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'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

-From staff

     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 ( Others in EMS who have STEMI alert programs, or are interested in creating one, are invited to participate. See


     Addressing a longstanding gap in domestic defenses against terrorism, the Department of Homeland Security issued comprehensive regulations in April for the protection of high-risk chemical facilities.

     Owners of facilities with designated amounts of certain chemicals will have to conduct preliminary screenings to determine their level of risk. Those found to be at high risk will be required to provide DHS with security vulnerability assessments and site security plans. Audits and site inspections will follow, with DHS helping substandard facilities come up to speed. Standards include securing perimeters and critical targets, controlling access, deterring theft and preventing internal sabotage.

     The guidelines can be enforced through civil penalties of up to $25,000 a day. Noncompliant facilities could be shut down.

     "The safety and security measures we take need to be tough and balanced," DHS secretary Michael Chertoff said in announcing the new rules. "We will significantly reduce vulnerability at high-consequence chemical facilities, taking into account important efforts in certain states."

     State rules not in conflict with the new federal regulations will not be preempted. The final regulation was to be published in the Federal Register, and will be online at

-Dept. of Homeland Security

     General Motors will join with the CDC in developing procedures to help emergency medical responders better and more quickly determine if motorists injured in car crashes need trauma-center care, the automaker announced in April.

     The CDC will convene a panel of emergency docs, trauma surgeons, vehicle experts and public-safety providers to review data from GM's OnStar and other similar telemetry systems and consider how it can be used to improve emergency care and transport.

     Systems like OnStar can automatically transmit crash data reported by sensors throughout the vehicle, giving emergency providers early information about crash severity, direction of impact, air bag deployment, secondary impacts and rollovers. This can guide the dispatch of appropriate personnel and resources and activation of specialized trauma teams.


     A study published in the New England Journal of Medicine suggests that firefighters face a risk of death from heart attack that can be up to 100 times the average person's.

     Researchers from Harvard examined a decade's worth of firefighter heart attack deaths and found the population's risk was highest-10 to 100 times the normal risk-when they were at fire scenes. While firefighters spend 1%-5% of their time putting out fires, 32% of their heart attack deaths occur at that time.

     Chances are also higher when they're going to or coming from an alarm or engaging in physical training.

     The study did not address specific causes or overall risk.


     High schools and colleges should be better prepared to save the lives of athletes who have sudden cardiac arrests, new guidelines published in April say.

     The guidelines, compiled by a panel of experts assembled by the National Athletic Trainers' Association, appeared in the journal Heart Rhythm. They call for schools with competitive athletic programs to establish emergency communication systems to summon help quickly; coordinate their plans with local EMS; ensure that an AED is always handy; train staff and students to respond, perform CPR and use the AED; and practice their cardiac arrest response procedures at least once a year.

     Sudden cardiac arrest is the leading cause of death among young athletes.

-Lifesaving Resources

     The New Orleans Medical Mission Services Foundation will hold its annual gala fundraiser, Mission Possible 2007, at the city's Generations Hall on June 23. The event is the primary revenue source for the Foundation, which donates medical equipment and supplies and delivers education and direct medical interventions for qualified organizations in foreign countries. The New Orleans-based nonprofit organization was founded in 2001 by local medical and business professionals to help the sick and injured in Central and South America.

     For more information:

-New Orleans Medical Mission Services Foundation

     The Department of Energy is offering a Web-based course, Hydrogen Safety for First Responders, that provides awareness-level instruction in dealing with hydrogen for EMS, fire and law enforcement personnel. The course covers hydrogen, its basic properties and differences with other fuels; its use in fuel cells; and potential hazards and protective actions. It also provides supplemental resources like videos, documents and hydrogen-safety links. Abridged versions will be available in print and on CD; call 877/337-3463.

-Pacific Northwest National Laboratory

     LifeGuard Medical Solutions has announced a new initiative aimed at equipping public-safety agencies with AEDs. Its Public Safety AED Program allows qualifying organizations to buy AEDs at a nationally contracted discounted rate structure. Deadline for participation is August 31; for more information, call 866/932-2331 or e-mail

-LifeGuard Medical Solutions

     The National Oceanic and Atmospheric Administration has announced the release of CAMEO Chemicals, an easier-to-use online version of the CAMEO program's most popular components. Emergency personnel and managers can use the resource to access the CAMEO database of more than 6,000 hazardous materials. Chemical data sheets contain information familiar to users of CAMEO, but with improved readability. Users can bookmark those they commonly reference. Visit


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