2012 NYS EMS Changes

[firedude 985]

About the bill...

…to amend the public health law, in relation to simplifying committee structure and increasing effectiveness of emergency medical services; to repeal sections 3002, 3002-a, 3003-a, 3009 and 3017 of the public health law, relating to the New York state emergency medical services council, the state emergency medical advisory committee, EMS program agencies, continuation of existing services and emergency medical services in Suffolk county; to amend the public health law, in relation to providing for the New York state emergency medical services board and regional boards; to repeal articles 30-B and 30-C of the public health law, relating to emergency medical, trauma and disaster care and emergency medical services for children; to amend the state finance law, in relation to the New York state emergency medical services training account…

Full explination by Mike McEvoy (NYS EMS Council)

Edited January 25, 2012 by firedude

[firedude 985]

So you don't have to read it all... this is how Mike McEvoy explains it...

1. Regional and State EMS Councils are changed to advisory boards. Their duties transition from statutory obligations to develop minimum training standards, minimum equipment lists, and minimum communications standards for certified providers at all levels to “advising the department and commissioner” on such minimum standards.

2. AED use is changed from people having completed a course approved by a nationally recognized organization or SEMSCO to someone having completed a course approved by a nationally recognized organization or the Commissioner and having completed the course recently enough to still be effective under the standards of said national organization.

3. No one can use an epi-pen unless they complete a course approved by the Commissioner (requirement for DOH to have rules for approval of epi-pen courses is eliminated).

4. Definitions are added for Pediatric, Trauma, and Disaster Care.

5. Requirements to be a CFR, EMT, and AEMT are now the responsibility of the Commissioner instead of SEMSCO and include training, education, and certification as determined by the Commissioner (such are no longer established by SEMSCO).

6. Regional Program Agencies are eliminated.

7. Mutual Aid is defined (for the first time, golly jeepers…) as the preplanned and organized response of EMS personnel and equipment to a request for assistance when local resources are depleted. Response predicated on formal agreements between agencies or jurisdictions.

8. MA agreements are redefined to include those made not only by EMS services but also by governments or fire departments and may include outside services upon request (i.e., services without operating authority).

9. Statewide EMS Mobilization Plan is defined as a statewide call up system.

10. County MA plans are defined as written agreements entered into to provide EMS treatment or transport. Players can include virtually anyone inside or outside the County.

11. SEMSCO is reduced to 23 members serving 3 year terms at the pleasure of the Commissioner (who also appoints the chair and vice-chair). Immunity from liability for members is maintained. SEMSCO becomes an advisory board (rather than Council) and combines SEMSCO, EMS for Children and STAC (the State Trauma Advisory Council) into one. SEMAC (the State Physicians Council), is eliminated. Meeting schedule is at the discretion of the Department. If a Region has no Advisory Board, or an ineffective Advisory Board, the State Board will handle that Regions issues.

12. TAGs can be appointed by the Commissioner at will (the will of the Commish, that is).

13. Regional Councils are renamed to Regional Advisory Boards and reduced from 18 to 6. Members are approved by the Commissioner (not the State Council). Membership remains 1/3 ambulance services and the rest from everyone else under the sun. County Coordinators remain ex-officio members. Councils (now called Regional Advisory Boards) can no longer rent, lease or own property, hire staff, contract for services, have a program agency, or make decisions (only recommendations). The Commish decides the geographical boundaries of the new Regional Advisory Boards.

14. REMACs continue to exist except members are recommended to the Commissioner by Regional Advisory Boards (formerly REMSCOs) and approved by the Commissioner.

15. You may wonder what Regional Councils (now called Regional Advisory Boards) can still do. They can coordinate EMS in their Region, establish training courses and determine certificates of need. Terms of members are 4 years and meetings held as needed. DOH is no longer required to provide support staff or any funding to Councils (previously each Council received $25,000 annually).

16. Any decision of any Regional Advisory Board can be appealed to the State Advisory Board.

17. REMACs continue to exist although their duties change somewhat. They are charged with developing regional protocols consistent with statewide standards/protocols which the Commissioner issues. Other duties of REMACs are unchanged.

