Sunday, September 13, 2009

WOW 2 in a row!

Another GREAT question from GAEMTPARA:


As previous comments have been removed because the monitors of the forum have felt that they did not conform to the guidelines here, let me advise you that my comments and yours may be edited or removed.

As per NAEMT: “The views expressed here are strictly personal and are not necessarily subscribed to by the association. Messages that harass, abuse or threaten other members; have obscene, unlawful, defamatory, libelous, hateful, or otherwise objectionable content; or have spam, commercial or advertising content or links are liable to be removed by the website administrator. We also reserve the right to edit the comments that do get published”

If you want additional information, or documentation, email me at

GAEMTPARA, thank you for the excellent question.

“What are your priorities with regards to EMS at the National Level?”

To answer your question GAEMTPARA:

First and foremost I would seek to have NAEMT adopt a resolution supporting the creation of a federal agency or administration as proposed by the Institute of Medicine. I would also make it our mission to work with other stakeholders in advocating for and ultimately the creation of a single federal agency. We desperately need a single federal agency to raise our identity within the federal government, and to advocate for issues that are important for EMT’s, paramedics, and EMS systems.

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.

EMS, while it responds to more calls than it’s fire service brethren, has been relegated to FICEMS, 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.

FICEMS has existed in the federal government in one form or another since the 1970’s. I was amazed too when I learned this fact, yes has been around since the 1970’s, being re-authorized in the mid-80’s and again in 2005. It has always been weak and ineffective, and to date still has not accomplished anything.

There are at least 10 different federal agencies that compose FICEMS. Ten. They all have SEPARATE directors, SEPARATE budgets, SEPARATE mission statements, SEPARATE grant programs, and SEPARATE employees. Not one of those 10 agencies of FICEMS is dedicated to EMS. All of them have different missions and different goals.

If you ever read the mission statement for the Department of Transportation or for the National Highway Transportation Safety Administration, neither one of them mentions EMS 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.

The Alameda County EMS Agency, in California has a budget of almost $30 Million and a staff of 28 people. The only office that comes close to being identifiable with EMS national is the National Highway and Transportation Administration, and it has a staff of 7 people and a budget of around $4 Million.

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? FICEMS = 10 different agencies. EMS in your state = ONE agency.

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.

All of the essential components of an EMS system were proposed and written about by the Institute of Medicine. NAEMT supports these ideas. The Institute of Medicine says we need a single federal agency. NAEMT does not, they think we are better off with FICEMS.

If it wasn’t for the Institute of Medicines report ‘Death and Disability on America’s Highways’ we would not have EMT’s, paramedics, EMS Systems, and trauma systems. We wouldn’t have the National Registry. If we didn’t have the National Registry, we wouldn’t have NAEMT!

Please GAEMTPARA remember that EMT’s and paramedics nationwide in several polls, 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.

This why we need a single federal agency, and why I will press for this, and keep the membership updated as to out progress.

GAEMTPARA the other issue I am passionate about is occupational injuries in EMS.

I wrote a report when I was Chairman of the Paramedic Division concerning occupational injuries in EMS. The greatest problem we have as an industry is that we have no quantifiable information on how many EMT’s and paramedics are injured in the line of duty or how they getting injured. My suggestions were that we work with the U.S. Department of Labor to devise a unique coding mechanism to begin to collect this information. My other suggestion, is that we identify programs of excellence that have been successful within a particular jurisdiction or company to reduce injuries.

Why is data important? Without data, we cannot design effective programs to reduce injuries/deaths because we cannot make a meaningful comparison. This would tell us if our efforts are making an impact on the EMT and paramedic in the field.

If you or anyone else talk to the National Institute of Justice, which is the scientific research arm for law enforcement nationwide (which would be nice if EMS had something comparable…) they will tell you that since the mid-1970’s, body armor has reduced line of duty deaths by over 600%.

If you talk to the NFPA, they can make specific reference to reductions in line of duty injuries and deaths due to addition of bunker gear for firefighters.

NAEMT spent money and developed a ‘Buckel-up’ poster campaign. We don’t know if anyone was positively affected by the poster because we have no data to do a comparison. We don’t know if poster program did any good. Are we using methods to distribute information to the public that isn’t reaching the intended audience?

EMT’s and paramedics Tweet, watch YouTube, have Facebook and MySpace pages. They text message one another. They email and surf the net at least once a day. The best PSA of the year was done by an EMS agency in Scotland, which was then posted on YouTube and has gone viral around the world ( )

The poster was not our best effort to reduce occupational injuries. How many people here have seen the NAEMT poster for the ‘Buckle-up’ campaign? The members need better.

NAEMT is developing an EMS Safety Officer Course. We will be in the same situation as we were with the poster, we will develop a program, market it to EMTs and paramedics, but because there is no data on how EMT’s and paramedics are injured/killed in the line, we will never be able to tell you if the program is effective.

The first question I think of when I think of regarding an EMS Safety Officer Course is: how much money are we going to charge for this program?

Most of our members pay to take NAEMT courses like PHTLS, AMLS, and EPC out of their own pocket because they want quality education. The economy is in a downturn, there is less money in the pockets of EMT’s and paramedics, and while I understand that NAEMT needs to generate revenue, going to the pockets of EMT’s and paramedics by developing another course is not the way to do it.

What we need is an EMS Safety PROGRAM. A comprehensive program that will incorporate safety into it all aspects of the organizational culture, where all managers and staff members are empowered with and tasked with being a part of the Safety Team. That was part of my original proposal to the Association. Give organizations the tools for a comprehensive approach for safety, and how to measure success, how to incorporate safety into all phases of the organization, from orientation, to continual training, to response, on-scene, during a large scale incident, etc. Again this was part of my original set of recommendations for the Association.

If this sounds like I have done this before, I have, with the Royal and Prudential Insurance Companies back in NJ.

If you want a copy of the Paramedic Division Occupational Injury report, email me at

If you get a chance to read my report and recommendations, we already could have begun to identify programs of excellence for reducing death and disability, and we could then begin to develop a national PROGRAM from these programs of excellence. We could then use this program we develop to assist organizations in reducing death and disability, something any agency could use.

A course for one person? Why not a program for an entire organization?

I have been to funerals for EMS personnel. We owe it to EMT’s, paramedics, and their families to get this one right. This is where we have the chance to give back to the EMS profession. Develop an entire program that we can give to the EMS community, so that they in turn can reduce death and disability to our profession.

In summary the three priorities I have regarding EMS on a national level:

Creation of a national EMS administration

Working with the U.S. Dept. of Labor to develop a unique coding mechanism for EMS Occupational Injuries

Develop a program to identify and recognize programs of excellence. From these programs, develop the tools and guides for organizations to incorporate so that they too may be able to reduce occupational injuries and deaths.

Thank you GAEMTPARA for your excellent question, stay safe and I will see you in the streets.

Daniel R. Gerard, MS, RN, NREMT-P

No comments: