ASM Company Newsletter!

The Ambulance Service of Manchester is pleased to announce the release of Pulse, the ASM employee newsletter. Released quarterly, Pulse will feature numerous articles outlining company news and events, training opportunities, case studies (periodically), health and wellness tips, and more. Additionally, each issue will contain an Employee Spotlight article, recognizing an EMT or Paramedic that has demonstrated a commitment to patients and co-workers alike via positive attitude, work ethic, and overall inspiring demeanor. The first issue of Aetna’s employee newsletter will be released on May 1st.

Click above to view!

Provider Wellness

Canadian Paramedicine is an informative and progressive magazine complete with numerous research articles beneficial to EMS providers. One such article entitled “Eat, Sleep and be healthy-a paramedic’s guide to healthier shift work,” outlines some of the risks associated with working outside of the traditional 8-hour daytime schedule. More importantly, it provides evidence based suggestions for healthy eating, staying fit, and developing better sleeping habits.

Quotes from the article:

 “Exercise can enhance alertness at work in addition to increasing neural activity and clinical performance. Blocking out 20 minutes (or more) prior to a shift will boost their mood and combat fatigue while working.”


“Prepare meals for a number of days  for quick and easy access. Experiment with slow-cookers or freeze portion sizes of healthy meals. Pack healthy snacks such as prepared fruit and easy-to-eat vegetable pieces like baby carrots and celery with hummus, or a small container of mixed unsalted nuts and seeds.”

Find the article in its entirety below:

Eat, sleep and be healthy – a paramedic’s guide to healthier shift work

“Love our First Responders”

MANCHESTER — On Valentine’s Day, the staff and residents of Arbors of Hop Brook Retirement Community graciously hosted a “Love our First Responders” breakfast demonstrating their appreciation and respect for members of The Ambulance Service of Manchester, Manchester Police Department, and Manchester Fire Department. Activity Director Laurie Robinson organized the event, and offered the following sentiment: “Thank you for your prompt, caring, professional, unselfish and noble actions. We respect and appreciate what you do for our community. Our hearts are thankful for your extraordinary efforts.” Included in the picture to your left are excited and grateful residents, members of the Arbors staff, Manchester Mayor Jay Moran, Police Chief Marc Montminy, Fire Chief David Billings, and EMT’s Sean Gregg and Elizabeth Miller from ASM.

Provider Wellness

Below is a link to an article published in JEMS Magazine. Written by 25 year veteran paramedic Bryan Fass, the piece tackles the important, yet often overlooked topic of physical fitness within EMS. Understanding the daily challenge of balancing work, family, finances, and health/wellness, Fass introduces what he calls “The Change Equation,” offering ideas on how to get motivated, form positive habits, and produce long-lasting behavioral changes.

In addition, Fass dispels some common myths that act as barriers to maintaining a healthy lifestyle. He even offers a sample training routine with detailed steps and photos demonstrating safe and effective body mechanics.

Check It Out!


Disaster Triage Online Game Needs EMS Study Participants

HARTFORD —  In a correspondence from Dr. James Parker of Connecticut Children’s Medical Center:

Calling all Paramedics, EMTs and EMS students!

60 Seconds to SurvivalLeaders of the Study are examining the utility of the video game as a learning tool for START/JumpSTART.

You are invited to participate in this fun research study based out of Yale University School of Medicine.


  • Access to an online GAME where you learn & practice MASS CASUALTY TRIAGE for PEDIATRIC and adult patients.
  • 3.25 hours of CME time.
  • $15 Amazon Gift card.


  • Agree to play the game once a week for 15 minutes (for 13 weeks).
  • Provide feedback on the game when prompted.


  • please email me at
  • Please include what organization you’re from.
  • She will send you the link to the game and further details about CME.
  • Remember, you can withdraw at any point – (but won’t get the gift card).

Your reply implies verbal consent (information sheet at end of message).

Feel free to contact me with any questions!

Jim Parker, MD

EMS Liaison


Aetna and ASM are not affiliated with this study. 

INTERACT Training for Emergency Medical Services – The ‘Red Envelope’

QIO-and-Qualidigm-logosINTERACT stands for Interventions to Reduce Acute Care Transfers. It is a quality improvement program designed to improve the early identification, assessment, documentation, and communication about changes in the status of residents in skilled nursing facilities.

The goal of INTERACT is to improve care and reduce the frequency of potentially avoidable transfers to the acute hospital. Such transfers can result in numerous complications of hospitalization, and billions of dollars in unnecessary health care expenditures. It includes clinical and educational tools and strategies for use in every day practice in long-term care facilities.

Here is the link to the INTERACT Training for Emergency Services:

Then select “INTERACT Training for Emergency Services”

The training is about 12 minutes in length and covers the new acute care transfer process between a participating nursing home and hospital.

