Regulation of Fire District Boards What's Your Opinion... Here's the AG's opinion.

 Regulation of Fire District Boards What's Your Opinion... Here's the AG's opinion.

Like other agencies in Arizona the AG's office picks and chooses what laws and opinions to enforce...

Attorney General Thomas C. Horne
Date Posted Tuesday, July 15, 2014
Opinion Number I14-003 (R14-011)
Regarding Regulation of Fire District Boards
I14-003.pdf

To: Honorable Andy Tobin
Speaker of the Arizona House of Representatives
Questions Presented

You have asked for an opinion on the following questions:
If a fire district board member is related to an employee by affinity (marriage) or by blood relation (consanguinity within the third degree), may that board member serve out the term of his or her office or does Arizona Revised Statutes (A.R.S.) § 48-805.03 require the board member to resign? In the alternative, may the relative or spouse resign instead of the board member?
Does the requirement that board members and fire chiefs be trained in “other matters that are reasonably necessary for the effective administration of a fire district,” A.R.S. § 48-803(H), mandate a specific type of training, and does an association of Arizona fire districts have the discretion to determine what types of training satisfy this requirement?
Will board members or chiefs be entitled to “credit” for attending past training sessions sponsored by the Arizona Fire District Association toward their training requirement under A.R.S § 48-803(H)?

Summary Answers
If a board member and an employee are spouses, either the board member or the employee must resign immediately. If a board member and an employee are related, but are not spouses, then the board member need not resign.
The requirement to complete training on “other matters that are reasonably necessary for the effective administration of a fire district” does not mandate any particular type of training. Any training will satisfy this requirement so long as it is reasonably connected to the district’s administration. Associations of Arizona fire districts therefore have discretion, but not unlimited discretion, to create training programs to satisfy this section.
No. A board member or newly hired fire chief may not use past training sessions to satisfy the training requirement in A.R.S. § 48-803(H).
Background

Fire districts are political subdivisions of the State charged with providing fire services within specified areas. See generally A.R.S. § 48-805. Three-, five-, or seven member boards manage the districts. A.R.S. § 48-803(A). The board members are elected under the procedures outlined in A.R.S. § 48-802.

In 2013, the Legislature created a committee to study the performance of Arizona’s fire districts and to recommend ways in which the districts might be improved. See 2013 Ariz. Sess. Laws ch. 104, § 1. Based in part on these recommendations, the Legislature made a number of changes to the management of fire districts. See 2014 Ariz. Sess. Laws ch. 252 (S.B. 1387); see also Ariz. H.R., House Summary as Transmitted to the Governor for S.B. 1387, 51st Legis., 2d Reg. Sess. (4/23/14), at 1. These changes were deemed “emergency measure[s] . . . necessary to preserve the public peace, health or safety” and went into effect immediately, on April 30, 2014, upon signature by the Governor. See 2014 Ariz. Sess. Laws ch. 252, § 15 (S.B. 1387)

Your questions involve several of these statutory changes. In interpreting these changes, the chief goal is to fulfill the intent of the legislature that wrote them. Bilke v. State, 206 Ariz. 462, 464, ¶ 11, 80 P.3d 269, 271 (2003). Determining the legislature’s intent begins with examining the language of the statute itself. Id. “If the language is clear,” then it should be applied “without resorting to other methods of statutory interpretation, unless application of the plain meaning would lead to impossible or absurd results.” Id. (internal citation and quotation marks omitted).
Analysis

A. Family relationships between board members and fire district employees.

There are two sets of provisions bearing on family relationships between board members and district employees. The first set of provisions governs spouses; the second set of provisions governs all other relatives.

1. If a board member is married to a district employee, either the board member or the employee must immediately resign.

The first provision bearing on family relationships is A.R.S. § 48-805.03(B), which provides in relevant part that “the spouse of an employee of a fire district may not hold membership on the governing board of the fire district that employs that employee.” Violation of this provision is a class two misdemeanor. A.R.S. § 48-805.03(D). The terms of this provision are absolute: a person may not serve on a district board if he or she is married to a district employee. Accordingly, a board member who is married to an employee faces immediate criminal liability if he or she continues to serve on the board. The board member therefore may not serve out the remainder of his or her term and should resign immediately.

Alternatively, the employee-spouse may immediately resign instead of the board member. However, the statute makes the board member criminally liable, not the employee-spouse. Accordingly, the primary duty to resolve the conflict lies with the board member. If the employee-spouse immediately resigns, that will also resolve the conflict. But if the employee-spouse does not immediately resign, then the board member must immediately resign or face criminal liability.

2. A board member need not resign if the board member is related to a non-spouse employee.

The second set of relevant restrictions governs non-spouse employees. Under A.R.S. § 48-805.03(A),

[i]t is unlawful for an elected or appointed officer or employee of a fire district to do any of the following:

1. Appoint or vote for appointment of any person who is related to that officer or employee by affinity or consanguinity within the third degree to any clerkship, office, position, employment or duty in any department of that fire district when the salary, wages or compensation of that appointee is to be paid from public monies or fees.

