Fire-based emergency medical services in the IAFF

Fire-Based providers as the sole form of EMS

EU member states do not follow a uniform EMS model. This often leads to difficulties at the times of crisis as the preliminary response to the situation varies from state to state. Each region is characterized by a unique set of geographical, cultural, linguistic and medical systems. The vast differences that occur can and do hamper response procedures and critical time. Health professionals and politicians need to have instant access to data of updated EMS structure from each member state to enhance proper care promptly.

Short-term recommendations:

The main issues that should be addressed in the uniform code for EMS services in the EU should include the academic qualifications to be possessed by the members of the response team, medical facilities and equipments that the in-hospital and out-of- hospital emergency services should mandatorily be equipped with, a reliable mode of communication between different member states to ensure transfer of critical information instantly.

It is suggested that an institution of repute and authority should overlook the enforcement of quality indicators of the on-site EMS teams. Reporting and evaluation procedures become important tools for planning and policy making is greatly facilitated. Volunteers, police personnel and fire brigade teams that form the first-response team should undergo an internationally accepted course on providing proper care.

It should be binding on each Member State to disseminate information through secure, dependable channels and medium to respective counterparts to form an uninterrupted cohesive response to an emergency. It is equally important that minorities are not made to suffer for want of access to medical support. Special care needs to be taken that foreigners and minorities find it easy to ask for and get assistance smoothly and in the shortest possible response time. Only type B and C. ambulances should be allowed to respond emergency calls.

Long-term recommendations:

It is proposed that a common minimum standards may be made binding to all member states. The issues involved may include:

The crisis management team of each member country should include a representative of the EMS

Specific efforts to create and generate a fund pooling mechanism for EMS training and operation are the need of the hour. (Organization, 2008).

The European Union should provide funding for a common research program applicable across the region.

The response provided by the teams attending to a crisis should be under administrative surveillance an evaluation.

It has been observed that the member states appreciate the necessity of improving the present day status that the EMS is operating in, in the EU. Option 1 provides for maintaining a status quo till the time effective steps can be reached. This however may be at best a short-term remedy, if at all. At its worst it may delay critical care and even jeopardize meaningful health care service. The reimbursement procedures and proper long-term medical may be rendered meaningless by then, though. Option 2, a Joint Services model should be employed. The basic premise on which this works is that there are more than equal chances of improving upon the basic systems that are already in place. The future of the system of EMS will lag behind if it chooses to maintain status quo (Gorman, 2007). An improvement made statistically in the existing system has the distinct drawback of lack of meaningful insights and inferences drawn to improve interoperability. It may even serve to camouflage discrepancies in the system and render more disservice than before. A holistic view is sought to address the wholesale disparities existing within members of the EU.

Background Information Concerning your Recommendation

Accidental Death and Disability, the Neglected Disease of Modern Society, a report on the existing health system published in 1966 on the state of affairs of EMS emphasizes upon the fact that ambulance services are more than just a transport for patients. It was a telling essay on the basis of which each state was asked to revamp its ambulance services for on-site or out-of -- the hospital medical emergencies. It was noted that ambulance service provided for, by the mortuary in most cases (Gorman, 2007). EMS and health services are one of the primary responsibility of the Municipalities, in as much as the police and fire brigades are, opined the authors of the epoch making report. In case the local body does not or cannot provide for services, regulatory norms should be put in place and vigilance should be placed on them to make the EMS services effective and within reach. All volunteer and private commercial services should be made to adhere to strict quality norms. As a consequence of the glaring loopholes in the EMS system that came to light, courtesy the report, the Congress was forced to pass the Highway Safety Act that encompassed a proper EMS system in place, rightfully.

The long held view that EMS means an ambulance service is changing rapidly. As awareness is increasing, more organizations are putting their weight behind better ambulance services, for instance the insurance companies demand better explanations, and the fire department seeks to be empowered to deal with emergency situations as they are the most frequent first-response personnel at sight of a mishap. Most of the times the local officials elected to law controlling bodies have control over these and allied services. Hence these issues play a very important role in decision making and allocation and generation of funds for the same. Though a perfectly healthy system for EMS has yet to be evolved, much of the foundation and support systems have been brought to practical use.

Since the intricacies are not fully comprehended by many local institutions, EMS begs to be defined more accurately. One definition makes an attempt at that by stating that EMS is a collective effort to address emergencies in a cohesive and well rehearsed, comprehensive manner to effect relief to the afflicted in the shortest response time possible. The systems should have at least the bare minimum facilities of dispatch utility, communication facility to be accessible, and a back up in-house hospital service equipped with trained staff (Gorman, 2007)

Fire Service-Based EMS

All public services include EMS as an integral part of their services. It is defined as a body that delivers time bound, effective; result oriented and well staged health care under emergency situations. The system invariably consists of adequately trained personnel, medical equipments, communications facilities, and transport vehicles following strict federal guidelines for procedures, equipment and the personnel manning it. (EMS act, 1973(P.L. 93-154)). However most conceptions of 911 services are mainly thought of as ambulance services instead of as pre-hospital medical service (Pratt, Katz and Pepe, 2007) that can go a long way in creating better service atmosphere by way of training, education in medical exigencies, and fund allocation for proper maintenance of personnel and facilities.

