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Fire and EMS Groups at Odds Over Proposal for Federal EMS Administration
The concept of creating a federal EMS administration has been discussed by some EMS leaders for years, but recently garnered national attention when it was recommended by the George Washington University Homeland Security Policy Institute.
In a report titled "Back to the Future: An Agenda for Federal Leadership of Emergency Medical Services," the HSPI proposes moving EMS leadership from it's current place in the Department of Transportation to the Department of Homeland Security, where it would be an equal but separate entity alongside the U.S. Fire Administration.
The paper has garnered support from the National Association of Emergency Medical Technicians, the EMS Labor Alliance, the International Association of Flight Paramedics, and state associations including Florida, Georgia and New Jersey.
What's missing is support from nationally recognized fire service organizations, which propose addressing EMS issues from within the current framework of the United States Fire Administration and its Federal Interagency Committee on Emergency Medical Services.
In a letter to DHS Secretary Michael Chertoff, several fire service groups outlined their disagreements with the report and its recommendations. These included the International Association of Arson Investigators, the International Association of Fire Chiefs, the International Association of Fire Fighters, the International Fire Service Training Association, the National Fire Protection Association, the National Volunteer Fire Council and the North American Fire Training Directors.
They agreed there is a need for better EMS funding and coordination, but argued that the report's recommendations would redirect limited homeland security money to for-profit EMS agencies, balkanize emergency response and diminish the role of the United States Fire Administration.
"Every report published since 9-11 by various task forces and commissions has advocated consolidation and integration in homeland security strategies," the letter states. "This idea of a new EMS agency contradicts the consensus opinion of the Congress, administration and think tanks alike."
HSPI co-chair Paul Maniscalco said the problem with the current EMS committee within the USFA is that it has no budget or authority.
He said the HSPI report does not discuss EMS delivery at the local level or support independent EMS delivery over fire-based EMS delivery - it simply addresses the need for a separate and distinct funding stream to enhance capability. He stressed that the recommendations are not intended to take money away from the fire service.
"Taking money away to address those EMS needs would be inappropriate and unacceptable," Maniscalco said. Instead, arranging separate federal funding for EMS would create two sources of funding for fire departments to go after, and lessen the burden on fire department budgets. "It benefits EMS across the board," he said.
In response to concern from the fire service that some funding would go to for-profit and hospital based transport agencies, which already receive some reimbursement for services from Medicare and other insurance coverage, Maniscalco said these reimbursements don't even come close to reflecting cost recovery for provision of services.
"What's happened is the provision of EMS has become a burden on local communities," he said, "and the level of readiness that is in question here could mean the increase of mortality and morbidity because we don't have the ability to respond effectively."
Part of the problem is that fire and EMS organizations disagree on what percentage of EMS provision is fire-based as opposed to independent or private.
"Actually, we don't know," Maniscalco said, because the federal government does not keep statistics.
Maniscalco cited not only a need for better statistics, but for protective gear for EMTs and paramedics, and for better ambulance standards.
"There's a whole host of serious operational issues that are taking place involving EMS," Maniscalco said. "By having one single advocate that can be a champion for EMS, and collaborate with everyone but have budget authority, it just makes sense. And it's not a bad thing for the fire service, it's not a bad thing for the third service, it's not a bad thing for the not-for-profits, and it's not a bad thing for America. Because In the end, we're going to have a better prepared EMS, and better prepared response to Mrs. Jones heart attack on Main street."
IAFF Assistant to the General President Lori Moore said the fire service is already working to address the lack of EMS statistics, and that starting over with a new administration would only set EMS back.
She said the report also neglects to mention ways in which EMS already is represented at the federal level. In addition, she said, "The people who wrote that report didn't do enough homework to recognize how much EMS is truly integrated into the fire service."
She said the fire service organizations clearly recognize EMS as a part of the fire service and engage it as such.
"I would agree that we need to do better data collection, and we need to do better analysis of good data. You bet we do," she said. "Do we need to do better reporting? You bet we do. But that's recognized throughout the country, and not only is it recognized, but actions are being taken to facilitate those things occurring," she said.
Moore said that since 1997 the IAFF and IAFC have been working to develop performance measures for EMS systems, including software development to report key indicators of performance.
"Only after we have good data collection can we go forward to make a case for what improvements and funding are needed," she said.
Along with other fire service organizations, Moore said the IAFF and IAFC are also involved in larger work being done by the DOT's National Highway and Traffic Safety Association, where EMS is currently housed - the development of the National EMS Information System, or NEMSIS.
"What we are advocating is that we need to work within the federal agencies that are already involved in EMS," she said, rather than thwart the efforts that have been underway for years.
Another voice in the discussion is that of 25-year fire service veteran Nathan Williams of Columbia, Missouri, a spokesman for the non-profit organization Advocates for EMS.
"I would say that there were some good things about the GW report, and there were some things that would probably be less than favorable for EMS in the long run," he said.
Although he agrees with many of the issues raised, including the need for EMS funding, Williams said he does not support the proposal to move EMS to the Department of Homeland Security. "I believe that that is not the best solution to this problem," he said. He suggests it would lead to turmoil in the immediate future and less than optimal coordination between the first responder communities.
However, Williams believes it is premature for either side to come to a conclusion on the best direction for EMS, because more information is needed. "We need to have critical questions answered, and we haven't done that yet," he said. He is waiting for an upcoming report by the Institute of Medicine to be published in the fall. He said they did a comprehensive two-year study on EMS, which he believes will come closer to answering the nation's questions on EMS than any other study done thus far.
Only after further study can both sides sit down and decide if creating one agency to oversee all of EMS is the prudent way to go, he said. And if they do, he said, "We will have done it based on research and fact."
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