The Future of Wildland Fire EMS

Gene Madden, Chair

NWCG Emergency Medical Support Group; and, Vice Chair, NWCG Safety & Health Working Team

“I’m an EMT & I’m from Montana”

 1998 Florida Wildfires (May 6-Aug. 21)       4,700 wildfires 507,000 acres burn 21 IMTs 10,000 firefighters from 48 States and 3 countries Resources via standing agreements, i.e. State Compacts, NIIMS ordering system, EMAC and other local, state and national systems.

“I’m an EMT and I’m from Montana.”

Background (cont.)

    White Paper issued by SHWT on EMS credentialing problem (Fall, 2001).

NASEMSD reads and unanimously adopts Resolution to support NWCG in quest to resolve EMS Credentialing issue (Oct.’02).

NASEMSP agreed to establish a Liaison with EMSG ( Feb. ‘03) with a Technical Rep.

Department of Homeland Security (DHS) & Transportation Safety Administration (TSA) interested in work.

NWCG Safety & Health Working Team

  Established Emergency Medical Support Group (EMSG) Feb. 2003 after Reno EMS Summit (Jan. ’03).

Membership:  Gene Madden, Chair, SE Rep-NASF/SHWT (FL)        Jeff Hatch, USDA/USFS Rep (WY) Sherrie Collins, DOI/NPS Rep (AZ) Kim Christensen, DOI/BLM Rep (ID) Jeff Scussel, USDA/USFS Rep (MT) Dia Gainor, NASEMSD Rep (ID) Fergus Laughridge, NASEMSD Rep (NV) Bobby Golden, Executive Secretary, USDA/USFS (MT)

Emergency Medical Support Group (EMSG)



Mission:

To establish a methodology to meet the emergency medical and occupational health needs of managed incidents and integration with local, state, and federal systems.

Emergency Medical Support Group (EMSG)



Primary Purposes:

 1) To develop a process to ensure proper credentialing of medical providers to include emergency medical and occupational health resources for incident management.

 2) Recommend to SHWT appropriate levels of care and type for EMS incident management.

Emergency Medical Support Group (EMSG)



Secondary Purposes:

      Improve communications among EMS Improve communication of EMS issues to incident managers & EMS leaders.

Incorporate uniform EMS guidelines and standards.

Provide a forum for providers Synthesis research into usable knowledge for managers & EMS.

SME for SHWT and other NWCG Working Teams on EMS and occupational healthcare issues

Wildland Fire EMS-Organization

     Most medical units under LSC.

Growing number of IMTs placing medical unit under SOF.

MEDL/IMS/FM may or may not automatically be on first call out.

MEDL/IMS/FM may/may not be a regular IMT member.

IMS and Firemedic typically function as a unit.

Medical Unit-Leadership

   Medical Unit Leader (MEDL) See Fireline Handbook, page 133 Incident Medical Specialist Manager (IMSM) (R1 & R6) See IMS Manual, page 20 Firemedic Coordinator (AK) See Firemedic Program Policy, page 6

Medical Unit ICS Organization

MEDL

Spike Camp, Branches, etc

IMS Programs

(R1 & R5)

Firemedic Program Assistant MEDL

(AK)

EMS

Line & Med Unit Personnel EMTs EMTPs Ambulance Services

Military/National Guard Occupational Health Care

RNs NP PAs, etc

EMS Challenge or Conflict?

Firemedic & IMS & EMS

  CHALLENGE: All states require state certification or license for EMS resources.

CONFLICT: Some believe that federal resources are privileged to work EMS anywhere.

  IMS: Credentialed in R1 or R6 jurisdictions. ( Reciprocity exists between R1/R6) EMS: Credentialed in “home” jurisdiction.

  IMS & FM: Has established protocols.

EMS: Typically follows “home” protocols or National Standard Curriculum.

EMS Challenges or Conflicts (cont.)

  IMS & FM: Personnel must attend annual refresher.

EMS: EMS recert every 2-3 years.

  IMS & FM: Frequently deployed as a unit.

EMS: Usually deployed as a single resource.

EMS Credentialing Issues

    No simple fix.

