I think it's pretty clear that most Providers agree that EMS needs more voice, more presence, more funding, more attention. But, the main issue is: where do we belong?

Are we a Public Safety entity, suitable to be working with Fire and Police (including CIA, FBI, etc) under Homeland Security? Are we best seen as an Emergency Response agency, prepared for terrorism and, well, emergencies (man-made or natural)?

Are we better off in the Health Department (whatever the offical term is (my brain is tired))? Do we respond to health emergencies? Are we involved in health education, injury prevention, and the like? Do we work with hospitals, trying to reduce mortality and morbidity (or shouldn't we be)?

At the end of the day, no matter where we belong, it won't be quite right. We're not JUST a health agency, nor are we JUST an emergency agency. Some agencies do interfacility transports only. Some do emergencies (911) only. But, we're individually tasked with taking care of *people* with medical situations, whether emergent or not.

We MUST be careful not to let this destruct into an us vs them argument, nor a one-size-fits-all/none descriptor of what we (EMS) do. Wherever we end up, we must be united in thought and action, and do the best within whatever confines our label Department places us.

This couldn't have been written better at all. I think you nailed it on the head. We must always remember that as EMT's (wether we are BLS, or ALS), our task is to help people who need help. That is the easiest way to say it. Who are we to judge wether someone dying of cancer is less important than someone who has been attacked by terrorism. When it comes down to it we are servants of the people. We are watched over by our government and they are trying to keep us safe and prepared, but we can't forget the fact that ALL people deserve our attention. The key thing to remember is that to that one person who may be sick in bed at 3 am, and had to call 911 because their "whatever" is hurting, to them..... this is an emergency!

Very well put. Having spent most of my years in EMS in the emergency sector I still tend to think in those terms. But, here lately, my eyes have been opened (can we say "slammed open"!) as to the plight of the transfer services as well.

I think we'll do well to add our own opinions to the polls, and then take a thoughtful (not in the "considerate" sense of the word, but in the "put some thought to it" sense) look at the responses. This should reflect what all of our sisters and brothers in EMS are thinking about.

Me personally, I consider us the emergency response arm of the medical community more so than the emergency responders for the DHS. So, I'd like to see us under Health, Education and Welfare (or whaever it's called now).

Just my humble opinion.

quote:

Me personally, I consider us the emergency response arm of the medical community more so than the emergency responders for the DHS. So, I'd like to see us under Health, Education and Welfare (or whaever it's called now).

Just my humble opinion.

Take a look at this citation from the pending Bioshield II legislation (Senate Bill 975)this will give you some more insight on why things are leaning towards DHS. You can see this for yourself by going to thoms.loc.gov and searching for S 975.

S.975
Project BioShield II Act of 2005 (Placed on Calendar in Senate)

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TITLE IX--OFFICE OF MEDICAL READINESS AND RESPONSE OF THE DEPARTMENT OF HOMELAND SECURITY

SEC. 901. OFFICE OF MEDICAL READINESS AND RESPONSE OF THE DEPARTMENT OF HOMELAND SECURITY.

(a) IN GENERAL- Title VIII of the Homeland Security Act of 2002 (6 U.S.C. 361 et seq.) is amended by inserting after section 879 the following:

`SEC. 879A. OFFICE OF MEDICAL READINESS AND RESPONSE.

`(a) ESTABLISHMENT- There is established within the Office of the Secretary an Office of Medical Readiness and Response.

`(b) ASSISTANT SECRETARY- The Office established under subsection (a) shall be headed by an Assistant Secretary for Medical Readiness and Response, who shall be appointed by the President by and with the advice and consent of the Senate.

`(c) DUTIES OF THE ASSISTANT SECRETARY- The Assistant Secretary for Medical Readiness and Response shall--

`(1) serve as the principal advisor to the Secretary on all matters related to emergency medical preparedness and response;

`(2) develop Federal strategy, training (including exercises), coordination, funding, and implementation of emergency medical response to mass casualty events for Federal, State, and local public health agencies and private sector entities in support of homeland security;

`(3) serve as the primary Federal official with respect to overseeing the identification and development, in consultation with nonprofit health and public health departments and medical centers, of medical preparedness centers and deployable medical care units designed to meet the demands of a terrorist event or other incident requiring mass casualty care and containment of infectious disease;

`(4) serve as the primary official of the Department relating to and overseeing medical emergencies, including emergencies incident to a terrorist attack or naturally occurring infectious disease outbreak;

`(5) in coordination with the Secretary of Health and Human Services, have the authority to deploy the Strategic National Stockpile and the Commissioned Corps of the Public Health Service;

`(6) report directly to the Secretary; and

`(7) evaluate and report to Congress on the preparedness of Federal, State, and local agencies to respond to major medical disaster.

