H1N1 Update from New York State

[Richard B the EMT]

The notice and guidance below was issued by the Suffolk County Department Health and contains information about the recently issued mandate from the NYS DOH requiring certain health care providers get seasonal and H1N1 flu shots. Notes from the September NYS EMS Council meeting indicate compliance is required by 11/30/09 but this window may move based on H1N1 vaccine availability.

Some EMS providers are covered by the mandate and others are not. Members of independent volunteer squads across the state do not appear to be covered by the mandate unless they are in EMT (B, I , CC or P) courses that requires hospital time. Nevertheless, vaccination is strongly encouraged.

Squads should check with their local Health Departments for availability of flu shots in their area. Some hospitals may be offering shots free to squads in their catchment area. Notice was sent out last week of North Shore-Manhasset’s offer and schedule of shots available to members of Queens squads.

Blue Cross-Blue Shield says it will cover H1N1 flu shots for its policy-holders this year and in 2010. BC-BS is the most popular plan with federal workers and retirees.

NY Governor David A. Paterson announced on 9/10/09 that insurers must cover seasonal flu and novel H1N1 vaccinations for children who are aged 19 and younger and enrolled in comprehensive health plans.

There is an exemption in the mandate where the shot is medically contraindicated. There may also have to be an accommodation to religious beliefs. In some individual hospitals elsewhere in the country that have mandated flu shots those personnel that have refused for whatever reason were required to wear surgical masks at all times.

No other state or city agency in America has a requirement for mandatory flu shots although it is almost universally recommended for health care personnel. News reports indicate a coalition of New York health care workers unions are considering filing a lawsuit to block the mandate.

Additional information about required vaccinations is on the NYS DOH web site at http://www.health.state.ny.us/diseases/communicable/influenza/seasonal/providers/health_care_personnel_influenza_immunization_requirements.htm

Jim Downey

Coeditor, BLANKET newsletter, NYSVA&RA

Editor, PULSE newsletter, District 4, NYC Region, NYSVA&RA

To be removed from the NYSVA&RA e-mail list please send a message to jamesbdown@aol.com

PULSE CHECK 2009, October 1 to 4. Full information at www.nysvara.org Click on the PULSE CHECK logo.

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SEPTEMBER 18, 2009

Reminder to all EMS agencies and providers that the seasonal influenza season, has officially started this month. Suffolk County continues using the Severe Respiratory Illness EMD Protocol, and continues to add the "FC" designation to the call determinant code. This designation is an indication that you may encounter a potentially infectious patient with influenza-like illness (ILI). Continue to employ our past recommendations for the use of PPE and early notification to hospitals. Regular and on-going communication within the county - between our Health Commissioner, our Division of Public Health, the Division of EMS, hospitals and FRES, and outside the county - with other key state and local officials continue, so that we can all keep abreast of on-going developments and recommendations to ensure a consistent message and approach to managing the situation.

The issue of vaccines has caused some confusion, based on some media reports and interpretations throughout the system, based on what some folks are hearing or being told. As of today-here is the current factual situation: Seasonal influenza vaccine became available in Suffolk County recently and our department and many private physicians began administering seasonal influenza vaccine last week, and will continue to do so, throughout the flu season. The Health Department's POD clinics will continue through November, 2009 and the location of these sites will be listed on the Health Department's website www.suffolkcountyny.gov/health Consistent with previous flu season guidance - EMS providers and other first responders such as firefighters and law enforcement personnel providing emergency medical response are at risk and are strongly encouraged to get seasonal influenza vaccine from their private physicians, from their agency physicians, or by visiting a local pharmacy, or a SCDHS Influenza Immunization POD Clinic.

The "mandate" that you have heard about comes from a recent change in the Section 405 of the NY State Health Code Regulations that govern Article 28 facilities, such as hospitals, skilled nursing facilities, diagnostic & treatment centers, licensed home health care agencies, health centers, and hospice programs. The modified regulation, in effect now, "requires that all persons employed or affiliated with an Article 28 facility, whether paid or unpaid, including but not limited to employees, members of the medical staff, contract staff, students, and volunteers, who either have direct contact with patients or whose activities are such that if they were infected with influenza, they could potentially expose patients, or others who have direct contact with patients, to influenza” receive the seasonal influenza vaccine, (now) and the H1N1 vaccine (if/when available). The only exemption included in the regulation is in cases where the vaccine is medically contraindicated and that exemption will have to be certified by a physician or nurse practitioner.

