Kevin N. Saisi CADC EMT

I had a similar discussion a while back with a collegue. His opinion was that "transfer medics" from the city have no clue what to do in rural emergency situations. When you are 30 minutes from a hospital, you have to handle the situation the whole time. His opinion was that you need to be well seasoned as a rural medic to be able to handle the prolonged transport time. Most IFTs are either not critical or under doctor's orders. When you arrive on scene and have to decide for yourself what is going on, THEN you are practicing REAL medical skills. Many times we have to handle such situations at the BLS level for 20 to 30 minutes. I would guess that the IFT providers don't usually have to do that too often. Skills don't maintain if you don't use them.

Well, in the great State of Vermont, where I hail from orginally, there definitely a "P" sound at the end. You could argue it was "Ay-yep", but never "ayuh", not unless its Jud Crandall in Pet Sematary, that is.

If you had said "as they say in Vermont" instead of "as they say in Maine" I would have had no problem with your comment.

I didn't see a specific thread for this topic, so here we go. I will start off with one from my experience...

I arrived to an ambulance call where the truck and crew were already on-scene as I arrive, a driver was approaching the truck from inside the building. As I approached, he said to me "[his partner] sent me out here to get the porblows" and asked me where they were on the truck. I chuckled and informed him that his partner was referring to the O2, which he called the "portable Os". The driver (who lives in town) is now an EMT with many more hours under his belt than I have (I work part time and live out of town). He is now well aware of both the appropriate and slang terms for everything on the ambulance.

Lots of chuckles on this one...

"Need a unit to respond to [address] for an 87 year old female on the toilet, needs help getting off"

When they repeated the call, they clarified she needed help getting off of the toilet.

Well, in the great State of Vermont, where I hail from orginally, there definitely a "P" sound at the end. You could argue it was "Ay-yep", but never "ayuh", not unless its Jud Crandall in Pet Sematary, that is.

When my grandmother used to say it , it sounded like someone saying "a-yu" while breathing inward. When she really agreed with you she would say it four or five times in rapid succession leading the unsuspecting bystander to think she was having a breathing problem.

As they say in Maine, YEP.

Actually, it's spelled "ayuh"

I will tell you though, I believe she is "from away", and not a "native mainah"

EASY TURBO! It wasn't a loaded question. At least it wasn't intended to be. I WAS genuinely curious about what you guys do. As has been stated by others yourself included, medical response is not and should not be your responsibility. It sounds like you perform support for emergency services already on scene which frees up people to do their jobs which is fine. What I don't know is what costs you accrue for staff, fuel, equipment, reimbursement to volunteers, etc. I jumped on a guy a few months ago here without taking the time to understand his point of view and regreted it.

I don't recall saying that medical response is not our responsibility. In certain events, the MRC may provide members to staff ambulances, or first respond to medical calls. MRC members range in qualifications from support functions to neurosurgeons. One of the Maine units is run by a Botox nurse who cliams to be ready to handle any Botox emergency that may arise . Due to the diversity of members, involvement in a disaster may involve members doing any function up to the level of their licensure & training.

As for our activities, I can only say that we live in Maine where disaster is as rare as a humble paramedic. We have been working with area providers to establish plans in acordance with the recent Presidential Directive requiring such services to have a plan for surge capacity. Please remember that there are differences between urban teams and rural teams, Hospital based teams and EMS based teams, and teams in high risk areas vs teams in low risk areas. No two MRC teams are exactly the same despite the fact that we share promising practices, operations forms and National Core Competencies.

Not saying that one community would have enough people to handle a major disaster. But if funds were distributed so all services properly staffed and equipped then in disaster all surrounding areas could afford to send people and equipment.

Except a global event such as a pandemic.

How often does your team respond to an emergency?

What does that have to do with it?? The comment made implied that money was being wasted on teams such as ours, but we don't even have the money to place an ad in the paper. A disaster team needn't be called out on a regular basis, but it should be prepared when needed. Our community has no plan for surge capacity in any of the related agencies. Luckily, President Bush recently signed a directive requiring such agencies to develop such plans. Our service area has 75 hospital beds. If we had any kind of regional event, it would be a cluster ****.

What money?? I am working with no budget.

Emergency Support Function Annexes

ESF 1 - Transportation

ESF 2 - Communications

ESF 3 - Public Works and Engineering

ESF 4 - Firefighting

ESF 5 - Information and Planning

ESF 6 - Mass Care

ESF 7 - Resource Support

ESF 8 - Health and Medical Services

ESF 9 - Urban Search and Rescue

ESF10 - Hazardous Materials

ESF11 - Food

ESF12 - Energy

There, is that better??

I understand that not all EMTs (or dare I say Paramedics) know much about disaster planning. I don't complain about the functions of city fire and EMS because I don't have sufficient knowledge of how they work. I have heard of striking alarms and tiered response but would be hard pressed to argue against the function of any service based upon my knowledge. Likewise, I would encourage those who have concerns about disaster response teams to learn about the systems in place and the functions of each before arguing that we have too many teams.