`(d) FUNCTIONS- There shall be transferred to the Office of Medical Readiness and Response the following functions, personnel, assets, and liabilities of the following:

`(1) The National Disaster Medical System (transferred to the Department pursuant to section 503(5)).

`(2) The Metropolitan Medical Response System (transferred to the Department pursuant to section 503(5)).

`(3) The emergency medical response functions of the Office of Emergency Preparedness (transferred to the Department pursuant to section 503(5)).

`(4) Other resources and offices of the Department as designated by the Secretary.'.

(b) CONFORMING AMENDMENTS- Section 502(3) of the Homeland Security Act of 2002 (6 U.S.C. 312(3)) is amended--

(1) in subparagraph (B)--

(A) by striking `, the National Disaster Medical System,'; and

(B) by striking the semicolon and inserting `; and';

(2) by striking subparagraph (C); and

(3) by redesignating subparagraph (D) as subparagraph (C).

TITLE X--NATIONAL EMERGENCY MEDICAL READINESS AND RESPONSE BOARD

SEC. 1001. NATIONAL EMERGENCY MEDICAL READINESS AND RESPONSE BOARD.

(a) IN GENERAL- Title VIII of the Homeland Security Act of 2002 (6 U.S.C. 361 et seq.), as amended by section 901, is further amended by inserting after section 879A (as added by section 901) the following:

`SEC. 879B. NATIONAL EMERGENCY MEDICAL READINESS AND RESPONSE BOARD.

`(a) ESTABLISHMENT OF BOARD-

`(1) IN GENERAL- There is established in the Department the National Emergency Medical Readiness and Response Board (referred to in this section as the `Board').

`(2) CHAIRPERSON- The Assistant Secretary for Medical Readiness and Response shall serve as the chairperson of the Board.

`(3) COMPOSITION- The Board shall be composed of the following members (or their designees):

`(A) The Assistant Secretary for Medical Readiness and Response.

`(B) The United States Surgeon General.

`(C) The Assistant Secretary for Public Health Countermeasure Development.

`(D) The Director of the National Institutes of Health.

`(E) The Director of the Centers for Disease Control and Prevention.

`(F) The Director of National Bioterrorism and Hospital Readiness of the Health Resources and Services Administration.

`(G) The Deputy Assistant to the Secretary of Defense for Chemical and Biological Defense.

`(H) The Commanding General, Army Medical Research and Materiel Command.

`(I) The Assistant Secretary for Health of the Department of Veterans Affairs.

`(J) The Deputy Commander, United States Northern Command.

`(K) The Commissioner of Food and Drugs.

`(L) The Secretary of Agriculture.

`(M) The Postmaster General.

`(N) Any other individual appointed by the President to the Board.

`(4) MEETINGS- The Board shall meet at the call of the chairperson.

`(b) DUTIES AND POWERS-

`(1) DUTIES- The Board shall oversee the following activities:

`(A) The development, assessment, and validation of national, interagency, emergency medical response plans, in coordination with State and local public health officials, for bioterrorism (including agroterrorism), chemical attack, radiological attack, nuclear attack, infectious disease, and high explosives attack.

`(B) In cooperation with State and local public health agencies, the development, testing, and implementation of a plan for the necessary training related to, and the assessment and evaluation of, the Federal emergency medical response plans described in subparagraph (A).

`(C) The coordination of the Federal emergency medical response plans described in subparagraph (A) among all the Federal departments and agencies represented on the Board through joint exercises that shall be observed and evaluated by the members of the Board (or their designees).

`(D) Defining, and determining when and how to implement, national level emergency medical response plans to medical disasters.

`(2) POWERS- The Board may secure directly from any Federal department or agency such information as the Board considers necessary to carry out this subsection. Upon request of the chairperson of the Board, the head of such department or agency shall furnish such information to the Board.

`(c) BOARD PERSONNEL MATTERS-

`(1) DETAIL OF GOVERNMENT EMPLOYEES- Any Federal Government employee may be detailed to the Board without reimbursement, and such detail shall be without interruption or loss of civil service status or privilege.

`(2) PROCUREMENT OF TEMPORARY AND INTERMITTENT SERVICES- The chairperson of the Board may procure temporary and intermittent services under section 3109(b) of title 5, United States Code, at rates for individuals which do not exceed the daily equivalent of the annual rate of basic pay prescribed for level V of the Executive Schedule under section 5316 of such title.

