Transcript Incident Medical Issues Challenges Facing IMT’s Nationally By: Jim Powell Region 6 IMS Coordinator (509) 446-7520 [email protected].

Incident Medical Issues
Challenges Facing IMT’s
Nationally
By: Jim Powell
Region 6 IMS Coordinator
(509) 446-7520
[email protected]
EMT’s and IMS Crossing State
Lines
• Currently, Pacific Northwest and Rocky Mountain IMS have
Protocols and approval to work on any FEDERAL Incident
nationally. These must be incidents of Federal jurisdiction i.e.,
Forest Service, BLM, NPS, Tribal Lands, etc.
• On Non-Federal incidents EMS and IMS must contact the State
DOH or presiding EMS Director and be granted permission to
operate.
• Alaska is very advanced in this process allowing reciprocity for the
period of time you are assigned to an incident.
• Montana has been a challenge, and currently will only let out of
State EMS to practice at the Basic EMT Level, limiting our ability to
provide quality treatment at levels of certification. Some other
States also have issues i.e., Washington GEO Board won’t permit
IMS to practice on State jurisdiction. The EMSG is working with all
states to standardize acceptance of Certification Levels.
EMS vs. IMS
• Limitations of Contract EMS Services:
– Unable to perform outside of their State and local Protocols.
Some MPD’s don’t support them out of their areas.
– Can legally only treat Serious Illness and or Traumatic Injuries
and transport, not normally treat and release.
– Cannot perform Clinical Triage and/or administer Over-TheCounter (OTC) medications i.e., Aspirin, Ibuprofen, Cough drops,
Eye drops, feminine hygiene products, Moleskin, etc. to incident
personnel.
– Must obtain definitive medical care for everyone that seeks their
help.
– High cost with Low use potential. Only treat acute illness and/or
trauma.
– Contract services may be all that is available and then should be
used.
– Limited qualified Contract services may be available i.e.,
Wilderness Medics, Inc., Paramedics Unlimited. These
resources are limited and usually specific to a geographical area.
EMS vs. IMS (cont.)
• Standards of IMS Services:
– EMT’s at various levels highly trained in clinical diagnostics and
pharmacology.
– Have a Physician Advisor with established Clinical Protocols,
operating under his license.
– Training and Protocols to dispense OTC medications.
– Ability to triage out patients not needing definitive medical care.
– Line qualified personnel for placement at various locations on
incident.
– Skilled in Helicopter Medi-vacs and wilderness care and rescue.
– Highly cost effective, even with annual pre-season training costs
and equipment maintenance.
Cost Containment
EMS vs. IMS
• Regional contract cost for ALS Ambulance with 1 EMTP
and 1 EMTB, usually NOT Line Qualified personnel =
$2400/day on average.
• Approx. Daily cost for IMS Team of 1-2 EMTP’s, 1-4
EMTI’s, and/or 1-2 EMTB’s for a total of 6 personnel with
at least 4 being Line Qualified = $2150/day.
• Usually 1 IMS Team can sufficiently staff an incident and
the Medical Unit, providing ALS coverage 24/7 on site.
Sometimes additional IMST’s are requested for large
complex incidents with multiple access points and
Branches to provide adequate line coverage.
Availability or Not of AED’s
(Defibrilators)
• It has been difficult if not impossible to obtain AED’s
and/or Defibrilators on Fire and All Risk
assignments.
• Buying Teams will usually not obtain or pursue this
issue, and cancel orders.
• Manufacturers are unwilling to rent AED’s and/or
Defibrilators any longer.
• Private companies i.e., Ambulance services, Fire
Depts, etc. charge very high rates for rentals.
Devices could usually be purchased for what it costs
to rent them if you can find any to rent at all.
• Bottom Line is we have been Lucky to date. We will
eventually have a fatality due to not having this
equipment available on incidents. This will likely be
one of our own!!!!!! This is due to our aging
workforce, and their general health in a high stress
related situation.
Availability or Not of AED’s (Cont.)
(Defibrilators)
• What is our responsibility and liability to our workforce?
Shouldn’t we provide them the best available care we can, and
are trained to provide?
• Doesn’t OSHA clearly state that all employees have the right to
work in a safe environment? Are we doing whatever possible
to provide such an environment?
• To the best of our knowledge we have not been tested in court,
but OSHA states an employer should provide appropriate firstaid on remote sites. Not just someone trained in CPR but
appropriate equipment also i.e., Defibrilators or AED’s.
• What can we do to address the problems and get them fixed?
• Documented save last year on Sexton’s Type I Team.
Contract Crews
• What Medical Services are we going to
provide?
• Do we transport to Medical Facilities
and/or off the line?
• Emergency Life Saving care will be
administered regardless and then sorted
out by finance.
Patient Privacy Issues
• All pertinent patient information is
confidential and will be kept as such
unless a release is signed by the Patient.
• Patient Evaluations will be sent to their
Home Unit with their CA-1 or CA-2.
Copies will not be kept in the Fire Packet
due to sensitivity of information.
Other Issues and Concerns
• What other issues and/or concerns are
there in the Medical arena?
• How can we fix what is broken, or not
working as well as it could?
• Other?
Thank You !!!
• Your participation in this Break-out session
is greatly appreciated.