The Future of
Wildland Fire EMS
Gene Madden, Chair
NWCG Emergency Medical Support Group; and,
Vice Chair, NWCG Safety & Health Working Team
“I’m an EMT & I’m from
Montana”
 1998 Florida Wildfires (May 6-Aug. 21)
4,700 wildfires
507,000 acres burn
21 IMTs
10,000 firefighters from 48 States and 3
countries
 Resources via standing agreements, i.e. State
Compacts, NIIMS ordering system, EMAC and
other local, state and national systems.
 “I’m an EMT and I’m from Montana.”
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Background (cont.)
 White Paper issued by SHWT on EMS
credentialing problem (Fall, 2001).
 NASEMSD reads and unanimously adopts
Resolution to support NWCG in quest to
resolve EMS Credentialing issue (Oct.’02).
 NASEMSP agreed to establish a Liaison with
EMSG ( Feb. ‘03) with a Technical Rep.
 Department of Homeland Security (DHS) &
Transportation Safety Administration (TSA)
interested in work.
NWCG
Safety & Health Working Team
 Established Emergency Medical
Support Group (EMSG) Feb. 2003
after Reno EMS Summit (Jan. ’03).
 Membership:
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Gene Madden, Chair, SE Rep-NASF/SHWT (FL)
Jeff Hatch, USDA/USFS Rep (WY)
Sherrie Collins, DOI/NPS Rep (AZ)
Kim Christensen, DOI/BLM Rep (ID)
Jeff Scussel, USDA/USFS Rep (MT)
Dia Gainor, NASEMSD Rep (ID)
Fergus Laughridge, NASEMSD Rep (NV)
Bobby Golden, Executive Secretary, USDA/USFS (MT)
Emergency
Medical Support
Group (EMSG)
 Mission:
To establish a methodology to meet
the emergency medical and
occupational health needs of
managed incidents and integration
with local, state, and federal systems.
Emergency
Medical Support
Group (EMSG)
 Primary Purposes:
 1) To develop a process to ensure proper
credentialing of medical providers to
include emergency medical and
occupational health resources for
incident management.
 2) Recommend to SHWT appropriate
levels of care and type for EMS incident
management.
Emergency Medical Support
Group (EMSG)
 Secondary Purposes:
 Improve communications among EMS
 Improve communication of EMS issues to
incident managers & EMS leaders.
 Incorporate uniform EMS guidelines and
standards.
 Provide a forum for providers
 Synthesis research into usable knowledge for
managers & EMS.
 SME for SHWT and other NWCG Working Teams
on EMS and occupational healthcare issues
Wildland Fire EMS-Organization
 Most medical units under LSC.
 Growing number of IMTs placing
medical unit under SOF.
 MEDL/IMS/FM may or may not
automatically be on first call out.
 MEDL/IMS/FM may/may not be a
regular IMT member.
 IMS and Firemedic typically function
as a unit.
Medical Unit-Leadership
 Medical Unit Leader (MEDL)
See Fireline Handbook, page 133
 Incident Medical Specialist Manager
(IMSM) (R1 & R6)
See IMS Manual, page 20
 Firemedic Coordinator (AK)
See Firemedic Program Policy, page 6
Medical Unit ICS Organization
MEDL
Assistant MEDL
Military/National Guard
Spike Camp, Branches, etc
IMS Programs
(R1 & R5)
Firemedic Program (AK)
EMS
Line & Med Unit Personnel
EMTs
EMTPs
Ambulance Services
Occupational
Health Care
RNs
NP
PAs, etc
EMS Challenge or Conflict?
Firemedic & IMS & EMS
 CHALLENGE: All states require state
certification or license for EMS resources.
 CONFLICT: Some believe that federal
resources are privileged to work EMS
anywhere.
 IMS: Credentialed in R1 or R6 jurisdictions.
(Reciprocity exists between R1/R6)
 EMS: Credentialed in “home” jurisdiction.
 IMS & FM: Has established protocols.
 EMS: Typically follows “home” protocols or
National Standard Curriculum.
EMS Challenges or Conflicts
(cont.)
 IMS & FM: Personnel must attend
annual refresher.
 EMS: EMS recert every 2-3 years.
 IMS & FM: Frequently deployed as a
unit.
 EMS: Usually deployed as a single
resource.
EMS Credentialing Issues
 No simple fix.
