Changes driven by VITA transformation activities may change OEMS’ ability to serve external agency and internal information technology customers. This will increase agency costs to meet the transformation mandates.

EMS agencies and personnel are expecting to transact more programmatic and financial business with OEMS across automated systems. This will require OEMS to expand electronic services.

Emergency Medical Services are available statewide, but the level of service varies. This will require a greater coordination of services by OEMS with local governments, EMS agencies and organizations.

Prehospital Patient Care Data collection system is inadequate and response time standards are needed. This will require OEMS to examine new technologies in the collection of data.

Recruitment and Retention of EMS providers are major problems for EMS agencies. Local, Regional, and State initiatives are needed to address recruitment and retention.

The availability to participate in educational programs by volunteers who have greater demands placed on them by family and employers, the educational content required to comply with national standards and increase in the cost of training affect the number of certified EMS personnel.

Revenue recovery and local funding of Emergency Medical Services is an emerging issue. In general, EMS is moving from a free service provided by volunteers to a service that bills for care.

Trauma Center designation is voluntary and has lead to gaps in trauma care in certain areas of the state. There has not been a financial incentive to being a designated trauma center. A recent JLARC report on “The Use and Financing of Trauma Centers” indicated that Virginia’s Trauma Centers were losing $45 million annually; at risk of downgrading or closing; experiencing difficulty recruiting specialty physicians; and facing increased medical malpractice liability costs.

§18.2-270.01 of the Code established the State Trauma Center Fund and it is expected to raise $4.2 million annually; however, this is less than 10% of the financial losses being experienced by the trauma centers.

Virginia’s Poison Control Centers have a growing financial concern. The centers have not had their funding increase in 10 years and actually had a budget reduction of 15% two years ago. During these 10 years of level funding the three poison centers that serve Virginia have managed an increase of human exposure consults by 43%. Despite these funding issues, they have had increased costs for staffing and services. This limits the community outreach, injury prevention and surveillance services they are able to provide and correspondingly relates to the costs associated with inflation and the 15% reduction of funding.

The Virginia EMS for Children Program has been funded through federal funds and it is unclear if federal grant support will continue. Demands for emergency care and EMS services for children with chronic illnesses, or technology-dependent conditions continue to increase.

Increased violence in the workplace, schools and public areas continue to drive the demand for CISM services.

National changes in laws and processes will impact the availability of EMS personnel and resources.
Homeland Security issues - National Incident Management System and local/federal coordination. Financial reimbursement - revenue recovery; Emergency Medical Treatment and Labor Act; and Medicaid/Medicare laws. New training – time and resource commitments.

Regulation and oversight of EMS agencies will remain a significant focus of this service area plan. Anticipated changes in the service area include the EMS System through OEMS and the regulatory process needs to promulgate new/revised regulations concerning fesignation of Regional EMS Councils (currently in development); ginancial assistance to EMS agencies (currently under revision); and pursuant to HB 2238 EMS regulations need to define response times, data collection requirements and, enforcement provisions to include civil penalties(currently in development).

Changes, updates and new legislation from the Federal Communications Commission concerning public safety communications will impact EMS agencies. Changes in communications technology (e.g., improved two way radios, voice over internet, digital radios, etc.) will have a financial impact upon EMS agencies and they will seek alternative sources of funding for these major investments. Greater technical and financial assistance from OEMS is anticipated. OEMS will continue to offer its program in emergency medical dispatch and accreditation program for 911 Public Safety Answering Points (PSAP) and Emergency Dispatch Centers. Accreditation promotes implementation of standardized emergency medical dispatch (EMD) protocols and continued training and education of dispatchers.

Critical Incident Stress Management (CISM) services has primarily focused on EMS and fire. Legislation passed during the 2005 General Assembly increased the objectives of § 32.1.111.3 to include CISM. OEMS has been working with Virginia’s law enforcement community and this service area is expected to expand substantially. There will be an increased need for CISM training and CISM services across the Commonwealth as violence in the workplace, schools and public areas continue to escalate. CISM is now being requested by public schools (school shootings), jails and mental hospitals (abused staff) and private business (robberies) leading to increased requests for debriefing services.

