Emergency medical services in the Portland Area.

The emergency medical services that are available, accessible, and used by the Northwest Indian Tribes of Idaho, Oregon, and Washington run the gamut from volunteer fire departments to paid county-wide paramedic services. The study was conducted in order to objectively describe the emergency medical services available to tribes of the Pacific Northwest and make recommendations regarding the training, funding, operation and governance of the emergency medical service programs and personnel. Narrative descriptions of the emergency medical service programs for each of the 34 Tribes are presented in a uniform format that discusses: description of emergency medical services used; problems or concerns documented; policy considerations; assessment of major components; and actions for improvement. Data collection, sampling, and data analysis procedures are not given. However, much of the information is related in narrative and table form. Based on fieldwork and information collected from all 34 federally-recognized Northwest Tribes, the study finds that emergency medical services are a major health need that, in many instances, is not being met. As many as twelve Northwest Reservations lack basic life support programs and there is a need to improve training and coordination of services area-wide. The following problems were noted Area-wide: 1) too few ambulance services available to ensure adequate coverage at all times; 2) county and local governments do not have the funding to pay for full-time ambulance personnel or procure equipment; 3) distance to in-patient facilities means the patient will often have to spend considerable time in transit; 4) emergency medical personnel receive few calls and are often unable to keep up their skills; and 5) there are shortages of medical personnel, including physicians. Consumer knowledge of emergency medical services on most Northwest Reservations is recognized as poor. Recommendations include: 1) IHS should make funds available during fiscal years 1982 and 1983 to implement first response programs for the Hoh, Quileute, Muckleshoot, Chehalis, Umatilla, and Squaxin Island Tribes; 2) training of emergency medical service personnel must be a major priority of the Portland Area IHS over the next three years, with Community Health Representatives making up a major part of the needed manpower; 3) all Portland Area Service Units should have an appointed emergency medical service program officer to provide direct technical assistance to all Tribes in the unit; 4) tribal specific health plans regarding emergency medical services need to be updated, and emergency medical service planning must be a part of all future disaster planning efforts; 5) Congress should make funding available over the next three fiscal years for the development and improvement of emergency medical services.