Michael M. Kiley
131 Stanley Avenue #202
Estes Park, CO 80517
970 586-2343
kileyd@peoplepc.com
Copy
8/30/3
Bill Owens, Governor
136 State Capitol,
Denver, CO 80203-1792
Dear Governor,
Executive Summary. As Governor of Colorado, take due care to discharge your
responsibility to protect the public health and safety by immediately creating a
proper Colorado State mountain rescue program at American College of Surgeons
standard of pre-hospital, critical care. This is a long-overdue and essential but
missing, component of the Colorado tourist industry.
You are hereby advised that the Special Agent in the Lakewood, Colorado Office of
Inspector General of the Interior Department was sent a letter of referral for
investigation of retaliation and intimidation in August, 2003, by Congressman Mark
Udall, in connection with the following.
Question: Is current practice and state law and regulation consonant with this
statement from Rocky Mountain National Park (RMNP): Emergency Medical
Technician (EMT)-I “Park Medics” (who are NOT paramedics in Colorado)
perform surgical field interventions? Kindly respond within ten days. (The letter
from RMNP Superintendent Vaughn Baker asserts the EMT-intermediates may
perform surgical interventions).
This subject concerns the health and safety of Colorado citizens and visitors, and
documents a possible failure by the State of Colorado and Rocky Mountain National
Park to provide and protect health and safety in mountain rescue.
I.
By way of copy to Michael Armacost, Colorado Pre-hospital Program Director:
May and do EMT-Is (with National Park Service “Park Medic” job classification)
performing under a Colorado pre-hospital care program Medical Director (hard copy of
agreement with RMNP enclosed) perform cricothyrotomy and chest decompression, and
intravenous infusion of medications for intra-cranial pressure sequel to traumatic head
injuries, procedures otherwise limited in Colorado to paramedics? Time is of the essence
in providing a reply. At present, we regard “Park medic” as a possible smokescreen for
not providing certified paramedics.
II.
This letter is part of an investigation through the Colorado Congressional
Delegation (Hon. Marilyn Musgrave and Mark Udall) initiated over the signatures of
representatives and/or members of the American Alpine Club, the Colorado Mountain
Club, and the Sierra Club. The investigation concerns failure, confirmed in writing by
Vaughn Baker, Superintendent, RMNP, to provide or permit life-saving services by
persons who are both expert rock climbers and Colorado certified paramedics
(documented in attached letter from Supt. Baker, admitting that RMNP neither staffs nor
uses as volunteers available expert climber/paramedics). In separate correspondence,
Supt. Baker attributes authority to determine “resource needs” to Scott Chew, MD, Estes
Park Medical Center, pursuant to written contract (contract copy enclosed).
Importance. Cell-phones now provide instant report of injuries in off-trail settings, like
Longs Peak, on which hundreds of people may be on a given day. This quick notification
makes many critical injuries survivable, but only within the “golden hour”. Surgical care
must arrive within that period; in Colorado, pre-hospital ‘surgical care’ means,
paramedics. In the mountain environment, access to the site of injury within the “golden
hour” requires expert climbers, who are paramedics, who are local, who are dispatched
first (not last), and who have emergency driving authority for local travel to the trailhead
or landing zone. These resources now exist in Estes Park and elsewhere, but sadly, are
not used.
III
As Governor of Colorado you know that Colorado provides no program of
organized mountain rescue at the paramedic level; that under statute, “search and rescue”
are the responsibility of County Sheriffs, whilst, pre-hospital care is conducted under a
Colorado state program, and no Colorado state program integrates these activities; and
that Colorado adopted American College of Surgeons criteria (requiring paramedic level
field care for critical and certain intermediate injuries and illnesses) in the Colorado
Trauma Act.
I have personally observed the non-governmental activities by “search and rescue
groups” (generally affiliated with the Mountain Rescue Association) and regard much of
these activities (for example, the Evergreen Alpine Rescue Team) as Elks Clubs with
light-bars in regard to life-saving critical care, because these groups (operating under
contract with the county Sheriff) are in practice primarily social, and rarely use
physicians or paramedics at the site of the injury in remote locales.
