A Truckload of Tools

The first thing to know, in an article about what equipment ambulances carry and why, is that we're not generalizing. There are 50 states that each do their own thing on this, and countless smaller jurisdictions that can add additional requirements above and beyond what their states mandate. There's a lot of overlap from system to system, of course, but don't go looking for exact matches or broad brushstrokes. It is, as one state EMS director put it, "quite a mosaic" of whats, whys and hows out there.

     But it might be useful, we figured, to look briefly at a few individual cases and find out a bit more about the whole process: how those lists are developed, who informs them, how changes occur and how it all affects you in the field. The following Q&As do that. We've provided a pair of views from on high (i.e., state bosses) and one from the ground (a top exec with a large ambulance service that operates in three states).

     If there are unusual requirements or other unique aspects to your mandated equipment and gear that are worth sharing with your peers or discussing further, let us know.

DAN WILLIAMS
Section Chief, EMS Systems Section Wisconsin Dept. of Health and Family Services

     In Wisconsin, EMS is under the Department of Health and Family Services. But minimum ambulance equipment standards are set by the state Department of Transportation in a regulation known as Trans 309, which covers equipment and vehicle standards as part of ambulance inspections. That's made things a bit tricky, but officials have worked to ensure EMS input into the DOT's work.

EMS is under Health and Family Services in your state, but the ambulance regulations come from DOT. How does that work?

Williams: Virtually all EMS activity in Wisconsin comes out of the Department of Health and Family Services. However, when we put the ambulance inspection program in place, nobody in that department felt comfortable inspecting the vehicles. So we had the opportunity to weigh in on all of the equipment and medications and those types of things, and they agreed to inspect for those things while they inspected the vehicles for safety. It works; it's just a little awkward at times. There are plans to open that rule up again later this year (2006) or next year, to review and revise the medical equipment list and medications and those types of things. They do that periodically just to make sure everything is current.

It seems like such an arrangement could make things slow or difficult to change as science evolves or new products emerge. How do you compensate for that?

     Each time the rule has been revised, we've tried to use more open-ended language. When something changes, we can usually make changes allowed under the rule without having to open the rule up to a new legislative process. Because when you do that, it takes about a year and a half for the process to be completed.

How politicized is the process? Are there people like vendors or advocacy groups who seek to influence it?

     I don't think they have much influence, but I'll qualify that. Any influence comes in their specific areas of care. A group like EMSC, for instance, might get all charged up about a piece of equipment or procedure or something they believe should be in the Trans 309 rule. But there's usually equal representation from other areas of EMS on the revision committee, so anything new really does get a fair amount of scrutiny and has to pass muster for everybody to be added or removed.

To what extent can local services exceed these minimums?

     They can add additional equipment, but they can't do things that would exceed their scope of practice. Each service is required to submit an operational plan to our office every other year or anytime something changes, and that's our opportunity to make sure they're not exceeding their scope of practice.

DIA GAINOR
EMS Bureau Chief Idaho Dept. of Health and Welfare