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Finding Practical Solutions to Inadequate EMS Budgets

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By Allison G. S. Knox
Edge Contributor

Inadequate emergency medical services (EMS) Inadequate emergency medical services (EMS) budgets is a decades-old issue. It is repeatedly discussed in every new class of emergency medical technicians and paramedics, and it seriously affects the EMS industry.

Traditionally, emergency medical services do not have a very large budget; their budget is often an afterthought in healthcare policy decision-making. Emergency medical technicians (EMTs) and paramedics spend a very short amount of time with a patient over the course of an injury or illness, and they won’t work with that patient a second time unless 911 is called. 

The short amount of time spent with a 911 patient does not justify a particularly large portion of the patient’s medical bill. However, healthcare expenses are more than just patient care; they include the use of medical equipment, the medical supplies, the truck and the trained personnel needed to man the ambulances. As a result, the use of first responders in the patient’s bill is always a particularly large expense.

In many areas around the country, creating an adequate EMS budget can be problematic because the funds are not enough to effectively create enough resources for EMS agencies. Rural communities, for example, are struggling to support EMS agencies; some simply cannot find the right number of trained personnel to manage an ambulance.

The budget issue is further complicated by the need to purchase Personal Protective Equipment (PPE) to protect first responders from COVID-19 and other factors at the local, state and federal level. If we’re going to fix inadequate EMS budgets, however, we need to rethink how we handle EMS as a whole in this country.

The Current Problem with EMS Budgets

One current issue with EMS budgets is the fact that it is expensive for a municipality to staff ambulances 24/7. As I noted previously, some American rural communities are having trouble offering 911 emergency medical services due to problems with staffing, expenses and revenue.

There is a lot of cost/benefit analyses that take place, arguing that because there aren’t many 911 calls in some communities, there doesn’t need to be so many resources dedicated to emergencies. For many non-emergency professionals, this line of thinking seems to be practical. If you don’t have the 911 call volume to support a large budget, then it makes sense to make budget cuts.

But public safety is far more complicated than a simple cost-benefit analysis. In fact, there is an ever-growing body of emergency management literature that promotes community resiliency.  With the community resiliency model, communities develop systems that will help a community bounce back from major disasters more easily. But what makes one community resilient may not apply to the next community, and the systems for each community needs to accurately reflect its needs.

Emergency medical services – the prehospital healthcare provider – are essential. They have a direct impact on a person’s survival from a traumatic experience – such as a car accident or fall) – or a medical event such as a heart attack.

When we start to think about community needs through the lens of community resiliency, emergency medical services stops being a luxury and becomes vital. If we want communities to be more resilient in the face of disasters or emergencies, then we need to rethink our priorities and how to make communities safer and more resilient.

Rethinking Managing the Current Problem

The EMS budget issue is complex and will not have overnight solutions. Political scientists might call inadequate EMS budgets a wicked problem, because trying to find a solution is almost as difficult as explaining why EMS budgets are complicated. We simply can’t do what we’ve done before: redirect funds, increase the budget and increase fundraising opportunities. We need to “think outside the box” and consider the needs of EMS, the structure of the emergency management system and billing practices.

In our online bachelor of science in fire management program, I teach a course on fire regulation, policy and law (FSMT 410). EMS budgets and other related topics are discussed in this type of class.

Allison G. S. Knox teaches in the fire science and emergency management departments at American Military University and American Public University. Focusing on emergency management and emergency medical services policy, she often writes and advocates about these issues. Allison serves as the At-Large Director of the National Association of Emergency Medical Technicians, the Secretary & Chair of the TEMS Committee with the International Public Safety Association and the Chancellor of the Southeast Region on the Board of Trustees with Pi Gamma Mu International Honor Society in Social Sciences. Prior to teaching, she worked for a member of Congress in Washington, D.C. and in a Level One trauma center emergency department. Allison is an emergency medical technician and holds four master’s degrees.

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