This regulatory change DOES affect EMS providers directly employed by an Article 28 facility, or those EMS providers working with an ambulance service under contract to an Article 28 facility, by definition. As of this writing….the rules change DOES NOT apply to volunteer or career EMS providers with ambulance services operating in the Suffolk County EMS System, as governed by Article 30. Given the impact that local ambulances have on daily emergency department volume, the State DOH has asked the Department of Legal Affairs (DLA) for an opinion as to whether or not this regulation extends to every EMS provider. We will keep you posted on any changes.

There is one cross over issue and that is limited to volunteer EMS or career EMS students enrolled in EMT-B or EMT-CC Original Courses as those courses have hospital clinical rotations associated with them. By definition, transient students doing clinical time in hospitals are indeed part of the "hospital community" and thus, must have the flu vaccine now, and H1N1 vaccine if /when available, along with other longstanding required vaccines required by the 405 Regulations ( Rubella, Rubeola, Hepatitis B, Tetanus, Diphtheria, and PPD) to be eligible for clinical rotations.

Regarding the H1N1 vaccine - It's too soon to for public discussion about the H1N1 vaccine policy as the Federal Government - to - NY State - to - Suffolk County distribution and supply methods are still under development and we don't yet know how we will address first responders as priority target audience. What we do know is that "first responders with direct patient contact" are in tier 1 (first to get) in both scenarios - plenty of vaccine; and limited supply of vaccine.

EMS agency leaders are strongly encouraged to:

·Facilitate programs where EMS providers and their families get the seasonal flu vaccine;

·Review their agency specific Respiratory Protection Plans to ensure that they have the necessary equipment, plans and preparations to protect their providers in cases of respiratory illness, fever and cough, especially when doing "aerosol increasing" procedures such as nebulized meds, BVM, suctioning, or intubation. The current recommendation is a fit-tested N95 mask in accordance with State EMS Policy Statements on infectious disease and respiratory protection;

·Review their agency specific Continuity of Operations Plans (COOP) to ensure uninterrupted response in cases of high absenteeism due to member / family illness; and

·Review infection control practices to ensure that EMS providers reduce the risk of infection and cross contamination by frequent hand washing, and by cleaning ambulance surfaces, including steering wheel, radio mics, stretcher, shelves, and durable medical equipment after every call.

[Richard B the EMT]

This just in from New York State Volunteer Ambulance and Rescue Association, relaying from the New York State DoH Bureau of Emergency Medical Services Director

NEW YORK STATE – DEPARTMENT OF HEALTH

INTEROFFICE MEMORANDUM

TO: EMS Agencies and Personnel

FROM: Edward G. Wronski, Director, Bureau of Emergency Medical Services

SUBJECT: Health Care Personnel Influenza Vaccination Requirements

DATE: October 7, 2009

There remains some confusion and concern among EMS Providers and Agencies regarding the applicability of the recent changes to Part 66 regulations regarding Health Care Personnel Influenza Vaccination Requirements and how they apply to EMS.

The Bureau of EMS requested a clarification of this health care regulation as it applies to EMS agencies. The following is a summary of the response provided by the Department of Health’s Division of Legal Affairs which we hope will clarify some of these questions.

1. Are EMS personnel mandated to receive flu vaccination under the recently enacted healthcare facility regulations?



EMS personnel who are employed by a hospital-owned ambulance service or ALS first response service must be vaccinated for the flu.



EMS agencies that have a contract with a healthcare facility to provide transport of patients are mandated to have their employees who provide these transports vaccinated. (Contracted EMS Agencies are encouraged to review their staffing practices as it relates to the conditions of these contracts and requirements of this regulation).