EMS agencies, particular volunteer agencies with higher turnover, will need to continue to develop new leaders who are competent to manage a changing and challenging environment and the complex issues of managing an EMS agency. Volunteers will be more dependent on career support for answering calls and managing the day-to-day operations. With the changing demographics of Virginia, leaders will need to be trained in dealing with a variety of ethnic and cultural backgrounds and issues. OEMS will experience an increase in demand for technical assistance services and funding related to recruitment and retention of EMS personnel.

OEMS customer services are anticipated to increase as the number of EMS responses increases. As the public’s expectations for EMS services increases, local governments and EMS agencies will seek the assistance of OEMS to increase the level of patient care while finding ways to maximize the impact of public funds. Informing the public remains a challenge and will require innovative methods to educate the public about the EMS System.

Demands for emergency care for children continue to increase due to inadequate access to primary care, increased survival and home care of children who suffer from chronic illnesses or who are technology-dependent, racial and ethnic disparities in pediatric emergency care, terrorism concerns, and staff, facility, and other resource limitations. OEMS will experience an increase in demand for technical assistance services and funding.

New regulations and contract requirements of Regional EMS Councils will increase the demands on council resources and local priorities

The quality of patient care can be improved when there is a coordination and integration of resources. Fuller integration of pre-hospital providers and hospital providers into a unified EMS system will result in faster access, better pre-hospital care, and continued high quality patient care through the rehabilitative phase. The provision of EMS training will change with technological improvements. OEMS will need to change the curricula to meet new technologies.

Due to workforce shortages and demand on services, EMS will see a trend in returning to basics, i.e., a rapid and robust Basic Life Support system followed by a smaller cadre of experienced and well supervised paramedics. The demand for technical assistance from localities, EMS agencies and organizations to develop strategies to address recruitment and retention of EMS personnel will increase.

There will be changes in EMS curricula and certification programs based on EMS training and educational core content, the National Scope of Service and educational standards.

Virginia’s trauma system is benchmarked with national and state systems to ensure continuous adherence with recognized best practices in trauma care. A biannual review process of trauma centers will be conducted. Additionally, in conjunction with the JLARC study, an analysis of geographic gaps in trauma system coverage, by region will be conducted, recommendations and plans developed to meet identified gaps in trauma care services.

There will be a greater role on safety of EMS providers. Compared to police and fire, ambulances experience the highest percentage of crashes with fatalities and injuries. Not being restrained in the back of an ambulance pose great risks. Motor vehicle crashes are the leading cause of work related deaths for EMS workers. There is a need to review current ambulance design and injury prevention and safety programs.

Other threats to EMS providers range from bloodborne pathogens, assault & homicides to back injuries and hearing loss. Overall occupational death rates per 100,000: police: 14.2; firefighters: 16.5; EMS: 12.7. The national average for all workers is 5.0.

There will be an increasing role for lay interveners. The impact of 9/11 has resulted in the development of citizen corps and other volunteer groups, support for neighbors and family, new courses being developed and an increasing role of bystander care until EMS arrives. This will require greater coordination and management of information and resources by OEMS.

Health care delivery issues such as declining on-call availability of specialists, diversion, hospital overcrowding, difficulty of access to primary care, uninsured patients and increasing EMS call volume will require EMS to play a significantly larger role in community health delivery and coordination of services. This will place a greater demand on OEMS programs, services and financial resources.

EMS will play a critical role in monitoring the health of a community, surveillance, early detection; ensuring patients have access to appropriate care – all of which will require additional training for EMS providers, additional resources and more reliance on OEMS programs and services.

New regulations governing the designation process and changing contractual requirements of Regional EMS Councils will place greater emphasis on performance and outcome measures for those designated councils to meet the needs and priorities of the EMS agencies and local governments within their designated service area.

