History

Year

Significance

Ambulance services on the Navajo Reservation, until about nineteen sixty were non-existent. The most accessible emergency aid for the majority of Navajos at the time were traders, schools, and missionaries, who, in addition to their regular activities, offered voluntary and cooperative efforts to transporting the sick and injured to treatment centers.

The Navajo Police Department assumed responsibility for ambulance services in 1965. The ambulance services, with its limited resources, was continually frustrated by geographic barriers, poor or no equipment and other problems. With more paved roads, the incidence of accidents increased which made the inadequate EMS services more troublesome. Properly equipped and certified ambulances were for the most part largely non-existent.

The development of an emergency medical services (EMS) system on the Navajo reservation has evolved only over the last twenty-two years involving the joint efforts of the Navajo Tribe, Navajo Area Indian Health Service and Navajo Health Authority. Each has been involved in some phases of the development of the department. Navajo Health Authority in 1974 had been the lead agency in that effort, developing training programs for emergency medical technicians (EMT's), preparing EMS grant proposals, developing the communications network, and providing EMS basic and continuing education for medical professionals.

In setting about the task of developing and upgrading services, assistance was sought for sources of aid. Through joint efforts of the Navajo Police Department and the Navajo Nation Office of Program Development, a grant was obtained for the acquisition of eight ambulances. The grant entitled: "Total Systems Emergency Medical Services Demonstration Project" specified that:

1) One ambulance would be located at each of the following locations: Chinle, Fort Defiance, Tohatchi, Kayenta, Crownpoint, Tuba City, Ganado, and Shiprock; 2) Ambulances be first inspected and approved by Indian Health Service: and 3) that the overall direction of the project lie with the Superintendent of Police, who would relate with the IHS Area Director for all necessary contractual agreements.

The intent was to train cadets of police officers as Emergency Medical Technicians, who would then operate the system under jurisdiction of the Navajo Police department.

The Navajo Health Authority (NHA) was created in 1971 and accepted responsibility for planning and development of an EMS system for the Navajo Area. Implementation of the EMS plan began in June, 1973, with the first course in emergency medical care conducted at the Navajo Police Academy. Twenty-two police officers were graduated and assigned as the first ambulance personnel.

However, severe budget cuts necessitated a reduction in manpower and resulted in a failure of the EMS plan. Faced with the possibility of no EMS system, other sources of manpower were explored. There was no funding available for emergency manpower through IHS, but there were contractual agreements available. In 1964, the Navajo Tribe established the CHR program.

The Navajo Community Health Representative (CHR) Program, responsible for health education at the local level also served as a liaison between the provider and community. CHR's also assisted in transporting people to care facilities. The structure of the program, allowed for some flexibility of functions and possibilities. It was therefore planned that CHR's be cross-trained to serve as emergency medical technicians.

A memorandum of agreement, drawn up in 1974, outlined the projected arrangement of the first Navajo EMS system: - Ambulance be stationed at Indian Health Service Facilities. - CHR's be trained as emergency medical technicians (ambulance attendants) by the Navajo Health Authority. - EMT's be under the administration of the Navajo Tribe. - EMT's work within the Emergency Room/Outpatients Departments when not on an emergency run, and receive training from the emergency room physician, who will also evaluate their performance.

The new ambulance service was supported through a DHEW grant for the purchase of 13 new modular vehicles (three (3) of which were assigned to Hopi and Zuni). IHS had also acquired several ambulance vehicles through General Services Administration for patient transport which augmented the Tribal Program. The communications network consisted of an ambulance-to-hospital radio, licensed to operate in the UHF frequency range, and a VHF radio connected to the Navajo Division of Law Enforcement. Development of an area-wide disaster plan had also been initiated under the guidance of the Navajo Department of Law Enforcement

Between 1976 and 1978, emergency response capability and transportation gradually increased with emphasis on improvement and stabilization. Over this three (3) year period the EMS program sent approximately 150 personnel to the NHA basic EMT course with approximately 50% passing. It was also during this period the turnover rate reached a peak of over 80%. Some determining factors were; low wages, no compensation for overtime, training requirements, and little interest in the EMS field.

Major changes in 1978 forced NHA to drop the EMT Training program altogether. One particular course NHA developed and conducted had been the emergency room technician (ERT) program. The course, designed for advance care of equivalent to the intermediate level EMT consisted of three weeks classroom work, continuing didactic and clinical training under physician supervision. However, the course was available only one year. Funding to support EMT training and continuing education programs by NHA did not become available after June, 1978.