  • Not all nursing homes are part of this initiative so EMS will find that some homes will still be using the W-10 and other documents during their acute care transfers
  • The nursing homes that are using the red envelope as part of their new acute care transfer process will seal the red envelope and have a set of transfer documents for the EMS service so they will not have to open the envelope
  • The rollout date to begin using the new acute care transfer process and the red envelope is August 31, 2015.
  • The entire red envelope should be handed to the ED staff either at triage or in the ED room as the patient is being transferred from the stretcher to the bed
  • The red envelope is to be used only for acute care transfers between participating nursing homes and hospital – they should not be used for other types of transfers
  • There will not be a W-10 as part of the transfer documents – the front page of the INTERACT transfer form along with the residents’ face sheet meet the Department of Health Public Health Code requirements

“Turn something tragic into something heroic and courageous”

LifeChoice LogoI began my career in the Westport, CT, Fire Department in 2007 as a 20-year-old kid who had just achieved his lifelong goal of becoming a firefighter.  During the first few years of my career, I became a volunteer with Donate Life CT to raise awareness about organ and tissue donation.

Ironically, only a couple years later, I blew out my knee on the job and required surgery that involved donated tissue.  I went through nine months of rehabilitation to get conditioned to do the job again and went back on the line.  Throughout this time, I had given speeches and worked events as a volunteer for organ and tissue donation, always thinking that organ donation was the biggest and most iconic part.

It wasn’t until I met another volunteer who had lost a sister in a motor vehicle accident that I realized how important tissue donation is.  We were talking about it and I mentioned how I never really felt like I had much “street cred” being a tissue recipient giving speeches next to heart and liver recipients.  She then told me about her sister and how she was only able to donate her tissue due to the circumstances of her accident.  I was truly humbled hearing her talk about how the experience of losing a sister was able to have some positive outcome.  And that is really the reason that I feel organ and tissue donation is so important, especially in the emergency services field.

Every day we are faced with terrible and tragic scenes where people lose their lives.  But given the advances in modern medicine, we have the ability as human beings to turn something tragic into something heroic and courageous.  I think that the mission of organ and tissue donation is an extension of our mission in the field, and I encourage everybody to talk it over with their friends and families.  Chances are you know somebody who has benefited from organ or tissue donation.  Even if you don’t, the statistics showing the need for more registered donors are staggering.

I encourage you to learn more about organ and tissue donation and consider becoming registered donors.

– Firefighter Joseph Arnson

Required Forms for Non-Emergency Ambulance Transport in Connecticut – Volume 2

ASM Bariatric 3This post is an update and rehash of a previous post due to renewed interest in the topic.

Below is a comprehensive list of forms needed to complete a basic life support, routine inter-facility ambulance transfer in the State of Connecticut in 2015. More medical and billing information and demographics are necessary but in regards to forms that go to the ambulance crew, this it…

None of the information below should be construed as legal advice. If there are questions always consult the proper authority. If you have basic questions on this material please call us or post your question in the comments and we will answer to help the greatest number of interested parties. 

Medical Necessity Form (aka Physician’s Certification Statement (PCS) or MNF):  An MNF is required on routine, non-emergency ambulance transports where the patient has Medicare as their primary insurance. It is helpful to have on file for beneficiaries of Medicare HMOs as well. The form essentially works as a prescription for ambulance transport. Medicare never pays for wheelchair van transport so this form represents the threshold between wheelchair van (and all other types of transportation) and ambulance. There are some types of transports from skilled nursing facilities (SNF) and hospital where the sending facility is required to pay for the transport and therefore will not issue or sign an MNF.

There is a misnomer that MNFs are not needed on hospital to hospital and STAT transports because they are inter-facility or emergent. They are indeed required regardless of acuity or receiving facility. Although there are some rules around this they are detailed and convoluted. It is best to provide an MNF on every scheduled ambulance transport in which Medicare or Medicare HMOs are the payor.

A Medical Necessity Form alone does not guarantee payment. In fact it does very little in this regard. It must be on file, but the most important factor is the patient’s condition. The patient must be unsafe to travel by any other means. There are more rules regarding repetitive patients in which a new PCS is only needed every 30-60 days.

The rules around the use of an MNF and meeting Medicare’s medical necessity requirements are extensive and cannot be captured adequately here. Aetna and ASM crews are trained, reviewed, remediated and subject to a rigorous quality assurance process in this regard. If you represent a facility in our service area and feel you would benefit from an in-service to learn more about this, please call (860) 647-9798 x 249.

Physician’s Emergency Certificate (PEC): A PEC is required for the ambulance transport of a psychiatric patient going to any destination (typically a locked behavioral health unit) against their will (or by the will of the physician). In other words, they are being committed to the facility and their ability to make self determination is temporarily suspended by law.

