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| By Skip Kirkwood, MS, JD, NREMT-P EFO, CEMSO , RT 1 PA tate dS uble Tro A earn L n We erience? t Ca Exp Wha waÕs m Io Fro onse to en in resp series writt April -part Register in t in a three es Moines is is the frs Th the D ges ublished in se challen l articles p nd respon severa sign a les at nifcant de riginal artic utlined sig that o Find the o stem. a's EMS sy com. facing Iow esregister. w.desmoin ww 42 For more information, visit EMSWorldExpo.com SKIP KIRKWOOD is a featured speaker at EMS World Expo 2013, Sept. 8–12, Las Vegas Convention Center, Las Vegas, NV. IOWA JUNE 2013 | EMSWORLD.com The state isnÕt alone in its challenges, but its mainstream media took note M uch of the EMS community was dismayed when a series of highly critical articles written by investigative reporter Clark Kauffman hit the newsstands and Internet. I was not. IÕm sorry our colleagues in Iowa had to be the focus of such reporting, but itÕs high time someone called public attention to the sorry state of EMS in the United States. The issues Kauffman raised are not faced by Iowa alone. The series touched on a number of key points that should be important to us and the focus of legislative and policy activity by proactive EMS organizations, municipal and county leaders, physician groups, hospital administrators, and everyone else concerned about the well-being of sick and injured citizens. In his articles, Kauffman raised the following key points: • EMS is not a mandatory local service in most states.1 While all states require or provide for law enforcement services in every community, and while most states require or provide for fre-suppression services, only a handful require that EMS be provided throughout the state. In most states the availability of EMS or ambulance services is a matter of local discretion or historical accident. • Most states do not have established standards for EMS or ambulance responses to requests for assistance. The ability to meet a particular standard is a matter of resource allocation, and most states are unwilling to require particular levels of any service in communities of varying demographics and wealth. • Although EMS personnel have unfettered access to the bodies and possessions of our most vulnerable citizens, most EMS agencies do not require comprehensive criminal background checks, psychological evaluations or even demonstrations of basic medical competence prior to hire. Often the standard is merely willingness to serve, which can mask a variety of issues. • Most state EMS offces are woefully underfunded and understaffed. Their existence is a schizophrenic one in which they are charged with "system building" (most often without the funds to do it, thus requiring the cooperation of existing EMS agencies) while at the same time policing those same agencies. When they do seek to carry out their enforcement mandate, it is often at the lowest possible level: sending inspectors to count the number of bandages