 National Registry (EMT or EMTP) is
not national certification.
 Very few states offer reciprocity and
then only after testing, fees, etc.
 “Practicing” medicine in w/o proper
certification/licensure may be a crime
with serious consequences.
EMS Equipment & Supply
Challenges
 Who can order what?
 Who’s responsible for the supplies?
 Are the items: Appropriate? Enough?
Antiquated? Need Updating?
 Re-supply Items: Local, Cache,
national/regional contracts.
National Park Service Emergency
Medical Guidelines (NPS 51)
 16 USC 12 “authorized to aid and assist
visitors within the national parks in
emergencies . . . .”
 16 USC 12 allows “rendering of emergency
rescue firefighting, and cooperative
assistance to nearby law enforcement and
fire prevention agencies and for related
purposes outside the NPS.”
 16 USC 13 “Secretary … authorized to
provide medical attention to employees …
at isolated locations. . . .”
DOH & DMAT
 Provides assistance through a
different ordering system. Claims to
have reciprocal agreements.
 DOH may be consider a “uniform
service.”
 DMAT teams tend to arrive “heavy.”
Military & National Guard
 U.S. Armed Services (Army, Navy,
Air Force, Marines and Coast Guard)
are allowed to provide medical care to
its personnel w/o regard to state/local
licensure and certifications.
 National Guard units are state
agencies working under the Governor
of each state and must abide by state
statutes.
State Rights
 States and county and local
governments are empowered to
license and credential medical
professionals including doctors,
nurses, emergency medical
technicians, etc.
Exceptions!!/Solutions??
 Presidential Disaster is declared by
President.
 Governor declares and signs Emergency
Declaration.
 States—statutorily or administratively,
establishes a process to enable currently
certified EMS personnel to enter into their
jurisdiction for the express purpose of
working on a temporary basis on a wildfire
or all-risk incident.
So What Are We Doing?
 Credentialing
 Request for Recognition Form.
 MEDL (or IMSM) to complete on EMS
resources and forward to State EMS
office.
 Request form DOES NOT provide a
license/certification.
 Form must be done whenever a resource
is reassigned from one incident to
another.
REQUEST FOR RECOGNITION
(Print or type all information. Use additional forms as necessary.
MEDLs are responsible for reporting arriving AND demobing resources
within 24 hours to the designated state EMS office.
See http://nasemsd.org/member list.html for contact information)
Authorization for recognition is requested for the following emergency medical
personnel assigned to the _______________________________incident. The identified
personnel will provide emergency medical and health care services for incident personnel. It is
anticipated that they may be providing these services for up to 21 days from the date of
this notification.
______________________________
__________
______
______
Full name
Cert/Lic. Level
State
NREMT#
______________________________
__________
_____
______
Full name
Cert/Lic. Level
State
NREMT#
The above individual (s) will be assigned starting on ________________________________
The location of the incident is: ________________________________________________
__________________________________________________________________________
The primary wildfire jurisdictional authority is: ____________________________________
I attest that I have physically examined the certifications/licenses of the above individuals.
____________________________________ (_______)_____________________
Medical Unit Leader-Print
Telephone Number
(_______)___________________
Fax Number
____________________________________ _________
Medical Unit Leader-Signature
Date
Completing the Request for Recognition Form
The purpose of the “Request for Recognition” form is to advise
the state EMS office (where your incident is) that you have
established a medical unit within their jurisdiction, and you are
identifying out-of-jurisdiction (the state’s) EMS personnel who are
going to be rendering care for a limited period of time.
This form does not provide certification/licensure reciprocity. It
only notifies authorities of the presence of EMS resources.
A new form must be completed for each resource as they move
from incident to incident within that state or if they travel to
another state.
Remember too, that advanced life support care rendered
requires in-jurisdiction Medical Direction. The state EMS Office may
be able to help you with this.
Simply click on the NWCG Emergency Medical Support
Group website
(www.nwcg.gov/teams/shwt/emsg/index.htm) and go to
the National Association of State EMS Directors
(NASEMSD) website link. The NASEMSD web address is:
www.nasemsd.com
Click on the state where your incident is located. You will
go immediately to the appropriate state contact number.
The National Registry of Emergency Medical Technicians
also has a website that will also provide you with the
correct state EMS contact information. The NREMT web
address is: www.nremt.com
Both websites may offer additional important and helpful
information to you about the area EMS facilities and
services in completing the Medical Unit Plan (ICS 206).