National Registry (EMT or EMTP) is not national certification.

Very few states offer reciprocity and then only after testing, fees, etc.

“Practicing” medicine in w/o proper certification/licensure may be a crime with serious consequences.

EMS Equipment & Supply Challenges

    Who can order what?

Who’s responsible for the supplies?

Are the items: Appropriate? Enough? Antiquated? Need Updating?

Re-supply Items: Local, Cache, national/regional contracts.

National Park Service Emergency Medical Guidelines (NPS 51)

   16 USC 12 “authorized to aid and assist visitors within the national parks in emergencies . . . .” 16 USC 12 allows “rendering of emergency rescue firefighting, and cooperative assistance to nearby law enforcement and fire prevention agencies and for related purposes outside the NPS.” 16 USC 13 “Secretary … authorized to provide medical attention to employees … at isolated locations. . . .”

DOH & DMAT

   Provides assistance through a different ordering system. Claims to have reciprocal agreements.

DOH may be consider a “uniform service.” DMAT teams tend to arrive “heavy.”

Military & National Guard

 

U.S. Armed Services

(Army, Navy, Air Force, Marines and Coast Guard) are allowed to provide medical care to its personnel w/o regard to state/local licensure and certifications.

National Guard

statutes.

units are state agencies working under the Governor of each state and must abide by state

State Rights

 States and county and local governments are empowered to license and credential medical professionals including doctors, nurses, emergency medical technicians, etc.

Exceptions!!/Solutions??

   Presidential Disaster is declared by President.

Governor declares and signs Emergency Declaration.

States—statutorily or administratively, establishes a process to enable currently certified EMS personnel to enter into their jurisdiction for the express purpose of working on a temporary basis on a wildfire or all-risk incident.

So What Are We Doing?



Credentialing

 Request for Recognition Form.

   MEDL (or IMSM) to complete on EMS resources and forward to State EMS office.

Request form DOES NOT provide a license/certification.

Form must be done whenever a resource is reassigned from one incident to another.

REQUEST FOR RECOGNITION

(Print or type all information. Use additional forms as necessary.

MEDLs are responsible for reporting arriving AND demobing resources within 24 hours to the designated state EMS office.

See http://nasemsd.org/member list.html

for contact information)

Authorization for recognition is requested for the following emergency medical personnel assigned to the _______________________________incident. The identified personnel will provide emergency medical and health care services for incident personnel. It is anticipated that they may be providing these services for up to 21 days from the date of this notification. ______________________________ __________ ______ ______ Full name Full name ______________________________ Cert/Lic. Level State NREMT# __________ _____ ______ Cert/Lic. Level State NREMT# The above individual (s) will be assigned starting on ________________________________ The location of the incident is: ________________________________________________ __________________________________________________________________________ The primary wildfire jurisdictional authority is: ____________________________________ I attest that I have physically examined the certifications/licenses of the above individuals.

____________________________________ (_______)_____________________ Medical Unit Leader-Print

Medical Unit Leader-Signature

Telephone Number (_______)_____________________ Fax Number ____________________________________ _________

Date

Completing the Request for Recognition Form The purpose of the “Request for Recognition” form is to advise the state EMS office (where your incident is) that you have established a medical unit within their jurisdiction, and you are identifying out-of-jurisdiction (the state’s) EMS personnel who are going to be rendering care for a limited period of time. This form does not provide certification/licensure reciprocity. It only notifies authorities of the presence of EMS resources.

A new form must be completed for each resource as they move from incident to incident within that state or if they travel to another state.

Remember too, that advanced life support care rendered requires in-jurisdiction Medical Direction. The state EMS Office may be able to help you with this.

Simply click on the NWCG Emergency Medical Support Group website ( www.nwcg.gov/teams/shwt /emsg/index.htm) and go to the National Association of State EMS Directors (NASEMSD) website link. The NASEMSD web address is: www.nasemsd.com

Click on the state where your incident is located. You will go immediately to the appropriate state contact number. The National Registry of Emergency Medical Technicians also has a website that will also provide you with the correct state EMS contact information. The NREMT web address is: www.nremt.com

Both websites may offer additional important and helpful information to you about the area EMS facilities and services in completing the Medical Unit Plan (ICS 206). Additional links are expected to be added.

