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When a piece of legislation is introduced in Congress, it can be tempting to offer support for the bill based solely on the title and/or what it appears to accomplish on the surface. This can be a mistake. It is important to know who or what is hidden “behind the curtain” influencing the process (as in “The Wizard of Oz”) and what details lie within a lengthy body of legislation. An early and cautious read is the best way to approach any bill so that an initial position taken on the legislation does not have to be withdrawn later as a clearer understanding of the content and intent unfolds.
There are several examples of legislation that, on the surface, appears to be in the best interest of the fire service, but in reality may not be. One example is H.R. 3144, The Field EMS Quality, Innovation and Cost-Effectiveness Improvement Act, introduced in the 112th Congress. It proposes many changes in the way EMS is managed at the federal level that may not be in the best interest of fire service-based EMS systems.
H.R. 3144 has the strong support of an organization called Advocates for EMS, whose membership and leadership are primarily connected to private, hospital and third-service EMS providers. Advocates for EMS should not be confused with the Fire Service-Based EMS Advocates Coalition because the two organizations are not connected to each other in any way. Although the legislation contains some elements that might be attractive, several major fire service organizations have not been particularly supportive of H.R. 3144 in its current state. You might ask who could be against improvements in the quality of EMS services in the field, innovation in EMS systems or enhancements in the overall cost-effectiveness of EMS. Probably nobody, but is that what the bill really does? That is an important question.
H.R. 3144, if signed into law, would have very specific impacts on EMS:
• Recognizes the Department of Health and Human Services (HHS) as the lead federal agency for EMS and trauma, but who would manage this within HHS and how would policy be developed and funding decisions be made? The bill also establishes additional departments to oversee EMS programs and compliance issues, but who would manage them, what would their backgrounds be and what would the compliance issues be?
• Mandates local adoption of federal guidance documents to be eligible for grants, but what would those documents mandate and what financial and operational impact would they have on fire service-based EMS agencies and providers?
• Mandates standard certification testing, adoption of a National Scope of Practice, instructor and medical director qualifications and other requirements, but who would oversee these mandates and where would the funding come from for mandated compliance at the local level?
This bill, although attractive on the surface, poses more questions than it provides answers at this time. With this in mind, it would probably be difficult for the fire service to offer universal support for the legislation unless these types of questions were answered in a complete and satisfactory way and significant modifications are made to the bill.
The fire service-based EMS model is more common than any other EMS model in the United States. An important goal for the fire service is to further enhance the understanding among policy-makers of the critical role that fire departments play in EMS integration. Fire service-based EMS systems provide this critical service better than any other emergency medical agency while emphasizing responder safety, competent and compassionate workers and cost-effective operations.
Total responsibility for the call
Due to their training, expertise and equipment, fire service-based EMS responders can simultaneously secure a scene, mitigate hazards, decontaminate (if necessary) and triage, extricate, treat and transport patients. Fire service-based EMS systems have responsibility for the call and the patient from initial contact until care is transferred at the medical facility.
For EMS to be effectively administered at the federal level, the fire service must play an important role in the development of policies, programs, procedures, training and distribution of funds. The fire service was not actively involved in the development of H.R. 3144 and that is probably why there seems to be skepticism from the fire service concerning the bill. n