DECEMBER 2014
News
Vol. 23
NEWSLETTER OF THE NATIONAL ASSOCIATION OF EMS PHYSICIANS®
No. 4
President’s Corner Ritu Sahni, MD, MPH
NAEMSP® President (2013-2015)
In This Issue:
Dr. Sahni Goes to Washington (Florida, Chicago … )
NAEMSP® 2015 Annual Meeting . . . 3 Tailoring EMS Systems Based on EMD Data . . . . . . . . . . . . . . . . . . . 4 2014 NAEMSP® Board of Directors Election Results . . . . . . . . . . . . . . . . . 4 Important EMS Certification Information . . . . . . . . . . . . . . . . . . . . . 6 EMS Patient Safety Event Report . . . 7 MMWR Early Release . . . . . . . . . . . . 8 Dr. Wang Receives Research Grant . . . . . . . . . . . . . . . . . . . . . . . . . 8 IAED Nurse Triage Research Wins Prestigious International Sophus Falck Award . . . . . . . . . . . . . 9 IAED Issues Updated Emerging Infectious Disease Tool Alert for Ebola Virus in Eight Languages . . . 10 Chief Medical Officer Ad . . . . . . . . . 11 Welcome New Members . . . . . . . . . 13 EMS Calendar . . . . . . . . . . . . . . . . . 13
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fter just completing a meeting with ACEP’s Executive Committee (more to follow on that) I was looking at my email on my phone and noticed an email from the domain Whitehouse.gov. “Well, this is interesting,” I thought to myself. I opened the email and found that I had been invited to the White House for an event that included “remarks by President Obama.” Of course, the event was TOMORROW at 2:30 p.m. and I was still eating lunch in Chicago. I quickly consulted with NAEMSP® Board members that I was having lunch with and the response was unanimous, “You don’t turn down a White House invite.” Just to make sure that I wasn’t hallucinating this, I decided to check with my inside source. Dr. Richard Hunt is a Past-President of NAEMSP® and Neely Award winner. He also serves on the President’s National Security Staff. I called Rick. He verified that this was a real event with the real President. “Is there any reason I shouldn’t go?” I asked. “Do you get invites like this often?” Well, there you go. I do not get an invite like this often. So I decided to go, but there was a nagging question. What was the announcement? Was the President going to
present me with the Presidential Medal of Freedom? Perhaps he was going to recognize the incredible importance of NAEMSP®? Of course, the event was about Ebola virus disease and the President was giving a speech regarding the fight against the disease and, more importantly, the proper treatment of healthcare workers helping fight the disease both abroad and in the United States. His message was a simple one – let science be our guide and let’s recognize those on the front-line of healthcare as heroes. I felt honored to represent the EMS world in the audience. I also felt honored knowing that NAEMSP® has played a role in helping fashion the response. Through our contacts, we have been able to help provide information and feedback to the Assistant Secretary of Preparedness and Response, the Centers for Disease Control and directly to the White House. While I know this has taken up a disproportionate amount of all of our time, it will hopefully help our overall public health preparedness as well as prove the importance that EMS plays in any major response. Plus, I got invited to the White House!
ACEP Meeting As I mentioned above, I received the invite while attending ACEP. One of the goals continued on page 2
President’s Corner continued from page 1
important that NAEMSP® remains engaged in this process. This is prime opportunity for collaboration with other EMS Associations.
of my term as President has been to continue to increase NAEMSP’s influence by improving relationships within EMS and the emergency care community. Earlier this year, the NAEMSP® Executive Committee met with ACEP’s Executive Committee and we agreed to meet again at the ACEP meeting in Chicago. It helps that former NAEMSP® President Bob O’Connor and former NAEMSP® Board member Debra Perina now serve on the ACEP Executive Committee. In a very productive meeting, we were able to continue to build on common ground regarding our specialty, the EMS Field Bill and the issues regarding mobile integrated healthcare. We believe this relationship is crucial to maintain and will play a key role moving forward.
Last Newsletter So, this is my last newsletter column as President of NAEMSP®. Those of you who know me know that the spoken word is much more my medium than the written word. As a result, getting these columns written has been difficult. In the end, it has been rewarding and I hope it has provided insight into my thoughts on EMS and the future of NAEMSP®. There will be many opportunities to thank people at our Annual Meeting in NEW ORLEANS but I did want to say one thing: it has been an absolute honor and privilege to represent our specialty and I thank you for the opportunity.
