Delaware Emergency Medical Services Oversight Council DEMSOC ANNUAL REPORT – 2006 Table of Contents Executive Summary ……….………………………….……….…………………………….2 Introduction ………….………………………………….……….…………………………….3 • National Issues …..………………….…………………………..……………….…4 EMS System Oversight ……….…………………………..……….……………..…...8 • Delaware Emergency Medical Services Oversight Council (DEMSOC) • Office of Emergency Medical Services • State Fire Prevention Commission • Medical Direction Delaware Emergency Medical Services System ……….…………..……28 • Statewide • Education and Training New Castle County .………………………….……………………………….…………47 Kent County ………….…………………………..…………………………………………64 Sussex County ……….…………………………..……………………………………....85 Delaware State Police …..…………………………………………………..……….95 Specialized Programs ………………….……………………………………..…..…107 • Trauma o Injury Prevention o Safe Kids • Emergency Medical Services for Children (EMS-C) o Special Needs Alert Program • Cardiovascular Care • Domestic Preparedness • Emergency Data Information Network (EDIN) • Crash Outcome Data Evaluation system (CODES) • Poison Control • Prehospital Advanced Care Directive (PACD) • Infectious Disease Control Appendix ………………….……………………………………….…..………….……...….II DEMSOC ANNUAL REPORT - 2006 Executive Summary The Delaware Emergency Medical Services Oversight Council (DEMSOC) presents this annual report in accordance with Title 16, Subsection 9703 of the Delaware Code. DEMSOC was formed pursuant to the Delaware Emergency Medical System Improvement Act of 1999 (HB332). The council is charged with monitoring Delaware’s EMS system to ensure that all elements of the system are functioning in a coordinated, effective, and efficient manner in order to reduce morbidity and mortality rates for the citizens of Delaware. It is also charged to ensure the quality of EMS services in Delaware. DEMSOC consists of 19 members appointed by the Governor. The Secretary of The Department of Safety and Homeland Security, David B. Mitchell, J.D., serves as the Chairman. Also serving on the Council is the Secretary of Delaware Health and Social Services, Vincent P. Meconi. DEMSOC also includes representatives from the following agencies: the Governor’s Office, each County government, the Delaware State Fire Prevention Commission, the Delaware Volunteer Firemen’s Association and its Ambulance Committee, the Delaware Healthcare Association, the Delaware Police Chief’s Council, the Delaware Chapter of the American College of Emergency Physicians, the State Trauma System Committee, the Medical Society of Delaware, the Delaware State Police Aviation Section, and the State EMS Medical Director. There is a representative for practicing field paramedics and there are three at-large appointments for interested citizens, one from each county. The Delaware Office of Emergency Medical Services provides staff support for DEMSOC. The main purpose of this report is to inform those interested in our State’s EMS efforts about current practices and initiatives and to provide measurements useful for monitoring the performance of our EMS system. Our inaugural report in 2000 allowed DEMSOC to begin the process of establishing a baseline from which to measure the impact of future changes and growth in Delaware’s Emergency Medical Services (EMS) system. Since EMS was first developed in the 1960’s, systems throughout the country have struggled with finding the best methods to measure and evaluate system performance. Delaware is no exception. One common method is to use response times, but response time data cannot readily measure the quality of care provided to a patient. Other equally important aspects of EMS system to measure are clinical performance and EMS system costs. This report addresses EMS system oversight, EMS system performance, EMS system costs and medical direction. Specialized programs/areas are highlighted such as: State Trauma System, EMS-C, Cardiovascular Care and Domestic Preparedness. The ongoing challenges seen by the Delaware EMS system are consistent with those seen nationwide. These challenges include: addressing the increased call volume related to the aging of our state’s population, and increases in the development of our counties. Issues with system finance and sustainability will continue. Many agencies receive funding through state and federal sources. Current federal funding cuts may adversely impact our system. In general, EMS systems nationwide are facing issues with personnel recruitment and retention. Our system must take a proactive approach to this issue if we are to maintain the quality and efficacy of our EMS services. - 2 - INTRODUCTION EMS originally was conceived to respond to accidental death and injury and cardiac conditions outside the hospital. But EMS, and its unique history in both health care and public safety, is much more complex. It was started by several influential areas - traffic safety, trauma care, cardiology, resuscitation science and military medicine - and it continues to cross the boundaries of numerous disciplines, including health care, medical transportation, public health and homeland security. - 3 - EMS ISSUES AT THE NATIONAL LEVEL In 2006, Delaware