Where Does EMS Fit the Federal Landscape?

Association Minutes features commentary from various EMS associations.

     One of the jobs I enjoy most being the president of the National Association of EMTs is the opportunity to meet and network with EMS providers around the country. At a recent dinner with two EMSers whom I admire and respect, we debated EMS's role in public safety vs. public health, disaster preparedness and response, the incredible diversity of EMS delivery models, EMS educational standards, and how EMS should best be represented in the federal government.

     Unless you have been under a really large EMS rock, you know that recent talk in our industry regarding a federal EMS agency has been spirited, if not passionate. On one side are the folks who believe EMS belongs in the Department of Homeland Security (DHS). Others think it should be in the Department of Health and Human Services (HHS). Still others think it's best to work with what we have: an Office of EMS in the Department of Transportation (DOT).

     As we discussed all of these options and more over dinner, I recalled a speech I heard recently by Dr. Jeff Runge, the DHS chief medical officer. In that speech, Dr. Runge asserted that EMS already has a lead federal agency--the Federal Interagency Committee on Emergency Medical Services (FICEMS).

     Dr. Runge is one of most well-respected EMS folks in DC. His background in EMS is impeccable. Yet, his view is not shared by many. I've heard FICEMS called a useless governmental entity, a waste of time, a proverbial toothless tiger. In one of his last writings, Jim Page blasted FICEMS. The FICEMS of 2007, which is supposed to be better, stronger and more accountable, is just getting started, yet cynics are already poised to pounce, claiming this FICEMS is no better than the old one.

     Since the proposal and inception of the new FICEMS, NAEMT has taken a position of support. It was and continues to be our opinion that FICEMS may be EMS's best chance for success in the federal arena. We are even more enthusiastic about the announced creation of the National EMS Advisory Council (NEMSAC), which will be a national stakeholder group charged with advising the NHTSA Office of EMS on key issues and policy matters that affect and influence those of us charged with providing EMS on a daily basis.

     As an EMT or paramedic, you may be asking, "How does this affect me, the street provider?" Regardless of your personal belief or philosophy, what goes on in Washington does affect you. It affects the very fabric of what you do. National leadership in EMS ultimately guides and affects everything we do from operational and clinical issues to preparedness/readiness, and to a certain extent, even the wages and benefits you receive.

     Part of the reason EMS has lagged behind other public safety and health entities in terms of presence and funding is that we have been unsuccessful in uniting our troops to define and speak a cohesive message. To an extent, we have been our own worst enemy.

     At the same time, we haven't had that single lead agency willing to fight the good fight. Most people will agree that NHTSA's Office of EMS has done tremendous work with a paltry budget. At the same time, there are many offices within the federal government claiming a stake in the delivery of EMS; yet, for the most part, communication and coordination among these offices have been lacking and, as a result, the funding stream for EMS is abhorrent.

     As an EMS community, we are a different and unusual breed. EMS is provided in a variety of settings by a variety of delivery models. We have one foot in public safety and another in public health. In this way, we are not like our brothers and sisters in the fire service or law enforcement communities. So maybe we need to quit trying to fit a square peg in a round hole. The police have the Department of Justice; the fire service has the U.S. Fire Administration. Does that mean that EMS must have its own stand-alone EMS agency? Yes. It just may not have the look of existing models.

     EMS is a multidisciplinary industry, so we need a multidisciplinary representative in Washington. FICEMS and the NEMSAC are currently our best option. Rather than argue DHS vs. HHS vs. DOT, let's focus our energies toward supporting those groups so they can ultimately work toward achieving the empowerment and funding we deserve. Let's put down our personal and jurisdictional biases for the betterment of our own and ultimately for those we are privileged to serve.

     That's what NAEMT's mission is all about: representing and advocating for EMTs and paramedics, regardless of the color or style of uniform we wear. That's why we believe that supporting FICEMS, NEMSAC and a single, high-level federal EMS lead agency is so vitally important to our profession and those we serve.

NAEMT President Jerry Johnston is a second-generation EMS provider who began his career in 1975 and currently serves as EMS Director of the Henry County Health Center (HCHC) in Mt. Pleasant, IA. Jerry has a BA in business management and economics and is a nationally registered paramedic.