Advocacy Update As many of you know, Advocates for EMS has ceased to function as a coalition organization. The last organizational member of Advocates is NAEMSP®. This is fitting – we were the first! The Board has created a small advocacy workgroup and is determining our next steps. The Board has reiterated that advocacy for our patients and our specialty is one of NAEMSP®’s core functions. We just need to determine the best way to move forward with this process. In the interim, we have retained Holland and Knight to represent us in Washington for the rest of this year, until we can develop a stronger plan moving forward. There is an issue that is moving quickly and one we may need further resources to tackle. At ACEP, the Drug Enforcement Administration announced that they would be finally creating Federal DEA rules specific to EMS. This clearly falls into the “Be careful what you wish for … ” category. We would all welcome standards that are clear, easy to follow and uniform. However, those standards could be quite cumbersome. It is very
NAEMSP® is the Lead Authority in EMS Medicine.
NAEMSP® is an organization of physicians and other professionals partnering to provide leadership and foster excellence in the subspecialty of EMS medicine. The NAEMSP ® newsletter is designed to inform members of interesting developments in the field of EMS. Members are encouraged to send information which may be of interest to others reading this publication. NAEMSP® News is the official newsletter of the National Association of EMS Physicians® (NAEMSP ®). Opinions expressed in articles in NAEMSP® News are those of the authors and not necessarily those of NAEMSP ® nor the editor of NAEMSP® News. Reproduction in whole or part is strictly forbidden without prior consent of the editor.
EXECUTIVE OFFICE STAFF LISTING
Copyright © 2014. The National Association of EMS Physicians®. Correspondence and inquiries should be sent directly to:
The NAEMSP ® Executive Office staff and email address information is listed below for your reference.
NAEMSP ® Executive Office, P. O. Box 19570, Lenexa, KS 66285 913-895-4611; 800-228-3677; Fax: 913-895-4652 Email: Info-NAEMSP@naemsp.org; Website: www.NAEMSP.org
General email address to reach staff: Info-NAEMSP@naemsp.org Executive Director, Jerrie Lynn Kind
Meeting Planner, Caitlin Arnold
Association Manager / Grants Project Manager, Stephanie Newman
Administrative Assistant, Diane Conner
NAEMSP ® NEWS
Articles for inclusion in the newsletter must be submitted by email (Word). To submit material for publication, contact the editor by telephone or email. NAEMSP® News Editor, Joseph DeLucia: 314-422-1244. Email: jlinde001@mail.com NAEMSP® Staff Contact, Stephanie Newman, Email: stephanie@naemsp.org
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We are very excited to host our NAEMSP® conference in New Orleans in January. Conference registration is open until December 17. We are offering several preconference workshops: yy NAEMSP® Advanced Topics in Medical Direction™ yy Building a Robust Quality Improvement Program in Your System yy NAEMSP® Resuscitation Academy yy Patient and Provider Safety yy Ebola – U.S. Experience with EMS Transport and Management Highlighted general sessions include: yy Katrina: 10 Years Later with General (Ret) Russel L. Honoré yy Controversies in the EMS Management of Severe Traumatic Brain Injury (TBI) yy MIHP or Best Practice Implementation – What's a Medical Director to Do? yy 5 Articles That Should Change Your Practice Click here for information on the 2015 Annual Meeting. Click here for our Annual Meeting program schedule. Click here to register online. We look forward to you joining us in New Orleans!
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Tailoring EMS Systems Based on EMD Data By P. Brian Savino, MD and Karl Sporer, MD
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ost EMS systems utilize some form of Emergency Medical Dispatch (EMD). EMD is used to categorize 9-1-1 calls into groups, helping to assign the appropriate medical response to the call. The Medical Priority Dispatch System™ (MPDS®) is an EMD system used by a large number of major U.S. cities and many international EMS systems. By asking callers a series of scripted questions, dispatchers are able to categorize the call into 33 different complaint categories which are further classified by priority into Alpha (BLS cold), Bravo (BLS hot), Charlie (ALS cold), Delta (ALS hot) or Echo (ALS hot with AED support). These categories can have further modifiers attached to give more information to the responders.
