Maintaining EMS Equipment in Times of Crisis

EMS (emergency medical services) agencies depend on a variety of supplies and services, including many provided by private-sector companies, to stay operational during major disasters and other crisis situations. However, very few if any EMS units are completely self-sustaining; all or almost all rely on other agencies and organizations – from the providers of supplies to the specialized companies that keep the medical equipment running safely to the mechanics who work on and maintain the ambulances – for just about everything they need before, during, and after a crisis erupts. A major difficulty that most EMS and other first-responder agencies encounter when planning for a “worst-case” scenario such as pandemic influenza that might affect the entire nation, or for regional disasters on the scale of Hurricane Katrina, is that such events also affect the providers of the supplies and services needed by those agencies. The end result, of course – when providers are facing both increased absenteeism and an increased volume of work in the same time frame – is an inevitable reduction in the flow of supplies and services when they are most urgently needed. There have been a number of strategies employed in facing this problem. The most common of those strategies are: (a) stockpiling (insofar as possible); (b) the increased use of memos of understanding (MOUs) between and among various political jurisdictions; and (c) the planned purchasing, ahead of time if possible, of major equipment items that probably would not be available “off the shelf” in times of crisis. The stockpiling strategy is often an expensive way to go, though, both in the initial outlay of cash required and in ongoing long-term storage and maintenance costs. The stockpiling strategy is often an expensive way to go, both in the initial outlay of cash required and in ongoing long-term storage and maintenance costs stockpiling of non-disposable equipment is a substantially more expensive proposition because the initial outlay is likely to be higher. For items that have a short shelf life and/or may soon be obsolete – and cannot be rotated through normal use – stockpiling therefore may be only a temporary solution at best.

The stockpiling of obsolescent equipment as it is being phased out is a more appealing plan because the equipment is already paid for and most outlays for replacement equipment are usually funded independently of the preparedness effort. There are a number of difficulties, though, in planning to use obsolescent or already obsolete equipment to meet a current crisis, the most important of which is that the proficiency of the staff using the equipment quickly atrophies when the equipment is withdrawn from use – there also may be safety issues involved. 

A Multitude of Operational and Fiscal Considerations 

A secondary but nonetheless significant consideration goes back to the reason the obsolete equipment was withdrawn from service in the first place. Here it is important to examine very closely the rationale for the replacement of one model of equipment with another, later, model to ensure that using the earlier model in times of crisis does not present a safety issue and/or is not as effective as using the later model. Another factor to be considered in any decision to use obsolete equipment is that servicing of the older equipment and/or finding spare parts for it may either be impossible or economically unfeasible. MOUs or Memorandums of Understanding are documents between agencies and/or companies that lay the groundwork for future actions. Unlike contracts, MOUs are often non-binding agreements to provide services or materials as available. The strength of using an MOU is that the provider and agency can enter into the agreement without slogging through all of the numerous fiscal and legal details usually required under a purchasing system, while still leaving enough flexibility to respond to conditions on the ground during the emergency. An important aspect of whatever strategy is adopted is to purchase equipment that is not only simple to obtain and operate but also capable of being serviced in the field. One line of thought is always – assuming that the funds are available – to purchase the simplest equipment with the lowest service requirements for everyday use with the intent that this equipment will remain serviceable under disaster conditions longer than more high-tech equipment is likely to last. This is a valid strategy as long as the routine standard of care does not suffer.   In any event, even the best-equipped and most fully prepared EMS agency will eventually be unable to provide service during a truly overwhelming regional, national, or global disaster. The real standard of success in that context, therefore, is that: (a) the staff should be empowered to improvise with the remaining equipment on hand; and (b) the various governing protocols, regulations, and legislation are written in terms that give both the provider and the agency involved reasonable coverage in the face of truly unique circumstances.

Joseph Cahill
Joseph Cahill

Joseph Cahill is the director of medicolegal investigations for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Before that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s paramedic program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.



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