EMS is Essential
By Albert B. Kelly
Over the past year and half, there has been a great deal of thought and discussion about exactly who is essential and who is not essential when it comes to workers. So much so, that jobs that were previously viewed as entry level for the unskilled and the semi-educated, now rank as “essential”. This has come about not because corporations and shareholders have a newfound respect for these workers, but they realize their profits are tied to whether or not these people are willing to mask-up in the midst of a pandemic and perform whatever task is necessary to keep the thing running.
It wasn’t always this way. Pre- pandemic, when we thought of “essential workers”, it was always in terms of public safety and it was usually discussed in response to some natural disaster such as a hurricane, earthquake, tornado, or blizzard. In a public safety context, this usually meant police and fire. After 9/11, that definition expanded and evolved somewhat in the face of terrorism and “essential” came to include those involved with “critical infrastructure”.
Yet surprisingly through all of this, at least here in New Jersey, “essential” does not include Emergency Medical Services or EMS. There is legislation knocking around Trenton that would classify EMS as essential and in light of what “essential” has come to mean these last two years, it is time that EMS receive the attention it is due. As we speak, there is a patchwork of EMS around the state. In some instances, it is privatized, in some it is volunteer-based, and in others EMS is a municipal function.
The implications of formally recognizing EMS as essential in the same way that police, fire, and sanitation is recognized as essential goes beyond cosmetics. First and foremost, it moves Emergency Medical Services from the category of a service a given municipality might choose to provide into the category of a service they must provide. Currently, municipalities are not required to provide ambulances with certified Emergency Medical Technicians or EMTs.
What that means is that should you or a loved one have some type of medical emergency; you better hope it happens in a jurisdiction where they have adequate EMS. If not, you may be waiting for some un-godly amount of time to get to a hospital. In emergency medicine, time is critical, whether we’re talking trauma or cardiac. We all want the maximum benefits that modern medicine can provide and that’s not an unreasonable expectation, formally recognizing EMS as essential would ensure those benefits are available out in the field as opposed to only when we cross the threshold into an ER.
That’s not a criticism of volunteers as there are few things nobler in civic life than a dedicated volunteer responding to an emergency. It’s just that running things this way is becoming harder. Not being classified as essential greatly limits the types of federal and state grants and resources that might otherwise be available.
As for privatized services, individual EMTs are great but what happens if corporations give in to the temptation to maximize profits at the expense of coverage by dropping minimum staffing, exploiting mutual aid, or prioritizing calls from neighborhoods perceived as being better insured and more likely to pay than those perceived to be uninsured or less likely to pay? Someone will insist it would never happen, but I take that claim the same way I take Facebook when they talk about protecting my personal information.
We’re now entering the third decade of the 21st century, technology and medicine can do remarkable things, yet we struggle with stepping up our game when it comes to ambulances and doing better by the people that staff them. By formally classifying EMS as essential, we will move this life-saving service from an elective to a requirement with minimum quality assurance standards for staffing, training, equipment, response times, and whatever else makes for an essential service.
This will help raise the level of compensation for EMTs and this is no small thing given what we ask of them when we call them. The other side of the coin is that we’ll necessarily need to support EMS through our tax dollars instead of through hit and miss reimbursement rates, hoping patients pay when the bill comes, and asking rescue squad members to stand hat-in-hand at busy intersections on holiday weekends to raise funds from passing motorists. EMS is essential, if you doubt that, just ask the patients.