Emergency Medical Services (EMS) Patient Transport Options

EMS First Responders (Fire Department / District resources) and Ambulances (Public and Private Operators) This presentation will focus on the Ambulance Transportation perspective of EMS

Type of Ambulance Service Basic Life Support BLS / EMT staffed Advanced Life Support ALS / Paramedic Staffed Critical Care RN staffed

Medical Transportation Resource Types Public sector = tax based / supported / cost of readiness Private Sector = Service Reimbursement Amount of available resources are based on justified utilization and reimbursement for service provided NO! this is not intended to be the “challenges” slide yet… …Ambulance services are rate regulated by AzDHS

The Az DHS - Bureau of Emergency Medical Services & Trauma System…. Issues Certificates of Necessity for ground ambulances Issues licensure for air ambulance services.

Ground Transportation – Ambulances The AzDHS-BEMSTS Ambulance Services Section oversees the regulatory process for ambulance providers in Arizona. Regulation includes all matters affecting services to the public, service areas, response times, and rates and charges to ensure providers are charging appropriately. Number of Licensed Ground Ambulance Providers = 85 Number of Licenses Ground Ambulances = 800

Air Transportation – Ambulances The Az DHS - Bureau of Emergency Medical Services & Trauma System…. Issues Certificates of Licensure for air ambulance services, Conducts inspections, Posts the rates for each air ambulance service, Investigates complaints against air ambulance providers. Number of Licensed Air Ambulance Services = 20 Number of Licensed Air Ambulance Providers with AZ address = 12

Do ambulance drivers require a special license or certification? (Air resources are Pilots)

The Az DHS - Bureau of Emergency Medical Services & Trauma System certifies Emergency Medical Technicians (all levels) in Arizona. To become certified as an EMT at any level in Arizona you must successfully complete: * A Department approved training course, * Submit required certification application and necessary forms * Successfully pass the National Registry written examination, * In addition, Intermediate and Paramedic applicants must pass the National Registry practical examination

Certified Emergency Vehicle Operator (CEVO) CEVO is a two day classroom & hands on practical program that covers the basic physics of driving, including gravity, velocity, weight distribution and mass inertia, along with the particular vehicle dynamics required of different types of ambulances. Rather than reacting to an accident once it occurs, CEVO instructs vehicle operators to drive in a manner that avoids situations that often lead to accidents. Drivers learn navigation skills for moving through traffic safely, and instructors challenge participants to develop solutions for varied circumstances. The course addresses backing up, parking with caution, ambulance hydroplaning, nighttime driving, hospital approach, patient drop off, tail gaiting and more.

What are your vehicle capacities? Ambulances inspected by the state have specific standards. Ambulance size / type (Basic to MICU) Patient size / type (Bariatric / Pediatric / WC) How many will fit in your ambulance vs. how many people need the attention of a care giver? Area that would require a 4 wheel drive or high ground clearances? Area that has vehicle height restrictions?

Is medical transportation a finite resource in the State of Arizona?

State of Arizona Population = 6 ½ Million Number of Licenses Ground Ambulances = 800 Number of Licensed Air Ambulance Services = 20

Transportation Challenges There is a finite amount of on duty immediate resources in the State In a disaster, most everyone will have their need to be “the priority”

Am I your priority? Yes you are….. And so are you.. The need will be greater than the resources.

What are the priorities of organizations like yours in a disaster? Responding to municipal needs Responding to the Medical Facility needs Responding to the needs of our employees and their families Responding to the public need

How does your company prioritize Memorandums of Understanding (if applicable) – when demands for limited resources are high? Contracts for Municipal Services (9-1-1) Inter Facility Contracted Services / Preferred Provider Non Disaster – Resources as allocated by contract / System Status Management program (Statewide resource allocation) Disaster – Triage and response via Emergency Management EOC

Transportation Challenges Does your facility have an emergency plan / disaster plan / evacuation plan? Some facility’s plan is to call In a disaster, resources may not be limited to unavailable. If there is no plan, how do you return your patients ?

Transportation Challenges Does your plan involve other resources and do they know it? Know your Facility / Agency Plan / Disaster Manager Know your Neighboring Facility Plan & Disaster Manager Real life example: Hospital evacuation plan to partner skilled nursing facilities Skilled Nursing Facilities evacuation plan to partner hospital Where will these patients actually go?

Transportation Challenges Limited mobility patients Limited specialty transport devices Special Events Stadiums or High Rise Structures Time to get special resources to patient Number of personnel to safely move patient

Transportation Challenges How many people do we really have to work with? Hospital and Pre-Hospital families Who goes where? What happens to the children? Special need individuals at home? Is there a way to report to the work location? (Transportation issues / Street closures? Etc)

Transportation Challenges Medical supplies / suppliers - same as other agencies and hospitals Fuel Communications Systems and failures / outages Radios, telephones, electronic medical records Service Animals – They ARE coming in the Ambulance

What can EMS do in an disaster? Provide Incident Command of the event Increase resources for the event. A/B/C Shift to A/B – Constant Staffing models Up staffing of spare ambulances Deployment from other counties within Arizona (Mutual Aid) Coordinate with Alternate transportation methods Wheel Chair / Stretcher Vans Buses Medical Escorts / Volunteers Deployment from outside of Arizona (DMAT/NDMS)

EMS has finite resources for disaster responses Be actively involved in your local disaster preparedness & response Know your local emergency management and public health team

Any Questions? Thank you! Joe Gibson Southwest Ambulance A Rural / Metro Company