## Transcript

 Estimated 17 min reading time.

Welcome to the USFA Podcast, the official podcast of the U.S. Fire Administration. I’m your host, Teresa Neal, and on this episode, we’ll discuss emergency medical services at the U.S. Fire Administration. You may not be aware that the USFA stood up the EMS branch under the National Fire and EMS Division.

Chief Richard Patrick, the division director, is here to discuss the importance of USFA’s focus on EMS. Chief Patrick began his service with the U.S. Department of Homeland Security in June 2008 as chief of the Medical First Responder Coordination Division in DHS’s office of Health Affairs, where he led outreach to the first responder community and the development of the department’s EMS system. He then served as deputy director and director of the Workforce Health and Medical Support Division within the Office of Health Affairs. In 2015, he was selected to serve a 1-year Brookings Congressional Legislative Fellowship in the U.S. Senate.

There he was senior advisor for first responder policy to the assistant secretary for health affairs and chief medical officer of DHS prior to joining the U.S. Fire Administration. Thank you for joining us, chief.

Thanks for having me, Teresa. It’s great to be here.

You have a long background in fire and EMS and have worked extensively to promote, better resource and train EMS and fire-based EMS.

Why is it important for USFA to place an emphasis on EMS?

Well, that’s a great question. And I think many fire departments around the nation, if not the majority, already know that to a degree for EMS. But bottom line is, data speaks for itself. And, as you know, the nation’s emergency medical services have a long history of a tremendous service to the community that they serve. With that and with the fire service here at the USFA, we collect fire response data.

And from the National Fire Incident Reporting System, last year, 2022, there were 32 million incidents. Well, 65% of them at minimum are emergency medical service-related responses for that. We believe that that’s even higher based on the number of total responses to EMS. And national data by the entire EMS industry has somewhere around 40% of the overall EMS responses are by fire departments, as well.
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So, if you think about 32 million incidents last year, that means that 21.4 million of those incidents were for emergency medical calls. So, I think it pretty much speaks for itself. And then the other factor that goes to this is the U.S. Fire Administration has been involved some way, shape or form in emergency medical services since its inception.

I mean, if you look at “America Burning” and the Fire Prevention and Control Act that created us, there is extensive history of doing certain things for EMS along the way, but it wasn’t until 2008 when — through one of our reauthorizations — that Congress injected specific emergency medical services authorities for us to do.

And yeah, it’s taken a while over time, but we’re getting resourced now to be able to do more. And the fire service is asking us and embracing us to do more.

So, what are the goals of the new branch?

Well, I have 2 initial overarching goals that the team here — when I say the team of EMS, we have involved our colleagues at the National Fire Academy who have some pretty extensive EMS backgrounds on the education side as well and then the, the internal team that we’re building.

And right off the bat, you know, it’s managing expectations and managing the resources you have. But we want to foster emergency medical prehospital or out-of-hospital systems as one of the big goals. And that’s supporting an equitable and effective EMS system across the nation itself. It is a broad term, but we’re defining more of that as we go along. But we want to assist EMS systems as a whole to engage with FEMA in prevention, preparedness, response recovery for all the disaster responses, as well.Something that myself and other colleagues have heard constantly across the spectrum of the EMS community is a seat at the table in order to be engaged in those, you know, disaster response entities.

So, we are working with that, which leads to the next goal, which is support and sustain a ready FEMA and prepared nation. And we have excellent support from the FEMA administrator and the U.S. fire administrator for engaging more EMS and the equities that FEMA has across the board. So, we are proactively doing that right now.

That’s awesome. So, what are some of the key initiatives that you all have been trying to line up or what you’ve already been doing, but we just didn’t have it under the umbrella of EMS at USFA?

Yeah, sure. That’s a great question. And we got a lot of exciting initiatives underway, but to your point of the things that have been there for quite some time. Right at the top of our webpage, there’s an EMS tab and when folks tap on that tab, they’ll see the plethora of manuals and documents that have been around and revised over the last couple — almost several — decades now. But to build upon that, when I said about the broad goals, the very high-level goals, we just finalized an EMS needs assessment. And this was a pretty in-depth view at the nation’s emergency medical services systems, which identified gaps that exist within that system. We are currently evaluating that report. This was a report to the U.S. Fire Administration.