2. Appoint, vote for or agree to appoint or to work for, suggest, arrange or be a party to the appointment of any person in consideration of the appointment of a person who is related to that officer or employee within the degree prescribed by this section.

Violating these provisions is also a class two misdemeanor. A.R.S. § 48-805.03(D).

These provisions are narrower than the employee-spouse provisions in subsection (B). Unlike subsection (B), subsection (A) does not criminalize mere service on the board when a family member is also an employee. Instead, it criminalizes only (1) directly appointing or voting for the appointment of family members at taxpayer expense; or (2) assisting in the appointment of someone else in exchange for the appointment of a family member. Because these provisions apply only to the initial “appoint[ment]” of non-spouse family members, they do not apply where the family-member employee has already been appointed. Accordingly, § 48-805.03(A) does not require board members who are related to non-spouse employees to resign their positions.

B. A Fire District’s Discretion to Determine What Training Programs Are “Reasonably Necessary for the Effective Administration of a Fire District.”

Under A.R.S. § 48-803(H), fire chiefs and board members must attend professional training provided by an association of Arizona fire districts. “The professional development training must include training on open meetings laws, finance and budget matters and laws relating to fire district governance and other matters that are reasonably necessary for the effective administration of a fire district.” Id. At the end of the year, the association that provided the training must submit a report “that describes the compliance with the training requirements to the county board of supervisors for every county in which the fire district operates.” A.R.S. § 48-803(I). Among other things, the report must include “[a] compilation of the professional development training delivered by the association.” Id.

Board members and fire chiefs who fail to meet their training requirements are “guilty of nonfeasance in office.” A.R.S. § 48-803(J). “Any person may make a formal complaint to the county board of supervisors regarding this failure to comply, and the county board of supervisors may submit the complaint to the county attorney for possible action.” Id. After receiving a complaint, “[t]he county attorney may take appropriate action to achieve compliance, including filing an action in superior court against a fire district governing board member or a fire chief for failure to comply with the professional development training requirements prescribed in this section.” Id. “If the court determines that a fire district governing board member or fire chief failed to comply with the professional development training requirements prescribed in this section, the court shall issue an order removing the fire district governing board member from office or the fire chief from employment or appointment with the district.” Id.

The training provided must include training on “open meetings laws, finance and budget matters and laws relating to fire district governance and other matters that are reasonably necessary for the effective administration of a fire district.” A.R.S. § 48-803(H). You have asked whether any particular type of training falls within the category of “other matters that are reasonably necessary for the effective administration of a fire district.” The answer is no. Neither the statute nor its legislative history defines “matters that are reasonably necessary for the effective administration of a fire district.” Accordingly, the guiding principle is reasonableness. If the subject of the training may reasonably be thought necessary for the administration of a fire district, then it satisfies the statute.

Given the breadth of the term “reasonably,” it follows that fire district associations have discretion to determine what training to provide. However, the oversight provisions in subsection (J) demonstrate that this discretion is not unlimited. Fire district associations must submit their training records to the board of supervisors in every county in which they operate. A.R.S. § 48-803(I). That accountability demonstrates a legislative intent to vest county boards with sufficient oversight powers to ensure that training covers “matters that are reasonably necessary for the effective administration of a fire district.”

Similarly, subsection (J) allows any person to report a failure to comply with the training requirements. A county attorney may seek to remove a noncompliant fire chief or board member by filing an action in superior court. In determining whether to remove a board member or fire chief for failure to complete the training, the superior court will consider the scope of the word “reasonably.” It will also likely consider the fire district association’s expertise in the management of fire districts. Ultimately though, the superior court must apply its own judgment to determine what is “reasonably necessary for the effective administration of a fire district.” Cf. Chaney Bldg. Co., Inc. v. Sunnyside Sch. Dist. No. 12, 147 Ariz. 270, 273, 709 P.2d 904, 907 (App. 1985) (“‘[C]ourts need not defer to administrative expertise unless they are convinced that the administrator is reasonably exercising this expertise.’”) (quoting New Pueblo Constr., Inc. v. State, 144 Ariz. 95, 103, 696 P.2d 185, 193 (1985)). In sum, the statute gives fire district associations discretion to develop sufficient training programs, subject to oversight by county boards, and, ultimately, to a superior court’s determination that the training covered matters reasonably necessary to efficiently administer fire districts, based on the facts and circumstances.

C. Use of Past Training Sessions to Satisfy the Training Requirement in A.R.S. § 48-803(H).

With exceptions not relevant here, A.R.S. § 48-803(H) provides as follows:

Beginning with the 2014 general election . . . all persons who are elected or appointed to a fire district board and the fire chief who is appointed or hired by the district board shall attend professional development training that is provided by an association of Arizona fire districts. District board members and the fire chief shall complete at least six hours of professional development training, with board members completing their training within one year after the date of the certification of their election and for the fire chief, within one year after the date of hiring.

