Tax And Spend Politics

Those of you who know me away from the computer screen (and many of you who do know me only via the screen) know that I tend very conservative. I mean, very conservative. I’m not a libertarian for a variety of reasons, largely because libertarianism is based on a very idealistic view of people and society. (The best argument against letting people do everything on their own with very few controls can best be witnessed when you see what passes for pop culture.) Nor am I of the anarcho-capitalist mindset that so many online edgelords think is cool.

I do believe there is absolutely a role, albeit a limited one, for government. I also believe that which government must do, it must do well. That requires adequate funding. Notice that I didn’t propose a blank check. It also requires accountability for results. It requires transparency. When a Chevy will do, you don’t have a God-given right to a Cadillac or even a Mercedes. It’s not your money. It is the taxpayers’ money. Many in public service have lost sight of this. I call this “other people’s money.” And like my libertarian friends, I don’t believe you have an automatic right to other people’s money. As Justice John Marshall said in 1819, “The power to tax is the power to destroy.”

So, on that note, let’s segue into a part of the public sector that has felt an entitlement to your money. This part of the public sector operates as if it has an entitlement to your money as they claim they provide an essential service that no one else provides. They claim a long history dating in this country back to Benjamin Franklin. Their union members (and union leaders) as well as their administrators work hand in glove to ensure that they receive more and more from the public trough. They ask for, and receive, spacious facilities and state of the art equipment and technology to accomplish their stated goals. When they come to the public or governing bodies for more of your money, they present themselves as community heroes and public servants who are asking for “pennies a day” or “the cost of a cup of coffee per week.” If you ask them for results or challenge their narrative, you’ll be told that you’re threatening their very mission unless you give them everything you want. Oftentimes, these “dedicated public servants” use taxpayer money to lobby for more money for themselves, for more unionized jobs, and for higher salaries. And while some suburban and rural areas get this delivery of a crucial public service down, many urban areas are an abject failure at providing this core, essential service that we as Americans expect from the government, primarily at the local level, but also with significant state and federal funding. And while many of their union members are right of center, their union and union leadership take far left progressive positions that alienate many of their members and much of the public. The oversight of these local service providers typically is performed by locally elected bodies who often function as little more than a rubber stamp for the administration who will approve tax increases and bonds in lockstep.

For my friends on the right, this sounds a lot like the public school system that has become a bete noir for the right. But this time, I’m NOT talking about the public schools, the teachers’ unions, school funding, or education politics. It sure sounds like them, doesn’t it?

Surprise. I’m talking about the American fire service. I’m talking about their left-leaning union – the International Association of Firefighters. I’m talking about their association for administrators – the International Association of Fire Chiefs. Let’s face it — have you ever seen the IAFF and the IAFC not present a united front to ask for more staffing, more apparatus, and more stations? When you oppose more money to what I’ll now call “big fire,” you’re demonized as un-American, as not caring if people die, and for being an all-around heartless SOB. And just like the education system, these folks make themselves out to be your local heroes. The reality is that, in many locales, building codes and modern construction have drastically decreased the need for structural fire suppression. That means that the American fire service has had to find new roles to remain relevant. In many communities, that’s meant expansion into EMS, whether it’s basic life support level first response, advanced life support (AKA, paramedic) first response, or operating an EMS transport division as part of the fire department. In fact, in many places in my home state of Texas, fire departments that are operated as a special local government district (we call them Emergency Services Districts here) have gone right back to the taxpayers for a second district to fund EMS separately even though the EMS service is part of the same fire department. Especially in larger departments, EMS is seen as a distraction from the “core” suppression mission. I know of at least one urban fire department in Texas where EMS duty on an ambulance is called “riding the penalty box.” All too many fire departments mandate paramedic certification for hiring or promotion. All of this creates a culture where prehospital medicine is shunned, where the funding for the EMS side of the department is bare bones, and where EMS training “meets minimum standards.” Look no further than the average fire department’s social media. Hashtag Always Training is almost invariably about structural fire suppression training. This isn’t only happening in metro areas with big departments. I’ve watched a volunteer fire department’s membership approve a $15,000 drop tank without discussion while they claimed poverty in not being able to buy an EZ-IO device for their paramedics and while their advanced airway supplies were stored in a gym bag. Like the school districts, those elected or appointed officials overseeing Big Fire rarely question anything the chief or the union presents them. Rather, they just turn on the spigot for more money. In fact, in Texas, there’s even an association (that lobbies the Texas Legislature with district funds) for these Emergency Services District commissioners. Just like the association for school board members. And just like many urban school districts and their lack of results with their core mission of education, all too many fire departments, particularly bigger ones, fail at providing competent, let alone GOOD, EMS care. Just like public education, Big Fire in many locales has become little more than a jobs and public works program funded by tax dollars while everyone else complains about rising property taxes. For everyone who complains about school districts’ spending on things like football stadiums that rival some NCAA programs, I’ve yet to see anyone question a suburban or rural fire department buying a tiller ladder that’s well over $1 million.

I honestly don’t oppose the fire service. Truth be told, in a lot of locales, the fire service even does a good job at the delivery of emergency medical care. But I want the public, especially those on the right, to view the fire service and their requests for MORE money with the same skepticism and demands for results, accountability, and transparency that they rightly demand of public education. It’s the public’s money. Those entrusted with it have an obligation to do better with it.

An EMS Week Message to the Hospitals, Nurses, and Doctors

Well, it’s once again EMS Week. Or to everyone else in healthcare who’s not an EMT or a paramedic (and yes, there’s a BIG honking difference), it’s Ambulance Driver Week.

