measure of consistency in support personnel? Will updates by Offeror need to be discussed prior to 259 D making changes? 260 D Will responses be prompt? Will progress on tickets be updated throughout being 261 D fixed?

RFP# WVEMS/OEMS300920 39 of 40 Will the manage application have settings that optimize 262 D speed and performance? 263 M Will there be emergency 24/7/365 application support? 264 M Will end-users have support for application errors? 265 M Are User Guides provided for each application?

266 M Will there be upgrades/updates/patches included during term of contract issued? Will a 3rd party be established for connections for 267 M vendors and data exchange with the NEMSIS repository? Manage application-specific, non-operating system 268 M programs? Will there be easy-to-use help tools / dictionary (ability 269 M to search by key word)? 270 M Is user support provided for state staff? Does your solution administrators have the ability to 271 M perform self-maintenance to keep user profiles current?

P. COMPLIANCE

# Level Requirements A B Is your solution NEMSIS v3.4 Compliant for State 272 M Systems? Is your solution NEMSIS v3.4 Compliant Software for 273 M EMS Systems? Is NEMSIS v3.5 Compliance actively being pursued? If 274 M yes, provide more information regarding timeline. 275 H Is your solution FedRAMP Compliant?

This needs to be filled out by the Offeror and submitted with proposal.

