IAFC President Expresses Field EMS Bill Concerns

By Bill Metcalf
IAFC President

The origins of the modern EMS delivery model can be traced to the mid-1960s when the National Academy of Sciences published a white paper called Accidental Death and Disability: The Neglected Disease of Modern Society. Referred to as “Death in a Ditch,” the white paper described the deplorable state of prehospital emergency care in the United States and strongly advocated for national attention and action. During the Nixon administration, a number of pilot projects looked at different EMS delivery methods and some local communities from coast to coast embarked on individual programs to improve out-of-hospital care.

In the early- to mid-1970s, national standard-training curricula were developed and the concept of trauma systems began to grow and mature. The emphasis throughout this early developmental period was on system design and standardization of training. The decisions about who would deliver EMS or how really didn’t matter, as long as it was done within a system and based on some minimum standards.

At the national level, from the very beginning, a number of different agencies have been involved in EMS–in recognition that EMS touches many disciplines and exists primarily at the intersection of public safety and public health. These agencies include the National Highway Traffic Safety Administration within the Department of Transportation, the Department of Health and Human Services (HHS), the Department of Homeland Security and its subsidiaries like FEMA and the U.S. Fire Administration, the General Services Administration and the Department of Defense, among others.

There has always been tension between these various federal agencies when it comes to EMS, for a variety of reasons, but they work together to move EMS forward.

Likewise, in our communities and on the streets, EMS has evolved in a number of organizational homes, such as the fire service, hospitals, government third services, private nonprofits and private for-profit organizations. How to structure and implement an EMS delivery system is largely a policy decision at the local level. There are excellent examples of each and there are also terrible examples of each. It’s not about the patch on the uniform; it’s about the quality of service being provided. As with the federal government agencies, there has always been tension between the various entities providing EMS in our communities.

In recent years, the tension between the various organizations and agencies involved in EMS has increased as competition and limited resources strain organizations. This has resulted in lots of name-calling and claims about who is better at providing EMS. In the midst of all of this noise, a piece of legislation, known as the Field EMS Bill (H.R. 809/S. 2400), has been introduced in the U.S. Congress. It has been languishing in Congress for some time, but seems to have found new energy lately.

The piece of legislation has become quite polarizing in the EMS community, and it’s being characterized as advocating one type of system over another or favoring one type of delivery model over another. That’s not what it’s about at all.

Read the full statement HERE.

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