Peninsulas Emergency Medical Services Council

I. Regional Medical direction - the Peninsulas Emergency Medical Services Council (pems) maintains a Medical advisory committee (mac), which develops, approves, implements, expands, and improves programs of Medical control and accountability. The committee coordinates the development and maintenance of regional Medical treatment protocols and Medical oversight of education and testing for all levels of Emergency Medical service certification within the region. The policies and protocols established by the mac are the default "standard of care" for the provision of prehospital Emergency Medical care within the geographic boundaries of the peninsula, middle peninsula, and northern neck. In fy23, pems renewed the professional Services contract with amir louka, md, as the regional Medical director (rmd) for pems, consistent with responsibilities listed under the Virginia ems regulations 12 vac 5-31-1890. Using grant funds in fy23, pems sponsored three people from among pems' staff, the region's mobile integrated healthcare programs, and mih education programs to attend the first national mobile integrated healthcare conference in charlotte, nc. Ii. Protocol, policies, and procedures implementation - the Peninsulas ems Council provides and manages the region's advanced life support (als), basic life support (bls), pediatric care, and weapons of mass destruction (wmd) patient care protocols, policies, and procedures for all local governments, ems agencies, ems providers, ems physicians and hospitals within the pems region. The pems patient care protocols, policies, and procedures are adopted by the mac as a regional template and guide for the provision of prehospital Emergency Medical care. Pems maintains a protocols, policies, and procedures committee (ppp) that drafts and revises protocols, policies and procedures for consideration by the Medical advisory committee. Through their work, the ppp ensures that regional protocols, policies, and procedures continue to meet national standards which reflects continuously changing Medical knowledge, and ever more effective therapeutic modalities. In fy23, twenty-eight (28) separate new and/or revised protocol sets were reviewed and enacted by the Medical advisory committee. These new or revised protocols became effective on march 1, 2023. The protocols, policies, and procedures were revised to align with the revised Virginia office of ems' (oems) "scope of practice- and "medication formulary" additionally, there was particular attention paid to the revision of the pediatric protocols. In order to improve the protocol, policies, and procedures development and review process, pems provided a system whereby any member of an agency, the healthcare system or the general public can make known their concerns regarding specific patient care protocols, policies, or procedures. Iii. Ems performance improvement - pems maintains an ongoing performance improvement program to regularly assess ems system performance. This program provides the information needed for continuous quality improvement in prehospital Emergency Medical care and outcomes. The Council's ems performance improvement work is led by its multi-disciplinary performance improvement committee (pic) which is responsible for assuring and improving the quality of prehospital care provided within the region. The pic is also responsible for assisting the Medical advisory committee with Medical case reviews and evaluation of patient care and system performance data. In addition, the pic conducts studies and investigations to support the trauma, stemi and stroke committees as well as other committees and workgroups as needed. The pems ems performance improvement (pi) plan and the regional performance improvement templates were reviewed without revision by the performance improvement committee and approved by the board of directors. In fy23, the pems field coordinator of clinical care provided data reports for the mac, ems operations committee, the stroke committee, the st- elevation myocardial infarction committee and trauma committee. The reports were utilized to provide feedback to agencies and to the region as a whole. In fy23, pems ems field coordinator - clinical programs and ems systems it specialist developed performance improvement assistance for rural/smaller ems agencies in the region. Along with representatives from other regional councils, the pems ems field coordinator - clinical programs and ems systems it specialist attended a week-long eso conference in houston, tx to gain additional experience with the pre-hospital patient care reporting system and its data bridge. All expenses for the regional Council attendees were paid for by the state office of ems, and it resulted in a significant amount of information and discoveries that should result in the system providing more utility for the regional councils than it has in the past by making it easier to obtain regional data. Iv. Medical incident reviews - pems provides an online Medical incident report (mir) for ems providers and hospital staff to document "incidents" for review. They are submitted by a hipaa secure email to pems staff to ensure review by the appropriate agency, facility, department, or pems committee. General data on trends from mir reports can also drive local or regional protocol, policy or procedure changes. V. regional medication and ems supplies restocking programs - pems provides a regional medication and ems supplies restocking agreement with all ems agencies and the ten hospitals in the region with full-service Emergency departments. This agreement meets all current centers for medicare and medicaid Services (cms) federal regulations and describes the region's restocking procedures between the hospitals and ems agencies located in the pems region. The Peninsulas interfacility cooperation organization (pico), the Council's standing hospital facilities committee, maintains this agreement. Regional ems supplies restocking program and agency/hospital agreements are updated to remain consistent with regional protocols and procedures. The new agreement was reviewed by the board of directors. In fy23, the Peninsulas ems Council renewed both its class 6 controlled substance registration (csr)and clinical laboratory improvement amendment (clia waiver) for ems agencies throughout the pems