What’s New at NEMSAC

On February 15–16, 2023, the National EMS Advisory Committee (NEMSAC) met at the Royal Sonesta hotel in Washington D.C. and online to discuss topics such as obtaining fair funding for EMS, deriving clear guidelines from vague rules covering medication administration, and ensuring “equitable” access to EMS across the country, among others.

According to ems.gov, “The National EMS Advisory Council was established in April 2007 as a nationally recognized council of EMS representatives and consumers to provide advice and recommendations regarding EMS to National Highway Traffic Safety Administration (NHTSA), part of the Department of Transportation, and to the members of the Federal Interagency Committee on EMS (FICEMS).”

EMS World covered the meeting and provides the following highlights.

Seeking Funding Parity With Police and Fire

The battle to get a fair level of funding for EMS agencies, compared to police and fire departments, is an ongoing priority for NEMSAC—so much so that its Sustainability & Efficiency subcommittee wants to rename its EMS System Financing Advisory as the Annual State of EMS Financing Advisory. The reason? This advisory “should be updated and looked at every year by the committee until we can get EMS funding fixed,” said subcommittee Vice Chair Jonathan Washko. “I don't know if that'll ever happen, but at least [we can] get the ball moved much farther down the field.”

The fundamental problem with EMS agencies’ funding, compared to other public safety agencies, is that it comes from “a fixed pool of dollars ... that doesn't grow when our expenses go up,” Washko explained. “We're kind of stuck within this constrained bucket of dollars when it comes to reimbursement, at least from insurance payments.”

This is why “I'm trying to expand federal grant opportunities,” continued Washko, “to help out the industry at the local level.”

Protecting EMS Workers from Vague Medications Law

NEMSAC’s Data Management Standards subcommittee is wrestling with the legal risks to EMS workers inherent in the Protecting Patient Access to Emergency Medications Act of 2017.

According to subcommittee member Tom Arkins, before this law was passed, “paramedics could only give a narcotic under the law if a physician was standing there or if there was a prescription written for that patient,” which just didn’t work on most EMS calls.

The Protecting Patient Access to Emergency Medications Act of 2017 is “more user friendly for EMS, but it does come with some other things that we need to be aware of,” he said. The biggest issue is the legalistic provisions within the law: “Unless you're a lawyer, some of the law gets kind of confusing sometimes,” he said. NEMSAC wants to work with other EMS regulatory bodies to “create some standardized guidelines, education and training that will help support this law and actually enable EMS providers to follow it correctly.”

Ensuring ‘Equitable’ Access to EMS for All Americans

In a perfect world, all Americans would have equal access to the same quality of EMS support, whether they live in a big city or somewhere rural and remote. However, our EMS funding model makes this goal unattainable, which is why NEMSAC’s Equitable Care subcommittee is working on achieving equitable EMS response for all U.S. jurisdictions regardless of population density.

“Our goal is making sure that the responses in more rural areas are as safe as we can reasonably achieve,” said subcommittee member Dr. Richard Bradley. “There's a number of measures that we can look at and see how close we are to achieving the minimum level that we would like.” These measures include providing universal access to enhanced 9-1-1 services everywhere, providing more training support to career and volunteer EMS workers, and adequately serving patients in areas that don’t have hospitals and other vital health care centers within reasonable driving distances.

The current EMS funding model is also an issue: “There's certainly areas of the country where per-use funding is not going to fund an adequate level of EMS response,” Bradley said.

Reducing Ambulance Crashes

According to the National Safety Council, 180 people died in crashes involving emergency vehicles in 2020, with 56% of these deaths being the occupants of non-emergency vehicles. Ambulance-related crashes accounted for 31 of these fatalities.

NEMSAC’s Ad Hoc Ambulance MVC subcommittee is trying to reduce this numer. “The goal of our subcommittee is to identify strategies to reduce the frequency and severity of ambulance crashes by enhancing opportunities for traffic crash investigations involving ambulances, which can be used for future development of countermeasures,” said subcommittee member Alicia Sledge.

Unfortunately, developing strategies that are based on solid research is proving difficult, as “there is no federal reporting mandate for such incidents,” she said. “So over the last 18 months the subcommittee has been researching, talking with agencies that are involved in ambulance crash investigations so that we can get a picture of how these crash investigations are initiated, what data elements are collected, what data gaps there may be, while trying to determine ways to improve on this process.”

The Ad Hoc Ambulance MVC subcommittee is advocating for a consistent ambulance accident database to be created, so that useful recommendations to reduce such accidents can be developed using hard evidence. They are also considering asking “the General Services Administration to study the vehicle design structure of ambulances, including patient compartment areas, and to determine the inspection criteria of the vehicle quality assurance procedures and then how to improve the safety for ambulance occupants,” said Sledge.

Enhancing Roadside Safety for Personnel

The latest news about the Federal Highway Administration’s Traffic Incident Management (TIM) program was delivered by Joseph Tebo, a transportation specialist with the TIM program.

“Safety is our top priority,” reported Tebo. To this end, TIM’s goal is to train a million first responders per year in safe roadside operational procedures. “Right now we're at 600,000,” he told the NEMSAC committee members. “We did slow down slightly through the COVID years, but it's picked back up.”

Focusing on NEMSAC’s field of interest as it pertains to EMS safety, Tebo declared that his agency is “going to take a look at what we can do to enhance the EMS providers, because I know that many times the EMS wagon is the first one on the scene. They don't have that heavy apparatus to block traffic from to set up cones and signs because they're first in, so they're vulnerable.”

To enhance roadside safety for EMS personnel, “we're going to take a look at maybe vehicle design, certainly lighting and maybe some personal protective equipment, (and) warning devices. Those are the things we're going to be talking about.”

To learn more about NEMSAC and its activities, click here.

James Careless is a frequent contributor to EMS World.