Federal Interagency Committee On Ems Strategic Plan

Congress mandated creation of the Federal Interagency Committee on Emergency Medical Services (FICEMS) in 2005, in order to ensure coordination among Federal agencies supporting local, regional, State, tribal, and territorial EMS and 9-1-1 systems. The FICEMS was also created to improve the delivery of emergency medical services (EMS) throughout the nation. The FICEMS accomplishes its mission by coordinating projects across the Federal government, predominantly for prehospital issues. Accordingly, FICEMS responsibilities include the following: 1) identifying EMS and 9-1-1 needs; 2) recommending new or expanded EMS and communication technologies; 3) identifying ways to streamline the process through which Federal agencies support EMS; 4) assisting local, regional, State, tribal, and territorial EMS in setting priorities; 5) advising, consulting, and making recommendations on matters related to implementation of coordinated State EMS programs. The conduct of the FICEMS activities is the responsibility of three organizational bodies: the FICEMS members, the Technical Working Group (TWG), and committees. The FICEMS is comprised of representatives from the Departments of Homeland Security (DHS), Transportation, Health and Human Services, and Defense, as well as the Federal Communications Commission and one State EMS director. The TWG is a working body of entities that sit on the FICEMS. The TWG meets monthly and coordinates much of the day-to-day EMS activities of the Federal government. Six committees currently support the work of the FICEMS by providing specialized expertise to both the TWG and FICEMS. Implementation of this strategic plan may necessitate a revision of the TWG committee structure. In addition, the National Emergency Medical Services Advisory Council (NEMSAC) provides advice and recommendations to FICEMS from a non-federal perspective. NEMSAC is a Federal Advisory Council established by statute consisting of 25 non-Federal EMS experts who advise both the FICEMS and the Secretary of Transportation on matters related to EMS. By statute, the National Highway Traffic Safety Administration (NHTSA) Office of EMS provides the FICEMS primary administrative support, including scheduling meetings, setting agendas, keeping records, and producing reports. Currently the director of NHTSA's Office of Emergency Medical Services chairs the TWG. Given the FICEMS's significant responsibilities, it is essential that the organization have a five-year strategic plan. This strategic plan is a shared vision among Federal agencies that support EMS. Once implemented, an overarching strategic plan for the FICEMS should help to improve the federal support of local, regional, State, tribal, and territorial EMS and 9-1-1 systems and facilitate their collective mission of saving lives.

Emergency Medical Services (EMS) agencies regardless of service delivery model have sought guidance on how to better integrate their emergency preparedness and response activities into similar processes occurring at the local, regional, State, tribal and Federal levels. The primary purpose of this project is to begin the process of providing that guidance as it relates to mass care incident deployment. The World Bank reported in 2005 that on aggregate, the reported number of natural disasters worldwide has been rapidly increasing, from fewer than 100 in 1975 to more than 400 in 2005. Terrorism, pandemic surge, and natural disasters have had a major impact on the science of planning for and responding to mass care incidents and remain a significant threat to the homeland. From the attacks of September 11th, 2001, the subsequent use of anthrax as a biological weapon, to the more recent surge concerns following the outbreak of H1N1 influenza, EMS have a real and immediate need for integration with the emergency management process, and to coordinate efforts with partners across the spectrum of the response community. The barriers identified from the literature review and interviews with national EMS leadership include: lack of access to emergency preparedness grant funding; underrepresentation on local, regional, and State level planning committees; and lack of systematic mandatory inclusion of all EMS provider types in State, regional, and local emergency plans. In December 2004, New York University's Center for Catastrophe Preparedness and Response held a national roundtable that included experts from major organizations representing the EMS system as a whole. The report from that meeting concluded that: “EMS providers, such as fire departments and hospital-based, commercial, and air ambulance services, ensure that patients receive the medical care they need during a terrorist attack. While EMS personnel, including Emergency Medical Technicians and paramedics, represent roughly one-third of traditional first responders (which also include law enforcement and fire service personnel), the EMS system receives only four percent of first responder funding. If EMS personnel are not prepared for a terrorist attack, their ability to provide medical care and transport to victims of an attack will be compromised. There will be an inadequate medical first response.” In 2007, the Institute of Medicine in its landmark report Emergency Medical Services at the Crossroads issued a recommendation that stated: “The Department of Health and Human Services (DHHS), the Department of Homeland Security and the States should elevate emergency and trauma care to a position of parity with other public safety entities in disaster planning and operations.” Since the time of these reports Federal progress to address these issues has included the creation of the Office of Health Affairs (OHA) within the Department of Homeland Security (DHS), the creation of the Emergency Care Coordination Center (ECCC) within HHS, and the creation of the Federal Interagency Committee on EMS (FICEMS) Preparedness Committee. In an effort to increase the level of preparedness among EMS agencies, the National Emergency Medical Services Management Association (NEMSMA) approached the DHS and OHA to engage them in a partnership that would provide a greater understanding of the shortfalls in EMS emergency preparedness and provide resources to fill those gaps. The primary objective of this project is to understand model policies and practices across a spectrum of disciplines and provider types that will lead to a better prepared EMS deployment to mass care incidents. This project should serve as a foundation for further development of EMS specific policies and templates that improve EMS readiness to manage the full spectrum of hazards that face their communities.

