Behind the Scenes

The July issue of EMS World Magazine contained two articles that the National Association of State Emergency Medical Services Officials (NASEMSO) felt would benefit from further clarification.

The articles, “Five Steps to Improve Your State’s EMS Climate” and “A Troubled State, Part 2: What Can We Learn from Iowa’s Experience?” brought up some issues NASEMSO would like to address.

For 40 years, state EMS offices have been involved with EMS system development, support and regulation, including implementation of innovative approaches.

In the interest of painting a complete picture of the contemporary role and duties of state EMS offices, it is important to remember that these offices are in the executive branch of government. As such, they are bound to a mandate dictated by the legislature and enacted by their governor.

As with any healthcare profession regulated by states, patient care interventions, technology, scope of practice and the expectations of the public change. When the solution or advancement of the system (that the state EMS office staff may be in full agreement with) is prohibited by law or rules, or wasn’t anticipated in the current laws or regulations, the state EMS office has no choice but to say “No—until the law or rule is changed.”
This is not an effort to be obstructionist. NASEMSO would like the EMS industry to understand it is a career-ending move for a state EMS director to violate state law or disregard administrative code. In addition, a state EMS director is rarely allowed to arbitrarily contact legislators to introduce legislation or lobby for any specific legislation—it is often prohibited by state policy.

For the most part, the role of the state EMS office as it relates to legislation is to serve as subject matter experts in estimating the impact of proposed legislation on the EMS system. What this really means is an EMT or paramedic has more sway over a state legislator than a state EMS office staffer may. As for state EMS office-introduced solutions, many states may have only one opportunity at a set time per year to introduce new or corrective language, or to repeal antiquated language.

One of the problem areas cited in the articles was the need for flexibility with medication formularies. In all likelihood, most state EMS offices would not have an issue per se with this, but in some states there is a board of pharmacy or board of medicine that must be consulted in regard to issues like these, or as outlined above, the formulary may be dictated by state rules. Similarly, new patient care equipment and/or supplies may be subject to review and approval by a board or advisory council before field use is possible.

The state EMS office ensures the quality of a statewide coordinated, high-quality EMS system in order to protect the health and safety of the public. Every state is a member of NASEMSO. On behalf of the state EMS offices and EMS systems throughout the U.S., NASEMSO is focused on several projects of national significance:

• EMS Workforce Planning: Documenting basic methods of quantifying supply, demand and need for EMS personnel education, certification and licensure;
• Implementation of an Evidence-Based Guideline: A demonstration project to document the successes, obstacles and barriers to statewide introduction of a new pain management protocol in five states;
• EMS Education Agenda Implementation: Facilitating states’ transition to the new levels of EMS personnel licensure, scopes of practice and educational standards;
• E.V.E.N.T.: Sponsorship of the online tool designed to improve the safety, quality and consistent delivery of EMS by collecting near-miss, patient safety, violence against EMS and line of duty death data submitted anonymously by EMS practitioners;
• EMS Personnel Licensure Interstate Compact: Development of legislation for states’ introduction to provide immediate legal recognition of EMS personnel licenses when they cross state lines.

The support, improvement and regulation of EMS systems is a complex set of tasks. State EMS directors and their staffs are dedicated individuals charged with conforming to their legislative mandate. Our challenge to all local and regional EMS system participants is to approach their state EMS offices in a collaborative, cooperative way with the primary interest of crew and patient safety and a desire to learn the “why” behind the challenge.

Most important, we appeal to all EMS system participants to work in concert in a multiagency manner to resolve issues to improve the EMS system in a evidence-based and accountable manner.