You asked whether board members and fire chiefs may use past training sessions to satisfy this requirement.

1. Board Members May Not Use Past Training Sessions to Satisfy the Training Requirement.

The statute provides that board members must complete their training “within one year after the date of the certification of their election.” Id. (emphasis added). Because this provision specifically requires board members to complete their training “after” their election, board members cannot count prior training hours toward their training requirement.

2. Newly Hired Fire Chiefs May Not Use Past Training Sessions to Satisfy the Training Requirement.

The statute similarly provides that newly hired fire chiefs must complete “their training within one year after the date of hiring[.]” Id. (emphasis added). As with board members, this provision specifically requires newly appointed fire chiefs to complete their training “after” their appointment. Accordingly, newly appointed fire chiefs cannot count prior training hours toward their training requirement. Note, however, that this requirement applies only to appointed fire chiefs “[b]eginning with the 2014 general election.” Accordingly, the training requirement applies only to newly hired fire chiefs. Fire chiefs hired before the 2014 general election need not comply with the training requirement.
Conclusion

Board members may not continue to serve on a fire district board if the district employs their spouses. However, board members who have non-spouse relatives that are employed by their district may continue to serve. Fire district associations have discretion, but not unlimited discretion, to develop training programs “that are reasonably necessary for the effective administration of a fire district.” Board members and newly appointed fire chiefs may not use prior training sessions to satisfy the training requirement in A.R.S. § 48-803(H).

Thomas C. Horne
Attorney General

If you're interested in medicine or want to know what doctors and paramedics do, take an ACLS Course

I know one grumpy paramedic will cringe when he see's this since he wouldn't even teach first responders how to use a bag-valve mask so they could assist with cardiac or respiratory problems..

If you're interested in medicine or want to know what doctors and paramedics do during a cardiac arrest you can get a sample by taking an Advanced Cardiac Life Support course, ACLS. 

In an ACLS course you learn how to run a code. You learn how to treat a cardiac arrest from CPR to reading the heart monitor and what medications to give when. Everybody from doctors to paramedics take the same course and follow the same protocols when treating a cardiac arrest. 

Do Not Do This at Home.... To make the grumpy paramedic happy, please do not do this at home. This does not mean you can actually run a code, only that you have the same knowledge as doctors and paramedics when it comes to treating a cardiac arrest. 

You will need to study up to take an ACLS course. You will need to know how to read a heart monitor, a basic knowledge of human anatomy and physiology, as well as medical terminology and pharmaceutical interventions. 

It takes some study but it's worth it to have the knowledge. 

The new EMT oath talks about how to use social media in a responsible and professional manner and not embarrass EMS.

The EMT Oath I took many years ago said 'I shall also share my medical knowledge with those who may benefit from what I have learned. I will serve unselfishly and continuously in order to help make a better world for all mankind". 

This is a good article on why various people in various occupations should take an ACLS course. If you have an interest in emergency medicine or just medicine, learn the algorithms and protocols take an ACLS course and see how you do.

If ACLS come easy you really should look into a career in medicine as a doctor, PA, NP, paramedic, EMT, nurse, or respiratory therapist, because if running a code comes easy, you're a natural, go do good. 

How Knowing Advanced Cardiac Life Support (ACLS) Could Help Save Someone’s Life

Bonnee Logic

Bonnee Logic 

I have a problem with people like Chief Bonnee who play word games leaving out important details in order to make others believe their point of view.

An example of Bonnee Logic

I suggested LMRFD firefighters and volunteers put the app Zello on their smartphones. Zello is free for first responders and would turn their smartphones into a walkie-talkie. This would allow the chief to talk to volunteers or other firefighters without tying up the dispatch channel. It's free has unlimited range and could cover some of our dead spots... Win Win...

But then there's Bonnee Logic... 

At a recent meeting Chief Bonnee told the technical committee that if the LMRFD asked volunteers to put Zello on their $1000 phones, the district would be responsible if they broke their phone on a call. So the LMRFD shouldn't use Zello because of liability?

What Chief Bonnee left out, and here's where I have a problem, is that LMRFD already put's the app Active911 on firefighters phones to receive fire calls. Active911 is NOT free...

I'm sure firefighters will be happy to hear the chief agrees the fire district should be responsible for firefighters personal $1000 phone if they get dropped on a call.

Bonnee Logic is passive deception, it's designed to deceive without actually lying. 

Passive deception is the withholding information. It's the suppression of truth rather than the expression of untruth. Both are designed to deceive, but withholding information makes a secret of the truth.

