Attachment 1 Amended Statement of Work.docx

A. Purpose

R1 MEDICAL DIRECTION STATEMENT OF WORK

The Forest Service requires professional Emergency Medical Service (EMS) Medical Direction for Forest Service (FS) Emergency Medical Service (EMS) providers in Region 1 (R1) and EMSs aligned with the R1 Incident Medical Specialist (IMS) program supporting all hazard incidents in R1. These employees are generally collateral duty EMS providers and as such are normally employed in natural resources career fields (wildland fire, recreation, range, fisheries, engineering, timber, law enforcement, etc.). In addition to FS EMS, there are also interagency and emergency hire employees included under the IMS Program.

B. EMS/IMS

1. All EMS and IMS participants are certified or licensed in their home state or state of their sponsoring unit as Emergency Medical Responders, Emergency Medical Technicians, or Paramedics. FS employees will be credentialled under the agency program (white card). The FS relies on other EMS agencies to provide patient transport to definitive care as the R1 medical program is a non-transportation program. Some of these medical responses may be for patients who are several hours away from definitive care. It is preferable that the federal emergency providers covered under this medical direction will have protocols that are appropriate for a remote, wilderness environment.

2. The FS EMS occasionally provide emergency medical care for public individuals, treating them upon happenstance discovery as they perform their routine jobs. These instances would also be covered under this medical direction.

3. Desired initiation into the medical director’s coverage would be those selected by the agency representatives who possess state certification or licensure in their home state of employment (Montana, Idaho, South Dakota, or North Dakota).

C. Location

1. Forest Service Region 1 (R1) includes the states of Montana, North Dakota, South Dakota, and northern Idaho. R1 Medical personnel could be located in any of the units in Region 1, including:

a) Montana (Beaverhead/Deerlodge, Bitterroot, Custer/Gallatin, Flathead, Helena/Lewis & Clark, Lolo, and Kootenai National Forests; and Missoula units including the Regional Office, Aerial Fire Depot, and Rocky Mountain Research Station)

b) North Dakota (Dakota Prairie Grasslands)

c) South Dakota (2 districts of the Custer/Gallatin National Forest)

d) Northern Idaho (Nez Perce-Clearwater and Idaho Panhandle National Forests).

2. The average number of emergency care events for these EMSs is estimated to be 250 per year, mostly in the IMS environment. Fewer than 20 incidents per year result in hospital admissions. The number of EMS and IMS personnel varies from year to year and throughout the year, and the number of R1 EMS and IMS personnel in all of R1 will not exceed 250 for EMS and 100 for IMS. The current number of EMS and IMS personnel are listed below:

Idaho EMS and IMS participants: 45 Montana EMS and IMS participants: 125 North Dakota EMS and IMS participants: 3 South Dakota EMS and IMS participants: 1

D. Licenses, Qualifications, Experience

1. The Medical Director must possess an unrestricted DEA license.

2. Although not required, it is preferred that the contractor have the following qualifications and background:

a) Experience providing or identifying available EMS courses or emergency medical presentations

b) Expertise in all-risk incidents (e.g. Wildland Fire, Wilderness and Remote Medicine, or Prolonged Patient Care)

c) Possess an American Board of Emergency Medicine Certification E. Technical Specifications/Requirements

Medical Direction: The provider or a designee must be a licensed physician or have an active physician licensure in Montana, Idaho, South Dakota, and North Dakota. The contractor must be capable of providing medical direction and have an unrestricted Drug Enforcement Administration (DEA) license in each state. Contractor must meet state requirements as a Medical Director.

1. Protocol and Optional Module/Endorsement Review and Approval: The contractor will function as the Medical Director and will review and approve treatment protocols, including optional modules or endorsements at least annually, or more frequently if needed. Protocols or optional modules/endorsements will not exceed the scope of a provider in the State in which the care is given. These protocols and optional modules/endorsements include, but are not limited to, Basic EMTs administering intramuscular injections of epinephrine; oral administration of aspirin, acetaminophen, ibuprofen, diphenhydramine; administering albuterol via a non-rebreather mask, administration of nitroglycerin, and airway administration.

