The national fire service organizations’ opposition to a federal EMS administration within the Department of Homeland Security (DHS) is misplaced. The idea, pushed by EMS groups for years, has gained some traction as of late with a thumbs-up position paper from the George Washington University Homeland Security Policy Institute (HSPI). But the fire service is not supporting it.
An EMS administration with DHS is a righteous idea. EMS is the third leg of the domestic preparedness triangle, with a stake in the emergency response matrix equal to police and fire. Underepresenting this critical component in the federal system makes little sense.
Currently, the U.S. Fire Administration’s (USFA) Federal Interagency Committee on Emergency Medical Services serves as a voice for all EMS providers, be they private, volunteer, hospital-supported, or fire-based. But that’s just a small budget item of a very small USFA pie. The EMS world demands a bigger piece of the DHS action-its own voice.
As unique as fire-based EMS is, so are the private, hospital, and volunteer EMS sectors. They face major operational, safety, management, equipment, data collection, standardization, and other challenges, as the fire service does. They represent a significant portion of the EMS universe, treat millions of Americans every day, and face the same risks on an EMS run that firefighters do. They are part of the domestic preparedness army.
But our fire service representatives argue that DHS funding shouldn’t be going to for-profit ambulance companies that are part of the EMS response world. They argue that the United States Fire Administration’s role in EMS will become reduced should a new EMS administration be established. That a new EMS administration will undo work already done by fire groups on the EMS front. That the EMS component of fire department response will become fragmented at the bureaucratic level. That third-party and private EMS providers don’t comprise enough of the service market to warrant a separate administration.
That’s shortsighted.
Whether the fire service likes it or not, private, for-profit services comprise a significant portion of the EMS response market and, until operating such a service becomes unprofitable, they will continue to exist. They exist because the tax base can’t (or taxpayers won’t) support a municipal (fire) EMS entity. Mrs. Smith deserves a high level of emergency medical care, regardless of how the service is sustained. Federal dollars can and are used to sustain profit-making companies that serve the public good, as in the case of the airline industry, the rail travel industry, and many other operations. It’s ironic that the people arguing against the private services in this regard are the same folks who want to represent them through the USFA.
Fire department-based EMS is strong and unique. Estimates suggest that 50 percent or more of 31,000 fire departments make three-quarters of all EMS calls in the United States. A discussion of EMS can’t ignore the role of the fire service, nor can or should the creation of a federal EMS administration be accomplished without the USFA.
In this regard, size matters and (for once) we’re in the position of power to be the major player in a new administration-two for the price of one, so to speak. Apparently, our leadership doesn’t see it. Instead, predictions of doom and gloom abound. It’ll all go to hell if the feds give the third component of the emergency response triangle the place it deserves.
Strip away the layers, and it’s all fueled by fear of losing turf and money. That’s a natural reaction in a political world. It’s how we deal with it that’s going to make the difference. We can take a leadership role in actualizing the concept to our benefit or let others take over and leave us behind. It’s the latter road on which we’ll realize our worst fears.
If the HSPI report has flaws, so what? It’s not law, only a stepping-stone to get our issues on the table. Debate and implementation come later. First, we have to get behind an idea that has the potential for adding a new fire service funding stream, which can only be a good thing, if we let it be-that’s to say, if we leverage our political power as EMS providers to make it work for the fire service.
A federal EMS administration within DHS is as right an idea for America as the USFA. The fire service needs to show how it will work, not why it won’t work, and so take the positive road leaders and winners travel.
Show me the money, not the fear.