18. Any decision of a REMAC can be appealed to the State Advisory Board.

19. Fee for initial certification of an ambulance or ALSFR increased from $100 to $300, voluntary services remain exempt.

20. Quality of care decisions previously relegated to SEMSCO for the purposes of determining fitness and competency are now made by the Commissioner.

21. Exemptions to minimum staffing must now be made by the Commissioner (not REMSCOs or the SEMSCO).

22. The 5-year Pilot Recertification program is limited to FDNY only; the 3-year pilot is made permanent.

23. Requirement for QI now applies to all agencies. The Department is charged with integrating a statewide QI program between trauma and EMS.

24. The Commissioner is now charged with determining categories of specialty patients transported between facilities (previously the duty of SEMSCO).

25. New: the Commissioner will issue EMS certifications to people who meet the minimum requirements issued by the Department.

26. New: the Commissioner will issue certificates to ambulances and ALSFR to agencies meeting the minimum requirements issued by the Department.

27. The Department will now be able to audit staffing, records, and QI documents of any ambulance or ALSFR (these were not included in previous regs).

28. The Commissioner is required to develop statewide minimum standards for Medical Control, scope of prehospital practice, treatment transport and triage including protocols for invasive procedures and infection control, and use of regulated medical devices and drugs by EMS personnel. The Commissioner can also issue advisory guidelines in any of these areas. The Department is now charged with reviewing regional protocols for compliance with statewide standards.

29. The Commissioner shall prepare and update a statewide EMS mobilization plan.

30. The Commissioner shall establish a minimum scope of practice, education, training, certification, and credentialing requirements for CFRs, EMTs, and AEMTs. The 51 hour cap on CFR training is eliminated.

31. The Department will provide every EMS vehicle with an official insignia.

32. Certified providers on active military duty whose cards expire while on active duty are extended for 12 months after release from the service.

33. The Commissioner may designate pediatric, trauma, burn and disaster centers in consultation with the State Advisory Board.

34. The Commissioner can reverse any decision of a Regional or the State Board but only after consulting with the State Advisory Board.

35. The department may revoke an ambulance certificate for 90 days (previously 30) without a hearing if it feels the public is in danger.

36. ALS provider practice is limited to participation in an ALS system (no more lone rangers).

37. Regions must use ALS protocols approved by the Commissioner. ALS systems must use Regional ALS protocols.

38. EMS training can now use coursework, testing, continuing ed and/or continuous practice to provide the means by which personnel, including instructors, can be trained and certified. This includes certification of EMT and AEMTs without the use of written and/or practical skills exams. The Commissioner, with consultation from the State EMS Advisory Board must develop rule and regs necessary to implement.

39. Training funds are maintained. The Commissioner must advise the legislature of the amount needed to assure training. EMT training must be at no charge.

40. The requirement for the Commissioner to conduct public service campaigns to recruit EMS volunteers is eliminated.

41. The mandate to submit electronic PCRs is changed from services exceeding 20,000 calls per year to a figure set by the Department.

42. The requirement for State EMS monies to be split 50:50 between training and operations is eliminated.

43. At the end of each year, any unused monies allocated to EMS training or operations will be reallocated for ALS training. Hint: there are no up-front monies allocated to ALS. The only funds will be scraps from unused EMT training and Bureau Operations dollars. If you read between the lines with these rewrites, there is also no intent to continue funding CFR programs.

Edited January 25, 2012 by firedude

[NWFDMedic 58]

Wow, I sure hope this doesn't pass. It would be a huge step back for EMS in New York State.

[Guest alsfirefighter]

Wow, I sure hope this doesn't pass. It would be a huge step back for EMS in New York State.

I've read through it and see some things good and some things I'm not so sure will be a plus. Just interested in your thoughts as why it would be a huge step back.

[OoO 24]

I found this to be rather troubling

38. EMS training can now use coursework, testing, continuing ed and/or continuous practice to provide the means by which personnel, including instructors, can be trained and certified. This includes certification of EMT and AEMTs without the use of written and/or practical skills exams. The Commissioner, with consultation from the State EMS Advisory Board must develop rule and regs necessary to implement.