So, now we’re going to evaluate that and from there we will determine, based on resource availability, which particular areas we will start with. What I already mentioned are already in that document, but there’s a lot more there. So, that’s going to feed it for our mission going forward. One of the areas, too, is the National Response Framework by FEMA and the community lifelines that exist across the board.

There’s quite a bit of speculation and somewhat misunderstanding of where EMS is, and we’re analyzing that. There’s a phenomenal thread of emergency medical services through all the community lifelines. So, we’re helping working with FEMA and then to reach out to our stakeholders to assist in education there, as well, to make sure they’ll have a system, you know, is designed and works. We have some federal initiatives through FICEMS, the Federal Interagency Committee on Emergency Medical Services, and then research and technology to focus on safeguarding medical first responders and the American people across the spectrum.

So, there’s a — quite a portfolio, if you will, of EMS activities going on by our staff.

So, I guess, one of the things is that fire departments are kind of run differently in every state, and so it’s hard to have an overarching “This is the way the fire departments should run.” Is it the same way with EMS?

Well, you know, I guess it depends who you might talk to referencing, even a fire department, how it’s run and operated. I mean, the mission of a fire department is essentially the same and then no matter what the fire department is. Same with EMS. At the end of the day, it’s about the patient, you know, and the emergency medical clinicians that are in there — from a basic emergency medical responder, EMT or a paramedic, and prehospital nurses and the like — are all after the same best outcome for a patient.

There are a variety of different ways that that is delivered. Fire-based EMS being one of the delivery models. But at the end of the day, it’s all about the patient outcome, which is essentially good wellbeing and health.

Right, and so what about some of the divisions, EMS research, and also, a little bit on the side, is how you’re helping some of this — emergent issues that are coming for, like the whole blood that we hear about in some of the bigger cities and those type of emergent EMS issues that we’re kind of keeping on our radar because maybe we can’t do a lot in that field, but we have partners that can come alongside us to help us.

Sure. Absolutely. Great, great question there. So, FICEMS, the Federal Interagency Committee on EMS, is designed, in a large way, to do what you just asked. And it’s to assure from the federal government’s side of the house that federal agencies that want to help emergency medical services collaborate, coordinate their efforts and make sure the right hand knows what the left hand is doing so we, A, don’t duplicate efforts, and B, we can complement.

So, we do partnerships and interagency agreements with the Office of EMS at the National Highway Traffic Safety Administration, with Health and Human Services, and EMS for Children, and the Department of Defense, and many others that coordinate and play along within that. Just to assure, hence the overall equity of what the federal government’s role is for EMS.

When it gets to maybe fire-based specific, just like I made note of the community lifelines earlier within FEMA, here at USFA, EMS and the role of that from the leadership and management supervision to even providing certain levels of patient care are interwoven through national fire and EMS programs, the National Fire Data Research Center and the National Fire Academy across the board.

So, we have some specific documents on the research side, such as an EMS Medical Director’s Handbook that has been around for quite a number of years. It’s in its second edition. We are vetting that right now and hope to have that published here in the early spring of 2024. We just recently released last month the Alternative Funding Manual for EMS and Fire Services. So, it’s a great additional resource to help with funding.

We have a study that’s ongoing for EMS and fire response to civil unrest. We have another collaborative project with the Department of Transportation on fire and emergency medical vehicle response to electric vehicle incidents. So, vehicle fires that are all electric, the Teslas, or whatever the case may be.

And as I noted earlier, on our website — I won’t list all of them because there’s so many great products there that we regularly revise — but we have EMS Safety Practices, what are the best practices for almost any given situation, Mitigation of Occupational Violence to Firefighters and EMS Responders and then the health considerations for the design, actually, of fire and emergency medical services stations, just to highlight a few of those particular areas. 2 other things that we operate here at the U.S. Fire Administration is what’s called the EMR-ISAC, which delivers EMS, fire and related "for official use only" information. So, you can think of it as it’s, you know, secret or almost-secret type of information that’s intelligence, that we have a process that distills that into information that we can deliver that has great utility to EMS chiefs, as well as fire chiefs and many other emergency responders and the officers for daily protection and response.

And then, last but not least, to that question specifically is the Homeland Security Information Network, or HSIN, that has an emergency services section that we run here at USFA. It’s actually within my division under our prevention branch. And we have an entire EMS section there where EMS providers, from the provider-level to the organizational-level, may join. The only caveat to that is they have to have a .gov address with that. Because it is a Homeland Security network, we can’t use AOL or Gmail or those types of email ...

