Emergency Medical Service: We’re Not in Kansas Anymore

In this classic movie, Dorothy quickly realized that something was different. The environment, the people, everything had changed.

We know change is inevitable: we deal with it on a daily basis, in both our profession and our personal lives. While some hesitate to deal with change, most of us know we should embrace it and make it work for us, not against us.

Today, we’re facing an environment of significant change.

The change started last November when Donald J. Trump was elected president of the United States. His views, positions and statements were of concern to many, and he promised significant change if elected. Along with this election of a Republican president, both houses of Congress retained their Republican majorities, increasing the odds that whatever the president wants to change, he’ll have a pretty good chance of implementing.

What does the election mean for those of us in fire and EMS?

Well, we saw it already starting in early January when the new Congress began whittling away at the Affordable Care Act. We’ve dealt with the impacts of Obamacare for the last six years and now all that we’ve worked on could be lost.

If it is repealed and replaced (as the Republicans promised), we could be dealing with a completely new set of rules, regulations and services that will certainly impact EMS operations. Accountable care organizations (ACOs) may be eliminated, funding for community paramedic programs may cease to exist and those who were able to secure insurance under Obamacare may find themselves without it once again.

While I don’t believe all will be lost, I do believe we should be prepared to adapt to the change that will come with a replacement program.

Change is happening at many other levels as well. New secretaries at the Departments of Homeland Security, Health and Human Services, Transportation and elsewhere will cause changes all the way down through each department. We’ll see multiple new under- and assistant secretaries, a new FEMA director, a new U.S. Fire administrator, a new NHTSA administrator, a new Medicare/Medicaid administrator—and the list goes on.

While each will work to implement directions they receive from above, they’ll also have their own opinions on what should be implemented within their respective departments. Each of these positions can have a significant impact on fire and EMS issues, ranging from grants, education, research and overall funding to operational and administrative applications and issues.

The key to all of this will be our ability to adapt to this new environment. We should expect to see changes on many fronts, some good and maybe some we perceive to be not so good.

However, as I’ve said before, fire and EMS agencies are very good at making it work. We frequently have to improvise, adapt and overcome, and this situation will be no different.

I wish I had a crystal ball or could foresee the future so I could give you specifics on what to prepare for and when, but like everyone else, I don’t. I can tell you to expect change from our new president and his administration, and you need to be prepared to respond and react to these changes.

One thing is for sure: we’re not in Kansas anymore.

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