Ronald Reagan stated that “Government does not solve problems. It subsidizes them.”
That axiom still rings true today, especially in this era of runaway deficits and government spending. For those of us in EMS, as in much of the public sector, we have unmet needs. For many in EMS, those unmet needs may include basic expenses such as a new ambulance, a new cardiac monitor, or maybe additional training. Some rural EMS services even have to get staffing waivers from their respective state EMS agencies.
And if you’re a member of the National Association of EMTs, you get continual email messages imploring you to support the “Field EMS Bill.” NAEMT claims to be the largest voice for EMS in the country and the bill is nobly named, so we should all support it, right?
No, no, and no.
I’m not going to pull a Nancy Pelosi stunt and tell you that you have to pass the bill before you can see what’s in it. In fact, NAEMT’s website has a fact sheet that describes what the bill would accomplish.
First, as you might’ve surmised, I tend toward the libertarian/conservative side of the political specrtum. As much as I love EMS and being a paramedic, I’ve yet to find anything in the Constitution that gives the Federal government any authority over EMS — or the authority to appropriate tax revenue to support EMS. I try to take a consistent view to the role of the Federal government, even if it’s a cause I support. Absent specific authority in the Constitution, it’s probably not the role of the Federal government. State and local government is a different story, however. The majority of the public safety and health roles are established at the state and local levels.
Now, aside from the philosophical issues of the Federal role in EMS, let’s take a look at the points of the “Field EMS Bill” and see what it really does for EMS.
First, it establishes an Office of Trauma and EMS within the U.S. Department of Health and Human Services. Again, I question the role of the Federal government within EMS. However, even if we accept such a role, I’ve got real concerns about EMS being placed within HHS. My experience with both Federal and state HHS bureaucracies is that they lean heavily towards a nursing and/or public health model. In other words, EMS is unlikely to be given sufficient attention within such a large bureaucracy, especially one focused towards welfare programs and public health. If you think EMS is in bad shape now, wait until HHS bureaucrats are approving what EMS does. They’ll get around to publishing the new EMS rules in the Federal Register once the Deputy Assistant Secretary’s special assistant finishes reviewing the stakeholder comments. Such is the nature of bureaucracy in general and the health and human services bureaucracy in particular. And what’s a stakeholder? An old legal colleague of mine described a stakeholder as someone who has no legal say in an issue, but is given one anyways.
Next, the bill establishes a variety of different grant programs. In short, grant programs redistribute Federal money to certain “deserving” entities. My experience with grant programs is that they rarely fund essential services, come with significant restrictions, and are often awarded not on need, but on the ability to submit the best grant application. I could give a description of the various grants awarded, but I’ll link you to NAEMT’s “one pager” instead. Suffice it to say, as with virtually any grant program, these grants will be less likely to fund real needs and much more likely to fund the usual “elite” EMS programs’ pet projects. In other words, we’re more likely to see certain large urban EMS systems get community paramedicine programs while the average small rural EMS system is holding bake sales to buy AED batteries. In other words, the grants in the Field EMS Bill are the EMS version of the Obama “green jobs” programs funded with the Stimulus Bill — politically chosen largesse of your tax money. In short, the Federal government will be picking winners and losers. Google “Solyndra” if you need more information on how well this works.
In other words, the Field EMS bill is much more about redistributing money from taxpayers to the “EMS Elite” for their pet projects. You know the “EMS Elite.” They’re the professional committee members on virtually every self-perpetuating, interlocking EMS committee. Why do they have the time to be professional committee members? Because they aren’t field providers and it serves their employers for these people to be on every committee.
There are two things EMS doesn’t need. More Federal involvement and picking winners and losers with “free Federal money.” Sadly, the “Field EMS Bill” does both — and does little, if anything, for the field EMS provider.
Right on target. The very last thing we need is for the US Health and Human Services Administration to get any sort of control over EMS. It will be a debacle.
Ditto, Wes & Gene.
In a perfect world, the federal government would have no role in the goings on of local governments and such. And in an even better world, state governments would stay out of local affairs, as well. But I guess this is not a perfect world.