Alameda County has over two years of linked MPDS data that we have made available on our website: http://www.alcoems.org/mpds-data. For each MPDS® category there is information regarding the rate of transport, field pronouncements, ALS vs. Non-ALS patients and the use of ALS critical interventions. Our goal is to develop committees, in cooperation with our community members and medical providers that can use this data to help define our EMS responses for individual calls. This may include identifying categories that would benefit from a more rapid response, as well as some categories that can be downgraded to a BLS response due to high rates of cancellations and an observed lack of ALS critical interventions.
By linking run data between MPDS® codes, computers aided dispatch (CAD) systems and electronic patient care records, EMS systems can directly measure their ability to predict what type of response is needed. This can allow individual EMS systems to tailor their response to the needs of their community. For example, the MPDS® code for seizure, stopped, with breathing verified is 12A1. San Francisco and San Mateo counties, located in California, found that these calls had a midazolam administration rate of up to 9 percent. These counties felt this was an emergent treatment need and maintained a lights and sirens response. Alameda County, however, had a much lower rate of midazolam administration for 12A1 calls. This led Alameda County to maintain a lower level of response.
The goal of any EMS system should be continual improvement and the ability to tailor the system to the needs of the community. The publication and use of MPDS® data, as done in Alameda County, is another tool that can be used to accomplish this goal.
2014 Board of Directors
Election Results
We are pleased to announce the newly elected NAEMSP® Board of Directors who will serve from January 2015 – January 2017. President-Elect
J. Brent Myers
Secretary/Treasurer
David Tan
Physician Member-at-Large
Jon Rittenberger Alex Garza Alex Isakov
Thank you to all our members who took the time to vote for your Board of Directors. Farewell to NAEMSP® Immediate Past President, Ron Pirrallo, Secretary/Treasurer, Kevin Mackey and Physician Members-at-Large David Slattery and Karen Wanger. NAEMSP® wishes to thank them for faithfully serving on the Board of Directors.
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IMPORTANT EMS CERTIFICATION INFORMATION 2015 EMS Application Period The American Board of Emergency Medicine (ABEM) will accept applications for the 2015 EMS Certification examination from January 15 through July 15, 2015. The 2015 EMS application form will be available to download from the ABEM website beginning January 15, 2015. The form must be completed and mailed to ABEM. To be eligible to take the examination, physicians must hold current primary board certification issued by an American Board of Medical Specialties (ABMS) Member Board and fulfill the ABEM Policy on Medical Licensure. There are three application pathways for certification in EMS: a practice pathway, a practice-plus-training pathway, and an accredited training pathway. Physicians must have fulfilled the eligibility requirements of the pathway through which they apply at the time they submit their application. Activity that occurs after the application is submitted will not be considered. Physicians who plan to submit a 2015 EMS application are encouraged to do so as early in the application period as possible. It takes time to process each application and independently verify the information that is provided. Physicians’ applications that are approved later in the application period will have more limited choices of examination locations.
2015 EMS Certification Examination The EMS certification examination is offered every other year in odd-numbered years. The 2015 examination will take place on November 9, 2015, at Pearson VUE testing centers across the country. ABEM encourages physicians whose applications are approved as meeting the eligibility criteria to register for the examination early to assure being seated for the examination. The EMS certification examination is based on the Core Content of EMS Medicine and the 2015 definition of the Minimally Qualified EMS Physician. These documents and additional information is available on the ABEM website. Go to www.abem.org, and click on “Subspecialty Certification” and “Emergency Medical Services” on the left navigation bar. For physicians who have an approved, active EMS application on file with ABEM and who wish to register for and take the 2015 examination, registration on the ABEM website will be available beginning February 2, 2015. (Those whose applications are not active will need to contact ABEM and reactivate their application in order to register online.)
EMS Maintenance of Certification Physicians who achieve EMS certification are automatically enrolled in the ABEM EMS MOC Program. Physicians who are currently EMS certified can now take the 2014 EMS LLSA test. Those who opt for the associated CME activity will earn 13 AMA PRA Category 1™ credits. The EMS LLSA and associated CME activity can be accessed via EMS MOC Online.
