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The Problems with Making EMS a Mandated Essential Service

By Allison G. S. Knox
Edge Contributor

There have been a lot of arguments recently that emergency medical services (EMS) should be a mandated essential service throughout the United States, so that EMS providers would have access to healthcare and retirement benefits. Ideally, making EMS an essential service should be a national-level initiative, even though EMS agencies are very much controlled by local governments.

Some local communities do not have EMS agencies, so residents must wait for life-saving care. Also, many areas do not have laws that really bind local governments to have an EMS agency for their community. The idea that EMS should be a mandated essential service in all states and all communities is important, but there is serious potential that such a mandate will backfire in a catastrophic way.

Community EMS Budgets Are Not Large Enough for the Expenses of Emergency Medical Care

One of the fundamental problems with EMS is that many communities do not have a budget large enough to afford ambulances and their equipment. For instance, an ambulance without any equipment can cost over $150,000, according to the Citizen-Times of North Carolina.

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The medical equipment and drugs that go into an ambulance are equally costly. Heart monitors are particularly expensive; the Citizen-Times notes that these monitors can cost $40,000.

Beyond the ambulance and equipment, there is the trained staff. The high cost of providing EMS personnel with training, salaries and benefits is a reason why many agencies choose to hire volunteers to manage their 911 call volume.

Rural Communities and the SIREN Act

Many rural communities often cannot afford emergency services at all, which is why the SIREN Act has been an important and critical contribution to EMS. This grant program from the federal government is meant to offset the costs of equipment, training and recruitment for rural agencies. Unfortunately, it cannot close the funding gap on all rural American EMS agencies because the wealth gap is far too wide.

Recruitment and Retention Are Ongoing Problems

In addition to insufficient community budgets, the emergency service industry has been plagued with recruitment and retention problems for decades. Many agencies don’t have enough personnel to manage their 911 call volume, and leaders point out that the low salaries of emergency service providers remain a problem.

Who Would Pay If EMS Became a Mandated Essential Service?

While the concept that emergency services should be a mandated essential service is definitely interesting, other issues would have to be taken into account to ensure success. In fact, moving to make EMS an essential service may create problems down the road that are difficult to foresee.

Mandating EMS as an essential service on the federal or state level will help agencies throughout the U.S. to band together. However, carrying out such a mandate at the local level may prove difficult in areas when agencies have developed organically on their own.

Considering the costs of running and staffing an ambulance – the vehicle, the equipment, the personnel, and the training – local ambulance agencies are already struggling throughout the United States. Creating a policy that would require local governments to have EMS agencies would certainly inspire personnel recruitment, but it could create a budgetary situation that would be difficult for local governments to meet. Ultimately, if EMS becomes an essential service, it will be necessary to determine who will pay for it. 

Allison G.S. Knox

Allison G. S. Knox teaches in the fire science and emergency management departments at the University. Focusing on emergency management and emergency medical services policy, she often writes and advocates about these issues. Allison works as an Intermittent Emergency Management Specialist in the Administration for Strategic Preparedness and Response. She also serves as the At-Large Director of the National Association of Emergency Medical Technicians, Chancellor of the Southeast Region on the Board of Trustees with Pi Gamma Mu International Honor Society in Social Sciences, chair of Pi Gamma Mu’s Leadership Development Program and Assistant Editor for the International Journal of Paramedicine. Prior to teaching, Allison worked for a member of Congress in Washington, D.C. and in a Level One trauma center emergency department. She is an emergency medical technician and holds five master’s degrees.

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