2. Emergency Medical Direction/ Subject Matter Expert (SME): As requested by the employees under medical direction, the contractor will provide advice and guidance on emergency medical service issues affecting the USDA Forest Service’s Region 1. The contractor must be available via telephone and email to answer questions and provide on-line medical control direction to EMS and IMS. The contractor or his/her approved physician or mid-level practitioner designee will provide a response within fifteen minutes from initial contact by an EMS, IMS, or Forest/Grassland dispatch office engaged in an emergency medical response OR provide Medical Direction through the FS’s Medical Director. If the occasion arises that the contract medical director or his/her designated representative do not respond within the 15 minutes required by this contract, the EMS, IMS, or Forest/Grassland dispatch office will contact the nearest medical facility for help with the emergency. The contractor will also have a designated email address for non-urgent questions from the field. The contractor or his/her designee will respond to non-urgent email questions, with a cc to the EMS/IMS program manager within 24 hours.

3. Documentation: Patient Care Report (PCR): The contractor will review the PCR Form required to be used by all R1 emergency medical providers to document patient treatment. PCRs which include a medivac or emergent patient will be sent to the medical director and reviewed by the medical director within 24 hours. Non-emergent PCRs will be submitted to the medical director within one month of care. Idaho requires all PCRs be submitted electronically through the IGEMS system. Review of Idaho PCR’s will be done through the IGEMS Elite PCR system. The contractor will provide a care refusal form so emergency medical providers can document the patient’s condition and the provider’s recommendations should the patient refuse care.

4. Quality Assurance – Patient Care Report Review: The medical director will review an adequate sample, approximately 15%, of all PCRs to determine quality of documentation for problem assessment/reassessment, treatment, and disposition. The review of emergent PCRs required in #4 is included in this 15%. Based on this review, the medical director will provide a written response to the R1 EMS/IMS program manager with recommendations such as a change in documentation or treatment protocol and recommendations for continuing education.

5. Quality Assurances Performance Plan (QAPP): The contractor will submit yearly written reports to the CO and COR reporting:

a) Summary of all submitted patient care reports (PCR.)

b) Summary of issues and concerns with Forest Service emergency care providers covered under this medical direction.

6. Medical Direction for Montana, North Dakota, and South Dakota EMS/IMS: A state license/certification is required per state regulations/laws for these three states. EMSs working in those states are required to meet State requirements to serve as an EMS within the state in which they are working. The contractor will be responsible for providing Medical Directors who meet state requirements as a Medical Director for the states of Montana, North Dakota, and South Dakota. Requirements include:

a) Review medical director agreements

b) Review medical plans

c) Approve medical education courses (including medical courses taught by appropriate agency personnel)

d) Approve provider licensure and re-licensure requests

e) Approve optional endorsements/modules

f) Provide medical direction to providers and to incidents (agency affiliated with a State license/certificate or approved providers on that incident)

g) Follow all State requirements including:

i. Maintain a state medical license

ii. Accept responsibility for the medical direction and medical supervision of the activities provided by licensed/certified EMS’s.

iii. Obtain and maintain knowledge of the contemporary design and operation of the EMS system.

iv. Obtain and maintain knowledge of state EMS laws, regulations and standard manuals.

v. The EMS medical director shall demonstrate appropriate training and/or expertise in adult and pediatric emergency medical services.

vi. If not previously completed, all current and new Medical Directors must meet all state requirements to function as a Medical Director in that state and obtain a license/certification as a medical director for said state.

7. Medical Direction for Idaho EMS Agency: Idaho requires agency affiliation for EMS providers working in the State. The northern Idaho National Forests (USFS) agency license #10003 covers employees, volunteers and emergency hire employees of the Idaho Panhandle National Forest and the Nez Perce-Clearwater National Forest anywhere within the State of Idaho. Requirements include:

a) Review and approve medical director agreements

b) Approve medical supervision plans

c) Approve the Education Program request within IGEMS so the Agency may teach EMR courses and Optional Module courses

d) IAW state protocols.

e) Approve provider licensure and re-licensure requests

f) Approve optional modules

g) Provide medical direction to providers affiliated with the agency and to incidents (and all State licensed or approved providers on that incident) within the jurisdiction of the Idaho National Forests in Region 1.

h) Must have or obtain access to IGEMS as a medical director for the Northern Idaho USFS National Forests EMS agency, #10003.

i) Follow all Idaho State requirements for medical directors including:

i. Maintain an Idaho medical license

ii. Accept responsibility for the medical direction and medical supervision of the activities provided by licensed/certified EMS personnel.

iii. Obtain and maintain knowledge of the contemporary design and operation of EMS systems.

iv. Obtain and maintain knowledge of Idaho EMS laws, regulations and standards manuals.

v. The EMS medical director shall demonstrate appropriate training and/or expertise in adult and pediatric emergency medical services.

vi. If not previously completed, all current and new Medical Directors must complete mandatory EMSPC approved Medical Director Education within one (1) year or be ABEM subspecialty board certified in EMS. Current EMSPC approved courses include: full NAEMSP National EMS Medical Director’s Course and Practicum or the Guide for Preparing Medical Directors sponsored by the Critical Illness and Trauma Foundation. Additional educational courses may be approved upon request.

