A Greater Focus Needed On Rural Preparedness
Much has been said by the Obama Administration about focusing on first responders to address homeland security preparedness in their communities. As part of the President’s agenda for homeland security, he calls out the need to support first responders with “…increase[d] federal resources and logistic support.” What we have seen in the years since the Department of Homeland Security has been created is a significant focus on urban areas of the country with a risk-informed approach that often resulted in a greater allocation of resources in non-rural communities. With the President’s call, the time is ripe to focus not only the needs of urban areas of the country but on rural areas and the first responders operating therein. The Rural Domestic Preparedness Consortium, or RDPC, is meeting the need of providing DHS certified, tuition-free training which is tailored to address the capability gaps of rural responders; but there are still many needs of rural communities that are left unmet.
Rural EMS agencies were described as the “health care safety net” decades before it was popular for the term to be applied to hospitals, clinics and other resources. One bad result of the 1997 Balanced Budget Act (BBA) was the closure of a number of rural hospitals and home health agencies. Congress responded to those closures by creating the Critical Access Hospital, Rural Health Clinic and Community Health Center programs. No similar program has been established to shore up vulnerable EMS agencies. I prefer to call rural EMS agencies the “final health care safety net.” While there have been closures of rural EMS agencies as a result of the BBA, communities recognize that EMS is that final safety net, and rather than let them close, many have adopted different ways of doing business, often substituting local taxes for reduced fee-for-service payments. This has resulted in longer response times and less advanced (paramedic) resources.
The typical rural EMS agencies fill three roles: public health, public safety and health care/transportation. Because of this, federal support is split between three federal agencies; the Department of Health and Human Services (DHHS), the Department of Homeland Security (DHS), and the Department of Transportation (DOT). The Federal Communications Commission also plays a role in EMS and public health issues. Most of the national public safety and EMS associations favor a focus split between these three agencies over having a single national agency responsible for supporting EMS. Unfortunately, because these three agencies have other parts of the system for which they are wholly responsible, none of the three has adequate budget authority to do a good job providing leadership for EMS.
Federal support for the major models of EMS services (public safety based – police or fire, non-profit, hospital-based and independent) needs to be increased; from including access to critical funding and programs to increasing budgets of the federal agencies such as the EMS office at DOT, which is currently the only dedicated EMS support office.
I also favor the approach of the three departments having responsibility for EMS because of its unique ternary mission. But, it is time for the administration and each of the departments to step up to the plate to recognize the critical role of rural EMS agencies, to prioritize the functions of EMS that are in their mission, and to focus more grants and programs like RDPC to supporting them.
What are some other high priority rural homeland security needs, in any discipline, that are currently not being addressed which you would encourage the new administration to remedy?