`(d) ADVISORY COMMITTEE-

`(1) ESTABLISHMENT- Not later than 180 days after the date of enactment of the Project BioShield II Act of 2005, the Assistant Secretary for Medical Readiness and Response shall establish an advisory committee that shall provide assistance and oversight to the Board and to the Assistant Secretary for Medical Readiness and Response.

`(2) COMPOSITION- The advisory committee established pursuant to paragraph (1) shall consist of representatives, appointed by the Assistant Secretary for Medical Readiness and Response, of--

`(A) designees of State and local public health and emergency management agencies;

`(B) State and local emergency managers or adjutant generals and State emergency medical services directors;

`(C) physicians and first responders (including nurses, police, and paramedics);

`(D) academic medical research institutions;

`(E) the World Health Organization;

`(F) the International Committee of the Red Cross;

`(G) the International Federation of Red Cross and Red Crescent Societies;

`(H) the American Red Cross;

`(I) the Infectious Disease Society of America;

`(J) professional medical and clinical societies, as appropriate;

`(K) local hospitals and hospital districts;

`(L) medical care delivery facilities (hospital outpatient centers);

`(M) pharmacies;

`(N) accredited schools of public health;

`(O) pathologists, coroners, and chief medical examiners; and

`(P) other individuals and representatives of entities appointed by the Assistant Secretary for Medical Readiness and Response to the advisory committee.'.

(b) CONFORMING AMENDMENTS- The table of contents in section 1(b) of the Homeland Security Act of 2002 (6 U.S.C. 101 note) is amended by--

(1) inserting after the item relating to section 511 the following:

`Sec. 510. Countermeasure Purchase Fund at the Department of Homeland Security.';

and

(2) inserting after the item relating to section 879 the following:

`Sec. 879A. Office of Medical Readiness and Response.

`Sec. 879B. National Emergency Medical Readiness and Response Board.'.

TITLE XI--ENCOURAGING GREATER COORDINATION WITH FORMER SOVIET SCIENTISTS AND TRANSFER OF COUNTERMEASURES

SEC. 1101. PURPOSE; REPORT TO CONGRESS.

(a) Purpose- The purpose of this section is to direct the Department of State and the Department of Commerce to develop and implement a program to secure the access to, and transfer of, compounds, culture collections, devices, scientific methods, and research tools to the United States to further the protection of the United States and its allies against biological, chemical, nuclear, and radiological agents or infectious diseases. Such an effort must address the state of intellectual property of such items and ensure the security of such intellectual property to allow for and encourage commercialization.

(b) Report-

(1) IN GENERAL- Not later than 180 days after the date of enactment of the Project BioShield II Act of 2005, the Secretary of State, in cooperation with the Secretary of Homeland Security and Secretary of Commerce, shall report to the Committee on Foreign Relations of the Senate and the Committee on International Relations of the House of Representatives on the existence and adequacy of all United States Government-sponsored programs or organizations responsible for encouraging commercialization of countermeasures developed by former-Soviet scientists and current scientists working within the Commonwealth of Independent States (referred to in this section as `CIS').

(2) CONTENT OF REPORT- The report described under paragraph (1) shall identify any known legal prohibitions and practical challenges in the United States or CIS to the purposes of this section, including laws governing intellectual property, export controls, and classification of information restricting or inhibiting private-sector exchange and development of such countermeasures. The Secretary of State shall provide such information as the Secretary determines to be necessary to enable such potential commercialization and cooperation.

TITLE XII--EMERGENCY CONTINUITY OF NATIONAL HEALTHCARE; REIMBURSEMENT OF INFECTIOUS DISEASE PHYSICIANS FOR COMMUNITY EMERGENCY PREPAREDNESS ACTIVITIES; MEDICAL LICENSE RECIPROCITY

SEC. 1201. CONTINUITY OF NATIONAL HEALTHCARE SYSTEM IN AN EMERGENCY.

Section 319 of the Public Health Service Act (42 U.S.C. 247d) is amended by adding at the end the following:

`(e) CONTINUITY OF NATIONAL HEALTHCARE SYSTEM IN AN EMERGENCY-

`(1) EMERGENCY HEALTH INSURANCE REIMBURSEMENT- In the event of a public health emergency determined pursuant to subsection (a), the Secretary may guarantee reimbursement to public and private healthcare providers (which shall include nurses and non-clinical staff) for care related to the public health emergency provided to individuals by such providers to the extent that the public or private health insurance reimbursement (as the case may be) to such providers is not applicable because of war or terrorism coverage exclusions at one of the following rates:

`(A) The applicable rates under the Medicare and Medicaid programs.

`(B) A per diem rate determined by the Secretary.

`(2) GUARANTEE OF PAYMENTS- During a closure of the United States mails due to a public health emergency determined pursuant to subsection (a), the Secretary may provide a guarantee of payment to private healthcare providers to enable such providers to maintain services and continuity in response to such emergency.'.