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Welcome! Welcome to the EMS Voluntary Event Notification Tool (E.V.E.N.T.)! This is an aggregate report of the patient safety events reported to E.V.E.N.T. in the second quarter of 2014. We want to thank all of our organizational site partners. For a complete listing of site partners, see page 4. E.V.E.N.T. is a tool designed to improve the safety, quality and consistent delivery of Emergency Medical Services (EMS). It collects data submitted anonymously by EMS practitioners. The data collected will be used to develop policies, procedures and training programs to improve the safe delivery of EMS. A similar system used by airline pilots has led to important airline system improvements based upon pilot reported “near miss” situations and errors. Any individual who encounters or recognizes a situation in which an EMS safety event occurred, or could have occurred, is strongly encouraged to submit a report by completing the appropriate E.V.E.N.T. Notification Tool. The confidentiality and anonymity of this reporting tool is designed to encourage EMS practitioners to readily report EMS safety events without fear of repercussion. When an anonymous EVENT report is submitted, our team is notified by email. In the United States, the anonymous patient safety event report is shared with the state EMS office of the state in which the event was reported to have occurred. The state name in the report is then removed and the record is shared through our Google Group and kept for this summary report. Canadian records have the Province name removed, and then the reports are shared through the Paramedic Chiefs of Canada, and kept for inclusion in aggregate reports.
As you review the data contained in this report, please consider helping us advertise the availability of the report by pointing your colleagues to www.emseventreport.com.
Notice/disclaimer: all manufacturer and model names are removed from this document because EVENT is an anonymous system. The anonymity of EVENT reports is protected and the reporter cannot be verified as a neutral party trained to provide a fair and unbiased assessment of the events or product usage. For this reason we redact all names, including the manufacturer and model. We operate another reporting system, the Emergency Medical Error Reduction Group (EMERG), which can provide states or individual EMS agencies a non-anonymous error reporting system. As a designated Patient Safety Organization (PSO), EMERG has federal discovery protection for all information entered and analysis completed. EMERG can help identify actual manufacturing issues and partner with industry to correct issues and thereby improve the culture of safety in EMS. For more information please about EMERG, contact Matt Womble, MHA, Paramedic, Director of EMERG (matt.womble@emerg.org). (EMERG is federally designated as PSO # P0133 by the U.S. Department of Health and Human Services, Agency for Healthcare Research & Quality.) NAEMSP ® NEWS
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Morbidity and Mortality Weekly Report MMWR Early Release MMWR Early Release Vol.63, 63, Early Early Release Vol. Release October 7, 2014 October 7, 2014
PDF PDF
InIn this thisreport report Vital Signs: Signs: Health Burden and Medical Costs of Costs NonfatalofInjuries to Motor Vehicleto Occupants — UnitedOccupants — Vital Health Burden and Medical Nonfatal Injuries Motor Vehicle States, 2012 United States, 2012 Gwen Bergen,PhD, PhD,Cora CoraPeterson, Peterson,PhD, PhD,David DavidEderer, Ederer,MPH, MPH,etetal.al. Gwen Bergen, MMWR 2014;63(Early Release):1-7 MMWR 2014;63(Early Release):1-7 Motor vehicle crashes are a leading cause of death and injury in the United States. To describe the Motor vehicle crashes leading cause of death and injury in thecrash United States.CDC To describe current health burden current health burdenare anda medical and work loss costs of nonfatal injuries, analyzedthe data and medical and work loss costs of nonfatal crash injuries, CDC analyzed data from 2012. The results of that analysis from 2012. The results of that analysis found that an estimated 2,519,471 ED visits resulted from nonfatal found that an estimated 2,519,471 ED visits resulted from nonfatal crash injuries, with lifetime medical cost of $18.4 billion. crash injuries, with lifetime medical cost of $18.4 billion. Approximately 7.5% of these visits resulted in Approximately 7.5% of these visits resulted in hospitalizations that required an estimated 1,057,465 hospital days in 2012. hospitalizations that required an estimated 1,057,465 hospital days in 2012. Department of Health and Human Services Department of Health and Human Services Centers for Disease Control and Prevention Centers for Disease Control and Prevention
Dr. Wang Receives Research Grant
Henry E. Wang, MD, MS, Professor and Vice Chair for Research of the Department of Emergency Medicine at the University of Alabama School of Medicine, received grant award UH2-HL125163 from the National Heart, Lung and Blood Institute for the study “Pragmatic Trial of Airway Management in Out-of-Hospital Cardiac Arrest.” In collaboration with the Resuscitation Outcomes Consortium and the University of Washington Clinical Trials Center, the five-year effort will compare the effect of paramedic intubation and supraglottic airway insertion upon outcomes after out-of-hospital cardiac arrest.
