What legislation will actually make EMS providers safer?
State legislators have passed or are considering several pieces of legislation intended to improve EMS working conditions and safety for providers
State legislators in Alabama, California, Kansas, Kentucky, Mississippi, Minnesota, New York and Wisconsin are considering or have recently passed legislation intended to make EMS professionals healthier and less at risk of injury. The proposed protections include mandatory meal breaks, allowances for concealed carry permit holders to bring their firearm to work, making PTSD eligible for a workers' compensation claim and labeling an assault on an EMS provider a hate crime.
These legislative efforts are especially noteworthy for two reasons. First, legislation in California and Minnesota has been proposed by elected officials who have field experience as an EMT and paramedic, respectively. Lawyers, farmers, bankers, doctors, accountants and business owners have long benefited from their interests being represented by current or former members of their profession who are elected to local, state or national government offices.
Second, the challenges of prehospital care and the needs of the EMS workforce are finally receiving much-needed attention. The interest in EMS workforce issues is likely attributable to state and federal lobbying by EMS membership organizations, intentional local and regional public affairs efforts and grassroots advocacy by individual EMS providers. There might be the additional impact of governing officials' awareness of EMS and increasingly realizing that a significant percentage of fire department responses, capital expenses and revenue are from EMS responses to 911 calls and interfacility transfers.
Other numbers likely to catch the attention of elected officials, especially at the local level, are the costs for continuing education, liability insurance premiums and workers' compensation for claims resulting from patient lifting and moving or injuries from being assaulted by a patient. Regardless of the reason, the legislative interest is heartening.
Will hate crime laws make EMS providers safer?
Kentucky joins Louisiana by broadening existing hate crime legislation to professional groups. The effort, which is often referred to as "Blue Lives Matter" legislation, makes EMTs, police officers and firefighters a "protected class" and an assault on a first responder will apply the same law that is applied to crimes motivated by race, religion, sexual orientation or national origin.
Mississippi legislators are working on a "Back the Badge" bill to triple penalties for crimes against police, firefighters and emergency responders. Alabama legislators are proposing a bill to add EMTs and firefighters to existing law that makes murder of a police officer a capital offense — death penalty eligible. A proposed bill in New York makes obstructing a firefighter providing emergency medical care a misdemeanor.
I am skeptical of the potential impact of hate crime legislation preventing any determined attacker, regardless of their motive. Dilution of hate crime legislation, in my opinion, by including other licensed professional groups — hairdressers, over-the-road truck drivers or registered nurses — is a relatively easy way to appease a constituency without actually improving the safety of the workplace.
Will mandated meal breaks make EMS providers safer?
The negative effects of shift work and fatigue on health and workplace safety are well-known. A patient was recently killed when an ambulance left the road. Long shifts, without adequate opportunities for rest and food, puts EMS providers and patients at risk for injury and death. The driver told investigators she fell asleep while driving just before 6 p.m.
The California EMS Workers Bill of Rights, proposed by assemblyperson Freddie Rodriquez, who is also an EMT, gives employees of private EMS agencies the rights to rest and meal breaks, protections against on-duty assault and access to mental health care. It's unfortunate that EMS employers need to be legislated to give EMTs and paramedics a chance to eat, use the restroom or be able to refuse a late call or long-distance transfer after 24 hours without sleep.
Instead of a new law, David Givot proposes that the existing California Firefighter Bill of Rights needs to be expanded to include any EMS provider, regardless of their employment affiliation. Givot's proposal has the added benefit of giving all EMS providers the same protections firefighters currently receive when facing investigation or discipline by their employer, local EMS authority and the state EMS authority.
Will guns make EMS providers safer?
Most of the assaults on EMS providers I am familiar with have been sudden, unexpected and when the EMS provider is only inches away from the assailant. The exception to the punching, kicking and spitting assaults might be the Louisiana EMT student who was shot while attempting to aid a murder victim or this report of a Kentucky EMT who shot a pit bull that had attacked a teenager.
A Texas legislator wants to allow EMS providers and firefighters who already have a concealed carry permit to carry a firearm while on duty. Last year, Kansas made it legal for public employees to exercise their concealed carry right at work.
Again, like the addition of first responders as a protected class for hate crimes, I can intuitively imagine a potential deterrence impact of concealed carry. And sure, there might be a potential benefit for an EMS provider to end an assault if they are able to draw their firearm. EMS1 columnists, contributors and readers have regularly discussed, blogged, voted and commented on what EMS providers should consider before carrying a concealed weapon on duty.
Will making PTSD eligible for workers' compensation make EMS providers safer?
I regularly hear anecdotes that EMS providers are reluctant to disclose mental illness to co-workers, supervisors or their employers because they fear losing their job. EMS employers need to take seriously this perception, that EMS providers are not forthcoming about the impact of traumatic stress, and work to match perception to a better reality. If a mismatch exists in an organization's culture it is also likely personnel will be reluctant to report near misses and patient harm incidents, like medication administration errors.
Assemblyperson Rodriquez wants all California EMS providers to have access to mental health care. Dan Schoen, a Minnesota state senator, who was a paramedic for five years before a career in law enforcement, is a co-sponsor of legislation to modify occupational disease provisions eligible for workers' compensation to include post-traumatic stress disorder. The provision applies to police officers, firefighters, paramedics, EMTs and public safety dispatchers.
Preventive care for every disease condition is less expensive and more practical. When employers begin to bear the true costs of PTSD through paying for the diagnosis and treatment of personnel, I suspect employers will begin to take prevention and education about traumatic stress more seriously. Those actions might make EMS providers safer.
Will better reimbursement for EMS care make providers safer?
With the exception of fatigue and shift length, all of the legislation passed or proposed to make EMS providers safer is based more on anecdotes and intuition than evidence. I want to propose another intuitive argument for making EMS providers safer — increase reimbursement for emergency transports, non-emergency transports that meet medical necessity criteria and non-transport patient encounters to match the cost of providing the service.
Until EMS funding matches the actual costs to deliver care, sensible safety improvements like better designed ambulances, body armor for every EMS provider or training to assess and manage patients with behavioral emergencies are unlikely to happen across the United States. In addition, increasing reimbursement will have the added benefit of paying EMS providers a living wage which creates two positive feedback cycles — better retention of high-performing personnel and EMS providers being better able to advocate for their profession.
What do you think? What legislation is most important for making EMS providers safer?