And for most hospitals, that means y’all will feed us (don’t forget we’re a 24 hour operation) presuming the staff doesn’t graze over our meals as well and/or give us swag festooned with your hospital logo all over it. Don’t get me wrong. I love food. I love cold drinks. I can always use an extra pen or pair of shears. And I love the EMS room at a lot of the hospitals I’ve been to. Sometimes, that snack is all that’s keeping me, your facility, and our patients from me getting hangry.

But there’s more I’d appreciate from the hospitals, nurses, and doctors. Every year, during EMS Week, we hear how we’re your “valued partners in healthcare.” Valued partners get real recognition and partnership every week of the year, every day of the week. And there’s at least some of us who would like more of a partnership than a week with a taco bar or a regularly stocked EMS room. (Like I said, I won’t turn away food.)

But a real partnership means more than that. A real partnership means including us in education. I’ve lost count of how many colleagues in EMS education tell me about hospitals turning down EMS education programs’ requests for their hospital to be a site for clinical rotations. Those sites that do remain know they have EMS educators at their mercy and such clinical agreements have become something that it takes a lawyer to review, read, and understand. (Fortunately, I know an attorney who can do this.) Further, these clinical site agreements now have more and more restrictions on them, specifically now requiring the EMS education program to send a paid preceptor to supervise the students. A real partnership with EMS means allowing EMS students to “do things.” Labor and delivery rotations shouldn’t be “observation only,” especially when nursing staff loudly asks the mother “You don’t want a male EMT/paramedic student in here, do you?” Clinical shifts should be more than “observation or basic life support only” for paramedic students. I am tired of hearing pediatric facilities complain about their perception of EMS providers being weak at pediatrics when they won’t allow EMS students into their facilities or severely limit their participation as they tell us, “All you need to know is to bring the kid here. WE are the pediatric experts.” (And don’t get me started about a certain Houston pediatric hospital mandating that EMS get vital signs on the hospital’s blood pressure monitor as opposed to accepting EMS obtained vital signs.) And for the doctors who say that paramedics shouldn’t intubate or do other low frequency, high acuity skills, when will you allow EMS students as well as current providers the opportunity to get into the operating room to intubate or to shadow you?

There absolutely are EMS providers who are as passionate about professional development, growth, and excellence as anyone on the other side of the hospital doors. There are also those of us who pencil whip continuing education and have to be dragged kicking and screaming to accept changes in medicine. There are similar providers inside the hospital as well. I can usually recognize these folks when they refer to oxygen saturation as “O Two Stats.” But for those of us who want to learn, make these opportunities available to EMS. At least some of us will attend.

If we’re truly partners in healthcare, treat us as such. Allow this partnership to benefit our collective patient population. And if the altruism doesn’t convince you, consider this. I did my EMT rotations all at one hospital. I did all of my paramedic rotations in the emergency department and intensive care department at the larger hospital in the same network. My family has used that hospital network virtually exclusively since I obtained my EMS certifications. I have recommended this network and their physicians to many other friends. If nothing else, this hospital network opening their doors to a student has paid off many times to the network and their associated physicians, bringing them patients (and revenue) they would have never seen otherwise.

I truly do love the hospitals, nurses, and physicians that I get to work with regularly. I don’t expect tokens of thanks. I won’t turn down a cold drink or a snack. But the education and collaboration would be a special treat on EMS Week and every other week.

The Current State of EMS as I See It.

We're getting closer and closer to EMS Week. What does that mean? For many of us, it leads to a slice of cold, cheap pizza and some random piece of EMS Week swag. For others, it's a chance for them to prove their bona fides as either an "EMS … [Continue reading]

I Know Better Than You Do

Over the last week, I've had some interesting conversations with some smart people in EMS. Likewise, I've had some conversations with people who think they're smart. During the course of these conversations, I noticed that a common trait of these … [Continue reading]

Doing The Right Thing

Last week, several EMS friends and colleagues asked me to look at the recent Kentucky case on EMS liability. Obviously, as a lawyer, my first and foremost answer is always going to be "it depends." I'd also remind you that even appellate cases are … [Continue reading]

Texas EMS Conference 2023 Postmortem

Well, it’s the week of Thanksgiving and for most people that meansturkey.  For me, Thanksgiving has always been stressful – mainly due tofamily issues.  But therapy has helped with that.  (Mostly kidding,y’all.) For me, this week has always been … [Continue reading]

Why Can’t We Get Perfect Volunteers?

Earlier this week, I watched a great documentary movie about the volunteer fire (and EMS) service called Odd Hours, No Pay, Cool Hat. The movie does a great job illustrating the various cultures of volunteer emergency services throughout the country … [Continue reading]

Blunt Talk

I was discussing some issues with some EMS friends online this afternoon and the topic of physician and nurse involvement in EMS practice, policy, and regulation came up -- and how physicians and nurses seem overrepresented when EMS policy is being … [Continue reading]

Enough with the British/Australian/Canadian Medic Comparisons.

First of all, apologies for not blogging in a while. Between practicing law during the day and two EMS roles that keep me busy, I tend to forget that I have a blog and only will wander over here when one of two things happen. One - when I get the … [Continue reading]

Recruitment and Retention: More of the Same

I was thinking about some of the recruitment issues that EMS is facing. Lots of large, well known departments are having challenges filling paramedic vacancies. Over the last decade, many of them have gone away from double medic staffing because of … [Continue reading]