On the evening of August the 26th I was privileged to sit in on an Open Forum at the 2005 EMS Expo in the great City of New Orleans. The question posed to the distinguished panel and arguably the brightest minds in pre-hospital medicine, was "Does EMS Belong in the Department of Homeland Security?"

I believe this forum was prophetic since it took place less than 48 hours before Hurricane Katrina hit land in a city that suffered the most damage of its effects.

I would like to start off by saying that members of the Emergency Medical Service have done an outstanding job of dealing with the disasters of the past month or so. Whether they are members of local first aid squads who packed up their kits and headed south or Army 91 Whiskeys, Navy Hospital Corpsmen or Air Force Medics at the Federal level, they have all made us proud.

Certainly the City of New Orleans medics, EMTs and first responders, the "regulars" have borne the brunt of 30-plus days in the middle of an MCI. Add to that the Emergency Medical Personnel of Galveston and Houston, Mississippi, Alabama and the surrounding Gulf States and I am proud to say the personnel of the NYPD and FDNY and brother and sister medical personnel from all over the country, continent and the world. Although they are not often acknowledged in the headlines, they are writing another page in EMS history. The way that EMS has conducted itself throughout this disaster is a credit to the service at large and its individual members.

It is no surprise to anyone who has ever occupied a seat in an ambulance. EMTs and medics are all self-starters, who can think independently and are experts trained to use the resources at hand. EMS managers are made of the same stuff since they were once in the driver's seat of an ambulance and know what needs to be done when the spit hits the fan.

That being said, the gift, and also the problem of our own resourcefulness are that we are able to function in impossible situations with or without a central command structure, which can be problematic.

I am sure that the individual units in the field had a varying amount of support and command leadership. Realistically, there is no central command and support system in place adequate to support such an enormous project.

On the federal level, EMS is tucked away in 14 different government agencies. The budget for the newly created Federal EMS Department is about one percent of what is allocated for either fire or police although it is mandated to perform a mission on the same scale.

Anyone who worked the great MCI of September 11th 2001 in New York City understands the frustration of not being able to treat the victims.

A similar frustration occurred when New Orleans and parts of the great American Gulf Coast were ravaged by Hurricane Katrina.

On September 11th after the initial rush of patients to local emergency rooms and hospitals, makeshift triage centers and the backs of ambulances, we searched for patients and none were found.

In the Gulf Coast, there still are many who are in need long after the flood waters have subsided.

The very real possibility of diseases such as West Nile, Tuberculosis, Influenza, Cholera, Leptospirosis, Norovirus, and Vibrio vulnificus looms in the horizon.

In the emergency medical service, we wake up in the morning to help the sick and injured. Watching our fellow Americans suffer is pure anxiety to those of us who most times call an ambulance our home.

The morning of September 11, 2001, I was working the end of the night shift with my partner in lower Manhattan.

The night before Katrina hit the Gulf States, the same medic partner and I were boarding a plane back to New York. I am a registered nurse and paramedic. My partner Steve works for the City of New York as a paramedic. Both of us served in the Marine Corps at the same time and were partners since medic school.

We were in New Orleans for the EMS Expo. When Steve and I made inquiries into staying on and helping with the aftermath of the upcoming hurricane, we were told like many others, that New Orleans had withstood many a hurricane. Like times past, the storm would blow over. We were thanked but politely told by a local official that our services would not be needed.

No one in their right mind could have predicted that the storm would wipe out an entire city. I don't think that it was cockeyed optimism, but a hopeful belief in the history of New Orleans. Finger pointing is always futile. From personal experience as a veteran of 9/11, 'Could have should have would have" is always useless. Blame is useless until the situation at hand is under control.

The mayor of New Orleans did not have a clue, neither did the Governor of Louisiana nor the President of the United States, nor the Amazing Kreskin that this would turn out to be a national tragedy, otherwise they would have evacuated everyone immediately and deployed the thousands of Emergency Managers and EMS personnel who were in the City of New Orleans a few hours before the hurricane hit. Galveston did not suffer tremendous losses because government officials and residents heeded the warnings of the tragic lessons learned in New Orleans.

My particular frustration, which I know is shared by many of my brothers and sisters in EMS, is getting back to the Gulf Area to help.

Since the day of the disaster, I have contacted numerous agencies in an attempt to volunteer as a registered nurse and/or paramedic. I have found myself in a sea of bureaucracy and red tape.

As a volunteer with the American Red Cross, I was told that they were not in need of nurses at this time, but I could put my name on a list, which I did. I still have not heard from them.