Another example is the wildland brush truck Chief Bonnee wants. It may be purchased with help from a grant, but he either didn't do his research, or left out that those big balloon tires on the brush truck cost $700 to $1000+ rather than $300-$400 for highway tires... 

When LMRFD blows tires on a regular basis, how much will we spend on balloon tires we don't need here?

    

Other Rural Fire Districts like Heber-Overgaard Fire District with Limited EMS Resources Use Emergency Medical Responders Why Can't We?

I don't understand the reluctance of Chief Bonnee to train and use EMR's Emergency Medical Responders in the LMRFD. Other fire districts like Yucca and the Heber-Overgaard Fire District in rural areas use EMR's, so why don't we?

I contacted Chief McCluskey of the Heber-Overgaard Fire District and asked how he uses EMR's in his fire district. 

When I told Chief McCluskey we had one ambulance and response times can be hours rather than minutes.

Chief McCluskey said "Our volunteer EMRs enable us to keep the higher trained firefighters and EMTs in the District for the 2nd call which happens pretty frequently" Just like here in Dolan Springs and Meadview

 

Thu, Oct 10, 3:11 PM (16 hours ago)
Chief McCluskey
Heber-Overgaard Fire District
chief@hofdaz.com

Jay,

Don’t let their short sidedness stop your pursuit. No an EMR is NOT and EMT. However when you want to keep, medically trained EMT’s in the district (when transporting patients to the hospital), EMR’s become VERY valuable.  If we respond with EMR’s, they are a 3^rd person. Currently our EMR’s either respond to the scene in an additional ambulance or wait at the station for the transporting crew to stop and change out drivers. This way the scene gets the higher level of care, but the transport driver meets the state requirements. 

Let the other districts know they can call us anytime to get information on what we do. 

Thanks.
Chief D. McCluskey
Office (928) 535-4346 Ext 106
Cell (928) 240-4149
Fire Chief / Paramedic
Heber-Overgaard Fire District

Jay Fleming <leapspeaker@gmail.com>	Thu, Oct 10, 11:00 PM (8 hours ago)
to chief

Sorry I'm old and forget things..... 2 Question 

Since the law allows for EMR's to assist and drive the ambulance in rural communities, and the state doesn't "certify" EMR's, do you know if the medical director can stop EMR's from driving?  

Your EMR's respond to the scene in an additional ambulance, then the EMT or paramedic  takes the 2nd in ambulance and the EMR and the EMT or paramedic  transport? 

Thanks again

Jay

 

William McCluskey	7:17 AM (6 minutes ago)
to me

1. I’d have to look up the statue regarding medical control/director, but he/she can only require what level of service is required for the care of the patient under their direction. The driver provides no care during the transport therefore doesn’t fall under the medical directors control. 

2. Our EMR’s volunteer for time periods during the week. When a call comes out the “Car #” comes up on the air and responds to the station. By the time they get to the station, the responding crew has arrived and the Captain directs the EMR to bring the second amb or wait at the station.  

a. If the EMR is directed to the scene, they always drive without lights and siren. Upon arrival the EMR then prepares for transport in either amb at the wishes of the captain. Then drives the medic to the hospital. We are 45-50 minutes from Summit, so it’s a 3 hour event from dispatch to back in the area. 

b. If the EMR is told to stay at the station, the call has likely occurred west of the station and the crew will simply stop by the station on their way to the hospital and switch out drivers. 

Correct. Our volunteer EMRs enable us to keep the higher trained firefighters and EMTs in the District for the 2nd call which happens pretty frequently. Of course we encourage and pay for the EMRs to become EMTs but some just don’t want to or have the time to go. 

It seems if you have the people interested in helping the community and district this way, it’s a Win-Win for the district and community.

My 2 cents 

Chief Dee McCluskey
Fire Chief/ Paramedic 
Heber-Overgaard Fire District
(928) 240-4149

 

This Repost of a 2017 Blog Post.... Heat Stroke Call at My House Shows Why the LMRFD Needs Volunteer EMR's

This is a repost of a 2017 Blog Post Heat Stroke Call at My House

We need trained EMS volunteers with an interest in EMS. Sadly to be a firefighter you're forced to also be an EMT even if you have no interest in EMS. 

The LMRFD did send a volunteer firefighter to EMR training, but he apparently had no interest.

In 2018 a group of NACFD firefighters including myself and Scott Aitken from the LMRFD took an EMR course taught by NACFD in Kingman. 

I took the final test and was awarded a certification as an Emergency Medical Responder from the same people who certify EMTs and paramedics. 

As I understand Scott didn't have any interest in EMS and after taking the training never bothered to take the test to become certified as an Emergency Medical Responder.

2017 Repost of Blog.....

Every EMT in Arizona should know the signs and symptoms and how to care for a heat stroke patient. The call at my home went very badly....