region. In fy23, the pems executive director was asked to represent the regional ems councils in a statewide working group effort to address ambulance patient off-load times (apot). This is the time interval between the arrival of the ambulance patient at the Emergency department and the time the patient is transferred to an Emergency department bed/stretcher, chair or other acceptable location with the Emergency department assuming the responsibility of the patient. The working group was formed to: understand the perspectives from each of the stakeholder groups individually, outline recommendations to reduce apot times, and develop monitoring and surveillance tools. Vi.medication kit standardization and exchange - medication kits, rapid sequence intubation (rsi) medication kits, and training medication kits are located throughout the pems region in support of the regional standard of care as identified in the regional patient care protocols, policies and procedures. While the individual ems agencies purchase additional or replacement medication kits, the Peninsulas ems Council assumes the ownership of the boxes for repair, replacement, and system oversight. The Council provides the medication kits, and the contents of the kits are restocked after use and are owned by the region's hospital pharmacies. A training medication supplier stocks the training medication kits. The Medical advisory committee, in cooperation with the pharmacy committee, develops the content lists for both medication kits and the related protocols. All ems agencies within the region comply with the standardization of the medication kits and participate in the regional medication kit exchange program managed by the pems's pharmacy committee. The Council's ems field coordinator (operations) is responsible for the inventory control and maintenance of the region's drug boxes. The pharmacy committee worked to assure adequate supplies of approved medications, or in the face of continued national medication shortages, worked with the Medical advisory committee to develop alternative treatment modalities. Systems were also established to identify drug boxes with incomplete contents. The pharmacy committee modified the content list for the region's drug boxes to support changes in regional treatment protocols. In fy23, the pems renewed both its class 6 controlled substance registration (csr) and clinical laboratory improvement amendment (clia waiver) for ems agencies throughout the pems region. In fy23, the pems began educating ems agencies and ems educational programs on how to comply with ems specific board of pharmacy

I. Regional information and referral - pems aided local jurisdictions, ems agencies, ems providers, ems physicians, hospitals, other health care providers, public safety officials, and the public with ems information and referrals; served as a clearinghouse for regional and state ems pamphlets, posters, displays and other ems public relation and recruitment materials; maintained and updated an informational website. All course offerings were posted, to include courses offered by the pems as well as other ems-related courses. Through the Council website, staff also provided contact information, including telephone numbers and e-mail addresses so that agencies, providers, and members of the community could contact any staff member with a minimum of delay. All Council business involving hipaa/phi communications takes place using secure email and fax systems. The Council sponsors facebook and twitter accounts and distributes information on a frequent basis. Ems education and training - the Peninsulas ems Council provides, facilitates, and supports education and training programs, including continuing education "required topics," throughout the region by coordinating instructor networking which facilitates and aids in the provision of quality education to support ems agencies within the region. The Council partnered with hospitals in the region to provide an annual trauma symposium for pre-hospital and hospital Emergency Medical care providers, maintained cdc, vdh and other health-related information on the Council website, partnered with education and training centers including rappahannock community college ems programs (emt-basic, emt- intermediate and emt- paramedic) oversight committee, Virginia peninsula community college (emt-basic, emt-intermediate and emt-paramedic) oversight committee, and ecpi (paramedic) oversight committee. In fy23, pems continued the scheduling, coordinating and providing a clearinghouse for ems continuing education opportunities for the 16 jurisdictions making up the pems region. In fy23, the pems began providing bls psychomotor skills verification for individuals seeking emt certification from the Virginia department of health office of ems through legal recognition, re-entry, or md/rn challenge. In fy23, pems hired an ems field coordinator - education programs with duties and responsibilities that included the development of training materials for protocol updates, new Medical devices and treatment modalities adopted by the Virginia office of ems (oems)and the pems Medical advisory committee. The ems field coordinator - education programs also acted as a resource to local agencies to ensure ems providers developed and maintained the knowledge, skills and abilities required to remain relevant in the rapidly changing prehospital Emergency Medical care environment. The pems ems field coordinator - education programs coordinated instructor networking to facilitate and aid in the provision of quality education to support ems agencies within the region, and partnered with hospitals in the region to provide an annual trauma symposium for pre-hospital and hospital Emergency Medical care providers. The ems field coordinator - education programs also maintained cdc, vdh and other health-related information on the Council website and partnered with education and training centers, including rappahannock community college ems programs (emt-basic, emt-intermediate and emt-paramedic) oversight committee; and Virginia peninsula community college (emt-basic, emt- intermediate and emt-paramedic) oversight committee. In fy23 the pems executive director continued to serve on the board of directors of the rappahannock area health education center, which has the mission to recruit, train and retain health