Time Is Running Out

Date: 01 February, 2007

By: Chief

ince 1968 We the People have been taught or indoctrinated that if an emergency occurs help is just a telephone call away.

"If this is an emergency, hang up and dial 9-1-1."

You've heard it. I've heard it. The "9-1-1" is stenciled on the sides of police cars, fire trucks and ambulances. Parents teach it to their kids and some schools teach it as well. Kind of an 'in your face' way to keep that specific telephone number firmly in the minds of We the People.

It works.

Thousands upon thousands of emergency calls are placed daily to the various city and county dispatch centers throughout the country. Indeed, we take emergency services — fire, medical and police — for granted. Dial 9-1-1 and by the time you hang up emergency responders are at your door. Or so we would like to think.

As each call is received the men and women who man the fire trucks, the ambulances and the police cars swing into action. I offer nothing but praise for these folks. I certainly cannot criticize the responders and I won't. They are motivated, they care and they will do everything they are allowed to do in order to save a life.

And therein lies the crux of the whole enchilada.

I said I would not criticize the men and women who respond to our emergencies, but I did not say that I would not criticize the emergency (9-1-1) system. For you see it is the system that has bollixed up what would otherwise be an emergency response system that would have the rest of the world green with envy.

Budgetary constraints, laws (federal, state and local), regulations, rules, lawyers and liability have basically hamstrung the 9-1-1 system. This is especially true if you happen to live in a rural area instead of a city.

As we all know in an emergency time is of the essence. Indeed in an emergency time is the enemy.

The golden hour.

According to the New Jersey trauma center which is located in Newark, the golden hour is:

"[T]he time period of one hour in which the lives of a majority of critically injured trauma patients can be saved if definitive surgical intervention is provided. Only 60 minutes from the moment of injury to notify the police; dispatch an ambulance to the scene; transport the victim to a hospital; summon the appropriate surgical and support staff; and perform the necessary life-saving surgery."

Of course dependent upon the nature of the medical emergency the golden hour may well be reduced to the golden few minutes. This is quite true for a diabetic who goes into hypoglycemia (rapid loss of blood sugar).

Further, people who live in rural areas or small communities along with ranches and farms are placed in jeopardy simply because the current 9-1-1 system does not recognize them as it is not designed to have emergency response personnel available within a reasonable area.

Personnel.

In rural areas and small communities, with the exception of police, most firemen and emergency medical people are volunteers. This means those volunteers have full time jobs (they have to earn a living also ya know), quite possibly not in the local area either. As such, response times are delayed as the volunteers race from their jobs to the fire station (when they can) and then respond to the call. Additionally, calls are passed to other departments or are missed entirely because volunteers may not be able to get the required time off should a call come in or be entirely out of the area at a distant job site. Don't kid yourselves folks. This actually happens and it happens somewhat regularly.

Training, qualifications and licensing.

Emergency medical services (EMS) are not created equally. Don't forget that. Unlike what Hollywood portrays and what we tend to think because of what we have been indoctrinated about the 9-1-1 system, the emergency medical technicians (EMT's) are tightly controlled by law and regulation as to what they allowed to do. In other words the law and regulations are extremely stringent as to how far an EMT can go in trying to save a life before they run afoul of law or regulation. Believe me when I say this — it ain't far.

There are six "classifications of fully licensed EMS provider that are recognized in the New Mexico registry of emergency medical services personnel" (per NMAC 7.27.2.8 (E)). These classifications are:

• Emergency medical dispatcher (EMD);
• Emergency medical dispatcher instructor (EMD-I);
• Emergency medical services first responder (EMSFR);
• Emergency medical technician - basic (EMT-B);
• Emergency medical technician - intermediate (EMT-I);
• Emergency medical technician - paramedic (EMTP).

Wonderful. But what does any of these qualifications mean to We the People? Not one hell-of-a-lot.

Here is a case in point: A person who suffers an attack of acute hypoglycemia (rapid blood sugar loss) has on average less than 25 minutes survival time from the moment of loss until either an injection of glucagon, glucagen or an intravenous line (IV) of saline and dextrose is administered. It is obvious that a dispatcher or a dispatcher-instructor can't do that. But neither can a EMSFR or a EMT-B (per NMAC 7.27.2.14 Appendix A). Only a EMT-I or a EMTP can perform those life saving steps (per NMAC 7.27.2.14 Appendix A). To put it another way, not counting the dispatcher or dispatcher-instructor, the first two levels of actual patient survival care are not allowed under regulation and law to perform basic procedures to save a diabetic's life.

