As EMS systems position themselves to serve as COVID vaccinators, they can look to Indianapolis EMS as a model for how to structure and deliver this essential service to the community.
In October 2020, Indianapolis EMS held a mobile flu shot clinic—a partnership between Indianapolis EMS, the Department of Homeland Security, and Shepherd Community Center, a nonprofit on the city’s East Side that offers food security, mentoring, education and advocacy for underserved populations. Over four days in October, approximately 475 city residents received a flu shot in the first program of its kind in the state.
Mass immunizations are a natural fit for EMS departments, states Shane Hardwick, paramedic with Indianapolis EMS who led the effort. “We’re in the community, we’re known, and people trust us,” said Hardwick, which is essential when attempting to vaccinate a community with high unemployment and limited access to healthcare.
“EMS is a kind of a ‘Swiss Army knife’ service,” agrees Michael Kaufman, EMS medical director for the state of Indiana and a long-time supporter of EMS in public health, pandemic response and childhood vaccinations. “When we looked to ways to fill the void [of flu shots] we realized, we have an entire workforce of vaccinators at the ready.”
For the October flu shot clinic, organizers targeted food distribution events to offer vaccinations. Gift cards for food and gas were offered as incentives. Three-paramedic teams were able to vaccinate, on average, 24 people per hour.
“A lot of times it’s the minor details you don’t think about, that take up a lot of time,” Hardwick says—directing people to a parking space, peeling the sticker from the vial, asking patient histories. Indiana has strict storage guidelines surrounding the flu vaccine, including storing it at a cold temperature similar to one of the COVID vaccine formulations. The flu vaccine was acquired through the state’s health department and was stored in a large walk-in cooler at Shepherd Center equipped with a wifi thermometer.
Pivoting to the COVID Vaccine
Hardwick and Kaufman look to leverage the success of the flu clinic and the buy-in from regulatory agencies to scale the project to include COVID vaccinations under the purview of EMS agencies. On December 31, the Indiana EMS Commission authorized EMTs to administer COVID-19 vaccinations, allowing a critical component to increase vaccination capacity in Indiana.
The Commission’s decision follows Indiana Gov. Holcomb’s Executive Order 20-51, permitting the EMS Commission to take such action. The ruling amended the scope of practice for certified Indiana EMTs to allow for vaccinations. As a result, EMTs may administer the vaccine when their EMS provider organization is offering vaccination locations authorized by the local health office or Indiana Department of Health.
According to the commission, the administration of vaccinations is a skill similar to intramuscular injection of epinephrine, which is within the scope of practice for EMTs. The state health department has offered training courses relevant to training for vaccination delivery, including Anaphylaxis & Epinephrine Administration for the EMT and Principles of Vaccine Administration.
Massachusetts passed similar legislation in December, allowing EMTs to vaccinate under supervision, with limitations and following specific training.
The Indianapolis flu clinic was funded largely through Indiana State Medicaid. An October 2020 announcement from Indiana Health Coverage Programs (IHCP) stated that EMS provider agencies will be reimbursed for administering vaccines. To be reimbursed, the agency must be an EMS-certified provider organization and enrolled with the IHCP. Diagnosis and procedure codes are outlined in a special IHCP bulletin (Z23 and 90471–90474 respectively). The bulletin also contains information on reimbursement rates, how to become a certified provider organization, ordering vaccine supplies and more.
Becoming an Enrolled Vaccination Agency
COVID vaccinations are free to the American public, explained Asbel Montes, senior vice president of strategic initiatives and innovation for Acadian Ambulance, in a November 2020 webinar offered by Solutions Group. EMS services wishing to become vaccination providers essentially act as a contractor of the CDC, operated through state departments of health. If you haven't already received information from your state health department, contacting them is the first step, Montes said. Your service must be enrolled as a Medicare "Mass Immunizer" (Type 73) provider in order to receive reimbursement from Medicare (vaccine recipients cannot be billed).
CMS is attempting to make enrollment as swift and easy as possible since they need "all hands on deck" to deliver the vaccine over the next 6–9 months, Montes said. Your Medicare Administrative Contractor (MAC) has set up a hotline that serves your area that you can call to begin the enrollment process, which should take no more than 24 hours in most cases. Claims for vaccination services are then submitted through your MAC.
"If you're used to doing flu vaccines or pneumococcal vaccines already, you're going to see a very similar process," said Montes, stressing that EMS agencies should consult with their legal team and insurance provider on topics such as risk mitigation and liability. Verify that your state scope of practice allows for paramedics and EMTs to vaccinate.
The Indiana State EMS vaccine document can be downloaded here.
Jonathan Bassett, MA, NREMT, is editorial director at EMS World. Reach him at firstname.lastname@example.org