[CSEMSmail] Updated Regional Consolidation Documents

[Dave Cullen]

Posted on the OEMS website within the last hour. Here is the link to that page.

http://www.vdh.state.va.us/OEMS/Files_page/RegionalCoordination/Process_Active_v2.pdf

Regional EMS Council Designation,

Considerations for Proposed Regional Service Areas

 

This document serves to give additional information and guidance regarding the

regulations governing Regional EMS Councils, the designation process, the proposed

regional service areas, and the processes by which these proposed service areas were

determined.

 

§ 32.1-111.11 of the Code of Virginia establishes Regional EMS Councils, and

defines their function and purpose, as follows:

 

The Board (of Health) shall designate regional emergency medical services

councils which shall be authorized to receive and disburse public funds. Each council

shall be charged with the development and implementation of an efficient and effective

regional emergency medical services delivery system.

 

The Board shall review those agencies that were the designated regional

emergency medical services councils. The Board shall, in accordance with the standards

established in its regulations, review and may renew or deny applications for such

designations every three (3) years. In its discretion, the Board may establish conditions

for renewal of such designations or may solicit applications for designation as a regional

emergency medical services council.

 

Each council shall include, if available, representatives of the participating local

governments, fire protection agencies, law-enforcement agencies, emergency medical

services agencies, hospitals, licensed practicing physicians, emergency care nurses,

mental health professionals, emergency medical technicians and other appropriate allied

health professionals.

 

Each council shall adopt and revise as necessary a regional emergency medical

services plan in cooperation with the Board.

 

The designated councils shall be required to match state funds with local funds

obtained from private or public sources in the proportion specified in the regulations of

the Board. Moneys received directly or indirectly from the Commonwealth shall not be

used as matching funds. A local governing body may choose to appropriate funds for the

purpose of providing matching grant funds for any council. However, this section shall

not be construed to place any obligation on any local governing body to appropriate funds

to any council.

 

The Board shall promulgate, in cooperation with the State Emergency Medical

Services Advisory Board, regulations to implement this section, which shall include, but

not be limited to, requirements to ensure accountability for public funds, criteria for

matching funds, and performance standards.

 

Regulations governing Regional EMS Councils were developed, and approved by

the State Board of Health in October 2007, and were enacted on January 1, 2008.

Included in regulation is language outlining a process whereby entities can apply to be

designated as Regional EMS Councils for specific service areas. As part of the

designation process, OEMS has distributed guidance documents that pertain to the

application and designation process, as well as a proposed regional service area map and

a list of localities included in these areas. The existing regional EMS Councils were last

designed by the State Board of Health in March 1980. It is important to consider the

number of changes that have occurred in the delivery of EMS and the location and

availability of facilities, resources and personnel during this time period. The Board of

Health will make the final decisions and determine the entities that are designated to

coordinate programs and services within the defined regional service areas, based on

recommendations and input from the Virginia Office of EMS.

 

The Office of EMS and the Board of Health are responsible for planning and

developing a comprehensive, coordinated, emergency medical care system in the

Commonwealth. The Board is further responsible to maintain a Statewide Emergency

Medical Services Plan and make revisions as may be necessary to improve the

effectiveness and efficiency of the Commonwealth's emergency medical care system. The

Office of EMS and the State EMS Advisory Board through its committee structure

ensures there is adequate input into the planning and evaluation process of the EMS

system in Virginia by all key stakeholders.

 

Discussions have been held for at least twenty (20) years concerning the role and

relationship of the regional EMS Councils in Virginia's statewide EMS system. In the

past several years these discussions have resulted in a thorough, formalized evaluation

and assessment of the regional EMS Council's in Virginia. Legislative studies, open

meetings, Board retreats, and studies performed by independent consultants have been

conducted. Revisions to performance based contracts, regulations governing Regional

EMS Councils and criteria for review and designation of regional EMS Councils have

been implemented. In all cases, these initiatives and activities have taken place with the

full knowledge and involvement of the state EMS Advisory Board with input from

stakeholders from all regions of the state and other interested parties.

 

The Office of EMS is soliciting public comments concerning the proposed

regional service areas until February 29, 2008. This matter is on the agenda for the next

state EMS Advisory Board meeting on Friday, February 8th. In addition, the Office of

EMS will hold a public hearing in Richmond on Monday, February 25 to allow further

input and comment from all interested parties.

 

At the conclusion of the public comment period, all documents, reports, and

testimony will be reviewed and a determination will be made if adjustments to the

proposed regional service areas are necessary. Only changes that improve, enhance and

more fully integrate emergency medical care to the citizens of Virginia will be

implemented.

