The Affordable Care Act - Challenges and Opportunities to Fire Service-Based EMS


Influencing EMS…The ACA Is Here

By Chief Dennis Compton


The Affordable Care Act (ACA) is being implemented across the country. The implementation has already started and brings challenges and opportunities to Fire Service-Based EMS Systems. There is urgency to the decision points presented in this major shift in EMS. But where, when, and how are leaders across the full spectrum of the fire service addressing them? Implementation may vary from state to state, urban to rural, etc., regarding some specific ACA elements, but there are also consistencies nationally that have clearly emerged:

• Partnerships between hospitals and the medical community at-large are strengthening.

• Fire Service-Based EMS service-delivery options are becoming more enhanced.

• New health care and revenue models are developing.

The extent to which fire department leaders are able to influence the implementation of ACA and its impact in their communities will set the stage for the future effectiveness of their Fire Service-Based EMS Systems…and this is not an overstatement. As political leaders and many in the fire service have communicated in no uncertain terms, the ACA is the law of the land. When fully implemented, it will significantly impact prehospital (9-1-1) emergency medical care. This will affect up to 80 percent of the emergency activity that occurs within many large and small fire department service delivery systems. Its impact will be felt in career, combination, and volunteer fire departments that provide some level of EMS. Fire chiefs, union officials, and other fire department leaders who choose to sit back and take a “let’s wait and see” approach are actually taking the risk that critical opportunities may be lost to their organizations in the process.

Sometimes it can be helpful to revisit a few timeless guidelines that drive the implementation of significant change and how to gain the support of people who control the resources, make the final decisions, and develop policy. The bad news is that there is not a secret formula for successfully accomplishing this every time. The good news is that steps can be taken that will improve the odds of being successful. I am going to share just a few hints in this article. They may seem simple and basic, but they are often overlooked or skipped altogether in the change process. It is very difficult to force people to do what they simply don’t want to do. However, these hints might assist your organization in influencing the decisions of others by helping them understand that what is being proposed is in the best interest of your community…and them as well in their roles as leaders.

Issue Processing Hints

• Become as educated as possible about the subject you are addressing. Then, develop strategic and operational goals and integrate them as important elements of the organization’s strategic plan. These should be outcome based and measurable, with realistic time frames for implementation.

• Identify and make contact with key partners and opinion leaders both internally and externally to encourage their input and support. Be willing to make revisions based on their input and suggestions. These might include regional, state, or even national-level partners. They often include fire service and non-fire service partners as well.

• Identify the resource requirements to implement the goals and objectives that are being set, including how these resources might be provided — and by whom. This is not only critical from an operational standpoint but can also be very helpful to political leaders and other policy level decision-makers. 2 Speaking of Fire

• Work in cooperation with your partners to encourage political leaders and other decision-makers to support what is being proposed. If there is known opposition to what you are proposing, be sure to share that information with them as well.

• When implemented, ensure that ongoing evaluation, revision, and training processes are in place to maximize the effectiveness of the system as a whole. This includes communicating effectively internally and externally with all parties throughout the process.

• For major and/or more controversial issues, this entire process can be most effective when it is done in concert as a labor/management initiative.

The opportunities and transitions coming forth in our Fire Service-Based EMS Systems due to the ACA are extremely timely and important. The opportunities and transitions provide even more incentive for you, your fire departments, as well as regional and state organizations to join the Fire Service-Based EMS Advocates Coalition. Joining might seem like a minor thing, but it is not. Your membership as an Advocate can be very important as the coalition’s steering committee continues its advocacy on behalf of Fire Service-Based EMS at the national level. Go to to sign up...and do it today. There isn’t a fee and it’s easy to do.

The implementation of the ACA will cause critical decisions to be made in the next one to three years that will impact EMS tremendously for many more years to come. Some of these decisions may end up being as important to fire departments as the decisions their leaders made years ago to enter the Fire Service-Based EMS business in the first place. As the fire service knows, our EMS service delivery model in most fire departments is so closely joined and aligned with our fire suppression deployment model that a reduction in EMS resources will also affect fire suppression resources.

People in labor and management will be sharing many more details about these issues as the ACA is phased-in. In the end, the final decisions will be impacted and/or made by elected officials, other policy level decision-makers, community leaders, the health care industry, fire department leaders, private sector EMS representatives, and other stakeholders. The success of the fire service in influencing those decisions in ways that will be in the best interest of public safety and the effectiveness of our fire departments is critical. Being able to do that effectively as an equal partner with others is a reality operationally — and needs to be a leadership and political priority.


About the author:

Chief Dennis Compton is a well-known speaker and the author of several books including his most recent offering titled Progressive Leadership Principles, Concepts, and Tools. He has also authored the three-part series of books titled When in Doubt, Lead, the book Mental Aspects of Performance for Firefighters and Fire Officers, as well as many articles, chapters, and other publications.

Dennis served as the Fire Chief in Mesa, Arizona, for five years and as Assistant Fire Chief in Phoenix, Arizona, where he served for twenty-seven years. Chief Compton is the Past Chairman of the Executive Board of the International Fire Service Training Association (IFSTA) and Past Chairman of the Congressional Fire Services Institute’s National Advisory Committee. He is currently the Chairman of the National Fallen Firefighters Foundation Board of Directors. 



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