Sorry,

ARC - American Red Cross

OSG - Office of the Surgeon general

I am surprised that we are even having discussions about who does what without reference to the ESF categories. Here is some information from the FEMA web site:

Emergency Support Function Annexes

1. Transportation

2 .Communications

3. Public Works and Engineering

4. Firefighting

5. Information and Planning

6. Mass Care

7. Resource Support

8. Health and Medical Services

9. Urban Search and Rescue

10. Hazardous Materials

11. Food

12. Energy

Please visit http://www.au.af.mil/au/awc/awcgate/frp/ for the definitions.

The ARC's primary function is under ESF#6, with support to ESFs#5,8 and 11. Although not listed in the matrix, I would presume, based upon training, that CERT provides support on ESFs #6,9 and 11. The OSG informs me that we are ESF#8, but we provide support in other areas based upon special needs, such as special needs shelters in which behavioral, mental or other health needs would need to be addressed.

Certguy,

While you are obviously welcome to join whatever group you please, and neither program has teams in every location, I believe that your training as an EMT would better serve your community in the Medical Reserve Corps. In a disaster in which both CERT and MRC are present, the MRC will likely be the ones providing the majority of the medical care. CERT teams are trained to provide care for those found while performing other tasks. MRC provides surge capacity for all established health care services from onscene triage to post mortem verification. Of course, each CERT and MRC are run differently. If your community does not have an MRC, your concept of how CERTs can assist will vary from communities in which an MRC does exist. I believe that some of those who are advocating for one group or another on this forum either don't have both teams in their community, or they haven't taken time to learn about the other teams. I am an MRC Unit Coordinator, but have also taken most of the CERT modules, so I am not just blowing hot air when I speak. The MRC comes under ESF #8, while CERT is either ESF #9 or ESF#6 (I don't remember which). If you look it up, you wil see the difference between the two functions.

The purpose of CERT as I understand it, is to assist in communities in the event of a disaster. CERT members are trained to perform basic first responder functions until EMS, Fire or Police can arrive.

While CERT teams are trained in first aid, it is not their primary function. They are more like the old Civil Defense block captains; they work to make sure that their communities are safe by supporting the functions of a number of agencies including medical. The Medical Reserve Corps is primarily a medical unit that tends to include licensed medical professionals and others with skills to support medical functions.

Having taken the CERT medical modules, I can say that I wouldn't want a CERT member to be responsible for much more than controlling bleeding. The training doesn't even qualify one to be First Aid certified by the Red Cross.

It doesn't take EMTs to distribute drug stockpiles from the central storage. Seems like a waste to me.

In Maine our state level CDC is a relatively small agency. We have no health officials at the county level, and our local health officer states that her job is to "tell people where to go". There is no structure in place to provide mass prophalaxis. If such services were required tomorrow, authorities would have to rely upon the understaffed hospitals. In Maine the MRC is authorized under Maine CDC for preparedness purposes. This means that at least six of the counties would have a structure for distributing the vaccine.

In times of a major health emergency, the system of triage using color codes will be used. Those who are triaged as green or yellow may still need medical assistance. Our Red Cross has made it quite clear that they will be concentrating upon shelter operations in this area due to the number of volunteers they have. If the MRC does not provide care for the lesser injured people, they will have to rely upon the care of spontaneous volunteers who are not trained nor credentialed, and certainly have not had a background check nor NIMS training. While we may have some volunteers who are licensed at a higher level, the majority of our medical membership will be below the EMT level. While we strive to be able to provide care to as many people as possible, we also see the need for people to provide support functions such as registration, sanitation and decontamination. We are there so the paramedics aren't tied up emptying trashcans.

One last thought: Before we judge how a program will be implemented in another community, perhaps we should know the plan for that community. I am certain that we in our county of 50,000 people do things much differently than in New York City. We don't have the resources that you have. I live in a community of about 15,000 people, and sometimes we have a difficult time getting a crew for that 4th ambulance.

You seem to have it all nailed down. I mean youve seen pictures of half a dozen or so team members, and most of the ones in the picture you are mentioning are nurses, commo, logistics, etc. I think other than the nurses, there is one medical specialist in that photo, but I could be wrong.

