The National Academies Press

Currently Skimming:

Index
Pages 273-286

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.

From page 273... ... Index A Agency for Healthcare Research and Quality, 100, 105 Accidental Death and Disability: The research program, 208, 214–215 Neglected Disease of Modern Air medical services Society, 18, 32, 75, 81 accreditation, 85 Accountability capacity and access, 161 fragmentation of EMS system and, 6, 83 coordination of emergency response, importance of, 83 10, 162 model systems, 91, 93, 94, 95 current system, 11, 61 recommendations for performance dispatch decisions, 157–158 indicator development, 11–12, 85 effectiveness, 61–62 shortcomings of current system, 73, 83 government oversight, 11, 161–162, Accreditation 170 of EMS system components, 85 Hurricane Katrina response, 188 national standardization of EMS interfacility transport, 162–163 personnel training, 125, 144 Iraq War experiences, 191–192 of paramedic education, 9 lack of coordination, 74 Acute Injury Care Research Agenda, 217 origins and development, 160–161 Advanced cardiac life support, 32 recommendations, 11, 162, 170 Advanced emergency medical technicians, regional disparities, 24 123 roles and responsibilities, 161 Advanced life support (ALS) safety concerns, 61, 161 ambulance equipment, 158–159 Ambulance services effectiveness, 164 accreditation, 85 field application, 21, 80, 209–210 ambulance crashes, 20, 159–160 fleet characteristics, 55 ambulance design, 159 research efforts, 218 design and capabilities, 27, 33 research needs, 164, 209–210 disaster preparedness funding for, 176 training curriculum, 33, 124 diversion, 22–23, 40–41, 86 transport reimbursement, 47 driver training, 159–160 Read the entire page →
From page 274... ... in rural areas, 65 citizen first responders, 65–66, 140 utilization, 83 origins of EMS system, 1, 32 See also Prehospital care; prehospital care research, 219, 220 Transportation of patient Categorization American Board of Emergency Medicine, of emergency providers, 8, 79–80, 9, 144 114–115 American College of Emergency Physicians of trauma care capabilities, 78, (ACEP) , 35, 78–79, 208 114–115 American College of Surgeons, 35, 78–79, Causes of ED visits, 16–17 85 Centers for Disease Control and Prevention Anthrax, 181 (CDC) Read the entire page →
From page 275... ... , 84 49–50, 113, 213 Defibrillators, automated external, 16, research and, 210, 213, 222, 223 140–141, 218–219 Congress, recommendations for, 6–7, Delayed treatment 13–14, 96, 115, 198, 202, 223, 224, ambulance diversion and, 40–41 226 field stabilization and, 21, 80 Coordination of care response times in rural areas, 63 air medical services, 10, 162 use of ambulance lights and sirens, 220 communication requirements, 76–77 Demonstration projects conceptual development, 34 funding levels, 98 current model systems, 90–91, 92, 93, granting agency, 98–99 94 purpose of grants for, 96–97 current shortcomings, 3, 10, 39–40, 73, rationale, 95–96 74–75 recipients of grants for, 96 demonstration projects to promote, 97 recommendations for, 13–14, 96, 115 disaster response, 201–202 Department of Health, Education and efficiency of care and, 23 Welfare (DHEW) establishment of national agency evolution of emergency medical care for regulation and support, 6–7, system, 33, 34 105–111 See also Department of Health and goals, 5, 9–10, 75–76 Human Services obstacles to, 6, 49 Department of Health and Human Services in pediatric intensive care system, 76 (DHHS) Read the entire page →
