Alabama

(May 2000)  The state plans to use Flex Program funds to support a rural EMS subcommittee working with the state hospital association.  They are also encouraging CAH communities to develop an EMS council to assess their needs. 

Alaska

• Training conference on EMS billing

• TA visits to sites needing EMS improvements

• Survey to find out why people leave EMS careers

• ETT to EMT training course

• Pre-hospital data collection

• Update state EMS regulations

• Communications upgrades

Arizona

(February 2001)  As part of the CAH conversion process, the state EMS office performs an analysis of the EMS system in the hospital’s geographic area and provides results to the hospital for use in the CAH designation planning process.

California

(November 2000)  The state plans to use Flex Program funds to update EMS equipment, provide training for EMS personnel, and give technical assistance in grant writing so that EMS providers can compete more successfully for outside funds.

Colorado

• Finalize EMS assessment tool

• Conduct site visits to CAH/potential CAH communities

• Provide TA to CAHs to develop patient transfer protocols

(October 2000)  The state EMS office has developed TA materials to work with communities and strengthen relationships.  In Year 2, they will provide EMS TA to communities.

Connecticut

(November 2000)  The state is using Flex Program funds to help rural EMS providers comply with a recent state mandate to collect data (e.g., purchasing computers); encouraging networking between rural EMS providers so as to facilitate adequate coverage during the daytime hours; and developing protocols for the transfer of critically-ill patients between rural hospitals and tertiary centers.

Florida

• Provide funding to 9 CAH network areas for EMS scholarships (n=45)

• Purchase communication and ALS equipment for CAH ERs

(July 2000)  The state has legislation permitting EMS personnel to provide more than emergency care, and is interested in promoting the use of EMS staff for community/public health endeavors.  Florida also recently began an EMS distance learning program to train rural providers (not using Flex Program funds).

Hawaii

(January 2001)  The state is using Flex Program funds to establish a database to track the number of cases transferred between islands.

Idaho

(March 2001)  The state EMS Bureau has developed an EMS assessment tool, and conducted assessments in six rural communities to date.  Results of these assessments are reported back to the community, with the aim of determining priorities and developing a joint proposal for grant funds. 

Illinois

• Training program for family practice residents on ED coverage in rural hospitals

• Support “EMS resource hospital training efforts”

• 5 small grants to hospitals for training programs and billing services/systems (awarded through competitive process)

(December 2000)  The state has recently completed a report on the status of EMS in the state.  They plan to use Flex Program funds to implement some of the report’s recommendations in training, recruitment and retention.  They also hope to establish a permanent advisory committee on rural EMS.

Indiana

• Grants to CAHs and CAH communities to improve EMS.  Specifics depend entirely on proposals received—very decentralized approach. 

 In Year 01, they funded 2 such grants.  One was for training upgrades.  The second was for EMS assessment for the area, including a study of the feasibility of an EMS/CAH merger.

(June 2000)  The state is facilitating group meetings and disseminating information so as to encourage CAHs and EMS providers to work together. 

Iowa

• Hire a full-time EMS network coordinator

• Conduct EMS needs assessments in CAH (and other rural) communities

• Provide small grants to CAHs to support discussions with support hospital(s) and EMS providers regarding opportunities for collaboration

• Provide TA to CAHs regarding integration of EMS into CAH network

• Fund a small EMS scholarship program (n=5)

• Develop EMS QA component (uniform patient transport protocol)

(December 2000)  Iowa has nearly 500 rural EMS units, most of which work independently.  The state has used Flex Program funds to hire an EMS coordinator who is meeting with EMS providers from a given county to review the status of EMS in the area and discuss ideas for collaboration.  Two counties appear to be ready to move forward with development of a more comprehensive system of EMS care.  Flex funds are being combined with tobacco settlement funds to promote local EMS system development.

Kansas

(February 2001)  The state has been providing grants to networks to promote integration of EMS services.  They have also formed an EMS Committee with representatives from the EMS industry, CAHs, and other providers.