A friend was out in the heat too long and when her husband came in and told us his wife had vomited, she was confused, disoriented and was having problems walking.  We got her into the shower and removed most of her clothing to begin cooling her off. Her condition continued to deteriorate over the next few minutes so I called 911 to request the LMRFD ambulance. 

She stopped breathing several times after what looked like a seizure. I called 911 again and I was told the LMRFD ambulance was on the way. but the dispatcher refused to give me an ETA. 

After several more calls to 911 asking for an ETA finally an EMT from Meadview arrived on a fire truck. He brought in a heart monitor but no oxygen or suction even after we had told dispatch she had vomited and stopped breathing several times for as long as two minutes. 

As I walked into the bathroom I told the EMT that the patient was decorticate posturing. He said I don't know, I’m sorry I’m just an EMT and pointed to his EMT patch. 

When I ask the EMT if I could see the rhythm or if he needed to use my AED? The EMT said he had pads on but wasn't authorized to use the heart monitor. The EMT was sitting on the floor holding the heart monitor the entire time my wife and her friend cared for the girl. The EMT kept saying I’m sorry I don't know what to do I’m just an EMT.

The EMT on the fire truck asked dispatch to have a helicopter put on standby, I asked him to please cancel the helicopter and start AMR, and he refused. I told the EMT to document on the chart that I had asked to cancel the helicopter and start AMR.

I called again and asked dispatch several times for an ETA for the ambulance and again she refused. I ask her to start AMR and again she refused. I know from monitoring the fire frequency that it’s standard practice when the LMRFD ambulance isn't available to start AMR ambulance from Kingman.

The EMT appeared to be very inexperienced and really not prepared to be on calls alone. Numerous times he said over and over I’m sorry I’m just an EMT and would point to his patch.

Paramedic

When the ambulance arrived I told them it wasn't possible to get the stretcher into the bathroom  and asked if they had a transport chair, they said no and rolled out the stretcher. I told the EMT that we wanted her transported by ambulance and not by helicopter. The paramedic yelled at me from the bathroom saying “he doesn’t get to make that decision, I do”

I ask why if they were tied up they didn't call AMR, the EMT in the ambulance said "he had worked for AMR for 12 years and it always take 2 ½ hours to respond to Dolan". Why he would say something so untrue I'll never know. AMR responds to Dolan on a regular basis and it takes 45 minutes to an hour at most.

They couldn't get to the bathroom with the stretcher and carried her out on a tarp. Using a tarp to move the patient almost bending her in a U shape when she was already vomiting and having respiratory distress was a bad choice in my opinion. I've used someone's kitchen chair many times to move a patient from a difficult area or down stairs.

If she had vomited there's a good chance she could have aspirated, something that can cause severe complications.

AMR is called all the time to Dolan when the LMRFD ambulance isn't available. Why on this call when all of the LMRFD resources were tied up on another call didn't they call AMR as is usually done?

When the LMRFD left my home the helicopter hadn't launched yet, and gave a 30 minute ETA. Its only 37 miles from my home to Kingman Regional Medical Center. If it’s only 30 minutes or so running code to get the patient to Kingman Regional Hospital Emergency Department why sit and wait a half-hour? The helicopter flight time was 30 minutes, 5 minutes to land, 5-10 minutes to load the patient, 30 minute flight time to the hospital, they were diverted to another hospital so 35 minute flight time? So 75+ minutes for helicopter transport rather than 45 minutes to the Kingman Regional Medical Center.

Was a $22,000 helicopter ride to a level one trauma center necessary when she was she released a couple hours later?

As an EMT I was taught that heat stroke is a true medical emergency with a 70% mortality rate. For an EMT in the Arizona desert to not know what decorticate posturing is, let alone that it’s a sign of heat stroke and a true medical emergency again shows the EMT lacks the experience to be on calls alone.

The Law on Emergency Medical Responders, You Decide

 Here's the Law on Emergency Medical Responders, you decide what the law says...

 

AS I read the law it’s pretty clear, EMR’s Emergency Medical Responders can assist an EMT or paramedic and drive an ambulance in rural areas as long as their primary responsibility is the driving of an ambulance.

 

 I’m told over and over that we can’t use EMR’s on the ambulance that we have to have a paramedic and an EMT on the ambulance. Not True

 

We could split the POC crew with two EMR’s and double our transport capability reducing response times and improving patient care.

 

ARS 36-2201 says "Ambulance Attendant" means any of the following:

A - An EMT, an advanced EMT, an EMT 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 EMR 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.

 

ARS 36-2202 - Duties of the director; qualifications of medical director

J. 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

LAWS

36-2201 Definitions

In this chapter, unless the context otherwise requires:

5. "Ambulance" means any publicly or privately owned surface, water or air vehicle, including a helicopter, that contains a stretcher and necessary medical equipment and supplies pursuant to section 36-2202 and that is especially designed and constructed or modified and equipped to be used, maintained or operated primarily for the transportation of individuals who are sick, injured or wounded or who require medical monitoring or aid. Ambulance does not include a surface vehicle that is owned and operated by a private sole proprietor, partnership, private corporation or municipal corporation for the emergency transportation and in-transit care of its employees or a vehicle that is operated to accommodate an incapacitated person or person with a disability who does not require medical monitoring, care or treatment during transport and that is not advertised as having medical equipment and supplies or ambulance attendants.

