Rules for Missouri Ambulance Districts

XIV. Training, Physical Fitness and Equipment

Today’s EMS

Nearly 20 million patients are treated every year by EMS in the United States. Many of these patients have complicated medical or traumatic conditions that require considerable knowledge, skill and judgment to be treated effectively in pre-hospital settings that were not possible just a generation or two ago. Proper care of the critically ill or injured can literally make a life or death difference that was previously not possible. Even if a crisis is not a matter of life or death, it is no less significant to patients and their families. High quality EMS has become an important part of the United States health care system.

Minimum training in Missouri

Nationally and in Missouri, minimum levels of training for EMS personnel have been set. However, it is up to the AD board to ensure minimum levels of competence through hiring qualifications and medical direction, which by state code of regulations (19 CSR 30-40.303[3][C][D][E]), is required to ensure EMTs and paramedics meet education and skill competencies.

EMT and paramedic training is available from EMS training centers licensed by the Bureau of EMS in the Missouri Department of Health and Senior Services (DHSS). EMS and organizational leadership classes are available from the University of Missouri Fire and Rescue Training Institute, sometimes for a fee, though grants may be available to cover the costs. (See License and certifications under Chapter XIX. Ambulance Services for more information regarding training for medical licenses and certifications.)

Advanced training is available from both these sources, as well as from the U.S. Fire Administration National Fire Academy, which is part of the Department of Homeland Security. EMTs and paramedics who attend the fire academy receive reimbursement of travel expenses, meals and dormitory space during training.

Physical fitness

Physical fitness may be nearly as important as EMS training. EMTs and paramedics need to eat right, exercise and get regular medical checkups. Everyone in an AD benefits when an AD board encourages better physical fitness for its EMTs and paramedics.

The leading cause of death among EMTs and paramedics is sudden cardiac arrest. This is true for both career and volunteer EMTs and paramedics. EMS involves long periods of intense boredom waiting for a medical call followed by short periods of extreme stress, physical activity and sometimes danger. Nationally, about 20 EMS personnel die each year; sudden cardiac arrest causes about 20% of these deaths. No statistics are published about nonfatal EMS personnel injuries; however, ADs could learn from reviewing online summaries of near misses.

Physical fitness also includes being protected against infectious diseases and bioterrorism. AD s must provide vaccination programs for all employees and volunteers who may be exposed to infectious diseases; however, participation in such vaccination programs should be voluntary.

AD boards should create a safe and healthy culture and work environment by adopting health and safety policies for all aspects of the AD. The board should also consider appointment of a certified safety officer with adequate budget and real authority to keep everyone safe. When creating a safe and healthy culture and work environment at the AD, members of the AD board should lead by example in their personal lives.

An AD Health and Safety Checklist can be found in the Sample Forms section of this manual.

Many national emergency service organizations support the Everyone Goes Home program to prevent line-of-duty deaths and injuries — and AD boards should consider supporting the campaign, especially because the second of 16 life safety initiatives is aimed at elected EMS officials:

Enhance ... organization accountability for health and safety throughout.

Equipment and grants

To properly provide staff uniforms and equip an ambulance is expensive for these four main elements:

  1. EMT and paramedic uniform, including footwear and U.S. Department of Transportation required reflectorized vests, jackets or coats for all types of weather and to help make EMTs and paramedics visible on the scene;
  2. Equipment, instruments, medical devices, kits, pharmaceuticals and supplies for infection control, diagnostics and treatment; patient handling equipment; and for some ADs, specialized tactical and rescue equipment and supplies;
  3. Personal protection equipment, or PPE, which includes items such as masks, gloves, gowns, glasses, reflectorized vests; inoculations; etc.; and
  4. A portable radio for communication within the incident management system.

Proper working EMS equipment is critical for effective EMS and safety (see Federal and state rules and regulations for ambulance services under XIX. Ambulance Services for more information about medical licensing of and equipping ambulances.)

Many ADs use automated external defibrillators (AEDs). The law (190.092) and FDA regulations for a class II medical device require an AD  to make sure expected AED users receive nationally recognized training in cardiopulmonary resuscitation (CPR) and AEDs, the AED is maintained and tested according to the AED manufacturer’s operational guidelines, and that clinical protocols, or “doctor’s orders,” are approved by the AD’s medical direction. Medical direction also must review all situations when the AED was used (190.092.2[4]). ADs are required to equip each basic life support (BLS) ambulance and stretcher van with an AED and staff each with at least one individual trained in the use of an AED (190.060.7; 190.092.5).

Many ADs also use epinephrine auto-injectors, commonly known by their trade name EpiPen; however, similar to AEDs, without completing a state-approved epinephrine auto-injector training course, no one without a medical license or certificate can use one (190.246.2[1]). ADs with epinephrine auto-injectors must use, maintain and dispose of the devices in accordance with the Missouri Department of Health and Senior Services (DHSS) rules (190.246.2[2]).

The federal government has several grant programs administered by the U.S. Fire Administration to help communities pay for equipment and facilities. These include Assistance to Firefighter grants and the Staffing for Adequate Fire and Emergency Response, or SAFER, grant program. Applications for both programs must be submitted electronically. The programs are highly competitive but helping to provide protective equipment is currently a high priority for the government.