If Advocates for EMS and other major EMS organizations get their way, your tax return may look a bit different in the years to come. Right alongside the box asking you to donate $3 to the presidential election campaign fund will be a second box asking you to donate $1 to fund the nation’s emergency medical services.
The concept is part of H.R. 6528, the Field EMS Quality, Innovation and Cost-Effectiveness Improvement Act, bipartisan legislation that was introduced by Rep. Tim Walz (D-Minn.) and Rep. Sue Myrick (R-N.C.) in December 2010. “We need a better, more efficient way to make sure the heroes in our community have the resources they need to save lives,” Walz said in a statement. “This will mean better care, lower health care costs and the increased efficiency will mean saved taxpayer dollars.”
Said Myrick: “Emergency medical services are a vital part of the health and well-being of any community. With the grants created in this bill, we can ensure that emergency medical providers in the field have the training, resources and communication necessary to provide the best care possible.”
The bill has wide support among the EMS community, including the National EMS Management Association (NEMSMA), the National Association of Emergency Medical Technicians (NAEMT), the National Association of State EMS Officials, the National Association of EMS Physicians, the National Association of EMS Educators and the Association of Critical Care Transport.
“Because EMS agencies provide health care services in both the public health and public safety sectors, EMS is often a legislative after-thought in [these] environments,” says Gary Wingrove, past president of NEMSMA. “H.R. 6528 is the first comprehensive bill to be introduced in a very long time that touches all the components of an effective EMS system.”
Among the bill’s major provisions:
Establishing the National Highway Traffic Safety Administration (NHTSA) as the primary federal field EMS agency. NHTSA has functioned in this role for decades but without federal funding and authority to drive improvements in field EMS quality, innovation and preparedness, says Connie Meyer, NAEMT president. (For more on Meyer and NAEMT, see our BP Interview on pg. 6.)
NHTSA would be charged with developing a national field strategy to strengthen EMS at the federal, state and local levels without taking jurisdictional power away from other federal agencies, including the Department of Health and Human Services and the Department of Homeland Security, that oversee aspects of EMS.
Establishment of three grant programs, including the following:
Total funding for the grants would be up to $321 million each year for five years. That’s about $1 for each U.S. resident, per 2013 population estimates. “We thought $1 per person to make sure that EMS is there when you need it isn’t too much to ask,” Meyer says.
Establishing national guidelines for medical oversight and direction by physicians of field EMS and improving data collection, with the goal of integrating EMS medical reports into electronic medical records.
To pay for it all, the bill would establish an EMS trust fund that would be funded by voluntary contributions; this would be done by checking the box on federal income tax forms.
Sound ambitious? It is, and having the bill introduced in the House is only the first in what will likely be a lengthy process, predicts Lisa Tofil, an attorney and lobbyist with Holland & Knight in Washington, D.C., who represents Advocates for EMS.
“It could take years, but we are hopeful of getting it sooner rather than later,” she says.
A long and winding road
The need for such a law at the federal level dates back to the 1970s, when federal money flowed out to the states to develop EMS systems but then dried up in the 1980s, according to Tofil. “From that point forward, you saw states and localities doing their best to provide EMS without federal funding or support,” she says. “As a result, EMS systems look very unique to their state and their locality, in many ways as it should be. You want those systems to be reflective of that locality. But as a result of the lack of federal funding, there have been many challenges for EMS practitioners and agencies.”
Many of the challenges were laid out in 2006’s Institute of Medicine (IOM) report, “Emergency Medical Services at the Crossroads,” which describes an overburdened, underfunded and highly fragmented system. Yet members of the public—and Congress—rarely know much about those challenges. The legislation would help reverse that. “We wanted to call attention to the totality of needs in field EMS,” Tofil says. “There is a big whopping need out there for an infusion of federal support and focus on EMS to ensure the public’s expectation that when you call 911, someone who is properly overseen by physicians and is part of a coordinated system is going to show up and have the right medical equipment.”
Advocates for EMS began working on drafting a bill about a year ago and finding congressional sponsors, Tofil says. They held summits with EMS leaders to get their input and by last summer had a draft that they worked on for another six months with representatives Walz and Myrick.
The legislation was introduced last year, but it will need to be reintroduced this year during the 112th Congress.
When drafting the bill, terminology mattered. The bill refers to “field EMS,” rather than “prehospital,” which implies that every EMS patient must be taken to the hospital, or “out-of-hospital,” which is vague, Tofil says.
“We wanted an easy term, that once people got used to it, they could latch onto it,” Tofil says. “When you talk to people in EMS, they talk about being ‘in the field.’ We felt it was an easier, less technical term than ‘prehospital’ or ‘out-of-hospital’ care.”
Tofil adds that the need for a clear, descriptive term is especially important because, like the public, many members of Congress and their staff that she speaks to aren’t sure of what EMS is and often think she’s talking about emergency department care.
NHTSA’s role questioned
Despite wide support from the EMS community, at least one aspect of the bill is generating much debate—the decision to establish NHTSA as the primary federal home. After much discussion, it was decided that it made sense to continue NHTSA’s long-time involvement in EMS.
The IOM report, for example, recommended the Department of Health and Human Services as the lead agency. A recent white paper by the International Association of EMS Chiefs and the National EMS Labor Alliance argues for the Department of Homeland Security to become the lead agency. (The Homeland Security Act of 2002 tasked DHS with preparing emergency response of all types to terrorist attacks, major attacks and other emergencies.)
But Tofil argues that NHTSA is the place to be. “NHTSA has a 40-year history of providing guidance and leadership in field EMS, but they certainly haven’t been given the resources other federal agencies have with regard to enabling the improvement and system development that needs to occur. The legislation would give them more tools in their toolbox so they can more effectively help EMS medical directors, state directors, practitioners, agencies and educational institutions.”
Getting legislation passed can take years, and there are several options for moving it through Congress, Tofil says. For instance, the bill could move through Congress as a stand-alone bill or be attached to other “fast-moving” legislation, either in parts or as a whole. “We are looking at various legislative vehicles that might provide an opportunity to attach it to,” Tofil says. More work needs to be done in gaining congressional buy-in to the idea that there needs to be federal funding of EMS, she adds.
Items in H.R. 6528’s favor: It’s bipartisan, a necessity with a Republican-controlled House and a Democrat-controlled Senate; and it’s self-funded through the income tax form donation. In an era of budget deficit worries and a Republican House that has pledged to slash $100 billion from the federal budget, additional federal spending for EMS wouldn’t fly among conservatives.
“There is a lot of consensus that there needs to be a much stronger federal role and a lead federal agency for EMS. It’s when you start getting into where should it be and what should that role be that there is disagreement,” Tofil says. “The only thing that is unacceptable to Advocates is the status quo. This bill is the beginning of the conversation, and we think it’s great that we are finally having it at the federal level.”
Jenifer Goodwin is Best Practices’ associate editor.
