The little bill that could (save EMS)

What would Americans do if federal law compromised how and how quickly paramedics can treat them or their child in a medical emergency? Thanks to an increasingly outspoken group of emergency physicians and bipartisan congressional collaboration, the bill that today became law ensures that they will never have to find out.

Yet this victory is just the first step in upending long-enduring misconceptions of emergency medical service’s (EMS) role, which hampers patient care quality and raises emergency medical treatment costs nation-wide.


The ability of EMS providers, such as paramedics, to provide rapid medical care relies on a combination of training and “standing orders,” which allow them to immediately perform certain procedures without waiting for a physician director’s permission. Any such delay in care can make a critical difference in the patient’s survival and suffering – but this exact delay nearly became law. 

A few years ago, the Drug Enforcement Agency (DEA) began deliberations on an unenforced provision of the 1970 Controlled Substances Act (CSA), which required a physician-written prescription to administer controlled substances. Despite intervention led by the National Association of EMS Physicians (NAEMSP) and allied stakeholders, the DEA proceeded with the intention to criminalize EMS administration of certain life-saving standing orders.

If this does not seem terribly frightening, consider what this would mean for patients. For example, a three-year-old girl having a seizure would be deprived of medication until paramedics got a physician on the radio or phone and then detailed her information or worse, until she arrived at the hospital – all while the seizure continues. Or consider a 50-year-old man with a mangled leg from a car accident, unable to receive pain medication as he is excruciatingly pried from his vehicle and transported to a distant trauma center.

The passage of the Protecting Patient Access to Emergency Medications Act means this tragic scenario will not come to pass. Guided by NAEMSP, the law does exactly what its name professes: protect every patient’s timely access to life-saving emergency medications. For that, and the years of determined advocacy and support from the EMS industry and congressional supporters, all of us are grateful.

But this narrowly-avoided crisis is just one consequence of a major, unresolved problem harming patient care quality and raising emergency medical care costs: the government’s fundamental failure to recognize EMS as a critical part of the U.S. healthcare system.

Immediate medical intervention for emergencies is a public expectation, but we only need to go back half a century to find a time when this was not the case. Fifty years ago, ambulances were simply a mode of transportation to the hospital, devoid of medical professionals capable of providing life-saving treatment. EMS has since matured into the nation’s front line of healthcare, but it’s not reflected in the laws governing it. Some of these laws exacerbate patient costs, shortchange the value of paramedics’ work, and stunt the advancement and even threaten the efficacy of this system of care. Few realize that Medicare reimburses EMS as if it were a taxi: by the miles traveled, not the care received, and only if transport to a health care facility takes place. This not only fails to recognize EMS as a provider of health care, but also incentivizes transport to hospital emergency departments – whether or not it’s the most appropriate facility.

We hope that the quiet passage of this important bill is the beginning of a change in how the government recognizes and utilizes EMS. In an era of unsustainable growth in health care expenditures and ever-more crowded emergency departments, we must put the needs of patients first with high-value, low-harm care. EMS is eager to be part of the solution through initiatives such as mobile integrated healthcare, which could treat patients in their home or take them directly to the most appropriate facility for each patient’s needs. Indeed, the industry is already making advancements through small initiatives led by dedicated individuals and organizations, such as NAEMSP. But in order to sustain these efforts and build a better system of care for all Americans, the federal government’s understanding of EMS and its reimbursement structure must modernize to recognize EMS’ contribution to the health and prosperity of the communities they serve, as well as to give patients the medical care they need and deserve. 

The brave and highly-trained first responders who make up EMS and America’s front line of health care have pledged to help us in our most vulnerable moments. It’s time all of our laws and health care systems reflect their place in the health care continuum, so they can help build a better system and continue to keep this pledge, as they did today.

Dr. Sahni is the Medical Director of the Lake Oswego Fire Department, Clackamas County EMS, and Washington County EMS, and is NAEMSP’s Advocacy Committee Chair and Past-President. Dr. Dorsett is a Senior Clinical Instructor of Emergency Medicine and Emergency Medicine and EMS Physician at the University of Rochester Medical Center and a member of the National Association of EMS Physicians. Dr. Moy is Medical Director for ARCH/Air Methods Helicopter EMS system in Missouri, Assistant Medical Director for Christian Northeast, Assistant Medical Director of Saint Louis Fire Department, Assistant Professor of Emergency Medicine at Washington University Saint Louis, and the Communications Committee Chair for NAEMSP.