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FOR IMMEDIATE RELEASE Contact Kris Berg 800-960-6236 ext. 116 kris.berg@emergencydispatch.org www.emergencydispatch.org
IAED NURSE TRIAGE RESEARCH WINS PRESTIGIOUS INTERNATIONAL SOPHUS FALCK AWARD AMSTERDAM— The International Academies of Emergency Dispatch® (IAED™) is pleased to announce that its secondary triage research was selected as the recipient of the 2014 Sophus Falck Scientific Abstract Award as the best pre-hospital care abstract at the prestigious European Society for Emergency Medicine’s (EuSEM) 8th European Congress on Sept. 29 in Amsterdam, Netherlands. A grant prize of 5,000 Euros ($6,300) accompanies the award sponsored by the Sophus Falck Foundation. The research project’s authors are Tracey Barron, IAED Research & Studies Officer and Chair of the Council of Research and Clinical Focus Group; Dr. Conrad Fivaz, Emergency Response Operations Director with Priority Dispatch Corp™. (PDC™) and Chair of the Emergency Communication Nurse System™ (ECNS™) Council of Standards; and Jerry Overton, Chair of IAED’s Board of Accreditation. The study, entitled, “Using EMS Telephone Triage Data to Assess the Amount of Ambulance Resources Saved through Telephone Triage,” found that from more than 2.6 million emergency 9-9-9 calls in the U.K. that received a phone or face-to-face response between April 2011–April 2012, nearly 90,000 were resolved through “hear and treat” secondary triage response, similar to the Academy’s ECNS. More tellingly, the study found that those secondary triage responses resulted in deployment savings of 22.5 million British pounds (or nearly $29 million) and saved the British ambulance services 134,935 total unit hours. “The results were spectacular and that’s why we feel they picked us for the award,” Fivaz said. “I think it’s a testimony to the Academy’s commitment to research. It shows that it is being recognized on an international stage.” Overton, who attended the Amsterdam awards presentation at which Barron presented and accepted the accolade on behalf of her colleagues and the IAED, echoed Fivaz’s sentiments. “It is superb to have the Academy prominent in the evidence-based community,” Overton said. “This piece of research is the perfect springboard for more studies into the important field of ‘hear and treat’ telephone triage,” Barron said. Fivaz said the prize grant will help fund further IAED research. “This award demonstrates the commitment of the Academy to the science of emergency dispatch,” said Dr. Jeff Clawson creator of the protocols and co-founder of the IAED. “It makes me believe that the initial, very distant dream, only imagined in 1987, of having the ‘Bell Labs’ of dispatch, has really been accomplished and continues to make the future a reality through the Academies’ ever expanding efforts. I couldn’t be prouder!”
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FOR IMMEDIATE RELEASE Contact Kris Berg 800-960-6236 ext. 116 kris.berg@emergencydispatch.org www.emergencydispatch.org
IAED ISSUES UPDATED EMERGING INFECTIOUS DISEASE TOOL ALERT FOR EBOLA VIRUS IN EIGHT LANGUAGES SALT LAKE CITY—In light of current growing global concerns about public health risks related to the spread of the Ebola Virus Disease (EVD) from West Africa, with some patients entering the United States and other countries, the International Academies of Emergency Dispatch® (IAED™) has updated its Emerging Infectious Diseases Surveillance (EIDS) Tool for computerized emergency dispatch center software in eight, in-demand languages. The Tool contains a list of possible signs, symptoms, and epidemiological risk factors—as defined by the Centers for Disease Control (CDC) and the World Health Organization (WHO)— including any recent patient travel and disease exposure information that might be observed or known about a given “patient of interest,” for emergency dispatch centers through a software interface of IAED protocols, including Priority Dispatch Corp’s™ (PDC™) ProQA® Paramount versions 5.0/5.1 and Legacy version 3.4. The updated EIDS Tool alert is available now (emergencydispatch.org/academy-news/eids-tool) to emergency communication centers around the world in English for ProQA users in the U.S., Canada, the United Kingdom, Australia, and New Zealand. Beginning on Monday, Oct. 13, it will also be available in French, German, Italian, Spanish, Portuguese, Arabic, and Dutch. “This list of possible signs and symptoms is extensive as ProQA is trying to capture information that might be useful for associated applications like FirstWatch™ (real-time data-trend surveillance software) to mine looking for emerging patient trends and patterns, or for notification of local health authorities and/or responder crews,” said Dr. Jeff Clawson, creator of the emergency dispatch protocols and IAED co-founder. IAED recommendations regarding EVD for travelers received from West Africa is also current[ly] available in English to the U.S., Canada, the United Kingdom, Australia, and New Zealand at http://www.emergencydispatch.org/academynews/ebola-alert[.] Clawson said that an upcoming update to the EIDS Tool will include an “Infection Prevention Instruction,” and that there will continue to be subsequent updates to the Tool as the public health risk to Ebola evolves. In the interest of public health, the IAED has also approved the release of a manual protocol card that is being posted Oct. 9 as a PDF on its website for non-ProQA users as well as non-Medical Priority Dispatch System™ (MPDS®) users to utilize.
