Accreditation of VA Hospitals: Since all VA hospitals are accredited by the Joint Commission on Accreditation of Hospitals, they have been required to meet (with some modification), the Commission's standards for Emergency Services. (See attached copy). While for the most part these standards are met to some degree by all VA facilities, between hospitals there are recognizable variations in meeting the requirements. For example, the standards indicate that an accredited hospital should perform a role in a total community emergency service program, provide an emergency care area, and be capable of meeting the immediate needs of any patient brought to the door. Although this requires arrangements with community agencies, VA hospitals cannot negotiate for a day-today, pre-planned, emergency service for either ineligible veterans or non-veterans. Nor does the VA have sufficient trained staff or the facilities to cover all areas of emergency care such as that required for the care of infants and children or for severe burns. The Role of VA Medical Facilities Following Community Disasters: One of the strongest commitments to community emergency services by the VA occurs when the provisions of Public Law 91-606 the Federal Disaster Relief Act of 1970 as amended, are activated by the President. To prepare for this, as well as for other emergencies, all VA hospitals have written disaster plans which cover disasters of different scope and magnitude including those that involve communities. VA staffs have participated in community disaster planning and have rehearsed their roles in concert with community authorities. Therefore, following major disasters, as declared by the President under PL 606, VA hospitals can make their resources available in support of the community to a limited degree. However, many local disasters are not officially declared eligible for Federal assistance by the President. In these instances, VA hospital directors, on a humanitarian basis, have still made their resources available to the community. An agreement with the Office of Emergency Preparedness, which may permit the VA to perform community disaster services for possible OEP reimbursement, is being negotiated at the present time. DM&S Emergency Radio Communications: Following the Los Angeles Earthquake in 1971, the Administrator of Veterans Affairs directed the provision of base and mobile communi-· cations equipment for VA hospitals; most have been so supplied. Currently, 21 VA hospitals have, in addition, 2-way radio communications with other hospital disaster networks in their area; 13 have ties with police and fire radio systems; and 19 with civil defense nets; 96 have no communications with community emergency networks or are in the process of negotiating for such. However, these interconnections with community emergency frequencies (special emergency radios) are, by FCC regulation, licensed to non-government users and therefore cannot be utilized by VA for daily communications. VA Training and Education Programs in EMS: With its medical school affiliations, training and educational resources, VA hospitals can meet certain community needs in continuing education of health professionals (MD's and RN's) and in the training of emergency medical technicians. For example, at the Little Rock Arkansas VAH, certain facilities, used during the daytime for a variety of VA allied health training programs, are used in the evening under a state CHPA contract to train ambulance technicians (EMT-A). Under a sharing agreement (see below) this same hospital also provides facilities, supplies etc. for training for physicians and nurses in cardiopulmonary resuscitation techniques. Sharing Agreements and Contracts: VA hospital directors can contract with community agencies for many necessary services for eligible veterans and under sharing agreements can also provide such services to non-veterans. A number of VA hospitals provide emergency hospital admissions for special emergency services (acute respiratory care, acute dialysis and emergency renal transplants, acute stroke care, emergency angiograms etc.) under such sharing agreements. The sharing of VA resources therefore is a limited legal mechanism for the VA to provide support in a total community EMS system. Emergent and other ambulance services are occasionally provided by contract with private ambulance companies. The VA as a Participant Under S.504: Interagency Technical Committees on EMS and National Emergency Medical Services Advisory Council (Sec's 1205 and 1206). The VA is currently represented on the new Emergency Medical Services Interdepartmental Committee chaired by the Administrator of HSMHA. This committee has held one meeting (3/2/73) to implement the 1972 presidential initiative in Emergency Medical Services. The membership of the current committee is similar to that proposed in S.504 except that the Departments of Labor and Commerce, the NIH, SCC, OEO, HUD, and NASA are not listed in the Bill. However, the Bill permits the Secretary of HEW to select the Federal agencies to be represented. The VA's representation on both the committee and council is appropriate. "Area Emergency Medical Services Planning Council" (See 1204): Currently VA hospital administrative and professional staffs are members with special EMS expertise or as representatives of the VA on The local community councils on Emergency Medical and Health Services. VA participation in planning for such programs is officially considered an appropriate community action effort. Under certain circumstances such community services can be rendered with reimbursement to the VA employee for limited periods (Circular 00-70-22 of 6/3/70). SUMMARY 1. The Veterans Administration by statute and regulation is limited in its provision of the full spectrum (ambulance services, outpatient emergency care etc.) of modern EMS to eligible veterans only. These are usually veterans with service connected disabilities for which emergency services are necessary. 2. EMS provided by the VA for ineligible veterans and non-veterans is limited to hospital services on a humanitarian and reimbursable basis. 3. The limited ambulatory care program in the VA precludes the establishment of anything more than small scale emergency facilities in VA. 4. Some limited participation by the VA in community EMS programs is permissible through sharing agreements or contracts for special patient care. 5. VA education and training resources can also be made available under certain limitations. 6. VA disaster services for communities are permissible under less restriction when related to Presidential declarations of major disasters but are quite limited in non-declared disaster situations. EXECUTIVE COMMITTEE: JOHN H. RINE, JR. WILLIAM P GREEN LAWRENCE D. BALLENGER JOHN T. WOSCEK Senator Alan Cranston Dear Senator: June 26, 1973 Two questions asked us by the Senate Veterans Affairs The second question unanswered was what ways do we, as Another area of savings could be in the rehabilitation a paraplegic is an individual... THE PARALYZED VETERANS OF AMERICA IS AN ORGANIZATION FORMED BY AND FOR THE MOST SERIOUSLY DISABLED IN THE WORLD. IT IS Senator Cranston part or full-time employment resulting in a reduction of tax burden on the public, making a taxpayer out of the veteran and better utilization of the Federal monies spent in the rehabilitation of that veteran. An area of multiple saving for everyone. In general a small portion of the taxpayers' dollar goes towards the support or restoration of the veteran. If money and energy were made available with the ultimate goal of complete rehabilitation of the veteran much of what is now a growing tax burden could be changed into a tax credit. |