Administration and Leadership, Major Incidents, Operations, Trauma

EMS Leaders Weigh in on Feds’ Plan for National Ambulance Deployment During Disasters

Fire service reportedly derails intention for single private ambulance contract

The federal government is wrestling with the question of how to best prepare for the massive deployment of EMS resources for large-scale disasters.

On April 4, the General Services Administration posted a notice stating that the Federal Emergency Management Agency would issue a request for proposals in May for the national deployment of ambulances in the event of a federally declared disaster.

In September 2006, the GSA issued a similar RFP to cover the remains of the 2006 hurricane season. American Medical Response and Acadian Ambulance Service, Louisiana’s largest service, won those contracts, which expired at the end of 2006. However, federal agencies reportedly now are reconsidering that plan, according to several EMS leaders who attended a federally convened meeting in late April.

In January, the International Association of Fire Chiefs EMS Section notified members that, “Fire departments and fire districts throughout the United States have received a solicitation letter from [AMR] regarding federal ambulance and paratransit support services.” The EMS section said it had contacted FEMA with its concerns about this, “and FEMA has placed a hold on this initiative until it can review the work and recommendations of the IAFC Mutual Aid System Task Force.”

The EMS section advised departments to “hold their response to the AMR solicitation letter until the IAFC and FEMA identify if the fire service can fill the potential need.”

The Department of Health and Human Services Office of Preparedness and Emergency Operations (the new home of the National Disaster Medical System) invited the representatives of federal agencies and some national EMS organizations to the April meeting to discuss the issue and provide feedback. (Neither AMR nor Acadian attended that meeting.)

Meeting attendee Chief J. Robert “Rob” Brown Jr., Stafford County (Va.) Fire and Rescue, a former IAFC EMS Section board member, reported to the EMS Section April 29: “At the start of the meeting, the contract officer was clear that it must be a private contract. But over the two days, we were able to steer them away [from that] to go with the ROSS used by the National Wildfire Coordinating Group.”

ROSS, the federal National Interagency Resource Ordering and Status System, is a NWCG-sponsored software program that automates the resource ordering, status and reporting process to bring large amounts of resources to wildfire locations.

According to the ROSS Web site, “ROSS tracks all tactical, logistical, service and support resources mobilized by the incident dispatch community.” It operates in some 400 interagency dispatch and coordination offices across the United States.

“That’s not to say that AMR and Rural/Metro and other private services can’t type their ambulances and put them into ROSS,” said John Sinclair, immediate past chair of IAFC EMS Section, who also attended the meeting at HHS. He noted that the IAFC’s strategic plan for a national mutual aid system for the fire service, which was released in August 2006, also “decided to utilize the ROSS system, and that system already does include many private resources.”

“I think it’s heading in a right direction, away from a national private provider,” Brown said.

Nevada EMS Director and National Association of State EMS Officials President Fergus Laughridge agreed with Brown’s assessment of the fire service’s influence on federal officials.

Laughridge also expressed concerns with a national contract for ambulance services. “A large private provider could stand up and say [it] will provide X number of ambulances, but the feds haven’t answered where [that contractor] would get them, and what would be the ripple effect. This would affect all states and municipalities, because the contractor would pull those resources [out of their local communities] and [wouldn’t] need to answer to anyone.” he said.

Laughridge’s primary concernƒno matter which way federal officials decide to goƒis to ensure that state EMS offices are kept in the loop. “I look at ambulances generically, but they should funnel EMS resources through a central location in each state, and that’s the state EMS office,” he said.

According to Laughridge, federal officials should let the state Emergency Medical Assistance Compacts handle the deployment of ambulances to large-scale disasters. “It fragments when FEMA, HHS and EMAC may all be calling for ambulances,” he said.

“It’s a misconception that the medical community cannot muster the resources through the EMAC system. We don’t know that to be true because we haven’t truly exercised that system,” Laughridge added. “We found out with the hurricanes that the reaction was to reach out to friends and colleagues and circumvent EMAC. But it’s a slippery slope when we begin to do that. EMAC was put into place for just the reasons we need it now, and if we don’t use it, we risk pulling resources of the state without the state’s knowledge.”

He said the concern is that such deployments could leave states short on resources for daily needs and for other large incidents that might occur.

“It would be similar to what we’re hearing from the Kansas governor about the National Guard,” he said. (Kansas Gov. Kathleen Sebelius reported that the response to the May 4 tornado that devastated Greensburg was hampered because the federal government had deployed much of the state’s National Guard personnel and resources to Iraq.)

Tristan North, the American Ambulance Association’s vice president for government affairs, said the AAA takes the position that the federal government should both issue a national RFP and coordinate with state EMS offices via EMAC.

“Our concern is that a majority of states do not believe that EMAC covers private providers,” he said. “We have confirmation from the feds that privates are included, and we’re asking Congress to clarify this in the homeland security [appropriations bill’s] committee language.”

Although Kurt Krumperman, Rural/Metro’s senior vice president for government affairs, represented AAA at the meeting, he declined to discuss it.

However, he said, “The ROSS is a positive model for having a national database people can draw from. It could probably be built out to accommodate [all types of] ambulance services, and the structure is already in place.”

Krumperman also emphasized that the AAA supports use of the EMAC system, adding, “It’s critical for states to make it possible for nongovernmental resources to be part of an EMAC response; that needs to be worked out at the state level, perhaps with federal guidance.”

To further address the issues related to a national ambulance deployment, NASEMSO is inviting federal officials and EMS organizational representatives to a June 20 meeting in Arlington, Va. (right after the NASEMSO mid-year meeting).

“We’ve invited the fire chiefs, firefighters, AAA, [National Association of EMTs], EMS managers, Jeff Runge [MD, chief medical officer, Department of Homeland Security], Jon Krohmer [MD, his deputy], NHTSA, Sandy Bogucki [senior medical advisor in the HHS Office of Preparedness and Emergency Operations], the Department of Defense, FEMA and way more,” Laughridge said. “Our hope is that if we have all those folks in the room, we will have a clearer picture.”

Krumperman said AAA had been working with NASEMSO to organize this meeting before HHS convened the April meeting. “We think it’s crucial to get all the stakeholders together,” he said.