Between the efforts of the NHTSA's Office of EMS and grant awards to consulting or stakeholder groups, EMS provider needs are being met. That's not to say there isn't room for improvement.
Emergency medical providers continue to call for the creation of a U.S. emergency medical services administration. Amid the calls for such an organization, one must stop to ask what it is that current governmental EMS organizations are not doing that needs to get done.
The National Highway Traffic Safety Administration's Office of EMS remains the lead agency. It has put together one of the most comprehensive consensus-building processes in government and has reached out to its partners to develop aspects of a national system. NHTSA's National EMS Advisory Council, formed over a year ago, is one of those consensus-building initiatives that will define the future of EMS. It has established priorities and assigned subcommittees to advance and develop those priorities.
NEMSAC brought most of its committee and subcommittee membership to Washington, D.C., for meetings Jan. 29-30. The diverse group focused on listening.
One presentation covered the safety problems afflicting air ambulance operations in the United States. The speaker detailed the changes in the market and reimbursement practices that have created a competitive, yet unsafe environment. There are many solutions for increasing air safety in EMS helicopters, but federal air carrier laws will make changes difficult.
The general meeting featured a presentation by the National EMS Management Association calling for management and leadership development in EMS. The Fire and Emergency Services Higher Education committee chair then detailed the ongoing activities of the model EMS management degree. The Center for Healthcare Professionals EMS Work Force Agenda for the Future project — done under an NHTSA grant — identified several key issues for EMS, including shortages, career ladders, pay, safety, professionalism, preparation and retention.
Some very clear demographic changes are in the offing, and every fire and EMS chief should become aware of them. However, between the efforts of the NHTSA's Office of EMS and grant awards to consulting or stakeholder groups, EMS provider needs are being met. That's not to say there isn't room for improvement.
Those actively involved with safety issues continue to be frustrated. For instance, no single place exists where statistics are being kept concerning ambulance crashes and related injuries. While crash data is collected in the National Crash Database, items specific to EMS — such as crew configuration, training in emergency vehicle driving, patient condition just prior to impact and the root cause of the crash — would go a long way toward understanding crashes.
In addition to a lack of a comprehensive database for crashes, a database of EMS worker injuries also is lacking. The aforementioned future work force project calls for the development of the National EMS Workforce Injury and Illness Surveillance Program. Further, the Centers for Disease Control and Prevention or the National Institute for Occupational Safety and Health needs to establish a portal through which individuals can submit EMS injury data and download and merge such data from different trade groups and associations. It is the EMS community's job to help define measurements and key indicators. This model currently is in place with the National Fire Incident Reporting System and the National EMS Information System. It might be possible to link or add these fields to the NEMSIS database and relate the databases with the national crash reporting systems used by law enforcement.
Grant funding continues to divide the EMS camps. While the Assistance to Firefighters Grants bought a lot of nice toys and supplied personnel, EMS received only morsels. The fire service remains steadfast about not sharing funding, and it should; however, the grant dollars should be equal. It seems that more grant funding will become available in the future for similar expenses seen in the FIRE Act Grant. A discussion that centered on an agency having an active medical director prior to being funded for its request clearly indicated that such money may be coming. EMS also may see the development of grants targeted to research and to resolving the problems identified in the Institute of Medicine's report, “EMS at a Crossroads.” The NHTSA has commissioned a study by Bechtel, a large homeland-security contractor, to look at EMS vulnerability to terrorism and may identify future needs for financing to harden national EMS.
The U.S. Fire Administration's National Fire Academy has statutory authority for EMS — under the Fire Administration Reauthorization Act of 2008 — and thus is the primary site for conducting EMS management training within the federal government. The academy is developing a long-awaited quality-improvement class, making major revisions to the “Management of EMS” class, and holding a stakeholder meeting this spring to provide future direction.
Moreover, the reauthorization act directs the U.S Fire Administrator to include fire-based EMS in his liaison and coordination activities across the federal government. This creates the final connections between the Federal Interagency Committee on EMS, the USFA, the U.S. Department of Health and Human Services, and a variety of other EMS agencies. FICEMS continues to meet and make progress on coordinating activities among the federal partners concerning key aspects of EMS.
With this mandated coordination connecting the agencies and federal assets, there is essentially a virtual EMS administration. We are living in the information age, and this collective communications ability now allows us to remove the bricks and mortar of an institution, yet still meet the needs of the people. This could very well be the birth of what will become modern government.
Bruce Evans is the EMS chief for the North Las Vegas (Nev.) Fire Department. He also is the fire science program coordinator at the Community College of Southern Nevada and an adjunct faculty member for the National Fire Academy's EMS and injury prevention courses. He has an associate's degree in fire management and a master's degree in public administration.
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