What can EMS learn from 100 years of the National Park Service?

Yellowstone, Yosemite, Glacier and the Grand Canyon are among the crown jewels of America that are under the stewardship of the National Park Service. Since August 25, 1916 the staff and volunteers of the federal agency have protected 412 national parks, monuments, battlefields, military parks, historical parks, historic sites, lakeshores, seashores, recreation areas, scenic rivers and trails and the White House.

Last week I visited several parks and monuments in South Dakota and Wyoming. During my hikes and explorations I contemplated the NPS 100-year anniversary and the lessons EMS leaders and providers can draw from the agency as it looks forward to its second century.

1. Uniformity from park to park
Park rangers have a distinct uniform, regardless of their work location or position in the NPS. Park visitors can quickly identify a ranger by the gray shirt, green pants and tan hat with a band. All park staff wear an NPS patch on their left shoulder.

EMS provider uniforms vary widely in color, styling and formality. Our uniforms are sometimes indistinguishable from law enforcement, often carry more fire department branding or try to carry over the trim of hospital scrubs or lab coats.

NPS vehicles are white with a single green stripe. NPS fire vehicles have a red stripe. Vehicle branding and specifications, likely easing purchasing across the NPS, is consistent.

2. A variety of services is available for visitors with different needs and wants
The NPS offers a multitude of services to meet the needs and interests of visitors. Front-country driving routes, scenic overlooks and interpretive programs cater to the majority of visitors looking to have a short-duration, low intensity experience. A smaller group of visitors can journey deep into the backcountry and wilderness of the larger parks. Devils Tower in Wyoming, the first national monument, offers visitors scenic views, ranger-led programs, overnight camping, hiking trails and rock climbing.

EMS, through programs like community paramedicine, is just beginning to explore how it might cater its expertise and service offerings to the people they served. For most agencies it is no longer enough to simply be a 911 response agency. EMS, in the second half of its first century, will interact with its customers through a combination of short patient contacts, ongoing community outreach programs and long-term connections with high-frequency utilizers.

3. Predictable, transparent fees are charged for access and experiences
The NPS charges an entrance fee for some of its properties and then visitors pay additional fees for experiences like overnight camping at the Badlands National Park or an interpretive tour of the Jewel Cave. In addition visitors can make donations to parks and a percentage of gift shop receipts are returned to the park. The fee system, though it varies from park to park, is expected, predictable and transparent to park visitors.

When a patient asks, "What will this ambulance ride cost?" the best answer is usually, "It depends." EMS fees depend on insurance coverage, level of service provided and local practices for billing. The specific cost, before providing care is rarely predictable or transparent.

4. Paid staff, volunteers and contractors work together as a team
The NPS provides services to visitors with 22,000 professional staff and 221,000 volunteers. The paid staff likely have specialized training and are considering the NPS as a career. Volunteers, often with unique expertise, are able to supplement the paid staff, support the different needs of the park and contribute in areas aligned with their interests. There are likely some parks with high numbers of professional staff and only a handful of volunteers. As well as some parks that are highly reliant on volunteers.

Is the 10 volunteers to one paid staff a comparable ratio for combination EMS departments to consider? The high participation of volunteers in the NPS might point to opportunities for public EMS agencies with all paid staff to integrate community-minded volunteers into non-clinical areas of operations.

The NPS also shifts some of the visitor experience and care to concessions operators. Hotels, restaurants, retail stores and recreational tours are often the domain of contactors working inside the park and within the regulations set by the NPS. The use of contractors is familiar to EMS agencies that contract certain types of calls, such as non-emergent transfers to private providers. Patient billing, staff hiring, education and fleet maintenance are other areas to consider contracting to a concession operator.

5. Career advancement and mobility
NPS professionals are able to, and often expected, to move between parks to advance their careers. Their knowledge, skills and abilities are transferable throughout the system. We met an interpretive ranger and educator at Devils Tower who was at his fourth park, including previous stints at Everglades National Park and Shenandoah National Park. He expects to be at Devils Tower for several years before moving to his next assignment.

Local protocol approval processes and licenses, based on state-specific scope of practice documents, make it difficult for paramedics to move between systems within a state and nearly impossible to move to services in different states. The Recognition of EMS Personnel Licensure Interstate Project is model legislation for States to make it easier for EMS providers licensed in one state to practice in other states. Making it easier for EMS professionals to move between organizations, including transition from the military to civilian EMS, is essential to the future of EMS.

Have you worked in a National Park as a paramedic or EMT? Tell us about your experience in the comments. What are other lessons for EMS from the NPS? Find Your Park to join in the NPS celebration.

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