professionals and build a pipeline for the community college for continuing education opportunities. In fy23, the pems ems field coordinator - education programs built a database for pediatric dose calculating software apps based on the pems regional protocols and pems regional medication kit system. Pems provided this database to the ems agencies in the region. Ii. Critical incident stress management (cism) team - the pems supports and manages one of the sixteen critical incident stress management (cism) teams recognized by the commonwealth of Virginia. The pems cism team provides critical support to the entire pems Emergency Services community, including police, fire, Emergency Medical Services, Emergency communications, and hospital Emergency departments who experience psychologically traumatic events or suffer from the effects of cumulative events. The pems cism team also provides Services to members of the community involved in similar events. Team members provide pre-incident education, post-incident defusing, demobilization, and debriefing. In fy23, the pems's cism team responded to requests for cism team interventions and education requests from both agencies and individuals in the region. Hosted and provided staff support at semi-annual meetings of the cism team. In fy23, the pems continued liaison support with ems, fire and law enforcement agency peer support teams in the region, coordinating education and assisting them with state accreditation. Iii. Regional awards program - each year, the pems conducts a regional awards program. These awards recognize the unique and essential role that ems plays in the community and honors the individuals and agencies that have made a significant contribution to ems in the pems region. The regional award winners are nominated for the governors ems awards. The Council also works with its partners to provide a regional award program to honor the nominees and recipients of the annual regional ems awards. In 2023, pems hosted the annual awards ceremony at ems day at busch gardens. The pems regional ems awards were presented for excellence in ems (michael b. Player award) - chief ryan t. ashe, james city county fire department; outstanding ems leadership (russell lowry, jr. award) - ems chief lewis a. kerns, gloucester county volunteer fire and rescue; outstanding ems agency - james city county fire department; outstanding prehospital provider (joseph b. howard award) - master firefighter/paramedic jeremy e. lefevre, newport news fire department; innovation excellence in ems - captain michael b. stinson, york county department of fire and life safety; outstanding contribution to ems by a physician (gaylord w. ray, m.d. Award) - dr. benjamin d. nicholson, operational Medical director for vcu health lifeevac and lancaster county ems; outstanding contribution to ems by a nurse (melissa holloway, r.n. Award) - matthew j. jensen, rn, vcu lifeevac; outstanding prehospital educator - philip n. shahan, ems adjunct instructor at rappahannock community college; outstanding contribution to ems for children - middlesex county volunteer rescue squad - camp rescue; outstanding contribution to ems health and safety - james city county fire department; outstanding ems telecommunications dispatcher - brooke tidwell, public safety specialist ii for newport news police department; outstanding contribution to ems preparedness and response - doug smith, riverside health system; outstanding contribution to ems by a high school senior (1,000 scholarship) - joshua craig, gloucester volunteer fire department and rescue squad; outstanding ems call - newport news fire department - response to the richneck elementary school shooting and the york county department of fire and life safety for its response to the interstate 64 party bus crash. President's award recipient for exceptional Services for the pems Council as board member 2017-2023 - trisha anest, md, system Medical director, us acute care solutions, bon secours mercy health Virginia; president's award for exceptional Services for the pems Council as board member 2020-2023 - bradley beam, nrp, chief of Emergency Services, amherst county, Virginia; president's award for exceptional Services for the pems Council 2019-2023 - eleanor erwin, md, Emergency medicine physician, sentara facilities on the southside as well as the williamsburg regional Medical center on the peninsula, and omd for eastern state ambulance; president's award for exceptional Services for the pems Council 2009-2023 - kimberly harper, rn, director of patient and team member safety, riverside health system; president's award for exceptional Services for the pems Council 2019-2023 - jeff t. sensenig, do, Emergency medicine physician, riverside walter reed hospital; president's award for exceptional Services for the pems Council 2012-2023 - frank wingfield, realtor, Virginia country realty; platinum partnership award - riverside health system; gold partnership award - sentara healthcare; silver partnership award - busch gardens williamsburg; silver partnership award - bon secours; bronze partnership award - vcu health; bronze partnership award - chesapeake bank/chesapeake wealth managem

I. Regional strategic ems plan - pems utilizes a regional strategic ems plan with established strategies and initiatives, to provide the Council and staff guidance with continual development and improvement of the regional Emergency Medical Services system over time. The document focuses on five core strategies: promoting collaborative approaches, creating tools and resources, developing infrastructures, assuring quality and evaluation, and strengthening the regional Council. The pems completed an annual review of the regional strategic ems plan and its core strategies and strategic initiatives. Ii. In fy23 the Council's continuity of operations plan (coop) was updated and approved by the board of directors. Iii. Mci support - the pems provides coordination and assistance with mass casualty planning and training on local, regional, and state levels. In conjunction with the hampton roads metropolitan Medical response system and the tidewater ems Council, the pems provides and updates a regional mass casualty incident (mci) plan and guide for all ems agencies, ems providers, ems physicians and hospitals in the region. The hampton roads mass casualty incident response guide