From page 276... ... need for coordination, 9–10 evolution of EMS system, 33, 34, 43, prearrival instruction for bystanders, 99 140 recommendations for, 12, 196–197, 202 recognizing nonemergency calls, See also National Highway Traffic 141–142, 157 Safety Administration roles and responsibilities, 141 Disaster Medical Assistance Teams selection of equipment and personnel (DMATs) , 100, 186–187 for response, 157–158 Disaster response training for, 141 accidental man-made disasters, 179 See also 9-1-1 systems biochemical threats, 181–182, 193–194, Dumping of uninsured patients, 48 199–200 certification and licensure for EMS E personnel, 13, 201 challenges, 182, 192, 202 Earthquakes, 178 communications and information Economics systems for, 182, 198–199 challenges for EMS system, 41 coordination of, 201–202 cost-effectiveness of EMS interventions, current readiness, 4, 43, 192–194 23 definition of "disaster," 175 demonstration project grant funding, emergency support functions, 185 98, 115 EMS involvement in regional planning, disaster preparedness funding, 12–13, 176, 196–198 176, 192–193, 197–198, 202 establishment of new lead agency for dispatcher compensation, 141 oversight and support, 108–109, EMS workforce salaries, 4, 42, 136 115 evolution of EMS funding, 2, 18, 31, funding distribution, 12–13, 176, 33, 34, 35, 41 192–193, 197–198, 202 fire-based EMS funding, 57 goals for EMS systems, 27 funding of new lead agency for EMS homeland security funding, 43, 176 system, 110–111 local capacity, 194–196 homeland security funds, 43 National Incident Management System, 9-1-1 systems funding, 151 184 patient transport costs, 48 natural disasters, 178–179, 193–194 possible negative consequences of recent events, 177, 183–192 regionalization, 78 recommendations for, 12–13, 196–197, 198, 200, 202 Read the entire page →
From page 277... ... INDEX recommendations for research, 7–8, shortcomings of current system, 3–5, 114, 116 14, 31, 37–43, 73 research funding, 13, 208, 210, 214– strengths of current system, 3, 16 217, 218, 220–221 Emergency medical technicians (EMTs) , 2 state funding for EMS services, 52 compensation, 42 structure of federal support for EMS, credentialing and certification, 124 43–48 disaster preparedness, 176, 200 See also Costs education curriculum, 123–124 Education. Read the entire page →
From page 278... ... EMERGENCY MEDICAL SERVICES AT THE CROSSROADS G Federal government air ambulance oversight, 161–162 Grant payments to emergency care system demonstration project granting agency, Centers for Disease Control and 98–99 Prevention block grants, 44–46 disaster preparedness funding, 176, demonstration programs for enhancing 192–193, 197–198 emergency care, 14, 96–99 disaster response, 184–185, 201–202 disaster preparedness funding, 12, 46, EMS research funding, 208 193–194, 198 establishment of new agency for federal block grants to states, 18 emergency care system integration, origins and early development, 34, 35, 6–7, 98, 105–111, 115 36 evolution of emergency medical care private funding, 34 system, 18, 31, 32–37, 41, 99 research grants, 221–222 fragmentation of EMS support and regulation, 99, 102 interagency collaboration in EMS, H 100–101 leadership in emergency care, 3 Health Insurance Portability and legislative framework of EMS system, Accountability Act (HIPAA) 48–53, 112–114 impediments to EMS in, 49–50, 113 to promote communications implications for research, 20, 113, 210, interoperability among EMS 213, 222, 223 systems, 166, 167 purpose, 49, 113 research support, 208, 214–217 recommendations for, 113–114, 115 structure of EMS oversight and funding, Health Level Seven, 84 43–48, 99–100 Health, Medical Care and Transportation See also specific goernmental entity of the Injured, 32 Federal Interagency Committee on EMS Health Plan Employer Data and (FICEMS) Read the entire page →
