Rural Emergency Crews Fear Proposed Rules

[Rose Siding]

CENTER, N.D. - The emergency medical technicians in this town are familiar faces from the high school, the county clerk's office and the coal mine. And like many of their counterparts around the country, members of the Center squad are worried that proposed national standards could more than double the amount of training they must have and thin their ranks.

"A lot of people can't comprehend what it's like to drive 345 miles and not see a house, not see anything, and to have to cover that," said Mickie Eide, the squad's leader. "If you keep requiring us to do more, there's going to be less of us to do it."

The revamped certification rules are being developed for federal regulators by doctors, EMTs and state emergency medical directors.
...
Many EMTs likely will find the new requirements too difficult to meet, said Dean Lampe, director of the North Dakota EMS Association.

"These guys have jobs. They work at the Cenex store, they work at the butcher shop. They're farmers trying to get their crops in," he said.

Emergency medical services in other states have found similar problems. In Texas, officials estimate that about a third of the state's emergency medical providers are volunteers.

"I think that there would be a lot of services that would have to make some major adjustments," said Pete Wolf, chief of the volunteer fire department in the north Texas town of Windthorst.

http://story.news.yahoo.com/news?tmpl=story&cid=519&ncid=718&e=6&u=/ap/20041228/ap_on_re_us/ambulance_rules

Didn't some of these less populous states get disproportionate per capita amounts of HS money? This seems like an appropriate way to use those funds.

[hadrons]

1. will they blame Clinton's penis or gay marriages for this???

or both???

[bahrbearian]

3. They wouldn't be "Patriots" if they didn't.

[oscar111]

2. blame TAXCUTS FOR THE RICH when u see cuts in services

MSM wont make that connection, u have to make it in your mind .

350 billion, bush's cuts.

Many more of course, before.

Truman's top tax rate, 90%. Now a pathetic third of that. We had prosperity in '52, when Reaganomics was the least ever... in recent decades. Not called that then.. i use the term retroactively.

Use Truman's tax structure now, and the fed revenues instantly more than double. An extra 2. 7 Trillion appears for programs. The EMT problem vanishes, along with all poverty... cost 300 Billion...all homelessness, all hunger - cost 16 billion for those two. Leftover.. 2. 2 Trillion.

reaganomiçs is a flop after 24 years of the experiment. Toss reaganomics.

Wages lower now than when it began.. adjusting for inflation... Reaganomics caused sudden mass hunger, mass homelessness.. no more housewives.. no more overtime pay.. vanishing pensions .. vanishing healthcare.. vanishing college aid.. potholes... fewer cops.. fewer firefighters.

Reaganomics is a failure.

Nothing can improve till we toss Reaganomics. It is the RW's biggest weapon against us. Voters still believe in it. Focus on it.
Help AAR defeat it.

[madrchsod]

4. my son is an emt and the additional

training would cost him thousands of dollars. what they are proposing is costly and time consuming that most entry level emt`s can`t afford. it is a good idea but how is my son and others who have full time employment going to find the money and time? another good idea but in the real world just won`t work unless someone comes up with the money...

[DS1]

5. EMT training was FREE for me

This was about 1990, Northern New Jersey - and I didn't even have a committment to make riding the ambulance - which is a good thing since I decided to march off to bootcamp a couple months later.

[NYC]

26. New Jersey has a state tax.

I believe Texas doesn't. That may explain the funding for your training.

[bahrbearian]

6. Can't he get a PEL grant? Oh never mind "no gov, funding"

[wellstone dem]

7. These rules are being designed

by people who work in offices in cities not in the areas where they will have to be lived (or died ) with.

[PaganPreacher]

8. Why are you complaining about a good thing?

1. The story says that national training and proficiency standards for basic EMTs would increase. That means that the people who work on the ambulances can do more for you and your relatives and neighbors if they need emergency medical services.

2. Licensing or certification of EMTs is a state matter (just as it is with doctors and nurses). Some states use their own standards, and some use the National Registry as their measure of proficiency.

3. In states that already have their own standards (like Missouri, where I am a licensed paramedic), this is a non-story. EMTs can get National Registry certification in addition to their state license, but it is not mandatory.

4. In states that currently use the National Registry as their licensing standard, the states are free to establish their own standards (which can be the previous standards for EMT-Basic, if the legislatures want.) The state Emergency Medical Services Association can lobby the legislature to change the standards, if their membership wants to.

