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By Tom Arkins, MSHI, EMT-P;
Brenden Hayden, BHA, NRP;
Brandon Morshedi, MD, DPT, FACEP, FAEMS, NRP, FP-C, CCP-C, TP-C, CP-C;
Mike Taigman, MA, NRP

Over the past several days, the National Emergency Medical Services Advisory Council (NEMSAC) has received significant public attention.

| MORE: National EMS Advisory Council board members terminated

As an EMS clinician, you may be saying to yourself any of the following:

• What is the NEMSAC, and why does it matter to me?
• I鈥檝e been working in EMS for decades and never heard of them, so they must not be important!
• I鈥檝e heard of them, but I don鈥檛 think the work they do is that important or meaningful.
• Since I鈥檝e never heard of them and don鈥檛 know what they鈥檝e done, maybe they deserved to be terminated!
• I read that they were just focused on DEI initiatives and climate change and haven鈥檛 been meeting in a long time, so it was time for a change!
• They鈥檝e been serving for too long, so it鈥檚 good to have them all terminated so we can get some fresh ideas in there!

If any of these statements above apply to you or if you want to learn more about NEMSAC or its recent termination, read on!

As a profession, we are all facing similar key issues and challenges, and it is important now more than ever to not only unify our voice to make positive change happen for our field, but to also educate ourselves as to how the change occurs so we can use our tools and resources properly and in the most efficient manner possible.

There are ~1M licensed EMS professionals in the U.S., but only ~14,000 subscribe to the to stay up to date on key EMS issues at the federal level.

Additionally, only ~400-500 engage with the NEMSAC quarterly meetings and read the advisories written and published by NEMSAC.

Although we are usually busy and many of us are involved at the local level with impacting positive change on behalf of our profession, we must understand how the process works at the federal level to truly gain insight into how our industry change takes place.

To put it plainly and to give the punch line up front:

The termination of the entire NEMSAC is a loss of the only federal voice that EMS had and an interruption in the key mechanism to effect change at the Executive Branch of the federal government. EMS no longer has a seat at the federal table at a time when we are facing an existential crisis, while simultaneously being tasked with the responsibility of being the safety net of the healthcare system. Without NEMSAC, the Executive Branch must instead rely on its internal processes to determine what is best for EMS, which lies at the crucial and complicated intersection between healthcare, public health, public safety and emergency preparedness.

Currently, NEMSAC represents the lone voice of EMS at the federal level to advise the Executive Branch of the U.S. Government. It provides a mechanism for key issues to be heard directly by those Cabinet-level departments that impact EMS at all levels of the federal government, beyond just the U.S. Department of Transportation.

Without NEMSAC鈥檚 voice, we must now rely even more heavily on our professional associations and organizations (e.g., NAEMSP, NAEMT, AAA, IAFF, IAFC, NREMT, NASEMSO, NAMIHP, etc) to effect change. However, their voices are heard through lobbying efforts at the Legislative Branch level with advocacy for new legislation and changes to rules and regulations.

This article explains the council鈥檚 purpose, its impact on the EMS profession, and addresses common misconceptions circulating on social media.

| MORE: NEMSAC dismantled: Inside the fallout shaking federal EMS policy

What is NEMSAC?

Established in 2007, was created to provide EMS with a unified voice at the national level. Members are appointed by the U.S. Secretary of Transportation and serve 2-year terms, with the possibility of one reappointment. No member may serve more than 4 consecutive years.

NEMSAC is a volunteer body, appointed based on their experience and qualifications, and must be actively working within their specific sector they are chosen to represent. Members are not paid and receive only reimbursement for travel, lodging and per diem expenses while attending quarterly meetings in Washington, D.C. NEMSAC members use their own vacation time to attend meetings. They also receive no compensation for their multiple monthly subcommittee meetings (six subcommittees in total), which are conducted virtually. The work of NEMSAC can be nearly a full-time volunteer commitment from these professionals who also work full-time in their respective sectors.

Rather than representing the special interests of any one professional association or organization, NEMSAC is comprised of 25 members from 25 different 鈥淪ectors鈥� of EMS, and thus represents the most non-partisan, comprehensive and collaborative voice of EMS professionals in the country. Its membership is the best of us who should represent us and the interests of the EMS profession.

Who does NEMSAC advise?

NEMSAC provides formal recommendations and advisories to:

• The Secretary of Transportation on matters relating to EMS issues affecting the including the (NHTSA) (OEMS)
• The (FICEMS)

What is NEMSAC NOT?

