Traffic Incident Management and Emergency Medical Services
Paramedic James D. Garcia
Scene safety at emergency and accident scenes is beginning to draw attention on many state and federal levels. The federal government, through the Department of Transportation and Federal Highway Administration, has begun addressing the safety of responders at these scenes after a number of high profile deaths and serious injuries. Many professional emergency response organizations are now committing themselves to finding ways to reduce the number of injuries, decrease scene clearance times, and increasing interagency cooperation at serious traffic incidents.
As these new Traffic Incident Management (TIMS) guidelines and recommendations develop, it is important that the Emergency Medical Services industry participate so that their unique needs are incorporated into the systems. First, however, we must look at where we as an industry currently stand on the issue of scene safety and traffic incident management.
When EMS is dispatched to a traffic accident, in many parts of the country we are often the first arriving agency. In some areas it may take up to an hour for Police backup to arrive and assume traffic control duties. In some areas, Fire Services may also respond to assist with traffic control and scene safety, but this may be delayed, and many times not readily available.
This can leave EMS in charge of securing a scene, assessing the scene safety, triage, assuming medical care duties, crowd control, traffic control, extrication, immobilization, loading and transport. This must be done at the same time as coordinating incoming resources and vehicles. Add to this the inherent danger of working in an extremely unsafe environment- vehicles going 70 to 90 mph whizzing past within inches of medics who are trying to save a life.
The importance of Traffic Incident Management cannot be denied, but it is an issue that is currently not a priority to most EMS professionals. Some of the reasons for this oversight:
1. No National Leadership
No one runs EMS on a national level. We have no one to issue training guidelines or directives. DOT runs an EMS Division, but they only put out suggestions for state protocols. They have not coordinated or addressed this issue as of yet. We have very few professional organizations that can communicate training on this level. The National Association of State EMS Directors would be the most logical choice to address this, but their concerns mainly deal with the medical aspects of EMS.
2. No Interstate Communication
EMS works on a state-by-state basis, with each state devising their own systems, standards and training. The prospect of working with each state one-by-one are overwhelming. States also cannot be mandated to include this type of training and there are no ways to enforce consistent standards.
3. No Training
Every day, in every county of this country, a Paramedic or EMT walks onto the road at and accident and does the best they can to handle all the factors mentioned above. This can be overwhelming enough, but it becomes even more of a danger when you realize we have never received any training in traffic incident management. We have learned by observation and experience, but this is not a legal and legitimate way to handle such a serious task. All EMS providers should be trained to a national accepted standard. The problem is, we don't have one of those, either.
4. No Interest
EMS has a different set of priorities. We must concern ourselves with the medical aspects of trauma and emergency medicine. We are self-funding, and due to budget constraints and poor reimbursement, have a difficult time justifying new training and equipment. We have volumes of state medical, legal and ethical regulations to fill up our time. The new HIPAA guidelines will also take up a large portion of our resources.
We are a loose system that tries to operate independently and competitively. This reduces the time, energy and interest we have toward making traffic incident management a reasonable goal.
5. No Funding
Great Idea, but who is going to pay for all this?
We are poor. Imagine a Police or Fire department being forced out of business because customers won't pay their bills. It could never happen- these are Community Services and belong to the municipalities. EMS services are frequently shut down due to lack of reimbursement and competition. The traditional 911 EMS service is in severe danger due to government cuts in Medicare reimbursement and lack of community tax based support. Some are being absorbed into the Fire Service. Other areas are switching to privatized services. Without some kind of financial change, 911 EMS is an endangered species.
6. No Cooperation
To put it bluntly, the highway belongs to the Highway Department. They don't want us there, and they certainly don't want us in charge of traffic or anything else. With our limited training, can you blame them? But there are other problems involved. Interagency communication is non-existent. Highway Officers have been known to move emergency vehicles if they don't like their position. Their only concern and priority is the rapid clearance and re-opening of the highway, and have a lack of understanding of the goals of EMS at these scenes. This has even led to fist fights and court battles. The TIMS goals work toward improving cooperation, but changing attitudes will be the toughest part of the battle.
7. No Guidelines
There are several local guidelines offered- the Lionville White pages, the FHWA TIM guide, the National Fire Service IMS Guide. But none of these have been finalized into a national standard through a federal or state agency that demands we must certify to a standard. Send all the guidelines you want, we've got other stuff to worry about until someone with authority tells us we have to have it.
Now, with all the problems before us, what can we do to work towards a goal of improving scene safety?
1. Strengthen the role of DOT EMS.
We want guidance, and someone who can tell us exactly what it is we are supposed to do. DOT EMS is the only federal agency we have anything to do with. Beef them up, put them in charge of coordinating these guidelines and issuing them to the states. They also need to strengthen their ties with the national Fire Service, FEMA, and the National Association of State EMS directors. Include scene safety management as a standard part of regular EMS training.
2. Mandatory TIMS Course
All emergency responders are required to take an "Emergency Vehicle Operations Course" from the National Safety Council. The NSC also offers a Flagger Training course, which could be combined to reflect aspects of Traffic Incident Management. This course should also be included as a "recommended" mandatory course.
3. Recognition of Issue as a Priority
Not just by EMS, but by others in the industry. Federal workplace safety standards should apply in our line of work. The construction industry long ago got the government involved with protecting their workspace. It's time we demanded the same protection and standards. Some states have "Move Over" Laws, but these are spotty, inadequate and not often enforced. They need to be better supported as just one small factor in accepting the nature of our work, and the need for better protection.
4. Funding
Again, who did you say is paying for all this? We don't have that kind of cash. The government's not doing it for free. If this is so important, some one has to sponsor and offer this training on a street level to all the organizations that require it. The Department of Transportation? The National Safety Council? The Federal Emergency Management Agency? The Occupational Health and Safety Administration?
Someone needs to accept responsibility for EMS enough to help fund these initiatives.
5. Publicity
EMS as a service needs to finally address TIMS as a goal and challenge. Our industry publications- JEMS, EMS Magazine, Firehouse; and the Mosby and Brady EMS Textbooks- have a responsibility to address the issue as a future requirement. We cannot treat the frequent stories of Emergency Workers injured at scenes as unique and isolated, but as part of a tragic growing pattern that must be addressed.
EMS has a long way to go before it is ready to incorporate TIMS guidelines into its day to day operations. We are familiar with the concept, based on our role in Incident Command Systems training, but seem to have a hard time focusing on scene safety being our own responsibility. I hope to increase awareness and participation until we can find a funded source willing to assist in bringing EMS online for their role to help reduce injuries at secondary crashes.