RFP# WVEMS/OEMS300920 40 of 40 Appendix

F April 2020 May 2020 June 2020 July 2020 August 2020 September 2020 Submissions up to Average Validity score last Hospital Name OEMS ID Validation Validation Validation Validation Validation Validation date? (last 6 months) 6 months Alleghany - LewisGale Hospital 2 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Augusta Health 92 80.91 83.22 81.53 85.37 90.98 91.31 Yes 85.55 Bath County Community Hospital 4 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Bedford County Memorial Hospital 5 Failed to submit Failed to submit Failed to submit 100.00 100.00 99.92 Yes 99.97 BelleHarbour Free Standing ED 207 100.00 96.00 Failed to submit 100.00 100.00 96.67 Yes 98.53 Bon Secours Short Pump Free Standing ED 372 Failed to submit Failed to submit 100.00 99.50 96.67 100.00 Yes 99.04 Bon Secours Westchester Emergency Center 210 Failed to submit Failed to submit 100.00 100.00 Failed to submit 100.00 Yes 100.00 Buchanan General Hospital 7 95.00 Failed to submit Failed to submit Failed to submit Failed to submit 90.00 Yes 92.50 Careplex Hospital 22 97.19 97.90 Failed to submit Failed to submit Failed to submit Failed to submit No 97.54 Cave Spring Free Standing ED 370 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Chesapeake General Hospital 8 96.56 100.00 Failed to submit 77.00 97.61 99.87 Yes 94.21 Clinch Valley Medical Center 25 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Community Memorial Health Center 13 100.00 100.00 99.75 100.00 100.00 99.55 Yes 99.88 Culpeper Regional Hospital 14 100.00 100.00 100.00 100.00 100.00 100.00 Yes 100.00 Danville SOVAH Health 44 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit DePaul Medical Center 15 Failed to submit Failed to submit Failed to submit 99.75 99.67 100.00 Yes 99.81 Dickenson Community Hospital 112 Failed to submit Failed to submit Failed to submit Failed to submit 100.00 Failed to submit No 100.00 Fauquier Hospital 17 100.00 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No 100.00 Franklin Memorial Hospital 18 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Giles Community Hospital 19 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Grant Memorial Hospital 329 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Greenbrier Valley Medical Center 367 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Gretna Medical Center 218 99.83 97.38 99.92 100.00 99.23 100.00 Yes 99.40 Halifax Regional Hospital 21 100.00 100.00 100.00 100.00 100.00 100.00 Yes 100.00 Hanover Emergency Center 217 Failed to submit Failed to submit Failed to submit Failed to submit 100.00 Failed to submit No 100.00 Harbour View Health Center 201 Failed to submit Failed to submit Failed to submit Failed to submit 100.00 100.00 Yes 100.00 Haymarket Medical Center ED 216 100.00 100.00 100.00 99.33 100.00 99.95 Yes 99.88 Henrico Doctors' Hospital - Parham 26 100.00 99.75 Failed to submit 100.00 99.93 Failed to submit No 99.92 Independence Hospital 24 100.00 100.00 100.00 100.00 100.00 100.00 Yes 100.00 Inova Alexandria Hospital 1 97.35 100.00 95.00 91.50 98.13 97.44 Yes 96.57 Inova Emergency Room - Fairfax 202 100.00 Failed to submit Failed to submit Failed to submit 96.60 95.14 Yes 97.25 Inova Emergency Room - Leesburg 203 100.00 Failed to submit Failed to submit Failed to submit 100.00 99.41 Yes 99.80 Inova Emergency Room - Reston/Herndon 204 97.50 Failed to submit Failed to submit Failed to submit Failed to submit 100.00 No 98.75 Inova Fair Oaks Hospital 11 99.94 98.33 100.00 100.00 94.43 98.47 Yes 98.53 Inova HealthPlex Emergency Room - Ashburn 364 100.00 Failed to submit Failed to submit Failed to submit 100.00 96.67 Yes 98.89 Inova HealthPlex Emergency Room - Franconia/Springfield 205 97.57 Failed to submit Failed to submit Failed to submit 97.88 96.60 Yes 97.35 Inova HealthPlex Emergency Room - Lorton 213 100.00 Failed to submit Failed to submit Failed to submit 93.63 93.50 Yes 95.71 Inova Mount Vernon Hospital 47 96.91 100.00 83.00 100.00 98.71 98.52 Yes 96.19 John Randolph Medical Center 28 Failed to submit Failed to submit Failed to submit Failed to submit 100.00 Failed to submit No 100.00 Johnston Memorial Hospital 29 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Lake Ridge Medical Campus 214 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Leigh Hospital 33 99.58 99.57 99.62 Failed to submit Failed to submit Failed to submit No 99.59 LewisGale Medical Center 34 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Lonesome Pine Hospital 35 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Martha Jefferson Free Standing ED 206 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Martha Jefferson Hospital 39 95.47 96.52 94.95 96.83 97.36 98.66 Yes 96.63 Martinsville SOVAH Health 45 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Mary Immaculate Hospital 40 Failed to submit Failed to submit 100.00 100.00 100.00 100.00 Yes 100.00 Mary Washington (Lee's Hill) Free Standing ED 117 Failed to submit 100.00 Failed to submit 88.67 Failed to submit 84.00 No 90.89 Maryview Medical Center 42 Failed to submit Failed to submit Failed to submit 92.00 99.80 90.88 No 94.23 Memorial Regional Medical Center 97 Failed to submit 99.83 100.00 100.00 97.76 97.94 Yes 99.11 Mountain View Regional Medical Center 115 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Norton Community Hospital 54 100.00 100.00 99.95 98.95 99.52 100.00 Yes 99.74 Obici Hospital 37 99.89 99.16 99.06 97.50 98.78 99.38 Yes 98.96 Page Memorial Hospital 55 99.00 98.57 100.00 98.33 97.14 97.78 Yes 98.47 Port Warwick II Free Standing ED 208 100.00 Failed to submit 100.00 100.00 Failed to submit 89.00 No 97.25 Prince William Hospital 59 99.63 99.91 99.96 100.00 99.19 98.22 Yes 99.48 Princess Anne Hospital 209 99.64 98.75 Failed to submit Failed to submit 100.00 Failed to submit No 99.46 Pulaski - LewisGale Hospital 60 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Rappahannock General Hospital 63 Failed to submit Failed to submit 100.00 97.86 Failed to submit 94.17 Yes 97.34 Retreat Hospital 64 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Richmond Community Hospital 96 Failed to submit Failed to submit 100.00 Failed to submit 100.00 96.50 Yes 98.83 Riverside Doctors Hospital 120 Failed to submit 100.00 100.00 100.00 100.00 100.00 No 100.00 Riverside Shore Memorial Hospital 368 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Riverside Tappahannock Hospital 80 Failed to submit Failed to submit Failed to submit Failed to submit 75.50 Failed to submit No 75.50 Rockingham Memorial Hospital 69 98.08 97.73 99.63 98.51 98.28 96.78 Yes 98.17 Russell County Medical Center 70 98.75 100.00 100.00 100.00 100.00 100.00 Yes 99.79 Shenandoah County Memorial Hospital 73 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Smyth County Community Hospital 74 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Southampton Memorial Hospital 75 100.00 100.00 100.00 100.00 99.38 90.17 Yes 98.26 Southern VA Regional Medical Center 20 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Southside Community Hospital 76 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit 99.91 Yes 99.91 Southside Emergency Care Center in Colonial Heights 373 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit 92.25 Yes 92.25 Spotsylvania Regional Medical Center 118 95.00 95.00 89.00 Failed to submit Failed to submit 95.00 Yes 93.50 St. Francis Medical Center 114 Failed to submit 93.20 97.88 98.17 94.50 96.83 Yes 96.12 St. Mary's Hospital Richmond 72 99.82 97.56 97.26 98.70 97.50 97.52 Yes 98.06 Stafford Hospital Center 116 100.00 96.50 91.67 91.40 86.67 95.69 Yes 93.65 Stone Spring Hospital Center 215 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Stonewall Jackson Hospital 77 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Swift Creek Emergency Room 121 Failed to submit Failed to submit Failed to submit Failed to submit 90.00 Failed to submit No 90.00 Tazewell Community Hospital 79 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit TriCities Emergency Center 369 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Twin County Regional Hospital 81 99.75 99.54 99.41 99.00 99.29 99.58 Yes 99.43 Virginia Baptist Hospital 83 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Virginia Hospital Center (Arlington) 3 Failed to submit 99.00 Failed to submit Failed to submit Failed to submit 100.00 Yes 99.50 Walter Reed Hospital (Gloucester VA) 85 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Warren Memorial Hospital 86 100.00 100.00 97.53 100.00 100.00 98.04 Yes 99.26 West Creek Emergency Center 211 Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit Failed to submit No Failed to submit Williamsburg Regional Medical Center 88 98.75 99.71 100.00 Failed to submit Failed to submit Failed to submit No 99.49 Wythe County Community Hospital 91 74.43 76.00 70.44 70.94 74.17 68.27 Yes 72.38

Updated 9.30.2020 Updated 10.1.2020 Updated 10.1.2020 Updated 10.1.2020 Updated 10.1.2020 Updated 11.5.2020

Green/Acceptable 98.00 to 100.00 Yellow/Below Avg 95.00 to 97.99 Red/Poor 0.00 to 94.99 Failed to submit