With so much bad news in the EMS world lately--H1N1, potential negative impacts of healthcare reform, the eternal tightening of the budgetary screws--there were some good tidings announced at the national EMS Town Hall Meeting held at the EMS EXPO in Atlanta, GA, this past October that should buoy the spirits of ambulance industry proponents as the year comes to a close.

The meeting, hosted by Advocates for EMS during EMS EXPO in Atlanta, consisted of updates from federal partners and an "Ask the Feds" session of audience questions. Panelists included representatives from NHTSA's Office of EMS; the office of the HHS Assistant Secretary for Preparedness and Response (ASPR); the Department of Homeland Security's Office of Health Affairs; the USFA/National Fire Academy; and the CDC's Division for Heart Disease and Stroke Prevention and National Center for Injury Prevention and Control/Division of Injury Response.

While there were no new national EMS administrations or dedicated federal spending packages announced at the event, attendees heard of positive developments on several key issues:

• On behalf of Advocates for EMS, industry lobbyist Lisa Meyer, of Cornerstone Government Affairs, reported that the Ryan White HIV/AIDS Treatment Extension Act, having successfully passed both houses of Congress, was ready to be signed by President Obama (and, five days later, was). The law reinstates first responder infectious disease exposure notification requirements deleted from the Ryan White CARE Act.

Prior to the CARE Act, medical facilities often focused only on testing their own employees after exposures to transmissible diseases--EMS, fire and law enforcement providers who had contacted infectious patients weren't automatically tested, or even informed of their exposure. The CARE (Comprehensive AIDS Resources Emergency) Act included these responders in postexposure notification processes, but that protection was dropped during a 2006 reauthorization.

Its restoration has been sought by EMS leaders ever since, so this is a major success. However, it comes with a caveat: Under the new language, the notification provisions may be waived, in whole or part, during a federally declared public health emergency. This resulted from concerns in the public health and hospital communities that the requirement notification could overwhelm hospital and health department staffs during crises when they should be caring for patients.

Advocates for EMS argued that only the requirement to make such notifications within 48 hours should be waived, not the requirement in its entirety, but ultimately agreed to the provision to get the language included. Advocates will continue to remind officials of the importance of quickly notifying first responders exposed to infectious diseases.

• In the latest U.S. Fire Administration reauthorization, the agency was given formal authority to address EMS operations and management issues, and will be providing advanced EMS training courses comparable to the high-level fire offerings available through the National Fire Academy.

This expanded involvement should help address a conspicuous void in management/leadership instruction for EMS professionals. Administration officials say they will cover system- and program-level management, rather than provider-level training, and have worked with an expert steering committee to evaluate these new needs. Content now being developed covers quality assurance programs and situation-based ICS training specific to EMS scenarios. "A lot of our EMS personnel aren't quite sure where to start with that [ICS] system," said NFA EMS training specialist Michael Stern, "so our scenarios are going to drive that experience."

• ASPR's Emergency Care Coordination Center, established as a federal base for coordinating the various aspects of emergency care, will likely be the home for the four previously reported regionalization demonstration projects created by the healthcare reform bill. While the ECCC is already operational, it should be formally authorized in the coming bill.

• The National EMS Information System (NEMSIS) is likely to get a big funding boost in current Congressional budgeting.

• Around 100,000 copies of the CDC's new National Trauma Triage Protocol have been disseminated this year, and Centers personnel will next develop an implementation plan for it.

Healthcare Reform

News on the healthcare reform front wasn't quite as happy. The House released its Affordable Health Care for America Act, H.R. 3962, on Oct. 29 without the strong public option sought by speaker Nancy Pelosi that would have reimbursed providers at 5% over Medicare rates. Instead, the bill--which was bound for the Rules Committee, then debate by the full House in November--lets the HHS secretary negotiate reimbursements on an individual basis. That's a concession to moderate Democrats whose votes are required for passage, but the bill's overall prospects were uncertain early in the month. It also requires employers to provide health coverage to employees or subsidize their buying insurance through a new national exchange.

On the Senate side, the public option will likely have an opt-out clause for states, but the passage of any version is even less certain than in the House. Moderate Democrats there remain wary of any public option or employer mandate.

For more as the process works toward culmination, see www.advocatesforems.org.