The Semi-Regular Reminder on EMS Politics

Yep. It’s that time again. “EMS On The Hill Day” is just around the corner.  As we all know from EMS social media and the EMS “Powers That Be,” AKA:the usual conference speakers and the people who now provide consulting services to fix the messes that they created in the first place, merely showing up one day in Washington DC in a uniform that’s a cross between Idi Amin and the Knights of Columbus will magically fix all that is wrong with EMS.


I’ve worked in state government for years.  I’ve been a lawyer for years.  I’ve been involved in many political campaigns and involved in political parties.  I’m telling you — that’s not how any of this works.


We can fix EMS through the political process.  But it’s going to take more than one day per year in Washington DC.  Here’s what it’s going to take.

  1. MONEY.  Money fuels politics.  The reality is that politicians need money to get elected.  Money buys access to the game.  In other words, you can’t watch the game if you don’t have a ticket.
  2. All politics is local.  This famous quote from Tip O’Neill is so true. The Federal government has a limited role in the provision of EMS services, much of which relates to the role that Medicare/Medicaid funding plays. Local governments make the decisions on how to provide (and fund) the EMS system.  State governments typically are the ones who license and regulate EMS personnel and services.  And here we continue to think that the solution to EMS lies in Washington DC. State EMS associations need to step up the advocacy game.  Period.
  3. This is a year round sport.  EMS has to be engaged in the advocacy process year round.  Even in states like mine where the Legislature only meets every two years, there’s plenty going on in the “off season,” which is when interim studies happen and future legislation gets planned.
  4. It’s all about the staff.  Elected officials’ staff members are the subject matter experts and they help the officials develop their positions.  Their schedules are usually much more open than the elected official — get to know them and turn them into your ally.  In turn, they may well call upon you for input — and influence.
  5. The regulatory process matters. Getting legislation passed is great.  But oftentimes, the devil is in the proverbial details.  That’s why it’s imperative to be involved in the rulemaking process and in monitoring how the various regulatory agencies implement and interpret the law.
  6. Funding matters.  When you get funding, things happen.  If you want to fix EMS, fix the laws and regulations that reimburse EMS for being a transportation service rather than a medical service.
  7. Present the image of being professionals.  You want the elected official or their staff to consider you a professional they’d trust, not someone who looks and acts like they just got out of a clown car.


Of course, we all want the quick and easy answer to “fix” EMS.  We’ve been trying the quick and easy answers for years and here’s where we are.  Maybe it’s time we try what the adults have done to get their various professions a seat at the table in terms of funding and professional recognition from government.


  1. We lobbied for years to get changes to our pension system so that it aligned with that of the police and fire service.

    We did all of the things that you describe. We showed up at the State House in uniform to lobby our individual legislators. A couple of years we dropped a couple of grand to put on a buffet in the lobby of said State House. We went to hearings, at least when we had advance knowledge of them, and some testified. We even had a paid lobbyist for a while and one of our members spent time working with him to learn how to lobby.

    We hired an accounting firm to show that it would be revenue neutral to the city.

    None of that worked. To be clear, this was over a period of about 15 years. We came close a couple of times. We even had a bill that was passed and sent to the governor. Who vetoed it as a favor to the Mayor of our city.

    We finally got it passed, but it took a large donation to a candidate for Governor. He was one that I didn’t like and in fact turned out to be a lousy Governor. BUT. He signaled to the legislature that this was an issue that he wanted resolved and that he would sign a bill if it crossed his desk.

    It did and he did. It took money and a fair amount of it to get that done. Not lobbying, not appealing to legislators better nature (they don’t have any), and not appealing to the public. Which doesn’t care about EMS until they need EMS. And only for the minutes in which they need them.