NYS EMS Coalition Issues Statement On Proposed Budget

The New York State EMS Coalition has issued the following statement regarding the proposed budget changes to the legislature that would restructure EMS on both the state and regional level.

February 1, 2012

The NYS Emergency Medical Services (EMS) Coalition represents the entire spectrum of EMS providers in New York State. We fully support Governor Cuomo’s efforts to improve efficiency and accountability and reduce waste in NY government. The work of the SAGE Commission to redesign Public Health Law Article 30 wholeheartedly seeks to achieve these ends at the State and Regional EMS levels.

Years of experience, decades of change and previous redesigns have demonstrated that the participation and involvement of physicians at the local, regional, and state levels is imperative for the efficient and effective operation of any EMS system or service. Physician medical directors must continue to be afforded a seat in oversight, operations, and policy making at all levels of our NY State EMS system.

The changes to Public Health Law affecting EMS are substantial and significantly change the oversight and delivery of EMS. In the best interests of uninterrupted public safety and to assure a smooth transition to a more efficient system, the NYS EMS Coalition recommends that changes to PHL Article 30 take effect no less than 180 days after passage into law.

Representation of Rural EMS is critical for service delivery in NY State. The NYS EMS Coalition recommends that Rural EMS be explicitly allocated a voice in regional and state level decision making processes. This could be accomplished by strategically aligning one of the proposed six EMS Advisory Boards to serve as the voice of Rural EMS Care or by adding extra EMS Advisory Boards so as to assure a redistricting that would not consolidate all of New York’s rural areas into Advisory Boards composed of predominantly urban neighbors.

We applaud the continued recognition of funding priority for EMS Training at the EMT Basic level. This represents the most important entry-level ambulance provider in our EMS system. We recommend that equal priority be afforded to First Responder training. Certified First Responders (or Emergency Medical Responders) arrive before ambulances in many areas of NY, providing lifesaving care and treatment. Funding for First Responders is also a priority for New York’s EMS system. Quite frankly, the strong work of our legislature in funding EMS training at all levels, from First Responder through Paramedic, has directly lowered health care costs for all New Yorkers over the past two decades.

Finally, as EMS professionals, the members of the NYS EMS Coalition stand ready to assist in any way needed to assure a smooth, coordinated and deliberate transition to a more effective EMS system. We respectfully request a meeting to provide input and support as we begin this important step into the future.

Not quite the support I think the REMSCOs thought they had.

The New York State EMS Coalition is comprised of the New York State Association of Fire Chiefs, New York State Volunteer Ambulance and Rescue Association (NYSVARA), United New York Ambulance Network (UNYAN), and the Fireman’s Association of the State of New York (FASNY). The group in its entirety represents the vast majority of EMS agencies operating in New York State, with the notable exception being that of the Fire Department of New York City.

You can download a copy of the statement

Does The Destruction Through Defunding Of The NYS REMSCOS Hinder Or Help EMS?

One of the big changes the proposed budget entails is the destruction of the state’s current 18 Regional Emergency Services Councils (REMSCOs) and reformation into 6 Regional Advisory Boards. This is a big change in how state EMS agencies are coordinated and governed in their respective regions.

There have been, not too surprisingly, two overall reactions towards the news. There are opinions for the REMSCOs and there are opinions against REMSCOs. To understand both reactions we should understand what the 18 REMSCOs are actually responsible for. From Article 30 of New York State Public Health Law:

Section 3003. Regional Emergency Medical Services Councils.

2. Each regional council shall be comprised of at least fifteen but not more than thirty members to be initially appointed by the commissioner, with the approval of the state council, from nominations submitted by local organizations applying for establishment as the regional council. Not less than one-third of the membership of the regional councils shall be representatives of ambulance services and the remaining membership of the regional councils shall consist of, but not be limited to, representatives of existing local emergency medical care committees, physicians, nurses, hospitals, health planning agencies, fire department emergency and rescue squads, public health officers and the general public. The county EMS coordinator, established pursuant to section two hundred twenty-three-b of the county law, of any county within the region shall serve as an ex officio member of the regional council; provided, however, nothing in this subdivision shall prevent a county EMS coordinator from serving as a voting member of a regional council. Members of each regional council shall be residents living within the geographic area to be served by the regional council. The presence of a majority of members shall constitute a quorum.

