All Those in Favor

All Those in Favor

This is the 10th installment in a yearlong series of articles developed by the Academy of International Mobile Healthcare Integration (AIMHI) to help educate EMS agencies on the hallmarks and attributes of high-performance/high-value EMS system design and operation. For more on AIMHI, visit

You can have an organization that’s on top of its game, clinically excellent, accredited and financially solvent, but all progress and momentum can be halted or changed beyond recognition as a result of four simple words: all those in favor. Politics and politicking is pervasive and exists at every level of the EMS world.

Politics is not just a four-year event. It is ever-present in the real world, surrounding every element of every type of public safety organization. Police and fire chiefs are generally political appointees; sheriffs are publicly elected in a political process; and even EMS organizations have owners, boards and shareholders.

Politics with a large and small P abound! Because of this, a modicum of knowledge and understanding of federal and, more important, local politics is a key to success for EMS agencies. The master principle is that the majority will always rule, so your mission must be to ensure you have more votes or influence than the other guy/party. If you have the votes, politics will flow your way, and you won’t get voted off the island; if you don’t have the votes, well, you can’t say we didn’t warn you.

Local Politics

On some level everyone is involved in local politics. When someone is elected to a local governing body, town or city council or board of supervisors, it’s your clue that you have something to do: Go meet them before they come to you with an issue. Additionally you can you go to their meetings, attend community events and establish yourself for them as a trusted community leader. 

A top tip to maintaining visibility is to attend the meeting and be the last one to leave. The way a city/town council usually works is that members of the public make their comments or presentations and then leave, which, if you’re patient, inevitably makes you the last person standing. This leaves you as the natural and exclusive person to talk to, providing you have your own briefing or pitch prepared. Politicians also like to be seen and heard—they enjoy being in front of the camera. To assist, invite them to your agency HQ, show them what’s going on, take photos, tweet and publicize their presence. This is all golden to a politician and aids in cementing firm relationships.

Drilling right down to your own front door, every type of EMS agency has a multitude of bosses, many with political agendas. Your public or privately appointed boards must always be informed of your activities and made to feel engaged and appreciated. Understand what members’ interests are in order to understand their approach to you and your organization.

State Politics

EMS is uniquely positioned in the intersection between healthcare, medicine, public health and public safety. We have the data, which means we have the intelligence. If we have the intelligence, we have the influence. That influence can turn you into a subject matter expert, which means your views will be listened to and acted upon. 

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At the state level, become known to the boards and commissions. If you go, stand up and speak in the public comment period. This means you get to state your name and whom you work for, and hopefully say something people remember. If you don’t do that, you’re just a face in a crowd, which doesn’t help your organization. 

State politics dictate how local EMS operates, setting our rules and regulations, scope of practice, Medicare funding and even ambulance standards. If you can get involved via your state EMS association or appointment to a state board or commission, you should.

As states create their laws, pay close attention to upcoming legislation. Most states have online programs to track the progress of bills and resolutions through their systems; Virginia’s Legislative Information System ( is a great example. 

The same rules for local politics apply at the state level. Get in front of your elected officials as often as you can. Finally, know the election cycle and who is up for election/reelection and thus may shy away from supporting proposals that disadvantage them (particularly if in a marginal seat).

National Politics

In the current political climate, all eyes are on the national capitol. Healthcare coverage is at a crossroads, and reimbursement and funding for the ambulance industry hang in the balance. Your contribution and voice are needed in the national arena. To aid this agenda, lobbying events such as the AAA Stars of Life event and NAEMT’s EMS On the Hill Day present an excellent opportunity for all to assist with the promotion of the national EMS legislative agenda. 

In a carefully crafted and expertly executed series of meetings on the hill, EMS providers and managers are placed, in uniform, in front of their local politicians—ones they even may have voted for. When you address national issues from a local point of view, your constituency politician (and their staffers) will listen and possibly engage, as that national concern now has a local focus because of your presence in their office.

Also use national events to invite your elected officials and their staff back to your headquarters in their district for a ride-along. This feeds many agendas, allowing you to tell your story and get on their radar, present national initiatives in a local setting, and provide everyone with positive publicity and media coverage.

Create Conditions for Change

Every issue is a political issue. It doesn’t matter whether you’re writing a policy at your business, station, department or squad; presenting to your local governing body; or lobbying your congressman in DC; everything you do should create the conditions for change. As someone remarked recently at the Pinnacle EMS Leadership & Management Conference, “If you’re not at the table, you’re on the menu.” Take your seat, cast your vote and think like a politician.  

Not sure where to start? AIMHI has member agencies that perform these functions very effectively. Contact Rob Lawrence at or Matt Zavadsky at

Sidebar: Political Checklist

• Influencing outcomes requires communication and contacts. Make sure you know who all your elected officials are at the local, state and national levels. The list may be longer than you think.

• Meet and know your representatives. Don’t wait for the one day of the year you need them; go see them ahead of a crisis and create a relationship. 

• Be factual with data and numbers. All proposed new legislation is part of someone’s political agenda, so expect anything you challenge to be vigorously defended.

• If you’re going in to make a presentation or pitch, rehearse your argument. Have someone take an adversarial side to help you prepare.

• Know or have a lobbyist, particularly at the state and national level. They will work the room for you (as will the opposition’s!)

Chip Decker, NRP, is CEO of the Richmond Ambulance Authority (RAA). His duties include administering the high-performance system to deliver clinical excellence in the most economically efficient way possible. He serves as a member of the Virginia EMS Advisory Board, chair of the board’s Transportation Committee, and member of the Old Dominion EMS Alliance (ODEMSA) board, ODEMSA Richmond Metro Council and Virginia Association of Governmental EMS Administrators (VAGEMSA). His experience in EMS spans over 35 years and includes both volunteer and career positions. 

Rob Lawrence, MCMI, is chief operating officer of the Richmond Ambulance Authority. Prior to that he was COO for Suffolk as part of the East of England Ambulance Service in the U.K. He serves as vice president of the Virginia Association of Governmental EMS Administrators (VAGEMSA) and vice chair of the American Ambulance Association’s Communications Committee. He is a member of the EMS World editorial advisory board and a featured speaker at EMS World Expo 2017.


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