The Latest From FICEMS

The December 11, 2024 virtual meeting of the Federal Interagency Committee on EMS (FICEMS) covered topics such as 9-8-8 suicide hotline call rerouting, prehospital blood transfusions, child safety while being transported in ambulances, and reducing violence against EMS workers.

According to the U.S. government website ems.gov, "The Federal Interagency Committee on Emergency Medical Services (FICEMS) was established by Congress in 2005 to ensure coordination among Federal agencies supporting local, regional, State, tribal, and territorial EMS and 9-1-1 systems. FICEMS was also created to improve the delivery of emergency medical services (EMS) throughout the nation."

Here are some of the highlights.

FCC Pushes Through 9-8-8 Call Rerouting

The Federal Communications Commission (FCC) has taken action to ensure that 9-8-8 suicide hotline calls get to the right people.

“In October, the Commission adopted an order that will require wireless carriers to route all 9-8-8 voice calls based on the location of the caller as opposed to the caller's area code, which is historically how those calls have been routed, both on the 800 number hotline and then on 9-8-8 when it was originally launched,” reported David Furth, deputy chief of the FCC’s Public Safety and Homeland Security Bureau. “This will be a significant improvement in the delivery of mental health services to the public because, as I'm sure you all know, the telephone number that happens to be on your wireless phone and the area code may not represent where you live or where you are at the moment. It will be a major change that will ensure that more 9-8-8 voice calls go to the appropriate crisis center for the location that the caller is calling from.” He added that this rule “will be effective in the very early part of 2025. So we expect the three major carriers to fully implement this very quickly.”

The FCC is also applying its Mandatory Disaster Response Initiative (MDRI) rules to wireless and other service providers, requiring them to provide roaming to each other’s customers in areas affected by major disasters. “The MDRI also requires the carriers to work closely with emergency response authorities and community leaders on both preparation and then response to disasters to maintain and restore communications,” said Furth, “and also to communicate with the public to provide emergency information. This was the first year that the MDRI was fully in effect and it was implemented for a number of the major storms that occurred over the summer and fall.”

Prehospital Blood Transfusions at Accident Scenes

As reported by Gam Wijetunge,director of the National Highway Traffic Safety Administration’s (NHTSA) Office of Emergency Medical Services, during the June 5, 2024 FICEMS meeting, the Department of Transportation's National Roadway Safety Strategy has set a national goal of zero deaths on U.S. roadways.

“So why do people die in a crash?” Wijetunge asked at the December 11, 2024 FICEMS meeting. “The number one preventable cause of death in trauma-related injuries in the United States is blood loss,” he answered. “People die when they don't have enough oxygen carrying blood circulating in their system.”

That’s not all: “We have learned from recent both civilian and military research over the past many years that prehospital blood administration can dramatically improve survival, while large volumes of crystalloid IV fluid can actually increase morbidity in mortality,” said Wijetunge. This is why NHTSA—along with many others in the EMS and hospital community—are promoting the administration of prehospital blood transfusions in accidents and other emergency situations.

To this end, “we currently have an interagency agreement with the Agency for Healthcare Research and Quality at HHS,” Wijetunge said. “They have contracted with the Pacific Northwest Evidence-based Practice Center at Oregon Health Sciences Health and Sciences University to conduct a comprehensive review of the literature on prehospital transfusion for hemorrhagic shock. Those draft key questions are actually open for public comment right now. Then Oregon Health Sciences University will initiate the comprehensive review of literature in 2025 and that will take about a year.” DOT’s John A. Volpe National Transportation Systems Center has also awarded small business innovation research grants associated with the storage and drone-based transport of blood in the prehospital setting to Dark Flight and Legacy Innovation, he noted.

Enhancing Child Safety During Ambulance Transport

David Bryson, EMS specialist with NHTSA’s Office of EMS, used his FICEMS speaking time to talk about making child restraint devices in ambulances safer and more effective. This is a project being supported by his office and other federal partners.

“The goal of this project is to create national test standards for all child safety restraints that may be used in the back of a ground ambulance,” said Bryson. “The three final test methods were for seated children in the back of the ambulance who may or may not be injured or ill, supine children that would have to be restrained on an adult patient litter or cot, and neonates children transported in any kind of a specialty transport system.”

Those draft test methods were finalized in June 2024. NHTSA and its federal partners are now trying to find funding for the next stage, where these standards would actually be tested.

CMS Looking to Improve EMS Safety

According to Dr. Sean Michael, regional chief medical officer for the Centers for Medicare & Medicaid Services (CMS) in Denver, CO, Medicare and Medicaid accounts for “approximately 14% of total federal spending,” he stated during the meeting. “We have more than 160 million Americans who receive health care coverage through Medicare and Medicaid and the health insurance marketplaces that CMS helps to oversee. So as an agency, we have a very critical stewardship role to ensure those public funds are spent in a way that advances health and healthcare of the high quality that the American people expect.”

As part of its mission, CMS is “working toward a vision of achieving zero preventable harm,” said Michael. “That touches on traditional quality and safety of care delivery in hospital and out-of-hospital settings, but also zero preventable harm to those who are delivering the care. Workplace violence, and traffic and scene safety, and many of the issues that you all care about and know deeply fit into that.”

To learn more about FICEMS and its many activities, go to www.ems.gov/resources/federal-interagency-committee-on-ems-fic/ .