Servers.

Servers, thank you. Yes.

So, you said that there’s a lot of collaboration between what you do in your division and the National Fire Academy. So, we know that there’s already training at the National Fire Academy for EMS, but there’s a lot more coming.

Yeah, absolutely. There’s a great team over at the Fire Academy, and we really have an excellent relationship across the board on all programs with them. But there is — I almost want to call it the National Fire and EMS Academy from the standpoint of nearly a dozen emergency medical-focused programs that are available both here on campus in Emmitsburg, Maryland, as well as through the state delivery model that the fire academy operates. And we have a number of online programs geared toward emergency medical services itself. Just to highlight a few of them — there’s so many, I’m not going to go through all of these.

These are all on the website. But for the listener out there, “Supervising Emergency Medical Services,” which is for first-line supervisor leadership competencies; that’s a relatively newer program. If I’m not mistaken, they piloted that earlier this year and great reviews.

“Management of Emergency Medical Services.” This is a class that I took — I don’t even know if I want to tell you, but it was probably nearly 30 years ago here. It was the first EMS program. I think it was like 1980 or ’81 with that. And it certainly has been revised over time. But I know one of the other most-popular classes, at least that I hear when I’m out and about across the country with stakeholders, is the Quality Management for EMS program. That is operated here at the National Fire Academy, but not to leave out, you know, some of the modern EMS systems that are getting into what’s called Mobile Integrated Healthcare and the program management for that. That’s a relatively newer program.

Community paramedicine and how they operate, but we also do Incident Command program specifically for EMS and how they integrate with fire and law enforcement and Homeland Security and other responders. So, and again, the list goes on. Those are existing programs. And I know the team at the National Fire Academy has at least another half a dozen EMS-related programs under development.

That’s exciting. So, now with this new division and it’s being staffed out. And when you, as the director, what is your vision for this division, for this branch within your division, for the EMS at USFA? And what kind of initiatives do you see in the future for USFA to be partnered with?

Sure. Absolutely. So, back to when I talked about the EMS Needs Assessment with that — that will help define an answer for your question more intimately, if you will, over the course of the next 3 to 6 months for that. It’s got some outstanding information and not just what is needed, but some ideas on how to accomplish that.

I don’t want to speak out of turn with that though. So, where we are right now, as we’re building this branch, it’s like building an aircraft in flight. So, we have reallocated most of the resources that we have, but we are up to 4 full-time employees in that specific branch.

And we have some more approaches in the works, and we have some requests through the federal funding process to be able to fund some of the projects I previously mentioned, as well as — as we go forward. But ultimately, from my vision, is we need to assure that everything we knew, not just in EMS, but you know, in prevention and all the other great programs and services, that it’s evidence-based. That’s a must.

So, it’d be evidence-based, has to be supported by data. So, I like to say evidence-based, data-guided information which allows for defensible decision-making. The end user at the end of the day, the stakeholders, they use data or want data and need more of that. We certainly are driving the data as we started off the podcast.

To your question, why are we getting more involved into EMS? It’s data, and we’re going to continue to build on that. In the national spectrum, the Department of Transportation’s Office of EMS operates NEMSIS, which is the National EMS Information System. And of course, we have NFIRS.

The issue over many years has been the 2 can’t talk to each other. So, with the new system that the Fire Administration is building, NERIS, National Emergency Response Information System, we’ll be able to talk with NEMSIS back and forth.

That’s exciting.

It is. It’s absolutely exciting. And for all aspects of the fire service and EMS, because the storytelling capability that’s going to come out of that will allow our stakeholders — we will be able to provide our stakeholders with more information that has just so much greater utility.

And I think it’s also really helpful for just the providers, for the firefighters and the EMS, because sometimes the firefighters know there’s an issue in an area because they’ve been there and EMS rolls up and they have no clue what they’re walking into. So, even that type of information can be captured and shared.

Well, absolutely, Teresa. And this is where, to the point of the question itself, the top issues that we hear and we know to be real are recruitment and retention. In fact, I’d probably argue and say it’s retention and recruitment, but nonetheless, that’s across the board of all public safety and public health with that.

