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Now Is the Time: Establishing a Federal Agency for EMS

In February of this year, just before the EMS Today conference, President Obama’s staff asked leaders in the fire and EMS community to provide comments on whether or not there should be a lead federal agency for EMS. If so, who should this agency be and what should this lead agency do and not do? And if there shouldn’t be a lead, why or what alternatives exist?

Since EMS is strewn throughout the federal government in the Departments of Transportation, Health and Human Services, and Homeland Security, this question has resulted in a number of different solutions from a variety of agencies.

When we look at how things work now, EMS continues to be a challenge: Whom do we ask when there are concerns about cardiac save rates? Whom do we ask about how new EMS technology should be implemented?

Where do we go to seek grant funding to support EMS? Where do we go to seek clarifications on legislation that may affect EMS? Who is collecting statistics and putting these numbers to use? Who is providing this information to our elected officials and the public?

From the fire service perspective, these types of questions are directed to the U.S. Fire Administration. From NFIRS data to questions about residential sprinklers to issues of fire safety, all of these can be addressed by the U.S. fire administrator.

The problem on the EMS side is that there is no U.S. EMS administrator who can do the same thing. At least not yet.

There are many arguments about where EMS should be and the executive board of the EMS Section examined each of these arguments, along with all the questions this topic can generate. While people still ask why EMS remains in the Department of Transportation, opinions vary much more widely when the question is asked if it should be located in Health and Human Services or Homeland Security.

Health and Human Service seems to be more policy oriented, while Homeland Security is more response oriented. How would Medicare and Medicaid reimbursements be handled if DHS were the lead agency? Would this lead agency establish training and certification requirements? What about protocols?

And the questions go on and on.

If there were only a couple of players in EMS, this might be an easy question to answer. However, when you look at how many different organizations have their fingers on the puzzle pieces, you’ll quickly find there are just as many solutions as there are organizations.

Here’s a test. Can you identify this small sampling of organizations with a vested interest in EMS just by their acronyms?

  • IAFC, IAFF, NVFC (those were easy)
  • CoAEMSP, NASEMSO, NHTSA, NREMT (a little harder)
  • Don’t forget NIOSH, OSHA, NFPA, NDMS and NIH

Do you see where this is going? Because there are more that could be added to this list.

As providers, we need to have a unified position. That’s why the executive board of the EMS Section held meetings with the executive boards of the International Association of EMS Chiefs (IAEMSC) and the National EMS Management Association (NEMSMA) at EMS Today. The goal was to see where we could work together with these two organizations to move EMS forward and potentially partner up on this issue. While we do have differences between us, I don’t believe we’re that far apart, and I believe that these meetings went very well.

As the executive board of the EMS Section, we provided the IAFC board of directors with our opinions and beliefs on how President Obama’s question should be answered.

We do believe that a lead federal agency would benefit EMS greatly, regardless of whether you’re fire-based, third-service, private, hospital-based or volunteer. There are just way too many pros as opposed to cons to let this chance slip by.

After we decided there should be a lead federal agency, we felt the Department of Homeland Security would be the appropriate home. DHS has a duty to reduce the loss of life and property and to protect the nation. We share the same mission to protect the lives of those entrusted to our care, our patients, in their times of need.
As the position statement submitted by the IAFC states, “During a national emergency, whether from a natural disaster or a terrorist attack, effective EMS response will be a primary expectation of Americans. We strongly believe that prehospital emergency medical service response is primarily a public safety function, focused on service to the community and the nation, not profit.”

A number of points are further explained in this position statement, which can be found on the EMS Section’s website.

If we—all EMS organizations—can put our differences aside and remember that providing the best patient care possible is our ultimate goal, we can work together to provide a solution to the president. Somewhere along the way, feelings will get hurt, including ours in the fire service, but we have not had an opportunity like this present itself in a very long time.

Since the question has been asked and the door has been opened, we need to take maximum advantage of this opportunity to elevate EMS to where it belongs: to the same level and playing field as the fire service and law enforcement. Now is the time!

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