The fire service department has become the first-response service provider in almost all medical cases of varying degrees. That is mainly because it is provided for by the local body, municipality, and more so because their training has made their response time minimal. The discipline exhibited by the firemen has made them the most sought after system across all sectors. With this background, EMS systems should incorporate the use of this dedicated workforce and empower them with larger facilities for on-site medical care and also provide them with facilities best available outside the hospital ( Pratt, Katz, and Pepe).

Feasibility of Implementing Recommendations

ESCi has envisaged a program to carry out small if decisive and effective improvements in the systems to provide for a common head to align various agencies participating in the process of overhauling the system and putting in place a joint services team. In the plan laid out for the South Whidbey area it further strengthens the program by scheduled intra and inter-agency meetings to move forward in a coordinated fashion to achieve maximum gains and effect comprehensive services.

ESCi further espouses the cause by asking for surveillance teams and reporting mechanisms to ensure adherence to rules laid down by the local authorities. The four main phases following acceptance of these recommendations are: Creation of a joint services Agreement (duration; six months), create a tangible method to evaluate performance (three to four months), protocols and formats for reporting (three to four months) and to plan a blueprint for system development. All the four stages of development are closely knit and are interdependent in nature and practice.

The job of creation of the Joint Services Agreement can be broken down into a series of steps leading to eventual formation of the agreement. Firstly meetings should be held both jointly as well as within the agencies, individually, laying down the factors to be involved in the Agreement. Provisions for funds to be taken up as a crucial issue for the system. Preparation of the draft with the consent of all agencies involved. JSA should then be submitted to the agency for adoption.

To create performance measures local participation was considered to be more important than any other factor. Ways and means to evaluate performance needed to be created with tangible and justifiable measures (Goman, 2007).

The insight of each agency had to be taken into account to ascertain parameters that would need reporting. Hospitals needed to be kept in the loop to know which data was accessible and could be transferred if the need arises. Another local agency of data accessibility is the fire department which should also be a party in the reporting process.

Having thus formed the framework, the next logical step is to zero in on the format of reporting in the most comprehensive manner possible (Gorman, 2007).

The last stage combines the effect created by all the above steps. The system plan making process involves inter-as well as intra-agency meetings. The reports have to be processed by proper evaluation and the JSA prepared has to be used to crystallize the system plan to address all agencies sought to be involved in the process.

Challenges

Workforce Issues

The Rural EMS, the Rural and Frontier EMS Agenda and various other assessments from several organizations have helped in specifying the issues that are being faced by the frontier emergency medical services environment and have taken a lot of attention in understanding the difficult component of the system of health care. Many of the problems are not rare but also inherent and persistent. The different challenges are:

Issues in retaining and recruiting various amount of career providers and volunteer of different skills: Emergency Medical Technician, Paramedic, Emergency Medical Technician -- basic, First Responder. There are a small amount of people who pay for the EMS services. The volunteer providers in 2005 respond to the emergencies in more than fifty percent of the entire country. Even the frontier and rural areas have salaries in career services which are commensurate and the providers can be lured easily somewhere else with high pays. With the shortfall in the staff, indirect and direct training is also an issue along with commitments for continuing and initial training, decreased or low benefits, decrease in volunteers, long hours, work of low volume and issues in getting some time off from the employees. Hiring the personnel also requires a satisfactory career unskilled or inadequate leadership, and not enough technical equipment or support.

The reimbursement for Nationwide Medicaid and Medicare of emergency medical system has not been adequate to cover the costs. The support of EMS has been coming from the mixture of government reimbursement and subsidies from the companies of insurance (Mohr, 2000). There is forty one percent of reimbursement among the bill insurers and there is lack of knowledge and resources which prevents a lot of billing system in the rural areas and there is no guarantee of reimbursement. Furthermore, the financial problems in the rural areas regarding EMS continue to be bringing complications because of long distances and transport along its high expenses. Moreover the present EMS system is created on incentives like not paying for health services and limiting the transport for patients.

Training/educational issues

The frontier and rural areas go through long distances for instructors and providers to receive continuing and initial training. Some issues can be addressed by the latest technologies of video lessons, tele-medicine or internet based on satellite classes. A lot of the courses are under development or have already been using certain models of delivery. Between 2000 to 2001, around 3 million people have enrolled in more than one million courses. From 2000 to 2004, a lot of students from the undergraduate programs were training through distant programs. Paramedics and EMTs are being faced by various programs and opportunities for initial education different from the traditional setting of a class room. The paramedics and EMTs working in the frontier or rural areas do not fully take advantage of the resources available to them. Dissemination or development of such resources should be improved where required (U.S. Department of Education and National Center for Education Statistics, 2003).

Definitive care in long distances requires a provider with good skills. The frontier and rural facilities in medicine are smaller and are also at a distance from each other and also contain less capability as compared to the ones that are located in the metropolitan areas. In a number of states, the qualified medical works in frontier and rural EMS system is of high concern. The physicians sometimes fulfill the need but the doctors there do not have proper training or incentives for active participation in EMS. The physicians and doctors have to receive good medical training for improvement in EMS (Bruce, 2004).