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Judging from a public forum held Wednesday afternoon in Baltimore, there is no question in most people’s minds that EMS should have a lead federal agency. In fact, it seems the most pressing question is which agency should take the lead.
“Bottom line is we need to move forward,” said Advocates for EMS President Kurt Krumperman, MS, NREMPT-P, who spearheaded the introduction last fall of the Field EMS Bill. The legislation, which would designate NHTSA as the lead office, died in the lame duck session but is expected to be reintroduced this year.
An alternate vision for federal leadership was laid out in a recent white paper titled “Consolidated Federal Leadership for Emergency Medical Services,” which was co-written by the International Association of EMS Chiefs (IAEMSC) and the National EMS Labor Alliance (EMSLA). Together, the organizations represent a broad coalition of public, private and volunteer EMS organizations and union members.
The question at the heart of the discussion at Wednesday afternoon’s Federal Interagency Committee on Emergency Medical Services (FICEMS) Public Forum at the EMS Today Conference & Exposition is how do we define EMS -- now and in the future under health-care reform?
“I think there’s a fundamental disconnect between how EMS appears at the national level and how it appears at the local level,” said National EMS Management Association President Elect Skip Kirkwood, MS, JD, EMT-P, EFO, as he addressed the audience gathered at the public forum. He said he believes that the disconnect comes from the fact that EMS is viewed as a medical profession at the national level but it’s often delivered at the local level by “public safety” agencies.
Moderator and FICEMS Chair Alexander Garza, MD, told the standing-room only crowd that he thinks one of the things that makes it most difficult to determine one lead agency for EMS is its multiple facets. “The field EMS part is very unique because it does have a lot of different roles that aren’t just limited to taking care of patients.”
Texas EMS Director Maxie Bishop, speaking only on behalf of his state, said having one federal agency could hold EMS accountable in many arenas, including education, certification and surge capacity, standards that they know they should improve but don’t have the ability to enforce. “There’s a false sense of security by EMS in the state of Texas,” he said. “We have to get the feds behind us to make us do it, basically.”
It’s a challenge for all of us. Federal government can set some guidelines and help with a finance mechanism, which is critically important in creating surge capacity,” said Troy Hagen, director of Ada County Paramedics in Boise, Idaho and president-elect at National EMS Management Association. “We’re looking for a champion of EMS issues at the federal level.”
“We need to find our voice, and I personally appreciate the conversation, because I think it’s going to take us that much farther ahead,’ said Chris Montera, EMT-P, chief of Western County (Colo.) County Ambulance. “But I agree with Troy that we need a champion on the federal level.”
Garza said even if one single agency is chosen to lead EMS in the future, a need for interagency collaboration will be necessary.
“Whatever agency does it is not relevant,” Kirkwood said. “Help us bring it together. Help us have a coherent EMS policy and funding.”
International Association of Fire Chiefs President John Sinclair and IAEMSC President Lawrence Tan, JD, NREMT-P, both agree with Kirkwood that any lead agency should be able to provide funding support, especially in a time of health-care reform focusing on cost effectiveness.
“We should be able to take people to a non-traditional destination in an ambulance that isn’t a hospital. And if we were to look at those two particular issues, it would have great benefit to the overall system,”
Sinclair said. “What we hope is they become an advocate for really a restructuring of the system, how we look at it and how we pay for it.”
Tan said the committee that worked on the white paper looked at several things when considering which current federal agency would be a good fit. (They believe it belongs under DHS rather than NHTSA, as AEMS supports.) He said the lead agency has to be properly resourced, will need to include EMS as part of the delivery of health-care and not just as transport that will have a downstream-savings impact. He believes a federal lead is imperative to preparedness.
“We have a common interest,” Tan said.
It seems this fact was not disputed.
Garza cited a May 15 deadline for submitting an options document to the White House on which federal agency would be best suited to champion EMS. “We’re looking at the whole spectrum,” he said. “We don’t have a whole lot of time in the grand scheme of things, and this is a very important discussion and we want to make sure we have everyone’s opinions.”
He added that his agency is looking at the full continuum of care—everything from 9-1-1 calls to emergency and trauma care of adult and pediatric patients. What is and is not the role of the federal government? he asked. The role of the office is to establish functions and issues it should perform and address.
“Speaking as a former EMT and paramedic, it really is a labor of love. Nobody does it for the money or the glory,” Garza said. “We truly do appreciate the job that you guys do day in and day out.”
An alternate vision for federal leadership was laid out in a recent white paper titled “Consolidated Federal Leadership for Emergency Medical Services,” which was co-written by the International Association of EMS Chiefs (IAEMSC) and the National EMS Labor Alliance (EMSLA). Together, the organizations represent a broad coalition of public, private and volunteer EMS organizations and union members. These two groups believe DHS currently holds the authority to be the lead federal agency for EMS.