Yes, higher standards are tough on volunteers.They always are.

A couple of decades ago, states started to require ambulance crewmembers to be licensed EMTs or paramedics. Employees of funeral homes, and unlicensed volunteers made the same complaints back then. EMS was better for the change, though (imagine having a heart attack, and being transported to a hospital in an ambulance with no paramedic or EMT taking care of you- just two guys with white coats riding in the front seat. That's how it was back then.)



The Pagan Preacher
Missouri Licensed Paramedic number P-1118x
(Valid through 07/31/06)
I don't turn the other cheek.

[One_Life_To_Give]

11. It depends, when it's not your full time job.

I hear you when it comes to standards vs. none.
But there needs to be several levels of training/certification.
Most volunteers can't be expected to keep up with the several thousand hours initial training plus currency maintenance requirements to be a paramedic like yourself. So requireing two certified paramedics to staff a Basic Life Support ambulance that makes less than 100 runs per year is probably not a good idea.

Under any circumstance I like to get a basically qualified person (50-100hrs, e.g. CT OEMS MRT or EMT) on scean before we commit a paramedic resource.

In many remote areas we need to be mindful of the commiment we are asking individuals to make. If it paid the bills, that would be one thing. But when it comes after having spent 40hrs to pay the bills, it is another.

[PaganPreacher]

20. You're right, of course.

It is tough on volunteers.

But, I did a little checking.

1. Currently licensed EMTs can take continuing education classes, at no charge, from the state. Check out this web page for more information:

http://www.health.state.nd.us/ndhd/resource/dehs/emstoday/default.htm

2. I also noted that the state of North Dakota has 5 levels of proficiency for ambulance personnel (source: article 33-11, state statutes):

1. Advanced first aid ambulance attendant
2. Emergency Care Technician
3. Emergency Medical Technician-Basic (Nationally Registered)
4. Emergency Medical Technician-Paramedic (Nationally Registered)
5. "Paramedic with additional training," a skill level, but not a licensure level

By regulation, each ambulance must have one "qualified" primary care provider, and one driver (who is not required to be certified in emergency medical care). A BLS ambulance can operate with a single "advanced first aid ambulance attendant," "emergency care technician," or EMT-Basic.

By choosing to implement higher National Registry standards for ND EMTs, the state will not create a hardship for ambulance services or currently licensed EMTs. The EMTs can take their training at no charge, via videotape, internet, and department training.

The Pagan Preacher
I don't turn the other cheek.

[JanMichael]

15. Just out of curiousity; when did MO license numbers

change from DM-**** EMT-P to P-****?

I was once a MO paramedic also! :)

Stephanie

[PaganPreacher]

17. This last time I renewed.

My old number was DM-116x (not going to give too much away.)

I renewed in 2001.

What part of the state were you in?

The Pagan Preacher
I don't turn the other cheek.

[JanMichael]

18. Bass Pro, MO

ummmm I mean, Springfield!

I haven't lived there in a decade or so-

Stephanie

Thanks for the reply--

[PaganPreacher]

21. Up north for me.

North of Kansas City.

First came to MO right out of college in 1990, worked EMS and law enforcement until 2001, when I had the big career-ending injury: ruptured disk. I had just renewed my license!

I work for a law firm now, using both medical and investigation skills. I think I fell into something good, at least for a broken-down old paramedic.



DC
The Pagan Preacher

[proud2BlibKansan]

16. Good points but I can see

where federal funding to help pay for the training might be in order.

When the ADA was passed, the feds gave loans and grants to businesses to pay for renovation costs to bring their property up to ADA standards. I don't see how this situation is much different.

[toopers]

19. Especially if they were employees of the funeral home!

EOM

[pop goes the weasel]

9. don't be silly

"Didn't some of these less populous states get disproportionate per capita amounts of HS money? This seems like an appropriate way to use those funds."

That money is not going out to rural areas. It never has and never will. It goes straight into the pockets of a few "experts" in the cities of the hinterlands.

It has been a constant scourge for rural people to have to comply with rules set up for urban areas. To the extent possible, those rules are simply ignored. But sometimes, they can't be, and are enforced as heavily in a rural community as in a large town, with the result being that the service that was formerly available becomes too expensive to be kept in operation.