From page 279... ... INDEX J problems in coordination with prehospital care, 39–40 Joint Commission on Accreditation of structure and operations, 58 Healthcare Organizations (JCAHO) , Hurricane Katrina, 175, 176, 178, 182, 85 185–189, 193, 194, 199, 201 Jurisdictions of responders, 10, 23, 38–39 I K Infectious disease Korean War, 33 pandemics and outbreaks, 178–179 public health surveillance, 75 risks for EMS personnel, 20, 41–42, L 137, 159 Influenza pandemics, 178–179 Language barriers, 21–22 Information technologies and systems Leadership for ambulance services, 163, 164, 170 current federal, 43, 52, 99–102 for disaster response, 198–199 disaster response, 201–202 EMS system data, 168–169, 170 establishment of new agency for goals, 167–170, 170 emergency care system, 6–7, 105– Health Insurance Portability and 111, 115 Accountability Act and, 49, 50, 113, Federal Interagency Committee on EMS 210, 213, 222, 223 for, 104–105 interoperability among EMS systems, Hurricane Katrina response, 185, 187 164–165 to promote communications National Health Information interoperability among EMS Infrastructure, 11, 169, 171 systems, 166 9-1-1 caller identification and location, strategies for improving EMS system, 151–154 102–104 patient data, 169, 170 See also Medical directors, EMS for performance measurement, 86 Licensure and credentialing Wireless Public Safety Interoperable air medical services, 161 Communications Program, 167 ambulance services, 158, 159 See also Communications technologies Disaster Medical Assistance Teams, 187 and systems disaster response training, 13, 200–201, Informed consent, EMS research and, 202 212–213, 222–223 emergency medical technician training Injury, accidental requirements, 124 data sets, 169 EMS personnel registration status, 130 preventive interventions, 75, 217 EMS subspecialty certification, 9, as public health problem, 36 143–144 research needs, 19 national EMS certification, 126–127 Injury in America: A Continuing Health national scope of practice model, Problem, 36 122–123 Interagency Committee on EMSC Research reciprocity among jurisdictions, 123, (ICER) Read the entire page →
From page 280... ... 0 EMERGENCY MEDICAL SERVICES AT THE CROSSROADS Longitudinal Emergency Medical Mortality Technician Attribute and air ambulance crashes, 61 Demographic Study (LEADS) , 215 ambulance crashes, 20, 159–160 ambulance diversion and, 40–41 automobile accident, 24 M EMS workforce occupational fatalities, 137 Maryland EMS and trauma system, 35, Mouth-to-mouth ventilation, 1, 32 90–92 Municipal EMS services, 59–60 Medicaid Mustard gas, 181 EMS reimbursement, 41, 46–48 EMS utilization, 52 payment incentives for performance N improvement, 89 state agencies, 52 National Association of Emergency See also Centers for Medicare and Medical Technicians, 35 Medicaid Services National Association of EMS Physicians, Medical directors, EMS 35 payment incentives, 89 National Association of State EMS potential problems, 143 Officials (NASEMO) Read the entire page →
From page 281... ... , 44, compensation, 42, 136 208, 214, 221, 224 disaster preparedness, 176, 200 National Quality Forum, 85 recommendations for training National Registry of Emergency Medical standardization, 125–126, 144 Technicians, 124, 126, 130 roles and responsibilities, 127, 129–130 National Response Plan, 37 scope of practice model, 123 National Standard Curricula, 123–124, supply problems, 134–135 125 training for research, 211 National Trauma Data Bank, 169 Patient-centered care, 21–22 9-1-1 systems Patient characteristics automatic crash notification, 155–157 challenges of special populations, 22–23 caller identification and location, 23, demographics, 16–17 151–154 Medicaid utilization, 52 capacity and utilization, 2, 53, 63, 151 See also Elderly; Pediatric care cell phone calls, 151–154 Pediatric care, 24–25 enhanced, 151, 152–154 challenges in EMS care, 22 establishment of new lead agency for coordination in intensive care system, oversight and support, 108–109, 76 115 emergency transport patients, 16 funding, 151 EMS-C, 35–36, 98, 106, 216–217 next generation, 154–155 prehospital endotracheal intubation, nonemergency calls, 141–142, 157 209–210, 219 origins and development, 2, 150–151 research, 216–217 performance measurement, 86 Pediatric Emergency Care Applied Research prearrival instructions, 54–55, 140, 219 Network (PECARN) , 216–217 regional disparities, 23, 150 Performance measurement strengths of current system, 16 access to data, 12, 88 structure and operations, 27, 53–54, Cardiac Arrest Registry to Enhance 151 Survival, 87 Voice over Internet Protocol, 154 current efforts, 84–85 current EMS effectiveness, 20–21 demonstration project, 97 O information technologies for, 86 Obese patients, 22 key indicators, 86 Omnibus Budget Reconciliation Act (OBRA) Read the entire page →