IV
As Governor of Colorado, you know that Colorado actively promotes visitation to
the mountains of Colorado for recreation (Colorado’s number one industry by revenue
annually), and that this marketing carries the implication that Colorado cares
appropriately for the few visitors and residents who become critically ill or injured.
V
As Governor of Colorado, you know or should know that ample resources exist to
provide expert climber/paramedic services in remote areas, that is, we do now have many
individuals who are both expert climbers and paramedics. Therefore, no lack of
resources excuses failure by any state or federal authority to provide for the public health
and safety. These people would probably cooperate voluntarily (at no cost) with an
organized state program on-call to provide expert climber/paramedic services.
VI
As Governor of Colorado, you know that the pre-hospital care and trauma
program stipulates certain regulations; that the same program creates the position of
Medical Director for conduct of paramedic services, and mandates compliance by that
person with said regulations; and you know that the legislative intent of the Colorado
Trauma Act was to remove arbitrary physician action, such as would further harm critical
trauma patients; but you know that no significant mechanism exists to enforce action or
inaction by Medical Directors of local pre-hospital care programs in their compliance
with the regulations of the pre-hospital care and trauma program. For example, if a
Medical Director chooses to not encourage or allow paramedic services for mountain
rescue, that person can simply point to the fact that such services are under “my license”
as a seeming excuse for what may be arbitrary non-compliance. We regard this as
playing with citizens’ and visitors’ lives.
VII
Owing to the absence of a regulatory mechanism to remedy non-compliance by
pre-hospital care Medical Directors, a paramedic (who must function under a physician’s
license in Colorado) who wishes to promote compliance by a local physician is subject to
retaliation by Medical Directors.
You are hereby advised that the Special Agent in the Lakewood, Colorado Office of
Inspector General of the Interior Department was sent a letter of referral for investigation
of retaliation and intimidation in August, 2003, by Congressman Mark Udall, in
connection with the subject of this letter to you. Actions by persons who perform under
the pre-hospital care contract with Rocky Mountain National Park have included reports
containing false information to a local police department, causing a “Gestapo-like” visit
to a signer’s employer; an attempt by the RMNP Superintendent to “poison the well”
with another local physician who employs a signer; and a complaint against a paramedic
for providing good Samaritan care at an accident scene, to the Colorado Board of
Medical Examiners that was instantly dis-proven by another Medical Director. These
actions had a chilling effect on the investigation of the possible failure to provide lifesaving services in Rocky Mountain National Park, as the actions mentioned were no
doubt intended.
VII
Therefore, I ask you as Governor of Colorado to take due care to discharge your
responsibility to protect the public health and safety by immediately creating a proper
Colorado State mountain rescue program at American College of Surgeons standard of
care. This is a long-overdue and essential component of the Colorado tourist industry.
VIII I further request that you, through Michael Armacost, reply within ten days to
answer the question in paragraph (I), for the purpose of the on-going investigation of prehospital care at RMNP.
XI
I write on behalf of all of the signers of the investigation. For identification only,
I am: grandson of the “father” of Rocky Mountain National Park (Enos A. Mills); Clinic
Administrator of an Estes Park facility; Colorado certified and Nationally Registered
Paramedic, with 30 years experience; member, call list, mountain rescue, RMNP; former
Rescue Operations Supervisor, State of California; former member, Facility Designation
Committee of the Colorado Trauma Council; former member, San Miguel County
Emergency Services Committee; former budget analyst, Colorado Department of Public
Health and Environment; former seasonal ranger, RMNP; expert climber (5.11, grade VI,
e.g. north face of Half Dome, Longs Peak Diamond) and skilled and experience in
mountain rescue, with letters of commendation from several Colorado counties and
towns.
Sincerely,
Michael Mills Kiley, PhD, MPH, FACMPE
Nationally Registered Paramedic
“Call list”, RMNP
CC: Michael Armacost, MA, NREMTP, Director, Prehospital Care Program, CDPHE
Hon. Mark Udall
Vaughn Baker, RMNP
Scott Chew, MD, Medical Director, RMNP pre-hospital care services
Greg Sievers, AAC
Deb Robison, Sierra Club
Steven Bragg, President, CMC
Press