Lead Agency Response Forthcoming

On May 15, FICEMS officials responded to the White House on options for a lead federal agency for EMS.

For the past few months, EMS officials and stakeholders from across the country have given their opinions on where such an agency, if created, should be located. While some have said the job should fall to NHTSA's Office of EMS, others say law already exists that authorizes the agency within Homeland Security. The Emergency and Trauma Care Coalition, which includes some top EMS organizations, believes it should be housed at Health and Human Services.

Regardless of location, EMS officials agree on one thing: A single lead agency for EMS is long overdue. Right now, several federal departments have roles in EMS.

FICEMS Chair Alexander Garza, MD, MPH, said the White House originally wanted an options paper by March. The deadline was then pushed back to May 15 in order to gather input from stakeholders, including providers and organizations. Rather than arguing for a particular home for any new agency, many groups used the comment period to submit proposals outlining issues that should fall under the agency's responsibility.

A joint union/management white paper on the single lead agency was requested by and submitted to the White House in December, according to James Orsino, president of the EMS Labor Alliance. The EMSLA joined forces with the International Association of EMS Chiefs on the project, which argued that law already exists to create the body within DHS.

"This is about patient care and the public we serve," Orsino said. "This is not a union or management issue."

The organizations pointed out that their effort was to "outline a clear path for consolidated federal leadership of EMS in America and delineate actions for improving the effective, efficient and equitable delivery of EMS under all conditions and for all hazards."

James Robinson, vice president of the IAEMSC, said the collaboration speaks volumes. "We did as requested. We identified issues and solutions, not just problems."

EMS cannot be effective with its components scattered, they added: "[The] Under Secretary of Emergency Preparedness and Response has the authority to establish and oversee a federal EMS administration. Leveraging this authority will have a resounding positive effect on the over 16 million patients transported by EMS agencies each year, as well as the many others who benefit from EMS services other than transport each year."

IAESMC President Larry Tan said he's pleased the Obama administration has promoted discussion. "This is something that has been dormant for a long time," he said.

In April, the National EMS Advisory Council (NEMSAC) developed a document specifically identifying issues that face providers across the country, and the need for a federal agency. "Despite individual agency efforts, the overall arrangement of federal management of EMS related matters remains fragmented, compounding the fragmentation at state and local levels in the EMS industry," they wrote.

The council went on to explain: "Optimal and safe patient care can only be ensured when a systems approach considering the full spectrum of EMS and its interface with public health--[including] prevention, public safety and emergency preparedness, 9-1-1 access, prehospital, emergency department, interfacility, and specialty systems of care--is carefully managed and executed."

The group also pointed out that EMS in the U.S. is underfunded, and receives only a small percentage of DHS grant funds. Also, ambulance companies aren't adequately compensated for Medicaid and Medicare transports.

NEMSAC members didn't say where a lead agency should reside. But they stressed it "should have a standing in the federal hierarchy at a level consistent with its scope of duties and authority."

They said it's important the agency establish and maintain a database that "encompasses quality of care and operating data; financial data; leadership development criteria; workforce safety and training data; and equipment safety and performance reliability, and injuries."