One of the biggest and most important challenges facing the EMS (emergency medical services) community in the coming years will be overcoming the divisions within the EMS community itself – e.g., emergency vs. non-emergency; municipal resources vs. for-profit models, etc. Like so many other issues that divide leaders, planners, and operating personnel, many of these divisions are self-imposed, while others amount mostly to a struggle for funding. Shrinking budgets combined with the rising volume of calls have forced many EMS agencies to make their systems leaner. Many EMS leaders have used historical call-volume estimates as the baseline for their future planning and staffing purposes. Like many other medical providers, EMS leaders plan for the “normal” day – which usually, but not always, is based on historical data for the time of year, recent call volumes, and a variety of other factors. A recent study in the Journal of Academic Emergency Medicine found that, generally speaking, historical data can predict call volumes with sufficient accuracy to make staffing decisions – but “historical data” might not be too helpful in mass-casualty situations. A key planning factor must be the EMS system’s ability to respond to surges of patients needing care during a major event, or just on a particularly busy day. In the development of those plans, though, EMS systems have a potential resource that is not sufficiently noticed or even considered. Under the regulations of most states an ambulance is an ambulance, regardless of its use or ownership. For practical purposes, this means there is a huge transportation resource available to meet most emergency needs. MetroCare’s Yamel Merino: A Heroic Example Usually, of course, a city will use its own ambulances to meet such needs. Many cities, though, also possess: (a) ambulance services that operate on an emergency basis but are not part of the 9-1-1 system; and/or (b) for-profit ambulances that usually transport patients on a non-emergency basis. An example of how this additional capacity can be used was seen in practice at the World Trade Center in the immediate If the public funding is available on an equitable basis to all private-sector agencies offering the same resources it would maintain a level playing field and there would or should be no basis for complaints. aftermath of the 11 September 2001 terrorist attacks. Both MetroCare (a for-profit privately owned service) and Hotzolah (a non-profit, volunteer, community-based service) provided an essential mix of emergency-response and non-emergency resources. Immediately after the terrorist strikes, both agencies dispatched ambulances to the World Trade Center. Some of the ambulances and other resources were lost, unfortunately – and one MetroCare paramedic, Yamel Merino, was among the emergency responders who died in the line of duty on that fateful day; she was only 24 years old. For EMS agencies to maintain their budget viability and be flexible enough to respond to unanticipated surges in call/patient volume, particularly disaster-based increases, these additional resources must be factored into the planning equation. Doing so will provide two solutions or partial solutions: (1) improve the disaster-response capability with targeted funding; and/or (2) include these non-public ambulance resources in the emergency planning. One of the concerns about allocating public funds to the for-profit EMS agencies is that this might seem to be public subsidization of private businesses. However, if the funds are provided only for resources that are not used in day-to-day operations, but are crucial for disaster response, the “subsidization” would in fact be restricted to only the disaster-response operations. Moreover, if the public funding is available on an equitable basis to all private-sector agencies offering the same resources it would maintain a level playing field and there would or should be no basis for complaints. In that context, inclusion should be recognized as more than just giving certain agencies a “seat at the table.” In fact, it is refusing to accept an “us-versus-them” mentality from anyone or any agency. This is a critical point that should be considered in both EMS and emergency planning. In short, the resources are there – but it is up to the EMS community as a whole to strengthen and engage those resources for the common good of all concerned.
Links for additional information on the topics listed: Statistical study on EMS call-volume predictions (Journal of Academic Emergency Medicine Volume 13, Number 5_suppl_1 84, © 2006) http://www.aemj.org/cgi/content/abstract/13/5_suppl_1/S84 EMS CFR systems http://www.cob.org/features/2005-04-08-ems-changes.htm Hotzolah http://www.hotzolahems.org/hatzolahs.html http://www.hatzolahw.org/ MetroCare http://www.metrocareems.com/index.html Yamel Marino http://www.defrance.org/wtc/Yamel.htm http://www.september11victims.com/september11victims/VictimInfo.asp?ID=1872
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.