DIRECTOR'S ORDER #51: EMERGENCY MEDICAL SERVICES
Approved: /s/ Fran P. Mainella
Effective Date: September 19, 2005
Sunset Date: Until revised or rescinded
Director's Order #51, in conjunction with Reference Manual (RM-51), and
the National Park Service Emergency Medical Services (NPS EMS) Field Manual,
establishes and defines standards and procedures for the National Park
Service Emergency Medical Services (EMS) program. The Emergency Medical
Services Guideline, NPS-51, Release No.2, January 1991, is hereby superseded
1. BACKGROUND AND PURPOSE
4. POLICIES AND STANDARDS
1. BACKGROUND AND PURPOSE
The NPS has traditionally provided visitor protection services-including
EMS-within areas of the national park system. Each year the NPS provides
emergency medical care to over 15,000 ill or injured persons in the parks.
The provision of these services is in accordance with the NPS Organic
Act of August 25, 1916 (16 USC 1 - 4), which states that the fundamental
purpose of the national park system is "to conserve the scenery and
the natural and historic objects and wild life therein and to provide
for the enjoyment of the same in such manner and by such means as will
leave them unimpaired for the enjoyment of future generations." Providing
for the enjoyment of NPS areas requires providing for a safe environment,
and the NPS will make reasonable efforts to provide for appropriate emergency
medical services for persons who become ill or injured.
The purpose of this Director's Order (DO) is to set forth NPS policy
and a procedural framework for providing EMS. The policies, procedures,
and standards in this document are to be implemented uniformly throughout
the NPS inclusive of the U.S. Park Police. The details for implementation
may be found in Reference Manual 51 (RM-51) and the EMS Field Manual.
2.1 Authority for This Director's Order
The authority to issue this DO is contained in the NPS Organic Act (16
USC 1 - 4), and in delegations of authority contained in Part 245 of the
Department of the Interior Manual. This order is intended only to improve
the internal management of the NPS and it is not intended to, and does
not, create any right or benefit, substantive or procedural, enforceable
at law or equity by a party against the United States, its departments,
agencies, instrumentalities or entities, its officers or employees, or
any other person.
2.2 Assistance to Visitors
16 USC 12 states that "The Secretary of the Interior is authorized
to aid and assist visitors within the National Parks or National Monuments
in emergencies . . .."
2.3 Assistance to Employees
16 USC 13 states that "The Secretary of the Interior, in his discretion,
is authorized to provide . . . medical attention for employees of the
National Park Service located at isolated situations, including the moving
of such employees to hospitals or other places where medical assistance
is available . . .."
2.4 Assistance Outside Park Boundaries
16 USC 1b(1) allows for the "Rendering of emergency rescue, fire
fighting, and cooperative assistance to nearby law enforcement and fire
prevention agencies and for related purposes outside of the National Park
The Associate Director, Visitor and Resource Protection is responsible
for developing mission-oriented policy, procedures and standards for,
and providing effective review, oversight and inspection of, the NPS EMS
Program. The Associate Director is hereby delegated authority to issue,
and revise as necessary, RM-51. The following positions are directly involved
in carrying out the mission of the EMS program. A complete, detailed description
of these positions will be provided in RM-51.
3.1 Branch Chief, Emergency Services
The Branch Chief, Emergency Services is located in the Division of Law
Enforcement and Emergency Services, WASO. This position is responsible
for providing management and direction to the Servicewide EMS program.
3.2 National EMS Medical Advisor
The National Emergency Medical Services Medical Advisor is the physician(s)
contracted by the NPS to provide recommendations and advisement for the
Service's EMS program, based on sound medical practice and standards.
This may include recommendations regarding quality improvement, data collection,
scope of practice, and curricula revisions for the Parkmedic program.