incorporates the processes of the Virginia triage tag as well as the simple triage and rapid treatment (start) and jumpstart (pediatric) patient triage which were adopted by the commonwealth of Virginia. The Peninsulas ems Council provides mci exercise planning and evaluation, and mci training, on request, throughout the region. The Council also works with the Peninsulas interfacility cooperation organization (pico) and the eastern Virginia healthcare coalition to monitor the regional hospital diversion plan. In fy23 the Council, in coordination with the tidewater ems Council and the hampton roads metropolitan Medical response system continued its re-write of the hampton roads mass casualty incident response plan. The plan is scheduled to be complete in fy24. Iv. Hampton roads metropolitan Medical response system (hrmmrs) - in partnership with the tidewater ems Council, the pems assists with the management and implementation of the hrmmrs. This program strives to improve regional Medical response to any large-scale disasters or acts of terrorism within the jurisdictions served by the hampton roads planning district commission (hrpdc), including surge capacity planning. Sustainment funding from the sixteen hrpdc cities and counties and various federal contracts and grants fund this program. In fy23, the hrmmrs continued regional planning and improvement of the health system response to disasters by actively participating with local and regional groups such as Virginia department of health Emergency planning and response planners (vdh ep&r), the Virginia department of Emergency management (vdem), the hampton roads all-hazards advisory committee, regional catastrophic planning grant workgroup, regional catastrophic planning grant planning team and mass care and sheltering workgroup, secure commonwealth health and Medical subpanel, the eastern Virginia hospital preparedness coordinating group, the cities readiness initiative and the regional all hazards advisory committee. In fy23, the pems began offering moulage artistry courses to train individuals to prepare "victims" with simulated illnesses and injuries to enhance participant learning in exercises, drills and training events. V. eastern Virginia healthcare coalition - in fy23 the pems continued its partnership with the eastern Virginia healthcare coalition to develop resiliency within the hampton roads and eastern Virginia region's hospitals and healthcare facilities, ems agencies, non- government and private healthcare organizations and Services and public health in times of crisis. The Council's executive director serves on the coalition's advisory committee. An "exercise and training" workgroup was established to assist the area hospital systems with continued regional planning and improvement of health system response to disasters by participating in tabletop, functional and full-scale exercises in order to assist with exercise planning and evaluation support. Vi. The Council also works with the Peninsulas interfacility cooperation organization (pico) and the Virginia hospital and healthcare association to rework and monitor the hospital diversion notification and closure process. Throughout fy23, the pems continued to coordinate or participate in regional planning and improvement of health system response to disasters including pandemics. The pems participated with local, regional, state and federal pandemic planning, response and evaluation efforts in fy23, the pems reworked its transportation decision protocol

I. The pems interacts with the Virginia office of Emergency Medical Services committees to provide avenues for two-way information sharing and statewide system improvements and enhancements. State committees for which the pems has committed staff, volunteers and resources include: state ems advisory board, state Medical direction committee, state Emergency management committee, state ems awards committee, state Medical direction committee, state legislation and planning committee, state financial assistance review committee, state trauma performance improvement committee, state workforce development committee, Virginia stroke care quality improvement advisory group, state provider health and safety committee, governor's secure and resilient commonwealth panel, health and human resources subpanel. Ii. Greater williamsburg heartsafe alliance - a community program involving the greater williamsburg area (the cities of williamsburg and poquoson and the counties of james city and york), the college of william & mary, the greater williamsburg chamber and tourism alliance, riverside health system and sentara healthcare. In fy23, the greater williamsburg heartsafe alliance engaged the greater williamsburg community through citizen education, hands-only cpr training and awareness of aed access. Through the use of the alliance's funded two smart phone apps "pulsepoint- and "pulsepoint aed (automated external defibrillator)," the two public safety answering points providing 9-1-1 Emergency dispatching in the greater williamsburg area, notified citizens when cardiac arrests occurred in public and the location of the closest available aed. In fy23, the greater williamsburg heartsafe alliance provided aeds to james city county and york county through a grant from the williamsburg health foundation. Iii. Ems systems information technology - in fy23, the ems systems - information technology specialist installed a new camera security system for the office. Pems also acted as the regional resource and advocate for technology solutions to secure timely and effective regional ems system data collection, management, and sharing. The ems systems it specialist worked with Council staff, committees and volunteers, ems agencies, jurisdictions and hospitals to develop and implement technology solutions to acquire information needed for ems system planning, patient care delivery decisions and evaluation. With the help of this individual pems assisted ems agencies and the Virginia office of ems transition the electronic prehospital patient care reporting contract from image trend to eso. In fy23, the Virginia office of ems sent the Council's ems systems it specialist and the ems field coordinator - clinical programs to the national conference to learn more about the eso database used by the commonwealth of Virginia for its prehospital patient care reporting.