 

The proposed changes to the existing regional service areas are based on basic

principles of EMS systems. The Office of EMS feels these proposed changes will

facilitate the collaborative interaction of EMS providers, public health officials, fire

departments, law enforcement, emergency physicians, emergency departments, and

hospitals. All of the components of the EMS system must be in place to provide care to

those in need and to ensure that the public health/public safety/emergency medical safety

net does not fail when it is needed the most. The Office of EMS believes changes are

needed and a different course of direction in necessary for the effective facilitation,

planning, coordination, and efficient provision of EMS programs and services within the

Commonwealth.

 

Proposed Regional EMS Council Service Area Considerations

The process of developing the map and locality list took many different items into

consideration; both maps (see Regional Service Area Considerations PowerPoint

presentation), documents and reports strictly related to Virginia, as well as documents

related to the provision of EMS service, and the new definitions of "regionalization" of

EMS systems found in the Agendas for the Future and the Institute of Medicine (IOM)

Report: "Emergency Medical Services at the Crossroads."

 

Regional EMS Councils are an integral part of the EMS System in Virginia. The

proposed regional service areas recognize that each locality and region has unique

geography, politics, and resources. It is the intent that the design, structure and

administrative responsibilities for the EMS system in these proposed regional service

areas will allow for different "regional accountable systems" while minimizing their

differences and eliminating fragmentation of services.

 

Each topic or item on the consideration list may not be applicable to every region

or locality. However, the majority of the considered items do apply to most areas of the

Commonwealth and the thought process utilized to develop the proposed service areas.

 

* Health Care System considerations, including

* Hospital Catchment Areas - Refer to map #22

* Specialty Systems of Care (i.e., Trauma, Cardiac, Stroke, etc.) - Refer to

maps #5, 6, 7 and 12

* Major Health Care Systems - Refer to maps #12, 22.

* Community and Critical Access Hospitals - Refer to map #13

Health care system coordination takes many different factors into consideration.

These include, but are not limited to: Patient census, transfer patterns, and rural,

suburban and urban factors. Many patients are transferred out of community

hospitals due to services not offered at those facilities (CT, Neurology,

Orthopedics, Obstetrics, Cardiac care, etc.). Many of these transfers fall along

major healthcare systems, meaning that a patient admitted to a hospital within one

health system will typically be transferred to another facility within that same

system.

 

* Health System Agency (HSA) boundaries. There are five HSA regions:

Southwest, Northwest, Northern, Central and Eastern. (Refer to map #10).

Region A + Region B is identical to the Southwest region.

Region C is identical to Northwest with the exception of Buckingham Co., Louisa

Co., Stafford Co., King George Co., Spotsylvania Co., and Caroline Co.

Region D is identical to the Central region with the exception of Buckingham Co.,

and the jurisdictions in the Richmond Metro area.

Region E is identical to the Eastern region with the exception of the jurisdictions

in the upper and middle peninsulas.

Region F is identical to the Central region with the exception of Buckingham Co.,

Louisa Co., and the counties in the upper and middle peninsulas.

Region G is identical to Northern with the exception of Stafford Co., King George

Co., Spotsylvania Co., and Caroline Co.

 

The proposed regional service areas facilitate collaboration and cooperation with

public and private entities engaged in activities that affect the public's health.

These activities include planning and response activities for public health

emergencies, health promotion programs, and developing partnerships with

healthcare providers and institutions, community based organizations, and other

government agencies engaged in services that affect health to collectively

identify, alleviate, and act on the sources of public health problems. In addition,

integrating EMS with HSA's facilitates the public health system's efforts in an

intentional, non-competitive, and nonduplicative manner.

 

* Hospital Preparedness Regions - Virginia Dept. of Health (VDH)/Virginia

Hospital and Healthcare Association (VHHA) - Refer to map #11.

 

The proposed service areas promote collaboration with local public health

systems to enhance readiness to respond to bioterrorism, infectious disease

outbreaks and other public health emergencies. The proposed service areas allow

EMS to more formally integrate with planning activities, especially in the

development of hospital surge capacity plans.

 

There are six hospital Preparedness Regions: Far Southwest, Near Southwest,

Northwestern, Central, Eastern and Northern.

Region A is identical to Far Southwest.

Region B is identical to Near Southwest with the exception of Rockbridge

County.

Region C is identical to Northwestern with the exception of Buckingham, Louisa,

and Rockbridge County.

Region D is an identical sub-set of the Central region.