NEMSAC is not a federal agency, association or organization. The members are civilians and recognized as subject matter experts within their respective Sectors. They are not employed by the federal government. By Charter, the members of NEMSAC are expressly prohibited from any lobbying efforts or activities on behalf of EMS and must maintain non-partisan viewpoints in their work product as a Council.

NEMSAC members are prohibited from advertising or marketing their position on NEMSAC or using their NEMSAC appointment for personal gain on behalf of themselves, their employer or any affiliated or interested EMS stakeholder. NEMSAC members are also prohibited from speaking individually about NEMSAC work products or business. NEMSAC speaks with one voice and only while seated and in session.

NEMSAC does not make or change rules or regulations, they do not create laws or set budgets, and they are not responsible for any allocation of funding at the federal level. They have no regulatory authority. They are not responsible for EMS being under the Department of Transportation.

Where does NEMSAC get its authority?

With FICEMS being formed in 2005 and recognizing that they are federal employees who all come from respective federal departments that affect EMS in various ways, they wanted to create an Advisory Council of subject matter experts to help inform FICEMS of how to best move forward on any variety of issues that can impact EMS.

Therefore, NEMSAC was established in 2007 and recently updated to be established pursuant to Section 31108 of the Moving Ahead for Progress in the 21st Century Act of 2012, in coordination with the Secretary of Health and Human Services and the Secretary of Homeland Security. The NEMSAC operates in accordance with the provisions of the Federal Advisory Committee Act (FACA), established in 1972 and regulates the nearly 1,000 different federal advisory councils across the country.

The Charter is renewed every odd-numbered year for the following 2 years and establishes the objectives, scope of activities, description of duties, reporting structure, support, cost, number and frequency of meetings, membership and designation, and subcommittee structure. The most recent Charter was published on in 2021. The current membership, which was just terminated, was appointed under the renewed Charter in 2023. The Charter was scheduled to be renewed again in April 2025.

Who serves on the council?

The 25 council members represent a broad spectrum of EMS stakeholders, from dispatchers to trauma surgeons. Each Sector was chosen by FICEMS in advance because of its unique contribution to the field of EMS. Each appointee to that Sector must be actively involved in an EMS-related role within that Sector to ensure the council reflects the up-to-date realities of the field. Failure to be actively involved in that Sector is grounds for dismissal from the Council. The 25 Sectors are as follows, and NEMSAC does not have the authority to add or remove Sectors:

What has NEMSAC contributed?

While NEMSAC does not have direct regulatory authority, it has shaped national conversations and created standards by advising federal partners on critical EMS issues. To date, NEMSAC has published a total of 66 advisories and letters to , (although 18 were removed recently). Review of the 18 removed advisories finds, amongst a number of factors, that their language supports enhancement of EMS services primarily for underprivileged regions and populations, which NEMSAC considers a key operational, ethical and moral consideration for EMS.

In addition to formal advisories and letters, NEMSAC鈥檚 work is often referenced by a variety of entities as expert opinion and advice based on the rigorous and lengthy process that is entailed in developing these important advisories and letters.

Over the past 18 years, and especially recently, NEMSAC鈥檚 grassroots advocacy touched every corner of our profession:

• The push for essential service designation
• Strategies for workforce recruitment and retention
• Improved funding and reimbursement
• Patient care advancements
• Wellness and resiliency initiatives
• Safety and scope of practice considerations
• Reduction of hospital wall times
• Treat-in-place and transport-to-alternate-destination (TIP/TAD) initiatives
• Medication shortage solutions
• Education
• Technology integration
• And so much more

Their work was not abstract 鈥� it directly shaped the future of EMS for providers and patients alike.

Over the previous 2-year Charter, the NEMSAC body that just terminated was the most productive in the 18-year history of NEMSAC, with 25% of the total body of work performed in NEMSAC鈥檚 history completed in just the past 2 years. Furthermore, NEMSAC was on track to have another record year in 2025 and publish another 14 key advisories and letters with nearly 100 different recommendations to the FICEMS and the federal government on ways to improve EMS. Now these Advisories are essentially on hold with no continuity planned for the next Council.

Despite being posted to for public viewing and being available for 6 months for public comment before posting, most EMS professionals have not been aware of or read these published Advisories and Letters. Regardless, as the work product of the Council, they are highly impactful to patient care and can be used to advocate for change at the state and local level, as NEMSAC is widely recognized as the subject matter voice of expertise for the EMS profession as a whole.

