Why it's important to meet state EMS standards

A few years ago, the Washington State Department of Health (DOH) received a complaint about the Coulee Dam ambulance service. They took note of dirty and unsanitary conditions, expired medications and supplies, non-functioning or defective critical-care equipment, inaccessibility to the supplies needed to stock the ambulance, and more. The town was put on notice and required to file a compliance plan in May, 2011. The DOH closed the case the following month without taking disciplinary action because the town had corrected the deficiencies and noted that “they are not likely to reoccur.” Fast forward to 2014 and here we are again, facing the preparation of a “Corrective Action Plan.” You ask, “What for this time?” Surprisingly, for the same set of issues noted by the DOH in 2011 and a lot more! Their faith that these problems were “not likely to reoccur” has been shaken — so has mine.

Following comments from EMTs serving three different agencies, I personally requested that the state conduct a surprise inspection of our ambulance, equipment, records, and more. And again, the state DOH noted non-functioning critical care equipment and a “filthy” ambulance among over a dozen other sub-standard problems and conditions. We have until June 15th to present a “Corrective Action Plan” showing how we intend to comply. I intend that we will have corrected virtually all of our deficiencies before that date. Our “plan” to comply will be our actual compliance. As more than a footnote, all of the equipment deficiencies and other life-safety measures have been corrected … we now have a safe and sanitary ambulance.

The management and oversight of our ambulance/EMS services falls generally under our ambulance lieutenant as a subordinate to the fire chief. Both of those positions require a contemporary understanding of the Department of Health standards, regulations, and protocols. Both also require the skill-set and knowledge it takes to supervise other volunteers, including at least an understanding of the town’s personnel policies.

Now let’s dispel the myth and mystique of “volunteer” without diminishing the notion of the commitment and dedication. Our volunteers are actually paid … for some that amounts to over $300 per month. A retired volunteer firefighter/EMT is paid $250 per month (for life), working or not. A retired volunteer can continue as a firefighter/EMT and, in that case they are paid the retirement plus a minimum of $24 per run — to some that totals well over $500 per month. And, you (or your medical coverage providers) are charged each time you use our volunteer service. As the result of their association with our Fire Department and the agreements Coulee Dam has with other agencies, the firefighter/EMT may also receive additional compensation from these other agencies. All that said, there is no question they earn and deserve their compensation, just understand (no matter how oxymoronic it sounds) that they are actually “paid” volunteers.

There is no better dedication of our time than by that chosen to serve the community. And that happens at its pinnacle when we choose to volunteer our service for the life and safety of others — as a firefighter and as an emergency medical technician (EMT). We respect, honor, and appreciate the dedication and commitment … and quite frankly, we often take it for granted. When we need it, we expect it … I know firsthand, as do many others. And in those moments, when our minds are lost to the pain and suffering, we don’t care much about the details. We don’t check to see if the ambulance is clean and tidy, we don’t know if the equipment is working, or even if the attending EMTs are certified. Don’t know if the gurney is functioning properly and we don’t care if the oxygen bottle is half empty or if the face mask is clean. Our minds and bodies are otherwise preoccupied, and during these times we are at our weakest and most vulnerable. And we are in the hands and hearts of those volunteers we have taken for granted. It is for these very reasons that standards are set — that the “volunteer” service has requirements and is “regulated” just as is a doctor or a hospital. Our peace of mind is insured in advance of our need by those requirements and by those regulations. And whether we admit it or not, we assume as much. The life one volunteer EMT saves is the same life another likely would have saved had they been the responding EMT(s). That is just an expected given.

Regardless of the attending EMT, we rely on their “credentials” to insure that we are attended to and cared for at a standard defined by the State Department of Health. We (the town) agree to that and, from my point of view, it’s even more — it is a solemn promise to all of those who one day may need the service. We all rely on the town’s certification to the state that our equipment, supplies, and medication meet the requirements they specify. And I rely on our committed volunteers to insure that we offer a service that is defined by pride, compliance with the regulations, and by the unspoken promise to those we serve.

It is true that some of our volunteer EMTs have given the better part of their lives unselfishly serving us; we know them, we know their families, we respect and love them, and we rely on them time and time again. There are also volunteer EMTs with less experience and maybe not as long of a history in our community as others. These folks may bring a fresh energy and perspective that we hope will add new ideas and synergy to the mix. With that comes change; and changes for many are difficult to accept. We also hope (or should) that a diversity of ideas, skills, and experiences will enrich the EMS service we provide. Medical care-providers (like all the rest of us), often work alongside others they just don’t like or respect. However, as “certified” professionals, they rise above their differences in deference to the lives and safety of those in their care. When one certified EMT refuses to work with another for personal reasons, they choose a path that endangers our mission to serve your emergency medical care needs and it violates the professional conduct requirement of their certification.

The Washington State Department of Health (our service regulator) does not distinguish between the volunteer EMT and the career EMT — they are both required to meet the same standards, both required to be equally trained, and both are required to pass the same examination for certification. Both the volunteer and the career EMT are subject to the same procedures for discipline and (if called for) face the same subsequent sanctions. While it is true that each EMT is required to demonstrate the same “minimum” set of qualifications, it is also obvious (as with any profession) that some are more dedicated, more committed, more prepared, more educated, and more progressive … and as well, some just get buy, take shortcuts, are not as physically able as they should be, have a poor “bedside” demeanor, and haven’t kept up with the emerging technologies. We applaud and reward the former and we (should) try to raise up those others by example and mentorship … if there is an unwillingness to meet our town’s performance standards, we have the recourse defined by our policies and procedures.

I’m looking forward to the changes that will define us as a standard other communities will want to emulate. And I know that if each of our firefighters and EMTs steps back, takes a deep breath, and considers what is best for the community, they will as well.

F. Gregory (Greg) Wilder, Mayor