The Field EMS Bill: Steps in the right direction?

The health care system has changed and so has our concept of emergency care

Proposed new legislation would set aside more than $300 million for EMS system development over a four-year period, beginning in 2012. In addition to providing grants to EMS agencies to provide training and drive improvement processes in quality, it would also require the federal government to identify alternative delivery models for low-acuity patients, as well as ways that EMS can streamline and help make cost-effective the delivery of emergent health care.

H.R. 6528, The Field EMS Quality, Innovation and Cost-Effectiveness Improvement Act (EQUIP) was introduced to Congress by House Representatives Tim Walz, a Democrat from Minnesota and Sue Myrick, a Republican from North Carolina, in the past week.

I like this bill. The provision to study ways to adapt our systems to the reality of patient care and transportation is an important step. EMS systems continue to operate as if it were the 1970s, when response time was king and that the only destination was a hospital emergency room.

It worked then, but the health care system has changed and so has our concept of emergency care. We are caring for patients that we know will benefit little from a rapid response and an expensive ride for a very expensive emergency department visit. In the process, we place the driving public at risk by trying to meet artificial and meaningless response times.

I like the philosophy that drives this legislation: Data. We need this in order to evolve out of the response time conundrum. We can better serve our communities if we know what works, and what doesn't.

The law enforcement community has done this, through community policing and other outreach efforts. The fire service has all but eliminated major conflagrations through aggressive code enforcement. We can do the same in emergency medical care, beyond trauma management and cardiac care.

There's also the underlying principle that EMS is part of the health care system. It may seem obvious, but we have struggled with an identity crisis since our inception. Are we health care? Public safety? Public health? Are we jack of all trades, yet masters of none? Personally, I'd like to see progress in this area, before I retire. Having clear direction and funding would be large steps in the right direction.

I'm not so sure if the federal lead agency should remain within the National Highway Safety Transportation Administration (NHTSA). There is a proud history that EMS developed as part of a system to reduce death and disability from traffic crashes.

Certainly the large investment made by the federal government and the Robert Wood Johnson Foundation jump-started the modern era of prehospital emergency care. Haven't we moved beyond that? There are certainly attempts outlined in the legislation to help overcome barriers in the federal infrastructure, through partnerships and councils; I'm not sure how successful that would be, compared to being located with agencies charged with homeland security or health care. It's a question of mission; resources and commitment may be more readily available when purpose is closely aligned with outcomes.

Overall, I think that there is real merit to the legislation and I encourage you to review the information. Kurt Krumperman, Clinical Assistant Professor at the University of Maryland Emergency Health Services and current President of Advocates for EMS states that this legislation represents "a major effort to move our nation's EMS delivery system forward in a cohesive and deliberate manner." You can help in a very real way: Advocate for real change by contacting your federal representative when he or she is home for the winter recess. Your efforts can make a real difference.

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