So, you have recruitment and retention. You have funding, funding streams, grants — not just grants though, third-party insurance reimbursement, which is an issue that FICEMS is addressing or works on with Health and Human Services through Medicare and Medicaid and things like that, because fire departments bill for ambulance services in many areas, just like a nonprofit ambulance service unrelated to a fire department may be, plus the other delivery models as well. So, funding’s there.

Ambulance deserts is a term that is getting some due recognition across the country where ambulance services are going out of business, you know, and communities are being left without coverage, and who’s picking up that difference and how do we resolve that? I mean, some of these are actually wicked problems that we need to pay some serious attention to. So, those are some of the big, big areas that we want to try to focus on and data will help us help our stakeholders tell that story to make their case. And then we also have a number of things in the works and that we’re looking at. Health and safety for the providers is always a priority both from the individual themselves to safe vehicle operations.

The USFA has been a leader in emergency vehicle safety and operations for decades with that. And we have some, you know, visibility and conspicuity studies underway. We have a study that’s getting ready to be taken under with a partnership with the Department of Transportation on struck-by incidents.

So, when a paramedic, you know, an EMT, a firefighter, police officer, even our colleagues in the wrecker service are operating along a roadway system, whether it’s at a crash or they’re operating on the roadway to provide medical care or fight a fire. Last year was the highest number on records of struck-by incidents and fatalities of those individuals.

So, we are going beyond best practices that we know work if employed. We want to understand, maybe, why they’re not being used or what more don’t we know in order to do that?

Yeah, when we were in Memphis at the NEMA conference, Dr. Lori went to some station visits and she asked each of the fire departments, you know, what is your main concern?

You know, give me your main concerns. And I think almost every fire department said responding on the highway, because they have the freeway there and that people, you know, aren’t paying attention or they want to try to get around or whatever. And I don’t believe that they’ve had — I could be wrong, so — that they had a fatality. I’m probably wrong on that. But they’ve had many incidents that it could have been terrible, you know, and they just don’t know how to get it. You know, you don’t want to close the freeway down. It’s like closing down 95. You know, it’s like “What?”

But they have to do something, and the people aren’t paying attention. They drive way faster than the speed limit. They can’t slow down even if they were able to see the accident and the first responders. And so, it’s really, I would say it would be terrifying to me, but these people are not running into a burning building, any of those things. Their main fear is responding on the highway.

That — that really says a lot.

It does say a lot. It speaks for itself and, you know, with that said, distracted driving, as you noted, is a major problem. All you have to look at is at any data that comes out of the transportation world to even the fire service and EMS world related to this topic. And it speaks loudly, you know, to that.

One of the things I would add just on that note is, you know, for us responders with that, and this has been a passion of mine, this topic for my entire career with it is we have a duty though, to give enough notice of approach. Meaning that the additional services of providing signage and warning that over the hill or around the bend or a quarter or half a mile down the road, there’s an incident. You know, slow down, move over. And a lot of our, you know, stakeholders around the country do a great job with that. But we say safety first all the time in everything we do. And then we let our guard down.

Well, because it’s just humans being humans. If something doesn’t happen for long enough, then we act like it doesn’t really matter until it happens. You know, I mean, we always say people, even people who are firefighters, they don’t check their smoke alarms.

Why? Because they haven’t had a fire for a long time, you know? And so, not until there is one, do they go, “Oh, wait.”

Exactly. So, all of this and more is why we spend a lot of emphasis in the best practice and the public speaking arena and sharing the information with stakeholders and colleagues to keep us all safer out there so they can do their ultimate job, right?

It’s mitigate the situation in EMS patient outcome, you know, at that point. So, and then I would say that last but not least, to your question specifically, if you brought up whole blood. You know, whole blood in the prehospital arena is relatively new domestically.

The military has been using it for, again, many times on the battlefield for decades. We know it makes a difference and there are some phenomenal programs out there. But as we support that from the USFA and we are proactive in the blood coalition that was formed for that, but we also have to keep the entire regulatory aspect and the permissions that are granted through states to be able to practice that part of prehospital medicine with that.

So, it’s a balance of support with working, too, with where are the barriers for the regulators within the states and how can we also, maybe, help them get past that to progress emergency medical services. The last thing I want to do is reinvent the wheel for things that exist that are federal roles or reinvent the wheel if you will, if there’s already a standard accepted practice, you name it, whatever it might be in EMS. We need to focus on where we know the gaps are and where the innovation is going to make a difference in saving lives for the patient and the responder.