enjoyed unprecedented representation in national organizations that influence EMS policy at the federal level. Former State EMS Medical Director and Former DEMSOC member Dr. Robert O’Connor completed his second and final year as President of the National Association of Emergency Medical Services Physicians. Additionally, State EMS Director Steven Blessing was selected by the members of the National Association of State Emergency Medical Services Officials to serve a two year term as President-elect, to be followed by a two year term as Association President. Secretary Mitchell serves as a member of the national SAFECOM Emergency Response Council, where the members’ unique experience and expertise to help set the course for the next two years. He is also a member of the Governor’s Homeland Security Advisors’ Executive Committee, which deals with “All Hazards, All people” response planning nationally. Secretary Mitchell is also a member of The All Hazards Consortium, which is comprised of regional stakeholders from government, industry, education and non-profit organizations. Several other EMS providers throughout the state have earned recognition as speakers at national EMS venues, or serve on committees in our national EMS organizations, and they continue to demonstrate that Delaware is a leader in providing EMS care. FUNDING Federal funding for critical EMS programs felt the pinch of a tightening budget in Washington. Several key federal grant programs have lowered their funding levels or have been left unfunded. Most preparedness grants saw reduced funding levels and reallocation of monetary assets. Two key federal programs provided to EMS were eliminated in 2006- the Rural Access to Healthcare grant and the State Trauma Systems Development grant. Both of these provided funding to EMS in Delaware. Other grants that affect Delaware, such as the Emergency Medical Services for Children grant, were threatened with elimination but ultimately regained funding. The tightening of funding in federal grant streams also brought about tougher funding standards, revised funding guidelines and very narrow performance measures across the board for all federal EMS grants. Although federal funding was reduced and in some cases eliminated, Delaware programs affected by these cuts continue to operate and thrive through other funding sources. DOMESTIC PREPAREDNESS Domestic preparedness remains a key topic for EMS at the national level. In 2006, EMS agencies still reported a general lack of training and equipment as the nation boosts its preparedness capabilities, and EMS improved its visibility in federal planning and policy development in an effort to correct this situation. Preparation for response during pandemic flu events was at the forefront in 2006 and EMS agencies throughout the country became involved with the planning and training at the state and local level. In the aftermath of Hurricane Katrina in 2005, discussion about the use of the Emergency Management Assistance Compact (EMAC) to allocate EMS assets was another issue of - 4 - concern, since the process did not go well during Katrina and its aftermath, and assets in several states were deployed without state knowledge. Delaware remains ahead of most states in its preparedness planning and efforts and the use of EMAC for Delaware assets worked well in recent times of need. WORKFORCE DEVELOPMENT Work continued in 2006 on recruitment and retention of EMS providers. There is a national shortage of EMS providers and a need to solidify EMS as a recognized medical profession. The national trend is toward the creation of a National Scope of Practice, which would standardize the provider levels recognized in each state and enhance interoperability, mutual aid and licensure reciprocity. Many states have also moved to mandate accreditation of their paramedic initial training programs (Delaware’s paramedic training program was re-accredited during 2006). The National Registry of Emergency Medical Technicians went to 100% computerized testing nationwide beginning January 1, 2007. Although Delaware is also affected by a shortage of EMS providers, our agencies across the state have worked hard to improve recruitment and retention, compensation, work conditions, training and diversity. As our population ages the demand for services will increase, as will the demand for EMS providers. The Delaware Population Consortium projects that from 2005-2015 Delaware’s population will increase by 15%, and the number of residents 60 years and older is expected to increase 27%. Sussex County is in position to be extremely hard hit by the aging population. In 2006, 47.5 percent of the paramedic responses are to patients over age 60. As the senior population increases, so will the strain on the system. While the aging population is increasing, the volunteer population is beginning to decrease. Information from the National Registry of Emergency Medical Technicians shows that the majority of EMS responders nationwide are between the ages of 20-45. Many people within this age range are finding it more difficult to volunteer their time with the increases in dual income