Background
In 1971 the North Carolina General Assembly directed the Legislative Research
Commission to study the problems of emergency medical care in this state. The result was
that the Commission identified sufficiently pressing problems to request interim action be
taken before the next session of the General Assembly to prepare a plan for a
comprehensive emergency medical services system in North Carolina.
In 1973 North Carolina's General Assembly passed the Emergency Medical Services Act of
1973 which greatly expanded the responsibilities of the state in the realm of emergency
medical services. The 1973 EMS Act vested responsibility for development of a
comprehensive emergency medicl services program with the Secretary of the Department of
Human Resources and authorized the creation of an EMS program. Subsequently, the Office of
Emergency Medical Services (OEMS) was established as the lead agency in North Carolina for
planning, development, coordination, and regulation of comprehensive emergency medical
services systems as specified in the 1973 legislation.
The Office of Emergency Medical Services:
The underlying philosophy of the state for the improvement of emergency medical services
is to: (a) foster emergency medical services which are designed and operated in accordance
with local initiative, regional needs, statewide standards, guidelines and regulations;
and (b) provide supportive statewide programs to ensure that every medical provider is
well trained, every emergency vehicle well equipped and properly operated, all components
connected by effective communications, and every citizen within reach of high quality
emergency medical services.
The field staff, consisting of 13 regional coordinators and 3 regional supervisors,
provides the linkage between the OEMS and regional and local emergency medical service
organizations. A regional coordinator's responsibilities include advising local EMS
providers, giving technical assistance to regional EMS councils, administering agency
programs on a regional basis, inspecting ambulances, administering certification
examinations, maintaining a liaison with local government, and generally coordinating
emergency medical services in his/her area. Regional supervisors have direct authority for
the regional coordinators, as well as responsibilities for such matteres as administration
of grants to the lead regional organizations (LROs) and advanced life support programs.
The eastern and western regional supervisors and their coordinators are located in the
Department of Human Resources regional offices in Greenville and Black Mountain. The
central regional office, including the supervisor and coordinators, is housed in the same
Raleigh location as the state EMS office. The activities of the field staff are tied to
the central office through the Chief.
The central office employs a core staff of specialists in the areas of transportation and
public education, facilities, education and training, and communications who provide
assistance to the field staff and to agencies and organizations involved in EMS throughout
the state. Among the statutory responsibilities of the OEMS is the mandate to endure the
availability of appropriately located emergency treatment centers. The EMS Act of 1973
also confirmed the state's regulatory role by requiring the OEMS to inspect ambulances,
issue permits for the operation of ambulance vehicles, and certify ambulance personnel, as
well as be responsible for all other quality control provisions of the Ambulance Act of
1967. In 1995 G.S. 131E-155.1 was passed which requires OEMS to license ambulance
providers. It is the responsibility of the OEMS to assist in the development of a
statewide EMS communications system. Medical input to the program comes from the Medical
Advisor, an emergency physician, who is contracted part-time. All of the activities of the
State Office of Emergency Medical Services are coordinated through the Chief of the
Agency.
The OEMS is a section within the Division of Facility Services which is a unit of the
Department of Human Resources. Ultimate authority over the agency rests with the Secretary
of the Department.
The Emergency Medical Services Advisory Council:
The State Emergency Medical Services Advisory Council was established by the Emergency
Medical Services Act of 1973 for the purpose of advising the Secretary of the Department
of Human Resources on all matters pertaining to emergency medical services in this state.
The actual duties of the Council are as follows:
1. Advise the Secretary of the Department of Human Resources on recommendations as to the
designation of multi-county emergency medical services regions;
2. Give advice as to all rules and regulations proposed by the Medical Care
Commission or the North Carolina Medical Board, and;
3. Give advice on other matters pertaining to emergency medical services in
North Carolina
According to law, the Council membership must consist of physicians, emergency room
nurses, providers of ambulance services, local government officials, and representatives
of the general public. Originally, the Council had seventeen members appointed by the
Secretary, but, in 1977, the law was amended to provide for membership of four members of
the General Assembly - two to be appointed by the President Pro Tempore of the Senate and
two by the Speaker of the House.