SEC. 1202. REIMBURSEMENT OF INFECTIOUS DISEASE PHYSICIANS FOR COMMUNITY EMERGENCY PREPAREDNESS ACTIVITIES.

Section 319 of the Public Health Service Act (as amended by section 1201) is further amended by adding at the end the following:

`(f) REIMBURSEMENT OF INFECTIOUS DISEASE PHYSICIANS FOR COMMUNITY EMERGENCY PREPAREDNESS ACTIVITIES- The Secretary shall reimburse board-certified infectious disease and public health specialists for services provided during a public health emergency under subsection (a) at applicable rates under the Medicare program, to the extent that such services are not otherwise wholly reimbursed by other public or private insurance.'.

SEC. 1203. MEDICAL LICENSE RECIPROCITY.

Section 319 of the Public Health Service Act (42 U.S.C. 247d) (as amended by section 1202) is further amended by adding at the end the following:

`(g) MEDICAL LICENSE RECIPROCITY- The Secretary may issue regulations requiring the establishment of reciprocity of medical licensing and certification between or among States during a national or local public health emergency determined pursuant to subsection (a).

`(h) MINIMUM STANDARDS- Medical licensing for the purposes of subsection (g) shall include the licensing of allopathic and osteopathic physicians, registered nurses, nurse practitioners, physician assistants, pharmacists, paramedics, respiratory therapists, and other first responders or allied health professionals.

`(i) PSA- The Secretary may issue regulations requiring or providing appropriate liability and workman's compensation coverage for healthcare professionals and others responding to a public health emergency, as determined under subsection (a).'.

SEC. 1204. LIABILITY PROTECTION FOR HEALTHCARE VOLUNTEERS AND HOSPITALS.

Part B of title III of the Public Health Service Act (42 U.S.C. 243 et seq.) (as amended by sections 202, 1402, 1631, 1901, 2101, 2102, and 1631) is amended by inserting after section 319F-9 (as added by section 203) the following:

`SEC. 319F-10. LIABILITY PROTECTION FOR HEALTHCARE VOLUNTEERS AND HOSPITALS LITIGATION MANAGEMENT.

`(a) FEDERAL CAUSE OF ACTION-

`(1) IN GENERAL- There shall exist an exclusive Federal cause of action for claims arising out of, related to, or resulting from care delivered by any person or entity at any location in the United States if the governor of that State has declared a state of emergency, or the Secretary of Health and Human Services declares that a public health emergency is in effect in that State, or the President signs a disaster declaration for that State. Such Federal cause of action shall be brought in the United States district court for the District of Columbia and shall be only for injuries that are caused by willful or wanton misconduct.

`(2) LIMITATIONS- Healthcare personnel, volunteers, and other workers providing emergency medical or triage care in field settings, alternative treatment facilities, and in vaccination or medication distribution settings shall be immune from claim for loss of property (including business interruption or other types of indirect losses), personal injury, or death.

`(b) SPECIAL RULES-

`(1) IN GENERAL- When a hospital is providing care under emergency conditions as described in this section and such care is not administered for or in expectation of compensation, then the maximum liability to the Federal Government on behalf of the hospital (or its employees, volunteers, officers, and directors) is $250,000 for each claimant.

`(2) PUNITIVE DAMAGES- No punitive damages intended to punish or deter, exemplary damages, or other damages not intended to compensate a plaintiff for actual medical expenses or lost wages may be awarded in an action under this section, nor shall any party in such action be liable for interest prior to the judgment.

`(3) NONECONOMIC DAMAGES- No noneconomic damages may be awarded for claims under this section.

`(4) LIMITATIONS- Hospitals and other health care organizations shall be immune from vicarious liability for the actions of volunteers providing care under emergency conditions described in this section, even if the hospital or health care organization is considered the employer for worker' compensation purposes.

`(5) ATTORNEY FEES- Attorney fees in an action under this section shall be calculated on a reasonable amount of work performed on behalf of the plaintiff.'.

TITLE XIII--ADEQUACY OF EMERGENCY MEDICAL RESPONSE ASSETS FOR HOMELAND SECURITY MISSIONS

SEC. 1301. ADEQUACY OF EMERGENCY MEDICAL RESPONSE ASSETS FOR HOMELAND SECURITY MISSIONS.

(a) STUDY- The Assistant Secretary for Medical Readiness and Response of the Department of Homeland Security shall perform a study and prepare a report assessing the state of medical and health readiness and response capability to respond to large-scale medical emergencies, such as terrorist actions. The study will evaluate the following aspects of medical and health readiness and response: