Attachment_1_-_140P1225Q0015-_Statement_of_Work_ZION_Medical_Director_2025.pdf

Emergency Medical Services Park Medical Director Statement of Work Zion National Park Page 1 of 7

STATEMENT OF WORK

Emergency Medical Services Park Medical Director

Zion National Park (ZION)

Prepared by: Tess Olsen, Zion National Park EMS Coordinator Date: 09 December 2024

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1.0 Section 1: Background

1.1 Overview:

This document is a statement of work (SOW) for the National Park Service (NPS). The purpose of this SOW is to describe services associated with the role of emergency medical services (EMS) park medical director in Zion National Park.

1.2 Background:

The Zion NPS EMS program facilitates emergency medical response and care to the residents, visitors, and employees of Zion National Park, Cedar Breaks National Monument, and Pipe Spring National Monument. Depending on the time of year, the Zion Visitor & Resource Protection division employs one to two dozen rangers who respond to emergency medical calls for service. Most responders are commissioned law enforcement rangers who are tasked with multiple duties in addition to EMS, including search & rescue, structural firefighting, and law enforcement. A small staff of one to four dedicated EMS rangers manages operational and logistical aspects of the EMS program, with one permanent paramedic serving as the park EMS coordinator. The park EMS coordinator is the main point of contact between the park EMS medical director and the EMS program.

Most Zion EMS providers are EMTs, though a smaller number of ALS providers manage the majority of EMS calls as the primary provider. To date in 2024, 46% of EMS calls were managed by two paramedics, 23% of calls were managed by five park medics (advanced EMTs with an expanded scope), with the remaining 32% being managed by a dozen EMTs.

In 2023, the EMS program in Zion responded to 301 calls for service. Of those calls, 21% were ambulance transports, 48% were referrals or refusals against medical advice (AMA), and 12% resulted in care being transferred to a non-NPS EMS transport agency.

To date in 2024, Zion EMS has experienced a 34% increase in EMS call volume. The EMS service averages approximately less than 30 telephonic calls to online medical control (OLMC) annually, with many of these calls directed to emergency department physicians at the local base hospital (St. George Regional Hospital).

Zion EMS providers deliver EMS care in a variety of environments, including roadways, trails, riverways, and in technical terrain. Rescues may occur during temperature extremes or inclement weather, and communications are frequently poor. In many slot canyons, radio or cellular communications are impossible. The park maintains one ambulance that transports to St. George Regional Hospital Emergency Department, located in Hurricane, UT and St. George, UT.

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1.3 Policy:

Per NPS Reference Manual #51, which governs the provision of EMS on NPS lands, all NPS areas that provide emergency medical care at the EMT level and above are required to have an EMS medical advisor. Policy dictates that park EMS medical advisors be licensed physicians who “provide advice and oversight to individual park programs, including online medical control, quality improvement, data collection, continuing education, protocol implementation and development of local protocols when national protocols are not available, treatment authorizations, endorsement of qualified applicants for National Registry of EMTs certifications at Levels IV=VI, and assist Park EMS Coordinators with the administration of examinations” (NPS Reference Manual #51, 12). It should be noted that the terms “medical advisors” and “medical directors” are interchangeable.

NPS Reference Manual #51 additionally states that any park unit with one or more AEDs on site will have a medical advisor to provide oversight to the AED program.

2.0 Section 2: Scope of Work

2.1 Objective:

The primary objective of this project is to establish a physician medical director for Zion National Park EMS.

2.2 Contractor requirements:

The contractor must be a licensed, practicing physician in possession of the following qualifications:

• A valid and unrestricted license to practice medicine in the U.S. state of Utah

• A current, valid DEA Controlled Substance Registration Certificate that includes schedule II, III, IV, and V controlled substances

• Board-certified in emergency medicine (ABEM, AOBEM, or BCEM)

• At least 5 years of EMS medical director experience (paid or volunteer)

• At least 5 years of experience in practicing wilderness medicine or providing medical direction for EMS providers who practice wilderness medicine

• At least 5 years of experience in responding to search & rescue incidents or providing medical direction for EMS providers who respond to search & rescue incidents

• Affiliation with local base hospital as an emergency department physician (St.