Members are appointed for terms of four years except when the appointment is
made to fill a vacancy of an unexpired term. The legislators' terms run concurrent with
their elected terms in either the House of the Senate. The Chairman of the Council is
elected annually by the membership of the Council.
The Council meets at least once each quarter, and the currently established meeting dates
are the second Tuesday of the months of February, May, August, and November. Other Council
meetings are held as required. All of the members are assigned to a committee of the
Advisory Council. The committees currently active are the Education and Hospitals
Committee and the Communications and Transportation Committee. Usually, committee meetings
are held on the same day as the Council meetings. Members of the Council receive payment
for travel and subsistence expenses when attending Council meetings.
A member of the State Emergency Medical Services Advisory Council has an important role
that goes far beyond the honor of being appointed and the routine of attending meetings.
Each member has a certain expertise and/or perspective that is essential if the EMS
program is to meet the needs of the people of North Carolina. Members are charged with
assisting the Secretary of the Department of Human Resources and the staff of the OEMS in
guiding the development and improvement of EMS in this state. This encompasses many
functions.
One of these functions, which was referred to earlier, is to give advice on all rules and
regulations proposed for emergency medical services. These rules and regulations pertain
to ambulance design, ambulance equipment, certification of personnel, and advanced life
support programs. While it is important to guard agains over regulation, certain
requirements are necessary to
establish minimum statewide standards for all types of services. An Advisory Council
member's role is to scrutinize the proposed regulations to determine if they are
necessary, understandable, reasonable, and cost effective. Members should not only react
to regulations proposed by the staff or some outside organization, but should also
consider areas where new minimum standards are
needed or where existing ones ought to be upgraded or deleted.
The Advisory Council also must be concerned with the future development of emergency
medical services in North Carolina. The Council must examine carefully the current status
of EMS in the state and provide advice to the OEMS as to what the EMS system should look
like in the years ahead. The staff oe the OEMS will strive to work with the Council on
this aspect.
Above all, the Council serves as a forum for the discussion of concepts, programs, and
problems. The meetings provide an opportunity for members to present viewpoints and ideas
to the staff of OEMS and to the Secretary. These should not only be personal ideas and
viewpoints, but should be representative of the various groups in the EMS community and
the general public with whom members are in contact. A member of the Advisory Council has
a responsibility to provide feedback, whether positive or negative, to the OEMS staff on
their various programs and procedures.
Members also have a responsibility to serve as a conduit for information in the other
direction and disseminate the positions, concepts, and policies of the Council to the EMS
community and the general public when possible. Many are members of various organizations
involved in emergency medical services, and the OEMS staff counts on them to disseminate
the information obtained
from Council meetings.
In essence, a member of the EMS Advisory Council is an advocate of good emergency medical
care for the citizens of North Carolina.
Regional Emergency Medical Services Councils:
There are 18 multi-county planning regions in North Carolina designated by the Secretary
of the Department of Administartion. One of the major focuses of the modern day EMS system
is the development of planned and coordinated regional EMS systems across the state to
ensure the effective distribution and efficient utilization of limited resources over a
broad geographic area. Regional EMS councils have been developed in each of the planning
regions for this purpose. Regional councils are composed of representatives of local
government, rescue squads, hospitals, the medical community, and the general public. The
responsibilities of these councils include the following:
1. Identifying regional needs.
2. Establishing priorities for the use of resources following OEMS guidelines.
3. Promoting the development of a systems approach to EMS.
4. Developing and implementing region-wide projects.
5. Serving as a forum for resolving problems.
Each regional EMS council is affiliated with the lead regional organization (LRO) in the
region. An LRO is a multipurpose organization responsible for planning and administering a
variety of programs. LROs are either councils of governments (COGs) or planning and
development commissions, and each receives its designation as an LRO from the Secretary of
the Department of Administration. They provide administrative support to the regional EMS
Council on a contract basis with the OEMS.
LROs are funded by dues from local governments, federal grants, and state grants. LROs
hire their own staff and assign to one of their employees the responsibility of providing
administrative support to the regional EMS council and of carrying out the projects of the
council. The boards of the LROs are made up of local government officials, and the
affiliation of both the regional EMS council and the OEMS with the LRO provides an
established mechanism for the involvement of local officials in the state and regional EMS
programs.
