Various federal agencies have teamed together to ensure the safety of oil spill responders include the U.S. Occupational Health and Safety Administration (OSHA), the Centers for Disease Control and Prevention (CDC) and the Department of Homeland Security (DHS), which recently released guidelines for those working in Gulf Coast clean-up response at www.DeepwaterHorizonResponse.com.
“Information, education and training is critical to any of the responders,” says Richard W. Patrick, director of medical first responder coordination with DHS.
Accordingly, DHS releases timely information to the first responder community via the Emergency Management and Response-Information Sharing and Analysis Center (EMR-ISAC) on a weekly to semi-weekly basis, Patrick says.
Although petroleum toxicity is a concern, he noted other occupational hazards that can compromise effective situational analysis, including heat exhaustion and dehydration.
He advises, “The first question [providers working in the area] need to ask themselves is ‘do they need to be there in the first place?’ Do they need to be there in the environment of the oil, or can the victim be decontaminated and brought to them?”
For those patients who have been in direct, or even non-direct, contact with oil, what does petroleum toxicity look like?
“The good news and bad news is petroleum toxicity depends upon the compound because nothing is absolutely pure by the time you get exposed to it,” says toxicologist and JEMS Editorial Board member Robin McFee, DO, MPH, FACPM, FAACT. “Petroleum toxicity depends upon the dose and route of exposure as well as your underlying health,” she says. “The impact can go from minimal to no toxicity to severe illness or death depending on a variety of factors—are you upwind or downwind; did you inadvertently get some in your mouth, on unprotected skin or clothing, where it can off gas as a vapor or sit on your skin and cause damage?”
Using the catchall term, “petroleum products,” given the fact that the oil can pick up other chemicals including dispersants, and what you ultimately are exposed to may not be merely crude oil, she describes the symptoms of petroleum toxicity.
For example, skin contact can cause simple irritation to skin necrosis, McFee says. Ingestion can cause gastrointestinal irritation or neurological problems, or it can lead to aspiration of oil into the lungs, causing hypoxia. Breathing vapors from petroleum products or chemical dispersants can cause bronchospasm and lung irritation, especially dangerous to patients with existing lung conditions, such as emphysema, asthma or chronic bronchitis. “Chemical vapors can also cause eye irritation,” she adds.
Medical providers should ask at-risk patients pointed questions about their exposure—the route, length of time in the exposure zone, personal protection equipment used—and focus questions about symptoms accordingly. They should also be careful about environmental hazards when responding, including contaminants on patients. The signs can be subtle or dramatic. Recognize that there are many chemicals in the region and a variety of processes used to address this environmental catastrophe, including burning, which aerosolizes particles. Fumes, particles and other burn off poses a health threat as well.
“This oil spill becomes very complicated because you could just be exposed to a variety of toxicants—the oil—or other things,” says McFee. As the oil spill spreads, there’s no doubt that petroleum toxicity will continue to be an issue, but how much of an issue remains to be seen.
According to McFee, the Exxon Valdez oil spill saw first responders at higher risk for severe psychological as well as physical trauma, like post-traumatic stress disorder. Some studies suggest there have been long-term effects including respiratory problems from breathing fumes, but “there are very few long-term studies looking at this problem,” McFee notes.
When in doubt, contact a regional poison center at 800/222-1222.
—Lorena Nava Ruggero
National Registry Celebrates 40 Years
Nearly 200 people—EMS educators and training coordinators, state and federal officials, medical directors, fire chiefs, ambulance-service executives, military officers, and current and former NREMT employees—converged in June in Columbus, Ohio, for the 40th anniversary celebration of the National Registry of EMTs.
On the afternoon before the celebration, a panel of past and present NREMT board members tried to explain the Registry’s role in the discussion, “The Influence of National EMS Certification on the Safety of the American Public.”
That evening, another panel of Registry notables talked about the Registry’s past, present and future. The panel consisted of NREMT Founding Executive Director Rocco V. Morando; current Executive Director William “Bill” Brown; Board Chair Jimm Murray; former board chairs National Highway Traffic Safety Administration EMS Chief Drew Dawson; Roger White, MD, a cardiologist at the Mayo Clinic, who was a board member for 35 years; and New Orleans trauma surgeon Norm McSwain, MD; Terry Shorr, the nation’s first NREMT (who later worked for the Registry 1993–2003 and was West Virginia’s EMS training coordinator); and Jeffrey Clark, the first NREMT-P in the U.S.
Morando was with the National Science Foundation in the 1960s and sat on the committee that came up with the term “emergency medical technician.”
Morando theorizes that when the U.S. Department of Transportation began designing the first EMT curricula in 1968, those classes would have taught EMTs to deal with only highway emergencies—if he hadn’t objected.
Brown, who has served as executive director since 1989, enumerated some NREMT milestones, including the group’s first board meeting in June 1970; the first EMT exam (which tested 1,500 candidates) in 1971; the first paramedic exam in 1978; the opening of the Rocco V. Morando Building, which now houses the Registry, in 1980; the first EMT-intermediate exam in 1982; the decision by the U.S. military in 1986 to require all its medics to become nationally registered; and the 1998 launch of an ambitious NREMT research project that uses the Registry’s massive database to answer questions critical to the development of EMS. In 2002, NREMT raised its fees by $5—its first-ever fee increase—and in 2007, exam-takers put down their pencils, moving to the Registry’s computer assisted testing.
By 2005, 46 states used the Registry, and some 600 people each day now take an NREMT exam. “We have certified 1,441,000 EMTs and paramedics over the past 40 years,” Brown reported.
