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National associations join forces to tell the story of the front line

The presidents of the AAA, IAFC and NAEMT closed ranks to advocate for EMS needs, and to take them to the national spotlight


Paramedics wheel a patient wearing a breathing apparatus into the emergency room at Wyckoff Heights Medical Center, Monday, April 6, 2020, in New York.

AP Photo/John Minchillo

Imagine this event happening, even a month ago: the presidents of three major national associations covering the majority of Fire and EMS, medics and firefighters sitting around the virtual table in wholesale agreement. Now, as one, they are advocating collectively for the welfare, funding, equipping and the lot of those that respond in the prehospital setting on our streets to those in need. If I hadn’t have heard it myself, perhaps I may not have believed it.

One of the COVID-19 “war roles” of the American Ambulance Association (AAA), Rapid Response Task Force is to assist with keeping the work of EMS and ambulance services across the nation in the public eye. Key to delivering that mission is to make sure that the focus of the story of service and devotion to the population at risk is always pushed out to the front lines, so journalists and reporters can see the selfless job staff are doing in the thick of it. During the pandemic, the Task Force has fielded requests from many local and national publications and stations, and farmed them out as much as possible. This one time, the media request was pushed up the stairs – all the way to the top.

Last week, the AAA were approached, via EMS1, by U.S. News, a national publication represented by journalist Gaby Galvin, asking about COVID-19 as it affects the front lines, rates of infection and quarantine, and generally life on the street. This opportunity provided the chance to bring together three national organizations who are all working hard to represent their members, lobby Congress and highlight the challenges at the tip of the spear.

COVID-19: One message

For possibly the first time, Aarron Reinert, President, American Ambulance Association (AAA); Gary Ludwig, President, International Association of Fire Chiefs (IAFC); and Matt Zavadsky, President, National Association of Emergency Medical Technicians (NAEMT) all joined the call to speak, as one, about the issues and frustrations facing one and all on the front lines at this stage of the COVID-19 pandemic. The article, released online Monday, has been received well and tells a strong story of the challenges and issues we are all facing.

To emphasize the power of collaboration, Zavadsky told Gaby Galvin that, “It is not often that we all agree on essentially the same issues. This is one of those moments. It doesn’t matter whether you are working for a private for-profit, a private nonprofit, a hospital-based, a fire department based – regardless of what uniform you wear, regardless of what it says on the side of your vehicle, whether you are doing first response services, ambulance services – we are all in this together, we are an extension of the healthcare system but we are not being treated by our governmental leaders as essential partners in this war.”

The leaders came together to appeal for help and assistance, not only with the provision of such shortfall items as PPE, but also to ask that the work on the front line be recognized and appropriately recompensed. Reinert emphasized that “police, fire, ambulance – all parts of the community are not often talked about as the front line. So as you hear things in the media, as you hear members of Congress, members of the administration speaking, they speak about the front line being hospitals, which are playing a critical role, but so are the men and women of emergency medical services.”

Chief Ludwig reinforced the importance of this recognition; “we are the warriors on the tip of the spear of this battle, and we are the ones that are treating, caring, transporting and being exposed to these patients, not in sterile environments that you may find in a hospital, but in the streets of America.”

As a further case in point, Google’s April 8 morning header, put up to pay homage to first responders missed EMS in its representation. A small issue, but it riled many front-line providers nevertheless.

The assembled presidents also focused on upcoming legislation that will hopefully fund all areas of EMS and first response delivery, as Reinert noted, “I think all of us share a worry that Congress and the public would understandably believe after three pieces of legislation, the last being some 2.2 trillion dollars, that the need of the people who are serving them was taken care of. We want to, with honor and grace, try to share the message that, while we are appreciative of the work that’s been done and appreciative of the work that’s been done for our colleagues, especially within the hospitals, the reality is, if ambulance services and emergency medical responders – and that is police, fire or EMS – don’t receive the resources and the tools that they need and receive them quickly, we either won’t have workers or we won’t have the ability to respond, and then it simply leaves all the citizens to fend for themselves to just go to the hospital.”

Legislative requests

Going forward, AAA, IAFC and NAEMT are continuing to keep the pressure on Congress, the attorney general and President Trump to ensure that we remain equipped, resourced and refunded to continue to play a key part in the COVID-19 response. Here are their key legislative requests as they lobby for the EMS industry in the next round of the Stimulus package.

Joint action

On Apr. 9, 2020, AAA and NAEMT sent a joint letter to Attorney General William Barr regarding the Public Safety Officers’ Benefit (PSOB) program. The associations identify that where communities have their emergency medical care and transport services provided by private for-profit EMS, (which occurs in one-third of communities in the U.S.) they are not covered under PSOB. The task at hand and inherent risks in COVID-19 response do not distinguish between publicly or privately employed EMTs and paramedics. Both are dealing with emergency response to the pandemic and therefore the organizations request AG Barr extend the PSOB benefit to all involved.


In its recent letter to HHS Secretary Alex Azar, NAEMT asked for guidance on how EMS can access the funds provided by Congress through the $100 billion Public Health and Social Services Emergency Fund included in the CARES Act. NAEMT also stressed its concern that EMS agencies and their personnel who are risking their lives daily to care for COVID-19 patients will not receive any relief from this new fund.