Kentucky

• Conduct EMS training in areas with CAHs

(December 2000)  The state plans to use Flex Program funds to assess communities’ EMS needs.

Louisiana

• Conduct a large range of EMS-related training programs in rural areas

• Provide matching grants to CAHs to subsidize ER physicians

The state has reached a memorandum of understanding for a pilot project for EMS integration in one area of the state having 5 potential CAHs.  They used Year 01 funds to develop a pilot training institute for EMS training for the area.

Michigan

• Provide a grant to support an on-going project in the Upper Peninsula to improve coordination of EMS services across multiple counties.  The area includes several CAHs and an established hospital network.  Activities include the standardization of treatment protocols across counties, collection of pre-hospital data, mobile training programs, and strategic geographic placement of ALS personnel.

Minnesota

(March 2001)  The state is in the process of getting all EMS systems connected for data collection and processing, and has been working to develop EMS networks in selected communities.

Mississippi

• Grants to each of 6 trauma system regions with CAHs to support EMS activities of their choosing (state is currently building a statewide trauma system)

• Purchase computer equipment and software needed for trauma registry data systems (for 10 CAHs or EMS systems)

(February 2001)  The state has had to scale back its planned EMS activities due to budget cuts, but is still hoping to use some Flex Program funds to purchase computer hardware and software so that their six rural trauma care regions can be linked into a statewide EMS database.

Nebraska

• Large number and variety of EMS-related training programs, including courses to train instructors so that more courses can then be offered closer to EMTs’ homes

• Distribution of recruitment and retention and QA/QI manuals (developed with Year 01 funds)

• Pilot test QA/QI manual in 5 CAH communities (with limited TA to others, as requested)

• EMS instructors conference

• 6 regional strategic planning sessions for medical directors

• Assess needs of local EMS systems and develop recommendations

(October 2000)  In addition to proposed activities, they are also conducting a large survey of local ambulance systems to ask about training needs, and providing training in Medicare billing procedures for ambulance services.

Nevada

(June 2000)  The state has several non-Flex Program initiatives designed to improve rural EMS, including an EMS training academy that would use on-site and distance learning.  State tobacco funds are being used for small grants to hospitals to be used for EMS, telemedicine, and planning.

In Year 02, the state plans to conduct EMS community assessments.  These will be modeled after Operation Rural Health Works but expanded to identify gaps in EMS coverage and coordination. 

New Mexico

• Award small contracts to improve EMS system operations in 3 regions

(January 2001)  The state has provided technical assistance in CAH areas regarding revision of EMS protocols (particularly for patient transfers) and other improvements to EMS services, including training for EMS and ED staff.  They have also developed a trauma registry data system so that patient information can more easily follow patients transferred between hospitals, and are placing computers in CAHs for use with this data system.

New York

• Grants to CAHs to establish emergency and non-emergency transport agreements with full-service facilities (and, perhaps, conduct other EMS integration or training activities)

• Hire consultants to provide TA re: development of EMS networks

(March 2001)  Most of the planned technical assistance was not provided due to budget cuts.

North Dakota

• Purchase software for 30 ambulance services to enhance pre-hospital data collection

• Fund two EMS Integration demonstration programs involving collaboration of CAH, network hospital, and at least two ambulance services (specifics to be defined in proposals submitted in response to RFP)

• Develop curriculum to educate EMS providers on advantages of networking, and conduct related training

 In Year 01, four grants to CAHs included EMS activities.  One CAH contracted with its network hospital to provide training at the CAH for local EMS personnel.  Three other CAHs purchased computer equipment so local EMS providers could access a statewide, on-line training program and earn CE credits.

Oklahoma

(April 2001)  The state is training approximately 30 new paramedics, who will be stationed at CAHs and available for ambulance runs.  They also plan to conduct training for hospital nursing staff.

Oregon

• Provide advanced trauma and cardiac life support training for nurses from CAH ERs

• Develop an EMS needs assessment tool for use in CAH communities, and apply this tool to 5 communities

• Hire 2 local contract workers who will promote EMS regionalization and standardization in their area

• Develop patient transport protocols

(December 2000)  The two regional EMS coordinators will work with local providers to apply the EMS assessment tool in 10 communities.  They will then convene the local providers to discuss the results of the assessment and to develop collaborative projects for Year 03.