3.3 Regional EMS Coordinator
Each of the seven regional directors will designate a Regional EMS Coordinator
to assist the Branch Chief, Emergency Services with the coordination and
collection of EMS data, regional training, and coordination of recommendations
for revisions to national EMS policy. The Regional EMS Coordinator will
maintain an inventory of EMS providers and EMS equipment such as CPR/AED
training supplies or a centralized drug cache that are available within
3.4 Park EMS Coordinator
The day-to-day management and funding of park EMS programs resides at
the park level. It is the responsibility of each superintendent to ensure
that the park EMS program is in compliance with this DO and RM-51. Superintendents
will appoint Park EMS Coordinators to ensure that their programs are compliant
with Servicewide policy and regulation, as well as applicable laws.
3.5 Park EMS Medical Advisor
Park EMS Medical Advisors are licensed doctors, preferably hospital-based
emergency medicine physicians designated by the park superintendent.
Park areas that provide Level IV-VI (EMT Basic - Paramedic) EMS programs,
and all parks with automated external defibrillator programs must have
a Park EMS Medical Advisor. The relationship will be formalized through
an appropriate Instrument of Agreement (see RM-51 Chapter 17, "Instruments
of Agreement," and DO-20 and the Agreements Handbook).
Park EMS Medical Advisors will provide oversight to individual park programs,
including on-line medical control, quality improvement, data collection,
continuing education, protocol implementation and development of local
protocols when national protocols are not available, treatment authorizations,
endorsement of qualified applicants for National Registry of Emergency
Medical Technician certification at Levels IV-VI, and assist Park EMS
Coordinators with the administration of examinations.
3.6 National Emergency Medical Services Advisory Group
The Branch Chief, Emergency Services may convene the National EMS Advisory
Group to advise and work on issues important to the Servicewide EMS Program.
This advisory group will represent a cross-section of the Servicewide
EMS Program and may consist of NPS EMS personnel, physicians, subject
experts, and other persons that may be important to resolving the issue(s)
at hand. The National EMS Advisory Group will be administered in a manner
that does not entail chartering under the Federal Advisory Committee Act
(see NPS Guide to FACA).
4. POLICIES AND STANDARDS
4.1 Department of the Interior Departmental Manual (145 DM 7.1.E)
"Ranger Activities Division: This division is responsible for the
formulation of policies, standards, and procedures for Servicewide programs
in . . . emergency medical services." [Note: Under recent reorganization,
this is now the "Law Enforcement and Emergency Services Division."]
4.2 National Park Service Management Policies
The saving of human life will take precedence over all other management
actions as the Park Service strives to protect human life and provide
injury-free visits. (Management Policies section 184.108.40.206)
The Service will make reasonable efforts to provide appropriate emergency
medical services for persons who become ill or injured. An emergency
medical services program will be maintained to provide transportation
of the sick and injured, and emergency pre-hospital care, which may
range from minor first aid to advanced life support in various environmental
settings. Transportation may include everything from patrol cars and
ambulances, to fixed-wing-planes and helicopter air ambulances. (Management
Policies section 220.127.116.11)
Qualified emergency medical services in local communities may be used
if such services can respond rapidly enough in life-threatening emergencies.
When such services are not available, the NPS will make a reasonable
effort to provide a level of emergency medical service commensurate
with park needs, and in response to an emergency medical needs assessment.
Each superintendent will develop and implement a program to meet those
needs, in accordance with Director's Order #51. Extended emergency medical
services operations will be conducted utilizing the Incident Command
System (ICS). (Management Policies section 18.104.22.168)
4.3 Operational Policies and Standards
4.3.1 Assistance Agreements
Superintendents may assist other agencies with emergencies that occur
outside parks. Parks are encouraged to pursue written general agreements
with such agencies where requests for assistance occur on a regular or
frequent basis. NPS employees who are directed by their supervisors to
provide emergency medical assistance to such agencies outside their area
of jurisdiction will be considered to be acting within the scope of their
4.3.2 EMS Needs Assessment
The EMS Needs Assessment is the fundamental tool used in the development
of a park's EMS program. Each superintendent must assess the emergency
medical resources available to them, and ensure that their EMS program
has been developed and maintained so that all persons have access to emergency
medical care as per current standards. It is important that each park's
EMS program be evaluated on a continuous basis and to make adjustments
as necessary. The EMS Needs Assessment will be completed or updated by
the Park EMS Coordinator and submitted every three years to the superintendent
or designee. The Needs Assessment will conclude with a recommended level
of service (Type I through Type VI) and justification.