Region F varies from the Central Region because it includes the upper and middle

peninsulas and does not include Buckingham County and includes Louisa County.

Region G is identical to the Northern region.

Region E is identical to the Eastern Region with the exception of the counties in

the upper and middle peninsulas.

 

* Other Commonwealth of Virginia Public Safety Agency service area maps

(VSP,VDFP,VDEM) - Refer to map #9

These service areas were created under Executive Orders of previous Governors. Portions

of each of the proposed regional service areas were considered to more closely align with

these service areas. The benefit of mutual service areas promote improved response to

emergencies by public safety agencies through integration of planning, coordination,

education and training, exercises and sharing of resources.

 

* Metropolitan Medical Response System jurisdictions.

The Hampton Roads MMRS service area is nearly identical to the proposed

Region E.

 

* Virginia Planning Districts and Counties and Cities

The proposed regional service areas still allow for many of the relationships

within planning districts and counties and cities to exist, and be maintained.

 

* Demographics and Geography (Including Metropolitan Statistical Areas

(MSA), population and geography) - Refer to map #16.

The population and geography of Virginia is varied, and diverse. The proposed

regional service areas take into consideration the areas of demographic

concentration, as well as some of the natural geographic boundaries (mountains,

rivers, etc.) that exist in Virginia.

 

* Proposed Regional EMS Council service areas -Refer to maps #1, 18.

The goal of the proposed regional service areas is to foster working relationships

between existing entities, to form synergistic alliances, and decrease

fragmentation and/or duplication of services.

Some of the benefits and positive outcomes of the proposed regional service areas

are:

a) Greater opportunity for consistent medical treatment protocols,

b) Greater uniformity in medical direction and leadership,

c) Greater opportunity to establish a Statewide drug box,

d) Greater consistency in the scope of practice and standard of medical care

of EMS providers,

e) Reduce inconsistency in certification examination registration and

administration,

f) Greater consistency and quality of regional plans (trauma triage, hospital

diversion, performance improvement, etc.),

g) Standardized review and prioritization of Rescue Squad Assistance Fund

grants,

h) Consistency in endorsement of EMS Physicians and ALS Coordinators,

i) Greater integration of community and public health resources,

j) Increased accountability and compliance to performance based contracts

and quality of deliverables,

k) Improved staff resources and reduced vulnerability for smaller regions as

cited in the Regional EMS Council study conducted in 2007 by the

Association and Society Management International, Inc. (ASMI). For

example, in the past ten (10) years, the Thomas Jefferson EMS Council

located in Charlottesville, VA has had no less than seven (7) different

Executive Directors. Staff turnover is costly, disruptive and compromises

the delivery of programs and services.

l) Greater economy of scale. Reduced redundancy in functional structure

and responsibilities such as accounting, budgeting, human resources,

information management, education, training, etc. These redundancies are

not cost effective and lead to disparate and fragmented services. Costs

associated with incremental changes in protocols, drug box programs,

development of regional plans, etc. are currently included in the scope of

work and deliverables of the contracts between the Office of EMS and

Regional EMS Councils.

m) Organizing regions on a larger basis is more consistent with IOM

regionalization concepts that establish a "critical mass" capable of

conducting system performance improvement using boundaries that better

resemble specialty regions for trauma, stroke, etc.

n) Reduced confusion about the role of the regions versus the state. This

confusion leads to fragmented delivery, quality and reporting on services

delivered.

o) Ability to offer a greater variety of programs and services to urban and

rural EMS providers,

p) Improved efficiencies in coordination, planning, and administration of

services on a regional level,

q) Provides flexibility to effectively reconfigure combined regional service

areas and to establish and/or maintain offices as needed. Any entity

providing designated Regional EMS Council services must demonstrate

their qualifications and capacity to plan, initiate, expand or improve

communitywide services to the entire regional service area. The

integration of urban, suburban, and rural delivery systems within a

regional service area is essential in order to avoid a "metrocentric"

influence or focus.

 

* Number of licensed EMS agencies and permitted EMS vehicles - Refer to

maps #2, 15, and 19.

The proposed service area map takes into consideration the location of existing

licensed EMS agencies and vehicles, future growth and expansion of these

services, and creates opportunities to enhance the facilitation, coordination and

integration of emergency medical services on a regional level.

 

* Accredited EMS Training sites - Refer to maps #3, 4, 20, and 21.

The number and location of current and future accredited EMS Training sites was

taken into consideration, in terms of enhancing the coordination of service

delivery among those sites, and relationships that exist or may exist between the

training sites and the proposed regional service areas.

