Within the last 24 hours, despite national recommendations and previous planning considerations, NYS is NO LONGER including EMS personnel in Tier 1a (First Distribution) availability for COVID Vaccine.  Given our unique work environment – operating in a confined space for extended periods of time with COVID patients – there are no words for my frustration. 

Specifically “Following the vaccination of 'high risk' health care workers, the priority will shift to all long-term and congregate care residents and staff, EMS and other health care workers.”  How EMS is not considered “High Risk” is beyond my comprehension.  https://www.governor.ny.gov/news/governor-cuomo-updates-new-yorkers-states-vaccination-distribution-plan 

Please consider communicating to elected officials, specifically the Governor and Commissioner of Health, as well as any other elected leaders at the state, County, and even federal level, that EMS must be included alongside our high risk hospital care providers else our already crumbling system will collapse.

Attached is a toolkit from the AAA and a draft letter that you may edit and communicate to elected officials.  Email, call, smoke signal.  Get the word out.

The need is now, this is moving fast, do not wait.  Vaccine will be here in days and I fear we may have already missed the window to advocate for our own lives.  Communicate to elected media, leverage media connections and use social media.  The need is now although I fear too late as this rug was pulled out from under us.

Jeremy
________________________________________________________
Jeremy T. Cushman, MD, MS, EMT-P, FACEP, FAEMS
Associate Professor and Chief, Division of Prehospital Medicine
Departments of Emergency Medicine and Public Health Sciences, University of Rochester
Monroe County, City of Rochester, and Monroe-Livingston Regional EMS Medical Director

With the recent increase in COVID-19 cases in the county and region we have updated our PPE recommendations for EMS providers.  We want to assure providers that this is not being done due to any exposure or incident with our providers. Our guidelines from the beginning have held up, kept our providers from getting infected, and are still inline with CDC recommendations.
That being said, out of an abundance of caution we are increasing some of our PPE recommendations due to the high community transmission rate we are seeing to further protect our providers.  In recent discussions with many of you, it appears many agencies are already utilizing an approach similar to these changes.  These are also similar to what our hospitals are employing.
Attached is the updated guidance. There are a few changes I would like to highlight.    

• All providers should continue to wear a surgical mask, eye protection, and gloves for all routine calls
• All patents should be screened for symptoms of COVID-19 regardless of call nature.  The symptoms list and risk factors have been expanded and updated according to current CDC facility screening questions.
• If a patient screens positive by answering “YES” to any screening question, then they should be considered a possible infectious disease (PIDS) case.  
  • Providers should then don an N95 instead of just a surgical mask.  (Even if no aerosol procedures).
  • Face shields are recommended over safety goggles in this instance.
  • For aerosol generating procedures, wearing of a gown should be added to the above PPE.

Please let us know if you have any questions.
Dr. Faulk & Dr. Walters
Brian M. Walters, D.O., FACEP, FAAEM
County Physician
​Chautauqua County Department of Health & Human Services
Chautauqua County Office of Emergency Services
Chautauqua County Sheriff’s Office

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​Please see the attached Travel Advisory from Chief Richardson, Olean City Fire Department. Road Construction on Front Street in the City is in progress and is expected to hinder emergency vehicle traffic that is inbound to Olean General or Route 16 from Route 417, East of the City of Olean.   
 
Emergency vehicles traveling on Route 417 west bound  (from East of the City) towards Olean General and/or Route 16  are encouraged to follow the "Emergency Vehicle Route" that is outlined on the attached map. Additionally "Emergency Vehicle Route" signs have been installed along the alternate route.
 
Construction is expected to be in progress for at least the next 30 days.

Click here for the Travel Advisory.
Click here for the Emergency Vehicle Detour Map.

Wednesday, August 12, 2020 – The New York State Emergency Medical Services Council and State Emergency Medical Advisory Committee will hold sub-committee meetings as follows:

• 8:30 am - 11:00 am Medical Standards Committee
• 11:00 am – 12:30 pm Education and Training Committee
• 1:00 pm – 2:30 pm Systems Committee
• 2:30 pm – 3:30 pm Finance Committee
• 3:30 pm – 4:30 pm Safety Committee
• 4:30 pm – 5:30 pm Legislative Committee
  
  

Thursday, August 13, 2020 – The New York State Emergency Medical Services Council and State Emergency Medical Advisory Committee will hold the following meetings:

• 9:00 am – 11:30 am State Emergency Medical Advisory Committee
• 1:00 pm - 4:00 pm State Emergency Medical Services Council
  
  

Due to the recent events and limitations on gatherings, all meetings will be held virtually via WebEx. Persons who would like to view the meeting webcast can use the links below to access the online registration form to receive the WebEx meeting invitation.

More information on how to view the meetings will be posted at:

• https://www.health.ny.gov/events/meetings/ 
• https://www.health.ny.gov/events/webcasts/
  

The Bureau Staff asks for your patience as this will be the first time that we are holding our meetings virtually and everyone has been working very hard to make sure they run as smoothly as they can be.

To register for the meetings on Wednesday, August 12 – click here.

To register for the meetings on Thursday, August 13 – click here.
​
To download the full agenda – click here.
 
 

All EMS Providers & First Responders,
I want to thank all of you for your hard work and diligence throughout the COVID-19 period.  I have received several compliments from area hospitals about how well our providers have taken appropriate infection control precautions, managed potential COVID patients brought in the ED,  donned appropriate PPE.  This is reflected in the fact that our providers have transported numerous COVID patients without becoming infected.

