DOH approves use of singular medics for trauma aid response

The Department of Health has eased concerns among local emergency aid agencies by stating they do not need a minimum of two medics when responding to a scene, only for transporting a patient.

The issue had been raised among officials during the Aug. 20 meeting of the Lewis County Medic One Interlocal Board, at which time Board Member Randy Pennington, with Lewis County Fire District 15, said his district had directed EMTs to not dispatch their ambulance until a required two medics were on board.

This declaration quickly created friction with EMS personnel from member districts, as past practice has been for one responder to drive the ambulance to a scene and meet a second EMT or paramedic before departing for the hospital. But Pennington insisted doing so would be, in his interpretation, a violation of the Washington Administrative Code.

"I cannot find any authorization that will allow District 15 to roll that ambulance out with one EMT to go meet a paramedic somewhere," he stated. "The way the statute is written, the ambulance does not roll unless it is properly staffed."

Pennington said the motivation for such strict adherence to what he himself called "ludicrous" regulations was to remove his district from liability if an incident were to occur involving an understaffed ambulance. He said it would be one thing for District 15 to be found liable for negligence if it was an honest mistake and could still be covered by its insurance provider, but said foreknowledge of the rules would lead to a finding a gross negligence with his district shouldering all resulting legal and financial burdens.

"Under law, there is no insurance policy in the world that will pay a community’s damages on a gross negligence claim," he said.

Pennington’s recommendations to the Inerlocal Board, which consists also of representatives from Lewis County Fire District 2, in Toledo, and Lewis/Cowlitz Fire District 20, in Vader and Ryderwood, had been to cease ambulance dispatching practices which would place their agency in liability and to seek a variance from the Department of Health (DOH) allowing them to continue offering ambulance services at their current capacity while remaining within the confines of the law.

Officials have since been in touch with DOH and, in an interview Thursday, Regional EMS Supervisor Mike Lopez said his department believes it is in the best interests of patients in the area for local aid agencies to continue past practice.

"The letter of the law needs to be more flexible, at far as its intent," he said, stating he does "commend" officials for their attentiveness to legal liability. "What we don’t want is for an ambulance to remain on scene and delay patient care."

Lopez added the challenges facing local aid agencies struggling to maintain an adequate roster of volunteer EMTs is occurring nationally, particularly in rural America, as people are finding less free time due to longer commutes, and sometimes a general unwillingness to volunteer.

"This is a phenomenon that is truly going on throughout the United Stated," he said. "There’s just a drop-off in the number of volunteers."

When asked about the practicality of requiring two medics for trauma patient transportation, when local medics say trauma patients are simple to stabilize and one medic should be enough, Lopez replied his department is charged with keeping the best interests of the patients in mind and having two trained individuals in an ambulance is what is needed to maintain adequate patient care.

"There are those circumstances where you will need two sets of hands, and you want those hands to be medically-certified," he said.

Lopez added his department was drafting a letter to the leaders of local aid agencies, as well as Lewis County Medical Program Director Patrick O’Neal, stating they will be in support of local EMS practices and will allow Medic One and its member districts to continue as they have been.