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Emergency Medical Services: Forever Changed

Ten years ago, the face of EMS was forever changed on September 11th when we lost the Twin Towers, a portion of the Pentagon and Flight 93. While this wasn’t the first terrorist attack on U.S. soil, it was certainly the largest and most costly in lives lost, responders lost, property lost and overall financial losses.

EMS had come of age in the 1970s, adapted to the changes that hazmat brought us in the 1980s and adapted again in the 90s for urban search and rescue (USAR); once again, we found ourselves adapting to a new discipline of terrorism in the 2000s.

Yes, the face of EMS changed significantly in 2001. Before then, it was rare to hear an EMT or paramedic talk about the incident-command system or how to treat a patient exposed to a biological agent. We had some knowledge of chemical agents from our hazmat days, but not such chemicals as sarin, VX and mustard.

We didn’t envision ourselves being part of a national incident-management system, working on national-preparedness goals or creating integrated priority lists that were a collective effort between law enforcement, fire, EMS and many other “first responders.” We didn’t even know who a “second responder” was or what they did.

When we talked about PPE for EMS calls, it was mask, gloves, gowns and glasses. We had no idea that PPE would include level-C suits, nitrile gloves, N95 masks or APRs, and duct tape. Those of us who are a little older may have been vaccinated for smallpox and knew it as a serious disease that had been eradicated. Our newer personnel were faced with having to be vaccinated for smallpox because now it was a potential weapon of mass casualty.

And it wasn’t just smallpox that was of concern. Anthrax, botulinum and other biologicals were now of concern. We already mentioned some chemicals, and we developed new acronyms like BNICE (Biological, Nuclear, Incendiary, Chemical, Explosive). That changed to CBRNE (Chemical, Biological, Radiological, Nuclear, Explosive), and we determined there was a threat of a “dirty bomb.”

We became much more aware of groups like Al-Qaeda, the Tamil Tigers, Hamas, Hezbollah and the Taliban. We also started paying attention to domestic groups like ALF and ELF and found that some U.S. citizens had been radicalized and were supporting foreign terrorist organizations here within our borders. We watched events overseas like the bombing of the USS Cole, the London transit bombings and the Mumbai hotel attacks.

And through all of this, EMS continued to move forward. We now attend basic situational-awareness classes on terrorism, learn how to deal with blast injuries and train with live agents in Anniston. The Department of Homeland Security was created, and many fire and EMS operational components were moved into this new federal agency.

The fire service, EMS, law enforcement, hospital and public-health personnel started working more closely with each other. We have worked hard to learn the best ways to run mass-vaccination clinics, install portal detectors at the entrances to hospital EDs and mass-decon hundreds of victims in a short amount of time. Firefighters and paramedics have been granted security clearances and now work in state fusion centers as well as national level intelligence organizations to provide their expertise in helping with intelligence analysis.

And then there was the money. Lots of money to law enforcement, fire and the urban-area security initiative cities. EMS saw just a small fraction of this, as most of it was geared towards hospitals, DMATs, push packs and the strategic national stockpile.

While the fire service didn’t receive as much as law enforcement, funds for field operations for most EMS providers were pretty limited, if there at all. Why? Well, some EMS systems are fire service-based, some are third service, some are volunteer, some are nonprofit and some are for profit.

Yet we all have the same mission of taking care of the victims regardless of what the patch on our sleeve says.

If there’s one thing the fire service and EMS does best, it’s adapt. And in the last 10 years, fire and EMS agencies across the country have adapted to the threat of terrorism. We recognize that it is not a matter of if, but when. Terrorism, both foreign and domestic-bred, is no longer the new discipline; it’s part of everything we do. And if we’re not prepared to deal with this, the results can be catastrophic.

So, we acquire the PPE, we go through the specialized training, we further educate ourselves on things like the eight signs of terrorism and we do it with very limited funds. It’s certainly different from what it was just 10 years ago, much less 40. Thus, once again, the profession of EMS has been forever changed.

Norris W. Croom III, EFO, CMO, is the deputy chief of operations for the Castle Rock (Colo.) Fire and Rescue Department. He’s been a member of the EMS Section since 1998 and currently serves as the section’s director at large.

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