Question: In a true crisis, what do we want our EMS services to do?
Answer: Respond as best they can and get the patient to the most appropriate place of care.
In an unprecedented crisis – like the current COVID-19 pandemic – EMS cannot afford to be hamstrung by regulations that govern “peacetime” operations, such as the makeup of the crew, having a driving certificate that qualifies you to negotiate road cones or the artificial boundary line that defines one service jurisdiction over another.
This “Let’s get the job done” approach was adopted by the Minnesota EMS Regulatory Board (EMSRB). On March 13 the board released a memo based on Statute 144E.266 suspending Emergency Ambulance Services for a minimum of five days but with a possible extension of up to 30 days that could be authorized by the State’s Executive Council.
Keep EMS staffed and operating
The order states that “during this declared emergency, normal operations should be maintained when possible.” However, operations may be modified, as outlined below, when necessary.”
Breaking the statute down, it simply entrusts an EMS agency to do whatever is necessary to provide service during a national emergency.
Services are authorized to provide the highest available trained staff even if this means a responding crew member has no certification (but is acting under the supervision of another). Related to this, the minimum requirements for interhospital transfer are also lifted. This could mean that an ambulance crew comprises a certified attendant and a basic driver. In terms of the driver, the additional removal of the EVOC qualification means that a “civilian” driver can also operate the vehicle if necessary. The ambulance could also conceivably be staffed by a single person if it keeps the service available.
Service designation and locality
The statute also allows services that cannot physically provide a 24-hour service to temporarily close, presumably to allow for crew rest and recuperation. Additionally, the designation of the ambulance provider of ALS or BLS is removed and all are simply “ambulances” and can all be sent to any and every call for service. The statute’s removal of Primary Service Areas means that the emergency ambulance response isn’t constrained to its own and original jurisdiction.
Stock and equipment
Ambulance stock and equipment are also covered. The state list of mandated equipment is suspended, as are the regulations governing the maintenance, sanitation, storage and testing of equipment, supplies and drug requirements. Minnesota also allows for the use of expired items, although they defer to the CDC for the definitive list.
Prehospital care data
The requirements for prehospital care data are waived, and I assume this to be CARES and NEMSIS state data requirements, but organizations are (and should) maintain basic data to understand the volumes and conditions to preserve their activity for the future.
What comes next for EMS leaders
In the coming days, weeks and months, EMS leaders will need to make brave command decisions to keep services levels up and serving the population. Minnesota’s actions have been the first, but I suspect not the only, regulatory constraining domino that will fall.
Minnesota’s statute was also released on the same day that the Interstate Commission for EMS Personnel Practice approved the use of the EMS Compact process, effective March 16, in response to personnel needs associated with COVID-19. This decision enables EMS personnel licensed in Compact member states (home states) to cross state borders using a privilege to practice and work in other Compact states (remote state) without getting an EMS license in the remote state. The compact contains 18 member states with two further states awaiting a governor’s signature. It may be that we may have to rapidly revisit this (now that the need has truly arrived) to rapidly induct the remaining half of the country not currently involved.
In analyzing our current situation, I reflect on my time as a military medical commander where we adopted the view that in the event of a high battle casualty day, an ambulance would be whatever I designated it to be. In other words, if the needs of the moment meant employing flatbed trucks with the cooks driving, then so be it – the priority was to evacuate and save a life. I think this is what Minnesota has just empowered its EMS systems to do.
