A lead federal agency for EMS seems to be a hot topic this month. The JEMS forums and all the other online EMS media are filled with discussions. Some of it’s helpful; some of it is … well, pretty inane.
The question of whether EMS is a federal matter of isn’t of interest to me. Although I love reading constitutional law—and once upon a time received an American Jurisprudence award in it—the question of whether the feds can play in the EMS game has long been moot. National Highway Traffic Safety Administration, Health and Human Services and a host of other federal acronyms have been involved in EMS for more than 40 years. So let’s not go there.
Many people in EMS complain that we don’t get any respect and, more importantly, don’t get our share of the federal dollar when compared with our law enforcement and fire suppression colleagues. Why not? Well, our inability to agree on anything substantial contributes to that dilemma. At least the police officers agree that criminals should go to jail, and firefighters generally agree that the fire should go out.
We often demonstrate that we lack even that basic level of consensus. We only want to be called for situations in which the person calling meets our personal definition of “sufficiently severe” or some such criteria. Also, we’re disorganized. Precious few of us belong to our professional association (National Association of Emergency Medical Technicians). We have at least four associations representing EMS bosses of various varieties (International Association of EMS Chiefs, National EMS Management Association, American Ambulance Association, International Association of Fire Chief-EMS Section). Many groups that don’t run EMS calls on a regular basis seem to have become organized and powerful while we weren’t being organized (and thus not powerful)—the regulatory officials (National Association of State EMS Officials), the educators (National Association of EMS Educators),and our medical directors (National Association of EMS Physicians). But all that is fact and history. If you want to have a voice in national EMS affairs, you have to join, pay and play.
We don’t have a federal agency that’s a lead voice for EMS. We have a committee (Federal Interagency Committee on EMS) that lacks power, teeth or direction.
The Department of Justice (DOJ) is the lead federal agency for all things law enforcement. DOJ is headed by a cabinet officer (the attorney general), and it advocates for things that are good for the criminal justice system, some of which trickle down to and benefit local service providers. They have a national academy (the FBI National Academy), which helps to develop future leaders, fellowships and research programs.
The fire service has the U.S. Fire Administration (USFA). Although not as elevated in the hierarchy as DOJ, the USFA is, nonetheless, on the political radar screen. Its administrator must be confirmed by Congress. USFA houses the National Fire Information Center, where fire data is crunched and published. It leads a public education effort, a technology effort and a training effort that includes a National Fire Academy and robust networks of state fire trainers and college degree programs (Fire and Emergency Services Higher Education). They manage several, well-known grant programs, including grants under the FIRE Act and the Staffing for Adequate Fire and Emergency Response Grants program.
What about EMS?
So what does EMS want from a lead federal agency? Lots of folks are asking that question in a variety of forums. I’ll give you my wish list.
First, its last name will begin with an “a,”—preferably “agency” or “administration.” In the federal hierarchy, that’s pretty well up there (because we’re unlikely to get a cabinet department). Along with that, the administrator should require congressional confirmation.
Next, it should have broad authority to coordinate and direct EMS activities within the federal government. While at EMS Today, I attended a day-long town hall meeting on federal EMS activities. What I saw was a multitude of agencies that have independent missions, which sometimes touch EMS. When the mission-oriented activities mention EMS subject matter, an EMS program spins off in to space.
For example, the Maternal and Child Health Bureau of the Health Resources and Systems Administration affects EMS, and what spins off is the Emergency Medical Services for Children program. That program isn’t necessarily coordinated with the EMS activities of other federal agencies, and it certainly isn’t coordinated and prioritized with the needs of local EMS provider agencies. Whoever winds up in the “head fed for EMS” position needs the authority to do triage and to direct resources where they’re most needed. It especially needs to have the authority to direct how the federal government spends money on EMS, and it should get us away from CMS-mediated reimbursement for EMS as a transportation service.
Finally, it needs to focus on EMS in the field: on getting medics, ambulances and other resources to the right patients at the right time and getting patients who need transporting to the right place at the right time. It needs to be headed, staffed and advised by “field EMS” providers. Our colleagues in Canada have a campaign under way to create a federal “Office of the Chief Paramedic” to advance EMS in their country. We’d be well-advised to do the same thing.
Just as our example agencies (DOJ and the USFA), the lead federal EMS agency shouldn’t license or certify personnel or agencies, nor should they regulate educational institutions; those are state functions. Their role should be “encouragement:” using what funds are available to advance the state of the art. That would include a whole list of items that would, in my opinion, better EMS across the U.S.:
• Coordinate, prioritize and harmonize EMS efforts of all federal agencies involved in EMS, specifically including direction of CMS to move (quickly) to a pay-for-treatment, pay-for-performance methodology;
• Encourage regionalization of EMS systems as recommended by the Institutes of Medicine report;
• Encourage a single standard of licensure across all states;
• Encourage a single standard of accreditation of educational programs by a recognized accreditation agency;
• Encourage the development of safer, more functional ambulances;
• Encourage research and development in EMS, not just clinical, but operational and organizational;
• Encourage the development of future EMS leaders through education and training programs, including development of a national academy, and through scholarships, fellowships and national and international exchange programs;
• Develop and encourage the implementation of programs to enhance the health and safety of EMS providers; and
• Tabulate, analyze and publish reports about EMS in the U.S. based on data collected from a robust National EMS Information System.
The list could go on.
How successful will we be in our effort to establish a lead federal EMS agency? I’m not certain at this point, but the movement seems to have some energy. We stand a better chance now than at any time before us, so it’s time to put our sector-based differences aside, stand together as one body of EMS providers and get this done.
Meanwhile … be safe out there.