The Navajo Tribe (NEMS program) took over the responsibility of the program in late 1979. Emergency Medical Technicians training and continuing education programs continued under the NEMS with the addition of some new modules. Search and Rescue, water safety, and defensive driving represented the new additions which expanded the opportunity for advancement and increasing EMS service capability. Ten (10) new 1979 Model Four-Wheel Drive ambulances were purchased by the Navajo Tribe in late 1978. In addition, eight 1976 model vehicles made it possible to place two (2) vehicles at each of the nine service units.

The Navajo EMS program established protocols for medical control and supervision; developed formal program policies and procedures; had representation on the Arizona state wide EMS Advisory Council; established Memorandum of Agreements with individual IHS facilities and nearby off reservation EMS entities; and added on specialized training in search-rescue, water safety, and EMT trainer/instruction courses.

The program received a special appropriation designated for IHS-EMS systems in September, 1980. The Navajo EMS program used the supplemental grant towards the improvement of three major areas identified within the system:

1) The improvement of radio communications system utilized by the Tribal EMS program. In addition, positions were created to better coordinate communication between the various Public Safety agencies.

2) Public Awareness and Education - This project involved announcements made through the local medical and the use of EMT's in teaching preventive measures at the local level. The presentations, made in both the English and Navajo language, greatly increased Emergency Medical Service Effectiveness.

3) Specialized emphasis on outdoor illness or injury care - At the time there were four (4) SAR teams in place at four (4) locations across the Reservation. Aside from OPD duties and pre-hospital care, many EMT's became instructor/trainers in CPR or Multimedia, trained in SAR or Water rescue. This provided the public with a wider range of services.

The NEMS sustained a 17% decrease in its yearly budget. This reduction effected the program enough to cripple the three initial projects begun with special EMS monies. This resulted in decreasing the program's 118 positions to 84, reduced the programs vehicle fleet of 23 to 17, and placed mileage constraints on the remaining 17 vehicles. In addition, there were no preventive maintenance and repair cost for the communications system, less cost for police frequency radio lease, a curtailment in EMT training, and less search and rescue activity. Much of the impact of this reduction still remains with the program. Adjustments had to be made in the operational procedures, as well as seeking other alternative resources again.

Navajo Tribal funding, first received in 1982, which at this moment, continues to support the ambulance fleet lease and mileage cost for 23 vehicles.

Also, New Mexico EMS Fund Act dollars, first received in 1982, contributes a small amount for equipment and operational costs for the five NEMS Offices located in New Mexico

The Department of Emergency Medical Service, Navajo Area Indian Health Service and other affiliated agencies formed a committee to access the Emergency Health Care System. The committee, after a year, produced the "Comprehensive Emergency Medical Service System Plan of 1984". the plan contained an analysis of the status of the Emergency Medical Service System and a listing of objectives to improve the system over a five year period.

Navajo Nation Legislation, approved by the Public Safety and Intergovernmental Relations Committees formally declared the Department of Emergency Medical Service as a duly recognized department of the Public Safety Division of the Navajo Nation.

By 1987, federal budget decreases had become a reality and new funding sources were sought after by providers, far and wide. Navajo Emergency Service concerned itself with Third Party Reimbursement revenues and finally by 1990, the department began costing, billing, and collections. As a fourth income source, Third Party Reimbursement is regarded now as the second major contributor of income to the department.

The 1984 model ambulance fleet of seventeen (17) vehicles were replaced with 1992 year ambulances. The Navajo Nation purchased fourteen modular (Type I) units, while the department of Emergency Medical Service using grant monies, acquired six van (Type III) units. Two ambulances were assigned to each of the nine (9) field offices, except for Canoncito and Torreon. They each received one.

Two Emergency Medical Service Sub-Offices were finally established after several years of planning and set backs. In April, 1993, the Torreon New Mexico Sub-Office was dedicated and services began. About a hundred miles to the southeast, Navajo Emergency Medical Service also began operations in the Navajo Community of Canoncito, New Mexico. The latter is financially supported, in part, by the Albuquerque Area Indian Health Service Offices and New Mexico EMS Fund Act Monies.

A majority of the staffing levels of the NEMS were Emergency Medical Technician Basic classifications. Out of one hundred Emergency Medical Technicians, three- fourths are basic, and one forth are Intermediate. In 1994, a Tohatchi Emergency Medical Technician Intermediate successfully completed the requirements and standards to become the first Navajo Emergency Medical Service employee to certify and obtain the New Mexico Paramedic License. As of this report, there are five paramedics permanently employed by NEMS.