George Regional Hospital in St. George, Utah)

• It is preferred, but not required, that the contractor have experience recreating in Zion National Park backcountry (hiking, backpacking) and technical terrain (rock

Emergency Medical Services Park Medical Director Statement of Work Zion National Park Page 4 of 7 climbing, canyoneering) to ensure the contractor has an understanding of the austere environments in which Zion EMS providers are required to provide care

2.3 Contractor deliverables:

2.3.1 Medical direction

The contractor shall provide EMS medical direction for Zion National Park 24 hours a day, 7 days a week for the duration of the contract period.

2.3.2 Online medical control

The contractor shall be available to provide online medical control (OLMC) by phone (within 2 minutes of call initiation) 24 hours a day, 7 days a week. OLMC is defined as the provision of verbal medical advice/orders specific to the patient being treated by the EMS provider who is making the call. Providing OLMC may entail relaying specific orders for medications, treatments, termination of resuscitative efforts, etc. At times, the contractor will be required to relay orders via a third-party (Zion dispatchers) when EMS providers are requesting OLMC from a location that does not have cellular access.

If the contractor cannot provide OLMC 24 hours a day, then they must facilitate an agreement between Zion EMS and the local base hospital to which Zion EMS’s ambulance transports (St. George Regional Hospital) to ensure that an emergency physician in the receiving emergency department is always available for OLMC.

2.3.3 Quality management program

The contractor shall provide oversight to the EMS quality management program by attending and providing feedback during quarterly QA/QI meetings (1-hour minimum length), reviewing EMS patient care reports (as requested by the EMS coordinator, not to exceed 20 reports per quarter), and collaborating with the EMS coordinator to address clinical issues uncovered during the quality management process. The contractor will be required to maintain access to Zion’s electronic health record system (currently emsCharts) to ensure access to patient records. Preferably all QA/QI meetings will be held in person in Zion National Park, but video conferencing may be used if necessary.

2.3.4 Clinical oversight and authorization of EMS providers

The contractor shall work closely with the EMS coordinator to ensure park EMS providers adhere to appropriate EMS policies, protocols, and standards of care. The contractor will work in conjunction with the EMS coordinator to authorize individual EMS providers to provide care at their licensed scope of practice.

2.3.5 Policy and protocols

The contractor shall annually review the Zion EMS Field Treatment Protocols & Procedures and make recommendations for changes based on the most recent medical research and QA/QI results obtained through review of patient care reports. The contractor shall review new or existing EMS policies at the request of the EMS coordinator.

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2.3.6 Training

The contractor shall provide a minimum of 8 hours of annual EMS training to Zion EMS providers (quality management run reviews included) on topics required by the National Registry of Emergency Medical Technicians (NREMT) for EMS provider recertification.

2.3.6 Liaison with Zion EMS coordinator

The contractor shall be available for a scheduled monthly telephonic call to last not more than 30 minutes with the Zion EMS coordinator to discuss quality management and programmatic issues.

2.3.7 Purchasing of regulated medical products and controlled substances

The contractor shall facilitate the purchasing of regulated medical products, including prescription medications, automated external defibrillators, oxygen, and controlled substances. The contractor shall support the EMS coordinator in purchasing regulated medical products by providing a copy of their current medical license and DEA Controlled Substance Registration Certificate to the EMS coordinator. The contractor may also be asked to fill out and sign vendor forms that require a physician medical director’s approval. To acquire controlled substances that are within ALS providers’ scope of practice, the contractor will assist with filling out and signing DEA 222 forms as required by the local pharmacy that supplies controlled substances to Zion EMS. The contractor has no financial responsibility for acquiring regulated medical products or other supplies that EMS providers use while providing emergency medical care.

2.3.8 Automated external defibrillator (AED) program oversight

The contractor shall provide oversight to Zion National Park’s AED program reviewing guidelines for emergency procedures related to the use of an AED, making recommendations for AED placement, reviewing all AED patient encounters, and providing a prescription for the purchase of AEDs as a regulated medical product.

