EMS AT THE CROSSROADS: AN OPPORTUNITY FOR UNITY?
Since its inception in the early 1970s, EMS never has been able to develop the focus for leadership at the national level needed to garner the funding and support it clearly deserves. At times, an individual surfaces who has a vision for the future, novel ideas for changing EMS, but little support to garner the interest of congressional leaders. In the current fiscal environment, one of the first victims of the Medicaid/Medicare axe was reimbursement for primary emergency medical services. Why has EMS never attained status on the national level, and how does this impact the fire service?
Since EMS is in its infancy, it continues to go through the growing pains one would see in any group or organization. Few people, though, have emerged from this organization on a national level that have shown the leadership and vision to attract the attention of Congress. Congress has never paid much attention to EMS. Few bills with an EMS focus are introduced; fewer bills are passed; and of those that pass through Congress, only a small number actually get funding.
While the fire service has strong national organizations, strong leadership, and the ability to speak with a unified voice on many issues before Congress, emergency medical services are not well represented in Washington. The National Association of State EMS Directors, in all of our wisdom, moved our national office from Kentucky to California. Somehow, we have managed to get farther away from the center of activity and have provided even less visibility for EMS in Washington. With this lack of focus and leadership in EMS, it’s no wonder that the fire service has been able to quickly grasp this and move forward in a very constructive way. The fire service has seized the moment and made EMS a visible entity.
AN IMPORTANT ISSUE
Let’s take a look at why this is such an important issue for the fire service. Some studies have shown that 84 percent of all fire services nationwide do EMS runs. The fire service, for years, has been the agency to call for any ty pe of problem. As fire runs have decreased, many fire departments have made the natural transition toward greater involvement in emergency medical services. The fire service’s interest in being more aggressive in EMS has been reflected in the establishment of the Emergency Medical Services Sections of the International Association of Fire Chiefs, the establishment of an Emergency Medical Services Office in the I S. Fire Administration, and the initiatives of many other fire organizations now looking to become involved in EMS issues. Some argue that the fire service is trying to protect its jobs. 1 would argue that if the fire service can augment an existing EMS service by providing early defibrillation, it is doing the community a service. In a system of free enterprise, if a firedepartment can provide prehospital care better than an existing ambulance service, let it do so.
I think it is a welcome relief to have a group with the strength of the fire service supporting EMS in Washington. The state EMS directors make the argument that EMS is a healthcare role and that the leadership in Washington for EMS should be in Health and Human Services and not in the Fire Administration. I’m not sure that having the fire service take the leadership role in this area necessarily excludes the medical focus of emergency medical services. If the fire service takes the lead, it is only because EMS has allowed it. The U S. Fire Administration and die International Association of Fire Chiefs have clearly seen EMS as part of the future of fire services in the United States. I think it’s time that EMS recognizes this relationship and moves forward to work toward a unified voice in Washington. EMS and the fire service share a common goal: providing quality care in the prehospital setting.
