By: Makeba Walcott, Public Relations Officer, 2016-2017
The Arlington Fire District (AFD) has changed how patients are transported to the hospital, with Mobile Life Services, Inc. now being the provider of emergency ambulance and transportation services for the district. Since 1981, Mobile Life Services, developed by the Arlington’s Board of Fire Commissioners, has been operating in Hudson Valley. Prior to January 1st, 2017, Arlington operated its own ambulances. This decision came as a result of a new contract agreement between the district and the Arlington Professional Firefighters Association, that agreed to switch health care plans.
According to Fire Commissioner Chairman Jim Beretta, this new change decreases the amount of taxes that residents pay while “absorbing the state-mandated cost increases that we have no control over.” According to the Poughkeepsie Journal, the $17.25 million proposed budget that lowers the amount of money taxpayers pay is approximately $85, 000 less than that of last year, and brings “the tax rate per $1,000 of assessed value from $6.27 to $6.19.” The change also allows Arlington to increase its firefighting services to its four stations 24/7 with firefighters who are paid and reduce overtime costs.
According to Jim Berretta, the use of a private ambulance company means “that a patient’s insurance coverage will cover most or part of the cost. The amount covered is going to vary based on a person’s insurance coverage. This is no different than the exposure people have now to the cost of an ambulance, should they need one, in many, may municipalities who use a commercial ambulance service.”
However, paid and volunteer members of the Arlington Fire District will still continue to provide immediate emergency responses to every call in the district.
Brant Abbott. “Arlington Fire District to outsource ambulances.” Poughkeepsie Journal 16 December 2016: 1. Web. 25 January 2017.
Schutzman, Nina. “Arlington Fire plans to cut taxes, outsource ambulances.” Poughkeepsie Journal 17 October 2016:1. Web. 25 January 2017.
By: Eric Lee, Equipment Officer, 2016-2017
For the Halloween of 2016, Vassar College EMS responded to a total of 15 intox calls and required no mutual aid assistance for the calls on campus. The call volume for the night of Halloween has decreased from last years 18 calls.
To prepare this year, all Halloween crews participated in an intox MCI drill geared towards preparing all crew members to split and run calls as a two pair team. The MCI drill was able to give some newer members the experience and guidance from the EMS 1 during an intox or drug call, while allowing crews to become comfortable working with their fellow crew members.
In order to allow crews to focus on calls, Vassar College EMS had a dedicated dispatcher from VCEMS working with Safety and Security to better organize the dispatch of in service crews and keep track of the status of each crew. The dispatcher also worked with one Mobile Life ALS and one BLS standby unit to dispatch appropriate ambulances for patient transport. With two units on standby, this allowed the Arlington Fire District ambulances to continue to serve the surrounding community.
A total of four VCEMS crews were tasked with responding to any calls on campus. One additional crew was tasked with navigating Mobile Life units to the call location. With four crews on call from 10 PM to 2 AM the following morning, VCEMS was able to handle 15 calls over the 4 hour period. Only one crew was required to split to cover all calls in the area. Each responded to about 4 to 5 calls each during the night.
By: Julia Beatini, Assistant Captain, 2016-2017
Patients and EMS agencies alike seek alternatives for the EpiPen, an epinephrine auto-injector used for treating anaphylaxis, after Mylan pharmaceuticals instated a 500% price increase in 2016. Hopefully, up-and-coming generic auto-injectors will provide a much-needed solution in 2017.
Anaphylaxis is an acute life-threatening allergic reaction that affects millions of people each year. When left untreated, it can result in airway obstruction, respiratory failure, shock, and death. However, epinephrine reverses the progression of anaphylactic reactions by constricting blood vessels and opening airways in the lungs, providing patients with nearly immediate relief. Since the 1980s, epinephrine has been widely available to patients, parents, and emergency healthcare providers in the form of auto-injector pens (1). These small, spring-loaded syringes are pre-filled with a dose of epinephrine that can be injected quickly and easily to stop the progression of an anaphylactic reaction.
The EpiPen®, produced by Mylan pharmaceuticals, was one of the first epinephrine auto-injectors on the market. Since their release in 1987, EpiPens have become the leading epinephrine injectors on the market and have received praise throughout the years for their efficiency and reliability (2). However, Mylan pharmaceuticals recently came under fire after 2016 saw a 500% increase in the price of a two-pack of EpiPen. While the price of an individual EpiPen soared from $60 to over $300, experts estimated that the auto-injectors cost only $30 to produce (3). Following a congressional investigation in the fall of 2016, Mylan agreed to pay the government $465 million to settle claims that the company shortchanged consumers (4). In spite of the outcome of the investigation, patients, parents, schools, and emergency medical providers are still struggling to afford the life-saving medication.
