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State ambulance
law: the worst
By SCOTT PENDLETON
Battalion Staff
Under Texas law, pickup trucks have been registered as ambu
lances.
Ambulance attendants are only required to have eight hours of Red
Cross training.
Those two facts easily qualify the Texas ambulance law as one of the
worst in the country.
Last revised in 1943, the Texas law sets no bounds on what type of
vehicle may be used as an ambulance. It only requires the vehicle to
cany a first aid kit when in service.
“You could register a wheelbarrow with a first aid kit,” T.K.
Williams said. Williams is the executive director of the Texas Associa
tion of Emergency Medical Technicians.
An EMT has 120 hours of emergency medical training. Since many
EMTs work for ambulance services, the TAEMTs is vitally interested
in the quality of ambulance legislation.
Regarding personnel, the law says that every ambulance “shall be
accompanied by at least one person who has acquired theoretical or
practical knowledge in first aid as prescribed and certified by the
American Red Cross...”
This has been interpreted to mean that successful completion of an
eight hour Red Cross course is sufficient qualification to be an ambu
lance attendant.
To emphasize the obsolescense of that training requirement, con
sider the fact that Texas requires cosmetologists to complete 1,500
hours of training and to pass a test in Austin before licensing them.
Requiring only one person to accompany the vehicle is another
serious weakness in the law, since two people are needed: one to drive
and one to attend the accident victim.
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“You could register a wheelbarrow with a first aid kit" as an
ambulance,” T. K. Williams, of the Texas Association of Emer
gency Medical Technicians, said.
And if there are two people, health officials say, the driver should be
a trained attendant as well. Both will be required to perform some
treatments, such as splinting a leg.
just because the state law is bad doesn’t mean that ambulance
services are uniformly bad across the state. The Dallas emergency
medical service is considered one of the best in the country.
But almost all improvements in emergency medical service in Texas
are made on a voluntary basis.
And while "the super-horrendous things don’t occur in Texas any
more, some ambulance services are still “load ’em and go operations.
The Emergency Medical Services division of the Texas Department
ofHealth should regulate ambulance services. But the ambulance law
limits narrowly the EMS division’s enforcement capabilities.
The EMS division has 30 field personnel in 10 district health offices
who inspect ambulance vehicles and issue them two-year permits.
They check the equipment in the vehicle and make sure at least one
attendant per vehicle is employed. First aid kits on ambulances must
contain a variety of bandages, splints, and breathing aids—15 different
kinds of items in all.
The inspectors must issue a permit for a vehicle, any vehicle, that
has the required first aid kit and qualified attendant.
Harold Broadbent, of the EMS division headquarters in Austin,
agreed that requiring the ambulance, rather than the company, to
have a permit is like requiring nothing at all.
“Right now a company could get one vehicle permitted and could
run three and we wouldn't know about it,” Broadbent said.
The EMS division can do nothing during the two-year permit period
to check up on the ambulance service, Broadbent said.
Theonly regular communications the EMS division gets from ambu
lance companies are ambulance activity reports. These forms are
submitted for the-EMS division’s data response program.
The companies fill out a report on every emergency run they make,
detailing the situation, symptoms, and treatment given.
These reports woidd seem to be a good way of checking on the
quality of care the ambulance service or individual attendants give. In
practice, this is never done.
“Submission of the form is voluntary from areas that don’t receive
federal funding,” Broadbent said.
“If ambulance services feel we re checking on them, they’ll stop
participating,” he said. The EMS division needs very much to get the
information from the forms to aid planning.
In addition to inspecting and permitting ambulances, the EMS
division administers an ambulance registry program and helps teach
emergency medical courses.
To join the program, which also registers individual ambulance
vehicles and not companies, participants must meet tougher require
ments than in the state law.
The ambulances are inspected yearly and must carry 12 additional
items, including oxygen apparatus, an obstetrical kit, a poison kit, and
a two-way radio.
Registered ambulances must be manned by two attendants who are
at least Emergency Care Attendants. To become an EGA, students
must complete 24 hours of training and be tested by the state health
department.
The problem with the registry program is that it is voluntary. Of
1,685 emergency vehicles in Texas, merely 167 are registered.
