We Should Be Equal Partners

Q&A with Randy Kuykendall, President, National Association of State EMS Officials; State EMS Director, Colorado

Coming out of 9/11, what did you see as the greatest needs for EMS in its preparedness for terrorism and major MCIs?

   As an industry, along with our partners in fire and law enforcement, we were probably naive in terms of what the potentials are, and what the dangers are. The world has changed an awful lot, and I don't know that we fully understood that. And 9/11 was a terrible way to come to that realization, but I think it helped our industry begin to think about the importance of regionalization, and of being able to generate large-scale responses to incidents of this nature.

How would you evaluate our progress toward that goal?

   We've made some significant strides. The changes in our capabilities, our ability to communicate, our ability to generate larger-scale responses in shorter periods of time, have come at a much faster rate over the last 10 years as a result of what we've come to understand of the world today. That's true of both routine healthcare and being able to respond to large-scale events.

Are there areas where we've fallen short or not progressed the way we've needed to?

   The area where we've probably continued to fall a little short is making sure we're fully inclusive of all the various models of EMS and patient transportation systems across the country. We need to make sure all the components that move patients from point A to point B--whether they're public or private, single- or dual-role--all are equal partners in terms of being able to respond. I don't know that we've done that real well. With the variety of large programs we've had over the last 10 years, the focus at times has jumped around a bit. There are segments of the EMS community that haven't benefited as they might have.

How much variation is left among the states in terms of preparedness for acts of terrorism or major MCIs?

   We're closer to standardized responses today than we've ever been in my career. That's a tribute to the federal initiatives that were driven post-9/11. I'm able to use the same vernacular and have the same levels of understanding, particularly talking about all-hazards or mass-casualty response, with people from other parts of the country. That is tremendous.

In this tough economy, how should we go about sustaining what we've achieved?

   In a state like Colorado, where many of our agencies are local tax districts, the decline in property values has resulted in a double whammy for local agencies. Federal funding for disaster response is dwindling at the same time local ability to fill the gaps between costs and patient revenue is declining as well. That is a significant concern. We need to be fully engaged in discussions with third-party reimbursement agencies, and we need to be fully engaged at the political level in making sure we secure a baseline resource level to maintain the progress we've had over the years.

As 9/11 recedes into history, what are the big lessons we should carry forward?

   It should make us more aware that we're part of a worldwide community, and that we live in a world that's more dangerous than it used to be. Disasters come in a variety of forms, and working within a system of care that you use every day and can upsize to address larger issues is an extremely important part of the EMS provider's repertoire.