Playing Politics with Boston EMS
It’s not unreasonable to sometimes wonder what, if anything, politicians actually do with their time on the job. One look at the dysfunction in Congress, not to mention many statehouses around the nation, and it’s pretty clear that as much time as some politicians actually spend doing their jobs, others are spending just as much or more simply arguing about who’s doing their jobs and how well they’re doing them.
For all the grief they get, having a lawmaker in your corner is a good thing. It can mean the difference between funding for programs or staffing coming through or being cut; lawmakers at all levels of government may cause some of the red tape that frustrates EMS managers and administrators, but they also possess the sharpest pair of scissors to cut through it.
Boston EMS has forged a remarkably positive and productive relationship with the city’s mayor, Thomas M. Menino, throughout his two decades in office. In particular, it’s with Menino’s support that Boston EMS has grown during that time.
Boston EMS, a bureau of the Boston Public Health Commission, is the municipal emergency medical service provider for the City of Boston. With approximately 350 uniformed personnel, the department receives calls and dispatches units to over 100,000 medical emergencies each year. With 111,074 clinical incidents, 138,352 ALS and BLS responses, and 81,509 transports in 2012, the 24 frontline ambulances stay busy around the clock. As a two-tiered system, Boston EMS deploys 5 ALS and 19 BLS units during peak staffing.
“Boston EMS has benefited from the continued support and involvement of Mayor Menino,” says Boston EMS Chief Jim Hooley. “He has recognized the department as an essential public safety service, supporting our expansion of personnel, addition of ambulances, wage increases, retirement benefits and new stations. Even when budgets are tight, he has promoted community initiatives, such as car seat checks and CPR education.”
Hooley notes Menino has always seen Boston EMS as more than ‘”just a ride to the hospital,” recognizing the skills and experience of its personnel, in addition to its value as a partner in serving his constituents. Beyond its public safety counterparts, Boston EMS frequently coordinate with many other city departments, including the Commission on Affairs of the Elderly, Public Works, the Transportation Division, Parks and Recreation, Schools, Emergency Management, and Boston Centers for Youth and Family, not to mention Public Health, its parent agency. The mayor’s administration encourages a coordinated team-based approach to ensuring constituents receive the best possible services. “So much of what happens in a city such as Boston, from planning for special events to preparing for disasters, has implications for EMS,” says Hooley. “By being closely tied into all services, we are better informed and have a voice at the table, which directly translates to improved prehospital care for residents of and visitors to Boston.”
On April 15, 2013, the world saw what it means for an EMS agency to have strong political support. The training, equipment and integrated involvement throughout the Boston Marathon planning process can be attributed to the mayor and his administration, says Hooley. “EMS is often overlooked when it comes to homeland security funding, but not in Boston. The Mayor’s Office of Emergency Management has funded much of our department members’ mass casualty incident training and equipment. Boston is one of the few cities where EMS has a pronounced role in regional drills and exercises. And, the city stands behind the medical consequence management plan and special operations efforts Boston EMS spearheads for special events.
“His comprehensive understanding of EMS as an essential city service is just one aspect of his dedication and attention to detail, which led to his well-earned nickname of ‘Urban Mechanic,’” Hooley continues. “Like all other public services, we are held accountable to the people we serve. The mayor and his administration’s focus on accountability have meant that every city service is held to that same standard. No detail is too small.”
According to Hooley, political support is invaluable for an EMS organization. Having an engaged city leader who understands the strengths or your organization as well as challenges faced, helps ensure fiscal and organizational stability, he says. “Early in his political career, Mayor Menino went on an ambulance ride-along. Throughout his tenure as mayor he has made reference to the experience, where he was able to see first-hand the hard work of our personnel, as well as our basic needs and resource limitations.”
Menino’s advocacy has extended well beyond the local level, says Hooley, representing Boston EMS in the public arena. Across the local, state and federal arenas, with regard to legislation, regulations and other matters, it is important to have someone who understands and believes in your organization, he notes.
“It should also be stressed that it is a two-way street,” Hooley advises. “Boston EMS is integrally involved and invested in proactive and preventive efforts to improve the city. Whether it involves sharing data, working as part of an interagency team or various other forms of collaboration, Boston EMS is actively engaged in efforts to reduce asthma, overdose, violence, pedestrian, cyclist, elder falls and diabetes-related incidents. We send real-time alerts to external partners when incidents relevant to them have occurred. For example, a paramedic works collaboratively with public health and police partners to manage a narcotic-related database. We also actively monitor and report on cyclist and pedestrian incidents, and more. In support of his whole community approach, Mayor Menino has recognized the role and importance of EMS in working toward safe and healthy neighborhoods.”
Hooley says having a strong relationship with the mayor or other elected official is about sharing and informing him or her about who you are as an organization and your priorities, while also taking the time to understand and embrace what is important to him or her. EMS enters people’s homes and takes care of people when they are at their worst. Whether it is improving public safety, injury prevention, elder wellness or child safety, there are opportunities for EMS to be an active participant in local initiatives. “When people call 9-1-1 they are looking to the city for assistance. Anyone in uniform who responds to that call represents the city. We emphasize to our personnel as soon as they are first hired as EMT recruits—all Boston EMT hires must successfully complete a six month didactic and field academy before being promoted to a badged EMT—that when they don a Boston EMS uniform, they are representing the department, the city and the mayor. In fact, the mayor attends our EMT graduations and often pins their badges.”
According to Hooley, the relationship with the mayor’s office is actually a natural one.
“As a service dedicated to public safety and public health, there is very little we do that doesn’t have political implications in some way or another,” he says. “The mayor depends on us to respond to emergency medical calls and to do everything we can to take care of the needs of his citizens. And we depend on him to sustain a healthy and thriving department where dedicated and hardworking individuals want to start a long-lasting career.”
Hooley offers this example of the mayor’s ongoing support: In 2007, Boston EMS worked collaboratively with Mayor Menino to address increasing demand for services; he approved a significant service expansion, including a 23% increase in personnel and four additional frontline ambulances.
And some of Menino’s other initiatives have also had indirect benefits for Boston EMS. The city’s 24-hour 3-1-1 constituent service hotline is run through the mayor’s office. It has served as an invaluable resource during incidents like Superstorm Sandy and Blizzard Nemo, in which Boston EMS sent non-uniformed staff to help man the phones, answering the questions of residents and directing them to appropriate resources. Services such as these reduce the demand on the 9-1-1 system, addressing non-emergent constituent concerns, says Hooley.
All in all it adds up to a productive working relationship for Boston EMS. And while not every lawmaker will hold as high an opinion of EMS, it’s a great example of how fruitful to benefits of a positive relationship with elected officials can be if EMS agencies take the time to properly nurture them.