Just about every day we are confronted by headlines declaring EMS systems to be in crisis, whether due to workforce shortages, volunteer recruitment and retention problems, or another pressing issue. With that in mind, it’s incumbent upon state legislatures to understand the importance of EMS as a whole and, more specifically, the need to designate it as an essential service by statute, just like law enforcement, public health, education and even snow removal.
Some context: The provision of EMS is understandably thought of in the same category as fire suppression and law enforcement. Yet while “essential services” are generally understood to be those that government is required to provide, definitions of essential services and who is required to provide them vary greatly from state to state.
According to the National Conference of State Legislatures, as of this April only 14 states and the District of Columbia had enacted legislation designating EMS as an essential service. These designations may establish minimum requirements for EMS provision across the state, or provide flexibility to organize and finance EMS at the local level, or even provide resources to support EMS system improvement. In some states, such as California and Colorado, the essential services designation for EMS focuses on the need for having a local, written EMS plan, whereas in others, such as North Carolina, the designations are more operationally focused and require each county to ensure that EMS is provided to all of its citizens.
In examining the current state of EMS, it is clear that it is replete with a myriad of critical issues. Included are overwhelming workforce challenges, a seeming inability to properly engage elected officials, and the acute need to move the funding model away from reliance on reimbursement. What problems would essential service designation solve? The advantages include ensuring a minimum of EMS capability across the state; the flexibility to organize and finance a system adequately; and the capacity to reflect local realities and provide the resources to support improvement over time.
Although EMS started as an emergency transportation provider only — essentially, ambulance service — the discipline has evolved over the decades to encompass a multitude of responsibilities. Its elements now encompass not only health care but also public safety, disaster response mitigation and public health. Today EMS is an unanticipated safety-net provider of pre-hospital health care to all patients regardless of their ability to pay for services.
One of the more interesting lessons learned from the COVID-19 pandemic is that emergency medical services providers have come to function as something of a “Swiss Army knife,” fulfilling multiple roles in an emergency. During the pandemic, EMS providers were fit-testers for personal protection equipment, served as contact tracers for health departments, staffed test sites, provided vaccinations and more.
While it’s imperative to make EMS an essential service in all of the states, this designation is just the first step. It must be backed up with a clear delineation of who is responsible for the provision of EMS, adequate funding for whichever governmental entity (county, municipal, regional, etc.) has that responsibility, and a vision for system improvement.
If the designation doesn’t come with the form, function and funding to maintain a sustainable EMS system, all we will do is assure that this designation is merely a hollow one. That would be a failure.
This story originally appeared in Governing, part of e.Republic, Emergency Management's parent company.
