Stakeholders and EMS administrators from across the nation joined the Federal Interagency Committee on Emergency Medical Service (FICEMS) during its teleconference meeting yesterday afternoon. They may have differed in opinions, suggestions and areas of expertise, but they provided a unified front when it came to whether EMS should have a lead federal agency.
Stakeholders joined moderator and FICEMS chair Alexander Garza, MD, MPH, assistant secretary for Health Affairs and chief medical officer for the U.S. Department of Homeland Security, from many federal agencies. These included the National Highway Traffic Safety Administration (NHTSA), Health Resources and Services Administration (HRSA), Department of Homeland Security, and Centers for Disease Control and Prevention (CDC).
EMS Labor Alliance (EMSLA)
After introducing everyone, Garza opened the floor to teleconference attendees, asking them to talk about what they do—and don’t—see a lead federal agency doing. The first to speak was James Orsino, president of EMSLA, who strongly suggested FICEMS review Consolidated Federal Leadership for Emergency Medical Services: An Essential Step to Improve National Preparedness: A perspective from EMS on the front line. This is the white paper EMSLA co-released with the International Association of Emergency Medical Services Chiefs.
He reiterated that overall, his group seeks a lead federal agency that runs EMS with elements of financial consideration and health oversight. “To that, our paper calls for the lead federal agency, and DHS meets those needs,” he said.
He added that even just having an open dialogue about where EMS best fits has been a breath of fresh air. Where EMS ends up is critical, he said, but he feels the discussion proves that the federal government is considering and listening to the EMS community for the first time in his 25-year EMS career.
American College of Emergency Physicians (ACEP)
Next to speak was ACEP EMS Chair Sabina Braithwaite, MD, FACEP, who also has more than 25 years as an EMS provider. “This whole EMS agency, and EMS as a whole, really needs to be primarily driven by health and medicine, and be patient-centric and really be focused on patient care,” she said. “Health and medicine must be the primary drivers for EMS.”
She encouraged FICEMS to avoid a start division between field and hospital EMS, stressing that allowing for continuity of care would benefit not only individual patients but also EMS through stronger leadership, funding streams, research opportunities, data integration and safety.
National EMS Management Association
Representing EMS managers on the conference call was Skip Kirkwood, MS, JD, EMT-P, EFO, CMO. Kirkwood started off talking about the public forum held at the EMS Today Conference & Exposition in Baltimore on March 2. “I came away with a clear picture of non clarity,” Kirkwood said, adding that the non-clarity stemmed from the fact that there are many federal programs doing things for EMS that are not necessarily things that are of concernt o EMS.
He said he appreciated Braithwaite’s comments but believes a gulf needs to be bridged first. “In most communities, EMS looks a lot like public safety,” he said. “Getting agencies to bridge that gap is going to be a great challenge.”
He suggested the 1) federal government should recognize, through policy, that EMS plays is more than transportation and plays many roles outside that arena; 2) the government should create a national policy level statement that EMS is an essential service that should be available in every community and that it should use the power of the purse to make sure that policy is adopted nationwide; 3) that it should make sure EMS is prepared for large-scale disasters; 4) that there's a need for a center for EMS doctrine as EMS moves toward evidence-based protocols; and 5) that it facilitates rapid movement away from transportation-based payment.
He said a lead federal agency should not run EMS at a local level.
Advocates for EMS
Representing Advocates for EMS was President Kurt Krumperman, MS, NREMT-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. He suggested FICEMS refer to The Future of Emergency Care in the United States Health System, published in 2007 by the Institute of Medicine (IOM). “It’s really hard to do much better than what was expressed in that document. I think it captures all the needs” in terms of how a lead agency would play a positive role for full continuum of emergency medical care and trauma, he said.
Krumperman added that his group is unsure what federal agency it recommends become the lead federal agency and plans to formally submit that recommendation in writing. However, the group is certain that it wants to see a central point of contact, an agency that advocates for EMS at a national level and develops a national-level strategy that others can work toward at all levels.
“Those are some of the functions that I think a lead agency can do,” he said. “I think having a lead agency is essential. I think the current state doesn’t serve us as well as a lead agency could.”