I think this is a real step back.

[NWFDMedic 58]

I've read through it and see some things good and some things I'm not so sure will be a plus. Just interested in your thoughts as why it would be a huge step back.

I know this is just one person's interpretation of what is in writing but it seems that authority is being centralized at the state level. It also seems that they are simultaneously shifting a lot of SEMSCO and SEMAC's authority over to the Commissioner.

As far as centralization at the state level, New York is looking to match several of the smaller states around us. I think that New York is a bit of a different animal though. Having lived and volunteered in St. Lawrence County, I can completely understand that some of the further regions of the state require significantly different protocols than the more urban or suburban regions of the state. I don't think one formula works for such a diverse state. Also, the bureaucracy involved with trying to get something passed at the state level will, in my opinion, hamstring those organizations that have traditionally been leaders in the progress of EMS in the state. Trying to get an aggressive new trial program approved to bring better care to our patients will likely be buried in red tape.

The regional system has many of its own problems but I don't think that removing them from the equation is the right thing to do at this point in time. Fix the problems at the state level first, make that a smooth running organization, and then revisit the consolidation of the regional authority.

[SageVigiles 1,194]

Yet NY still has its own separate EMT standard that doesn't comply with National Registry, correct?

[Guest alsfirefighter]

I can't see how anyone could gain a certification without testing in both skills and written testing. This is how NY State fire training was for volunteers for years and no one would accept NY certificates because of it and many instructors fought for years to get testing that counted and now you have the national certification on top of it. That one makes no sense to me. I'm a bit more liberal with certain other areas as I conduct online fire training courses but they incorporate more "written" testing including 2 exams administered by me and students still have to show proficiency in the skills as outlined in the skill sheets that are by NFPA standard.

[Guest alsfirefighter]

Just another thought that came to mind to me. Is this a cascade from Gov. Cuomo's realignment and budget that is causing a shift to do things to be able to earmark funding for things that are ongoing as well? Just food for thought.

[MoFire390 118]

I thought NY was going to go to the National standard for EMT's??? I am currently waiting for my paper work form Michigan to arrive so I can file for resoprocity there. so far I have PA, and OH.

[FD828 77]

Does anyone think this will be a first step towards a licensure as apposed to a certification? It would be income coming in every year as apposed to going out. I am not holding my breath, but it would be nice.

[NWFDMedic 58]

Does anyone think this will be a first step towards a licensure as apposed to a certification? It would be income coming in every year as apposed to going out. I am not holding my breath, but it would be nice.

I am in the extreme minority but I think licensure is a bad idea. The CME based recertification is a quasi-licensure program and I believe the program leads to some erosion of essential skills over time. We have actually had some empirical evidence to support this claim. I think it's a lot different for paramedics that are practicing full-time but for the EMT that rides 12 hours a week for their squad that might do 1 call a month, I think the regular refresher programs are important.

[NWFDMedic 58]

I can't see how anyone could gain a certification without testing in both skills and written testing. This is how NY State fire training was for volunteers for years and no one would accept NY certificates because of it and many instructors fought for years to get testing that counted and now you have the national certification on top of it. That one makes no sense to me. I'm a bit more liberal with certain other areas as I conduct online fire training courses but they incorporate more "written" testing including 2 exams administered by me and students still have to show proficiency in the skills as outlined in the skill sheets that are by NFPA standard.

I didn't understand that language either. I was guessing that it might have been added in for the air medical companies that employ flight nurses and want to certify them as medics too (as, of course, a medevac is an air ambulance and must have a medic on board). I surely hope they aren't planning on doing what NYS did with the fire courses way back when. My initial EF course had no requirement that you pass a test and then a short time later they went to the program of testing but you would still get a certificate if you failed; it just didn't have some stamp or sticker. The premise was that a firefighter can do the job without necessarily being able to pass a test. My personal opinion is that a firefighter has to have the basic knowledge and critical thinking skills to do the job properly and that can be evaluated with testing.

