State of Utah, Department of Health
MC# 2090525: - From David N. Sundwall, MD, Executive Director: I would like to thank the NTSB for recognizing the importance of having an integrated EMS system in place to respond to such tragic crashes as occurred in Mexican Hat, Utah. We recognize, as public health officials, that the most common mechanism of injury in rural areas is blunt trauma from motor vehicle crashes. Rural emergency healthcare providers face numerous challenges such as the access and discovery of the incident location, communications dead spots because of geography, long transport times, inclement weather, and limited resources. Optimal care for injured patients in rural areas requires sufficient funding to support an inclusive and regionalized system of emergency healthcare, with the resources needed to meet the needs of communities and robust enough to "surge up" in the event of a disaster. The recommendation we have been asked to respond to is H-09-6: "Establish written contingency plans for response to large scale transportation-related emergencies along rural roads traveled by tour and charter buses, such as occurred in Mexican Hat, Utah, that cannot be handled by air medical services due to inclement weather." As part of our response to the recommendation, we decided to take a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis approach to our capabilities in accomplishing the action identified in the recommendation.
1. San Juan County and other regional EMS systems have Mass Casualty Plans in place utilizing the Utah Mass Casualty Incident Plan as the foundation. (Please see attached MCI plan).
2. Utah has prior experience is assessing capabilities of healthcare providers (hospitals) through our administration of funds and activities associated with the ASPR grant.
3. Availability of State EMS Strike Teams, Disaster Response Trailers, and integrated disaster plans.
4. Affiliation of Utah Department of Health staff with the National Association of State EMS Officials (NASEMSO), the Association of State and Territorial health Officials (ASTHO), and the National Organization of State Offices of Rural Health (NOSORH). Long established partnership with the Utah Highway Safety Office.
6. Established county EMS councils with representation from EMS, fire, law enforcement, dispatch, public health, hospital, and emergency management.
7. Experience in disaster planning, training, exercises, and response by state EMS personnel.
8. Availability of Paramedic and Advanced EMT training in Utah to provide ALS care in rural areas.
9. Enabling legislation to designate trauma centers and establish a statewide trauma system.
1. Limited Utah EMS staff and restricted funding to travel to rural regional EMS systems to provide technical assistance.
2. Lack of resources and criteria to evaluate capabilities of EMS systems.
3. No standardized method to quantitatively profile the capability of EMS systems.
4. Reduction in Force for MCI and EMS disaster planning staff.
5. Insufficient local, state, and federal funding to EMS providers for disaster preparedness and basic infrastructure development.
6. Obvious and inherent nature of rural areas: isolation, rugged geography, limited resources, weather, and transport times.
7. Unavailability of data and resource assessments from contiguous states.
8. No integration of EMS response capabilities across state lines.
9. Lack of data to specifically identify roads in rural areas traveled by tour and charter buses.
10. Limited communications capabilities in rural areas for access and response.
1. Recognition by NTSB of the importance an EMS response is to large scale rural transportation crashes.
2. Foster relationships with other state, national, and federal partners to address the safety of rural roads, identify counter measures to prevent bus crashes and improve the ability of rural EMS to provide a safety net when prevention fails.
3. Participate in the development of an assessment tool to determine the capabilities of regionalized rural EMS systems.
4. Collaborate with contiguous states to assess available resources and develop contingency plans.
5. Update and enhance our state and MCI plans.
6. Network with peers to address rural EMS issues such as disaster preparedness through our national professional organizations.
7. Seek any and all funding opportunities to support EMS disaster preparedness activities at local, state and federal levels.
8. Utilize existing forums to further discuss the issue and NTSB recommendations.
1. Current economic situation and further reductions in EMS grants program funds to local EMS providers and Utah Department of Health staff to coordinate EMS statewide.
2. Availability of technology to address the needs of rural areas for EMS and trauma care.
3. Lack of data to support policy decisions pertaining to EMS and trauma development.
4. Public perception that paramedics and level 1 and 2 trauma centers are readily available in rural areas where resources for healthcare are limited.
5. Lack of education to the public and public officials regarding the capability to maintain normal standards of care as a result of a major disaster.
6. Appropriate application of public policies without consistent data to support the decisions.
7. Research to support best practices in rural areas regarding system development and the effects of regionalization of care.
8. Lack of focus in general on prevention efforts to identify areas of need and to implement and evaluate strategies to mitigate injuries and death. Though we have identified threats and weaknesses, we will now begin discussions for the creation of contingency plans for the lack of air ambulance response in the Mexican Hat area, specifically and other rural areas in general. In cooperation with local EMS providers, the Utah Department of Health Bureau of EMS can utilize existing forums for discussion with rural emergency healthcare providers to review requesting additional transportation assets from the county, state, or contiguous states. We can make recommendations for adjustments to those plans and exercise them at all levels. We can also engage in discussions with federal, national, and state partners to seek resources for assessing the capabilities of our rural EMS providers utilizing standardized criteria. In addition the, Utah Bureau of EMS and Preparedness and the Arizona Bureau of EMS and Trauma Systems have begun discussions to implement cross-border planning and exercises designed to address mass-care events in a rural regions along the Utah and Arizona shared border. We anticipate completion of this process resulting in a written contingency plan by July 2011. In conclusion, thank you for your recognition that injury is a public health issue. According to the American College of Surgeons, Resources for Optimal Care of the Injured Patient 2006: "The principal underpinning of a regional system of trauma care is the recognition, on the part of public officials and the general population, that major trauma is a manageable public health problem amenable to primary (preventing the event), secondary (reducing the degree of injury resulting from the event), and tertiary (optimizing outcome from the injury once it occurs) prevention. Enhancing this recognition requires overcoming several commonly held views on traumatic injury involving the incidence of major trauma ("it won't happen to me"), the availability of optimal trauma care ("if I am injured, I'll be well taken care of by my local hospital"), and the preventability." Since injury is the leading cause of death in children and young adults, we ask that trauma and EMS become a priority, with continued funding support, to ensure that the safety net of a regionalized emergency healthcare system is readily available when prevention fails. The endorsement and support of the NTSB for these efforts at the nation level would be greatly appreciated.
If we can provide further information or clarification, please do not hesitate to ask