 

* Access (service radius) to aeromedical services - Refer to map #8

In evaluating the service area maps for medevac services in the Commonwealth,

they all closely follow the proposed regional council service areas.

 

* Institute of Medicine (IOM) Report: "Emergency Medical Services at the

Crossroads" - 2006

The IOM report mentions insufficient coordination, uncertain quality of care,

lack of readiness for disasters, and divided professional identity as systemic

problems that EMS faces. Systems have substantial variation among emergency

and trauma care systems, with differing effectiveness of the regional EMS

councils. It is believed that the proposed service areas will help to address these

issues as they pertain to areas of the EMS system in Virginia.

 

* American Society for Testing and Materials (ASTM) Standards Designation

F 1086-94 - "Standard Guide for Structures and Responsibilities of EMS Systems

Organizations"

This document focuses on the structure and responsibilities of EMS systems at all

levels, including the regional level. It addresses focusing on the planning,

development, and coordination of a functional and comprehensive EMS system.

§ 3.2.1 of that standard states "To implement a regional EMS system, the state

lead agency will identify the geographic or demographic area that is a natural

catchment area for EMS provision for most, if not all, patients in a designated

area."

 

* The National Highway Traffic Safety Administration (NHTSA) EMS Agenda

For The Future - 1996

The vision of the EMS Agenda for the Future involves integration of resources,

even those across various health care and public safety agencies. Implementation

of the Agenda will result in improvements in community health, and promote

more appropriate use of resources. Recommendations call for collaboration of a

number of areas of the EMS System. The proposed service areas are a necessary

step towards improving the overall EMS system, and ensuring efficiency in

contributing to that goal.

 

* House Document 34 - Joint Legislative Audit and Review Commission

(JLARC) Report "Review of EMS in Virginia" - 2004

The JLARC report outlines the strengths of the Regional EMS councils, but also

mentions the varying focus of each Regional EMS council. The goal of the

proposed changes to regional service areas is to raise the overall level of service

and decrease the variations that exist, and promote an enhanced, comprehensive

delivery of services to a larger number of EMS system stakeholders.

 

* EMSTAR Regional EMS Council Study - 1998.

Among the items listed as recommendations by the study group, specific mention

of OEMS taking the responsibility of designating an appropriate number of

regions based on specific attributes, many of which appear as criteria listed in

determining the proposed regional service areas. The summary of the study

includes the opinion that changes will enhance the EMS system in Virginia.

 

* The Regional EMS Council Study document prepared by Association and

Society Management International, Inc. (ASMI) consultants in 2007. - Refer

to map #17.

The ASMI study made several recommendations, including alteration of Regional

EMS Council service area boundaries. As stated in the executive summary, "The

resulting regions would be larger, have deeper staff resources, affect some

economies of scale, be able to offer varying services to urban and rural providers,

and begin to implement system performance improvement on a scale and with

boundaries better resembling specialty care regions."

 

Summary

The Institute of Medicine report states "...today the system is more fragmented

than ever, and the lack of effective coordination and accountability stand in the way of

further progress and improved quality of care. EMS has the opportunity to move forward

toward a more integrated and accountable system through fundamental, systemic

changes. Or it can continue on its current path and risk further entrenchment of the

fragmentation that stands in the way of system improvement."

 

The Office of EMS endeavors to improve the overall EMS system, through a

process whereby services that currently exist in some parts of the Commonwealth can

exist in a larger portion of the EMS system. The process by which the regulations

governing Regional EMS Councils were developed involved stakeholders representing a

large number of the regional EMS councils. The process that Regional EMS Councils are

designated is mandated in the Code of Virginia, and is specifically addressed in

regulation. The Office of EMS has exercised due diligence and used all available

resources in formulating proposed regional service areas that ultimately will greatly

enhance and improve the EMS system for the citizens and visitors of the Commonwealth

 

David E. Cullen, Jr.

Executive Director

Central Shenandoah EMS Council

2312 W. Beverley Street

Staunton, Virginia 24401

540-886-3676

 

-------------- next part --------------
An HTML attachment was scrubbed...
URL: http://csems.vaems.org/pipermail/csemsmail_csems.vaems.org/attachments/20080125/1c1ac4f1/attachment-0001.html 
-------------- next part --------------
A non-text attachment was scrubbed...
Name: not available
Type: image/gif
Size: 145 bytes
Desc: image001.gif
Url : http://csems.vaems.org/pipermail/csemsmail_csems.vaems.org/attachments/20080125/1c1ac4f1/attachment-0001.gif