A PEC must be an original form, typically demonstrated by being two-sided and often written in blue ink for this purpose. A copy cannot be used and it must be signed by a physician. It must accompany the patient and therefore cannot be faxed or emailed ahead as facilities will not accept a copy. This form is NOT used for voluntarily committed patients or patients who are conserved where the conservator has ordered transport.

This form also authorizes the ambulance crew to hold the patient against their will. In Connecticut, the only forms that allow an ambulance crew to hold a patient against their will are a PEC and an Emergency Examination Report issued by a licensed clinical social worker or a police officer. It is the policy of Aetna and ASM to also accept and enforce hospital and healthcare ‘Voluntary Commitals’ as granting authority to the ambulance crew to hold patients against their will. Ambulance crews must always use the minimum force necessary and most often this means simply confining the patient and does not necessarily mean the use of force or restraint.

Ambulance crews are not trained or equipped to subdue individuals. Chemical and physical restraints used by ambulance crews are intended to be applied with the assistance of law enforcement or healthcare staff. Judicious, prophylactic application of soft restraints should be strongly considered for patients that present a risk of elopement or danger to self and others. The back of an ambulance is not a controlled and static environment and this should be taken into consideration.

Transportation Authorization Certificate (TAC): A TAC compels the State of Connecticut to pay for the transportation of a patient in need of psychiatric care who is being admitted to an inpatient, state-operated facility. The receiving facility representative signs on Line 4 of this form and it is used as a check and balance before issuing payment to a transportation provider.

There are only five state-operated, inpatient psychiatric facilities in the state, Blue Hills, Cedarcrest (closed), Connecticut Valley Hospital (CVH), Greater Bridgeport Mental Health and Capitol Region Mental Health Center. An ambulance crew does NOT need this form if the destination is any other facility. The need for this form is not created by any other factor such as the chief complaint, the payor or the sending location.

W-10 (demographic portion of the discharge summary): Hospitals and skilled nursing facilities (SNFs) are required to provide the ambulance provider with enough information to safely complete the ambulance transport. Aetna and ASM are Covered Entities under HIPAA, have approved policies and procedures in this regard and all employees have been trained in appropriately handling protected health information (PHI). A hospital or SNF can restrict the amount of information they issue as long as the transport can be safely completed and sufficient information has been provided to carry out treatment, payment and healthcare operations.

Hospitals and SNFs are no longer required to provide a State of Connecticut W-10 form or a full discharge summary and quite often they send the summary electronically to the SNF. Although the W-10 format is not mandated, hospitals and SNFs must provide demographics, history, meds, allergies and any other pertinent information even if the patient is returning to a private residence without scheduled services.

No other form is required for routine BLS ambulance transport. Ambulance crews should NOT be looking for a full discharge summary, so-called “No Harm” letters, full medication administration logs (MARS), psychiatric notes, or any other form that is not listed above. EMTALA-type forms may be useful in informing an ambulance crew as to the patient’s condition and though they may be required paperwork, they are not for the ambulance crew.

Questions? Call the billing office at (860) 647-9798.

National Donate Life Month: Jason’s Story

Jason age 12 (2)The following is a guest blog post that came to us as via our commitment to the intersection of EMS and Organ Donation, courtesy of LifeChoice Donor Services, and as part of National Donate Life Month.

The fear which truly speaks to the heart of a first responder and parent answering a child trauma call is, what if that were my son, daughter, niece, or nephew.  I’m here to tell you, having that fear realized is even worse than your worst anticipations. I was a police officer on the City of Groton PD for 25 years. I was on the Dive/Rescue team for 16 years, a Critical Incident Stress Debriefer, started the Dept. bicycle team, MRT, CPR Instructor, and received the Dept. Life Saving Medal. I have seen just about every type of crime, accident, injury, or wrong that can be perpetrated by one human being against another.  None of those skills prepares you to respond to your own son’s motor bike accident in front of your house on a cold early December Saturday while decorating for Christmas in 1997.

Memories of a screech of tires, a scream for “Dad”, doing CPR with my wife, a Nurse Practitioner, the distant sirens, and faces in the periphery. The aftermath of a miscalculation by Jason, my 15 year old, and another friend’s collision, would never be undone.  The hazy memory of an ambulance ride, hospital personnel, worried faces, and then finally a pronouncement the next day of an unrecoverable traumatic brain injury, despite the helmet, all reside within me still.

Through the haze, numbness, denial, phone calls, hugs, and raw soul-wracking tears, I remember being quietly asked about donation.  My wife, having been a critical care nurse at one time, found it easy to respond yes, while I was not yet ready to accept this finality.  But I also knew deep within my heart that if lives could be saved by such a simple choice when no other outcome was possible, then of course we’d do that.  And it might even make some sense out of a senseless loss, or at least be a life-affirming positive side to an otherwise helpless situation.  It also gave us some sense of control in the chaos around us.