[gpeifer 89]

About the bill...

Full explination by Mike McEvoy (NYS EMS Council)

Take a look at how Pennsylvania does things.

[Medicone 14]

About the bill...

Full explination by Mike McEvoy (NYS EMS Council)

I guess I may be the only one who believes that this change is fantastic.

1. Individual regions retain their respective ALS protocols and REMAC’s;

2. The monopolistic effects of competing ambulance services planting their members on the REMSCO’s and SEMSCO’s is limited; and probably their collective lobbying groups on SEMSCO as well. This is a huge problem under the current system as any new agency/expansion can only be created if its competitors on the REMSCO vote to allow it; then when it’s appealed to the SEMSCO, the collective commercial lobby group sitting as members of SEMSCO backs the commercials.

3. Allows the commissioner to have more oversight and involvement in EMS regulation and operations;

In the long run, EMS will most likely run smoother due to less road blocks and less political nonsense.

Just a few thoughts.

[mvfire8989 22]

Does anyone think this will be a first step towards a licensure as apposed to a certification? It would be income coming in every year as apposed to going out. I am not holding my breath, but it would be nice.

Could you elaborate on how a licensure would be different from the current certification process?

[Goose 188]

Could you elaborate on how a licensure would be different from the current certification process?

Just need to pay the state on a yearly basis to keep you're credentials current, continuing education would be a regional requirement to keep you're regional credentials (i.e. MAC) current.

[helicopper 1,050]

The biggest issue that I see with this is the responsibility placed on the Commissioner of Health - not a State EMS Commissioner/Director. The "Bureau of EMS" is one of many subdivisions within the State DOH and it is ridiculously small and short-staffed.. All these "powers" bestowed on the Commissioner will probably in practice be delegated to the Bureau of EMS that has an "acting" director right now. The turnover in Commissioner's is going to affect continuity and could result in drastic changes in policy and practice with every change in administration.

[FD828 77]

Could you elaborate on how a licensure would be different from the current certification process?

Like "Goose" said, you would pay a yearly fee for your license renewal and would not have to report any CME's to the STATE. However it would be the responsibility of the local REMAC's to set CME/skill requirements. They could do it on an annual, semi-annual or every 3 years as they currently do. But here are some benefits that I see. What if you wanted to take a couple years off to say persue another carrer path, say nursing or PA school? What happens now? You don't recertifiy and you loose your medic card. But if you could send a check every year, you wouldn't have to worry about loosing something you worked so hard to get. It would be up to each REMAC to certify each medic working in their perspective regions. Not to mention it would be income for the state. I pay $150/yr on my birthday to Connecticut for my license. $150yr x how many medics in NY? = $$$ for good old NY. If EMS was truly a career with the same pay/benefits/retirement as PD&FD, and you only had to work one job, then maybe it wouldn't be so bad to recert every 3 years. And isn't making it a license saying it is more proffessional? Don't nurse's get licensed? And no offense to RN's at all(Married to one, mother-n-law is another, most of my aunts are RN's), but I think what a medic does in the field in some terrible conditions is more then what an RN can do at an ER with all the proper lighting, security, an IV team, respiratory and an ER doctor all sitting there. But what is the average number of hours someone in EMS works in a week and at how many different jobs? Maybe that is what the state should be concentrating on doing. Make EMS a CAREER not a JOB.

[ny10570 745]

Licensure vs certificate has no bearing on the perception of EMS as a career or just a job. It has zero bearing on our pay or our respect as profession. Its a semantics argument and nothing more. Guess what, doctors and nurses have to regularly recertify with their various boards through testing and continuing education. Instead of paying the state for our license and then some private group for their seal of a[[roval we just have to pay the state to retest us. I don't want someone stepping away for a few years and then being able to come back and work just because they've been paying their dues. We b**** constantly about the decrease in standards yet people would encourage something like this??

