What is Best for EMS

I think back to when my cousin served in Congress. Even as the population continued to change, he did one thing that was crucial…he continued to serve and REPRESENT the needs of his community.


What federal government agency represents us?


When we look at our police and fire service brothers, they have a clear identity. When they go to the federal government, they can go to U.S. Fire Administration and the Department of Justice. The Department of Justice has a huge budget, and the capability to hire and fire, as well as give out grants, underwrite programs. They have a national training academy run by the FBI in Virginia. The U.S. Fire Administration has a large budget, and the capability to hire and fire, as well as give out grants, and underwrite programs. They have a training academy in Maryland.

What federal agency represents EMS?

EMS, while it responds to more calls than it’s fire service brethren, has been relegated to the Federal Interagency Committee on EMS or FICEMS for short, an arrangement that has no program budget, no hiring or firing capability, cannot issue grants, and it’s ‘biggest’ stick so to speak is to an issue a report to Congress, that Congress is under no obligation to act-upon. Some people will over that this is just as good.

It isn’t. Someone explain to me how is this just as good as the Department of Justice or the U.S. Fire Administration? Doesn’t EMS deserve better?

For those of you who don’t know, FICEMS has existed in the federal government in one form or another since the 1970’s. Yes ladies and gentlemen, FICEMS has been around since the 1970’s, being re-authorized in the mid-80’s and again in 2005. It didn’t do anything for EMS in the 1970’s and FICEMS hasn’t done anything for us now.

There are at least 10 different federal agencies that compose FICEMS. Ten. TEN SEPARATE directors, with SEPARATE employees, TEN SEPARATE budgets, TEN SEPARATE mission statements, and TEN SEPARATE grant programs.

What does FICEMS do? The 10 different agencies that compose FICEMS is tasked with discussing EMS issues and writing reports and recommendations to Congress.

FICEMS CANNOT make policy. FICEMS CANNOT institute programs. FICEMS has no budget, FICEMS CANNOT hire or fire anyone. FICEMS CANNOT issue any grants. FICEMS does not provide any training or education

NOT one of those members of FICEMS is dedicated to EMS. All of them have different missions and different goals. Have you ever read the mission statement for the Department of Transportation or for the National Highway Transportation Safety Administration where the EMS office lives? It doesn’t mention EMS at all in their mission statements.

In my current state of California and where I was originally from in NJ, EMS has one agency, in California it is the EMS Authority in Sacramento and in NJ it is the Office of EMS in Trenton. No other state in the United States breaks up EMS between 10 different agencies and then tries to manage it by committee.

Isn’t it just possible, that what has been working in the individual states over the last 40+ years, that ONE agency, with ONE purpose and ONE mission is the right way to do this?

Yes EMS overlaps with the fire service, as well as the police. Just as EMS overlaps with the fire and police services, fire overlaps police, and police overlaps fire.


No one would ever say that the police service or the fire service do not deserve their own departments or agencies in the federal government. No one is suggesting that police and fire aren’t multidisciplinary services, they are, and they are UNIQUE and extremely complex, JUST AS UNIQUE AND COMPLEX AS EMS.


The Institute of Medicine is a learned scientific body. In 1966 they saw a need for change in our community. EMS was horrible hodge podge of service delivery models, running from one extreme to another. Private funeral homes, without any training to first aid and rescue squads, providing the best they could with text’s from the American Red Cross.


In 1966 the Institute of Medicine realized that we were in danger, researched the issue and published this report ‘Accidental Death and Disability: The Neglected Disease of Modern Society’.


Consider this:

Do you and your community need EMT’s?

Do you and your community need paramedics?

Do you and your community need an EMS system?

Do you and your community need a trauma system?


All of these components of the EMS system were proposed and written about in the Institute of Medicine in their 1966 report ‘Accidental Death and Disability: The Neglected Disease of Modern Society’. If it wasn’t for this report we would not have EMT’s, paramedics, EMS Systems, and trauma systems, or even the National Registry.


Where is the science or expert opinion to support an assertion that FICEMS was the best option for EMS?


In 2007 the Institute of Medicine published a new report, ‘Emergency Medical Services: At the Crossroads’. One of their most important recommendations - Create a lead federal EMS agency, that the federal government should consolidate all functions related to emergency care that are currently scattered among multiple agencies into a single agency in the Department of Health and Human Services (DHHS).


Let me ask you a question: why, would anyone not support the Institute of Medicine’s recommendation for a single federal agency for EMS?


EMT’s and paramedics are smart. They already knew we needed our own EMS agency! Prior to the IOM report, EMT’s and paramedics in several nationwide polls OVERWHELMINGLY stated that they wanted a single federal agency, with one purpose, to advance the mission of EMS and to represent EMS as effectively as police and fire within the federal government.


What do we need? We need somebody to say that the FICEMS isn’t the best for us, somebody who is supposed to FIGHT and not take the easy way out. That isn’t the EMS way, we do a job no one else can handle. We don’t take the easy way out.


In my personal opinion, FICEMS is doing EMS a disservice.


I am a paramedic. I earned my EMT-A card in 1981 and my paramedic certification in 1985. Am I not an equal to my brothers and sisters in the police and fire services?


In my personal opinion, FICEMS doesn’t work and this is an example why:


Everyone knows the EMT-Basic curriculum. When Medicare came out with the negotiated rule making committee for the Ambulance Fee Schedule, they stated that Medicare wouldn’t re-imburse service providers for an IV, because it was a basic skill.


Everyone knows initiating of an IV, by and large, is the domain of Intermediates and Paramedics. Where was the EMS Office from NHTSA during this process? Better yet, where was FICEMS? As FICEMS stood idly by, show me where did they weigh in on the fee schedule? What was FICEMS recommendations? If FICEMS really worked, this would never have happened.


We need our own federal EMS agency. Please read the IOM report, 'Emergency Medical Services: At the Crossroads' you can access it here for free: http://www.nap.edu/catalog.php?record_id=11629#podcast



My name is Daniel R. Gerard, I am a paramedic, and I want to represent EMT’s and paramedics. I have 28 years in the field and I am proud of my service to the community.


I am running for the NAEMT Region IV Director. If you haven’t voted for me, vote today, I will fight for what is right and for what you want. I will make it my mission to get a federal EMS agency, one that will effectively represent the needs of the EMS community.


I will represent the profession passionately, with pride, and without prejudice. I am not afraid to say what I believe in. I am not afraid to do what is right.


Stay safe my brothers and sisters, I will see you in the street,


Daniel R. Gerard, MS, RN, NREMT-P
http://www.linkedin.com/in/dangerard