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Visionary EMS Leadership: Our Fire Duty to EMS

Fire chiefs and EMS leaders should take note of the dominating role the fire service plays in our nation’s emergency medical services.

The fire service is the largest provider of EMS in the United States, and by no small margin. The last National EMS Assessment showed fire-based EMS agencies are 40% of all EMS organization types. This was followed by nonhospital-based private agencies (25%), nonfire government-based agencies (21%), hospital-based agencies (6%) and everyone else (8%).

With that leading role comes tremendous responsibility for guiding, nurturing, directing, defending and delivering EMS.

As the leading EMS provider, the fire service controls how patients are cared for. Our patients are our number-one customers. The most important people in our departments are our members; if we take good care of them, they will provide excellent service to our customers.

EMS is a tough calling and our ever-changing healthcare system brings increasing challenges, greater expectations, declining reimbursement, more difficult patients and new threats to our safety. In the same way that we own fire, we need to own EMS. This sometimes means making difficult choices. It means standing up for our members and our patients.

The IAFC’s EMS Section is your voice at the national level for EMS issues. The section listens to your concerns and needs, then represents you in leadership positions on federal government committees and task forces, national organizations, accreditation and certification bodies, associations, alliances and consortiums.

Our responsibility to you, your members and our patients leads us to take stands on important issues that are sometimes quite unpopular with the remaining minority of EMS organizations. In the past year, this has included opposing a proposal requiring entry-level paramedics to have a college degree and opposing a national movement to change the name of EMS to paramedicine and call all EMS providers paramedics

We also work tirelessly to fulfil our responsibility as shepherds of EMS. It was the IAFC that pushed to establish a national accreditation system for paramedic programs that included the option to obtain a college degree. It was the IAFC that pushed to require graduation from an accredited program to sit for a National Registry exam. We continue today to lead the work of the Commission on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP).

When we heard that our members were being bullied by hospitals that refused to comply with the testing and reporting provisions of the Ryan White Law, we called on the secretary of Health and Human Services to enforce the law. When our calls fell on deaf ears, we talked with Congress and as a result we will shortly have regulations published that provide for enforcement of the Ryan White Law by NIOSH.

This spring, EMS Section leaders will bring your concerns about drug shortages to Congress to ensure they know our patients are being harmed day in and day out by medication shortages.

Our responsibility also extends to quality in EMS. We have actively worked with our partners at the National Highway Traffic Safety Administration to refine and develop the National EMS Information System (NEMSIS) so that it captures information needed to report, reflect and improve upon the care we deliver in the streets. The IAFC works with government leaders to ensure that monies are allocated for EMS research, such as ambulance crash testing, studies on fatigue in EMS personnel, revisions to the National EMS Scope of Practice and planning for the future.

The annual Fire-Rescue Med conference brings hundreds of EMS Section members together with other EMS leaders, government officials and partners as well as the best and brightest minds in fire and EMS. FRM offers an opportunity like no other to network, learn and make your voice heard.

When Congress cut the Medicare ground ambulance extender payments last year, the IAFC joined with other stakeholder organizations to get the payments restored. We are now working closely with the Centers for Medicare and Medicaid Services to develop cost-reporting tools that will allow Congress to make future adjustments in Medicare payments based on actual costs of providing EMS service.

This article has barely touched on the many activities the EMS Section is working on with you to fulfill our responsibility to EMS. The more important question for fire chiefs and EMS officers is, “How are you exercising your role as the leading provider of EMS?”

If you are not at the table, it is quite likely you are on the menu. Just as we are the recognized leaders in our communities in fire prevention, fire safety and firefighting, we absolutely need to step up to the plate as leaders in EMS. To do otherwise is to let others – of considerably smaller size and share of the EMS market – determine where we are going and what our future will be.



National Highway Traffic Safety Administration. EMS System Demographics. 2011 National EMS Assessment Research Note. (Report No. DOT HS 812 041). Washington, DC: National Highway Traffic Safety Administration; 2014.


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