As for the future, Dawson says, “We in EMS will be required to be increasingly competent and accountable, and NREMT is uniquely situated to enable that.”
“We all worked together through hard times and good times, and that work has paid off,” Morando said.
—Marion “Mannie” Garza
Improving Accountability in California
Billed as “the biggest administrative challenge the EMS system in California has seen in the past decade,” the state’s EMT 2010 Project came to fruition on July 1 after several years in the making.
In 2008, Gov. Arnold Schwarzenegger signed Assembly Bill 2917 into law, with the goal of improving EMS accountability and oversight. The law required the California Emergency Medical Services Authority (EMSA) to develop a set of statewide standards for certification, disciplinary orders and conditions of probation for EMTs.
As of July 1, EMSA must provide a central registry of EMT and advanced EMT (AEMT) certification data; all certified EMTs and AEMTs must be fingerprinted for state and federal background checks as a condition of certification; and, when requested, local EMS agencies must afford EMTs and AEMTs a hearing before an administrative law judge when taking disciplinary action on a certificate.
The new standardized certification process includes a Department of Justice background check and establishes who can and can’t hold an EMT-1 certificate, according to Steve Tharratt, MD, MPVM, director of EMSA. The new central registry is publicly accessible, providing EMTs’ name, certification number and status. Prior to this, “we had no idea how many EMTs were certified in the state because there was no way to centrally coordinate or check them.”
California is the only state that does not provide a central certification or licensing of EMTs, he says.
The new requirements will also make it more difficult for an EMT with serious disciplinary issues to move to a new service because any adverse certification actions will be recorded on the registry within 72 hours.
For more information on the EMT 2010 Project, visit www.emsa.ca.gov and click the “quick link” to “EMT 2010 Project Information.”
Just an hour after speaking to a producer in Hollywood, Calif., Chronicles of EMS (CoEMS) executive producer Thaddeus Setla spoke to JEMS. The pilot episode of CoEMS was released to an eager San Francisco crowd in February 2010, and it hasn’t lost steam since. The highly anticipated reality series is currently being pitched to Bravo, TLC and Discovery Health. CoEMS is also involved in Oprah’s “Your OWN Show” competition, which is seeking the next television star to appear on the Oprah Winfrey Network (OWN). Setla’s video pitch received 80,624 votes. “It was truly about getting our community to come together to start making this powerful woman understand exactly what we have,” he says.
That’s precisely the project’s intention—building a community and looking toward the future of EMS. In fact, the CoEMS team reached out to the EMS community by creating a naming contest for the series. Stay tuned to see what the project will be named and where you can watch it.
A Shared Responsibility: How can you help prevent certification fraud?
Massachusetts Public Health Commissioner John Auerbach told the Boston Globe the fraudulent certification of more than 200 of the state’s recently suspended EMTs was “a systemic effort to falsify information” requirements—including credit for courses never held or attended.
As EMS professionals, we must uphold the integrity of the certification process at all times. Otherwise, the public will lose the trust they place in us—a trust that has taken years to earn. We each have an individual ethical responsibility to protect the entire process of certification, or the value of that certification will be compromised for all.
How can large-scale falsification of credentials happen in our system? It starts with one person taking advantage of a weak system that allows others to participate in the improper conduct with relative ease. Then the group mentality and “justification” for the improper behavior consumes those involved as they rationalize the conduct. Put simply, this breach of public trust occurs when compromised individual ethics operate in a system that can be taken advantage of—and no one steps up and says, “This is not right!”
We rely on thousands of part-time or volunteer instructors across the U.S. to provide recertification and continuing education programs. It’s tough to manage all those instructors and to monitor the administration of every course. That’s why it’s up to each of us in the EMS system to take personal responsibility for maintaining the integrity of the recertification process, whether you’re a certified field provider, instructor or EMS agency leader. Here are some tips:
Field providers: Never let others “sign you in” to a course. Make sure you attend the course you certify you attended. Keep up to date on your continuing education requirements and obtain your credits well ahead of your expiration date to avoid the temptation that last-minute panic can cause when you’re about to expire. Report others who violate these basic tenets of honesty and integrity so critical to our profession, and be objective and factual in reporting your concerns. (Many professions require the reporting of others observed to violate ethical rules—that’s part of being a professional). We have an obligation to police ourselves. We can’t expect our agency or the EMS office to look over our shoulders all the time.
Instructors: You have a higher professional duty as role models. Set a positive example in what you teach, how you teach and how you respect the certification process. Always follow the regulations and your state’s rules for instructors. Don’t take advantage of your power to certify attendance at a training program that was never held or never attended—even if you’re trying to help someone out and save their certification. By doing so, you ultimately do the individual a disservice, and you compromise the entire system. Don’t make an individual’s recertification problem your problem.
EMS agencies: Insist on frequent validation of credentials—at least annually. And don’t accept “copies” of certification cards or certificates where alteration can go easily unnoticed—demand to see the originals. Check with the state EMS office to verify certification requirements are met. Establish policies that emphasize the importance of individual responsibility in maintaining certification and clearly communicate to all that dishonesty or unethical conduct will have severe consequences. Recognize those who exemplify professionalism and ethical behavior in their duties.
Pro Bono is written by attorneys Doug Wolfberg and Steve Wirth of Page, Wolfberg & Wirth LLC, a national EMS-industry law firm. Visit the firm’s Web site at www.pwwemslaw.com for more EMS law information. JEMS
This article originally appeared in August 2010 JEMS as “Petrol Primer: Identifying toxicity presentation from Gulf oil spill.”