8. Over-the-counter (OTC’s) Medications: Allow Incident Management Teams to make OTC medications available in the medical unit tent on all-risk incidents. National Wildland Coordinating Group (NWCG) IMS curriculum requires education regarding OTC medications for all IMS medics.

9. Medical Direction for Out-of-State EMSs: Limited Recognition processes are controlled by the State, and each state has a process in place to verify EMS credentials. Out-of-State EMSs will request limited recognition or reciprocity from the state they are working in via the Medical Unit Leader (MEDL) on the incident. If there is no MEDL on the incident, the EMS will contact the EMS/IMS program manager, Forest/Grassland Safety Officer, or Forest/Grassland EMS coordinator who in turn will contact the Medical Director or his/her designated representative for review and approval of required state processes. The EMS will operate at the level approved by the State they are requesting limited recognition or reciprocity from, and the MEDL will approve any paperwork requested by the Agency or host state.

10. Personnel Competency: The contractor, at the Medical Director’s discretion and with approval of a Forest Service representative, may develop and implement a process to assess competency of Emergency Care Providers at the EMS’s licensure/certification level. The Medical Director may choose to allow select R1 EMS personnel to assist in these competency assessments. This competency assessment shall only be used in situations when the medical director or contractor does not have firsthand knowledge of the provider’s skills. This competency assessment would not supersede the state in complexity, content, or difficulty. Competency assessments should be fair, unbiased and establish that a provider continues to meet the minimum requirements of their licensure/certification level. Assessments may not require the provider to take additional formal exams, require a provider to travel, or require additional expenditure by the provider or host unit. These assessments should occur no more than every two years unless documented incidents occur warranting an assessment of a provider.

For those providers who do not pass the competency assessment, immediate on-the-spot training may be provided to rectify the deficiency; other options may include additional training. Providers who do not pass the competency assessment may not practice as an EMS until the Medical Director approves their skills.

Competency assessments for incoming out of state incident EMS providers shall not delay a provider who has been granted permission (recognition, licensure or reciprocity) by the state from being assigned to the incident and working as a EMS.

11. Credentialing: EMS will be credentialled at the level of their state license(s) if they hold a state license, have met continuing education requirements for renewal, have met all other requirements, and have been deemed competent in Section 11. EMS’s will also obtain an EMS Credential through the FS EMS Program (White Card).

12. Site Visits: The Medical Director or his/her designated representative may visit Forest Units and/or all- hazard incidents to gain familiarity with the work and work environments of the EMSs. Site visits may lead to changes in protocols, suggested additional training or be used as part of the QAPP. The Medical Director will notify the R1 EMS/IMS Program Manager as far in advance of the visit as possible and is required to provide notification at least 24 hours prior to all visits.

13. EMS and IMS Status: The Forest Service and contractor will share information and knowledge of all EMS and IMS personnel approved to operate under the contractor’s medical direction. The Forest Service will develop a qualifications tracking system which will include, at a minimum: EMS and IMS name; contact information; home unit (Forest/Unit and District/Unit); states that provider is approved to practice in; what level they are approved to work at; and what endorsements/optional modules are held. This database belongs to the Forest Service and will be posted on a web site or other site available to the contractor, Forest Service personnel, and all EMS and IMS personnel, such as Box.

14. Liability Insurance: The contractor shall have and show proof of liability insurance to cover all aspects of the contract.

15. Medical direction and program expectation: The contractor will participate in the annual Region 1 IMS training to provide information on his/her medical direction requirements, processes, and protocols. IMS personnel will attend training by approved providers (see Section 17 below) that will cover indications and contraindications for over-the-counter medications, indications and contraindications for prescription medications, use of specialized equipment such as athletic injuries, Otoscope/Ophthalmoscope, occupational illnesses, and other topics as required by the NWCG or desired by the medical director. Forest Service will coordinate the IMS training at least 4 months in advance and the Medical Director will be in attendance for a minimum of 6 hours.

16. Training: Contractor will accept EMT refresher training and endorsement training provided. For any training that occurs in a federal facility, contractor personnel shall be accompanied by FS personnel.