That’s awesome. Well, is there anything else you’d like to share with us about EMS?

I know that you could go on, you could probably give us a whole class on EMS. So many things that you said I don’t even consider that you have over the years brought up or spoke about. And I’m like, really? I know you were really instrumental in getting all parties together after COVID. After the big push of COVID to kind of get them together, EMS and fire and kind of say, okay, we’ve all been through this, now let’s lay it out on the table and try to find out what are our initiatives. What are the top ones that we can really make a difference in so that when we have another pandemic, we aren’t starting from scratch. I know that one of your main points was after that was over, it’s like, okay, we got to do something and we got to get ahead of this. We cannot have the next one be like this one.

Yeah, that’s a great point, Teresa. And you were very much involved in the hot wash that we did the COVID listening session afterwards. And for the listeners that may not be aware, we had all of the NGOs — the nongovernment organizations — that represent a good bit of the responder community were present and participated in this.

And, you know, when that report was published, it’s interesting today to how we started off this podcast, where I was making comments about the community lifelines and some of those aspects within FEMA and the like, they came right out of this report. So, it was the — here are the recommendations from the stakeholders and they also provided us some recommended solutions and we are utilizing those.

At the simultaneous time of that report development, FICEMS was also doing a report collectively for the government as a whole for federal EMS responses. And that report’s available, too. Just like ours is on our website, the FICEMS one is on ems.gov. And when you look at the results at the end of the day, they both are saying the same thing. Which is refreshing to know that, most importantly, we heard the community, we’re doing something with the resources we have, and just about everybody involved in EMS are singing from the same song sheet because we had the same issues.

Yeah, that’s what’s awesome is that when you look at it, the outcomes are about the same. You know, they are in the same line.

And that’s important because like you said, you listen to what everyone said and that you were on the right track. If 2 different groups come up with the same one, then you’re on the right track. And that’s good for the service.

And I must say for our FEMA team, during the whole response, I can’t speak highly enough of not just FEMA itself, but all the federal collaboration, our colleagues at NHTSA’s Office of EMS, Health and Human Services, and all the other — I could go on and on, but the point is the issues such as N95 masks versus fake N95 masks, supply chain issues became a major situation. Still exist in many aspects related to this yet today.

Try to get an ambulance is what you’ve told me.

Try to get chips for chassis for any emergency vehicle, as well as some other materials that are needed to make certain things with that. But what I can tell the stakeholders is that progress is being made on all of these topics. You know, we truly are seeing some great progress as a result of that unified, you know the term, one voice. But it’s a one voice topic related in this aspect to COVID or a pandemic as a whole.

So, my message would be going forward is that all emergency services, if you don’t have a pandemic or related type of incident plan, develop one. If you have one, revise it, dust it off every few months or 6 months, at least once a year. It frustrates me a lot when I’m out and about and I hear people say, well, there were no plans for COVID.

That is absolutely false. It is absolutely false. There were many plans. There were federal government plans. The plans were being used. We were challenged by a lot of other forces and things globally. Hence the supply chain is one of them that created some things that we got to learn from.

Exactly. I mean, that’s how we got the National Response Framework, was from Katrina. Those things happen. Unfortunately, terrible things happen, but we are learning from them. And sometimes people say the government is so slow. Well, sometimes it’s because it’s proven out. They’re trying to prove out the best practices and not just everybody’s idea.

I might have a great idea of how you can do EMS because I’m not doing EMS. I really shouldn’t be speaking into how you do EMS.

Well, I’ll leave you with this or pending what other questions you may have. My message to the community of EMS, and our fire colleagues and law enforcement, whoever else is listening to this, is let your voice be heard. There are avenues to do that. FICEMS. The National EMS Advisory Council. FEMA’s National Advisory Council. So, and you can look at other ones or if somebody wants to reach out to me, I’ll gladly point them to wherever they’re interested in through formal processes in order to provide your ideas and give your input because we are all out here for the same mission.

Right. Well, thank you for being on the podcast. Thank you for your time. And thank you to our listeners for listening to the USFA Podcast. And if you have a topic or a speaker you would like us to interview, just email the show at fema-usfapodcast@fema.dhs.gov.

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We share our new episodes every third Thursday of the month. You can visit us at usfa.fema.gov or on social media by searching “usfire.” Until next month, stay safe.