Author(s): John Montes. Published on July 1, 2020.

Fighting for EMS

The pandemic continues to prove that emergency medical services are vital. So why doesn't EMS get the support it needs? 
When I worked at Boston EMS, our department motto was “Where Public Safety Meets Public Health.” COVID-19 has proven that motto true as never before. It’s time for political leaders, the health care system, and communities to embrace that reality and make the changes necessary to keep this indispensable service from collapsing.

Every day, our first responders are asked to do more with less—less personal protective equipment, less funding, fewer EMS staff. During the current pandemic, stressed health care systems have depended on EMS personnel to move and divert patients, while also keeping them out of hospitals by evaluating and treating them at home. And yet, in most cases, EMS providers are not paid for these services—instead, they are only paid for transport to the hospital.

In the UK, Australia, and most other industrialized countries, EMS falls under the national health services, meaning it is paid for services provided under the same system as doctors and nurses. In the US, by contrast, only 11 states legislatively designate EMS as an “essential service,” or one that must be provided to communities. This lack of financial support has real consequences—our EMS system was not optimally prepared for the first wave of pandemic. Immediate action must be taken so that fire and EMS agencies are sufficiently supported for the second wave of outbreak, never mind the long-term support needed to begin creating the first responder system we need for the 21st century.

Throughout the recent crisis, many of the organizations that represent first responders have collaborated to push government to stand up and take notice of these injustices. They have advocated for finally paying fire and EMS for the services they provide beyond hospital transport. They have fought for workers compensation and line-of-duty death benefits for responders who have contracted coronavirus. They have argued for stimulus funding to communities to sustain underfunded fire and EMS systems.

So far, none of these efforts have gained much traction. While politicians and government appointees are happy to thank responders in front of a camera, they have taken little real action to support their needs during the pandemic. To date, according to the International Association of Fire Chiefs, 46 fire and EMS responders have died from coronavirus—surprisingly low considering the circumstances. How many more need to lose their lives or their jobs before leaders take action?

For real change to occur, society needs to adjust how it thinks about EMS. Throughout the pandemic, fire and EMS personnel have been in every hot spot risking their lives to meet the challenges of their communities—yet often these efforts are met with less fanfare and resources than similar efforts in the health care sphere. But emergency responders need to be treated as a part of the health care continuum, not as a separate entity. Every community in the US needs to know that, and demand funding for this critical piece of our health system. At the same time, our health care system needs to acknowledge that EMS is a partner that it can work with to provide the best possible care for patients in and out of the hospital.

For the past four decades, many people responsible for leading, planning, and funding the fire and EMS systems in the US have followed the paths of least resistance. But we can no longer afford this approach. Responders have to step out of the shadows, show the world the incredible value they provide, and make our elected and appointed leaders take the necessary actions to support and sustain them. If nothing is done, our communities will lose.

And who will pay that price?

John Montes is specialist, emergency services public fire protection, at NFPA. Illustration: Michael Hoeweler