Being a Player: How NAEMT is Positioning Itself for the 21st Century

     Beginning this issue, we debut a column that features commentary from various EMS associations.

     The National Association of EMTs (NAEMT) is working to strengthen its role in addressing the national needs of EMTs and paramedics. With the recent Institute of Medicine (IOM) report on the future of emergency care describing numerous areas in EMS that need improvement, NAEMT is hoping to leverage its claim as the oldest and largest national EMS association into a leading position in addressing those needs.

     The following interview with outgoing President Ken Bouvier and President-Elect Jerry Johnston, who will assume the presidency in September, sought to find out how NAEMT will position itself for the future. In addition to their NAEMT duties, Bouvier is the administrative liaison at New Orleans EMS, while Johnston is the EMS director for two rural, hospital-based systems in Iowa. Both men also run calls as field paramedics.

     Q: Both of you have been outspoken about the plight of EMTs and paramedics in America. What is the current climate for EMTs and paramedics out there?
     Bouvier: It's mixed. Because we don't have a good national reporting system, we have to make some assumptions from what our members tell us, what we hear in the press and the limited research out there. Everyone is hearing about personnel shortages, about pay, benefits and the lack of a clear career path for people in EMS. Rural areas are having trouble finding volunteers, and all of these issues are related to money and funding. Another big issue is health and safety. We're seeing too many EMTs and paramedics getting hurt and sometimes losing their lives in traffic accidents, violent scenes and especially in the air ambulance systems.
     Johnston: A big issue is recognition. EMTs and paramedics are tired of not being recognized. While our brothers and sisters in fire and police are being recognized, and enjoy even more recognition since 9/11, EMS workers are getting left behind. Not only are EMS workers not being acknowledged for the work they do, EMS in general is not being recognized at all levels of government-federal, state and local-and this is affecting the funding stream. Reimbursement for ambulance transport is not keeping pace with costs and little of the funding from Homeland Security is reaching EMS.

     Q: What is NAEMT doing to help EMTs and paramedics?
     Bouvier: First, you have to understand that NAEMT has had to change with time. When this association started 30 years ago, it was primarily focused on helping EMTs and paramedics gain professional recognition in the medical community. Over the years, it has had its ups and downs and has struggled with membership, finances and lack of recognition, but in the last several years, this association has reinvented itself as a major force in the EMS community so it could begin to speak about the issues that all EMS professionals are concerned about.
     Johnston: The big issues-the EMS funding and workforce issues-are complex because EMS is provided by different kinds of agencies and paid for by a variety of means, and because EMS uses all types of workers-volunteers, part-timers, paid union and non-union employees. There isn't one easy answer. The best way I believe NAEMT is addressing the big issues is by putting itself in a position of being able to speak nationally on these issues.

     Q: How is NAEMT positioning itself to address these issues?
     Bouvier: Earlier this year, we had an outside research firm survey nearly 3,000 of our members to find out what they think about how EMS is represented in the federal government. Another thing we're doing to strengthen our voice is growing our membership. We now have more than 20,000 members, making us the largest association representing EMS professionals in America, but we can do better. We need every EMT, paramedic, nurse, physician and medical director involved in EMS to join NAEMT.
     To position ourselves, we're making sure NAEMT is a national player-that we're on national committees, boards, projects, organizations and commissions. Any place where decisions are made that impact the EMS profession, we need to be there. When I became president, I said the days of NAEMT operating in a corner by itself were over. I personally made it my mission to get to know all the leaders of EMS in government and all the major organizations so I could advocate for our members.
     Johnston: NAEMT has markedly increased its visibility and willingness to collaborate with our partners and stakeholders at the national, as well as the local level. In the past, for a variety of reasons, NAEMT wasn't even invited to the table in a lot of forums. Because of the strides we've made recently, not only are we positioned to be a stakeholder at the table, we are actually being invited to venues that we haven't been invited to in the past.
     Bouvier: I've been a member of NAEMT since 1983 and I've never seen NAEMT get the exposure it's getting today. A lot of the exposure comes as a result of the NAEMT leadership's commitment to our mission statement: "To represent EMS professionals through advocacy, education and research." Today, people are calling us. We're being asked to attend important meetings in Washington, to meet with administration officials, to sit on panels and to participate in projects. We're talking with people in Cabinet-level positions, senators and congressmen. The result is people are getting to see that NAEMT speaks for all EMTs and paramedics. Every important national leader I've spoken with, including President Bush, I've told them about NAEMT and asked them not to forget the important work that EMTs and paramedics are doing out there every day.

