There are a lot of new ideas floating around EMS these days. Compact licensure for EMTs and paramedics just like nurses already have. Community paramedicine. New educational standards. And the list goes on.
Here’s why many of these well-intentioned ideas remain just that — well-intentioned ideas. Many well-intentioned EMS opinion leaders with well-intentioned ideas have no idea how, or more importantly, where a well-intentioned EMS idea makes into law.
With a few notable exceptions (EMTALA, HIPAA, and CLIA coming to mind immediately), most EMS laws and regulations are creatures of state government. Overall, emergency medical services are provided at the local level and are regulated by state statutes and administrative rules/regulations.
I see a lot of EMS folks wanting either Congress or some national body (e.g. National Association of State EMS Officials, the National Association of EMTs, or the National Registry of EMTs) to DO SOMETHING, DAMMIT! I don’t always oppose their ideas (well, except for my healthy dose of skepticism about the so-called “Field EMS Bill.”), but they’re usually barking up the wrong tree. If you want to make changes to the regulatory framework of EMS, you need to quit looking toward Washington.
As a valued service to my minions and other readers, I’ll tell you the way to fix EMS. First, learn where your state’s EMS laws are located in statute. Second, learn where the state administrative regulations regarding EMS can be found and which state agency or agencies create, implement, and enforce these regulations. Next, learn who your state representative and senator are. Also, learn who are the senior management in your state’s EMS regulatory entities. And learn who are the chairs of the legislative committees overseeing EMS laws.
And then, when you want to change how we do EMS, contact those people. Write, call, email, or better yet see them. While the results may not be as sexy as going to Washington DC in a hotel doorman’s uniform and getting pictures posted online, the results will be more effective, easier, and might just improve EMS. One state at a time.