Over the past year and half, there has been much discussion about exactly who is essential and who is not. When it comes to workers, jobs previously viewed as entry level for the unskilled and the semi-educated, now rank as “essential.”

It wasn’t always this way. Pre-pandemic, we thought of “essential workers” in terms of public safety and the subject was discussed in response to some natural disaster—a hurricane, earthquake, or tornado. In that context, this usually meant police and fire. After 9/11, that definition expanded; in the face of terrorism “essential” came to include those involved with “critical infrastructure.”

Yet surprisingly, at least in New Jersey, “essential” doesn’t include Emergency Medical Services (EMS). There is legislation in Trenton that would classify EMS as essential, and given the last two years, it’s time that EMS receive its due. Currently there’s a patchwork of EMS around the state—whether privatized, volunteer-based, or EMS as a municipal function.

Recognizing EMS as essential—in the same way that police, fire, and sanitation is—goes beyond cosmetics. First and foremost, it moves EMS from the category of a service a municipality might choose to provide into the category of a service they must provide. Currently, municipalities are not required to provide ambulances with certified Emergency Medical Technicians or EMTs.

Should you or a loved one have a medical emergency, you better hope it happens in a jurisdiction where they have adequate EMS. If not, you may be waiting. In emergency medicine, time is critical, whether we’re talking trauma or cardiac. We all want the maximum benefits that modern medicine can provide and that’s not unreasonable; formally recognizing EMS as essential would ensure those benefits are available outside of and enroute to the emergency room.

That’s not a criticism of volunteers as there are few things nobler in civic life than a dedicated volunteer responding to an emergency. It’s just that running things this way is becoming harder. Not being classified as essential greatly limits the types of federal and state grants and resources that might otherwise be available.

As for privatized services, individual EMTs are great but what happens if corporations give in to the temptation to maximize profits at the expense of coverage by dropping minimum staffing, exploiting mutual aid, or prioritizing calls from neighborhoods perceived as being better insured and more likely to pay than those perceived to be less likely to pay? Someone will insist it would never happen, but I take that claim the same way I take Facebook when they talk about protecting my personal information.

As we enter the third decade of the 21st century, medicine can do remarkable things. Yet we struggle with stepping up our game when it comes to ambulances and the people who staff them. By classifying EMS as essential, we will move this life-saving service from an elective to a requirement with standards for staffing, training, equipment, and response times. This will help raise the level of compensation for EMTs—no small thing given what we ask when we call them.

The other side of the coin is that we’ll necessarily need to support EMS through our tax dollars instead of through hit-or-miss reimbursement rates, hoping patients pay when the bill comes, and asking rescue squad members to stand hat-in-hand at busy intersections on holiday weekends to raise funds from passing motorists. EMS is essential, if you doubt that, just ask the patients. n