I have closely followed the presidential campaign over the past 18 months. Today as I review the results, read the analysis and scroll through the cries of despair and boasts of triumph on Facebook, I am reminded of the EMS adage, “Don’t treat the monitor, treat the patient.”
Clearly the surveys, polls and data-driven predictions misdiagnosed the outcome for the presidential race. Too many prognosticators saw horses when they heard hoof beats and not zebras. With only a few hours of hindsight — an eye blink in a 500-day campaign — the professional and armchair pundits are explaining the signs and symptoms we missed by focusing on the data and not on the candidate and his supporters.
I didn’t receive responses to the questions I posed to the Clinton and Trump campaigns before the nominating conventions — not that I expected them to send a thoughtful reply or grant me an interview. Although we are on the front lines of the opioid overdose epidemic, chronic disease management and disaster preparedness, EMS compared to the massive ecosystem of health care is a single premature ventricular contraction in a lifetime of heartbeats.
It will be months or years before we for sure know what a President Trump means for EMS, but here are seven areas where his election and the continuing Republican majority in the U.S. House and Senate might impact EMS.
1. Affordable Care Act repeal
Since its enactment, dozens of attempts have been made to repeal the Affordable Care Act. Undoing Obamacare is one of the top campaign promises and is likely to happen in early 2017. EMS agencies should anticipate a significant period of unknown as the number of people with health insurance changes and the coverage provided by health insurance, including emergency transport, is upended.
In addition, the Affordable Care Act drove some of the innovation to develop community paramedicine and mobile integrated health care programs. We are likely in a state of limbo regarding the future of programs to reduce readmissions or provide out-of-hospital monitoring for chronic diseases. How to pay for community paramedic services has not been resolved and that resolution may remain elusive.
2. Regulatory rollback
Reduction of federal regulations has been a top refrain during the campaign. The rollback of regulations with a goal to grow small business and industry may have unintended consequences on health. When Colorado legalized marijuana, traumatic injury secondary to marijuana intoxication increased. Easing of consumer protections which impact automobile design for passenger safety, flame-resistant materials in children’s clothing or electronic components that go into hoverboards and smartphones could have an indirect impact on EMS by increasing injury rates and severity.
There might also be regulatory changes that make it easier for ambulance agencies to transport patients across stateliness, procure equipment or lower operating costs through changes to employer-paid tax rates, employee hiring requirements and employer-provided health insurance. Removing threads in the safety net might also empower citizens to become self-reliant and motivated to better care for themselves and their loved ones.
3. Border security and the labor force
Trump’s promise of a 2,000-mile wall and deportation of the 11 million or more people illegally in the U.S. will have sweeping changes on employment opportunities and demography in every city, town or village. Public safety employers, like EMS agencies, will see increased competition for a shrinking labor force as jobs become available in construction, law enforcement and border patrol. At the same time, expansion of oil, natural gas and coal extraction, like we have seen in North Dakota in the last decade, will have an increasing impact on the demands placed on rural EMS agencies while the volunteer pool continues to shrink.
Through increased border security restricting access to new immigrants, increased local and federal law enforcement action to deport existing illegal immigrants, as well as self-deportation, there is the potential that the population some EMS agencies serve is going to decline. That’s a positive outcome for an EMS agency that has a high population of patients who are here illegally and are either non-payers or inadequate payers for service. But for most agencies, I suspect the majority of patient volume will continue to be the rapidly aging and increasingly sick geriatric patients.
4. Opioid overdose epidemic
Both candidates made vague promises to address the opioid epidemic, a leading cause of accidental death in the U.S. Of special concern is losing people to addiction or death in their prime years for raising children, earning income and contributing to their community’s churches, schools, civic groups and volunteer EMS and fire departments. Trump’s ability to encourage and facilitate federal, state and local solutions that are innovative, adequately funded, empathetic to the causes of addiction and curtail accessibility to opioids will have a significant impact on the overdose call volume for EMS agencies.
5. Terrorism and preparedness
One of the top realizations from 9/11, Hurricane Katrina and mass shootings too numerous to list is that EMS is on the front line for the top threats to citizens from non-state terrorism, lone-wolf terrorists in our midst, natural disasters and emerging infectious diseases. An all-hazards approach to funding and training assures EMS providers with our colleagues in public health, emergency medicine, fire and rescue and law enforcement are adequately prepared for whichever threat might affect us next as no community is immune.
Trump campaigned on his strength and capability to defeat international terrorists. EMS leaders and field providers can be both hopeful for the fulfillment of that promise and vigilant in the protection of their communities.
6. Take care of yourself
Recent presidents have intentionally role modeled the benefits of exercise for overall health and stress reduction. President Clinton was a runner. President Bush found respite in mountain bike riding and gardening. President Obama shot hoops and enjoyed the mental and physical challenge of golf.
Trump’s wellness habits or hobbies are not obvious to me. Trump, like all of us, should regularly pause from the demands of work and seek balance through turning away from social media, getting daily exercise, spending time with friends and family, eating healthy and getting plentiful sleep.
7. Be a caregiver
Finally, while President-elect Trump is preparing to “Make America Great Again,” you can make EMS great for you, your partner and patient’s today and every day from now until inauguration and well into Trump’s first term. Treat one patient at a time, not the non-stop monitor data. Be a caregiver who listens, acknowledges suffering and provides compassionate treatment from activation to transfer of care.
