State and federal agencies charged with the responsibility to oversee EMS operations and organizations are often viewed with disdain by EMS providers.  Our palms sweat as we near "inspection time", unexpected letters with return addresses of "ABC State EMS Office" tend to cause PVCs in even the most secure service chief or director, and the pages upon pages of statutes and administrative rules can cause the worst insomniac to doze off.

However, it is my contention that EMS needs strong and effective oversight for numerous reasons.

Effective oversight helps keep us honest...
Let's face it – it is human nature to occasionally try to get away with the least effort needed.  If we did not have periodic inspections from the State or County EMS office, we would be tempted to omit that tool box from the ambulance or not really carry the spare tire (since it takes up too much room in the "Autopulse" compartment, and we never change tires anyway).  If we were not required to submit personnel rosters with PROOF of CURRENT certifications for every one of our

EMTs and paramedics, we might actually go a year without knowing that Tom Davidson forgot to give us a copy of his ACLS card.  Having those checks and balances helps assure that we are not caught off guard.  Having this type of external oversight helps us keep our house in order and identify areas we can improve upon (and avert a potential litigious event). 

Effective oversight creates a basic framework for service delivery...
Effective State or local regulation helps us develop EMS delivery systems that meet the needs of the patient.  Examples can include such things as trauma, cardiac, and stroke patient destination requirements; provision of emergency medical dispatch; minimum requirements for licensure, certification, and training; and minimum staffing requirements.  Local politics and competition among hospital networks sometimes prevent local systems from implementing protocols for transporting the right patient to the right destination facility.  When the State promulgates statute or administrative rule for these issues it often provides local medical directors the ability to set protocols that require trauma patients to be transported to trauma centers.  The same is true for cardiac and stroke patients. 

Similarly, state rules can help establish how EMS systems will be governed.  In Florida, State statute empowers county governments to establish ordinances on how EMS services are to be provided, allowing elected officials to create county-wide service delivery models.  In Wisconsin, the lack of statute in this regard often leads to fragmented and disparate service delivery across the state.  In Minnesota, the state actually assigns "Primary Service Areas" and in the absence of serious delivery failure or the significant desire of local officials to change providers, there is minimal local decision making necessary.

Effective oversight provides a system for evaluation and improvement...
Many states and the federal government have finally embarked on data collection initiatives to objectively evaluate the key components of EMS service delivery and outcomes.  Without formal legislation mandating the submission of data, it is doubtful that any meaningful evaluation of EMS systems would occur.  Admittedly, establishing the methods and format of data collection in most instances has been harder than giving birth to a bowling ball (not that I would have firsthand knowledge of that phenomena - you get the drift...), but we are making progress little by little.  Without the state and/or federal government mandating data submission, most services would miss the valuable opportunity to internally evaluate their service provision and the EMS industry would lack valuable benchmarks for service delivery.  Remember pay for performance is on the horizon, how will we be able to determine and demonstrate this without data?!

From the data being submitted, we as an industry will be in a better position to establish standards and benchmarks that really matter, as opposed to allowing constituency groups with conflicting agendas to establish meaningless standards (more on creating standards that matter in my next column).

Effective oversight advocates for the patient...
State and federal legislators are often willing meet with service providers and association lobbyists, but they generally LISTEN to the regulatory agencies.  We can work for months on changing legislation that we think would improve our lot in life, or make the system better for the patient and in five minutes at a committee hearing, one sentence from the regulatory agency can derail everything we've been working for.  The influence of an effective regulatory agency can be a huge asset when we work together with them to promulgate positive changes to EMS systems.  Just look at the discussions and changes already taking place federally based on the recent IOM report.

Effective oversight....
Notice that a key concept in this entire discussion has been "effective".  While there are many excellent state and federal oversight agencies, there are also some that are...well shall we say, less than effective.  To be effective, regulatory agencies and their leaders need to be visionary and be able to look at the "big picture".  All too often the regulatory agency is too focused on whether or not we have 12 band aids and three OB kits on the ambulances and less focused on establishing programs designed to help EMS providers create innovative programs to help patients.  Worse yet, some oversight agencies are so under staffed and underfunded that they don't even have the ability to do program development of any kind – or in our case in Wisconsin, to even return phone calls. 

We need to support those agencies that are effective through cooperation and innovative recommendations.  We have a similar obligation to change regulatory oversight agencies that are ineffective.  In Wisconsin, the Professional Ambulance Association of Wisconsin, as well as former State EMS Medical Directors have formally applied for a bi-partisan Legislative Council on EMS to study the needs of the Wisconsin EMS system and the needs of the State EMS Division in an effort to strengthen the State's EMS oversight and make it more ‘effective'.  It may seem unusual for a professional association of private ambulance providers to actually seek more oversight, but we recognize its value to the state-wide EMS system and the patients we serve.

If your state or local EMS oversight agencies are less than effective, you owe it to your EMS system and your patients to do everything you can to improve the agency - effective oversight is invaluable.