Celebrating EMS: An Essential Public Safety Service

By Chief Juan Bonilla, NVFC EMS/Rescue Section Chair
May 17-23 is National EMS Week, a time to recognize the tremendous contributions of emergency medical response personnel nationwide. Although most communities across the United States are required to provide fire and police protection services, a surprising number do not have to provide emergency medical services (EMS). In spite of this, EMS providers respond to approximately 40 million incidents per year and transport approximately 28 million patients. 
Clearly, EMS is an essential public safety service. It is past time that EMS received the recognition and stable funding mechanisms that it deserves. The National Volunteer Fire Council’s (NVFC) EMS/Rescue Section encourages departments and individuals to use National EMS Week as an opportunity to raise awareness about the value of EMS providers. 
EMS as a formal discipline has only been around for a few decades. Initially, EMS was primarily focused on transporting sick and injured people to hospitals where they could be treated. Over time, as medical knowledge and technology advanced, the EMS industry has evolved. EMS personnel today – both career and volunteer – are medical professionals who are trained to administer life-saving interventions. In order to successfully treat patients, EMS providers need advanced medical training and agencies need to be able to deliver care quickly and reliably. This requires a significant investment of resources and in too many cases, EMS gets short-changed.
Generally speaking, emergency response in  the U.S. is organized and funded locally, while medical treatment is paid for through fees charged (mostly) to public and private insurance. EMS is both an emergency response and a medical function, but in terms of how it is paid for EMS is caught between the two. Fees cover the cost of ambulance transport but not the significant costs associated with general system readiness. Local governments may pay for some readiness costs, but because they are not required to provide EMS and because many local leaders view EMS as a fee-based service, it is often given a lower priority compared to other essential public safety services.
This is a particular problem in volunteer EMS systems, which tend to operate in rural areas and serve smaller, more dispersed populations. With fewer people to serve, call volumes are lower, which means there are fewer transport fees to cover operational costs. If the agency does not transport – such as a volunteer BLS-level fire district or rescue squad – or does not charge for transport, there is no opportunity to collect fees. While using volunteers helps to reduce operating costs somewhat, recruiting, training, and equipping EMTs is not cheap, particularly if the department has a high turnover rate. Additionally, with a small population supporting most volunteer agencies, there are less resources available to pay for system readiness. 
Not all rural EMS systems struggle financially. The system in Valley County, ID, where I serve as the fire chief of the Donnelly Rural Fire Protection District, relies on three rural fire districts deploying firefighters cross-trained as emergency medical responders, emergency medical technicians, and paramedics. Each fire district gets adequate funding from the county to pay for readiness and we also keep our ambulance transport fees to cover operational costs. Our system works because we have excellent leadership within and cooperation between the county government and the local fire districts. Unfortunately, those characteristics are not easy to replicate.
Being considered an essential public safety service is not a panacea. There are small communities that are required to provide fire protection services where the local volunteer fire department receives little or no support in the form of tax dollars and has to rely on private donations to cover most operational costs. In many rural communities, the financial challenge of paying for emergency response transcends the essential public safety service discussion because the basic readiness costs associated with maintaining an emergency services agency dwarf the resources available. Being considered an essential service isn’t necessarily worth much in a community with a small tax base, particularly if the local government and emergency services agencies do not work well together. 
EMS is an essential public safety service, even if the implications of that designation vary from community to community. The public depends on and expects to receive quality, timely emergency medical care. The private sector has a role to play in funding and in some cases delivering EMS, but ensuring that public demand for EMS is met is the responsibility of government. Broad recognition of that fact is long overdue.  
National EMS Week is an opportunity to celebrate what EMS has done and will continue to do in communities nationwide, while raising public awareness about the resources and support needed to continue these systems at the local level. For resources and information about National EMS Week, visit www.acep.org/emsweek. For more information about the NVFC EMS/Rescue Section, visit www.nvfc.org/ems-rescue. The NVFC extends our thanks for the selflessness and service of EMS providers every day of the year. 
Juan Bonilla is Fire Chief of the Donnelly (ID) Rural Fire Protection District and managed the implementation of the fire training program and 24 hour station coverage. He is a state Firefighter Essentials Instructor, has served as Fire Captain/Training Officer and Assistant Chief, and is active in advocacy on the local, state, and national levels. He serves as Chair of the NVFC EMS/Rescue Section, a member of the Advocates for Fire-Base EMS and WRWG ICC committees, a board member of the Idaho Volunteer Fire and Emergency Services Association, the District 4 Alternate Representative and EMS Division President of the Idaho Fire Chiefs Association, and Chairman of the Valley County Wildland Fire Working Group.