Twenty-five years ago, 911 became the national number for emergencies. Today, it covers 96% of the geographic United States.
Calling 911 and answering the dispatcher’s “What’s your emergency” activates services – but which ones? If you don’t know, do some homework before you head out to vote in your state and local races. Because the answer to that question varies not only among urban, suburban, and rural areas, but from town to town. In part, that’s because Emergency Medical Services (EMS) are still not categorized as an essential service in most of the US.
Before I became a volunteer educator for regional EMS and fire, I assumed access to 911 meant access to every type of emergency service – including fire, police, and EMS. But it turns out that these are all distinct branches of the emergency response system, not every service is available everywhere, and specific capacities vary wildly by region and municipality.
Each branch needs people, expertise, infrastructure and funding to operate, plus an explicit public mandate to command its resources. Yet two thirds of states do not recognize EMS as an essential service, and of those that do (16 states plus DC), not all earmark funding to sustain it.
Essential services are those necessary for the public’s safety and health. EMS clearly fits this definition. Emergency medical technicians (EMTs), paramedics, and doctors collaborate along a continuum from home to hospital, but most states only classify the latter as essential.
Especially as more hospitals close or limit services, the onus falls on first responders to provide safe interventions and transport to definitive care. Designating EMS essential – and coupling that with financial backing – signals society’s commitment these services. It ensures lower priority interests don’t supplant our ability to receive high-quality medical care during life-threatening emergencies.
Without essential service designation, EMS lacks parity with fire and police. When all three are assigned equal professional status, it is easier for each to attract talent and to collaborate to ensure full coverage. In areas where demand for medical response exceeds that of fire, for example, synergistic relationships provide mutual benefit and security.
In my town of 61,000, in a state where EMS is essential, EMS and fire partner across five stations to respond to approximately 18,000 calls annually. One of those calls came from me.
Years ago, my infant daughter developed trouble breathing and required urgent medical care. As a pediatrician trained in neonatal critical care, I worried, given how she looked and sounded, that it wouldn’t be safe to drive to the hospital with her in her car seat.
I called 911. Within minutes, my fear turned to relief as the lights and sirens of an ambulance and firetruck crested the hill leading to our house. The EMTs and paramedics treated her in the ambulance with life-saving medication and transported us to the children’s hospital for continued care.
I was lucky; I never doubted that assistance would arrive. But what if we lived somewhere less accessible or in an ambulance desert – more than 25 minutes from an ambulance station – like 4.5 million Americans? In areas where EMS is nonessential, residents can experience significant delays. With EMS hours away, some never dial 911, knowing their arrival will come too late.
Once states establish EMS essential, they can delineate clearly who takes care of what, and where. States decide whether county or individual municipalities will set standards for care levels and personnel. Localities then determine how best to configure agencies – public and private, for-profit and non-profit – to serve the public.
To be sure, prioritizing and financing EMS can be expensive, and declaring EMS essential could place states in legal jeopardy if they fail to provide services, even if they have no funding. But to do otherwise is to fail to respond appropriately when stakes are highest.
As we head to the ballot box, this should be an issue on which we can all agree. In places where EMS functions well, it merits protection. Where the public lacks access, we must focus on growth and support. Pending federal legislation includes bills regarding EMS. But no essential service federal mandate exists, nor is one proposed. While several states enacted essential service bills in the last three years, few of the remaining states lacking this safeguard for EMS are actively considering it. More should be.
To find out whether EMS is essential where you live (odds are, it’s not), start with the resources provided by the National Conference of State Legislators. To learn about federal legislation affecting EMS, check out the National Association of Emergency Medical Technicians’ federal legislative agenda, and see if your representative is part of the congressional EMS caucus. Discover how you can get involved. Then advocate and vote to ensure the lights and sirens racing to your next emergency bring the medical specialists you need.