NEMSAC myth vs. fact

• Myth: 鈥淣EMSAC is a paid political organization.鈥�
• Fact: None of the members of NEMSAC are asked for a political affiliation when applying, and none of the members are paid for their work. Historically, despite coming from various parts of the country and from various political backgrounds, NEMSAC has and always will be non-partisan in the work it conducts.
  
• Myth: 鈥淣EMSAC has not met in a year.鈥�
• Fact: The last publicly held meeting for NEMSAC was Nov. 6, 2024. The next scheduled in-person Council meeting was in February 2025. However, shortly after the presidential transition of power in January 2025, all federal advisory council meetings were put on hold, whether in-person or virtual. Therefore, NEMSAC was prohibited from meeting quarterly in person, as well as from conducting our six virtual subcommittee meetings every month to continue the work of NEMSAC. The decision to not meet was a governmental decision forced upon NEMSAC and was not the will of the Council.
  
• Myth: 鈥淣EMSAC was focused on climate change.鈥�
• Fact: NEMSAC explores a wide range of issues impacting EMS, from ambulance deserts to clinical documentation. Guest speakers 鈥� including one in early 2024 鈥� informed NEMSAC on the new standard of care for treating exertional heat stroke (EHS) with immediate cold water immersion on-scene as a definitive means of significantly reducing mortality. NEMSAC does not and did not address climate change specifically, but advised on the clinical conditions seen from such environmental changes, including fireground rehab and EMS professionals who are in danger while working in these conditions. The advisory focused nearly exclusively on the management of heat-related illnesses to inform best practices, standard of care, education updates, etc. However, this letter was one of the 18 advisories and letters that have since been removed from EMS.gov. Special guest speakers often provide updates on topics to help inform NEMSAC on how to provide recommendations, but do not dictate the recommendations formulated by NEMSAC.
  
• Myth: 鈥淣EMSAC was focused on DEI.鈥�
• Fact: Every member of NEMSAC believes that patients receiving EMS care should be treated equally and have access to the same level of care, no matter where they live or their personal background. NEMSAC was working on an advisory that addressed ambulance deserts, where EMS is not readily accessible, and unfortunately is a significant problem in this country. Additionally, NEMSAC was crafting an advisory to update documentation best practices to remove outdated terminology and include more patient-centric language, something we should all be striving toward.
  
• Myth: 鈥淣EMSAC can move EMS out from under DOT.鈥�
• Fact: NEMSAC does not have the authority to make such a change at the federal government level. EMS was first put under NHTSA because it was focused on , also known as the EMS 鈥淲hite Paper.鈥� Currently, NEMSAC believes that FICEMS serve as the key regulatory group that oversees EMS at the federal level, with DOT/NHTSA being a key player on FICEMS, but working collaboratively with many other Cabinet-level departments. The funding at the federal level is more robust for EMS through DOT/NHTSA, and due to DOT being a smaller Department, EMS receives more attention. It is the belief of NEMSAC and many industry experts that EMS crosses multiple federal Departments and is currently better served under DOT to preserve allocated funding. Moving to another Department would likely mean losing existing funding and starting over. Ultimately, EMS is 鈥渞egulated鈥� at the state level in every state. However, guidance and funding come from DOT/NHTSA through the Office of EMS.
  
• Myth: 鈥淣EMSAC can separate EMS from fire.鈥�
• Fact: NEMSAC does not have the authority to do this, nor would this be advantageous for the EMS profession. The fire service is a crucial provider of EMS services nationwide, and NEMSAC appreciates that EMS is offered in a variety of service models that work well for that specific community. Regardless of the service model utilized, NEMSAC has a desire to ensure the highest quality of care is delivered by the entity serving that community.
  
• Myth: 鈥淣EMSAC can make EMS an essential service.鈥�
• Fact: The decision to make EMS an essential service is determined and regulated at the state level, not the federal level. NEMSAC can make recommendations for states to move toward this designation, and in fact made such recommendations in a 2022 advisory to FICEMS.