Emergency Medical Services (EMS) is a critical component of our nation's emergency and trauma care system, providing response and medical transport to millions of sick and injured Americans each year. At its best, EMS is a crucial link to survival in the chain of care, but within the last several years, complex problems facing the emergency care system have emerged. Press coverage has highlighted instances of slow EMS response times, ambulance diversions, trauma center closures, and ground and air medical crashes. This heightened public awareness of problems that have been building over time has underscored the need for a review of the U.S. emergency care system. Emergency Medical Services provides the first comprehensive study on this topic. This new book examines the operational structure of EMS by presenting an in-depth analysis of the current organization, delivery, and financing of these types of services and systems. By addressing its strengths, limitations, and future challenges this book draws upon a range of concerns: • The evolving role of EMS as an integral component of the overall health care system. • EMS system planning, preparedness, and coordination at the federal, state, and local levels. • EMS funding and infrastructure investments. • EMS workforce trends and professional education. • EMS research priorities and funding. Emergency Medical Services is one of three books in the Future of Emergency Care series. This book will be of particular interest to emergency care providers, professional organizations, and policy makers looking to address the deficiencies in emergency care systems.

Catastrophic disasters occurring in 2011 in the United States and worldwide-from the tornado in Joplin, Missouri, to the earthquake and tsunami in Japan, to the earthquake in New Zealand-have demonstrated that even prepared communities can be overwhelmed. In 2009, at the height of the influenza A (H1N1) pandemic, the Assistant Secretary for Preparedness and Response at the Department of Health and Human Services, along with the Department of Veterans Affairs and the National Highway Traffic Safety Administration, asked the Institute of Medicine (IOM) to convene a committee of experts to develop national guidance for use by state and local public health officials and health-sector agencies and institutions in establishing and implementing standards of care that should apply in disaster situations-both naturally occurring and man-made-under conditions of scarce resources. Building on the work of phase one (which is described in IOM's 2009 letter report, Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations), the committee developed detailed templates enumerating the functions and tasks of the key stakeholder groups involved in crisis standards of care (CSC) planning, implementation, and public engagement-state and local governments, emergency medical services (EMS), hospitals and acute care facilities, and out-of-hospital and alternate care systems. Crisis Standards of Care provides a framework for a systems approach to the development and implementation of CSC plans, and addresses the legal issues and the ethical, palliative care, and mental health issues that agencies and organizations at each level of a disaster response should address. Please note: this report is not intended to be a detailed guide to emergency preparedness or disaster response. What is described in this report is an extrapolation of existing incident management practices and principles. Crisis Standards of Care is a seven-volume set: Volume 1 provides an overview; Volume 2 pertains to state and local governments; Volume 3 pertains to emergency medical services; Volume 4 pertains to hospitals and acute care facilities; Volume 5 pertains to out-of-hospital care and alternate care systems; Volume 6 contains a public engagement toolkit; and Volume 7 contains appendixes with additional resources.