Youve missed what I said from the beginning so to try to civilize the tone, I will try again. Im not saying we are going to take anything away from anyone. If nothing else, we have far greater resources by shear volume than the CFD. We show up about 4 hours post event and fill the gap between overwhelmed local responders and the arrival of the feds. And DMATS dont go overseas, so the Iranian earthquake is out. DMATs are federally funded and operated by their individual state. Hence their designations as DMAT-MA-1 (Disaster Medical Assistance Team- Massachusetts-Task Force 1. The team to which I belong shows up at the request of the Governor of Illinois or with the signing of a EMAC (emergency medical assistance compact). We are there to help local and other state teams, including the NG. Yes, we do have the right to commandeer local resources...maybe thats right, maybe its not. Take it up with governor Blegoiavich. Im sure he would listen to someone from outside the state who doesnt know a thing about how these teams operate. He has been behind us since he took office. As have the Presidents who have awarded members of the team special Presidential Citations. Youre a medic. We show up in your town. If you are part of a command team, our command team will meet yours in the TOC and say "what can we do to help you" and you, if you were overall IC would tell us. Then we would start talking to our logistics and commo boys and set up a command center of our own complete with things like satellite phones, weather radar, direct lines to Illinois or other state governors and Washington. If there ever was a true example of "We're from the government and we are here to help" its teams like IMERT and the various DMATs, etc. Im sorry that you and folks like you have a problem with it. Im sorry you think we are glorified EMTs. Thats not even close to the reality of the situation. Before I joined up, IMERT deployed three seperate teams to the Gulf Coast, which you know if you saw our site. We also deploy to events where there are large groups of people in huge public venues. We have the assets of the NG and ANG at our disposal per orders of the Governor. We're not coming in to take anything away from anyone. The closet we get to ambulances that I know of are John Deere gators modified with roll cages and med beds. We are there to help you. But those field hospitals of which you speak so nastily can mean the difference between life and death. They can be heated and air conditioned, as can our trailers, which when emptied of gear and vehicles can be used as further command posts and team quarters. Are you really that threatened? I must admit I dont get it. Did you ever check our that map I recommended. The kinds of events it shows are the kinds of things we respond to or go on standby for. We have more than 1000 members throughout the state any number of whom are on call at any given time and ready to deploy and those whose comittments require that they serve on a general medical or sort of a second wave team.

I know I came out guns blazing and that that could be an embarrassment to the team and for that I am sorry. But for the life of me I can understand why, living in Oregon or Massachusetts or Florida (which by the way has one of the country's best DMATs) you would not want high tech, high volume help which can provide you with personnel and material you may not have. If your responders homes are destroyed, we can house you. If you run out of something, we likely have it. The shear quantities of assets alone that we can bring to bear should be a comfort and not a source of rivalry. IMERT, DMATs, Disaster Mortuary Teams...all here to help the people of their respective states when asked. Its just that simple. Your governor says "we need more boots on the ground"and we can send you EMS, logistics, communications, nursing, HAZMAT, WMD specialists, dentists and even veterinarians. As part of theOffice of Homeland Security/ Illinois Terrorism Task Force, in the unthinkable event that something like 9/11 happens to you, or something even worse, how will your agencies respond if 2/3 of their responders are dead or critical. We provide medical for the ITTF and USAR teams. When we work along side you, your going to be safe because we are provided with security teams from the National Guard MP batallions. Our medical director is head of Emergency Medicine and Trauma at a level 1 in Chicago. Our team commander and deputy commander are both CCP and flight medics.

So at first I gave a bad impression and made it sound like we would swoop in and save you from yourselves. That isnt the case at all and if thats what it sounded like I apologize. We are mutual aide on a huge scale. Everyone associated with the team is the best at what they do and in their chosen discipline. Thats why they are there. My field happens to be disaster/terror medicine. I will be training at Hadassa Hospitals Terror Medicine Center on a fellowship next summer. EMS and Disaster/Terror med are different fields. We are trained and continually train to deal with MCIs on massive, massive scales. If being proud and honored to serve with the first team of its kind in the country and one that is acknowledged by those in the disaser/terror med field to be among the very best is wrong, them Im wrong. Illinois falls down in a lot of places in EMS. But IMERT isnt one of those weak points. We were first set up to work in IL alone. Then Katrina happened and we were called into out of state service. This is now part of our protocol. Im sorry that intimidates of angers you. Do you have this reaction to the National Guard and FEMA showing up. Would you rather do it all by yourselves no matter what it is. All i want to be is the best I can be at what I do and I spend hours each day working toward that goal. Someday the seams will disappear. But until they do, history shows this is the best practice way to do things

The mistakes you made in representing the organization to which you belong are the very reason that I restrict members of our group from representing the griup in public discussion. If a response is to be made, it needs to come from someone in a leadership position, in accordance with ICS practice. Everybody makes mistakes, but those in leadership usually take care to choose their words more carefully and not enroll themselves in long debates defending their organization.

Have a GREAT day,

Kevin

Just for clarification, CERT and The Medical Reserve Corps are affiliated programs. Cert is more of a general disaster response program in which people are trained to staff shelters and support their neighborhoods after a disaster has passed. They do learn how to do some light S&R techniques and basic first aid. The Medical Reserve Corps is a program to assist the medical community when it is overwhelmed. In our community we have designated teams under six categories: Hospital, EMS, Public Health, Mental Health, Case Management and Public Education. Each of our teams is set up under the agency they will serve. Our focus is primarily our home service area, as opposed to DMAT and other surge capacity teams who respond outside of their home area. Here in Maine we believe in self reliance. If we cannot handle a situation ourselves, then we will (reluctantly) ask for help. I hope that this has been helpful.

Have a GREAT Day!

Kevin N. Saisi, CADC, EMT-B, Unit Coordinator

Oxford County Medical Reserve Corps

P.O. Box 334

Rumford, Maine 04276

(207) 357-3468