South Carolina

(June 2000)  In Year 01, the state gave a small grant to one county to implement a computerized patient record system within EMS transports.  In Year 02, they hope to expand this pilot program to more counties, and plan to offer small grants to EMS units for equipment, training, and coordination improvements.

South Dakota

• Conduct 10 medical direction courses (n > 50 people)

• Assist 25-30 “critical access ambulance services” with training and computer resources for billing and data collection. 

In Year 01, the state scaled back their planned EMS activities due to budget cuts.  They were able to conduct  4 training sessions for medical directors (in CAH communities), and to conduct a study to identify “critical access ambulance services”—defined as the sole provider in the area, often in a “fragile” state, whose closure would result in hardship for local residents.

(February 2001)  The state wants to use Flex Program funds to help critical access ambulance services establish electronic links with the state EMS office to facilitate billing, data collection, and distance learning.

Tennessee

• Hire EMS consultants for 10 CAHs (e.g., for training, communications, data collection, medical direction)

• Support 8 EMS-related training programs (clinical and administrative topics)

• Small grants to 10 hospitals for communications networking (e.g., telemetry)

• Distribute report on national survey of EMS integration activities under the Flex Program

(June 2000)  The state uses local community councils to decide how Flex Program funds should be used in their area.  To respond to identified training problems, Tennessee Health Authority is helping hospitals access an on-line EMS training system.

Texas

(April 2001)  The state is continuing to use Flex Program funds for an EMS Scholarship Program, with priority given to training new entrants to the profession in order to increase the overall supply of EMS personnel.  They also convened a statewide conference on EMS in an effort to better integrate urban and rural EMS systems and to share protocols.

Vermont

(December 2000)  The state used a task force of hospital and EMS representatives to develop an EMS needs assessment tool, and plans to make grants to hospitals to permit them to conduct the EMS needs assessment for their community.  However, the size of these grants has been reduced from the proposed budget due to budget cuts.

Virginia

(December 2000)  The state intends to develop a statewide EMS plan, and to provide funding for continuing education and training for EMS personnel.

Washington

• Award competitive mini-grants to joint EMS/CAH or EMS/tribal applicants (forces hospital to include EMS)

• Have an EMS consultant participate in CAH designation site visits

(July 2000)  In Year 01, Flex funds went to an Indian tribe and a hospital to develop EMS protocols.  In Year 02, they plan additional EMS/hospital mini-grants.

(February 2001)  Hospitals were apparently slow to apply for the EMS grants because they were more concerned with completing their financial feasibility studies.  However, several EMS mini-grants have now been awarded.  The state is also working to include an assessment of the strengths and weaknesses of the EMS system in the state plan, and will provide technical assistance to help EMS providers bill Medicare for ambulance services.

West Virginia

• Grants to CAHs to do EMS training, develop protocols, deal with planning and reimbursement issues.

• Hold CAH/EMS workshop to explore further integration issues

The state has a history of successful integration of EMS with an RPCH hospital.  In Year 01, they gave grants to 4 CAHs to promote EMS integration projects.  Three CAHs brought EMS into the CAH, and one is studying the idea.

(January 2001)  The state is actively encouraging CAHs to partner with local EMS providers.  They have conducted some training and awarded grants to study the feasibility of integrating EMS into the CAH, and are planning a statewide EMS workshop to bring together EMS and CAH representatives.

Wisconsin

(February 2001)  The state has used Flex Program funds to hire a consultant to conduct EMS needs assessments in CAH markets.  Based on results of these assessments, several awards have been made to enhance emergency communications capabilities, provide training, establish data collection systems, and develop inter-facility transport arrangements.

Wyoming

(April 2001)  The state is using a grant process to award Flex Program funds to small rural EMS services for activities such as training and equipment purchases, including computers that squads can use for billing and data collection.