The IOM Report on EMS: What Will Its Impact Be on the Fire Service?

Last summer, the Institute of Medicine (IOM) released three separate and widely touted reports on the state of emergency care in the United States. One of those reports was an EMS component called Emergency Medical Services at the Crossroads.

Collectively and in summation, all three reports indicate that the United States emergency care system is fragmented and stretched to the breaking point, and unable to respond to disasters. The reports call for an end to gridlock in emergency departments and support the notion that any future emergency care system should be more patient focused.

Instead of writing on this last summer, I decided to wait and see what would come of this report, hyped as the second coming of the National Academy of Sciences/National Research Council's groundbreaking 1966 report, Accidental Death and Disability: The Neglected Disease of Modern Society. According to many, that report led to the formation of pre-hospital emergency medical service systems around the country.

Now, as we sit with another report, I wonder what the implications will be for the fire service. First, out of the entire group of individuals responsible for generating the report, there was only one fire service representative - and that person sat on a subcommittee, not the main committee. Even with only one representative from the fire service, the report recognizes the vital role the fire service plays in delivering EMS. On page one of the report, it says, "There is enormous variability in the design of EMS systems across states and local areas. Nearly half of these systems are fire-based, meaning that EMS care is organized and delivered through the local fire department."

In reality, the numbers are higher. Approximately 90% of career fire departments and many combination and volunteer fire departments provide some form of EMS delivery in their communities - even if it is only a first-responder company. The report mainly makes reference to fire departments that provide EMS transport.

Aside from the lack of fire service representation, the committee hits on many points that are accurate. Additionally, some recommendations in the report are favorable to the fire service while others are not. One that is not, however, is where the report recommends that "Congress establish a lead agency for emergency and trauma care within two years of the publication of this report. This lead agency should be housed in the Department of Health and Human Services, and should have programmatic responsibility for the full continuum of EMS, emergency and trauma care for adults and children, including 911 and emergency medical dispatch, pre-hospital EMS, (both ground and air), hospital-based emergency and trauma care, and medical-related disaster preparedness."

This recommendation is not surprising, considering the number of physicians who sat on the main committee as well as subcommittees. The placement of a federal lead agency in the Department of Health and Human Services (DHHS) would mainly view EMS from the medical side of the equation and discount that EMS is largely delivered by public safety agencies. Many of those public safety agencies deliver EMS from non-transporting vehicles such as engines, truck companies and squads. The age-old question remains: Is an ambulance that shows up at your door a medical agency providing public safety service or a public safety agency delivering medical care? In many cases, delivering EMS at an emergency scene is not just medical. Specialized and technical rescue has to occur simultaneously in order to free a victim from a car, roof, a collapsed trench or many other possible scenarios.