Additional links are expected to be added.
REMEMBER TO VERIFIY ALL INFORMATION TAKEN FROM
WEBSITES e.g. telephone numbers, services, etc.
It cannot be overly stressed that it is the responsibility of
the Medical Unit Leader (or the Incident Medical Specialist
Manager or Firemedic manager, if so designated) to
complete the Request for Recognition form.
Remember, there are a multitude of statutory and administrative
regulations from state to state. You may be required to provide
additional information and proof of certification/licensure to the
State EMS Office. Contact them for specific information and
assistance.
What Are We Doing?
 Scope of Practice
 Working with NASEMSD to redefine the
National Standard Curriculum (NHTSA)
into the new National EMS Scope of
Practice Model.
 Define the role of the various types and
kinds of EMS resources (April ’02).
 This will include emergency medical and
occupational aspects traditionally
provided in medical units.
What Are We Doing?
 Emergency Medical Services Group
webpage.
 www.nwcg.gov/teams/shwt/emsg/index.
htm
 Mission
 Charter
 Members
 Conference Call Notes
 Links
What Are We Doing?
 Medical Unit Resource Web Page
 www.nwcg.gov/teams/shwt/emsg/
 Under Construction
Emergency Medical Services Group
Medical Unit Leader Resources
This page is for EMS individuals with the primary responsibility to organize and manage an
effective and efficient medical unit for a wildland or all-risk incident. Whether you're a medical
unit leader (MEDL), incident medical specialist manager (IMSM), or involved with the fire
medic program, this site will help you develop the medical unit quickly and also serve as a
resource for you. The forms and templates provided here will help you get started quickly and
accurately. It is your responsibility to verify the information on these forms and
websites provided. The information and procedures here will change periodically before it
can be posted.
Forms
Request For Recognition of Out-of-State EMS Resources
ICS
Medical Unit Plan-ICS 206
State EMS Bureaus
National Association of State Emergency Medical Services Directors (NASEMSD)
Burn Centers
American Burn Association
United States
www.ameriburn.org/pub/2003-2004PubPagefinal.pdf
Canada
www.ameriburn.org/pub/2003-2004finalCaPub.pdf
Safety and Health Working Team
National Interagency Fire Center
3833 S. Development Avenue
Boise, Idaho 83705
EMS Programs
IMS-Region1
www.fs.fed.us/r1/fire/nrcg/Committees/Operations/ims_web_site/index.html
IMS-Region 6
www.fs.fed.us/rg/uma/ims/
Alaska FIREMEDIC
Critical Incident Stress Debriefing/Management (CISD/CISM)
Wildland Firefighter Foundation
www.wffoundation.org
Public Safety Officer Benefit Program
Line-of-Duty Death (LODD)
www.ojp.usdoj.gov/BJA/topics/PSOBProgram.html
Fallen Firefighter Program
www.fallenfirefighter.com
All-Risk Topics
Other
Center for Disease Control (CDC)
www.cdc.gov
National Registry of EMTs and EMTPs
www.nremt.org/EMTServices/emt_card_news.asp
Resource Order Forms and Sample Templates
Personnel
Supplies
Equipment
Medical Evacuation Plan-Sample
R1 IMS Evacuation Plan
EMS Equipment & Supplies
 Cache Kits: If it is a national
resource it is a national resource.
 It is the MEDL/IMSM’s responsibility
(and everybody else in the unit) to
manage their business!
 Order what you need. Be reasonable.
 Maintain the kits as well as supply
conditions will allow.
 Return kits promptly to cache. Identify
broken/missing items.
EMS Equipment & Supplies
 It is OK to have more than one 500 person
field first aid station kit (NFES 1835) on an
incident.
 500 person FA kits were originally prepared
for use for the IMS program. However, they
are a national resource and can be ordered
by appropriate personnel, e.g., MEDL
absent the med pack or “IMS kit” unless
appropriate personnel are present.
 EMSG has offered to act as a SME for the
FEWT. (Oct. 03)
Some Final Thoughts
 Greater appreciation and tolerance of
the differences between EMS types
and kind. Who’s more correct? IMS?
FM? EMS? Others?
 We’re all there to serve the
incident personnel and the
agency that brought us there in
the first place.
Thank You – Questions?