An article published recently by The New Yorker highlights a public health issue that has been growing every year since I started in EMS back in 1990. As a member a suburban community and an on-call Firefighter/EMT, I have watched as our community has struggled to maintain staffing levels such that we can meaningfully respond to emergencies. When I was growing up in this community, many of our fire department members worked at businesses located within our community and were owned by other community members who supported their member’s duty to respond. Additionally, many members had a spouse or other family member at home to keep an eye on the children so that they could drop everything to help their neighbor.
Today, many locally owned businesses have closed and employers cannot or chose not to let their employees leave work to help others in their town. Even if employers will let their employees drop everything to respond, there are fewer people interested in volunteering for their local fire or EMS based service despite an all-time high in volunteerism in the U.S. In addition, those who operate EMS organizations with paid EMS professionals have also been struggling for many years with recruiting and retaining EMS workers and the staffing shortages are reaching a critical level.
There is no single solution to this problem. The American Ambulance Association and other industry groups have been working to find solutions to these problems. However, there needs to be greater local, state, and federal support for EMS systems in this country. EMS agencies provide critical mobile medical health services to millions of people every year while community health systems continue to consolidate or shrink. In many communities, the EMS provider is the only healthcare available for miles and cost of providing that care continues to rise as the response area grows and the sophistication of the pre-hospital medical care available to patients increases. In addition, many state Medicaid programs have not provided rate adjustments for over a decade and the Medicare program continues to reimburse EMS providers below their cost of providing services. These factors combined with insurers shifting a significant portion of the financial burden to patients through high deductible health plans is setting the stage for a public health crisis.
It will be only through the active engagement and actions of all of stakeholders that we will begin to forge a solution to this crisis. While many believe that every person in this country is entitled to essential health care services, we cannot forget that there is a cost to ensuring those services are available when people need them, as well as when those EMS providers are waiting for a call for help.