3. Each regional council shall have the power to:

(a) have a seal and alter the same at pleasure;
(b) acquire, lease, hold, and dispose of real and personal property or any interest therein for its purposes;
(c) make and alter by-laws for its organization and internal management, and rules and regulations governing the exercise of its powers and the fulfillment of its purposes under this article; such rules and regulations must be filed with the secretary of state and the state EMS council;
(d) enter into contracts for employment of such officers and employees as it may require for the performance of its duties; and to fix and determine their qualifications, duties, and compensation, and to retain and employ such personnel as may be required for its purposes; and private consultants on a contract basis or otherwise, for the rendering of professional or technical services and advice;
(e) enter into contracts, leases, and subleases and to execute all instruments necessary or convenient for the conduct of its business, including contracts with the commissioner and any state agency or municipal entity; and contracts with hospitals and physicians for the purposes of carrying out its powers under this article;
(f) undertake or cause to be undertaken plans, surveys, analyses and studies necessary, convenient or desirable for the effectuation of its purposes and powers, and to prepare recommendations and reports in regard thereto;
(g) fix and collect reasonable fees, rents, and other charges for the use of its equipment and the provision of its services;
(h) contract for and to accept any gifts or grants, subsidies, or loans of funds or property, or financial or other aid in any form from the federal or state government or any agency or instrumentality thereof; or from any other source, public or private, and to comply, subject to the provisions of this article, with the terms and conditions thereof; provided, however, that the councils may contract for payment of debt evidenced by bonds or notes or other evidence of indebtedness, either directly or through a lease purchase agreement;
(i) recommend to the department approval of training course sponsors within its region, and to develop, promulgate and implement annually an EMS training plan which addresses the needs of its region;
(j) enter into contracts or memoranda of agreement with other regional councils to provide services in a joint or cooperative manner; and to enter into contracts or memoranda of agreement with an EMS program agency to carry out one or more of its responsibilities under this article;
(k) procure insurance against any loss or liability in connection with the use, management, maintenance, and operation of its equipment and facilities, in such amounts and from such insurers as it reasonably deems necessary;
(l) approve regional medical advisory committee nominees;
(m) provide focused technical assistance and support to those voluntary ambulance services operating under exemptions, to assist such services in progressing toward the uniform standards established pursuant to this section. Such assistance and support shall include, but not be limited to, volunteer recruitment and management training; and
(n) do all things necessary, convenient and desirable to carry out its purposes and for the exercise of the powers granted in this article.

4. Each regional council shall have the responsibility to coordinate emergency medical services programs within its region, including but not limited to, the establishment of emergency medical technician courses and the issuance of uniform emergency medical technician insignia and certificates.

5. The regional council shall have the responsibility to make determinations of public need for the establishment of additional emergency medical services and ambulance services and to make the determinations of public need as provided in section three thousand eight. The regional council shall make such determination by an affirmative vote of a majority of all of those members consisting of voting members.

Although not scientific in nature, I’ve had a number of conversations with people regarding the REMSCO dissolution from across the state. Here’s a summary of the arguments:

The Opinion For REMSCO

The opinions for keeping REMSCO vary from region to region, but there were common themes that emerged. Some specific arguments for keeping them include:

  • the opportunity for all agency types to be represented
  • the opportunity for a cost/effect analysis of proposed protocol changes prior to enacting them and adding unreimbursed operational cost to agencies
  • direct support provided to volunteer agencies
  • a point for regional coordination of an EMS system comprised of multiple agencies
  • the means to complete projects and achieve goals too big for one agency

The Opinion Against REMSCO

The opinions against keeping REMSCO vary from region to region but some common themes emerged. Some specific arguments include:

  • the beauracratic composition of the councils not accurately representing the region
  • failures in successfully implementing programs that were conceived on the regional level to begin with
  • failures in the effective coordination of resources
  • failures to support the volunteer sector that they are directed specifically to do
  • relying too heavily on one agency to define a regional system

The Public Hearing

The legislature is holding joint public hearings on the budget items. The hearing for the Department of Health is scheduled for February 8 at 10:00am in Hearing Room B of the State Capitol. You can read the official press release here. Whether you are for or against the decimation of the REMSCOs, that’s your opportunity to have your voice heard.

NYS Dramatically Alters EMS Through Budget Proposals

Recently Governor Cuomo made his proposal for the 2012-2013 fiscal year in New York State. Amongst his recommendations is the merger of governmental entities to streamline government operations. In the Article VII proposal is a rewriting of New York State Public Health Law Article 30 that governs EMS in New York.

I spent the weekend reading it (it’s dry drool fodder) but some of the most notable changes I came across are:

  • State EMS funds for training remains intact
  • “Mutual Aid” is defined (it previously was not) as “means the pre-planned and organized response of emergency medical services, and other emergency personnel and equipment, to a request for assistance in an emergency when local resources have been expended. The response is predicated on formal agreements among participating agencies or jurisdictions.”
  • The State Emergency Services Council (SEMSCO) is downsized and changed to an Advisory Board whose recommendations the Commissioner can accept, modify, or reject
  • The 18 Regional Emergency Medical Services Councils (REMSCOs) are dissolved and reformed into 6 Regional Advisory Boards
  • Only members of the Fire Department of New York City may participate in the 5-year CME recertification program

So what do you think of some of the changes? Good, bad, or indifferent?

Download the 2012 NYS Entities Merger – Article VII and give it a read for yourself. It is a 130 page document but the EMS portion begins on page 80