The Forgotten First Responder

In December 2004, New York University’s Center for Catastrophe Preparedness and Response (CCPR) held a national roundtable on the preparedness of EMS to face a national disaster, be it from terrorism or natural causes. The one-day summit included experts from across the spectrum of EMS organizations. Cherokee County (GA) EMS Chief Gregg Lord attended as a member of the board of directors of the National Association of EMTs (NAEMT), representing EMS providers.

Lord praised the meeting for bringing the problems EMS providers face every day to the attention of people who can do something about them.

“It has generated somewhat of a stir on Capitol Hill—there are probably half a dozen bills talking about grant funding issues,” he says, including House Bill 3266: The Faster and Smarter Funding for First Responders Act of 2005, which has provisions for EMS. “I think the NYU meeting accomplished its goal.”

The meeting made clear that while EMS represents roughly one-third of all first responders, only 4% of first responder funding goes to EMS, revealing a lack of institutional support despite mandates from the Departments of Homeland Security (DHS) and Health and Human Services (HHS) to the contrary. This situation results in a dearth of training and equipment across the board. Even the National Academy of Sciences’ Institutes of Medicine (IOM), which were represented in the audience, “were clearly surprised,” says Lord. “Everybody just expects EMS to happen. They have no idea how deep our problems go.”

In brief, the report includes these findings:

• 58% of ambulance providers receive no direct federal funding for homeland security preparedness.
• 60% of ambulance providers receive no homeland security preparedness equipment purchased with federal funds.
• 33% of ambulance providers are not represented on community-based emergency planning panels.
• More than half of EMTs and paramedics have received less than one hour of training in biological, chemical and explosive hazards. Twenty percent of EMTs and paramedics have received no WMD training at all.
• Fire department-based EMTs and paramedics received an average of 4.5 hours of training in homeland security and disaster management. Those not affiliated with fire departments received an average of less than an hour.
• EMTs and paramedics in urban areas have received less than 3.5 hours of training in homeland security and disaster management. Those in rural communities have received less than one hour.
• Only one state reported that adequate personal protective equipment would be immediately available, on a statewide basis, for all EMS personnel in the event of a biological or chemical event.
• Only 13% of fire departments can handle a hazmat EMS incident involving 10 patients or more.
• Only 11% of fire departments can handle a technical rescue with EMS at a building collapse.

Other issues highlighted in the report include the absence of an EMS-based detection system for biological threats; and the lack of interoperable communications between EMS and other first-response agencies, healthcare facilities and public health.

Roundtable Recommendations

Not confining themselves to mere reiteration of the problems, the CCPR panel sent recommendations to the federal government that outline ways to improve the EMS system. These include: establishment of a Federal Interagency Committee on Emergency Medical Services (FICEMS) to improve coordination among all federal agencies involved in EMS activities; better coordination of federal grant guidance and funding priorities; increased funding for EMS to improve preparedness and surge-capacity goals; establishing EMS-specific all-hazards preparedness standards and guidelines; nationwide needs assessment based on science to identify costs and methods for bringing the nation’s EMS system into compliance with these standards and guidelines; improved support from federal, state and local governments for research, modeling and development of best practices, including integration with public health and the traditional medical care system; implementation of interoperable communication and data systems; and development of effective and uniform EMS data collection mechanisms, including funding the National EMS Information System.

In direct response to the report, Senator Susan Collins (R-ME), chair of the Senate Committee on Homeland Security and Governmental Affairs, has introduced legislation to help increase and improve federal support for community-based EMS. In particular, the Emergency Medical Services Act would establish FICEMS, improving coordination of all federal efforts to strengthen EMS preparedness. It would also establish an advisory committee consisting of EMS organizations and providers.

There is reason to hope that these and other House and Senate bills (including HR 3266’s sister Senate bill, S.21, the Homeland Security Grant Enhancement Act of 2005), also introduced by Collins, will change the landscape drastically. The main difference, says Lord, “is they dictate that EMS will have a seat at the table. [Now it’s up to us] to be more unified about the mission and less proprietary about local interests.” The NYU report is particularly valuable, he says, because “domestic preparedness issues do nothing but shed light on the day-to-day operations that need support.”

To read the entire report, visit www.nyu.edu/ccpr.