Aim For Integration

Q&A with Lawrence Tan, President, International Association of EMS Chiefs; Chief, New Castle Co. (DE) Dept. of Public Safety, EMS Div.

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

   New Castle County EMS sent a group of ALS personnel with a contingent of BLS ambulances from Delaware to the Meadowlands in northern New Jersey that day to stage for possible response into New York City, and one of the things we immediately noticed was a need to address our surge capacity--the ability to field additional paramedic units without decreasing the existing resources for our own jurisdiction. We encountered hurdles in our effort to send ALS resources out of state.

   One of the ways we addressed the issue after 9/11 was to change our agency to a dual-fleet configuration. For every 24-hour paramedic unit we deploy, we maintain two fully stocked vehicles that are assigned to that EMS station. The crews rotate which units are in use, which enables us to routinely check our medications and make sure all vehicles assigned to an EMS station are always response-ready. It also helps divide up the fleet mileage. More important, it gives us the ability to rapidly deploy additional personnel and vehicles with a full ALS capacity. We now have the ability to increase the number of paramedic units in service for any local or regional major incident. This can also be accomplished by holding paramedic crews over beyond their scheduled shift, if needed.

Are there areas where we've not achieved as much as we should have?

   There's still a need for more integrated communications and intelligence sharing between EMS and other public safety agencies. It's improving, but there are some agencies that struggle to be in the loop on these issues.

   Certainly from a safety perspective, you'd want EMS personnel to have improved situational awareness about potential and emerging threats, and from a security perspective, EMS personnel can be a valuable source of information about what's going on in the community and may be able to identify potential threats before they create a public hazard.

   The other issue that could use some additional attention would be the need to integrate security considerations into our daily EMS operations. Examples include credentialing of EMS staff, EMS facility security, and the security of EMS uniforms and vehicles. In 2008, the IAEMSC posted a position statement offering EMS chiefs information on methods to improve the operational security of their agencies. [Find that at www.iaemsc.org.]

In this tough economy, how can we sustain what we've achieved?

   We still struggle to have the same type of resources that are available to other public safety agencies. When the American Recovery and Reinvestment Act was enacted, it included funding to support fire service and law enforcement positions, but EMS positions were not eligible for that level of support. The EMS profession, as a public service, is dependent on the personnel who are ultimately going to sustain the operation and enable us to respond to a catastrophic event.

   How do you sustain it? Maintain ongoing training and don't become complacent. New employee orientation should include reviews of contingency plans, participation in exercises for major event operations, and routine communications. It is imperative that EMS organizations maintain a level of operational readiness even in these difficult economic times. Collaboration with other EMS agencies at the local and regional level to share resources and formalize mutual aid arrangements may provide better utilization of pooled resources.

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

   My advice for chiefs looking to continue and enhance the preparedness of their agencies is, No. 1, take advantage of training opportunities that will provide you with the skills to not only plan but execute the mission during a major event. Second is to network--have a collaborative relationship with fellow EMS chiefs, and lean on those types of resources to stay in tune with changing national policies and politics.