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National Fire Protection Association Technical Committee On National Fire Protection Association Technical Committee on Emergency Medical Services National Stakeholders Meeting on Mobile Integrated Healthcare and Community Paramedicine Report National Fire Protection Association 1 Batterymarch Park, Quincy, Massachusetts 02169-9101 Telephone (617) 770-3000 ∙ Fax (617) 770-0700 ∙ www.nfpa.org Report on the NFPA Technical Committee on Emergency Medical Services National Stakeholder Meeting on Mobile Integrated Healthcare and Community Paramedicine April 2 & 3, 2014 MGM Grand Hotel Las Vegas, NV Background The NFPA Technical Committee on Emergency Medical Services (EMS-AAA) convened a national emergency medical services (EMS) stakeholders meeting to discuss the subject of Mobile Integrated Healthcare/Community Paramedicine (MIH/CP). Previously, the EMS Technical Committee had reviewed a new project request for a MIH/CP document, though that request was later administratively withdrawn. The entire EMS Technical Committee worked to develop that new project request which was submitted individually by Dr. David Tan, representing the National Association of EMS Physicians (NAEMSP) in late 2011. Since submittal of the proposal by Dr. Tan there 1 have been many changes to the delivery of healthcare, including the delivery of EMS. These reforms compelled the EMS Technical Committee to organize a meeting for stakeholders to garner input from a broad group of healthcare professionals and to discuss the possibility for a new request on MIH/CP. The meeting afforded the opportunity to not only learn the opinions of prominent national EMS and healthcare professionals, but also to discuss how the NFPA could assist the community of actors involved in MIH/CP. History The concept of MIH/CP has existed for quite some time, but more prevalent in other countries around the world than in the U.S. The primary purpose of MIH/CP programs is to provide more healthcare services directly to patients on location and to minimize trips to the hospitals. Healthcare purveyors in Canada, Australia, and New Zealand have used the same model successfully for a number of years. U.S efforts initiated, due in large part to the Affordable Care Act, to launch MIH/CP programs, include programs in Colorado, Maine, Michigan, and Texas. As the profile of MIH/CP programs rises among providers for the delivery of an evolving unique and specific type of healthcare, delivery of these services by those already engaged in pre-hospital medical care is an obvious progression. As MIH/CP programs proliferate and increase across the country, the lack of standardization, leaves interested parties without definitive guidance for implementing a successful program. This identified lack of standardization resulted in the EMS Technical Committee’s development of the original project request submitted in 2011 (see 2 attachment 1) to initiate standards to address the potential needs and demands of those involved in the delivery of MIH/CP. As required by the NFPA standards development process, all new project requests are published for public comment to determine whether there is support to develop a project. The public comments (see attachment 2) received on the MIH/CP request did not provide the EMS Technical Committee with a definitive direction of pursuit. Some encouraged the NFPA to develop a document on this subject, while others discouraged the NFPA. Based upon public comments received, the EMS Technical Committee decided to solicit additional public comment to support an informed, and balanced decision regarding standards development. Receiving no further public comments and after discussions with the EMS Technical Committee and Staff, it was decided to administratively withdraw the request for possible resubmission at a later date. Simultaneously, the EMS Technical Committee recognized that with ongoing changes in the EMS and healthcare landscape, it would be advisable to revisit this topic at a later date. During the same time, several organizations were taking active steps towards the development and implementation of a MIH/CP program-again without an established national standard. Local agencies identified needs or gaps that could be filled by existing resources to provide some level of care that resembled a MIH/CP. Typically these local agencies would seek to align existing resources to the types of services delivered by MIH/CP programs in other communities or to apparent gaps of available healthcare in their own communities. These assessments considered other communities’ MIH/CP services, then modifications were integrated where necessary. 3 Local programs ranged from those as simple as blood pressure clinics, health and wellness checks, flu shot clinics, and blood glucose checks to more involved healthcare services. Another aspect of MIH/CP programs being explored was an analysis of telecommunication services to ensure appropriate resource deployment, for example, assisting someone from the floor, re-connecting oxygen tubing, re-bandaging a wound, and treating a person in the home while arranging up a follow-up appointment with their doctor. Supporters of a national MIH/CP standard recognize that there is a financial aspect with a MIH/CP program to be addressed. Historically most pre-hospital care providers do not receive reimbursement for services provided unless the patient is transported to the hospital. This is counter to the foundation of MIH/CP care, which strives to provide intervention in the pre hospital setting and reduce the need for transport to a hospital. Hospitals share this goal because new healthcare laws and regulations include financial penalties for the readmission of patients who were recently discharged. MIH/CP programs partnering with hospitals are poised to achieve this goal. In fact, many hospitals are developing agreements with EMS providers to include these services within local EMS delivery systems in order to provide reimbursement for treating these patients at home and avoiding unnecessary trips to the emergency rooms. The ideal result of these partnering programs allows the patient to stay at home, receive treatment for immediate medical need, while avoiding the emergency room treatment, and receiving a definitive follow-up care plan. The scope and breadth of the 4 care provided under a MIH/CP program is dependent upon approval by state and local protocol, in conjunction with the medical director. Based on the continuing evolution of MIH/CP programs, the EMS Technical Committee convened a meeting that included national stakeholders and sought their comments and feedback. Invitees included representatives from nursing associations, EMS chiefs, fire service representatives, private EMS transport company representatives, EMS educators, and others whom are actively engaged in the implementation of a MIH/CP program (see attachment 3). The intent of the EMS Technical Committee and NFPA was to engage as many organizations in the discussion as possible. The meeting also allowed those organizations and agencies who are not as familiar with the NFPA process to gain insight into that process. The EMS Technical Committee established a meeting goal to seek input and feedback that would then help determine an action regarding a new project request on the subject of MIH/CP. Committee Actions The meeting took place in Las Vegas, Nevada at the MGM Grand Hotel and Casino April 2nd and 3rd, 2014. The list of attendees, Technical Committee members and guests, is included with this report (see attachment 4), along with the meeting agenda (see attachment 5). To open the meeting, EMS Technical Committee Chairperson Kenneth Knipper welcomed everyone and called it a “historical meeting” noting that such a group of some well-known and well respected professionals in EMS were in the same room, at an NFPA meeting, and talking about the same issue: 5 Ensuring that the appropriate level of healthcare is delivered to those in need. Simply, the key concern of the NFPA EMS Technical Committee and stakeholders is to ensure that the needs of communities are being met efficiently. During the first day of the meeting, the attendees discussed the role of NFPA in MIH/CP and EMS generally. At present, the NFPA has approximately 40 EMS related standards. This fact was not well known by many of the non-committee member attendees. Some attendees indicated they were not aware that NFPA had developed any EMS related standards and voiced reluctance to NFPA being the organization to develop a document focused on the “delivery of healthcare”. The attendees recognized NFPA’s great work and reputation in the field of standards development, yet stressed that any standards on MIH/CP should be borne of a collaboration of medically-centered organizations and NFPA. Technical Committee members emphasized NFPA’s well- established and respected process, noting that NFPA adds value and credibility to any standards development on MIH/CP. Another meeting discussion examined the newness of the MIH/CP field and if attempts at standardization were premature. The models and concept of MIH/CP programs are rapidly changing, creating the possibility that a standard developed today could be outdated in 6 months. NFPA staff and EMS Technical Committee members recognized that a new standard takes longer to develop than a revision of existing standards, but NFPA has developed sound, consensus standards on a shortened timeframe where necessary. In response to concerns of the uncertain future of MIH/CP development, it was noted the NFPA process allows for future trends to
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