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Emergency Medical Services in Trouble

Posted on: Tuesday, 18 April 2006, 21:00 CDT

By Patrick O'Neill, The Oregonian, Portland, Ore.

Apr. 18--Oregon's emergency medical services system, which licenses ambulance services and emergency medical technicians and oversees hospital trauma centers, was once so good it could have been a model for the nation.

But things have decayed badly.

A federal study released Monday found that the state's EMS system has undergone such "dramatic deterioration" that it places Oregon residents at risk, and it called for "immediate, dramatic change."

The main finding: Care of accident victims varies widely from place to place in Oregon.

The National Highway Traffic Safety Administration performed the study at the request of the Oregon Department of Human Services. Federal surveyors had "looked forward to seeing all of the improvements and enhancements to emergency care in Oregon," surveyors wrote, but instead were "dismayed" at the state of Oregon's system.

During the past 14 years, the Oregon system has "become lost in the basement of bureaucracy" and a "revolving door for short-tenured EMS directors," the study stated, and it is "experiencing erosion of the already inadequate funding for leadership, planning and development . . ."

Among other things, surveyors criticized several elements of the state's program, saying:

--It lacks a medical director who can develop standards for all Oregon communities. Without standards it is impossible measure how well services are delivered.

--Resources for emergency services vary widely across the state from urban to rural areas.

--It lacks a plan to improve services in frontier and rural areas.

Dr. Grant Higginson, the Department of Human Services physician who has overseen EMS since March 1, says the report was not a surprise. Higginson said his agency asked for the review because he was concerned about the state of the EMS program.

"This was not because of a complaint or concerns of the federal government," he said. "It was a voluntary program so that we could see the status of the EMS system."

Federal reviewers urged Gov. Ted Kulongoski to elevate the EMS and trauma systems to a level equivalent to the State Police, Fire Marshal or Office of Emergency Management, and to move it to the Office of Homeland Security. This would give a small agency the heft and authority it needs to follow through on its mission.

And they urged EMS officials to perform an inventory of work force needs. This would help establish how many personnel at specific levels of training are needed in various parts of Oregon.

Jeanne Arana, director of Oregon emergency medical services, said she is the 10th person in that job since 1992. She reports to Higginson.

She said that since 1992, the number of employees in her agency has dropped from 50 to 18.

The report represents a challenge, she said. But Arana said surveyors were impressed with the dedication of emergency medical technicians and physicians throughout the state.

The main difficulty, a lack of resources, can be addressed through legislative action, Arana said.

Rose Howe, an intermediate emergency medical technician in Monument in Grant County, said she and others would like more resources to keep current on their training. Like most EMTs in rural areas, Howe is a volunteer who must pay for her own training.

The nearest hospital to Monument is in John Day, about 60 miles away.

"We serve upwards of 50 square miles," she said. "We are on call 24-7. We all carry our pagers all the time."

Training is important for volunteers in rural areas, she said, because calls are relatively infrequent -- about 50 a year -- and it's necessary to practice lifesaving skills.

"When our pager goes off, we know we are going out to someone who is a friend, a neighbor or a family member," she said. "It's very seldom we go to someone who's a stranger, someone who we'll never see again."

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Copyright (c) 2006, The Oregonian, Portland, Ore.

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Source: The Oregonian

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