President Donald J. Trump has been officially on the job for a year since his Jan. 20, 2017 inauguration. In that time, Trump has shown a clear affinity for public safety personnel, especially police officers. He has spoken to police officers about the MS-13 gang, posed for photos in a Pierce fire engine, invited members of the U.S. Coast Guard to a round of golf and visited paramedics at a Florida fire station.
Trump’s tough talk, like his description of how police officers are too kind to arrestees, often resonates with the audience, but distracts from the underlying messages of increased investigation and prosecution. Maybe we take what he says too seriously, but after all, even if joking, he is the president.
The day after the 2016 election, I tried to balance prediction, speculation and hopefulness in the article “What a President Trump means for EMS.”
At the one-year mark of the Trump administration, it’s worth looking at what he’s accomplished and what remains to be done. Are the public appearances, photo ops and quips backed up by action that will have a lasting and positive impact on EMS?
Opioid epidemic National Public Health Emergency is about to expire
Trump’s underwhelming declaration of the opioid overdose epidemic as a National Public Health Emergency instead of a National Emergency is set to expire on Jan. 23, just three days into his second year in office.
Trump’s remarks when making the public health declaration emphasized the importance of will power and promised a “massive advertising campaign” to encourage citizens, especially kids, to not try drugs. There were host of other policy recommendations and promised tactics from Trump – tougher enforcement, more package inspection, cooperation with Chinese, drug courts and research into non-addictive pain killers – that have yet to amount to obvious success.
Local efforts, without the benefit of federal funding, research or resource coordination, continue to be the only battlefronts in the war against opioid overdose deaths. A paramedic in Missouri is doing great work to stop heroin. Fire stations in Maryland and New Hampshire are referring addicts to care and treatment. Community paramedics in Pennsylvania are following up with patients after they receive naloxone. Police and EMS are coordinating their response in Wisconsin to keep addicts out of the criminal justice system. All of these efforts are outstanding and commendable, but none of them will scale without a serious executive-branch response.
Of course, the opioid epidemic wasn’t going to be solved in 90 days, but there is no indication of meaningful effort from the administration to combat the epidemic or even the assignment of a leader with expertise in addiction treatment and prevention. The president may have donated a portion of his salary to fund the public-service announcement campaign, but Trump needs to demonstrate unwavering resolve to the crisis.
Trump’s legislative accomplishments impacting EMS
On Nov. 17, 2017, Trump signed H.R. 304, the “Protecting Patient Access to Emergency Medications Act of 2017,” into law. The Department of Justice is now authorized to register certain EMS providers to dispense controlled substances.
“This law will make sure emergency medical services agencies can continue to administer approved medications, such as anti-seizure and pain management drugs, to their patients under the authority of the Drug Enforcement Administration (DEA),” said Paul Kivela, MD, FACEP, president of the American College of Emergency Physicians.
The legislation, a longstanding priority for EMS advocacy groups, helpfully codifies existing processes and procedures.
The U.S. Congress made several efforts in Trump’s first year to repeal and replace the Affordable Care Act. After several failed attempts, a partial victory was included in the comprehensive tax bill. The individual mandate for health insurance coverage has been repealed. How will this impact EMS transports and reimbursements? I am not going to guess, but I am 99 percent certain there was no pause or debate to consider the impact the repeal might have on our industry.
Disaster response has been good enough
Significant natural disasters – fires, floods and hurricanes – with the notable exception of Puerto Rico, have been within the capacity and capability of local and state responders. Though the impact of those disasters has displaced thousands and cost billions, Trump wasn’t challenged in the same way Hurricane Katrina flummoxed the Bush administration. Perhaps local and state responders are applying the lessons from previous terrorism incidents and natural disasters to better prepare their personnel, upgrade equipment and improve training.
Use the bully pulpit to improve public safety recruitment and retention
Recruitment and retention are top concerns of many public safety leaders. The combination of a booming stock market, unemployment levels at the lowest they have been in a decade and stagnant wages aren’t doing anything to broaden and improve the applicant pool. If job vacancies outnumber job seekers in your service area, it’s also likely your paramedic, firefighter and police officer training programs have low enrollment.
Given Trump’s vocal support for public safety, including signing a bill into law last week to help police officers with mental health problems, this is a clear opportunity for him to develop policy to match his talk. We can and should expect more from the bully pulpit of the public safety president. For starters, Trump could work with Congress to extend these mental health benefits for police officers to firefighters, paramedics, EMTs, medical first responders and corrections officers.
What’s your read on Trump’s first year in office and his impact on EMS, fire and rescue, and law enforcement?