     Q: How does NAEMT's board-level position with Advocates for EMS help EMTs and paramedics?
     Johnston: This is a good example of how we continue to strategically position ourselves. EMS has long needed a united voice to speak about issues on Capitol Hill that affect the rank-and-file field providers. In the past, that voice has been rather fragmented. When Advocates for EMS was started by the EMS physicians and the state EMS directors as a collaborative lobbying organization to go after federal money and push for pro-EMS legislation, we thought it was a good idea-a first step in uniting the EMS voice on Capitol Hill. We joined, but we also told them that they needed to have EMTs and paramedics represented at their board level to be effective. Eventually, they heard us, and we now have three NAEMT members on the board and an NAEMT past president [Nathan Williams] as president of Advocates.
     Bouvier: Through Advocates, we have a professional staff of policy people in Washington keeping us informed about legislation, helping us to be better prepared when talking to our Congressional representatives and helping us push for what will help the EMS profession.

     Q: What is your view on creating an EMS office in the federal government?
     Johnston: Many EMTs and paramedics are upset about this issue because it reflects on what I mentioned earlier about the lack of recognition. EMS is an essential public service, like police and fire, yet EMS hasn't enjoyed the same recognition as our brothers and sisters in police and fire at the federal level. So, NAEMT believes there should be an office of EMS at the federal level that is on par with fire and police. However, at this time, we don't believe it serves EMTs and paramedics for us to push for that office to be in a specific department. We want to leave that option open and see how things develop in Washington. The recent IOM report recommended an office in Health and Human Services and we are exploring what that might mean. In the meantime, we will work closely with the EMS Office within NHTSA.
     We've also had a longstanding support for FICEMS [Federal Interagency Committee on EMS]. Some people have said that FICEMS is a waste of time, but it is the only means we have within the federal government to coordinate EMS activity at this time. We're pleased that it's being reorganized under NHTSA, and we need to give this a chance to work unless we see movement for something better.

     Q: What are you doing to address the workforce issues?
     Bouvier: We're trying to understand the issues, figure out where the needs are and then look at how we can help by funding research, creating positions and advocating within government and to the public for change. The big challenge right now is figuring out exactly what's going on with the EMS workforce, so we're doing a couple of things. We've put up $5,000 to fund research on the EMS workforce. We're also participating with NHTSA's EMS Workforce for the 21st Century Project being conducted by the allied healthcare workforce experts at the University of California San Francisco. We expect a comprehensive report about the EMS workforce later this year.
     Johnston: The workforce project is the first real national effort to understand the problems, and we expect it will help guide our actions. Another thing we're doing is trying to get a handle on the health and safety issue. Last year, NAEMT conducted a survey of more than 1,300 NAEMT members where we found that four out of five EMS workers have experienced some kind of injury or medical condition as a result of their work. That should make everyone concerned. Too many folks in this business do not have the right protective equipment, are experiencing career-ending back injuries and are getting hurt or killed in the line of duty. EMS has lagged behind. Our Health and Safety Task Force is picking up momentum, but we need people who are willing to help us formulate positions, advocate for standards and mount campaigns to improve the safety of our industry.

     Q: What would you say to an EMT who wonders what he or she gets for being a member of NAEMT?
     Bouvier: The most important thing NAEMT gives you is a voice and a vehicle to help give EMS the recognition and respect it deserves. NAEMT gives you the opportunity to have your voice heard. I am not sure who said this but "It's not always about what you get out of something, but sometimes the greatest reward is what you put into something."
     Johnston: We constantly ask ourselves if NAEMT is delivering a tangible, value-added product to our membership. I think, even more important, what NAEMT really offers members is an opportunity. All of us leaders started as members who watched the organization and then got involved. It's actually exciting to watch and then participate in the process. Not everyone wants to lead or has time to participate, but by joining NAEMT, you are making a significant contribution to the betterment of EMS. Beginning this issue, we debut a column that features commentary from various EMS associations.