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.

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.

13. "Department" means the department of health services.

14. "Director" means the director of the department of health services.

15. "Emergency medical care technician" means an individual who has been certified by the department as an emergency medical technician, an advanced emergency medical technician, an emergency medical technician I-99 or a paramedic.

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 an equivalent training program and who is certified by the director to render services pursuant to section 36-2205.

17. "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 an equivalent training program and who is certified by the director to render services pursuant to section 36-2205.

18. "Emergency medical services provider" means any governmental entity, quasi-governmental entity or corporation whether public or private that renders emergency medical services in this state.

23. "National certification organization" means a national organization that tests and certifies the ability of an emergency medical care technician and whose tests are based on national education standards.

Radio Receivers for when the SHTF How Important Will News From the Outside World Be?

 When the SHTF one of the most important things we will need is some way to get news. We depend on our phones for all types of news today but when the SHTF your phone may not work. You need some type of radio receiver to get news and information. 

This will be a stressful time, and without some way to know what's going on out in the world, it will be much more stressful. What's going on, who's coming to help us? Did we have a way to tell the outside world were still here and what we need? Is anyone coming to help us? 

Some people have AM-FM radios that run on batteries, others have shortwave receivers that cover AM-FM shortwave and ham frequencies. Many hams have general coverage receivers or the new software defined radios. 

When the SHTF we don't know who will be sharing news on what frequency. Will radio stations or TV stations still be on the air or will it be ham radio operators or even bootleg stations? The more frequencies you have the ability to receive the better. 

Today we have inexpensive software defined radios that cover from 0.5 megacycle to 6,000 megacycles, in AM FM NB WB MW SW and upper and lower SSB single sideband. That's pretty much everything.

This SDR Beginners page is a good place to start 

This SDR software has a waterfall display. Rather than just spinning the dial looking for a signal, you can see signals and their strength. This makes looking for signals much easier. 

There are many SDR's on eBay and Amazon but if your looking for a SHTF SDR then look for a stand alone radio so you don't need to power your computer to listen..

Good Luck 

When the SHTF Who Ya Gonna Call?

Who Ya Gonna Call?

Since I’ve been talking about SHTF and communications a number of people have told me they’ve purchased two-way radios so they can communicate when the SHTF. If the S does HTF, Who Ya Gonna Call?

It's not hard to enter the same numbers into a couple radios and talk to each other, but who else can you talk to? There are many local repeaters in Arizona and Nevada but you need to understand how to program your radios. 

UHF and VHF frequencies are line of sight. But because of the curvature of the earth the range of a handheld radio is 1-2 miles depending on terrain. If you’re on a mountain top you're good otherwise it’s 1-2 miles. So again I ask, Who Ya Gonna Call?

Do you know how to program your radio? Receive Frequency Transmit Frequency & Tone

Who will you talk to?

How often do you test your radios to make sure the batteries are good and everyone’s radios are on the correct frequency and working properly. That's why we need a local GMRS NET to test equipment and who's available in an emergency.

A simple home brew 1/4 wave antenna that can increase range many times. The higher the better. This example is made with a SO239 connector and some brass brazing rod. You can calculate the correct length for your antenna HERE

This is the antenna I have on 9th, it's 20' up and talks from milepost 26 to milepost 52 or so on US93.

 

 

At the CPR Demonstration at DSCC We Learned the Survival Rate for Sudden Cardiac Arrest in Dolan Springs is Near Zero and What WE CAN Do.

Dolan Springs Needs AED’s

We learned a lot at the recent first aid film and CPR demonstration at the DSCC. We discussed the survival rate for cardiac arrests and it’s not good, only 3% to 10% nationwide and closer to zero here.

Again It’s NOT the Fire Districts Fault.

It’s because we decided to live in a rural area with long response times. BUT teaching CPR to increase the availability of effective CPR and early defibrillation by citizens using an AED can improve this situation.

If you suffer a sudden cardiac arrest the ONLY thing that will save your life is the rapid use of an AED, and you don’t have a lot of time 5-10 minutes.

Timeline...
If someone collapsed at the DSCC from a sudden cardiac arrest it would take 1-2 minutes for someone to recognize the problem and make the decision to call 911. Hopefully someone would start CPR at this point.

It would take another 1-2 minutes for 911 to answer the call and transfer you to fire dispatch. There it would take another 1-2 minutes for you to explain the problem. We're at 3-6 minutes...

