Ice Cube on a Plate Glass Window
First responders should support increased EMS funding
By Paul M. Maniscalco & Gregg C. Lord

Since 2001, the federal government has spent $28.6 billion on response preparedness and homeland security development,
but only 4% percent of DHS funding has gone to EMS. In addition, EMS has received only approximately 5% of the
funds disbursed by the Department of Health and Human Services for bioterrorism preparedness. Unlike our peers in law enforcement and fire suppression, EMS has been treated like the unwanted stepchild.

The average EMS responder has received fewer than two hours of training to prepare to respond to WMD incidents, according to the Longitudinal EMT Attribute and Demographic Study conducted annually by the National Registry of Emergency Medical
Technicians (NREMT) (a national testing organization). A survey by the National Association of EMTs (NAEMT) found that most
EMTs and paramedics in the United States (with the exception of those cross-trained as firefighters) also don’t have adequate personal protective equipment (PPE).

This means that following a WMD attack, firefighters and law enforcement officers would don their PPE, which was paid for by the federal government, while EMS providers would stand unprotected and untrained on the sidelines, unable to treat patients in need of their immediate lifesaving help. The only other option available to EMS personnel would be to enter a contaminated environment unprotected and face almost certain bodily harm. Unprotected EMS personnel would then become victims themselves, leading to further casualties and creating an unmitigated disaster.

Because of its unique background, EMS has evolved in many different venues, with many types of organizations providing
ambulance transport, including volunteer organizations, fire departments, private companies, hospitals and even funeral
homes. In 1966, The National Academy of Sciences authored a white paper, Accidental Death and Disability: the Neglected Disease of Modern Society, which prompted the federal government to address an “injury epidemic.” Consequently, EMS did get some federal financial help for the next 15 years and an EMS office in the Department of Transportation that still exists today. But the federal government has basically ignored EMS for the past two decades.

From a national perspective, EMS today looks like an ice cube that someone has thrown against a plate glass window: It is
splattered into numerous delivery models and systems with separations, barriers and divisions that make it difficult to convince the federal government to develop a cohesive funding stream for EMS. This explains why EMS providers—who are roughly equal in numbers to firefighters and law enforcement officers—have received far less in funding, training or support.

With little federal support and no federal oversight of the EMS mission, states—and even some local jurisdictions—freely make their own choices regarding EMS delivery and standards. Meanwhile, EMS responders struggle to survive with reimbursement rates that don’t even cover the costs of the services they provide, and volunteer EMTs hold fish fries and pancake breakfasts just to buy gas for their ambulances. Now, we’re expected to prepare to respond to a WMD
disaster without federal fiscal relief.

Because of the complexities and dangers involved in responding to WMD incidents, EMS responders require appropriate training that includes scenario-driven exercises. This currently does not happen. If Congress does not intervene and provide the necessary support for EMS preparedness, this situation could contribute to increased mortality
and morbidity and even act as a “force multiplier” in the event of another major terrorist attack within the United States.

In a step that many people saw as a minor victory for the EMS community, Congress stipulated in the 2005 DHS appropriations
bill that 2% of the funds for the Assistance to Firefighters (or FIRE) grant program should be set aside for municipal
or not-for-profit EMS organizations that are unaffiliated with a fire department (or a hospital). Although non-fire-based EMS organizations appreciated the support, we did not appreciate that it came at the expense of the fire service.

Taking money from the fire service for EMS is not a solution to the problem; that’s like having a flat tire on the front of your car and moving it to the back. The fire service has its own vital issues that must be addressed if our nation is to remain ready to respond.

The bottom line: Congress must intervene and support the critical function served by EMS responders to reverse the fiscal burden that has been hoisted upon the local EMS agencies. A recent report from DHS illustrates the need: During the most recent application period for FIRE grant funding when $13 million was available for EMS, EMS response entities submitted applications seeking in excess of $138 million—or 1066% more than the available funds.

It serves the interests of other first responders to support EMS in its efforts to convince Congress to give EMS the necessary funding and support. In modern history, no army has gone into battle without a properly equipped and trained medical response force. What has changed that makes the situation today any different or acceptable?

PAUL MANISCALCO, EMT-P, MPA, DRBA(c)is an assistant professor at The George Washington University, a former
deputy chief/paramedic for the City of New York and a board member of the National Association of EMTs. He represents EMS on various federal committees related to homeland security and served as chair of the Gilmore National Terrorism
Commission’s State and Local Response Panel and Threat Reassessment Panel.

DIVISION CHIEF GREGG LORD is EMS coordinator for the Cherokee County (Ga.) Fire Department and an NAEMT board member.


32 HOMELAND FIRST RESPONSE • July/August 2005 http://www.homelandfirstresponse.com
Ice Cube on a
Plate Glass Window
First responders should support increased EMS funding
By Paul M. Maniscalco & Gregg C. Lord
HOT ZONE

Homeland_First_Response_-_Editorial_Hot_Zone.pdf (53 Kb, 3 downloads) Hot Zone column in Homeland First Response