EMS World Q&A: Jon Krohmer

Jon Krohmer, MD, FACEP, FAEMS
Career highlights
2016–2022: Director, NHTSA Office of EMS, DOT
2011–2016: ICE assistant director, ICE Health Service Corps, Department of Homeland Security
2006–2010: Principal deputy assistant secretary/deputy chief medical officer, Office of Health Affairs, Department of Homeland Security

It’s been an interesting last few years in EMS, and that’s true whether you’ve been running calls or running the U.S. government’s federal EMS shop in the Department of Transportation. 

Jon Krohmer, MD, FACEP, FAEMS, who has done the latter since 2016, retired at the end of January as director of the National Highway Traffic Safety Administration’s Office of EMS. Capped by the unprecedented COVID-19 response of the last two years, his tenure also included the ambitious EMS Agenda 2050 project and the office’s involvement and leadership in numerous other key EMS issues. 

In this month’s exclusive Q&A, Krohmer—who has also served with the Department of Homeland Security’s Office of Health Affairs as well as with the health services arm of U.S. Immigration and Customs Enforcement—reflects on his 5½ years with NHTSA, career in EMS, and what the future might hold. 

EMS World: How’s the retirement going? What are you waking up and doing these days?

Krohmer: I’m doing a little bit of reading. Candidly, I’m catching up on some projects I wasn’t able to finish before I left the office so I can get stuff back to them. And just kind of chilling out—it’s weird not to be busy all day every day. What I’d like to do is maybe take a month or two and just chill out, relax, and then figure out what kind of EMS projects I can get involved with. 

So you intend to stay involved in EMS rather than making it a true retirement? 

Krohmer: I doubt it can be a true retirement. I’ve been doing EMS stuff now for over 45 years, and it’s just a part of me. My wife affectionately refers to it as the EMS blood type. So I don’t think I’ll be able to totally separate. The folks in EMS are such great people that I don’t want to completely give it up. I don’t think I can.

As you look back at your tenure with the Office of EMS, what were some of the highlights and aspects you’re most proud of?

Krohmer: One of the great things I’ve taken home has been the opportunity to work with the EMS community and staff. The folks in the Office of EMS are so unbelievably dedicated and talented—they’re a great group to have worked with, and [new Director] Gam [Wijetunge] is in a perfect position to continue its activities. 

The evolution of the National EMS Information System has been really fun to watch over the last several years. Almost all of that can be attributed to Noah Smith, when he was there, and Eric Chaney and the folks at the NEMSIS Technical Assistance Center. Over the last several years, we’ve been able to engage more with the EMS community and stakeholder groups. We’re intimately involved with CMS [the Centers for Medicare & Medicaid Services] and CMMI [Center for Medicare & Medicaid Innovation] on a number of programs. There are several things going on with the CDC, the assistant secretary for health at HHS, and obviously with ASPR. 

We still have a long way to go in our effective use of EMS data, but I think we’ve been able to improve the understanding throughout the community and the resources they have available.

The Agenda 2050 project I was really excited about, and I think we found, as a result of COVID-19, that we’ve compressed into two years a number of things that were envisioned to occur over many years getting us to 2050. 

We did an update of the Scope of Practice Model, which I think was very appropriate, and the nice thing with the new model is the urgent update process that was developed. That allows us the opportunity, when there are things that need to be addressed in the scope of practice that weren’t included with the update, to bring those forward to NHTSA. NHTSA will form a special working group to look at them and then can provide addenda or updates to the scope of practice. 

We used that process shortly after the scope of practice update was released for hemorrhage control, which addressed the issues of wound packing and hemostatic agents and use of tourniquets, and then during COVID-19 we did some updates allowing EMS clinicians to be more involved in vaccinations and testing and things like that. 

Updates to the Model EMS Clinical Guidelines will be released soon. There are several evidence-based projects we’ve been involved with, pain management and airway management and things like that.

And probably one of the things I’m most pleased with, we have increased our interactions and engagement with our federal interagency partners and the national EMS stakeholder organizations. Some of that was facilitated by COVID-19 activities, but a lot of it had been going on previously and is something I hope will continue. 

