One of Many Washington Orphans-EMS


This post is a repost from Jolie Breeden’s wonderful little newsletter Disaster Research You Can Use:

EMS Still Wandering the Nation’s Capital Homeless

Emergency Medical Services had a rough upbringing. The product of a tense coupling between public safety and medicine, EMS bounced back and forth between fickle foster parents—federal agencies that enabled its development but whose support has waxed and waned with the federal budget. Since it was a teenager (about the past 30 years now), EMS has been camped out on the National Highway Traffic Safety Administration’s couch eating leftovers.

Now several groups have intervened; determined to somehow create a loving home for EMS in Washington.

Most recently, the International Association of EMS Chiefs and the EMS Labor Alliance released the whitepaper Consolidated Federal Leadership for Emergency Medical Services: An Essential Step to Improve National Preparedness. They say it’s time for the Department of Homeland Security to step up and take EMS in.

What does this mean? Understanding that requires delving into the federal government’s relationship with EMS. As Consolidated Federal Leadership for EMS details, NHTSA became the lead federal agency driving U.S. EMS development following the National Academies’ 1966 Accidental Death and Disability: The Neglected Disease of Modern Society, which focused on unnecessary highway deaths. Both NHTSA and the then-Department of Health, Education and Welfare backed EMS with direct grant funding through the 1970s. In the early 1980s, the federal government moved EMS funding into state health block grants. According to the IAEMSC and EMSLA, this move led to states prioritizing other services above EMS, the dissolution of the Department of Health and Human Service’s Office of EMS, NHTSA trying to nurture EMS without dedicated funding, and ultimately very inconsistent EMS care across the nation.

In its 2007 Emergency Medical Services at the Crossroads, the National Academies reported that EMS “is more fragmented than ever, and the lack of effective coordination and accountability stands in the way of further progress and improved quality of care.” The report claimed that Congress establishing a federal lead agency for EMS, in HHS, within two years was essential to fixing these problems. Unsurprisingly, the report also recommended that Congress allocate substantial funds to improving EMS—recommendations that have received little congressional action.

Advocates for EMS, another coalition of EMS organizations, did succeed in provoking action—sort of—when Representatives Tim Walz (D-Mn.) and Sue Myrick (R-N.C.) introduced the Field EMS Quality, Innovation and Cost-Effectiveness Improvement Act on December 16. The Advocates for EMS bill would recognize NHTSA as the primary federal agency for field (outside the hospital) EMS, create a tax check-off funding mechanism, and appropriate about $70 million in startup funds. The Field Act promptly died at the end of the last Congress, although Advocates for EMS hopes for its resuscitation this year, according to EMS Insider.

Tired of waiting, the IAEMSC and EMSLA think they might have found a solution. In Consolidated Federal Leadership for EMS, they argue that existing 2002 Homeland Security Act authorities would allow the “Under Secretary for Emergency Preparedness and Response” to create “a federal EMS administration within the existing DHS Directorate of Emergency Preparedness and Response,” which among other things, would include a new National EMS Academy. In fact, the whitepaper implies that DHS may have a duty to do something about the fragmented state of national EMS if it’s to fulfill its statutory mandate to “ensure the effectiveness of emergency response providers to terrorist attacks, major disasters, and other emergencies.”

“Our white paper looks at existing statutory authority to accomplish the fundamental goal of designating a lead federal agency with responsibility for EMS through existing legislation that’s already on the books,” IAEMSC President Lawrence Tan told EMS Insider. “That being the case, it may be a faster way to accomplish the same goal and get thing[s] started.”

However, there are a couple of problems with the plan. First, it’s not clear who in DHS possesses the legal authorities the IAEMSC and EMSLA plan relies upon after the 2006 Post-Katrina Emergency Management Reform Act DHS reorganization. In other words, who would establish the new agency and where in the DHS organizational hierarchy would it go?

And then there’s that much bigger problem that plagues all the plans—funding. Practically speaking, the federal EMS administration proposed by Consolidated Federal Leadership for EMS would logically sit next to the U.S. Fire Administration (which includes the National Fire Academy) in the Federal Emergency Management Agency organization chart. But even if FEMA Administrator Craig Fugate were to claim the mandate—he is a paramedic, after all—where would he get the resources?

Firefighters are already alarmed about President Obama’s proposed FY 2012 budget, which includes more cuts to the U.S. Fire Administration. According to a recent Congressional Research Service report, “debate over the USFA budget has focused on whether the USFA is receiving an appropriate level of funding to accomplish its mission, given that appropriations for USFA have consistently been well below the agency’s authorized level. An ongoing issue is the viability of the USFA and National Fire Academy within the Department of Homeland Security.”

The CRS notes that one of the many services the National Fire Academy may have to cut is wireless Internet in its dorms. Sounds like it might not be the best time for EMS to move to FEMA’s couch.

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