Group Asks for Federal EMS Admin

A task force of EMS professionals is urging the federal government to create a United States Emergency Medical Services Administration within the Department of Homeland Security, akin to but separate from the U.S. Fire Administration.

Project USEMSA leaders have received strong support from EMS organizations. However, some fire/EMS organizations, such as the International Association of Fire Chiefs and the International Association of Fire Fighters, are questioning the need for a separate EMS administration and are concerned about how oversight from two separate adminstrations would affect them.

Project USEMSA chairman, Assistant Chief Paramedic Donald W. Walsh, Ph.D., EMT-P of the Chicago Fire Department, said he and his colleagues began discussing the idea while teaching at the National Fire Academy in Emmitsburg last year. When the academy suffered budget cuts, the first courses to go were EMS, Walsh said. "This is a very typical scenerio we hear all the time," he said. "EMS is the first one on the chopping block. It just didn't seem right to us."

Walsh said he and his colleagues began wondering why there isn't a national EMS academy and an administration specifically to look out for EMS, provide leadership and to track the industry as a whole, from fire department-based EMS to private EMS to third-party EMS.

Project USEMSA came out with a web site in May 2003 and organizers started talking to EMS agencies and associations. Walsh said they expected it to take a few years to gather support, but then on Dec 15 an unrelated federal report came out recommending a study on the state of EMS in the U.S. and the possible creation of a federal EMS administration.

The report is known as the Gilmore Commission, after former Virginia Governor James S. Gilmore III, who chaired the Congressional Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction. The panel submitted its final report to President Bush and Congress on December 15, 2003.

The report concluded that, "Emergency Medical Technicians and Paramedics who comprise EMS in the United States, unlike their fellow responders in the fire service and law enforcement, have no designated 'EMS' Federal funds and no single Federal agency for coordination on State and Local EMS operational matters." The report recommended that these issues be studied and addressed.

Project USEMSA put out a press release heralding the federal report and their movement took off. "We can't handle the emails," Walsh said. "It turned into sort of a grassroots campaign."

Project USEMSA's first priority, like the Gilmore Commission's, is to push the government to study, research, and assess EMS in the United States. After that is done officials will have a clear picture of the state of EMS and can make recommendations for improvement, Walsh said.

"We feel that once they investigate, they'll say how have you guys been doing this the last 30 years," he said.

Project USEMSA co-chairman Christian E. Callsen, Jr., L.P. of Austin-Travis County EMS, said "In order for EMS to take its next steps as a profession and part of public safety, an EMS administration makes sense. It's even more important because EMS is provided in so many different ways."

The federal government does have a committee in place to provide EMS oversight. The Federal Interagency Committee on EMS operates within the U.S. Fire Adminstration and meets quarterly to coordinate among federal departments and agencies involved in EMS activities, according to the USFA's web site.

Acccording to the USFA, the mission of the FICEMS is to develop recommendations that will:

1. Strengthen the communication and coordination of Federal policies and programs
2. Promote harmony and avoid duplication of efforts
3. Promote uniformity of standards and policies consistent with existing Federal laws and regulations regarding EMS.

Callsen said the reason EMS officials want to see an EMS administrtion separate from the U.S. Fire Adminstration is because they want EMS be recognized as a profession and service without limiting how that service is provided. For example, he said, private EMS providers are not eligible to attend some training available to fire-based EMS providers or to apply for grants available to fire organizations.

Callsen also said there is not enough organized input from EMS leaders when public safety and terrorism are discussed by federal officials. He pointed to the post 9/11 government directive for EMS providers to get smallpox vaccinations in case of a biological terrorist attack. He said the discussion was fragmented and lacked sufficient input from EMS leaders. "Part of it is that EMS is the youngest of the public safety services, at a point between public safety and public health," Callsen said. "It exists in two worlds."

Callsen argued that although it's no one's fault, EMS becomes largely invisible when it is several layers down in an organization. He also said that because EMS is provided in so many different ways, there are no complete national statistics on runs per day, cardiac arrests per day, etc.

Callsen also raised concerns over protection for EMS workers at street level. There is currently a a great deal of variation in equipment available such as helmets, gloves, and chemical and respiratory protection, he said. "There's a whole range of those issues," he said.

"The thing that we think is the most important question is what is EMS in the United States?" You can answer all those other questions after you have some facts," Callsen said.

Gary Ludwig, vice chairman of the EMS section of the International Association of Fire Chiefs, said the IAFC has no official position on the movement to create an EMS administration and is currently studying the idea.

He said it was definitely the Gilmore Commission that brought the movement to life. "What seemed like a floundering effort has now popped up on some radar screens," he said.

And fire service leaders have some concerns, he said.

Many believe that EMS belongs in the fire service and that a separate administration would dillute that effort, he said. "That's why we're studying the issue," he said.

Ludwig said about 75 to 80 percent of what firefighters do is provide EMS. "So when you form another federal agency to handle EMS that takes the responsibility away from the U.S. Fire Administration," he said.

The International Association of Fire Fighters is questioning the need for an EMS administration because EMS interests are met within the existing infrastructure, said Lori Moore, DrPh, MPH, EMT-P and Assistant to the General President of the IAFF. "EMS as an entity is already established as an essential public safety ? first responder emergency service in the Fire Service Administration," she said.

Moore said one of the reasons data collection in EMS is problematic is that it is governed at the state level, making data varied and a national database virtually impossible. There is no way to compile statistics on response times, for example, when states define it differently, Moore said.

Moore said efforts are already underway to rectify this problem. Some EMS data is collected under the National Fire Incident Reporting System within the USFA. Also, the National Highway Traffic Safety Administration is taking the lead to identify and define all data elements and then encourage states to collect and report appropriate EMS data, she said, through the NEMSIS project.

"If all states agree to use the new data set, then a national database may eventually be established," she said.

"Finally," Moore said, "the four objectives listed under the 'Proposed authority' of the USEMSA are already completed or underway by various national organizations."

The NFPA, she said, has EMS related standards in place and will be voting on another EMS related standard this spring (NFPA 450). Also, the NHTSA EMS division continually works to revise and improve EMS education standards and curriculum. She said the IAFF and other organizations have federal grant money to train EMS professionals in disaster response and that the NEMSIS project is moving forward for data collection. She said the NHTSA also produced an "EMS Research Agenda for the Future" as part of their "EMS Agenda for the Future."

President John Roquemore of the National Association of EMTs said his organization is behind the idea. "We support the concept of the creation of an EMS administration," he said. "We need to get the study done to know where we are in EMS today." He said this is something his organization has always been interested in and they are glad the issue is getting attention.

He pointed out that you can get statistics on all firefighter and police line of duty deaths, but you can't do that with EMS. "Statistical data analysis needs to get done for EMS," he said, for issues including health and safety, recruiting and retention.

"We're just very encouraged that we're watching this very closely. It's in our best interest to support this study and see where it goes," he said.