4.3.3 EMS Plan
Each superintendent will develop and maintain an EMS Plan to serve as
their guideline for EMS. The EMS Plan may be independent or part of an
over-arching document such as the park's Emergency Operations Plan. Where
appropriate, the plan should address circumstances under which the park
will recover the cost of services rendered.
4.3.4 Training and Certification
The NPS will ensure that all employees receive the level of EMS training
required to perform their duties. In accordance with NPS Human Resource
Bulletin 02-07, "Designation of Testing Designated Positions"
(TDP), assignment of EMT duties, either as a primary or collateral duty,
should result in the determination that the position is a TDP.
The NPS has six designated levels of EMS certification that correspond
to curricula that have been established by nationally recognized organizations.
To obtain a certification, employees must successfully complete a training
program that corresponds to the level of certification being sought.
The NPS White Card is the document used to identify all certified NPS
EMS providers that are authorized to provide EMS in the parks for Levels
III-VI. It is to be issued under the guidelines established in RM-51.
4.3.6 Scope of Practice
Servicewide scopes of practice (protocols and procedures) as described
in RM-51 and the NPS EMS Field Manual are to be implemented Servicewide
as they are developed.
4.3.7 Information Management and Disclosure
The Patient Care Record is the document used by the Service to record
all pertinent medical information about a patient in the pre-hospital
setting. These records will be maintained as per the requirements of the
NPS Records Disposition Schedule.
All parks with an EMS program will participate in the Servicewide data
collection program called "Information Management and Reporting System"
(IMARS). The data will be collected and submitted at the end of each calendar
year through the Regional Offices to the Branch Chief, Emergency Services,
WASO. See DO-19 (Records Management) for more information.
The NPS will provide information to the public, consistent with the Health
Insurance Portability and Accountability Act of 1996 (29 USC 1181 et seq.;
P.L. 104-191), Departmental policy, and DO-75B (Media Relations). Information
concerning a patient's medical history or present condition is subject
to patient confidentiality laws (e.g., Privacy Act).
4.3.8 Continuous Quality Improvement
The continuous quality improvement (CQI) process is essential to the success
of the Service's EMS program. Ongoing program evaluation will help to
ensure that EMS program management and patient care are being provided
at an optimal level. Accountability for quality assurance lies with the
superintendents and the Chief, U.S. Park Police. These responsibilities
are detailed in RM-51, Chapter 8, 3.11 "Quality Assurance/Continuous
4.3.9 Injury and Illness Prevention, Analysis, and Research
Injury prevention provides an opportunity to achieve significant reductions
in human morbidity and mortality, and meet the goals for public safety
as established by the NPS per the Government Performance and Results Act
(31 USC 1115 et seq.). Prevention programs and public education help to
reduce the number of emergency responses, limit exposure of EMS providers
to hazardous conditions, and reduce workload factors.
Superintendents are responsible for the development and maintenance of
a safety-oriented atmosphere within the park for both employees and the
visiting public. EMS training programs will include the principles of
illness and injury prevention and its role in improving public health.
By improving its ability to document the circumstances and incidents of
injury and illness, the NPS will improve its analysis and research, and
its on-going prevention programs. In identifying public recreational related
risks, the NPS will develop programs for mitigating those risks with an
emphasis on prevention, education and self-reliance. See NPS Management
Policies section 8.2.5 for more information.
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