EMS services that respond in the 9-1-1 system and do not have a contractual relationship with a healthcare facility as described above are not required to be vaccinated. They are strongly encouraged to be vaccinated.

2. Will the mandate include H1N1 Vaccine?

Yes. As soon as H1N1 vaccine is made available, EMS personnel and agencies that fit the criteria in Question One will be mandated to have H1N1 vaccination. They are also required to have the regular seasonal flu vaccination.

3. Do all EMS students who have clinical rotations at a Healthcare institution covered under Part 66 have to be vaccinated?



Yes. Any EMS student, who is doing clinical or internship rotations at a Healthcare institution, even if they do not work for an EMS service, must be vaccinated with a seasonal flu shot and H1N1 when it is available. This includes BLS or ALS clinical and internship rotations. (EMS Course Sponsors are encouraged to review their clinical agreements as it relates to the requirements of this regulation)

4. Should all other EMS personnel who have patient contact be vaccinated?

Yes they should - While not mandated beyond the circumstances stated above, EMS personnel have been identified by the Department of Health and Human Services (HHS) as a high priority group to be vaccinated. It is highly recommended by the NYS Department of Health that all healthcare workers who work with patients, including EMS, be vaccinated with seasonal flu vaccine and H1N1 vaccine.

The New York State Department of Health Call Center Line for Novel H1N1 Flu questions and concerns is: 1-800-808-1987.

EMS Program Agencies

Regional DOH Offices

Regional Emergency Medical Service Council

State Emergency Medical Services Advisory Committee

State Emergency Medical Services Council

State Trauma Advisory Committee

Add this item, received from the same relay, from REMSCO, the Regional Emergency Medical Service COuncil of New York City :

Attention EMS Agencies,

As has been previously announced, the New York City Department of Health & Mental Hygiene has activated our regional Point of Distribution (POD) plan for distribution of H1N1 (swine flu) vaccine for all Proprietary and Volunteer ambulance providers. The Regional EMS Council of NYC is currently working with NYC DOH&MH and the City Immunization Registry (CIR) to obtain the vaccinations for our providers and coordinate the process of vaccine distribution and vaccination registration.

Last week, REMSCO requested that all agencies complete a survey requesting updated information on your medical director and personnel. Agencies are reminded that completion of this survey is MANDATORY. If your agency hasn’t already completed the survey, please do so ASAP by following this link: http://www.nycremsco.org/survey/TakeSurvey.asp?SurveyID=913lo3LKmnlKG .

For clarification, all hospital based and proprietary EMS providers are required to get both the seasonal & H1N1 flu vaccinations. Volunteer EMS providers are not required to receive either vaccination, but are strongly encouraged to do so as per the NYS DOH & NYC REMAC. Please review the attached NYS DOH memo for further details on EMS Personnel Flu Vaccination Requirements.

Additionally, this activation is for the distribution of H1N1 vaccinations ONLY. While REMSCO understands that many agencies are having difficulties obtaining seasonal flu vaccinations, we will not provide seasonal flu vaccines. Due to the recent outbreak of H1N1 in the country earlier this year and the H1N1 virus being so new, the government is providing an allotment of H1N1 vaccines for vaccination of high risk populations, which includes healthcare providers. This allotment is what has allowed REMSCO to provide this vaccine. However, such an allotment was not made for seasonal flu and as such, is not being provided by REMSCO.

REMSCO is aware of the November 30th deadline for all healthcare providers to be vaccinated for both H1N1 & seasonal flu. We are currently working to make NYCDOH, NYSDOH & NYC HHC aware that EMS agencies are having extreme difficulties in obtaining the seasonal flu vaccine due to the shortage. NYS DOH has stated that it may consider extending the deadline due to seasonal flu shortages, however such a decision will not be considered until the deadline is closer.

If you have questions or concerns regarding any of the items in this memo, do not hesitate to contact me.

Joseph Raneri, Emergency Preparedness Coordinator

Regional EMS Council of NYC

475 Riverside Drive, Suite 1929, NY, NY 10115

(212) 870-2301, option 4

jraneri@nycremsco.org