EMS: Neither Fish Nor Fowl Nor Good Red Meat

As much as it pains my libertarian soul to say this, it’s time for the fed.gov to take an active role in EMS.

One of the things that most attracted me to EMS was that we kind of straddled that line between public safety and public health. EMS calls have always been like Forrest Gump’s box o’ chawklits, and that’s a big part of the romance of the street.

Unfortunately, “box o’ chawklits” also describes federal policy toward EMS; you never know what you’re gonna get. As it stands now, we are a hodgepodge of reimbursement schemes, system delivery models, staffing requirements, and practice standards.

The United States doesn’t have an EMS “system.” It has a big, unwieldy Rube Goldberg device made of redundant and disparate parts. If you think U.S. health care system is hopelessly muddled and fragmented, EMS makes the rest of it look downright OCD in its orderliness.

EMTs around the country have trouble obtaining reciprocity to practice in other states, because state licensing agencies still cling to the conceit that a CHF patient in New York City somehow requires different treatment than one in West Bugscuffle, Texas.

And as a result, when it comes to grants and federal funding, strategic planning – be it for pandemic flu or response to weapons of mass destruction – or regulation, EMS is the forgotten, redheaded stepchild, written in only as an afterthought. We’re too immature to sit at the big table with all the adults of Public Health, and we’re forced to beg for scraps at the back door of Public Safety, useful only as staffing justification and a revenue stream.

Thus, the push for a lead federal agency for EMS, tasked with shaping a coherent, nationwide strategy for developing local EMS systems, enhancing interopability (hey, I coined a word!) and communication with other systems, and maximizing efficiency of existing EMS systems.

Yeah, I know, the words “efficiency” and “federal government” are antithetical terms, but hear me out. Law enforcement has the Department of Justice. Fire suppression has the U.S. Fire Administration.

Who represents EMS at the federal level?

Like it or not, our reimbursement and regulation flows from Washington, and that’s a fact not likely to change no matter how much we want smaller government. A lead federal agency for EMS is probably going to happen. The thing we’re most likely to influence is where it will happen.

So it’s time for EMS to decide if we’re fish or fowl or good red meat. I know in practice we are a hybrid profession, but where beats the heart of EMS? Should our lead federal agency be under the umbrella of public health, or public safety?

Well, the Federal Interagency Committee on EMS (FICEMS) is asking for input in just that.

That link is a direct email link to the committee, where stakeholders may provide their input. Copied directly from the email I received from our state EMS office:

The Federal Interagency Committee on Emergency Medical Services (FICEMS) was created by law to help ensure coordination among Federal agencies involved with State, local, tribal, or regional emergency medical services and 9-1-1 systems. As discussed at their December 16, 2010 meeting, FICEMS is assessing the current and future role of the Federal government in EMS and evaluating the options for establishing or designating a Federal lead office or agency for EMS. The National Security Staff Resilience Directorate has requested that FICEMS engage with stakeholders and develop an options paper by May 15, 2011.

FICEMS is interested in any stakeholder input about the role of the Federal government in the full continuum of emergency medical services and emergency and trauma care for adults and children– including medical, 9-1-1 and emergency medical dispatch, prehospital emergency medical services (both ground and air), hospital-based emergency care and trauma care, and medical-related disaster preparedness.

With respect to this full continuum of emergency medical services and emergency and trauma care for adults and children any stakeholder input would be appreciated regarding topics such as:

• The role of the Federal government
• Activities or functions that should NOT be the role of Federal government
• The role of a Federal lead office for EMS if it were established including the functions/issues it should perform and address
• Other comments or suggestions
  

Most of the usual players have weighed in with their own opinions. The U.S. Department of Transportation, specifically NHTSA, has been the de facto federal agency of EMS ever since our inception. They develop and promulgate our educational standards even today.

But the plain fact is, we have outgrown our infancy as trauma care technicians trained to pull people of of wrecked cars. EMS has become the safety net of the entire health care system, and as such, we’ve outgrown NHTSA. As long as we’re housed under an agency whose primary function is managing transportation infrastructure, we will always be an afterthought.

The U.S. Fire Administration, being the altruistic bunch that they are, would welcome us with open arms. But since EMS calls make up over 80% of the run volume of most dual-role fire departments, I sense a bit of a mission conflict. Somehow, I doubt they’d be willing to reorganize their entire rank structure and rename the place “U.S. EMS Administration (With A Little Fire Now And Then).”

The International Association of Redheaded Stepchildren EMS Chiefs and the EMS Labor Alliance have already submitted their White Paper on the subject. A synopsis of the document: we belong under Department of Homeland Security.

Sorry, bad idea. The Department of Homeland Security already has the TSA. It doesn’t need another agency of poorly trained employees who touch people in intimate places, yet still can’t prove that all the probulating actually makes us safer.

So that leaves the Department of health and Human Services, which is my pick for the umbrella department to house a new lead federal agency for EMS. What we provide is health care, after all. Most of the science is a subset of medical care, and most of our funding and reimbursement comes from the federal government under CMS. It’s the logical place for Emergency Medical Services, and the one that will best help us take our rightful place amongst the other health care professions.

But enough about what I think. What do you think? And don’t just tell me, tell FICEMS, too. Here’s the chance for the EMS 2.0 movement to show that it really has legs. Get your social media revolution on, people!