Fire dispatch would alert the crew, it takes 1-3 minutes to get the door up and the ambulance in route. We're at 4-9 minutes as they leave the station.

It's three miles from Station 41 to the DSCC, so it would take the ambulance about 4 minutes to arrive at the DSCC and 1-2 minutes to offload equipment. 

That's 9-15 minutes for the ambulance to arrive at a call only three miles from the fire station. 

That's why we need to teach everyone effective CPR and place AED's at the DSCC and other local businesses. 

Again It’s NOT the Fire Districts Fault.

First Responders and Rugged Phones - Who Ya Gonna Call With a Broken Phone?

I shake my head when I see people using their phone with cracked screens, but I cringe when I see first responders with using one. 

First responders need phones that work anytime and every time, so they need a rugged case or a rugged phone.

I'm hard on phones and tablets. I broke two phones and a tablet in a week, so we buy rugged phones now. it's just less expensive. 

I carry a Sonim XP8. It's a rugged phone and I can attest to that because I've dropped it so many times. 

I love this XP8 review they say "We put the Sonim XP8 through the wringer. We dropped it on concrete several times, jumped on it, skipped it across a small pond, and it only suffered a couple of scuffs". 

I know most Androids are not water resistant, but there are Android based rugged phones that are water proof. iPhones 7 and later models say they're splash proof. Splash proof?

There are many rugged Android phones on the market but only rugged cases are available for iPhones. Like the Xciel has rugged iPhone cases that are water proof and drop resistant but spending $725 for a case for a $1000 iPhone is out of my price range.

The Blackview BV9900 Pro rugged phone is $500 but has FLIR for firefighters. 

The Sonim XP8 is $699 at AT&T or around $200 used on eBay AT&T is the FirstNet service provider. 

In day to day operations if a firefighter breaks a phone they get a new one the next day. In a disaster if a firefighter breaks a phone it may be days to weeks to get a new phone. 

So First Responders Please STOP Buying Breakable Phones 

This is a Uniden UV350 Mobile Android Phone on FirstNet it's made for first responders with external antennas for phone and GPS for extended range in rural areas where first responders work on the fringe of cellular coverage.

The New Uniden UV350 Smartphone/Radio blurs the line between two-way radios and smartphones with GPS and it's Bluetooth PTT Push-to-Talk microphone and PoC Push-to-Talk over Cellular service it's the future of first responder communications.

Studies Show survival to hospital discharge was greater in those treated by BLS

I see on the LMRFD minutes Larry Tennant was demanding a paramedic in Meadview.. WHY 

Studies show Paramedic vs EMT Survival Rate Your chances may be better with an EMT and rapid transport...

Over 80% of calls are EMS calls and 80% of those BLS calls. 

Truth is There is little difference between the survival rate of patients treated by an EMT using Basic Life Support or a Paramedic using Advanced Life Support.'

If fact the study says you have a 2.51-fold increased odds of dying if treated with ALS care rather than BLS

Cardiac Arrest Survival 

The findings from the OPALS trial are consistent with those of an observational cohort study of a sample of Medicare beneficiaries who experienced OHCA done by Sanghavi et al. from 2009 – 2011 

[7]. The authors found that survival to hospital discharge was greater in those treated by BLS (13.1% v 9.2%) [7]. Ninety-day survival (8.0% vs 5.4% ) and neurologic function among hospitalized patients (21.8% vs 44.8%) were also found to be greater in the BLS group [7].

MAJOR TRAUMA

They found no substantial difference in survival to hospital discharge between BLS an ALS care (81.8% for BLS v 81.1% for ALS). In fact, in those with GCS <9 ALS care increased mortality (60.1% v 51.2%).

The reasoning for this may be due to delayed hospital transport while ALS interventions are performed on scene or complications of endotracheal intubation. A meta-analysis by Lieberman et al performed before the publication of the OPALS trauma study came to the same conclusion – there is no benefit to on-site ALS intervention for patients with major trauma [12].

The authors also postulate that the delay in definitive care to perform ALS interventions on scene is the underlying cause of the findings. A more recent study by Rappold et al evaluated survival in patients with penetrating trauma in an urban environment who were transported via ALS, BLS or police [13]. Their findings are consistent with previous data. They found the overall adjusted OR identified a 2.51-fold increased odds of dying if treated with ALS care. The outcomes of these studies emphasize that definitive care for severely injured trauma patients is most likely to be in the operating room rather than on the side of the highway.

Additionally, as our knowledge evolves about the effect of permissive hypotension in trauma patients, the findings supporting BLS care as optimal make more and more sense [14,15].

TAKE HOME POINTS ON ALS VS. BLS CARE

The standard of EMS care has evolved over time towards ALS level care in many communities around the world. To justify the cost of maintaining this level of care and skill for providers there should be considerable improvements in patient-oriented outcomes, such as neurologically intact survival after out of hospital cardiac arrest and decreased morbidity and mortality after major trauma.

