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Donkeys, elephants and lame ducks: Developing our political EMS response plan

Leading the charge to combat COVID-19, promote telehealth and advance the EMS agenda, while prioritizing patients and staff


The presidency, House and Senate seats have been won and lost and as new officials find their way around the corridors of power, we too must work out who is new, who is a friend, and who is a frenemy as our legislative agenda continues.

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This article originally appeared in the Nov. 5, 2020 Paramedic Chief Leadership Briefing, EMS political agenda | 2020 AHA guide | Ketamine for critical care. To get leadership content delivered straight to your inbox, sign up here.

Writing this article was a bit like cramming, last minute, for an exam, or dare I say being at a national conference, preparing the presentation hours before you go on. I am penning this article at the last possible moment in case something happens, which it hasn’t! I have been glued to the TV, for what seems like days, waiting for the seat count to turn to 270 and the winner in the presidential race to be identified. As we all know, this election has become a long drawn out process that may not even end soon as recounts and litigation will follow an announcement.

Right now, it feels like we the citizens are the lame ducks, not knowing whether to cheer or cry, it is that close. My original plan for this article was to highlight the policy and plans of the 2021 administration – not so much now. But we can continue to crystal ball gaze though, as it appears the Senate will remain Republican and the House, with a slightly reduced majority, will still be ruled by the Democrats. This could indicate that, win lose or draw, business will carry on as usual. Proposal and motions created and debated in the house, could as before, travel across and die on the floor – and that represents no net change to the current legislative session.

As for the top job, if President Trump is destined for one term only, his lame-duck period will begin as early as next week, and allowing a break for Thanksgiving and Christmas, will give him six or so working weeks at the helm. Simultaneously, word is that the Democratic transition team is formed up, appointments made, and ready to sweep in to prepare to hit the ground running by the first of the year. If the President prevails, then there is theoretical business as usual, although civil unrest is widely forecast. Right now, chiefs have one eye on the results and one ear on the ops radio to hear if crowd control and medical standbys are required.

By January however, change, either on a small or inaugural scale will occur. House and Senate seats have been won and lost and as new officials find their way around the corridors of power, we too must work out who is new, who is a friend, and who is a frenemy as our legislative agenda continues. This activity will not only be occurring at the federal level but in state assemblies, municipal councils and amongst local supervisory boards. Faces will change and new relationships will have to be forged. As I have often said, if you have the word chief or director in your title, you are involved in politics, as you must always influence the ayes and avoid the nays. Everyone has work to do.

The EMS agenda

Our legislative agenda will not change too much either. High on our to-do list for any administration is COVID-19 relief, DEA issues, prescription drug pricing, LODDs, telehealth, and much more. Domestically, the realities of up to billion-dollar budget cuts will also have to be planned for. Next week, we will also see the commencement of oral arguments in California vs. Texas – the challenge to the constitutionality of the Affordable Care Act and its individual mandate with the requirement to maintain a minimum level of health insurance coverage. Any of the above could change the way we do business and generate income in EMS, and we have to both monitor and act.

Amongst the Washington turmoil, we still have an emergency to deal with. Von Moltke warns us that “no plan survives contact with the enemy.” In this case, that enemy is COVID-19 and we must fight on and force it into retreat. Operation Warp Speed and the conclusion of vaccine trials will lead to the beginning of COVID-19 vaccination on a grand scale. As with everything else pandemic, we will most probably lead that charge, lending our organizational agility, as we have already been doing, to the distribution and administration of the bolus. In EMS, there is never nothing to do!

Finally, we have seen in the run-up to the election, a country of bipolar opinion, palpable tension and short tempers. Our staff is tired from 8 months on the pandemic front lines, nerves are frayed and fuses are probably short. Today might just be a good day to create and pass a positive message of support that no matter the politics, their priority is the patient, and your priority is your staff as you serve to lead them.

Read next: 5 things a lame-duck Trump presidency can do for EMS

Developing our political EMS response plan: EMS One-Stop With Rob Lawrence

Listen below for this election result edition of EMS One-Stop, Rob is joined by American Ambulance Association Senior Vice President of Government Affairs, Tristan North. Rob and Tristan discuss the election results, the lame-duck period, the Democratic transition team, as well as the composition of both House and Senate for the 2021 legislative session.

Tristan is a registered lobbyist with more than 20 years of expertise and experience in government affairs. He has been a lobbyist for the American Ambulance Association (AAA) since 1996. In his role, Tristan oversees all aspects of the legislative and regulatory priorities of the AAA before the Congress and Federal agencies. He is the lead lobbyist for the AAA and is responsible for shaping and implementing the public policy of the organization.

Tristan began his career in politics with the U.S. House of Representatives Committee on Financial Services where he worked as a professional staff member and investigator. While on the Committee, he was responsible for issues involving anti-counterfeiting efforts, the redesign of the currency and the review of the U.S. banking system.

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.