While the number of COVID cases across NYS has decreased dramatically, we are still seeing sustained low levels of transmission in the community.  Remind all your responders to remain vigilant when responding to calls to ensure appropriate social distancing, limit the number of responders in contact with the patient and family/bystanders, screen patients for COVID symptoms or contacts, and to wear appropriate PPE for all calls.  We don't want to see any of our providers exposed to the virus.
 
Attached you will also the NYS DOH guidance for healthcare workers returning to work after travel or exposure to a COVID person.  This document provides appropriate precautions and timeframes for EMS providers in these circumstances.
 
Thanks again for all your continued efforts throughout the pandemic.


Brian M. Walters, D.O., FACEP, FAAEM

Please find the attached documents that are applicable to EMS agencies and providers. The attachments include:

1. Business Reopening Safety Plan Template
2. Essential Employer FAQ (see question #9)
3. Interim Guidance for Cleaning and Disinfection of Public and Private Facilities for COVID-19
4. Interim Guidance for Quarantine Restrictions on Travelers Arriving in New York State Following Out of State Travel
5. Revised Protocols for Personnel in Healthcare and Other Direct Care Settings to Return to Work Following COVID-19 Exposure or Infection
6. Protocol for COVID-19 Testing Applicable to All Health Care Providers and Local Health Departments
7. New York State Registered Disinfectants Based on EPA List
8. NYS Health Care Provider Webinar Slides (June 18, 2020)
9. Interim Guidance for Fourth of July Observance and Celebrations During the COVID-19 Public Health Emergency
   ​

Additionally, all EMS agencies and providers are reminded to frequently check the websites below for updated guidance and advisory documents. 


NY Forward | New York Forward

Novel Coronavirus (COVID-19) | Department of Health

​Bureau of EMS Policy Statements and SEMAC Advisories - New York State Department of Health

Coronavirus Disease 2019 (COVID-19) | CDC

The NYS Office of Attorney General's Charities Bureau has issued Guidance for Conducting Virtual Meetings of Members of New York Not-for-Profit Corporations. As many of our ambulance, ALSFR and BLSFR services are not for profit based organizations, please review the guidance. 
 
EMS agencies are always encouraged to review guidance like this with their own legal counsel.
 
We also continue to recommend NFP EMS agencies consider looking into whether or not the NYS Council of Nonprofits, Inc. could be helpful to them as it has been to several Regional EMS Program Agencies.

Click here to download the guidance.

(May 7, 2020), the FDA reissued the Emergency Use Authorization (EUA) for Non-NIOSH-Approved Disposable Filtering Facepiece Respirators Manufactured in China to revise one of the eligibility criteria –  the criterion for authorization of respirators based on review of test reports from recognized independent test laboratories submitted to the FDA by the manufacturer or importer – and accordingly removed from Appendix A the respirators that had been authorized under that criterion, regardless of whether they passed or failed the NIOSH testing.
 
https://www.fda.gov/medical-devices/letters-health-care-providers/certain-filtering-facepiece-respirators-china-may-not-provide-adequate-respiratory-protection-letter?utm_campaign=2020-05-07%20Concerns%20with%20Filtering%20Facepiece%20Respirators%20from%20China%20-%20Letter%20to%20HCP&utm_medium=email&utm_source=Eloqua
 
 
 
 
Daniel J. Clayton, BS, EMT-P
Chief, Operations Section
Bureau of Emergency Medical Services
 
New York State Department of Health
875 Central Avenue
Albany, NY 12206
(518) 402-0996  | daniel.clayton@health.ny.gov |
https://www.health.ny.gov/professionals/ems/
​

Please see the attached memo regarding the “COVID-19 Public Health Emergency EMS Cardiac Arrest Standards of Care” which has been rescinded by the New York State Commissioner of Health. 
  
______________________
Ryan P. Greenberg, MBA, FACPE, NRP, EMD
Director
Bureau of Emergency Medical Services & Trauma Systems
New York State Department of Health
P: 518-402-0996
E: Ryan.Greenberg@health.ny.gov

Click here to download the memo.

After discussions with the NYS BEMS, the protocol that was released and disseminated a few days ago regarding cardiac arrest during COVID-19 was not intended to be released in the manor it was.  After further discussions with the BEMS and the EMS medical directors in the region,  the WREMAC have put forth the following statement.  
 
We anticipate that the NYS guidance entitled, “The COVID-19 Public Health Emergencies EMS Cardiac Arrest Standard of Care,” will be modified by the state shortly.
 
Agencies should notify their providers to delay implementation of this guidance until further notice.
 
This standard was built as a crisis guideline. At the date of this memo, our EMS medical directors of the WREMAC do not feel we meet a community crisis standard. The WREMAC will issue new cardiac arrest guidance in the near future.
 
Providers should continue managing cardiac arrest in accordance with the current NYS Collaborative Protocols and agency practices.
 
We have requested that the WREMAC be granted the ability to activate this protocol in the future, should the need arise.
 
 We apologize for any confusion this has created in the interim.  We will be putting forth additional guidance in the near future.
 
 
 Brian M. Walters, D.O., FACEP, FAAEM

 Please click here to download the WREMAC guidance document. 
​