[FD828 77]

Licensure vs certificate has no bearing on the perception of EMS as a career or just a job. It has zero bearing on our pay or our respect as profession. Its a semantics argument and nothing more. Guess what, doctors and nurses have to regularly recertify with their various boards through testing and continuing education. Instead of paying the state for our license and then some private group for their seal of a[[roval we just have to pay the state to retest us. I don't want someone stepping away for a few years and then being able to come back and work just because they've been paying their dues. We b**** constantly about the decrease in standards yet people would encourage something like this??

Absolutely. That's why I said it would be up to the REMAC to be responsible for all working in their area through (hopefully higher standards then we presently have) whatever means. I would hope it would involve senarios and skills stations. And IMO I disagree that having it be a license as opposed to a certification does have a bearing on our profession. You think the pilot recert program is doing anything for the quality of EMS personnel working in this state? It is a joke. You sit for CME's and send it to the state and you get a new card. With the REMAC being responsible, you could ensure competent people working in the field.

[Goose 188]

Licensure vs certificate has no bearing on the perception of EMS as a career or just a job. It has zero bearing on our pay or our respect as profession. Its a semantics argument and nothing more. Guess what, doctors and nurses have to regularly recertify with their various boards through testing and continuing education. Instead of paying the state for our license and then some private group for their seal of a[[roval we just have to pay the state to retest us. I don't want someone stepping away for a few years and then being able to come back and work just because they've been paying their dues. We b**** constantly about the decrease in standards yet people would encourage something like this??

How do you feel about extending the 5 year card to everyone? I treat as many patients as any FDNY paramedic...there is absolutely no reason why AT LEAST that can't be extended to others.

Edited January 27, 2012 by Goose

[mvfire8989 22]

Licensure vs certificate has no bearing on the perception of EMS as a career or just a job. It has zero bearing on our pay or our respect as profession. Its a semantics argument and nothing more. Guess what, doctors and nurses have to regularly recertify with their various boards through testing and continuing education. Instead of paying the state for our license and then some private group for their seal of a[[roval we just have to pay the state to retest us. I don't want someone stepping away for a few years and then being able to come back and work just because they've been paying their dues. We b**** constantly about the decrease in standards yet people would encourage something like this??

I completely agree with this. I asked the question to see if by licensure FD828 was implying a lifetime ability to practice as a medic without any further testing. I am a medical student now, facing 3 more years of education to get my M.D., followed by a minimum of 3 years of residency to receive my full board certification and medical license. At that time, I will still need to retest every so often to maintain my board certification, as well as a CME requirement. I don't see any traction for changing the medic to something that would not require testing.

[ny10570 745]

How do you feel about extending the 5 year card to everyone? I treat as many patients as any FDNY paramedic...there is absolutely no reason why AT LEAST that can't be extended to others.

I don't know about any medic. Many medics, absolutely. Chest thumping aside, I wouldn't hold my breath on the 5 year card any time soon as we're reviewing substantial changes to the program. Turns out there's a big difference between training and doing. In my opinion a smaller agency with more oversight would be better suited for the 5 year recert. There's just too many differences in experience amongst the 5 boroughs. An overnight unit is Staten Island just isn't staying as sharp as an evening crew in East New York or the South Bronx. The details aren't final, but we're probably going to a 3 year challenge refresher. I still think 5 years is better with the annual core concepts training and then a challenge refresher, but the system is so large they can't do anything simply.

Quick addition, Its more than just treating patients. Its about actually using the skills. There are some Manhattan units that are through the roof in call volume but in the basement with the more intensive ALS interventions. Treating 100 sick calls isn't the same as running 10 "mega codes". That is not to dismiss those 100 patient contacts. assessment is an invaluable skill that needs patients to develop, but at some point you need to use your skills and protocols or you lose them. In the Bronx I was doing Asthmatics so frequently we set up a little asthma kit with all of our drugs all ready in it. Now, in Manhattan I had to pause for a second trying to remember how much Mag Sulfate to give. It's been over a year since the last time I'd given it. In exchange for my Asthma/APE experience, now my knowledge of recreational pharmaceuticals and psychology has grown exponentially.

