2019 Oregon Rural & Frontier Emergency Medical Services LISTENING TOUR IMPROVING THE QUALITY, AVAILABILITY AND ACCESSIBILITY OF HEALTH CARE FOR RURAL OREGONIANS The Oregon Office of Rural Health (ORH) coordinated a Listening Tour of licensed rural and frontier Emergency Medical Services (EMS) agencies to discuss operational sustainability within a rapidly changing health care delivery model. This report is a summary overview of the issues heard during the Listening Tour, including agency-reported effective practices and challenges to program success. More detail, including current opportunities and activities to address challenges, is available at the ORH website at: www.ohsu.edu/orh. The 2019 Rural and Frontier EMS Listening Tour report was made possible with funding from the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under a Medicare Rural Hospital Flexibility Program EMS Supplement award. If you have any questions or CONTENTS suggestions, please contact: Acknowledgements 3 2019 EMS Listening Tour Meeting Locations 4 REBECCA DOBERT, Field Services Program Manager ORH Defined Urban, Rural, and Frontier Areas 5 Oregon Office of Rural Health What is Rural and Frontier? 6 [email protected] | 503.494.6627 ASAs and Health Districts 7 EMERSON ONG, Data and GIS Analyst Oregon Ambulance Service Areas 8 Oregon Office of Rural Health Tour Logistics 9 [email protected] | 503.494.5226 Consistent Challenges and Reported Benefits 10 LIZ HECKATHORN Personnel 11 EMS and Trauma Systems Professional Standards Overview 11 Public Health Division, Oregon Health Authority Education and Training 12 [email protected] | 971.673.0532 Oregon EMS Education and Training 13 Overview 13 EMS Education in Tour Counties 13 Education Programs Available in Tour Counties 14 Billing and Reimbursement 15 Overview 15 Electronic Patient Care Reporting 16 Participating Rural County Demographics 17 Participating Frontier County Demographics 18 Action Items and Follow Up 19 Advocacy 19 Program Grants 19 Community Paramedicine and EMS 20 EMS Provider Resources 21 Data Sources and Maps 22 Acknowledgements Thank You Adrian Quick Response Unit Jefferson County Public Health Adventist Health Tillamook EMS Jordan Valley Ambulance Service Agency Adventist Health Tillamook Klamath County Fire District Number 1 Participants Bay Cities Ambulance Lake Chinook Fire and Rescue Blue Mountain Health District EMS Lake County Sheriff’s Office Blue Mountain Health District Hospital Lake District Hospital Bonanza Ambulance Lakeview Disaster Unit Chiloquin Fire and Rescue Malheur County Ambulance Service District Crescent Rural Fire Protection District Malheur County Emergency Management Crook County Emergency Preparedness Mitchell Ambulance Crook County Fire and Rescue Mitchell Fire Department BETWEEN FEBRUARY AND JUNE 2019, Douglas County Fire District Number 2 North Lake County EMS EMS LISTENING TOUR MEETINGS OCCURRED Fossil Ambulance Ontario Fire and Rescue ON-SITE IN 10 OF OREGON’S 36 COUNTIES, Glide Rural Fire Protection District Rager Emergency Services INCLUDING 5 RURAL AND 5 FRONTIER COUNTIES. Grant County Health Department Silver Lake Rural Fire Protection District Participants represented licensed transporting Jefferson County EMS District Spray Ambulance and non-transporting EMS and fire agencies, Critical Access and Rural Hospitals, Treasure Valley Paramedics county and public health agencies Wallowa Memorial Hospital EMS and law enforcement. Wheeler County Emergency Management We appreciate the 36 organizations who Wheeler County Sherriff’s Office made time to attend and share with us. 3 2019 EMS LISTENING TOUR Meeting Locations LEGEND 4 ORH Defined Urban, Rural, and Frontier Areas LEGEND 5 What is Rural and Frontier? 33% (1,166,154) and 2% (94,669) of Oregon’s population lives in rural and in frontier communities, Marion County The Oregon Office of Rural Health defines rural as any geographic areas respectively. in Oregon ten or more miles from the centroid of a population center of 40,000 people or more. Frontier counties are defined as those with 10 of Oregon’s 36 six or fewer people per square mile. For more information on definitions of rural and frontier, visit the ORH website at: counties are frontier. www.ohsu.edu/orh. 6 ASAs and Health Districts What is an ASA? What is a Health District? As defined in Oregon Administrative Rule Chapter 440 of the Oregon Revised Statutes (OAR) 333-260-0000,1 an Ambulance Service (ORS) regulates the creation and management Area Plan (ASA Plan) outlines a process for of health districts in Oregon. Health districts establishing a county emergency medical are municipal entities, authorized by the State services system. An ASA Plan addresses the need of Oregon, that create