integrate EMS providers across regions within the same state. All of this limits the flexibility of EMS resources both during disasters, and for more routine purposes such as maintaining the fluidity of our industry’s labor resources. It would therefore be prudent for states to take action to enable greater portability of EMS licensure. One such action being promoted by the National Association of State EMS Officials (NASEMSO) involves model compact legislation known as REPLICA (Recognition of EMS Personnel Licensure Interstate Compact). While there is current legislation that allows for some cross-state EMS work during large-scale emergencies – most notably the Emergency Management Assistance Compact (EMAC) – this does not apply for routine operations. As a means to growing and retaining a strong EMS workforce that self-identifies and is externally recognized as a profession, it may be valuable for state and national leaders in EMS to improve the portability of licensure for provider relocation purposes as well. EVALUATE CERTIFICATE OF NEED POLICIES While the regulation of entrants into EMS may be an important tool to maintain quality, local policymakers need to evaluate all the tools at their disposal to foster local innovation. By transforming to a model where the primary service has a “right of first refusal,” it is conceivable that new entrants could potentially offer new services, such as non- emergent visits, telehealth, or services integrated with home care, hospice care, and others when the established service is not willing or lacks the
capacity. Recognizing the complexity of this issue, policymakers may wish to proceed cautiously and perform detailed needs assessments prior to implementing changes. UNITED ADVOCACY To effectively innovate, EMS agencies must be allowed to provide safe, appropriate patient care within the carefully considered boundaries of legislation and regulations that are constructed with innovation in mind and with the assistance of EMS experts. In order to overcome some of these legal and regulatory hurdles, it is critical that EMS as an industry, along with its partners in health care, be able to advocate for its needs with a unified voice. This has heretofore proved difficult, and many efforts at improving the landscape for EMS fail due to disagreements within the EMS community. Often these disagreements stem from the competing priorities and intersecting roles of EMS along the three domains of public health, public safety, and health care. There is no regulatory solution to this internal division, but this division must be overcome in order for EMS to advance. Some suggestions are provided in the Regional Coordination chapter. The partners of EMS in the health care community have the potential to greatly enable innovation by advocating alongside us for a more favorable EMS regulatory framework. Finding ways to effectively communicate and collaborate with all stakeholder groups is critical to being able to find and implement new ways to improve patient health outcomes.
MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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