I guess the frustration comes in with the whole ‘grant’ thing. I personally am against federal grants to buy local ‘toys’ like fire trucks to replace 15 year old trucks that are perfectly functional but don’t meet the latest standard, tactical gear for local police departments that have never had a remote need in the past, and other such stuff. They can even get money to hire PEOPLE.
At the same time, I am frustrated as I sit and watch EMS agencies struggling to replace ambulances with 300,000+ miles on them, Lifepak 11’s and Lifepak 10’s, and hand-me-down radios and such. They even prepared great applications, justified their needs, but were passed over.
Plus, I see fire departments and police departments (as well as EMS agencies) that are TRULY in need that for whatever reason can’t get a leg up.
There is so much that the feds are into these days that they don’t have the authority for (other than what the public has conceded) that are considered ‘necessities’ by many.
I would say, at this point, no to a federal EMS agency, but, I know it will probably happen. I don’t think DHHS is the right place, given their track record on most everything. DHS/ FEMA is probably not the best place, either, but I would rather EMS go there than DHHS.
I agree that we don’t need federal involvement in EMS.
That said, I think DHHS is a better landing place than DHS, or God forbid, U.S. Fire Administration.
I think the future of EMS aligns more closely with a public health role than public safety. As such, DHHS seems a better fit.
AD, I love ya pal, but on this one, I think you’re wrong. As a government bureaucrat myself, I’ve watched how health and human services bureaucracies work. EMS is the furthest thing from their collective minds. Benign neglect is one thing, but their bureaucracy is stifling and heavily oriented towards nursing and public health. EMS would be smothered by them.
-Right now- EMS is the furthest thing from their minds. Would it be safe to assume that that would change when EMS is added to their responsibilities? Bureaucracies are not known for being progressive or efficient, that’s for sure. But how else do you propose we organize and get results on par with other professions? I’m with AD. The future of EMS is more closely aligned with general public welfare services than with disaster or “public safety” services.
Let’s not forget our EMS History..HHS has had EMS oversight/involvement a couple of times in history…both times it “handed us over” to someone else when the funding ran out. I have no reason to not believe it will happen again. While DHS may not seem like the right place because of Fire, I have seen the plan outlined to put EMS in DHS and it has an Office of EMS position NEXT to the Fire Service, no in it or beneath it. DHHS’s model has TRAUMA and EMS in ASPER (which is DHHS’s idea of DHS preparedness) which places us much lower on the organizational ladder than DHS has us positioned.
Interesting thoughts
I’ve had reservations about the Field Bill since the beginning. The “funding mechanism” is a gimmick… No dedicated funding for the grants.
I’m with you in a libertarian/ true liberal viewpoint.
I’m not fond of giving the government more control – but let me run though some of the “good” talking points.
Right now EMS is split across 3 agencies, all of which sometimes want to excert control over EMS (DOT, HHS, and DHS). All are issuing various directives, and there are various grant programs EMS is eligible for (of course, some of those will still exist, so that’s might be a complication).
What could be changed to make you happy?
It doesn’t seem that what the Federal Government is doing for EMS presently has been any help at all as you have all stated. EMS is so varied in reference to demographics of clients served and geographical locality any organization at a national level would be hard pressed to regulate all of our unique agencies into one static model. Unfortunately, state and local governments aren’t doing much better. Iowa and New Jersey come to mind at the state level and Detroit and DC at the city/ local level are just a few popular examples or division and failing services. Also, as stated above, it is the politicians and their promoters making decisions without advisement on something they know little to nothing about.
I appreciate that NAEMT is trying to gain traction at the Federal level, but what is needed is a full court press. National, State, Local: we need the lobby at every level with a cohesive platform for officials to get on board with so they are not afraid (or too cheap) to give us some money toward our needs. EMS also needs a full court press on the general public, give them knowledge on what we provide BEFORE they need it so they demand it from their leaders and it is a voting issue. Honestly, fire unions like the IAFF have done an awesome job doing this. Perhaps NAEMT or similar groups should look at what has worked for other lobby groups and use that as an example of techniques EMS could employ. This would also help in the area of grant management. From my limited experience, grant proposals are written with a certain type of agency involved due to previous actions from a lobby (ie. Fire Based EMS, SAFER Grants, etc). EMS needs to be proactive and tell those who govern us what we NEED and not vice versa.