local, non-operational 69% of for, and coordination of, ambulance services by revenue streams to fund health services.2 Health establishing ambulance service areas for the districts in rural Oregon are often used to fund Oregon’s entire county. EMS service. Under ORS 440.320,3 health districts are authorized to: Ambulance An Ambulance Service Area (ASA) is a geographic area which is served by an ambulance 1a. Be incorporated as municipal corporations Service Areas service provider and may include all or a portion for the purposes of: providing clinically related of a county, or all or portions of two or more diagnostic, treatment and rehabilitative are in rural contiguous counties. services on an inpatient or outpatient basis; providing outreach programs in health care and frontier Oregon has 36 ASA Plans and 152 ASAs. There education, health care research and patient are 49 individual ASAs within the 10 counties that care; serving as a resource for health providers communities. participated in the EMS Listening Tour. in the district; and promoting the physical and mental well-being of district residents. For additional OAR and ORS pertaining to EMS visit https://secure.sos.state.or.us/oard/ Health districts generate revenue based on displayDivisionRules.action?selectedDivision=1356 voter-approved tax rates per $1,000 of assessed and www.oregonlaws.org/oregon_revised_statutes. property value within the district’s defined service area. Health districts may also issue 1 https://oregon.public.law/rules/oar_333-260-0000 public works bonds and levies. Finally, providers operating in health districts are authorized to charge fees for people who use the district’s facilities or services. 2 McGinnis, Paul B. MPA, Howk, Sonya, MHA:HA, Ong, Emerson, Simeon, Jennifer, MPH. Health Districts in Oregon. 2016. www.ohsu.edu/sites/default/files/2018-08/Health%20 Districts%20in%20Oregon%202016.pdf 3 www.oregonlaws.org/ors/440.320 7 Oregon Ambulance Service Areas 8 TOUR LOGISTICS The Oregon Office of Rural Health, in collaboration with the Oregon Health Authority (OHA) EMS & Trauma Systems Program (EMSTS), conducted the Rural and Frontier EMS Listening Tour to directly discuss operational strengths and challenges with the agencies and personnel who provide and support first responder services. Approximately 20% of Oregon’s licensed transporting agencies participated, representing organizations which operate across 10 rural and frontier counties. These participating counties contain nearly 50,000 of Oregon’s 98,000 square miles of territory—slightly larger than the state of Pennsylvania and home to geographic peaks averaging 4,900 feet higher. The tour was designed to help identify impactful and relevant ways to support sustainable access to high-quality emergency medical care for Oregon’s rural and frontier communities. Meeting site locations were based on analysis of transporting EMS agency licensure survey data. The analysis assessed operational stability, and inclusion in the Tour was targeted to balance participation by agencies experiencing system stability along with agencies experiencing instability. The on-site meeting requirement was ideal to achieve a real-time view of how current funding, staffing and regulatory models contribute to the function of rural and frontier agencies. In many cases, their needs and challenges are distinct from those of their urban and metropolitan counterparts. Consistent Challenges and remote communications challenges were commonly cited as needing consideration by EMS Personnel - Recruitment, Training planning and policy bodies. and Retention A more recent phenomenon was reported “Being a rural or National analysis consistently shows that, primarily in southern and southwestern compared with urban agencies, rural EMS Oregon. As rural communities scale back law agencies typically rely more on volunteers with enforcement budgets there can be unintended frontier EMS agency lower-level training, and have less access to 4 consequences—such as police officers not being means trying to oversight and skill maintenance. Oregon is no first on scene to establish safety. This can mean different; two of the participant counties do that EMS responders are the first uniformed be everything not have EMS educational catchments. Among personnel to arrive, potentially encountering a the EMS provider agency partcipants, 100% violent response. In some communities, where to everybody.” reported difficulty with recruitment, training and there is no overnight law enforcement, citizens retention of personnel. This included paid career will activate the 911 system to summon any — FRONTIER COUNTY and casual staff, and volunteer or unreimbursed EMS MANAGER responder, even though medical response