Reports have indicated that despite the significant amounts of money that has been allocated to emergency preparedness activities, EMS has received only a small portion.  In the 2002-2003 funding cycle, EMS received only four percent of the $3.38 billion in terrorism preparedness funding distributed by the federal government.  Position papers by the National Association of State EMS Directors have indicated that an infusion of over $583 million dollars would be required nationwide to adequately address EMS preparedness needs.

A report developed by New York University’s Center for Catastrophe Preparedness and Response,  "Emergency Medical Services: The Forgotten First Responder," also reported that:

• More than half of the country's 900,000 emergency medical technicians (EMTs) and paramedics have received less than one hour of training in dealing with biological and chemical agents and explosives since the 9/11 terrorist attacks, and 20% have received no such training.

• Fewer than 33% of EMTs and paramedics have participated in a drill during the past year simulating a radiological, biological or chemical attack.

• EMS received only 5% of bioterrorism grant money from the Department of Health and Human Services.

• Six in 10 ambulance services received no federal funds to buy emergency preparedness equipment.

• In 25 states, 50% or fewer of EMTs and paramedics had adequate equipment to respond to a biological or chemical attack

• Over 50% of ambulance services had no written emergency response plan

• Over 30% of EMS services are not represented on local emergency preparedness and response planning organizations.

This week, a follow-up report “Final Report of the 9/11 Commission Recommendations” concluded that the progress that has been made in national preparedness is not acceptable and provided a failing grade for government preparedness efforts.  This report was developed by the influential, bi-partisan National Commission on Terrorist Attacks upon the United States (better known as the 9-11 Commission) chaired by Thomas Kean. This report does not address EMS specifically, but does point out some of the issues facing EMS. 

Levels of preparedness vary significantly between EMS services.  Some services are adequately staffed, equipped, trained and funded to be able to at least initially respond to and manage a mid- to large-scale event.  Other services are taxed on a daily basis by events involving only small numbers of patients. 

A certain level of preparedness should be expected for all EMS services, but that level of preparedness must also be based on the expected risk for the service area and the potential for significant casualties.  A small volunteer service with a vast rural coverage area does not have the same level of risk as an EMS service in a large city, and does not need the same resources.   

Unfortunately, as with many government programs, the first step in emergency preparedness was to throw money at the problem.  A lot of money for emergency preparedness is being distributed and more is in the pipeline, but is it going to the right places and are the right things being done with the available funding? 

The 9/11 commission report references the purchase of air-conditioner garbage trucks as part of one city’s emergency preparedness efforts.  Other news reports have listed various other questionable expenses.  Quite often the (somewhat defensive) response of emergency service leaders when questioned on their spending has been to attempt to justify the expense.  Others have been significantly more honest and admitted that they could find no other use for the available funding, and politically could not dare to return the funds as unused.

Perhaps EMS is lucky that we have received only a small portion of the available funds.  With a limited funding source, administrators must make practical decisions on what equipment items are most needed and would most benefit their service on both a daily basis and in an disaster.  Hopefully, EMS has not yet succumbed to the philosophy of spend the money just because it is available, regardless of the utility of the purchased equipment.

Hurricane Katrina demonstrated that Mother Nature is as great (if not greater) threat than a terrorist attack.  Should Avian Influenza become a pandemic along the lines of the 1918 influenza pandemic, EMS will face issues and demand unlike any in history.  These issues must also be considered in emergency preparedness planning.  Current funding processes must be addressed to ensure that they are permitting “all-hazard” preparedness and not just terrorism preparedness.  Many of the issues are the same.  All-hazard preparedness ensures that we are ready for what ever may be thrown at us.

Regardless of your coverage area: urban; suburban; or “more deer that people”, your service must be prepared to a basic level to ensure that your personnel can adequately identify; respond to; and mitigate the impact of any type of disaster, be it man-made or natural occurring.

Emergency and disaster response is ultimately a local issue.  State and federal resources will be available, but they will take time to arrive at the scene.  Until that time, it is the local responders that will have to manage the situation. It is also the local responders that must determine their own capabilities and need for improvement.   

Emergency preparedness is one of the areas where it is imperative that people understand that the life they save may be their own, or that of their family.  EMS administrators must make realistic decisions on what they need and what they need to do to become as prepared as possible for the next major event in their community.  Part of that must be a realistic evaluation of the various risks to the community and the potential steps to mitigate those risks.  Equipment and planning should be dual purpose.  Planning for a nerve gas attack by a terrorist is not that much different from planning for an organophosphate spill.  A bioterrorism attack has many of the same issues and impacts as a naturally occurring outbreak.  A hurricane can collapse a building just as effectively as a terrorist bomb.

If your organization is already involved; and is one of the services that is actively planning to manage the next major event in your community—kudos.  If you are not yet  involved—get involved!  Make an effort to reach out to other emergency preparedness planning organizations to determine what role you will play; what support they can provide; and what needs currently exist for equipment and planning. 

Clearly, we are not yet where we need to be.  Are we safer than we were?  Of course.  Are we as safe as we could be?  Certainly not.  Preparedness efforts have to begin at the grassroots level.  Someone in Washington will never be able to tell you how to prepare for a disaster in your community in anything more than very broad strokes.  It takes the people on the ground to get involved…to identify the needs in their community…to make those needs known…and to drive the process.  It’s your community—your home---your family.  You have to do it!