That is insane. I have successfully administered glucagon before and the only license I have is a drivers license.

All of this is based on the assumption that an emergency wagon of some sort arrives before that hypoglycemic person drifts into a diabetic coma. Once that happens the chances of survival are approximately 4 in 10 — or less.

Additionally the emergency wagon must have the equipment — the materials — on board along with enough qualified personnel to be allowed to use the life saving equipment.

Laugh if you will but I am here to tell you that there are fire departments whose emergency vehicles do not carry some emergency medical or rescue (jaws of life) equipment because the department does not have enough licensed or qualified personnel.

This situation is absolutely intolerable. Bureaucrats and politicians, at all levels of government, are playing the role of God. By statute or regulation those people are deciding who lives and who dies.

In New Mexico without a doubt both the state law ([external link] NMSA 24-10B) and state regulation (NMAC 7.27.2 [pdf file]) are written in such a manner as to preclude emergency responders from administering life sustaining treatment. Isn't red tape wonderful? This could also be called a SNAFU (situation normal, all fouled up).

In 2005 the New Mexico legislature passed a memorial directing the state department of health to "study and make recommendations to improve the state wide system of trauma care" (quoting the memorial). Naturally the department of health's (pdf file) response was 42 pages long and, in a nutshell, stated the cure all was more money and more (I'm not kidding), not less, bureaucracy.

Contained in the first paragraph of the executive summary was this gem:

"Our trauma care services are on the brink of collapse."

I completely disagree. From my vantage point our trauma care services collapsed years ago, if we ever had any to begin with.

While I agree that additional funding is required and that additional trauma centers are needed in the the state (currently there are only three — Farmington, Santa Fe and Albuquerque). That is as far as my agreeing goes.

Building and staffing new trauma centers is all well and good but it is also putting the cart before the horse. A trauma center is utterly worthless if a patient dies:

• Before EMS personnel arrive (due to distance, time, responder license and availability),
• Because EMS personnel are unable to provide the necessary life sustaining treatment because of their license, or
• En route to the trauma center (due to distance, time, responder license and availability).

The study was basically silent in that regard.

What can be done.

It is my opinion that before spending millions of dollars erecting new trauma facilities we need to fix the current and very broken EMS system. At a minimum we need to:

• Ensure all government mandated or funded studies, at any level and for any purpose, shall include citizens on the study panel as well as purported experts.
• Rewrite the existing EMS statute from scratch.
• Rewrite the existing EMS regulation from scratch.
• Include hold harmless and good Samaritan clauses for all emergency personnel.
• Abolish the Bureau of Emergency Medical Services.
• Unfetter counties, municipalities and fire departments so that they can adapt the law and regulation to fit their particular area of responsibility and situation.
• Grant the senior on site EMT person the discretion to exceed the regulated "scope of practice" based upon his or her evaluation of the situation, with or without medical direction.
• Ensure that continuing education, training and licensing are available locally for emergency personnel.
• Improve radio communications.
• Ensure the 6% home owners insurance tax shall go directly into the local fire departments budget.
• Ensure there are enough EMS stations, personnel and medivac helicopters located throughout the state that no citizen should be outside of a 'XX' mile range of an EMS station or medivac helicopter.
• Ensure that medivac helicopters have all weather capabilities and sufficient flight crews.
• Provide Fire and EMS personnel a discount on personal vehicle registration.
• Provide volunteer fire and EMS personnel reimbursement for any salary lost due to responding to an emergency call, required continuing education or training.
• Ensure Volunteer fire and EMS personnel are reimbursed for fuel costs if a personal vehicle is used to respond to an emergency call.
• Provide fire fighter license plates at a reduced cost to fire and EMS personnel.
• Reduce the cost of licenses and renewals.
• Have classes locally available to citizens in emergency aid (CPR, intramuscular injection, etc.) for a minimal fee.

I am quite sure that if We the People put our heads together along with our local fire and EMS personnel we would come up with a much more viable and productive plan than anything Santa Fe could ever come up with. After all it was government that screwed this up to begin with.

Tick, tock, tick ...

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