NAEMT is asking HHS to take urgent action to ensure that EMS agencies and their personnel receive relief through this fund, as Congress intended, by:

  • Designating $5 billion from the fund to provide relief and support to EMS agencies and personnel
  • Providing clear guidance to states to allocate designated funds to EMS to cover pandemic response expenses
  • Fast-tracking the application process for EMS agencies to receive relief through this fund as soon as possible

NAEMT concluded with the sobering but realistic offering that “funds are desperately needed as EMS agencies are quickly becoming overwhelmed by the financial costs associated with COVID-19 response and preparedness. In many communities, EMS is at the breaking point.”


The American Ambulance Association in its Apr. 6, 2020 letter to Secretary Azar expressed thanks for “the waivers that had already passed allowing reimbursement to be granted while transporting patients to destinations other than hospitals and skilled nursing facilities.” It is important to remember that EMS only makes payroll from the income generated from the transportation of patients to a hospital. Some may say that this only applies to private, for-profit services, but all sectors, even volunteer rescue squads and municipally funded fire departments now bill for service to top their coffers up.

In line with the theme of NAEMT, the AAA is also focusing on the request for ground ambulances to “be reimbursed for the treatments that they provide at the location where they encounter the patient, even if there is no transport.” Under current rules, this is not the case and for all the good services are doing on the scene, keeping a patient at home and not transporting to a medical facility is a free good and loss leader for which there is no reimbursement to fund wages.

This treatment in place (TIP) funding request is the same reimbursement being offered to those undertaking the ET3 pilot program. Even though ET3 has been delayed, the arrival of COVID-19 has essentially proven the ET3 concepts of telemedicine and treatment in place versus transport, so why not pay out?

The AAA points out that, “Similar to hospitals, ground ambulance services are carrying an enormous burden and responsibility as part of this pandemic.” Where NAEMT asked for a total sum of $5 billion, the AAA devised and suggested a calculator of “$48,000 per registered vehicle as the appropriate amount, based on the increased expenses related to the coronavirus, lost revenues due to the cancellation of elective procedures and similar medically necessary non-emergency transports, and increased labor costs to expand workforces to help address the surge in COVID-19 patients and to eliminate gaps in the workforce when employees are quarantined.”

AAA further justified its request by defining clearly the critical role of ground ambulance services. “Whether responding to 911 or equivalent emergency calls, caring for patients in their homes when hospitals or other facilities cannot accept them, or transporting patients who require isolation to or from essential healthcare appointments, such as dialysis treatments, the paramedics and EMTs who are following medical protocols designed by medical directors and approved by the local or state governments are experiencing the same shortage of supplies, medicines, personal protective equipment and personnel that hospitals are facing.”


In an IAFC press release issued on Mar. 31, 2020, Chief Ludwig noted that “proper funding is absolutely required and needed to win this war and keep our communities safe.”

“I call on Congress and the President to fully fund the needs of fire and EMS personnel in the next stimulus bill and ensure that funding provides immediate and direct funding to fire departments,” he expressed.

In the discussion with “U.S. News,” Chief Ludwig told reporter Gaby Galvin, “I’m calling for the establishment of a fire and EMS fund, a general fund, that fund will be dedicated to fire or EMS departments that treat, care and transport patients that are dispatched by the 911 system or those agencies that are involved in the interfacility transport of these patients from one facility to another, and that funding would be targeted for reimbursement and of our past expenses including overtime, equipment, future purchases of PPE including N95s and in future expenses such as daycare expenses for our personnel, testing, any new medical expenses they might have as a result of this.”

At this time, the IAFC is finalizing its next letter to President Trump on COVID-19 funding, equipment and issues allied to the delivery of service within the pandemic.

As is often said, “a week is a long time in politics,” and in this long week, we have closed ranks, promoted our cause, put a paramedic on the front cover of “TIME” magazine and lined up our case for support in future stimulus rounds. But, as this is turning into a marathon and not the hoped-for sprint, there is still a lot to do, all the way from the front line on the streets to the legislators on the Hill. It is very clear that these associations have our backs and are in it for the full 26.21 miles.

Additional resources

Learn more about first responder COVID-19 advocacy efforts with these resources:

Rob Lawrence has been a leader in civilian and military EMS for over a quarter of a century. He is currently the director of strategic implementation for PRO EMS and its educational arm, Prodigy EMS, in Cambridge, Massachusetts, and part-time executive director of the California Ambulance Association.

He previously served as the chief operating officer of the Richmond Ambulance Authority (Virginia), which won both state and national EMS Agency of the Year awards during his 10-year tenure. Additionally, he served as COO for Paramedics Plus in Alameda County, California.

Prior to emigrating to the U.S. in 2008, Rob served as the COO for the East of England Ambulance Service in Suffolk County, England, and as the executive director of operations and service development for the East Anglian Ambulance NHS Trust. Rob is a former Army officer and graduate of the UK’s Royal Military Academy Sandhurst and served worldwide in a 20-year military career encompassing many prehospital and evacuation leadership roles.

Rob is a board member of the Academy of International Mobile Healthcare Integration (AIMHI) as well as chair of the American Ambulance Association’s State Association Forum. He writes and podcasts for EMS1 and is a member of the EMS1 Editorial Advisory Board. Connect with him on Twitter.