Experts say EMS does not belong in DOT, where its role is marginalized by lack of funding and strong leadership.

EMS - a program to develop and improve overall emergency medical services and care for patients - is housed in the National Highway Traffic Safety Administration, part of the DOT. On Tuesday, a panel from the George Washington University Homeland Security Policy Institute is expected to recommend that Homeland Security Secretary Michael Chertoff create a U.S. Emergency Medical Services Administration, modeled after the U.S. Fire Administration, according to the report, obtained by CQ Homeland Security. "EMS needs a seat at the table as first responder policy, funding and operations are debated at the federal level," the report says. Neither DOT nor DHS officials would comment for this story.

Fragmented System

The current EMS structure is fragmented at best, experts say, and gets lost in DOT.

In the fiscal 2006 budget, EMS is lumped in with $74 million in highway safety programs designed to improve seat belt usage and strengthen motorcycle safety and bicycle and pedestrian safety. Emergency medical services are delivered by stand-alone local government agencies, fire departments, hospitals and other private and public safety entities. "It would be good to have a better coordination of these assets," said Mark Ghilarducci, vice president of James Lee Witt Associates, a crisis and emergency management consulting firm based in Washington.

Although Ghilarducci had not seen the GWU report, he said there have been ongoing concerns that EMS does not get the homeland security funding it deserves. EMS providers get about 4 percent of DHS first responder funding, the report says, although there are as many emergency medical providers as there are firefighters and police officers. EMS does not have any grants programs dedicated to its basic needs, whereas the fire service has the Assistance to Firefighters Grant Program and law enforcement has the Community Oriented Policing Services program, the report says. In addition, there is no national training academy for emergency medical services providers. One of the report's recommendations is to create a national EMS training academy.

Collins Support

In March, Sen. Susan Collins, R-Maine, introduced legislation to create a federal interagency committee on EMS. That legislation (S 611) has been referred to the Senate Homeland Security and Governmental Affairs Committee, which she chairs. The House's version (HR 1240), sponsored by Rep. Joel Hefley, R-Colo., has been referred to the House Committee on Energy and Commerce Subcommittee on Health. But experts say creating a committee to coordinate federal EMS roles does not solve the main problems: lack of leadership and of funding. EMS does not receive the money it needs because it does not have strong representatives at the federal level, experts say.

An Emergency Medical Services Administration should have a high-ranking official and more funding for EMS grants to states and local governments, the report says. The EMS community is very splintered, said Craig Sharman, director of government relations at the National Volunteer Fire Council. But a separate EMS agency within DHS may not be the answer, he said.

Almost half of all EMS organizations are attached to fire services, according to a 2004 study published in the Journal of Emergency Medical Services. The rest are stand-alone operations or are associated with hospitals.

Scattered Elements

Matt Spengler, the International Association of Fire Chiefs' EMS program manager, said it is wrong to assume that a move from one federal department to another will cure any of EMS' ills. The federal EMS community is not just located in DOT. There are EMS programs in the Department of Health and Human Services, DHS and the Centers for Disease Control and Prevention.

"Any reorganization of federal EMS needs to look at all of these agencies in a holistic way and not simply pluck one agency from DOT and drop it down in DHS," Spengler said. The National Association of Emergency Medical Technicians is similarly concerned about an interagency transfer. "EMS is very complex, and there's just a lot of projects and programs in different places that we're involved with," said Kenneth Bouvier, president of the association. "We walk a fine line between emergency response, disaster and public health." Bouvier's association asked Congress to do a study two years ago on where EMS should be located in the federal bureaucracy, but it has yet to see any such study.

The GWU study was meant to highlight the fact that EMS should not be located in DOT, said co-author Daniel J. Kaniewski, deputy director of the Homeland Security Policy Institute. Although other agencies have EMS programs, Kaniewski said, none is as large as DOT's.

"Currently, DOT is viewed as the central authority on EMS, and those smaller programs are scattered throughout the federal government," he said. "What we address in our report is the need for a more significant and more appropriately placed presence, which our task force found to be DHS."

Weldon Could Support

A longtime advocate of the emergency preparedness and response community, Rep. Curt Weldon, R-Pa., said he had not seen the GWU report but would support the panel's findings if the EMS community was behind them. "For too long we've allowed fire and EMS to be whipsawed around by other federal agencies," Weldon said. "I want to make sure that whatever we do, the EMS community is fully on board."

Full Report from GWU (pdf)