Edited January 27, 2012 by ny10570

[Guest alsfirefighter]

I didn't understand that language either. I was guessing that it might have been added in for the air medical companies that employ flight nurses and want to certify them as medics too (as, of course, a medevac is an air ambulance and must have a medic on board). I surely hope they aren't planning on doing what NYS did with the fire courses way back when. My initial EF course had no requirement that you pass a test and then a short time later they went to the program of testing but you would still get a certificate if you failed; it just didn't have some stamp or sticker. The premise was that a firefighter can do the job without necessarily being able to pass a test. My personal opinion is that a firefighter has to have the basic knowledge and critical thinking skills to do the job properly and that can be evaluated with testing.

And that take the test, still fail and walk out with a certification is long gone for 7 or 8 years now as well. You either pass or you don't..there are no hand outs. This came about when Firefighter 1 and 2 were rolled out replacing the basic, intermediate and advanced curriculums of circa 1999/2000 and which was not what was originally what the state wanted but the usual lobbying groups fought bringing in FF 1/2 curriculums at the time with the same usual arguments.

[Guest alsfirefighter]

Does anyone think this will be a first step towards a licensure as apposed to a certification? It would be income coming in every year as apposed to going out. I am not holding my breath, but it would be nice.

Maybe I'm missing something...or after reading about 5 lines I start to skim as its a tough read..but some of the things in there I would associate with stepping as far away from licensing as could be.

As far as the "pilot" program..which is the longest "pilot" I've ever been involved in...I think when administered correctly that it can actually enhance knowledge..but I'm lucky to have a good system locally that mixes lecture and hands on and the lectures are done in a way while the same topic gives you basics and often gets into detail on the topics as well with newer things out there.

[ny10570 745]

Absolutely. That's why I said it would be up to the REMAC to be responsible for all working in their area through (hopefully higher standards then we presently have) whatever means. I would hope it would involve senarios and skills stations. And IMO I disagree that having it be a license as opposed to a certification does have a bearing on our profession. You think the pilot recert program is doing anything for the quality of EMS personnel working in this state? It is a joke. You sit for CME's and send it to the state and you get a new card. With the REMAC being responsible, you could ensure competent people working in the field.

Why would remac be any more capable of administering the training? Most have a hard enough time filling all their advisory positions. No matter who is in charge it is up to the individual agency to maintain the training and certificate standards. REMAC or the state just establish a minimum and ensure compliance. If remac followed the same recert standards as the state you'd still have people just handing over cmes and getting their card.

[Goose 188]

Why would remac be any more capable of administering the training? Most have a hard enough time filling all their advisory positions. No matter who is in charge it is up to the individual agency to maintain the training and certificate standards. REMAC or the state just establish a minimum and ensure compliance. If remac followed the same recert standards as the state you'd still have people just handing over cmes and getting their card.

Hes referencing how the state of Connecticut organizes things. You're licensed through the state DPH and credentialed to work by the state's respective regions.

[Guest alsfirefighter]

Hes referencing how the state of Connecticut organizes things. You're licensed through the state DPH and credentialed to work by the state's respective regions.

Isn't it slightly the same here minus the licensure? You get NY State certification and then to work in a region you have to be credentialed by the region.

I have no opinion on the 5 year vs. 3 year recert. I think if anything it might be slightly more manageable to agencies and the state to have it every 3 but that's just a thought not speaking from any actual fact. I could also see it harder for those who like to cram at the last minute to get 5 years worth vs. 3 at the end.

[SmokeEatter40 8]

Regarding the 3 or 5 year recert plan, with all the recent changes and changes coming down the pike I believe sticking with the 3 year plan is the way to go. Keep up on the updates more readily, if your agency does not provide protocol updates. And a lot less on your plate when recerting.

Also, I have been both in the generic recertification and the pilot program. I agree with both teams here. The generic class recert is prbably the way to go, to make sure you are up to date and compitent with the most up to date training. Yet, at the same time, taking the pilot program allows more free range training in emergency service certification. Catching a lot more modern training knowledge and techniques in new technology. In my opinion I would more side towards with general recert class for the best and most direct EMS traning.