As a member of the Medical Reserve Corps I put an application through my local chapter, which happens to be the City of New York. They wisely partnered with the American Red Cross so we can be deployed as a group. I hope that I will be hearing from them shortly.

I contacted Health and Human Services on the Federal level. They even had an impressive website set up to take preliminary information for critical specialties such as registered nurses, doctors, and pre-hospital specialists.

After quickly filling out forms, I was given a special code and website to submit my credentials. Although I tried on numerous to access the site, it never worked.

A couple of weeks later, a link to a new website appeared. I was able to gain access and after spending the better part of three hours uploading copies of my licenses and certifications, the server would not accept the final application.

This was frustrating because I was informed that the website would no longer be available after a certain date. On the morning of the date the website would be terminated my application was finally accepted by the server. At last I was getting someplace!

Much to my dismay, the very next day I received an email from the Surgeon General thanking me for my response to the initial call and that over 34,000 volunteers had likewise responded. It further stated the following:

"We have deployed more than 150 'unpaid, temporary federal employees' at the request of state and local health departments; and, we will deploy more. But, at this stage of the response, we believe that the extremely high demand for volunteers which we originally anticipated will not occur. While we will certainly call on a number of you to help in the response, we believe those numbers will now be in the hundreds rather than the thousands."

WOW! 150 unpaid, temporary employees. Are they all medics, EMTs, Nurses and Docs? At the Central New Jersey ambulance garage I now work at there are over 150 medics, nurses and EMTs serving a couple of counties. That doesn't include the dozens of volunteer first aid squads. New Orleans has over a million people. Is that the best we can do?

The initial estimate for HHS was 4400 volunteers per week. Where the heck did they come up with the new figure of 150? A month into multiple disasters with the potential of other hurricanes in the wings and they are content with a mix bag of a buck and a half volunteers?

Unfortunately, on the state level, there is no intention of deploying EMS personnel at this time. Additionally, there is a mandate that no emergency service personnel deploy individually.

This was one of the first thoughts that I had. I know I was not alone. Our basic instincts as pre-hospital personnel would be to grab a bag and go to the call.

I believe that the emergency response to hurricane Katrina has been incredible, courageous and unprecedented in the history of our country. But the work seems like it has just begun. 9/11 in New York City was a totally different scenario, because our basic infrastructure was still in place. The heart of the City was torn out, but Manhattan at large was still able to function. Also, the accessibility of the surrounding metropolitan areas gave us a tremendous pool of emergency medical personnel.

In the case of the City of New Orleans, so much was destroyed and the infrastructure was washed away. It is naïve to think that the government on all levels responded perfectly. Mistakes aside, now is the time for a solution to be found.

We need desperately to keep this tragedy in the forefront of our national consciousness and not let it fade away when the media grows weary of it. Doctors, nurses, medics and EMTs need to be relieved of their duties by us as medical reservists, so they can temporarily get rest and recreation and recharge their stressed minds and bodies.

With hurricane season still in full force, the threat of disease and those who need immediate medical attention in temporary shelters scattered throughout the country, medical personnel are essential for the recovery of the people of the Gulf Coast and our nation as a whole.

If this latest tragedy has taught us anything, it shows us once again that we were not adequately prepared. We were not prepared in so many areas, but especially in deploying emergency medical personnel to the disaster site and having a pool of deployable personnel in the future. Prematurely disbanding a medical workforce and repopulating the affected areas can result in further tragedy. The work has just begun.

If ever there were a reason to have a National EMS Agency, the disaster in the Gulf has made it clear. Instead of multiple agencies trying to provide EMS in addition to the other areas they are responsible for, National EMS in coordination with State and Local EMS agencies would take care of staffing on the national level in their very specific area of expertise. EMTs, Medics, MICNs and Emergency Doctors should make the decisions for EMS. Ideally, no one without a pre-hospital certification or license should make a decision for the deployment of EMS resources.

On an operational level, in times of disaster or national emergency, if every first aid squad or 911 service in the country would send one EMT or Paramedic to the National EMS Unit for a typical 14-day deployment there would be tens of thousands of medical personnel available at any given time. All that is needed to make this work is planning and funding. The government can rely on street EMTs, medics, MICNs and emergency Docs to do the rest.

Until that day comes, and I hope it does before the next national disaster, don't forget our brothers and sisters in the Gulf.

I hope to see you there soon.

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Please feel free to contact me with any questions or comments. www.francisrella.com