• Myth: 鈥淣EMSAC is influenced by commercial interests.鈥�
• Fact: All NEMSAC members are required to report any conflicts of interest initially before appointment and at each quarterly meeting during their entire term. The Council tries to ensure that recommendations are not influenced by commercial vendors when writing about a topic. Occasionally, outside vendors, along with professional associations and organizations, will present on various topics to inform NEMSAC on issues that directly affect EMS. This information is then used in its full context to develop advisories that seek to improve the delivery of EMS nationwide without any commercial influence or endorsements. Furthermore, the current NEMSAC has modified its quarterly meetings to allow each of the large national stakeholder organizations time to present issues that directly affect or impact their constituents so that NEMSAC can be even more informed of current matters and create timely advisories with recommendations for FICEMS to address these critical issues of value to our stakeholders.
  
• Myth: 鈥淣EMSAC needs evidence-based ideas.鈥�
• Fact: Every NEMSAC Advisory entails an extensive amount of research on the current scope of the issue, informed by EMS stakeholders and industry experts, as well as individual literature reviews from Council members. All available data is considered, and when data or current information is unavailable to properly inform recommendations to address an issue, NEMSAC often advises the development of mechanisms to collect data so that truly informed recommendations can occur.
  
• Myth: 鈥淣EMSAC hasn鈥檛 produced any new ideas.鈥�
• Fact: The current NEMSAC that was recently terminated was the most productive NEMSAC in the Council鈥檚 18-year history. They produced a record number of Advisories and Letters in the first 21 months of their term, comprising 25% of the entire Council鈥檚 work since its inception in 2007. They had 14 active Advisories and Letters in development simultaneously on a multitude of various critical topics at the time of their termination, which will not be allowed to move to completion. Prior to being prohibited from meeting, the current appointed Council was scheduled to finalize six Advisories at the final meeting of their term in February 2025. With the expected new Charter in April 2025, the anticipated newly appointed NEMSAC members were slated to have continuity with the existing members staying for a second term and work together to complete and publish another record number of Advisories for FICEMS. The assertion that NEMSAC has not been producing work of any consequence or in an expected volume is completely unfounded.

NEMSAC explained: Summary & conclusion

In summary, NEMSAC exists to ensure that EMS has a respected and informed voice at the federal level. While the council does not set regulations or control funding, its advisories directly influence national policy discussions, highlight critical challenges, and promote solutions that protect both patients and clinicians. Dispelling the myths and recognizing the true role of NEMSAC helps EMS professionals better understand how their interests are represented in Washington, D.C. 鈥� and why continued support for this council is essential to the future growth, recognition and sustainability of EMS.

As EMS clinicians and leaders, we are all called to be advocates. It is up to us to stay informed, share accurate information and raise our collective voice. Whether through professional associations, contacting elected officials, or engaging in local and national initiatives, every clinician has a role in ensuring EMS is heard and valued. The future of our profession depends not only on councils like NEMSAC, but also on our willingness to stand together and advocate for the recognition and resources EMS deserves.

ABOUT THE AUTHORS
Brandon Morshedi, MD, DPT, FACEP, FAEMS, NRP, FP-C, CCP-C, TP-C, CP-C, is the former acting chair of the NEMSAC.

Brenden Hayden, BHA, NRP, is the former chair of the NEMSAC.

Mike Taigman, MA, NRP, is the former acting vice chair of the NEMSAC.

Tom Arkins, MSHI, EMT-P, is the former vice chair of the NEMSAC.

麻豆蜜桃mv在线观看 readers respond

鈥淭his is really disheartening. I wrote the testimony for Senator Collins (R-ME) when she led the effort to create the NEMSAC in Congress. The IOM report in 2006 called for a national office to support EMS. When it was clear the politics were not going to let that happen many of us worked with Dr. Jeff Runge and Drew Dawson to create the FICEMS and then NEMSAC. Having served on the NEMSAC with Drew, Susan McKinley, and Dia Gainor I can attest to the long term impact of this low cost, high value effort and thank the numerous leaders across the country who have volunteered their time to NEMSAC and the goal of ever improving our EMS system.鈥�

鈥淲here did the directive to terminate the board come from? Is this a DOGE decision?鈥�

鈥淎fter reading your article as well as being a past member of the NEMSAC, I鈥檓 extremely disappointed of the recent mass termination of this very important & EMS informational group. As a past member representing Volunteer EMS, we reviewed & found new & safer techniques to respond to EMS situations to shared to save lives. And yes there are still Volunteers in EMS nationwide. The person responsible who decided this action, should take a good close at themselves and realize what a huge mistake is being made. So the next time your having an emergency medical situation, where ever you at, just think who will show up to treat you.鈥�

鈥淒id you solve hospital hallway waiting? No? That鈥檚 reason enough. Thank you, you鈥檙e dismissed.鈥