The results of several large studies question the benefit to ALS interventions when BLS care is optimized. Review of the literature suggests that an understanding by EMS systems and providers of what interventions lead optimal outcomes is more complex than just the distinction between BLS and ALS care.

Some patients will benefit from advanced interventions such as fluid resuscitation and dysrhythmia management, while others require rapid transport to definitive care in the operative suite. While the issue of what level of care is best for each individual patient is far from settled, it is clear that the prehospital phase of care for all patients is critically important for outcome.

BLS is more than basic, it’s fundamental to good care              

MAIN OUTCOMES AND MEASURES

Survival to hospital discharge, to 30 days, and to 90 days; neurological performance; and incremental medical spending per additional survivor to 1 year.

Survival to hospital discharge was greater among patients receiving BLS (13.1% vs 9.2% for ALS; 4.0 [95% CI, 2.3–5.7] percentage point difference), as was survival to 90 days (8.0% vs 5.4% for ALS; 2.6 [95% CI, 1.2–4.0] percentage point difference). Basic life support was associated with better neurological functioning among hospitalized patients (21.8% vs 44.8% with poor neurological functioning for ALS; 23.0 [95% CI, 18.6–27.4] percentage point difference). Incremental medical spending per additional survivor to 1 year for BLS relative to ALS was $154 333.

Just My Opinion

The ability to rapidly transport patients to definitive care has a lot to do with survivability. Waiting an hour or calling a medical helicopter because we lack resources isn't right. 

Why should a taxpayer in the LMRFD pay a $25,000 medical helicopter bill because their ambulance was transporting a dehydrated hitchhiker at milepost 5 on US93?

It would be better to have several backup ambulances staffed by paid volunteer EMTs and EMRs with good Basic Life Support skills who can do rapid transport to KRMC.

If a patient has trauma and needs a Level I Trauma Center, call a medical helicopter. But KRMC can handle respiratory, heat stroke, cardiac, stroke, and most other calls not requiring a trauma surgeon right now.

Rapid Transit $2500 vs Medical Helicopter $25,000

Dolan Springs to KRMC is 38 miles, it would take 28 minutes to get to KRMC at 80mph

Meadview to KRMC is 58 miles, it would take 49 minutes to get to KRMC at 70mph.

In Dolan Springs paramedics routinely call for a medical helicopter with a 30 minute flight time from Vegas for calls KRMC can handle. Then they load the patient in the ambulance and drive to the fire station where they sit and wait for 30 minutes. 

When the helicopter gets there it takes10-15 minutes to land, shutdown the helicopter, load the patient, and take off. 

Then it's another 30 minutes flight time back to the hospital where it takes 5 minutes to land and off load the patient. 

That's 75 minutes rather than 28 minutes to get to definitive care. 

LINKS to More Info  

The Ontario Prehospital Advanced Life Support (OPALS) Study – a must read for EMS, investigates cardiac arrest, major trauma and respiratory distress

Rethinking EMS: Don’t Knock ‘Homeboy Transport 

Another STUDY READ THIS

Why Would Anyone Annex Into the LMRFD Raising Their Property Taxes by Hundreds of Dollars if They Get the SAME Services NOW?

Why Would Anyone Annex Into the LMRFD? 

Every time we talk about raising property taxes by a few dollars, people say no. 

So what are the chances of getting people to voluntarily raise their property taxes by hundreds of dollars? My guess is slim to none.

Be Honest, would you annex into the fire district and raise your property taxes by $200 to $400 a year, if you get the same services now at no cost? 

You see they get the same services for free, unless they have a fire or call the ambulance, they pay nothing.... 

If the fire district wants people to annex into the fire district we need to offer them something for the hundreds of dollars of increased property tax? 

Did you know in other fire districts if you call 911 for a medical emergency you get fire paramedics and private ambulance. If the fire paramedics do something like a breathing treatment and you refuse the ambulance ride, it cost you nothing.

In the LMRFD when you call 911 for a medical emergency you get fire paramedics in a private ambulance and it costs you $2200

Things need to change... If you live in the LMRFD and pay property taxes you should be able to get .....................

The LMRFD is 144 square miles while the ambulance CON, the area the LMRFD ambulance is 2200 square miles. The main part of the fire district is made up of two main parts, Dolan Springs and Meadview. The area between the two communities is confusing at best, it's outside the fire district but inside the CON.

The Meadview area especially Meadview City is made up of a checkerboard of parcels in and outside the fire district. If there were two fires at the same time one in and one outside of the fire district, firefighters would have no way to know. The fire district worries about liability with volunteers, where's the liability if they go to the wrong house and someone dies?

In Meadview some parcels just blocks from the fire station are not in the fire district,

If the fire district wants people to annex into the fire district we need to either offer them something for their tax dollars or reduce the CON and let them call someone else..