Garza agreed that his group should review the 2007 IOM report.
An EMS Visionary
Next to speak was David Boyd, MD, an Illinois trauma surgeon who was responsible for trauma center establishment in the Chicago area and who became the federal EMS manager for the Department of Health and Human Services in the 1970. He developed the framework and guidelines necessary to implement EMS systems throughout the U.S. He used federal HHS grant funds as the incentive for EMS system development.
Boyd said the future success of a lead federal agency depends on where it is located within the government. He suggested there are two camps involved in this discussion: those who think EMS belongs in healthcare and those who think it should reside within transportation.
If you’re on the transportation side, you must barter for healthcare-related aspects of the system, such as certifications.
If you’re on the healthcare side with him, you must become credible and carry the ball, he said, stressing that he believes EMS should be a part of the Department of Health and Human Services Health Resources and Services Administration.
“That’s where it was initially and that’s where I think it should return,” he said. “I think I’m pretty much right on this subject. Let’s see if we can see through our parochial, limited, partisan positions and bring this back together as a program.”
International Association of EMS Chiefs (IAEMSC)
IAEMSC President Lawrence Tan, JD, NREMT-P, said he believes there are two issues involved in the determination of a lead federal agency. First is how to determine preparedness from an EMS perspective. Second is how to implement a national preparedness goal for EMS. The common theme that stemmed from those questions was the necessity of a lead federal agency for EMS that is properly resourced.
He said the role would be to get its arms around the current state of EMS in the U.S., the develop an infrastructure that provides an understanding of what EMS does on a daily basis, and to identify and provide support to address gaps.
“The time is now. We cannot continue to try and survive in the way that we are,” he said. “The reality is we need to move forward.”
His group has already submitted written comments to FICEMS.
Two speakers represented rural provider areas: southern Alaska and Northern Michigan. Southern Region EMS Council Regional Training Coordinator Thomas Meyer said listed the following items as the role of the federal government in EMS:
1. To guide research-based education,
2. To provide research-based outcomes for the delivery of medicine’
3. To create a minimum set of standards for all agencies with regard to Center for Medicare and Medicaid Services reimbursement;
4. To assist in disaster planning on a regional level
He said it should not restrict EMS, and that it should fall under DHS HRSA and the CDC.
Speaking on behalf of northern Michigan was Upper Penninsula EMS Director Bob Struck, who’s organization was created from the grants Boyd oversaw. “There is definitely a role for the federal government to re-engage and become a leader. At the minimum, it will be a resource for the rest of us, because we need it,” he said. “We need a federal role, and perhaps with a lot of cooperation and goodwill, it will develop into what we need it to be.”
Representing the Association of Public-Safety Communications Officials was Kathy McMahon-Ruscitto, who urged FICEMS to include emergency medical dispatchers in the conversation.
“Please remember that emergency medical communications is an important component,” she said, citing next generation 9-1-1, advanced notification of crash data and transmission of medical data.
Garza noted that McMahon-Ruscitto’s comments are further proof of the broad reach of EMS.
International Association of Fire Chiefs (IAFC)
The last group represented on the call was the IAFC. Furthering what McMahon-Ruscitto said, IAFC Board of Directors member Jim Cole stressed that EMS is multifaceted, a medical agency that does transportation in the public safety arena. “Traditional EMS is not what a lot of this country does," he said.
He said because of that, EMS has typically been fractured. “We have lacked cohesion. We’re not a unified and solidified voice,” he said.
His colleage Dan Gerard, MS, RN, NREMT-P, who is secretary for IAEMSC, reminded FICEMS to remember what the core provider needs day in and day out. “They need equal footing. They need to have their leg up, and that’s where the battle is being fought day in and day out. They need a voice. They need to be equally represented. The need to have funding a representation equal to fire and police professionals,” eh said. “Field providers—those are the people we need to pay attention to.”
Cole also stressed that when large-scale disaster strikes, the places that are usually least served are rural.
With no other teleconference attendees left to speak, Garza urged anyone who hasn’t yet provided comments to e-mail them by April 18 to firstname.lastname@example.org.
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