You mentioned Agenda 2050. Can you summarize how you saw the importance of that document and how the EMS community can benefit from it moving forward?

Krohmer: EMS Agenda 2050 was interesting because during the early parts of the project, we identified that there is so much changing from clinical and technological perspectives that nobody on the work group could really predict what some of the day-to-day things would be. So they rapidly adopted the six guiding principles that are the core of the project, and we have seen states adopting those principles in their state EMS plans and some of their legislation. They have also been adopted as the basis for the structure of activities for both the Federal Interagency Committee on EMS and the National EMS Advisory Council. The guiding principles were really a phenomenal outcome of that document. 

More specifically as it relates to activities associated with COVID-19, the agenda talked about things like treat and release or treat and no-transport, treat and transport to alternative destinations, and the use of telehealth and other electronic technologies. We saw all of those happen during the COVID response. Albeit in relatively small situations, but COVID proved those concepts were doable, valuable, and, at least that we’ve seen so far, have not had any untoward effects on clinical care activities. 

When COVID-19 started we had some serious conversations with CMS about the ET3 project and expanding it and providing reimbursement for many of the things the project is looking at. Unfortunately, CMS on its own lacks the authority to make those kinds of broad changes. Some private health care systems and insurers have realized the value of those ideas both clinically and financially and started implementing them. But for CMS to make those changes broadly, Congress will have to provide it additional authorities it currently doesn’t have.

You’ve noted the adaptability and flexibility required to speed up the agenda timetable and become active in testing and vaccinations. What else did COVID-19 show us about EMS in America?

Krohmer: I think it revealed a couple of things. As you note it revealed responsiveness and adaptability. When EMS is faced with something, they will figure out a way to do it. During the COVID response, unfortunately, that came at the expense of our clinicians. They were overworked, and they were stressed. We’ve put an unbelievable amount of mental  and physical stress on our workers, just by the nature of the care they continue to provide and the fact they’ve had to work overtime and suffer through quarantines and isolations and all sorts of things. 

The good part of the experience is that EMS has stepped up to the plate and done what it needed to do to continue to take care of patients. The downside of it has been those stresses. We were experiencing workforce issues before COVID, and the issues we’re experiencing now have increased exponentially. 

The other thing I’ll note is that the EMS community came together in very dynamic ways. EMS has always been a little siloed, and many of the national organizations had their own agendas. Now a lot of the organizations have come together and are holding regular meetings to talk about their issues and find ways they can work on them together. 

One thing I think we really need to do moving forward is better educate our communities about EMS, and that includes their assumption that when they call 9-1-1, an ambulance will always respond. Stresses on the system really question whether that will be able to continue. So we need to educate the general community better, and without question we need to educate governmental officials at all levels better.  

We have to do a better job of beating the drum and saying, “Yes, other professions are also under great stress, but you know what? Doggone it, so is EMS. You need to understand the important role EMS provides to your community. And there’s a real threat that a lot of that will go away.” 

The volunteer communities in our country have been decimated over the last two years! I understand elected officials are faced with all sorts of issues they need to address, but we haven’t pointed out as aggressively as I think we should that EMS is one of those, and they have to step up to the plate and support it. 

With the first Emergency Medical Services Agenda for the Future in 1996, we talked about EMS is being the intersection of health care, public health, and public safety. There are a lot of folks who are of the opinion that EMS is health care, and that’s how we should view ourselves and be viewed. And I agree with that. But we are increasingly becoming part of the public health community. We will always be viewed as part of the public safety community. And this is my own bias, but we also need to engage more with the emergency management community. 

So my thought right now is, those 3 circles need to expand to 4, to include health care, public health, public safety, and emergency management, acknowledging that the size of those circles is not all the same. The health care circle is much larger than the public health circle, which is larger than the public safety and emergency management circles. But to function effectively, EMS really now has to be the intersection of all those disciplines to be able to serve the community appropriately.  about the Author

John Erich is the senior editor of EMS World. Reach him at jerich@hmpglobal.com.