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Empowerment Ends Bias
A.J. Heightman, MPA, EMT-P

Now is the time for Congress and the Bush administration to realize that EMS has been sorely neglected since the early 1980s and to create, empower and fund a lead agency to correct the problem and to prioritize funding so that it's no longer sucked up by special interest groups.

Back to the Future: An Agenda for Federal Leadership of Emergency Medical Services, a report released in May by The George Washington University Homeland Security Policy Institute (GWU/HSPI), recommends the establishment of a U.S. Emergency Medical Services Administration (USEMSA) under the umbrella of the Department of Homeland Security (DHS).

The report woke a sleeping giant and has given this long-neglected issue the momentum of a freight train. Although I don't necessarily disagree, I want reassurance that EMS will receive the necessary priority (and funding) and won't get lost in the multi-level bureaucracy of DHS.

EMS often walks like an emergency service duck and sounds like an emergency service duck, but it has many needs that differ from fire, police and other emergency service agencies, particularly because of the "M"-Medical-in EMS.

Medical programs that require close interaction with the medical community, administer medications and controlled substances, and perform invasive treatments on the human body differ significantly from those emergency services that deal with roof ventilation, the disarming of bombs and WMD planning. Therefore, the physician most knowledgeable about EMS in the federal government, U.S. Surgeon General Richard Carmona, should be involved in the design of USEMSA; a big part of his office's mission is to "ensure public health preparedness, eliminate health disparities [emphasis added] and prevent disease."

Congress must realize that EMS does not fit the same mold as fire, law enforcement and emergency management but, instead, follows more closely in the U.S. military model. The military has branches (Army, Navy, Air Force, Marines and Coast Guard) that, although frequently lumped under the "military" label, have unique needs that must be addressed and funded separately.

For example, when Congress was made aware that the Army and Marines lacked a sufficient number of armor-plated Humvees in Iraq and our soldiers were getting blown apart due to the lack of proper protection, it authorized extra funding and directed the military to fix the problem experienced specifically by those two branches.

The same situation exists in EMS. Although all EMS agencies have a common mission, how fire departments, hospitals, private services and volunteer agencies accomplish the tasks and procure the equipment they need are based on strategies that often differ greatly.

Fire agencies respond with ambulances and fire apparatus from strategically positioned stations but rarely operate interfacility critical care or pediatric ambulances, medical helicopters or specialized bariatric vehicles.
Private, hospital and third-service agencies respond from strategically calculated zones within an assigned service area and do operate these specialized vehicles. Volunteers often respond from their homes to a station or directly to an incident scene, depending on their location.

Federal initiatives since 9/11 have failed to evenly distribute funding to each of the EMS "branches" and have primarily targeted resources to the nation's most heavily populated areas. There are now enough terrorism-related medications and antidotes in urban centers to fill a small lake.

Travel 50 miles outside of "Dodge City," however, and you won't consistently find Mark III kits, escape hoods or triage tarps in an ambulance. If a terrorist sets off a dirty bomb or blows up a train in most municipalities with a population of less than a million, EMS won't be ready. EMS has received only 4% of the funds distributed for homeland defense. In addition, EMS is in a daily battle against the challenges of an aging and increasingly obese population, serving a public with a more statistically plausible threat of dying from a heart attack or gunshot wound than being harmed by a terrorist.

EMS is now, and has been throughout my 35-year career, a political football that's continually punted into the wind. In the 1970s, when David Boyd, MD, ran the government's EMS program under the Department of Health, Education and Welfare, he frequently rejected funding applications from regions that failed to meet the rules of the program, neglected the development of mass casualty plans and didn't have medical directors empowered to oversee, audit, change and improve their EMS systems. No empowerment, no money.

During the same time period, the National Highway Traffic Safety Administration (NHTSA) was funded at a much higher level and empowered to award grants to municipal governments to improve EMS. But then funding was reduced, and NHTSA was relegated to a planning, coordinating and supporting role. Those at NHTSA have done their best, but you can't build a solid house out of straw.

Guess what, Congressman Nobucks, your local ambulance service can't transport a constituent who's bleeding to death on a white paper or GAO report about the deficiencies that exist in this country's EMS systems.
Congress needs to make sure EMS gets the priority attention it deserves-today.

The most important thing you-and your agency or organization-can do is contact your federal representatives and request that they ensure through legislative mandate that the agency designated to serve as the lead, federal EMS agency plans, coordinates, funds and provides oversight to all branches of EMS with the strategic needs of each in mind. Find your representative at http://thomas.loc.gov.