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Too Little, Too Late

The National Association of Emergency Medical Technicians has just released its position paper on a proposed lead Federal agency for EMS.

The money quote:

NAEMT believes that a lead agency or administration within a cabinet-level department should be established to lead EMS efforts at the federal level, including development and implementation of a national EMS framework and coordination of all EMS programs and activities undertaken throughout the federal government. NAEMT believes that, as the core function of EMS is the provision of medical care to patients outside of the hospital, this lead agency should be located within the Department of Health and Human Services.

(bold emphasis mine)

Nice job, NAEMT. I've said the same thing myself.

Five months ago.

I'm glad that NAEMT is out there diligently representing my interests, a full three months after the May 15 deadline that FICEMS imposed for stakeholers to offer their input.

I appreciate the sentiment, really, but that does about as much good as plastering a Ron Paul bumper sticker on your car six months after Obama took the oath of office.

Comments - Add Yours

  • Anonymous

    Um…. Day late and a dollar short???

  • Thomas A. Craighton

    Actually the comment may be in position papaer late but when were out for EMS Day on the Hill we had several discussions about it with legislators.
    I think the more important point for them is that there is no statute that make EMS an Essential Service at the federal level and in Iowa that is our first issue. It is mandated someone will come save your house from fire and thief but we dont have to save your life.

    • Too Old To Work

      That’s not a function of the federal government, or shouldn’t be. For the record the police have no responsibility to respond to your emergency and no obligation to protect individuals from crime. That’s a US Circuit Court of Appeals decision, so that shows you what happens when you ask the federal government to decide what is and isn’t a mandated service.

      The fire department might have to respond to your fire (or might not if you’re in a subscription area), but they don’t have to save your house from burning down. In fact, I don’t even know that cities and towns are required to maintain fire departments since it’s the insurance companies that stand to benefit.

      Given the dismal performance of the federal government in just about everything, I for one would prefer that they leave EMS alone.

      • Joe Paczkowski

        There’s several court cases. Probably one of the most horrifying is Warren v District of Columbia. At least if a medical provider screws up, you can win a malpractice lawsuit. If the police screw up (3 distinct and separate times in this case too), you get raped and beaten for 14 hours.

        • Too Old To Work

          Warren is the lead case, although as you point out, there are others.

  • Dan Limmer

    I think nominations for NAEMT board may have closed…but you should be nominated.

    I agree this statement was much too late. While NAEMT may have advocated for this in a day on the hill, mobilization and informing members by communicating a clear, concise, early vision should have been an earlier step.

    • Anonymous

      I think NAEMT is a good organization, but they move at the blistering pace of a sloth on Quaaludes, and their priorities are skewed.


    Every time that I feel like maybe I should get off the sidelines and join, they go and do something that makes me question the wisdom of giving them hard-earned money.  It’s specific instances like this that make me think I’d be better off giving YOU the money. 

    • Too Old To Work

      You would. I have a friend on the board of the NAEMT and she’s getting pretty disgusted as well. At least AD would spend the money on something worthwhile, like ammo or beer or BBQ.

      • CBEMT

        Exactly.  He’d stimulate the economy with it.  NAEMT will use it to mail me a ballot full of people I’ve never heard of once a year. 

        And, apparently, advocate for important EMS issues long after the most advantageous time to do so. 

  • Nick

    Don’t do it!
    Funding and management wise, the worst thing our statewide service did was move from Department of Emergency Services to Department of Health.
    We’re now a very small funding concern in a big pond, whereas previously we were one of five services to get a big share of funding.
    We’re also now part of the behemoth of government red tape that is DoH, therefore reducing our ability to be the leading innovator in out of hospital emergency care that all ambulance services should be!

  • Dave

    Kelly, I enjoy your writings–I read you daily–and I like a lot of what you say, but I have to disagree on this one.  I could write pages on the subject, but it’d all boil down to one thing: show it to me in Article I, Section 8, or give it up.

    • Anonymous

      So you object purely on libertarian, Constitutional grounds. Okay, I can’t argue with that.
      So what would you suggest to resolve the fragmented nature of EMS, and the haphazard patch work of delivery models, reimbursement, and scope of practice in the U.S.?
      I’m like you, I think the U.S. government could fuck most things up like a soup sandwich. But let’s just imagine that a lead Federal agency for EMS was a given. If it were, where would you house it?

      Ambulance Driver


      • Dave

        That’s just it–I wouldn’t do it as a federal agency.  The AMA isn’t a government agency, the various bar associations aren’t federal agencies, any number of professional organizations exist to standardize and regulate their profession (the Financial Accounting Standards Board is another great example).  I have no objection to resolving the fractured nature of services, I just don’t see Another Government Agency as any sort of solution.

        • Anonymous

          Yeah, but go ask your average doctor if the AMA represents his interests, or its own. I think you’ll find that most of them are very bit as disenchanted with the AMA as we are with NAEMT.

          Ambulance Driver


          • Sigivald

            True – the AMA doesn’t really represent doctors.

            But why would a Federal EMS agency (whether standalone or, worse, as part of HHS) represent the interests of EMS personnel?

            It’d represent its own bureaucratic interests, wouldn’t it? And then, in fact, as part of a giant intra-agency dogfight with every other part of HHS (or whatever the top-level blob is), with the rest of the parts likewise sticking their grubby fingers in.

            Federalization is the kiss of death for efficiency and innovation. But hey, it’ll make for lots of rote-work and time-wasting, I’m sure.

            If interstate fragmentation is a problem, maybe NAEMT should lobby better, and give the States reasons to change.

            Making a federal agency sure seems like it makes EMS problems worse far more than better…

          • Too Old To Work

            You said that much better than I did. Kudos.

          • Too Old To Work

            Any organization large enough to influence policy or take on the role of certification runs the risk of becoming overwhelmed by it’s own bureaucracy. JCAHO comes to mind, although I’m sure there are others. In their way, they are as bad, if not worse, than the federal government.

            It’s the nature of bureaucracy, public or private, for self survival to become more important than whatever it’s original mission was.

  • Rogue Medic

    We should be in the Department of Red-Headed Stepchildren, located on the Island of Misfit Toys.