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Who Should Be the Guardian of EMS?

EMS as we know it today was born out of a white paper authored by the National Academy of Sciences, titled Accidental Death and Disability. This paper focused on preventable injuries, especially those related to motor vehicle collisions, and called for the development of standards for prehospital trauma care. In response to this report, the government passed the Highway Safety Act of 1966, which established the National Highway Traffic Safety Administration (NHTSA) within the Department of Transportation, charging NHTSA with overseeing and improving EMS systems nationwide, as well as advancing prehospital care through the development of national standard curricula.

NHTSA has embraced this mission for nearly 40 years. But now, say some, we need a change. In this post-September 11 world, EMS requires a different guardian, one who is well-versed in the challenges terrorism poses to frontline personnel and who will be able to get the feds to be more generous with their purse strings when it comes to funding prehospital care.

A recent report from the Homeland Security Policy Institute (HSPI), out of The George Washington University, outlines the reasons why EMS should pack its bags and move to the Department of Homeland Security (DHS), which currently oversees fire operations through the U.S. Fire Administration. The primary argument behind such a switch is that EMS’ slice of the pie is smaller than any Oliver Twist serving—in 2004, EMS received just 4% (yes, you read that right) of available DHS funding for terrorism preparedness and response. Eating at the big table, argue the authors of the report, may help guarantee EMS does not go hungry.

Not everyone agrees with the report’s findings. Some members of Advocates for EMS, a non-profit EMS advocacy organization, support developing alternative approaches to increasing federal support for EMS systems, specifically through the Federal Interagency Committee on EMS, to ensure that the needs of EMS are addressed at the federal level.

The arguments for and against a move will no doubt get very heated in the coming months. The issues are complex, and passions on this topic run high. But such controversy is not new in the EMS industry. In the April 2001 issue of EMS Magazine, Associate Editor John Erich authored an article titled The State of EMS. In that article, Paul M. Maniscalco, co-author of the HSPI report, said in response to the question of why the EMS profession is in crisis: “It doesn’t help that we have no single entity in the federal government that really champions the EMS cause.”

The August issue of EMS Magazine will review the issue of who should represent EMS at the federal level. In the meantime, I encourage you to visit our website at to complete a brief online survey regarding the hot topic of where EMS belongs.

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