Is a New Federal Agency the Solution for What Ails EMS?

On the June morning this was written, two subcommittees held a hearing in Washington. The Subcommittee on Emergency Preparedness, Science and Technology and the Subcommittee on Management, Integration and Oversight are both part of the House of Representatives’ Homeland Security Committee. They came together to examine the subject of “The National Training Program: Is Anti-Terrorism Training for First Responders Efficient and Effective?”

Testifying at this hearing were representatives of law enforcement (New York Police Commissioner Raymond Kelly, National Sheriff’s Association WMD Committee Chair Patrick McGowan) and the fire service (the North American Fire Training Directors’ Steven Edwards, and National Fire Academy Board of Visitors member Jack Reall). The Congressional Research Service’s Government and Finance Division had a seat at the table. So did the VP of Research and Economic Development from the New Mexico Institute of Mining and Technology. Notice anyone missing?

Darn right you do. Last time we checked, EMS providers were first responders too. And they probably have some interesting and pertinent thoughts on whether antiterrorism training for first responders is efficient and effective.

This is just the latest instance of EMS being overlooked, even when the discussion is specifically about emergency response. It’s nothing new. We all know about the initial exclusion of nonfire EMS from the Assistance to Firefighters (FIRE Act) grants, and we’ve all heard that EMS got just 4% of the first responder funds awarded by the Department of Homeland Security in 2002–03. We’ve all heard the aggravating references to “police and fire” when political leaders or news media talk about the importance of emergency preparedness and response and those who protect our nation’s citizens. We’ve all felt the snub of being forgotten. Nobody likes it.But as far as changing the situation and gaining public recognition of the role of EMS, well, we haven’t got very far. For too many of the people in power, EMS is still painfully, infuriatingly, simply not on the radar screen.

Getting it there is imperative. If and when the next big one hits, the EMS providers who respond in those first critical moments will need state-of-the-art training and equipment just like their police and fire counterparts. Lives will hinge on their preparedness. And just ask them—they’re not prepared. When the Assistance to Firefighters grants were opened to nonaffiliated nonprofit EMS organizations this year, nearly 1,600 of them applied, seeking a total of $138.6 million—more than 10 times the $13 million available. These applications included $77.5 million for operations and safety programs and $61.1 million for vehicles.

And that’s just part of it. The needs go far beyond readiness for terrorism and major 9/11-style disasters. In many places, routine delivery of everyday medical care is in increasing jeopardy. Rising call volumes mix combustibly with provider shortages. Equipment and gear are lacking. Standards vary. Data to describe the scope of problems and point the way to possible solutions are insufficient. EMS, almost anyone will tell you, is in trouble.

So with all these problems, what do you do? How do you get the help you need? How do you raise the profile of EMS with leaders and decision-makers and prompt them to deliver the money, policies, nurturing and care necessary to fix what ails this vital industry?

Destination DHS?

The Homeland Security Policy Institute (HSPI) has an answer. In May, the HSPI, part of The George Washington University, released an issue brief titled Back to the Future: An Agenda for Federal Leadership of Emergency Medical Services that called for a reevaluation of how EMS is handled at the federal level. It suggested that the best solution is to transfer federal control of EMS from the National Highway Traffic Safety Administration (NHTSA) to a new EMS Administration to be created under the Department of Homeland Security (DHS).