'Major Problems' Looming for EMS in Oklahoma

          In Oklahoma City, April 18 was all about emergency medical services: It was EMS Legislative Day, an occasion for the state's providers to come to the capital and help make lawmakers and the public aware of the issues they face. The date was especially poignant, coming two days after the Virginia Tech shootings and a day before the 12th anniversary of the Oklahoma City bombing.

     It was a perfect occasion, then, to publicize the grim findings of governor Brad Henry's Task Force on EMS Readiness.

     The group's bottom line: An immediate infusion of big bucks-up to $20 million by 2011-is needed to prevent a potential total collapse of Oklahoma's EMS system.

     "Ambulance providers themselves," the task force concluded, "are in a situation best described as critical and unstable. Oklahoma's EMS system is crumbling; intervention is needed to ensure access statewide."

     Between declining federal reimbursement and a lack of a dedicated public funding mechanism for EMS, the state has lost nearly four dozen services in recent years, the group reported, leaving more than a dozen communities without ambulance coverage. Others are hanging on by their proverbial fingernails.

     "EMS is in crisis," task force member Rebecca Smith, president of the Oklahoma Ambulance Association, told Tulsa's KOTV, "and it's not going to be very long before there are major problems."

     The 16-member group, composed largely of EMS providers, was commissioned in 2005 to study the state of Oklahoma EMS. It discovered major problems with funding, recruitment and retention, medical direction, major-incident readiness, training and the quality of prehospital care delivered in some communities.

     It also made recommendations for fixing what ails EMS, but they don't promise to come cheap. "The broad package" of repairs, members determined, "carries an annual cost of $4,935,000 to $5,860,000 and includes initiatives to encourage the proliferation of more efficient regional EMS providers, to improve EMT recruitment/retention, to better equip responders for disasters and much more."

     Some steps, the task force suggested could be taken at no public cost, such as raising a cap on district tax assessments and providing EMS medical directors with tort protection. But others will carry significant price tags. In the area of funding, for instance, the group recommends providing free operational efficiency assessments for services, as well as development and capital-improvement grants. For medical oversight and QI, it argues for funding research to develop evidence-based protocols, protecting EMS QA/QI programs from legal discovery (thus minimizing physician liability), and designating state funds for regional dispatch centers. On the personnel front, it supports expanded distance education, tax credits and line-of-duty death benefits, tuition reimbursement and training grants, and studying the feasibility of a statewide pension plan for EMS providers. For disaster readiness, it promotes revamping the state communications plan and pursuing regional response teams.

     Some of these proposals are already being considered in the state legislature. For more on the report and EMS issues in Oklahoma, see www.okama.org.

-From staff

HOW CAN EMS SPEED BALLOON TIMES FOR STEMIS?
     EMS is a critical component of door-to-balloon times for STEMI (ST-elevation myocardial infarction) victims, and a new Yahoo discussion group will focus on how it can help expedite the critical process of balloon angioplasty in this patient population. The E2B (EMS-to-balloon) initiative is a followup to the successful D2B (door-to-balloon) initiative led by the American College of Cardiology (www.d2balliance.org). Others in EMS who have STEMI alert programs, or are interested in creating one, are invited to participate. See http://health.groups.yahoo.com/group/E2B.

-http://ems-l.org