Sunday, May 5, 2019

Why Doesn't the LMRFD Use Volunteer Emergency Medical Responders on the Ambulance?

UPDATE
It's fairly obvious the Arizona Legislature had using Emergency Medical Responder’s in rural areas with under 10,000 people like Dolan Springs and Meadview. 

The law seems pretty clear so I contacted our state representatives explaining we had no fire or EMS many hours some days. They said they understood the problem and would look into it. 




Original Post
Every time I ask why we don’t use Emergency Medical Responder’s to drive our ambulance I’m told we can’t, THE LAW says we must have 2 EMT’s or an EMT and a paramedic.

So I did some research on the laws governing EMR’s and found that wasn’t really true… 
Not the way I read the law, so read it for yourself, tell me if I'm wrong..

The legislature understood the need for EMR’s in rural areas like ours. That’s why when they wrote the EMS laws they allowed Emergency Medical Responder’s to drive ambulances in smaller communities like ours.

The law says an ambulance serving a rural area with a population of less than 10,000 must have at least one EMT or Paramedic….
The other “ambulance attendant” can be an Emergency Medical Responder who is employed by an ambulance service whose primary responsibility is driving the ambulance

This information is from the EMS Bureau Statutes and Rules April 2019


36-2202. Duties of the director; qualifications of medical director
J. The standards, criteria and procedures adopted by the director pursuant to subsection A, paragraph 5 of this section shall require that ambulance services serving a rural or wilderness certificate of necessity area with a population of less than ten thousand persons according to the most recent United States decennial census have at least one ambulance attendant as defined in section 36-2201, paragraph 6, subdivision (a)  and one ambulance attendant as defined in section 36-2201, paragraph 6, subdivision (b) staffing an ambulance while transporting a patient and that ambulance services serving a population of ten thousand persons or more according to the most recent United States decennial census have at least one ambulance attendant as defined in section 36-2201, paragraph 6, subdivision (a) and one ambulance attendant as defined

  
36-2201. Definitions
EMR’s are mentioned 5 times in 36-2201
6. "Ambulance attendant" means any of the following: (a) An emergency medical technician, an advanced emergency medical technician, an emergency medical technician I-99 or a paramedic whose primary responsibility is the care of patients in an ambulance and who meets the standards and criteria adopted pursuant to section 36-2204. (b) An emergency medical responder who is employed by an ambulance service operating under section 36-2202 and whose primary responsibility is the driving of an ambulance. (c) A physician who is licensed pursuant to title 32, chapter 13 or 17. (d) A professional nurse who is licensed pursuant to title 32, chapter 15 and who meets the state board of nursing criteria to care for patients in the prehospital care system. (e) A professional nurse who is licensed pursuant to title 32, chapter 15 and whose primary responsibility is the care of patients in an ambulance during an interfacility transport.

8. "Basic life support" means the level of assessment and care identified in the scope of practice approved by the director for the emergency medical responder and emergency medical technician.

16. "Emergency medical responder" as an ambulance attendant means a person who has been trained in an emergency medical responder program certified by the director or in a certified by the director to render services pursuant to section 36-2205.

36-2204. Medical control
11. Standards for ambulance service and medical transportation that give consideration to the differences between urban, rural and wilderness areas

36-2205. Permitted treatment and medication; certification requirement; protocols A. The director, in consultation with the medical director of the emergency medical services and trauma system, the emergency medical services council and the medical direction commission, shall establish protocols, which may include training criteria, governing the medical treatments, procedures, medications and techniques that may be administered or performed by each classification of emergency medical care technician. These protocols shall consider the differences in treatments and procedures for regional, urban, rural and wilderness areas and shall require that emergency medical care technicians authorized to perform advanced life support procedures render these treatments, procedures, medications or techniques only under the direction of a physician.

ARTICLE 2 REGULATION OF AMBULANCES AND AMBULANCE SERVICES 36-2232. Director; powers and duties; regulation of ambulance services; inspections; response time compliance

2. Regulate operating and response times of ambulances to meet the needs of the public and to ensure adequate service. The rules adopted by the director for certificated ambulance service response times shall include uniform standards for urban, suburban, rural and wilderness geographic areas within the certificate of necessity based on, at a minimum, population density, geographic and medical considerations


ARTICLE 9. GROUND AMBULANCE CERTIFICATE OF NECESSITY R9-25-901. Definitions (Authorized by A.R.S. § 36-2202 (A))
37. “Rural area” means a geographic region with a population of less than 40,000 residentsthat is not a suburban area.


I went through Emergency Medical Responder training with NACFD a couple years ago. The main difference in basic EMR and EMT training is that EMT’s get more training on transporting patients, and spend 10 hours or so in an emergency department.

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