Trending Topics

Free EMS to continue service during a national emergency

Minnesota EMS Regulatory Board removes constraints on EMS response to the coronavirus epidemic


Colorado National Guard medical personnel perform coronavirus test on a motorist at a drive-through testing site outside the Denver Coliseum Saturday, March 14, 2020, in Denver.

AP Photo/David Zalubowski

Question: In a true crisis, what do we want our EMS services to do?

Answer: Respond as best they can and get the patient to the most appropriate place of care.

In an unprecedented crisis – like the current COVID-19 pandemic – EMS cannot afford to be hamstrung by regulations that govern “peacetime” operations, such as the makeup of the crew, having a driving certificate that qualifies you to negotiate road cones or the artificial boundary line that defines one service jurisdiction over another.

This “Let’s get the job done” approach was adopted by the Minnesota EMS Regulatory Board (EMSRB). On March 13 the board released a memo based on Statute 144E.266 suspending Emergency Ambulance Services for a minimum of five days but with a possible extension of up to 30 days that could be authorized by the State’s Executive Council.

Keep EMS staffed and operating

The order states that “during this declared emergency, normal operations should be maintained when possible.” However, operations may be modified, as outlined below, when necessary.”

Breaking the statute down, it simply entrusts an EMS agency to do whatever is necessary to provide service during a national emergency.

Services are authorized to provide the highest available trained staff even if this means a responding crew member has no certification (but is acting under the supervision of another). Related to this, the minimum requirements for interhospital transfer are also lifted. This could mean that an ambulance crew comprises a certified attendant and a basic driver. In terms of the driver, the additional removal of the EVOC qualification means that a “civilian” driver can also operate the vehicle if necessary. The ambulance could also conceivably be staffed by a single person if it keeps the service available.

Service designation and locality

The statute also allows services that cannot physically provide a 24-hour service to temporarily close, presumably to allow for crew rest and recuperation. Additionally, the designation of the ambulance provider of ALS or BLS is removed and all are simply “ambulances” and can all be sent to any and every call for service. The statute’s removal of Primary Service Areas means that the emergency ambulance response isn’t constrained to its own and original jurisdiction.

Stock and equipment

Ambulance stock and equipment are also covered. The state list of mandated equipment is suspended, as are the regulations governing the maintenance, sanitation, storage and testing of equipment, supplies and drug requirements. Minnesota also allows for the use of expired items, although they defer to the CDC for the definitive list.

Prehospital care data

The requirements for prehospital care data are waived, and I assume this to be CARES and NEMSIS state data requirements, but organizations are (and should) maintain basic data to understand the volumes and conditions to preserve their activity for the future.

What comes next for EMS leaders

In the coming days, weeks and months, EMS leaders will need to make brave command decisions to keep services levels up and serving the population. Minnesota’s actions have been the first, but I suspect not the only, regulatory constraining domino that will fall.

Minnesota’s statute was also released on the same day that the Interstate Commission for EMS Personnel Practice approved the use of the EMS Compact process, effective March 16, in response to personnel needs associated with COVID-19. This decision enables EMS personnel licensed in Compact member states (home states) to cross state borders using a privilege to practice and work in other Compact states (remote state) without getting an EMS license in the remote state. The compact contains 18 member states with two further states awaiting a governor’s signature. It may be that we may have to rapidly revisit this (now that the need has truly arrived) to rapidly induct the remaining half of the country not currently involved.

In analyzing our current situation, I reflect on my time as a military medical commander where we adopted the view that in the event of a high battle casualty day, an ambulance would be whatever I designated it to be. In other words, if the needs of the moment meant employing flatbed trucks with the cooks driving, then so be it – the priority was to evacuate and save a life. I think this is what Minnesota has just empowered its EMS systems to do.

Rob Lawrence has been a leader in civilian and military EMS for over a quarter of a century. He is currently the director of strategic implementation for PRO EMS and its educational arm, Prodigy EMS, in Cambridge, Massachusetts, and part-time executive director of the California Ambulance Association.

He previously served as the chief operating officer of the Richmond Ambulance Authority (Virginia), which won both state and national EMS Agency of the Year awards during his 10-year tenure. Additionally, he served as COO for Paramedics Plus in Alameda County, California.

Prior to emigrating to the U.S. in 2008, Rob served as the COO for the East of England Ambulance Service in Suffolk County, England, and as the executive director of operations and service development for the East Anglian Ambulance NHS Trust. Rob is a former Army officer and graduate of the UK’s Royal Military Academy Sandhurst and served worldwide in a 20-year military career encompassing many prehospital and evacuation leadership roles.

Rob is a board member of the Academy of International Mobile Healthcare Integration (AIMHI) as well as chair of the American Ambulance Association’s State Association Forum. He writes and podcasts for EMS1 and is a member of the EMS1 Editorial Advisory Board. Connect with him on Twitter.