REMEMBER TO VERIFIY ALL INFORMATION TAKEN FROM

WEBSITES e.g. telephone numbers, services, etc.

It cannot be overly stressed that it is the responsibility of the Medical Unit Leader (or the Incident Medical Specialist Manager or Firemedic manager, if so designated) to

complete the Request for Recognition form.

Remember, there are a multitude of statutory and administrative regulations from state to state. You may be required to provide additional information and proof of certification/licensure to the State EMS Office. Contact them for specific information and

assistance.

What Are We Doing?



Scope of Practice

  Working with NASEMSD to redefine the National Standard Curriculum (NHTSA) into the new National EMS Scope of Practice Model.

Define the role of the various types and kinds of EMS resources (April ’02).

 This will include emergency medical and occupational aspects traditionally provided in medical units.

What Are We Doing?

 Emergency Medical Services Group webpage.

 www.nwcg.gov/teams/shwt/emsg/index.

htm   Mission Charter    Members Conference Call Notes Links

What Are We Doing?

 Medical Unit Resource Web Page  www.nwcg.gov/teams/shwt/emsg/  Under Construction

Emergency Medical Services Group Medical Unit Leader Resources

This page is for EMS individuals with the primary responsibility to organize and manage an effective and efficient medical unit for a wildland or all-risk incident. Whether you're a medical unit leader (MEDL), incident medical specialist manager (IMSM), or involved with the fire medic program, this site will help you develop the medical unit quickly and also serve as a resource for you. The forms and templates provided here will help you get started quickly and accurately. It is your responsibility to verify the information on these forms and websites provided. The information and procedures here will change periodically before it can be posted.

Forms

 Request For Recognition of Out-of-State EMS Resources  ICS Medical Unit Plan-ICS 206

State EMS Bureaus

 National Association of State Emergency Medical Services Directors (NASEMSD)

Burn Centers

 American Burn Association United States www.ameriburn.org/pub/2003-2004PubPagefinal.pdf

Canada www.ameriburn.org/pub/2003-2004finalCaPub.pdf

Safety and Health Working Team National Interagency Fire Center 3833 S. Development Avenue Boise, Idaho 83705

EMS Programs

IMS-Region1 www.fs.fed.us/r1/fire/nrcg/Committees/Operations/ims_web_site/index.html

IMS-Region 6 www.fs.fed.us/rg/uma/ims/ Alaska FIREMEDIC

Critical Incident Stress Debriefing/Management (CISD/CISM)

Wildland Firefighter Foundation www.wffoundation.org Public Safety Officer Benefit Program Line-of-Duty Death (LODD) www.ojp.usdoj.gov/BJA/topics/PSOBProgram.html

Fallen Firefighter Program www.fallenfirefighter.com

All-Risk Topics Other

Center for Disease Control (CDC) www.cdc.gov

National Registry of EMTs and EMTPs www.nremt.org/EMTServices/emt_card_news.asp

Resource Order Forms and Sample Templates

Personnel Supplies Equipment Medical Evacuation Plan-Sample R1 IMS Evacuation Plan

EMS Equipment & Supplies

 Cache Kits: If it is a national resource it is a national resource.



It is the MEDL/IMSM’s responsibility (and everybody else in the unit) to manage their business!

   Order what you need. Be reasonable. Maintain the kits as well as supply conditions will allow.

Return kits promptly to cache. Identify broken/missing items.

EMS Equipment & Supplies

   It is OK to have more than one 500 person field first aid station kit (NFES 1835) on an incident.

500 person FA kits were originally prepared for use for the IMS program. However, they are a national resource and can be ordered by appropriate personnel, e.g., MEDL absent the med pack or “IMS kit” unless appropriate personnel are present.

EMSG has offered to act as a SME for the FEWT. (Oct. 03)

Some Final Thoughts

  Greater appreciation and tolerance of the differences between EMS types and kind. Who’s more correct? IMS? FM? EMS? Others?

We’re all there to serve the incident personnel and the agency that brought us there in the first place.

Thank You – Questions?