Emergency Medical Services
(EMS)
Patient Transport Options
EMS
First Responders
(Fire Department / District resources)
and Ambulances
(Public and Private Operators)
This presentation will focus on the
Ambulance Transportation perspective of EMS
Type of Ambulance Service
• Basic Life Support
BLS / EMT staffed
• Advanced Life Support
ALS / Paramedic Staffed
• Critical Care
RN staffed
• Medical Transportation Resource Types
Public sector = tax based / supported / cost of readiness
Private Sector = Service Reimbursement
Amount of available resources are based on justified
utilization and reimbursement for service provided
• NO! this is not intended to be the “challenges” slide yet…
…Ambulance services are rate regulated by AzDHS
The Az DHS - Bureau of Emergency Medical
Services & Trauma System….
Issues Certificates of Necessity for ground
ambulances
Issues licensure for air ambulance services.
• Ground Transportation – Ambulances
The AzDHS-BEMSTS Ambulance Services Section oversees the
regulatory process for ambulance providers in Arizona.
• Regulation includes all matters affecting services to the public,
service areas, response times, and rates and charges to
ensure providers are charging appropriately.
• Number of Licensed Ground Ambulance Providers = 85
• Number of Licenses Ground Ambulances = 800
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Air Transportation – Ambulances
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The Az DHS - Bureau of Emergency Medical Services & Trauma System….
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Issues Certificates of Licensure for air ambulance services,
Conducts inspections,
Posts the rates for each air ambulance service,
Investigates complaints against air ambulance providers.
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Number of Licensed Air Ambulance Services = 20
Number of Licensed Air Ambulance Providers with AZ address = 12
• Do ambulance drivers require a
special license or certification?
(Air resources are Pilots)
The Az DHS - Bureau of Emergency Medical Services & Trauma System
certifies Emergency Medical Technicians (all levels) in Arizona.
To become certified as an EMT at any level in Arizona you must
successfully complete:
* A Department approved training course,
* Submit required certification application and necessary forms
* Successfully pass the National Registry written examination,
* In addition, Intermediate and Paramedic applicants must pass the
National Registry practical examination
Certified Emergency Vehicle Operator (CEVO)
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CEVO is a two day classroom & hands on practical program that covers the basic
physics of driving, including gravity, velocity, weight distribution and mass inertia,
along with the particular vehicle dynamics required of different types of
ambulances.
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Rather than reacting to an accident once it occurs, CEVO instructs vehicle
operators to drive in a manner that avoids situations that often lead to accidents.
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Drivers learn navigation skills for moving through traffic safely, and instructors
challenge participants to develop solutions for varied circumstances.
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The course addresses backing up, parking with caution, ambulance
hydroplaning, nighttime driving, hospital approach, patient drop off, tail gaiting
and more.
What are your vehicle capacities?
Ambulances inspected by the state have specific standards.
• Ambulance size / type (Basic to MICU)
• Patient size / type (Bariatric / Pediatric / WC)
• How many will fit in your ambulance vs. how many people
need the attention of a care giver?
• Area that would require a 4 wheel drive or high ground
clearances?
• Area that has vehicle height restrictions?
• Is medical transportation a finite resource
in the State of Arizona?
State of Arizona Population = 6 ½ Million
Number of Licenses Ground Ambulances = 800
Number of Licensed Air Ambulance Services = 20
Transportation Challenges
• There is a finite amount of on duty
immediate resources in the State
• In a disaster, most everyone will have their
need to be “the priority”
Am I your priority?
Yes you are…..
And so are you.. And so are you..
The need will be greater than the
resources.
• What are the priorities of organizations like yours in
a disaster?
Responding to municipal 9-1-1 needs
Responding to the Medical Facility needs
Responding to the needs of our employees and their
families
Responding to the public need
• How does your company prioritize Memorandums
of Understanding (if applicable) – when demands
for limited resources are high?
• Contracts for Municipal Services (9-1-1)
• Inter Facility Contracted Services / Preferred Provider
• Non Disaster – Resources as allocated by contract / System Status
Management program (Statewide resource allocation)
• Disaster – Triage and response via Emergency Management EOC
Transportation Challenges
Does your facility have an emergency plan / disaster
plan / evacuation plan?
Some facility’s plan is to call 9-1-1
In a disaster, 9-1-1 resources may not be limited to
unavailable.
If there is no plan, how do you return your patients?
• Transportation Challenges
Does your plan involve other resources and do they know it?
Know your Facility / Agency Plan / Disaster Manager
Know your Neighboring Facility Plan & Disaster Manager
Real life example:
Hospital evacuation plan to partner skilled nursing facilities
Skilled Nursing Facilities evacuation plan to partner hospital
Where will these patients actually go?
Transportation Challenges
Limited mobility patients
Limited specialty transport devices
Special Events Stadiums or High Rise
Structures
Time to get special resources to patient
Number of personnel to safely move patient
Transportation Challenges
• How many people do we really have to work with?
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Hospital and Pre-Hospital families
Who goes where?
What happens to the children?
Special need individuals at home?
Is there a way to report to the work location?
(Transportation issues / Street closures? Etc)
Transportation Challenges
Medical supplies / suppliers - same as other agencies and hospitals
Fuel
Communications Systems and failures / outages
Radios, telephones, electronic medical records
Service Animals – They ARE coming in the Ambulance
• What can EMS do in an disaster?
Provide Incident Command of the event
Increase resources for the event.
A/B/C Shift to A/B – Constant Staffing models
Up staffing of spare ambulances
Deployment from other counties within Arizona (Mutual Aid)
Coordinate with Alternate transportation methods
Wheel Chair / Stretcher Vans
Buses
Medical Escorts / Volunteers
Deployment from outside of Arizona (DMAT/NDMS)
• EMS has finite resources for disaster
responses
• Be actively involved in your local disaster
preparedness & response
• Know your local emergency management
and public health team
• Any Questions?
Thank you!
Joe Gibson
Southwest Ambulance
A Rural / Metro Company