• EMS Education, Training and Medical Direction Regulatory authority to establish certification and re-certification qualifications and standards for EMS personnel: EMT Basic Life Support curriculum and competency standards; EMT Advanced Life Support curriculum and competency standards; EMT Instructor curriculum and competency standards; and certification examinations. Maintain certification records of EMS personnel: Initial certification candidates and re-certification candidates. Establish accreditation criteria and standards for training sites/programs. Perform accreditation site visits of training centers/programs.
• Critical Care and Trauma Trauma Center Regulatory Authority: Designation criteria development and designation inspections. Trauma System Planning (State Trauma System Plan): Oversight & Management Committee; Statewide Trauma Triage Plan Development & Compliance Monitoring; and Regional Trauma Triage Plan monitoring/administration. Trauma Center Fund Administration Emergency Medical Services Patient Care Information System data collection and analysis: Statewide Trauma Registry administration; participation in the Crash Outcomes Data Evaluation System (CODES); and Poison Control Center Network contract administration.
• Emergency Operations: OEMS is responsible for developing a comprehensive and coordinated response during a declared “state of emergency”. This is achieved through Health and Medical Emergency Response Teams (HMERT) and the training of EMS personnel and other first responders. Disaster Response Teams: Health and Medical Emergency Response Teams (HMERT) and Disaster Task Forces. Training Programs: Public Safety Response to Terrorism – Awareness; Heavy and Tactical Rescue; HMERT Team Member; HMERT Team Leader; and Mass Casualty Incident Management - Modules I -V.
• Emergency Medical Services for Children (EMSC): Integrate EMSC within the state EMS system. Incorporate pediatric issues in all aspects of clinical care through outreach and education in the prehospital setting, emergency departments and primary care offices. Administer and maintain a statewide emergency medical services for children program to provide coordination and support for emergency pediatric care. Assess the existence of a statewide, territorial, or regional system that recognizes hospitals that are able to stabilize and/or manage pediatric emergencies. Assess the percentage of Virginia licensed hospitals that have written interfacility transfer agreements, and written guidelines for effecting interfacility transfers. Improve and expand pediatric emergency care education systems. Improve EMS/EMSC systems development. Ensure that integration of health services meets children’s needs by increasing the availability of pediatric injury prevention, first aid and CPR programs throughout Virginia. Develop broad-based support for prevention activities. Increase both unintentional and intentional injury prevention programs. Increase community linkages between EMSC and the Children with Special Health Care Needs (CSHCN) program. Identify and recommend pediatric equipment for EMS vehicles.
• EMS System Evaluation & Research: Assist all areas of EMS system development with supportive data from the EMS Patient care Information System to ensure prehospital emergency care is developed in an evidence based fashion. EMS Research can contribute to high quality EMS and to drive improvements in patient outcome. Vast amounts of money are being spent for patient care with little rigorous evaluation of the effectiveness of that care. Methodologically sound research must be incorporated into all facets of the EMS system. EMS Research can assure new technologies and therapeutic approaches are scientifically and rapidly evaluated prior to or at the initiation of their use and for continued monitoring.
• Human Resources Management and Technical Assistance: Technical Assistance – OEMS will coordinate with regional EMS councils and other state organizations to assist local EMS and government officials with specific system issues. Technical Resources – Develop, produce and distribute manuals, tool kits, curriculums, and self assessment guides to help local EMS and government officials to identify solutions to their own retention, leadership and management related issues. Resource Coordination - Partner with regional EMS councils and statewide EMS organizations and agencies to pool resources and assist volunteer and governmental EMS agencies. Financial Support - Promote the Rescue Squad Assistance Fund grant program to localities to help fund management and leadership and recruitment programs. Workshop and Seminars - Sponsor leadership and management workshops and seminars at EMS Symposium and other state-wide conferences.
• Public Information and Education: Provide public education and awareness programs to increase interest, knowledge and participation in Virginia’s emergency medical services system; promote and publicize Office of EMS programs and services identified under the Service Area Description of this plan; assist EMS agencies in recruitment efforts; promote of the National EMS Memorial Service to recognize EMS personnel who died in the line of duty in Virginia and throughout the nation; and coordinate of Virginia’s Durable Do Not Resuscitate (DNR) program, and education of the public, EMS providers and health care facilities on rules and regulations.
• EMS Regulation and Compliance: EMS Agency Licensure and Vehicle Permits: Inspect and license new and existing EMS agencies and inspect and permit EMS vehicles. Compliance and Review of EMS Regulations Conduct investigations of EMS agencies and/or personnel; periodic review and revision of EMS regulations; and review and evaluate EMS agency or personnel requests for variances and exemptions to regulations. EMS Field Services: Coordinate and administer certification examinations and povide technical assistance to EMS personnel, agencies, local governments and organizations.
• Critical Incident Stress Management: Establish and maintain a process for crisis intervention and peer support services for emergency medical services and public safety personnel, including statewide availability and accreditation of critical incident stress management teams.
• Communications: Establish and maintain a program to improve dispatching of emergency medical services including establishment of and support for emergency medical dispatch training, accreditation of 911 dispatch centers, and public safety answering points; and coordinate FCC licensure authorization for EMS agency radio communication.
• EMS Registry: Conduct regular statewide EMS system needs assessments and report the results through the appropriate committees of the EMS Advisory Board; perform monitoring of the quality of emergency medical care being provided in both the out of hospital and in hospital environments; submission to the National EMS Information System (NEMSIS) database hosted at the National Highway Traffic Safety Administration (NHTSA). OEMS signed an MOU with NEMSIS in 2004 for agreeing to use the NHTSA 2.2 dataset and submit to the national database; support the Code mandated monitoring of patient transfer patterns of trauma patients throughout the Commonwealth. EMS System Evaluation performed as presented on the OEMS web site and during events such as EMS Symposium by the Office of EMS Statistician Analyst; and support system resource analysis for efforts of Commonwealth preparedness, homeland security, and others.
• Regional EMS Councils: Develop, coordinate and improve the delivery of EMS in the region through implementation of Regional EMS Plan, Regional EMS protocols, Regional Mass Casualty Incident Plan, regional coordination of basic and continuing education of EMS providers and , other services as defined in the performance based contract with the Office of Emergency Medical Services.