2.3.9 Compliance with applicable federal and state laws

The contractor shall maintain strict confidentiality of all information supplied by the NPS or any other public or private entity on the NPS’s behalf. Release of information is granted only as needed for education and quality management purposes. The contractor will ensure compliance with the Health Insurance Portability and Accountability Act (HIPAA) and any other applicable federal and state law. The contractor may, upon approval of an Institutional Review Board for Research (IRB) and the NPS, perform and publish research concerning Zion National Park EMS activities.

2.4 Work location:

The contractor may provide online medical control from any location with cellular service. The contractor will be required to travel to in-person quality management meetings and trainings in Zion National Park.

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3.0 Section 3: Government furnished items and services

The contractor shall provide all the labor, materials, supervision, and facilities necessary to satisfy the online medical control requirement of this project. The Zion Visitor and Resource Protection (VRP) division will appoint an EMS coordinator who is responsible for serving as the liaison between the contractor and the EMS program. The VRP division will provide, or work with other park divisions to provide, suitable facilities to conduct EMS training and quality management meetings. The EMS program will maintain a contract with an electronic health record provider (currently emsCharts) that the contractor will be required to access to review patient care records.

4.0 Security

Unclassified; security clearance is not required. The contractor shall be responsible for handling information in a safe and secure manner including maintaining all imposed restrictions for computer access, security provisions, document safeguards, and maintain proper handling procedures including post-performance provisions restricting divulging sensitive/secure information.

5.0 Contract terms and management

5.1 Period of performance:

Base year: April 1, 2025 – March 31, 2026 (12 months, plus 4 option years)

Option year 1: April 1, 2026 – March 31, 2027 (12 months)

Option year 2: April 1, 2027 – March 31, 2028 (12 months)

Option year 3: April 1, 2028 – March 31, 2029 (12 months)

Option year 4: April 1, 2029 – March 31, 2030 (12 months)

5.2 Data:

The government has unlimited rights to all deliverables including intellectual property rights. All supporting documentation, manuals, reports, and other documentation materials produced by the contractor as part of this contract shall become the property of the government.

5.3 Travel and per diem:

There shall be no travel established under this contract. The government reserves the right to modify the contract if such a need is recognized by the NPS. Should such a need be recognized, any travel other than local travel must be clearly defined prior to performance and have been established by the awarded contract. In addition, all travel when authorized by the NPS must be coordinated with the project contact and the COTR/CO seven workdays prior to the start of the proposed travel period. All travel shall be reimbursed as per the current federal travel regulations in effect at the time of travel.

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5.4 Recognized holidays:

The contractor is required to provide medical control services 24-hours a day 7-days a week throughout the calendar year.

5.5 Contractor key personnel:

The contractor shall provide notification of all key personnel changes and receive approval of replacement personnel by the government prior to personnel start date.

The contractor shall provide key personnel with the ability to speak, read, and write in fluent English.

6.0 NPS points of contact

6.1 Contracting officer representative (COR)

The COR will be identified by a separate letter. The COR monitors all technical aspects of the contract and assists in contract administration. The COR is authorized to perform the following functions:

• Assure that the contractor performs the technical requirements of the contract

• Perform inspections necessary in connection with contract performance

• Maintain written and oral communications with the contractor concerning technical aspects of the contract

• Issue written interpretations of technical requirements, including government drawings, designs, specifications

• Monitor contractor's performance and notify both the contracting officer and contractor of any deficiencies

• Coordinate availability of government furnished property

• Provide site entry of contractor personnel.

A letter of designation issued to the COR, a copy of which is sent to the contractor, states the responsibilities and limitations of the COR, especially about changes in cost, price, or changes in delivery dates. The COR is not authorized to change any of the terms and conditions of the resulting contract and any task orders placed against said contract.

6.2 EMS program point of contact

The main point of contact between the contractor and EMS program shall be the EMS coordinator for Zion National Park.