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.