Objective Description

The Commonwealth regulates the qualifications for certification and recertification of emergency medical services personnel.

Alignment to Agency Goals

Objective Strategies

Objective Measures

Objective Description

The Commonwealth licenses and regulates EMS agencies through inspection and licensure of EMS agencies, permitting of EMS vehicles and investigation of complaints alleged against EMS agencies or personnel.

Alignment to Agency Goals

Objective Strategies

Objective Measures

Objective Description

OEMS is the state agency responsible to plan, coordinate and integrate a system of care that encompasses all aspects of emergency medical care.

Alignment to Agency Goals

Objective Strategies

Objective Measures

Objective Description

No state is immune from mass casualty events. The EMS System in Virginia must increase its efforts to plan for and mitigate the special types of events that consume both local and regional resources. These continue to increase at alarming rates, and many agencies are not prepared or equipped to respond in a timely or adequate manner. Effective response to major events, natural disasters or acts of terrorism is critical to the provision of EMS to the citizens of the Commonwealth.

Objective Strategies

Objective Measures

Objective Description

Effective planning and coordination is essential to the success of Virginia’s EMS system. Such plans should facilitate the development and coordination of effective and efficient delivery of EMS in each region. Virginia’s Regional EMS Councils provide overall coordination and leadership in establishing and maintaining EMS related plans, which are approved by the Virginia Department of Health Office of EMS.

Alignment to Agency Goals

Objective Strategies

Objective Measures