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4 Challenges Facing the Prehospital System
Pages 31-44

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From page 31...
... human resources. Another challenge for response planning in rural America is risk analysis, which assesses the likelihood of the occurrence and subsequent consequences of an event, and then defines the metrics or markers on which a successful preparedness strategy hinges.
From page 32...
... , · Existing statutes, and · Contingency planning. Dinerman also described the "rural-urban paradox" of prehospital care: the most highly trained responders are in urban America where the transport times to hospitals are short and the need for in-depth prehospital BOX 4-1 Challenges Facing the Prehospital System · Absence of dedicated federal funding mechanisms · Communications capabilities · Weather impact on mobilization and deployment of resources · Acquisition and mobilization of supplies and assets · EMS human resources o Integration into healthcare delivery system o Recruitment and retention of personnel o Transitioning to paid staff to offset decreasing incentive to volunteer o Training and education (time, expense, availability of personnel)
From page 33...
... . · ptimize air medical capability and safety (e.g., designated landing zones, fuel O and support services, automatic weather reporting, night vision goggles)
From page 34...
... Wood explained that the ability to survive an unexpected event, that itself killed 23 people along its 123-mile trajectory, was a direct result of preplanned surge capacity. Vital Link is an active participant in regional preparedness planning and practices and continuously updates its mass casualty incident (MCI)
From page 35...
... Binning advocated educating EMS volunteers about finding and applying for appropriate grants. While both Wood and Binning demonstrated the difference creativity in leveraging community resources can make during MCIs, Binning cited the problem of limited and decentralized EMS funding as an inescapable traditional obstacle.
From page 36...
... Pediatric hospitals and regional trauma centers, for example, likely have specialty care assets and expertise to share, perhaps through remote medical direction technology during the incident or a specialty team that can come to the scene. Communications and Incident Command Systems Robust and redundant communications systems are crucial to an incident command system (ICS)
From page 37...
... Dow suggested, for example, that local service groups such as the civil air patrol or the local flying club could be trained to take over landing zone command during MCIs. Similarly, the first helicopter to arrive will often have three qualified people on board; therefore, one could be assigned as a triage officer, one as a medical officer, and the pilot as the ground officer for the landing zone.
From page 38...
... Quiram encouraged participants to convene all of the stakeholders, including the faith-based community, healthcare providers, funeral home associations, extended care organizations, school nurses and principals, and others who may never have engaged each other on MCI response issues, and discern the community's preparedness level and improvements they can make together. Response is local, Quiram concluded, so communities must
From page 39...
... Without the daily case load of urban EMS, rural paramedics can take on greater public health responsibilities to improve the systems' ability to handle day-to-day care. The importance of maintaining such daily efficiency to adequate surge capacity will be discussed in greater detail in Chapter 5; however, a community can meet its MCI preparedness requirements by establishing a workforce of people with emergency skills to provide a service every day to meet rural health requirements.
From page 40...
... The strategies are built around integrated command centers, standardized communications, flexible authority to alter the scope of practice, targeted training, maintained supply caches in anticipation of a surge response, and established quality improvement mechanisms. The first strategy was the establishment of an incident command and control system that integrates local, state, and federal emergency response using a common operating structure.
From page 41...
... North Dakota's fifth strategy was to amass the necessary surge assets, including personnel, communications equipment, durable medical equipment, and medical supplies. Wiedrich explained that there is a state medical cache of about 3,000 pallets of supplies (roughly 30 full semi trucks)
From page 42...
... The prehospital system is also affected by communication gaps and a lack of resources in rural areas, including equipment, funding, and personnel. Participants discussed the "rural-urban paradox" of prehospital care: the most highly skilled and highest-level providers are generally in urban areas where there are short transport times to care facilities, while in rural areas, with long transport times and limited health care resources, there are fewer providers that can address complex care issues en route.
From page 43...
... Participants raised concerns about the general fragility of the current rural EMS infrastructure. Many rural EMS agencies struggle to meet the basic community needs.


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