The decision was made to donate any and all organs, bone, and skin tissue, and I distinctly remember thinking why do anything limited or ‘half-ass’, that if a life or lives could be saved by this simple act, even though my son’s could not, then that’s what we’d do, and I signed the papers.  (As a side note to all this, we were still able to have an open casket and say our final goodbyes to Jason.)   I won’t pretend it was easy, but it was right, and over time has made life without Jason easier knowing his life had meaning, and does, in a real sense, still go on.

By Jim Murray, Jason’s dad

Norwich, CT

LifeChoice is the federally designated, non-profit organ procurement organization (OPO) for six counties in Connecticut and three counties in Western Massachusetts, with a combined population of 2.3 million people. The OPO serves 23 acute care hospitals for organ and tissue donation, and has two organ transplant hospitals: Hartford Hospital in Hartford, CT, and Baystate Medical Center in Springfield, MA. For more information or to schedule an in-service, please contact Donna Crombez at

Myths about organ donation, and its relation to EMS, debunked

WFSB 3 Connecticut


Organ donation is a popular topic, however there are some myths that may keep people from joining the registry.

Organ donors can change the lives of so many people in need.

“A gift of medicine, that only a person can give,” said Caitlyn Bernabucci, of Life Choice Donor Services. “Just one donor can help more than 50 people through the gift of organs and tissues.”

She said the need is great right now, and that about 21 people die every day waiting for a transplant.

Still, more than half of Connecticut residents are not signed up for the donor registry, and Bernabucci said some damaging misconceptions are to blame.

“We want to make sure people understand the facts,” she said.

The first misconception is that organs will be taken before the person is actually dead, but that simply is not the case. Read the whole story here…

Public Service Announcement on EMS Use of Lights and Siren

Courtesy of MONOC this Public Service Announcement (PSA) discusses the use of emergency lights and siren in EMS response and its impact on the public policy and the public’s best interest.

Aetna and ASM support the judicious use of lights and siren and industry best practices in regards to “hot” and “cold” responses.

Update to CDC’s Response to Ebola

CDCCDC Tightened Guidance for U.S. Health Care Workers on Personal Protective Equipment for Ebola

CDC is tightening previous infection control guidance for health care workers caring for patients with Ebola, to ensure there is no ambiguity. The guidance focuses on specific personal protective equipment (PPE) health care workers should use and offers detailed step by step instructions for how to put the equipment on and take it off safely.

Recent experience from safely treating patients with Ebola at Emory University Hospital, Nebraska Medical Center and National Institutes of Health Clinical Center are reflected in the guidance.

The enhanced guidance is centered on three principles:

  • All healthcare workers undergo rigorous training and are practiced and competent with PPE, including putting it on and taking it off in a systemic manner
  • No skin exposure when PPE is worn
  • All workers are supervised by a trained monitor who watches each worker putting PPE on and taking it off.

All patients treated at Emory University Hospital, Nebraska Medical Center and the National Institutes of Health Clinical Center have followed the three principles. None of the workers at these facilities have contracted the illness.

For more information visit:

CDC Newsroom — Tightened Guidance for U.S. Healthcare Workers on Personal Protective Equipment for Ebola Fact Sheet – Oct 20

CDC Guidance on Personal Protective Equipment To Be Used by Healthcare Workers During Management of Patients with Ebola Virus Disease in U.S. Hospitals, Including Procedures for Putting On (Donning) and Removing (Doffing) – Oct 20 Continue reading

Comfort, Safety, Space Features Added to Bariatric Ambulance Stretchers

1363718992_IMG_8412MANCHESTER and HARTFORD — The specialty bariatric stretchers operated by Aetna and ASM have now been equipped with Stryker’s Expandable Patient Surface (or XPS) system.

The XPS System consists of a new wider mattress and new side rails that fold out instead of down. The side rails are not intended to support the patient primary body weight. Instead they are intended to enhance patient comfort.

XPS_LargeAccording to the Stryker website, “XPS is adjustable with seven locking positions and includes a wider mattress that reduces transfer gap and designed with patient comfort in mind. This solution helps address growing obesity trends and supports a variety of patients and environments.”

EMS Structured for Quality: Volume 1

specialevents4Essential Performance Results

In 2008, the American Ambulance Association issued a best practices white-paper entitled EMS Structured for Quality. The paper was intended as a guide for “those who want to achieve the balance between quality and cost factors, while earning the satisfaction of patients, taxpayers, elected officials, ambulance service managers, employees, and other customers.”

The white paper identified four Essential Performance Results for high performance emergency ambulance services:

  1. Clinical Excellence.
  2. Response-time Reliability
  3. Economic Efficiency.
  4. Customer Satisfaction.

The next four volumes will describe how Aetna and ASM match up to and use these results to succeed and thrive.