National EMS Advisory Council Approves Several Advisories, Learns About Medicine on Mars

By Michael Gerber

Members of the National EMS Advisory Council approved several new advisories, including one on creating paramedic practitioners that has stirred some debate in the EMS community.

The council also heard from experts on a number of topics, ranging from microscopic—the nation’s response to emerging infectious pathogens—to beyond global, when they learned about preparations for providing medical care to astronauts traveling to Mars.

Several times a year, the council meets to learn about and discuss pressing topics in EMS. Composed of 25 members appointed by the US Secretary of Transportation, NEMSAC is authorized by Congress to make recommendations to the secretary or to the Federal Interagency Committee on EMS (FICEMS). The council itself does not have the authority to enact any policies or laws, but their recommendations in the past have led to national efforts such as EMS Agenda 2050 and revising the EMS Education Agenda for the Future.

In an advisory entitled “Designation of Graduate-Prepared Paramedics as Federally Recognized Practitioners,” council members urged federal officials to prioritize “the creation and federal recognition of paramedics who possess clinically focused graduate-level degrees as paramedic practitioners.” The advisory specifically clarified that it was not recommending degree requirements for EMTs or paramedics, but rather the creation of a new tier of EMS clinician, with graduate education, who would be recognized as qualified practitioners under federal law. This would theoretically allow these practitioner-level EMS clinicians to obtain individual NPI numbers and bill Medicare for actual treatment and care provided, not simply for transport.

Last year, drafts of the advisory received support from several EMS organizations, including the National EMS Management Association and the National Association of EMS Educators; at the same time, a letter drafted by the National Association of EMTs, American Ambulance Association and groups representing firefighters and fire chiefs called the proposal “well-intentioned,” but said it would “detract” from EMS’s primary mission.

Despite the opposition, the advisory was approved during last week’s meeting with little debate by the full council and a nearly unanimous voice vote from members who were present, with just one abstention.

As with all NEMSAC advisories, the recommendations are not binding, but federal law does require agencies to respond to the council.

The council also approved an advisory calling on the Department of Transportation and NHTSA to mandate reporting of all ambulance crashes. They recommended that the National Highway Traffic Safety Administration support a national reporting system and convene an expert group to identify and define data elements to capture.

Other advisories finalized by the council covered topics such as crash scene safety, with several recommendations asking FICEMS and NHTSA to support federal, state, and local efforts to make crash scenes safer for responders; EMS data manager education and career pathways; and encouraging and incentivizing better planning for large-scale events.

Final advisories and letters from the council are made available on ems.gov. NEMSAC also maintains a public comment portal for feedback on advisories and letters prior to finalizing; the draft and interim advisories from the May meeting should be available for public comment shortly.

NEMSAC advisories are written over several months or longer, with members doing extensive research and discussing drafts at the committee and full council level before voting to finalize. At the May meeting, the council voted to move forward with several other advisories that they will continue to draft before potentially finalizing at future meetings. Topics that were moved forward include best practices for using interpreter resources to overcome language barriers and the EMS response to active violence incidents.

Council Hears From Experts

In addition to acting on advisories, council members also hear updates from federal agencies and other EMS stakeholders on critical topics, often in areas that the council is considering addressing in future actions.

This month’s meeting included a fascinating update from Kris Lehnhardt, an emergency physician serving as a scientist with the National Aeronautics & Space Administration. Lehnhardt discussed NASA’s efforts to deliver medical care to astronauts on the International Space Station and, in the near future, Mars. Among the many challenges of sending people to the red planet is the possibility that a crew member will experience a medical emergency when they are not only unable to be brought home—the trip will take about a year—but even communications will lag at least 20 minutes, making real-time conversations difficult at best.

Bringing the conversation back down to Earth, Lehnhardt talked about some of the innovations being tested at NASA—from creating IV fluid out of drinking water to telehealth advancements—and how they may eventually allow for better EMS care in our communities.

A little closer to home, but still up in the air, the council also heard from Susan Northrup, a federal air surgeon with the Federal Aviation Administration, who reviewed some of the data on and challenges associated with providing medical care on commercial flights. She also discussed the medical equipment required on commercial flights and how to access it during an emergency and told the council that legislation being considered by Congress this year to reauthorize the FAA may change how the agency determines what equipment is mandatory.

Speakers from Austin-Travis County EMS and the Austin Fire Department updated NEMSAC on some smaller aircraft: the departments’ use of drones in emergency response. The two agencies serving the Texas capital reported 772 hours of drone flight time during 2023, using unmanned aircraft to help improve situational awareness during large events, structure fires, and other responses. They are also investigating the use of drones to deliver life-saving interventions that can be provided by bystanders, such as naloxone to reverse opioid overdoses or inflatable flotation devices during water rescues.

Even the presentation by Alex Isakov, an Emory physician who serves as EMS lead for the National Emerging Special Pathogens Training & Education Center, included some discussion of aircraft, although only in the context of the development of a national special pathogens system of care, modeled after the trauma system. “Every EMS personnel in the field should be able to identify, isolate and inform and render a life-saving intervention when needed,” Isakov said. “And specialty teams should be developed and identified within those states to cover the geography of their state and roll up in regional concepts of operations for transport across the nation.”

The council also heard presentations from members of the NHTSA Office of EMS and their partners at the National EMS Information System Technical Assistance Center on EMS data and grant funding available from the DOT.

NEMSAC Encourages Public Participation

At the conclusion of the meeting, NEMSAC Chair Brenden Hayden thanked the council for its hard work and also explained to the public why it seemed no “new” advisories were proposed during the two-day session. The council was hard at work, Hayden said, on 22 advisories or letters in various stages of development, “so there’s quite a bit of work going on in the background,”

“And I'm certainly at our next meeting, which occurs in August,” Hayden continued, “there will be more advisories that will be propagated, so we'll look forward to that as they develop over time.”

He also encouraged the EMS community and the public to reach out to the council. 

“It's important that the EMS public understand that we are their voice—and without their voice, it's just our voices,” Hayden said. “So please come forward. Give us feedback. Give us ideas. Tell us your problems. Let us understand the challenges that you experience on a daily basis working in EMS so that we can do our best to try and create advisories that are value-add and help to address many of those issues.”

The next NEMSAC meeting is tentatively scheduled for August 7 and 8. Members of the public interested in attending in-person or online should sign up for updates at EMS.gov and will receive an email when meeting details are announced.

"Michael S. Gerber is a paramedic and writer in Washington, DC. The views expressed in this article do not represent those of Health Affairs, where he serves as a senior editor."