and single parent families, and the fact that many people are working longer hours. The National Association of Emergency Medical Services Educators has created an EMS Diversity Task Force, and has appointed Glenn Luedtke, Director of Sussex County EMS, as Chairman. The goals of this task force include: • Increase the awareness of diversity issues in EMS • Conduct research to accurately identify EMS diversity issues throughout the United States • Increase stakeholders’ understanding and promote consensus regarding steps that should be taken to enhance diversity among EMS providers • Develop model institutional and policy-level strategies that may increase diversity within EMS - 5 - • Identify existing programs that have successfully addressed diversity in EMS and share them with stakeholders • Develop broad coalitions to encourage EMS agencies, their accreditation bodies, and federal, state and county sources to support initiatives that will enhance diversity among EMS providers Some of the strategies identified by this task force are: • Increase awareness of EMS as a profession within minority communities • Improve training availability to members of the minority community • Reduce financial barriers among minority and lower-income students • Increase emphasis on diversity in EMS training programs • Improve EMS agency “climate” for diversity DEMSOC created a workforce diversity subcommittee in 2006 to address issues with the recruiting and retention of a more diverse EMS workforce. This subcommittee will work closely with the NAEMSE group to address this critical issue within our State. As part of this effort, the Office of Emergency Medical Services is working with technical high schools throughout the state to develop an EMS program that would increase the availability of training and allow students to transition to the Delaware Tech program upon graduation. TRAUMA CARE The provision of trauma care is an important and often underestimated aspect of EMS. Many states are still in the process of designating trauma hospitals and some states are still in development stages in the creation of their statewide trauma systems. Trauma care across the country suffers from a lack of funding for system development, and this was intensified with the termination of the Trauma Systems Development Grant in 2006. Several issues facing our trauma centers today include escalating costs, exorbitant malpractice costs and litigation, overcrowding, availability of specialty care providers, patient destination issues (where injured patients are taken to the hospital) and aeromedical coverage. Delaware has a well developed trauma system and a strong aeromedical system as well. Loss of systems development funding does not affect our state as severely as many others. However, Delaware’s system is not immune to the other issues faced nationally, such as overcrowding, litigation and the availability of specialty care providers. DEMSOC is considering ways to provide funding to improve our trauma system in the coming years. CARDIAC/STROKE CARE Lifestyle issues and a maturing population are the major drivers for national concern about cardiac arrest and stroke. EMS is on the front lines of all efforts to battle cardiovascular disease. National standards for prehospital cardiac care are under development and there is discussion about the development of statewide cardiac care systems that mirror the statewide trauma systems developed in many states. Improved - 6 - technology and continuous research in this area have provided the opportunity to make great progress. Delaware is a leader in the deployment of Automatic External Defibrillators, and its prehospital protocols for providers are considered among the most progressive in the country. Delaware’s extensive data collection ability and its EMS operational climate have enabled the state’s providers to be on the forefront of many research efforts in this area, as well. The Office of Emergency Medical Services developed plans for an EMS Cardiac Care program in 2006, with implementation scheduled to begin during 2007 with the creation of a dedicated position to coordinate cardiac care and enhanced research efforts. DATA COLLECTION Data collection is at the heart of what is done in EMS. Data helps make crucial operational decisions, serves as the basis for quality assurance measurements and is the source of research to improve future care. The National Highway and Traffic Safety Administration (NHTSA) continues to lead an ongoing effort to develop a national EMS database, known as NEMSIS. It is hoped that information gained through NEMSIS will serve as a catalyst for future research and growth in EMS. In order to participate in NEMSIS, states must collect all of their EMS data in a specific electronic format and have the capacity to transmit that data to the national database. Many of the current NEMSIS data points are based on Delaware’s EDIN system. It is projected that Delaware will be one of the first states ready to participate in NEMSIS, sometime during 2007. There are currently 4 states participating in a pilot version of NEMSIS nationally. - 7 - SYSTEM OVERSIGHT - 8 -