Confused Can of Worms

Went to the EMS regional meetings today. While these meetings are very good and often productive, today we dealt with some issues that were just bang your head against the table difficult.

First off at the education meeting, we had a nice guy from the state there to explain what services would have to do to meet the new federal NIMS mandates:

Here's a blurb from a state memo about NIMS:

"The National Incident Management System (NIMS) has been developed in accordance with Homeland Security Presidential Directive – 5 (HSPD-5). It provides for a flexible framework that facilitates government and private entities at all levels working together to manage domestic incidents. This flexibility applies to all levels of any incident. NIMS provides for a set of standardized organizational structures, as well as requirements for processes, procedures and systems designed to improve interoperability. It employs two levels of incident management structures: The Incident Command System, and the Unified Command concept, a method of coordinating a multi-agency response by combining the leadership of responding agencies into a cooperative incident command structure."

Here are some of my notes from today's meeting:

"NRP...Playbook...will be shredded, didn't work...Presidential directive #8, Presidential Directive #5..work to local level...series of documents, many documents. Ex documents, feds didn't know where the issues were, issuing new documents..new one is five pages longer...NIMS compliant...ICS 100, ICS 200, duplicative, half of it is just a review of ICS 100, let's get to the meat and potatoes, but that's fallen through the cracks ...resource typing assets, they have a list of 520 assessts including bulldozers, gotten a million inquires so they are redoing the asset list...questions, revising...IS 700 compliant...ICS 100 will be required for all street level providers, ICS 200 for all supervisors, including anyone who might be in charge of anyone, so a Paramedic in charge of an EMT or even an EMT in charge of an EMT has to take ICS 200. ICS 300 will be a requirement in FY 07. ..But things change and there could be additions...developed work groups composed of multidisciplinary under contract to homeland security...developed a traing maitrix, but the federal matrix is different...things could change and there could be additions....I envision this taking years to get done and there will be changes..similar to NIMS but for NRP..."

Now here are some comments from the committee:

"Is that going to happen? No?"

"Who is paying for this?"

"If they want the president of the hospital to take 12 hours of classes on this, they are crazy."

"I go to those meetings and walk out more confused than when I go in."

"Like sitting in a corner talking to yourself."

"My head hurts, my head really hurts."

Here's what I understand: The federal government wants everyone even marginally involved with any kind of response to be trained to know what to do in emergencies. Their initial plan was a disaster as proven by Katrina and Rita. As a street medic I will be required to take at least 2 three hour courses to start, amd most likely 12 hours of classes. My service will be responsible for me taking them. If I don't they won't get federal grant money, which they already don't get, and because they are a commercial service they miss out on all the tons of money given to police and fire. That aside, the federal government plan which is not completed is subject to change and will in fact change.

And I will say this: While people have been going to countless meetings to develop this plan or that plan, since 911, I have not taken one class nor recieved any new training that has had anything do with disaster preparedness, weapons of mass destruction, biological warfare or anything like that. Not one class. And I am most likely to be one of the first one scene because I work all the time, and am in an ambulance which is like the first response sent.

***

Other issues we discussed at the next meeting -- the medical meeting: Quality assurance for intubation attempts, lights and sirens responses, the new ACLS guidelines, critical care transport protocols, cessation of resusication and use of the CMED radios to coordinate mass casualty incidents. Every single one resulted in extremely complicated set of problems. Or as the chairman of the medical commitee said, "Clearly this is a bigger can of worms than I had anticipated."

But it is a good committee and we do get things done. Many of the problems, at least in this state are caused by lack of county government which has spawned a nearly unmanageable array of services, responders, communications centers, etc.

If you were to start over you would clearly blow up the system we have, but you can't blow it up and start over.

So we try to patch work things.

I don't think we will be able to fix the federal response plan, but some of these other issues, we may be able to at least problem solve our way into making something workable.

***

I'm back in the street tomorrow.