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Chief Medical Officer Boston MedFlight, a world renowned critical care transport program established by a consortium of Boston’s leading academic medical centers in 1985, seeks a Chief Medical Officer to provide expert medical oversight of the organization’s clinical staff and clinical education. Under the direction of the Boston MedFlight Chief Executive Officer, the Chief Medical Officer (CMO) will provide oversight of all patient care, clinical performance and medical control. The CMO will work to ensure a smooth clinical interface between Boston MedFlight and outside hospital and emergency medical services, such that a synchronized, harmonious and seamless delivery of care model is provided. The CMO will work closely with the CEO to promulgate organizational strategy for the provision of excellent critical care transport. The CMO will also directly participate in the education of referring clinicians to encourage, enable and achieve economically and clinically appropriate utilization of MedFlight’s services. The CMO must possess the ability to build consensus, particularly among various medical disciplines and multidisciplinary specialties. The CMO must have the ability to develop, pursue and champion best practices and inspire the entire Boston MedFlight critical care team to do the same. As such, the individual must be a strong clinical and administrative leader who can strategically and tactically achieve the goals of the organization. The CMO is a part-time position and will be combined with a clinical role at one of the consortium hospitals, depending on the background and goals of the selected applicant. The CMO will be a physician who possesses broad-based training and expertise and a firm commitment to critical care transport. Interested candidates should submit a letter of application and curriculum vitae to: Brien A. Barnewolt, MD Chairman and Chief, Department of Emergency Medicine Chair, Boston MedFlight Chief Medical Officer Search Committee Tufts Medical Center 800 Washington Street, #311 Boston, MA 02111 617-636-9616 bbarnewolt@tuftsmedicalcenter.org Additional information about Boston MedFlight can be found at www.bostonmedflight.org. Boston MedFlight is an equal opportunity employer.
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Welcome
Joanna Adams Abdulaziz Alali Arash Armin Russell Baker Katherine Bateman Kurt Bloomstrand Michael Bohanske Christopher Bosche Erica Carney Matthew Chovaz Dan Cohen Gregory Conrad Anders Conway Alan Dobrowolski Raul Easton-Carr Daniel Ebbs Joel Edminster David Feldman
New Members
Robert Feldman Jennifer Fischer John Freese Christopher Gainey Elena Garcia Javier Gascot Aric Gray Michael Guttenberg David Hakkarinen Jason Hums Kara Kohfield Nicholas Kroll Mary Lou Kyne Thomas Lardaro Douglas Lee Nicholas Leonowicz Mark Lockett John Maino II
Joshua Marks James McCarthy Michael McGrath Ronna Miller Hannah Muthersbaugh Regina Mysliwiec Paul Pepe Tushar Pishe Mark Raaka Colby Redfield Mark Rogers Wendy Ruggeri Kenneth Scheppke Kevin Schulz Sandra Schwemmer Anthony Scopel Justin Sempsrott Michael Sheeser
Lauren Shephard Jeffrey Siegler Joelle Simpson Matthew Smetana Kathleen Snow Dugg Steary Andrew Thomas Stephanie Trowbridge Pauline VanMeurs Christopher Ward Leah Watson Sandi Wewerka Geneva Whitmore Keith Widmeier Erin Wirths
EMSCalendar Be sure to check out the most updated version of the EMS Calendar at www.NAEMSP.org.
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