For years, EpiPens have been one of the most commonly administered medications in emergency medicine. According to a 2013 study, more than half of patients who have experienced multiple anaphylactic reactions report “calling an ambulance” as their immediate action plan when experiencing symptoms of anaphylaxis (5). The study also indicated that only a third of patients who have experienced multiple anaphylactic reactions carry EpiPens with them, and this number is likely to decrease as fewer patients are able to afford them. This presents a growing need for EMS agencies to carry EpiPens at a time when many agencies lack sufficient funds to keep the auto-injectors on their ambulances. Although VCEMS will continue to carry EpiPens, many other agencies – especially those situated in small rural areas – are seeking alternatives.
To address the issue, some states are pushing for EMTs to manually administer epinephrine syringes instead of the classic auto-injector. The syringe kits would save districts thousands of dollars, as they cost only $20 (6). However, they also require more time to administer and present a higher risk of infection. States would also need to provide EMTs with extra training in order to administer them safely.
Luckily, different drug companies provide EpiPen alternatives that are steadily gaining popularity. Amedra pharmaceuticals offers Adrenaclick, a pre-filled auto-injector priced at $140 for a two-pack (7). Adamis pharmaceuticals and Windgap Medical are also working hard to get their own auto-injectors on the market. They claim that their products will have longer shelf lives than EpiPens, which must be replaced after one year without use, and that they will be available for roughly half of the current market price of an EpiPen (8). Their products are still pending FDA approval, but are set to be released in 2017. CVS pharmacy also plans to release a generic EpiPen alternative later this year, priced at $110 per two-pack (9).
With the growing number of EpiPen alternatives, individual consumers and EMS agencies will continue to carry epinephrine to treat anaphylaxis. However, the new drug options are certain to change the epinephrine market as we know it, ending Mylan’s long-held monopoly on the industry.
By: Lauren Middleton, Captain, 2016-2017
According to the Centers for Disease Control and Prevention (CDC), bioterrorism is defined as “the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants…” These agents are classified into three categories based on their potential risk. Category A contains the highest priority agents that are easily transmissible, result in high mortality, and would cause major systemic disturbances (1). Category A includes anthrax, botulinum, Ebola virus, and plague (2). Since these agents are found in the environment, it can be difficult to distinguish accidents and natural causes from harmful intent.
Bioterrorism is not a new threat. One of the earliest recordings of a major bioterrorist attack was in the 1346 Siege of Caffa in which the Mongols threw bodies infected with plague over the city walls (3). In more recent history, there have been attacks using botulinum, salmonella, and anthrax. Although the 2001 anthrax attack was a relatively small scale event with only 22 cases, 35,000 people were vaccinated against anthrax and smallpox and the government was in turmoil. The stock of smallpox vaccine had been almost depleted because it was considered eradicated in 1980. Since then, larger amounts of the vaccine have been stored (4). Plans have also been put into place on how to respond to bioterrorism and highly infectious diseases such as Ebola and Zika (5).
Rapid identification and response are important elements in limiting the severity of a natural outbreak or attack. Healthcare workers, including first responders, play an important role in minimizing the disease spread. Starting on October 4, 2014, dispatchers asked about any recent travel to Ebola-affected countries for patients complaining of fever. If the patient had travelled to West Africa, a specially trained Haz-Tac team was dispatched rather than the nearest EMS. From December 2014 to February 2015, 3090 EMS responders were trained in putting on and using the appropriate personal protective equipment (PPE). They were also trained in asking about travel to West African countries for patients with symptoms suggestive of Ebola (6). In June 2016, New York implemented training programs for first responders to protect themselves and safely treat patients infected with high risk diseases such as Ebola and Zika (7). Emergency responders can help by identifying potentially infected patients by knowing which symptoms to look for. Training such as in these examples could be used to minimize illnesses and deaths following a bioterrorist attack.
Effective Immediately: Commercial Ambulance Service Now Responsible for Hospital Transports in the Arlington Fire District
Effective 7 AM on January 1, 2017, Arlington Fire District (AFD) will no longer transport patients to the hospital. While EMS providers from AFD will still respond to all EMS calls and provide on-scene treatment, Mobile Life Support Services (MLSS), a commercial ambulance agency, will take over hospital transports. Whereas previously, AFD provided free transportation to area hospitals, MLSS will now bill patients for their services. While many health insurance plans will cover this, it is still possible that the patient will be required to pay a co-pay depending on their specific insurance plan and provider.
The operations of VCEMS will remain the same; when anyone on campus calls the CRC (845-437-7333), VCEMS will be dispatched. In the event that the patient requires transport to the hospital, VCEMS will request an ambulance, but care will now be transferred to MLSS as opposed to AFD. While we understand that this new change may be a financial burden, we still urge all members of the community to call the CRC and request EMS in any instance where emergent medical care is needed.
Arlington Fire District Media Release