This is a real issue for rural people, and if Democrats start making noise about how there needs to be more sensitivity to local economic realities, Democrats might be able to reverse some losses in rural America.

[PaganPreacher]

10. Why do you think Federal money is necessary?

Do you know who trains the EMTs on Smalltown, ND's volunteer ambulance?

It's Joe Bob Neighbor. Joe Bob (or his ambulance service) paid to become an EMT instructor.

Joe Bob, or his ambulance service, decides how much to charge his students.

If Joe Bob doesn't raise his prices, then the students get more education for the same price. If he does, he won't raise prices out of the range of his student demographics (or he loses income).


West River Ambulance Service
Hettinger, ND

The Pagan Preacher
I don't turn the other cheek.

[One_Life_To_Give]

12. They get paid to teach?

Wow

The instructors for the volunteer ambulance where I grew up were not paid. Furnished Cling and CPR Manaquins for training. But never paid.

[PaganPreacher]

13. Yep: paid to teach.

I don't teach any more, but I am a former EMT instructor, Basic Life Support (CPR) Instructor, and Advanced Cardiac Life Support instructor.

Instructors charge for EMT training and refresher training. Generally, CPR and ACLS instructors only charge for materials.

The Pagan Preacher
I don't turn the other cheek.

[Streetdoc270]

14. I get paid through the local Community College

They charge the students. And they wave the fees if you are on a squad

[PaganPreacher]

22. That's a nice deal!

Good for the instructor (don't have to collect the money), good for the squads (waived fees), and good for the college (EMT courses almost aways always fill up.)

The Pagan Preacher
I don't turn the other cheek.

[pop goes the weasel]

23. you misunderstand me

I don't think federal money is necessary. I think flexible federal requirements are necessary.

[Robb]

24. The SO's a rural EMT

...I'm learning to drive the ambulance next week. Hello, cheap date! :)

And I agree, flexible requirements are key. You can't implement any national standards in rural areas without some tweaking.

Example: my local post office of some 400 boxes.

Postmaster is retiring after 20 years because a new federal standard cost him his bonus for the first time ever. New standard is bonus is based upon how much of the mail gets out before 5 p.m. Which sounds fine... except we're at the end of a long truck line from Denver for the mail, with several major stops, and hundreds of miles of weather-dependent road. The centrally-delivered mail gets later and later with each stop, and we're at the end. Most days the mail doesn't get to the post office, much less into the boxes, in time.

No flexibility in the federal standard to account for the rural issues. Federal money for rural EMS to implement the new standards is only one of many possible routes.

[PaganPreacher]

25. National Registry standards for EMTs are not a Federal "requirement."

Each state decides whether to use the National Registry to set standards for its EMTs and paramedics, or to have its own standards. No office of the Federal government requires states to conform to a "Federal standard" for EMT proficiency, because "Federal standards" do not exist.

"National" is not the same as "Federal."

If the state licensing authority wants the state's EMTs to be responsible for more information, it will increase the standards (by following the new NREMT-Basic standards, or by toughening its own standards.)

If the state licensing authority doesn't want to use the new standards, it can set its own standards for EMT-Basics. The state licensing authority may be lobbied by the state's EMT Association, to hold to current standards, or to increase the standards.

How much more flexible can it get?

But, you are right, I misunderstood, and talked about the idea of Federal funding, when you did not mean that. I am sorry.

The Pagan Preacher
I don't turn the other cheek.

[pop goes the weasel]

28. right

and my point that flexibility in standards is a good position for Democrats to take still holds. Elections need to be won at state and local levels before we can hope to recover at the national level. Running for state senator? Denounce inflexible standards! Demand local control! If flexible standards and local control are already in place, don't let that stop you either. The Democratic Party must become the party of flexibility and local control, the party that people think of for rescue when they are aggrieved by a federal or state standard. (National standards set as an ideal by a private entity are one thing; when those standards are adopted at the state level, they can become a problem.)

[PaganPreacher]

29. Excellent point, and I agree 100%.

The Pagan Preacher
I don't turn the other cheek.

[ObamaFan2500]

27. Two faces to this dice

On the one hand , you got to have ambulance drivers who nkow what they are doing.. on the other,s you can't be telling people not to do their other job just for a tough bio test.. My ex wife was s nursea nad a fire fighter, and she couldn't do the pressures for the hoses to save her life, but she could really do the nursing, see?