EMS Groups Agree on Industry Priorities

BALTIMORE -- The Institute of Medicine report on the nation's EMS system hasn't been sitting on a shelf gathering dust since its release last year.

The comprehensive study has been scrutinized by representatives of many EMS organizations, and workshops on the issues were conducted across the country.

Now a multiple-association committee, chaired by the president of the American College of Emergency Physicians (ACEP), Dr. Brian Keaton, has used the report to agree on six specific priorities. Their report is expected to be released later this month.

The task was daunting, given the number of recommendations and comments received, said Dr. Robert Bass, executive director of Maryland Institute for Emergency Medical Services Systems (MIEMSS).

"We struggled. There were so many issues. We wondered how we would ever get it down to five," Bass said. "It wasn't easy."

The group -- that included representatives of national organizations -- first chose five specific categories: pediatrics, trauma, hospitals, EMS and research. Then, each voted on their top priorities prior to last week's meeting, called to reach a consensus.

The EMS groups that voted were National Association of State EMS Officials, National Association of EMS Physicians and National Association of Emergency Medical Technicians.

In the end, the committee agreed to support the report and show a united front.

The priorities include:

• Research
• Establishment of a regional system approach to EMS
• Categorization of EMS Centers; identifying specialty and levels of care facilities
• Reimbursement for EMS
• Issues regarding Uncompensated Care

The group agreed that hospital boarding and ambulance diversion was such an important issue that it was added as a sixth priority. Bass said that the practice should end except in extreme conditions.

Diverting ambulance crews to other hospitals puts patients at risk, and often delays response time to other emergencies. And, EMS managers say they also are concerned about liability.

"The patient comes first. This can be detrimental, and we also should not be putting our people in harm's way," said Paul Maniscalco, NAEMT past president.

Some crews have reported hauling a patient in an ambulance for three hours before finding a hospital to accept them. EMS officials say that's unacceptable, and far exceeds the provider's training.

When a patient winds up at a hospital outside their community, other systems are impacted as well, Maniscalco said.

In addition to being short-changed in the DHS budget, crews also are not being reimbursed for patient care.

"They get nothing unless they transport to a hospital. They often treat a diabetic, and leave. But, they won't be reimbursed," Bass said.

The additional money could be used to offset training and equipment expenses, and other associated costs.

As for obtaining more federal dollars, Bass said it's an uphill battle and the barriers are tough. EMS is still considered "the new kid on the block."

"We need to keep beating the drums...that it's not all guns and hoses," Bass said, adding that shifting funds away from fire and police will not be easy.

But, that won't happen until EMS displays a united front, said Jerry Overton, past president of the American Ambulance Association. "We can't stay the course any longer...You have to get involved."

Overton said Congress sees EMS as fragmented, and that is hurting the cause.

Other issues listed by the group as priorities include the nationwide shortage of nurses and trauma physicians as well as the need for EMS to recruit a more diverse workforce.