Federal Leadership of Emergency Medical Services

There is some brewing activity in Washington to finally give EMS the federal attention it deserves. It has largely been overshadowed by Police and Fire. What follows is an intereseting article on the issue and a link to a new federal report.

***

Tension Between Emergency Medical Crews and Firefighters Stays on Simmer
By Eileen Sullivan, CQ Staff

From pay disparities to what they see as a lack of respect for their mission, emergency medical services providers say they have felt slighted by firefighters for years. In normal times, public service rivalries like these would be the stuff of firehouse sessions and city council meetings. But now, a prominent think tank’s recommendation that emergency medical services (EMS) providers get more money and clout has turned up the heat. It began in May, when George Washington University’s Homeland Security Policy Institute recommended moving EMS into the Department of Homeland Security (DHS) from the Transportation Department’s National Highway Traffic Safety Administration (NHTSA). The idea would be to create a separate program, similar to the U.S. Fire Administration, which was moved into DHS along with the Federal Emergency Management Agency (FEMA) when the department was formed in 2003. Friction from the recommendation garnered the attention of the House Homeland Security Committee, which may hold a hearing on the issue. One hurdle the committee will have to clear is the sticky question of exactly what an EMS provider is. Some say it is a state-certified, medical responder who arrives at the scene of an emergency and treats patients. Others say it is anyone with state certification to handle an emergency, including workers with private ambulance and organ transport services.

A History of Friction

EMS came on the scene as an organization in the 1970s, making it the youngest of the three first responder groups, which includes police and fire, by hundreds of years. As fire departments began to respond to fewer fires and more medical emergencies, it made sense to combine EMS with fire, experts say, although not all communities chose to do so. Currently, 44 percent of EMS providers are located in fire departments. The rest are private, hospital-based or housed in a separate government agency. There is not one correct way to organize EMS, and this has led to some of the tension between EMS and fire, said Jeff Dyar, the EMS chairman at the U.S. Fire Administration’s National Fire Academy in Emmitsburg, Md., from 1992 to 2003. “There’s always been turf battles about who should house that function, how it should be dealt with,” Dyar said in a telephone interview. “Fire thinks they do it [EMS] best. Private [EMS providers] think they do it best. Hospitals think they do it best. That all leads up to competition on the street.” Philosophical differences about whether EMS is part of a fire department’s mission also causes tension, Dyar said. “[Some departments] tend to say fire departments just fight fires,” he said. Larger, more established departments in cities such as New York tend to have this view, he said. However, some departments, like Phoenix’s, have embraced the EMS mission, realizing it is most of what they do. “With fire protection efforts, improved fire codes, fewer people smoking, the number of fire suppression runs has dropped dramatically in the past 20 years,” said Dan Rosenbaum, editor of fireEMS, a New Jersey-based magazine. About 80 percent of the calls fire departments respond to are medical emergencies, Rosenbaum said. “When fire departments began taking over EMS departments . . . you had a significant culture clash,” he said. “You had the guys who walked into the burning buildings and the guys who didn’t. Now, more fire departments are cross-training firefighters and EMS providers,” said Jeff Zack, spokesman for the International Association of Fire Fighters, a union. “It’s the future of the entire emergency response system,” he said. “The most efficient way to provide EMS services is through the fire service.” It is important to realize that EMS is still comparatively new on the first responder scene, Rosenbaum said. “Some of what we’re seeing now is growing pains, which doesn’t make them less painful,” he said.

More Clout

The EMS office in the Department of Transportation is staffed with eight full-time employees, according to NHTSA. In the fiscal 2006 budget, EMS is lumped in with $74 million in highway safety programs. The George Washington University study recommended that EMS be moved to DHS to bring it into the homeland security community. “Catastrophic events such as terrorist attacks will demand significant resources and specialized capabilities from first responders,” according to the GWU report. “However, even in a post-9/11 environment, a fundamental component of the first responder community, Emergency Medical Services (EMS) is a missing piece of the preparedness puzzle. Today, EMS needs a seat at the table as first responder policy, funding and operations are debated at the federal level. NHTSA would not comment on the GWU proposal. Proponents of the move argue that the EMS community is too fragmented and does not receive the attention or funding it deserves. “We are the left-alone public safety entity that’s not getting any attention, and we’re doing the bulk of the work in the United States,” said Donald Walsh, assistant deputy commissioner for EMS in the Chicago Fire Department. “DOT has been working their hardest with the resources they have,” he said. But put EMS under homeland security with the rest of the public safety community.” Consolidating federal EMS functions may be in order, said a Homeland Security Committee staff member, who asked to remain anonymous. “Everyone recognizes EMS is not getting the amount of attention they deserve,” he said, but the GWU proposal to create a separate office within DHS might not be the solution. “You don’t want to pit first responder groups against each other.” Some say it’s a little late for that.

Rescue Me

The complaints of EMS providers in Washington mirror those of providers in other communities. Two D.C. EMS officials, both of whom spoke on condition of anonymity, say they do not get the respect they deserve from the fire department, in which they are based. There is a feeling that you don’t belong, that you’re tolerated, one said. Firefighters, the officials said, seem to think their jobs are more important than EMS. The difference in pay contributes to this perception, they said. An EMS lieutenant in the District gets paid between $43,690 and $57,005 annually, whereas a fire lieutenant is paid between $61,920 and $93,534, according to statistics from the EMS Officers Association. Where firefighters make more money, it’s because they work hard and negotiate good contracts, said Zack, of the International Association of Fire Fighters.

One of the Washington EMS officials said, however, “Our hazards are as great as police and fire. What’s simple to me is hooking up a hose to a truck and spraying it on a building.” His colleague added, “Give us our fair share, that’s all.”

***

Click here to download a copy of federal Report.

Back to the Future: An Agenda for Federal Leadership of Emergency Medical Services

***

I have some run-ins over the years with fire departments, but in most cases, it was either a run-in with a badly designed system or with a particular individual, as opposed to a problem with a group of people. Years ago when I worked as a volunteer, the fire department was feuding with the ambulance, more of a clash between the two people heading each organization -- long-time small town foes than anything. The problem was the fire chief used his authority as head of the overall scene to control what the ambulance did, when he would have been better to just let EMS do what EMS does. I remember several times being denied access to patients in cars that in other towns, the fire department would routinely let us get right in the car and with the patient. Not here-- the scene wasn't safe for us, they said. Yeah, right. Fortunately, now I only rarely function anywhere where the fire department gives me any kind of problem. In the city, they are very helpful. The only problem I have with them is they often get dispatched before us, get better dispatch information and get all the credit in the paper when their role is really often just one of assisting us. Rarely do we venture into a town where the fire department has paramedics who are in charge. There we must allow the fireman to enter our ambulance and call the shots even if we are there first and have everything under control. Fortunately, I know many of the fire medics there, and have never had a problem. Other people have, but I guess that comes with the territory.

I have nothing against fire. I wish that there were departments in this state where instead of crosstraining people as firefighters and medics, they had a role for just medics. I personnaly think that paramedicine is complex enough that it demands a person's total attention. People who serve as medics should be first and foremost medics. They should be medical specialists. That's just my opinion.