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Summary
Pages 1-14

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From page 1...
... It includes emergency calls to 9-1-1; dispatch of emergency personnel to the scene of an illness or trauma; and triage, treatment, and transport of patients by ambulance and air medical service. The speed and quality of emergency medical services are critical factors in a patient's ultimate outcome.
From page 2...
... Coordination of the regional flow of patients is an essential tool in ensuring the quality of prehospital care, and also plays an important role in addressing systemwide issues related to hospital and trauma center crowding. Regional coordination requires that many elements within the regional system -- community hospitals, trauma centers, and particularly prehospital EMS -- work together effectively to achieve this common goal.
From page 3...
... And medical equipment, including air ambulance service, has extended the care available to emergency patients, for example, by bringing rural residents within closer range of emergency and trauma care facilities. Systemic Problems Despite the advances made in EMS, sizable challenges remain.
From page 4...
... • Divided professional identity -- EMS is a unique profession, one that straddles both medical care and public safety. Among public safety agencies, however, EMS is often regarded as a secondary service, with police and fire taking more prominent roles; within medicine, EMS personnel often lack the respect accorded other professionals, such as physicians and nurses.
From page 5...
... In this new system, dispatchers, EMS personnel, medical providers, public safety officers, and public health officials will be fully interconnected and united in an effort to ensure that each patient receives the most appropriate care, at the optimal location, with the minimum delay. From the patient's point of view, delivery of services for every type of emergency will be seamless.
From page 6...
... Thus while EMS is a medical discipline, the National Highway Traffic Safety Administration became its first federal home, and it has remained the informal lead agency for EMS ever since. The need for a formal lead agency for emergency care has been promoted for years, and was highlighted in the 1996 report of the National Highway Traffic Safety Administration Emergency Medical Serices Agenda for the Future.
From page 7...
... The working group should include representatives from federal and state agencies and professional disciplines involved in emergency and trauma care (3.5) .1 This lead agency would be designed to create a large, combined federal presence to increase the visibility of emergency and trauma care within the government and to the public; coordinate programs to eliminate overlaps and gaps in funding; create unified accountability for the performance of the emergency care system; and bring together multiple professional groups and cultures for interaction and collaboration that would model and reinforce the integration of services envisioned by the committee.
From page 8...
... To that end, the committee recommends that the Department of Health and Human Services and the National Highway Traffic Safety Administration, in partnership with professional organizations, convene a panel of individuals with multidisciplinary expertise to develop evidence-based categorization systems for emergency medical services, emergency departments, and trauma centers based on adult and pediatric service capabilities (3.1)
From page 9...
... The National EMS Scope of Practice Model Task Force has created a national model to aid states in developing and refining their scope-of-practice parameters and licensure requirements for EMS personnel. The committee supports this effort and recommends that state governments adopt a common scope of practice for emergency medical services personnel, with state licensing reciprocity (4.1)
From page 10...
... In addition, deployment of air medical services often is not well coordinated. While air medical providers are not permitted to self-dispatch, a lack of coordination at the ground EMS and dispatch level sometimes results in multiple air ambulances arriving at the scene of a crash even when all are not needed.
From page 11...
... However, questions remain regarding the clinical efficacy and appropriateness of sophisticated air ambulance care, as well as its cost-effectiveness, given that the cost can be more than five times greater than that of ground ambulance service. In addition, in recent years there has been a significant increase in fatal crashes involving air ambulances, resulting in heightened safety concerns.
From page 12...
... The committee recommends that the Department of Health and Human Services, the Department of Transportation, the Department of Homeland Security, and the states elevate emergency and trauma care to a position of parity with other public safety entities in disaster planning and operations (6.1)
From page 13...
... . Moreover, to address the sizable gaps in the knowledge base supporting EMS, the committee recommends that federal agencies that fund emergency and trauma care research target additional funding at prehospital emergency medical services research, with an emphasis on systems and outcomes research (7.1)
From page 14...
... EMS is now at a crossroads. In the 40 years since the publication of the landmark National Academies report Accidental Death and Disability: The Neglected Disease of Modern Society, much progress has been made in improving the nation's EMS capabilities.


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