Administration and Leadership

The Agenda is Set … Now What?

In September, Jon Krohmer, MD, FACEP, marked the end of his second year as director of the National Highway Traffic Safety Administration (NHTSA) Office of EMS. His tenure has included major initiatives, such as EMS Agenda 2050 and a revision of the National EMS Model Scope of Practice, as well as continued efforts to support state and local EMS organizations battling the opioid crisis and addressing other public health issues.

Krohmer has a long career in EMS, starting as an emergency physician and EMS medical director in Michigan. He served in national organizations, including a stint as president of the National Association of EMS Physicians (NAEMSP). After leaving Michigan to serve at the federal level, he was deputy chief medical officer and principal deputy assistant secretary of health affairs at the Department of Homeland Security. He also led the Health Services Corps for Immigration and Customs Enforcement and provided medical expertise to the U.S. Coast Guard.

In this interview, Krohmer talks to us about the important role the federal government plays in supporting EMS systems, the value of standardized EMS data and how we can plan for the future without predicting it.

Q: What is the role of the NHTSA Office of EMS and its federal partners?

A: The Office of EMS looks at EMS systems from a national perspective to figure out what can be done to help develop, refine, and sustain EMS systems. This could include coordinating federal collaboration, mitigating nationwide challenges that agencies face, or supporting the development of new technologies to provide better patient care and safety. Our office has no regulatory role—EMS is regulated at the state level—which gives us the benefit of really being able to focus on the important issues of today and responding to the needs of our colleagues across the country.

Working in close collaboration with other federal agencies and programs, OEMS has been able to bring stakeholders together to address pressing issues. The Department of Transportation has a long history of doing this, dating back to the original national EMS curricula in the seventies, to more recent efforts, including the development and improvement of the National EMS Information System (NEMSIS). This national-level coordination has many benefits, such as providing access to national data for research purposes and improving EMS care or allowing EMS clinicians more flexibility in their careers.

We also serve as a voice for EMS at the federal level. While we are prohibited to lobby or advocate for any specific laws, we often serve as educators when our federal colleagues have questions about EMS. We work hard to make sure that across the federal government, policymakers are aware of the critical role EMS providers can play in improving the nation’s health and safety. For example, with the recent legislation on controlled substances, the OEMS team was involved in a working group with the Drug Enforcement Administration (DEA) focused on the administration of controlled substances by EMS personnel, contributing an EMS perspective to what is ultimately a DEA decision. With our staffs’ participation, it’s a very advised, educated decision by the DEA that considers the needs and challenges of EMS providers.

Q: But why the Department of Transportation?

A: That is a question we get quite a bit. Let me clarify that it has nothing to do with ambulances being modes of transportation and is in no way related to how EMS is reimbursed by Medicare or Medicaid programs. In fact, it dates back to the origins of the modernization of EMS systems. Traffic crashes were killing thousands of people as the proliferation of vehicles and development of interstates far outpaced safety efforts or the creation of coordinated responses to trauma care. When the issue rose to national prominence, the National Highway Traffic Safety Administration was created—and within it, the Office of EMS.

Because of our history, which is intertwined with the history of organized and funded systems of care for trauma patients, we have always looked at EMS issues through a “systems” lens. It will take more than one new piece of equipment, new drug, or new training program to solve any major public health crisis—whether we’re talking about opioid overdoses or traffic crashes, which unfortunately both kill too many people.

But it’s important to note that many agencies play a role in supporting EMS, and we all work together through something called the Federal Interagency Committee on EMS—or FICEMS. FICEMS ensures we have a forum for communicating with each other, sharing information back and forth, and coordinating our various activities. FICEMS is composed of representatives from the Departments of Transportation, Defense, Health and Human Services, Homeland Security, and the Federal Communications Commission.

FICEMS also works with the National EMS Advisory Council, a group that’s composed of about two dozen individuals representing all disciplines in EMS. These individuals are not federal employees—they work for local agencies such as public and private EMS services, 9-1-1 communication centers, fire departments, hospitals and more. They take their job as advisors to NHTSA and FICEMS very seriously, and their recommendations have led directly to projects funded and supported by the federal government. A few notable examples include EMS Agenda 2050 as well as two projects that are just getting kicked off: 1) the revision of the National EMS Education Standards; and 2) a stakeholder driven look at the nomenclature we use to describe our profession.

Q: You mentioned EMS Agenda 2050. That project kicked off just weeks after you became director of the office. What has it meant to you and what will it mean to the profession?

A: It’s been incredibly exciting for me. I served as president of NAEMSP just a few years after the publication of the original EMS Agenda for the Future, and I remember the impact it had on us then. Since 1996, we’ve been able to achieve many pieces of its vision, but we’ve also seen the landscape of EMS, healthcare, public safety and public health evolve. EMS Agenda 2050 is part of that evolution.

Q: Was it challenging to predict what EMS might look like in 30 years?

A: Very much! I will admit freely that trying to think about what could be, without getting too caught up in what is, was—and remains—very difficult for me. That’s one of the reasons we made sure this project was not a federal one, but a community effort. While NHTSA and our colleagues at HHS and Homeland Security funded EMS Agenda 2050, a great group of EMS professionals from across the industry led the conversation. And I use the word “conversation” intentionally—it was a dialogue, with hundreds of people giving input, both in-person and online.

The community acknowledged early on that we were not trying to predict the future, but to create a vision for how the entire profession can shape the future and also be prepared for whatever the future brings. The project team developed a vision structured on guiding principles that will remain true whether ambulances still have wheels, people still have heart attacks or hospitals still have ICUs. I’m really excited for the people-centered vision that was created and look forward to the official release of the EMS Agenda 2050 document soon. This will only be the beginning, and now comes the fun part—working together to make it real.

Q: What about data? It seems to be what everyone is talking about. Is it a big part of the vision?

A: Clearly, data must play a role in the future of EMS systems. And throughout EMS Agenda 2050, you’ll see examples of how data can be used to measure and improve patient care, safety and efficiency. But in some ways it hides in the background, and I think that says a lot about the vision the community wanted to see: one in which the focus is on the people and outcomes, and in which data can be used to support our efforts to get there.

Historically, we haven’t always done a great job of explaining the important role that data can play. The impetus behind NEMSIS—which was one of many achievements called for in the original 1996 Agenda for the Future—was to provide consistency in how we capture data electronically and standardize data collection from agency to agency, with the goal of then using that data to help us meet our objectives of caring for our patients and communities. Sometimes we get so focused on data collection as the goal that we forget why we’re doing it in the first place; to measure and improve the care provided to patients in EMS systems across the country.

Q: So now that EMS Agenda 2050 is nearing the end, what’s next?

A: Well, while the initial phase of developing the vision is complete, I think that was really just the beginning. It will take all of us working together to advance this profession and implement some of the recommendations of 2050. At the federal level, we’ll be working together to see how we can support that effort. But it’s also up to everyone, including clinicians at all levels, administrators, educators, medical directors, local and state regulators, and so on, to start thinking about how these guiding principles can be incorporated into their daily work. And to come together to figure out what short-term actions we can take that will lead us to the long-term goals in the agenda. It’s not going to be easy, but I think we’re all up to the challenge.