A Decade of Remembrance

But every service has to have a plan to deal with those situations, and I think you have to depend on your neighbors to help you. I don’t think it’s realistic that any service can handle any major incident without mutual aid. We can’t live in that bubble anymore, thinking we’re the only ones who can take care of our county, and we’re never going to need help.

Moving forward, what should be our top priorities?

There are actually some parts coming up in the field EMS bill, when it gets reintroduced, that provide funding to the states to do regional planning and response. That’s going to help. But at the basic level, I think it’s incumbent on local EMS agencies to develop whatever plans work the best for them in their circumstances. And with the way the economy is now, we have to be as self-sufficient as possible.

As 9/11 recedes into history, what are the big lessons younger providers should take from it and carry forward?

The big thing they need to know is that EMS is an important profession, and it’s not just about taking care of people, but taking care of yourself too. You have to be safe. You can’t help a patient if you’re not safe yourself.

Randy Kuykendall

President, National Association of State EMS Officials; State EMS Director, Colorado

Coming out of 9/11, what did you see as the greatest needs for EMS in its preparedness for terrorism and major MCIs?

As an industry, along with our partners in fire and law enforcement, we were probably naive in terms of what the potentials are, and what the dangers are. The world has changed an awful lot, and I don’t know that we fully understood that. And 9/11 was a terrible way to come to that realization, but I think it helped our industry begin to think about the importance of regionalization, and of being able to generate large-scale responses to incidents of this nature.

How would you evaluate our progress toward that goal?

We’ve made some significant strides. I think the changes in our capabilities, our ability to communicate, our ability to generate larger-scale responses in shorter periods of time, have come at a much faster rate over the last 10 years as a result of what we’ve come to understand of the world today. That’s true of both routine healthcare and being able to respond to large-scale events.

Are there areas where we’ve fallen short or not progressed the way we’ve needed to?

I think the area where we’ve probably continued to fall a little short is making sure we’re fully inclusive of all the various models of EMS and patient transportation systems across the country. We need to make sure all the components that move patients from point A to point B—whether they’re public or private, single- or dual-role—all are equal partners in terms of being able to respond. I don’t know that we’ve done that real well. With the variety of large programs we’ve had over the last 10 years, I think the focus at times has jumped around a bit. There are segments of the EMS community that haven’t benefited as they might have.

How much variation is left among the states in terms of preparedness for acts of terrorism or major MCIs?

We’re closer to standardized responses today than we’ve ever been in my career. That’s a tribute to the federal initiatives that were driven post-9/11—we are very much closer. I’m able to use the same vernacular and have the same levels of understanding, particularly talking about all-hazards or mass-casualty response, with people from other parts of the country. That is tremendous.

Do you see any of our gains being threatened by cutbacks in this tough economy? How should we go about sustaining what we’ve achieved?

In a state like Colorado, where many of our agencies are local tax districts, the decline in property values has resulted in sort of a double whammy for local agencies. Federal funding for disaster response is dwindling at the same time local ability to fill the gaps between costs and patient revenue is declining as well. That is a significant concern. I don’t think any state director or agency has a magic answer, but I know it’s something we need to address. We need to be fully engaged in discussions with third-party reimbursement agencies, and we need to be fully engaged at the political level in making sure we secure a baseline resource level to maintain the progress we’ve had over the years.