The training courses have been more successful. EMS division
Nothing short of a new ambulance law would revolutionize
emergency medical service in Texas.
statistics show that the number of paramedics trained by the state has
increased from zero in 1973 to 751 in 1978.
In the same period, the number of EMTs went from 1,231 to 7,129.
The number of EGAs rose from 1,616 to 6,582.
When an ambulance company violates the state law, the EMS
division can fine it $100 upon conviction.
But to convict a permittee, the EMS division must file a formal
complaint with the county attorney, who handles it from there.
“Several years ago we made a lot of formal complaints, ” Broadbent
said. But he said the reaction of some county attorneys was “I don’t
want to file on old Joe.”
The EMS division quit filing when it realized that it was costing the
taxpayers more than the results were worth, Broadbent said.
“After that we pulled in our horns and came back to wait for a better
law that we can administer,” Broadbent said. The EMS division hasn’t
filed on anyone since then.
Nothing short of a new ambulance law would really revolutionize
emergency medical service in Texas. Such a law would delight the
EMS division.
“We 11 do anything we can not to cause a stink so we can get new
legislation through, ” Broadbent said, including “backstepping a little”
from ambulance requirements.
The EMS division can’t actually lobby for legislation. But Dr. James
Atkins, a consultant to the Texas Department ofHealth, has prepared a
model emergency medical services bill for consideration at the next
legislative session.
Atkins’s bill, 27 pages long, is a comprehensive plan for establishing
an emergency medical service system. The bill corrects deficiencies of
the the existing three-page ambulance law.
Whether or not the legislature would pass Atkins’s bill is another
matter. Attempts to pass similar legislation in the last two sessions
succumbed to opposition from private ambulance services and rural
legislators — the “stink” Broadbent referred to.
Ambulance services are already chronic money losers. As one EMT
put it, “A private owner should go into an ambulance service as a tax
write- off, because he won’t make money.”
Stricter legislation would only add to the financial burden of private
companies. They might be forced to go out of business or to ask for a
subsidy from the local government. Rural governments wouldn’t be
able to subsidize an ambulance service easily.
THE BATTALION Page 9
WEDNESDAY, DECEMBER 13, 1978
Monday-Saturday 10-6
CUSTOM
SOUNDS
Ultrolineof loudspeakers
System 15" (38.1cm) foam-edqe suspension
Components: low frequency driver with large
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6" (15.2cm) foam-suspension
midrange transducer in separate
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1" (2.54cm) high output soft dome
high frequency radiator.
1" (2.54cm) ultra-high frequency
soft dome radiator with refractive
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Crossover
Frequencies:
Nominal
Impedance:
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Midrange and high frequency front
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8 ohms
Frequency
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Power
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Dimensions:
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Shipping
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per carton.
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Motor: 4-pole synchronous
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(WRMS) Signal-to-Noise Ratio:
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(3% ips) Dimensions: 18%"(W)X9K 6 "(H)X14 1 % 2 "(D) Weight: 44 lb.
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Continuous power output of 20 watts per chan
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(1) Dolby system (ON/OFF) with LED indicator
(2) Fluorescent display level meter
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(3) Electronic digital tape counter
(4) Bias adiustment control
(5) Automatic tape selector for CrO-j tape
(6) Memory stop and play
(7) Automatic repeat (Counter and End repeat)
(8) Input selector (LINE/MIC)
(9) Automatic tape slack canceller
(10) Cassette compartment illumination
(11) Timer aid recording/playback device
Compact cassette tape deck.
2-channel stereo/mono
s: Electronically-controlled DC Servo motor with
a built-in generator for capstan drive. DC high
torque motor for fast forward and rewind
"Sendust Alloy Solid" recording/playback head
(combination type). Ferrite erasing head x 1
Within 85 seconds (C-60 tape)
No more than 0.04% (WRMS)
Standard LH tapes: 20 to 1 7.000Hz
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Chromium dioxide tape 20 to 19.000Hz
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Ferrichrome tape: 20 to 19.000Hz
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Signal-to-Noise Ratio: Dolby Off: more than 54dB
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Fast Winding Tim
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846-5803