From page 282... ... EMERGENCY MEDICAL SERVICES AT THE CROSSROADS Q Prehospital care bystander care, 65–66, 140–141 Quality of care categorization of services, 79, 114–115 ambulance diversion and, 40–41 historical and technical development, current system, 4 32–37 financial incentives for performance jurisdictional issues, 10, 23, 38–39 improvement, 88–89 need for coordination, 9–10, 74 measurement, 4 participation in National Health out-of-hospital stabilization, 21, 80 Information Infrastructure, 11 regionalization of services and, 77 patient stabilization out of hospital, 21, 80 recommendations for protocol R development, 8, 80–83, 115 recommendations for research, 13, 221, Radioactive materials exposure, 181 224 Red Cross, 32 research efforts, 218–220 Regional flow of patients, 2 research needs, 42, 163–164, 209–210 Regional variation in EMS systems research rationale, 207 causes of, 95 in rural areas, 63–64 medical oversight and review, 9 safety risks, 19 9-1-1 systems, 23, 150, 153–154 scope of, 15 origins of, 2, 35, 41 strengths of current system, 16 response time, 22 transmission of clinical information, 10 role of demonstration projects, 95–96 See also Air medical services; scope of practice, 122–123 Ambulance services; Dispatch of shortcomings of current system, 2, 53 emergency services; Emergency strategies for enhancing emergency care medical services system; 9-1-1 and, 13 systems as strength, 53 Preventive Health and Health Services, 44 structure of state government EMS Preventive interventions oversight, 50–51 accidental injury, 36 training of EMS personnel, 9, 125 coordination of EMS with public health workforce qualifications, 119 agencies, 75 See also Rural areas Private EMS systems, 58–59 Regionalization of EMS system Public Access Defibrillation (PAD) trial, benefits of, 77–78 218–219 categorization of emergency Public health agencies, coordination departments for, 8 between EMS and, 75 characteristics, 99 Public involvement current model systems, 91, 93–95 citizen first responders, 65–66, 140–141 definition of "region," 26 goals for EMS system, 5–6 implications of Emergency Medical self-triage, 83 Treatment and Active Labor Act, Public perception of EMS system 112–113 performance, 18, 83–84 possible negative consequences of, 78 Public reporting rationale, 2–3, 8, 77–78 of aggregate performance data, 12, 88 recommendations for, 8 current state, 88 in rural areas, 65 forms of, 87 Reimbursement goals, 87–88 efficiency of care and, 23 importance of, 87 federal system, 46–48 Public safety answering points, 53, 141, 151, 154. Read the entire page →
From page 283... ... INDEX incentives for unnecessary transport, Response times 88–89 ambulance diversion and, 22–23 Medicare and Medicaid, 44, 46–48 causes of delay, 22 payment incentives for performance current system, 4, 16 improvement, 89 determinants of, 4 recommendations for research, 7–8, performance measurement, 86 114, 116 in rural areas, 63 state role, 52 variation among EMS systems, 22 Research Rhode Island, 2003 nightclub fire in barriers to, 18, 210–217, 220, 222 West Warwick, 190 current EMS knowledge base, 207, Ricin, 181 208–210 Robert Wood Johnson Foundation, 34 data sources for, 210–211, 212–214, 223 Roles and Resources of Federal Agencies demonstration program for enhancing in Support of Comprehensie emergency care, 13–14, 95–96 Emergency Medical Serices, 19, 33 development of EMS system, 34 Rural areas disaster preparedness, 221 air medical services, 161 establishment of new lead agency for challenges for EMS systems, 42, 62–64 EMS system and, 109 crash fatalities, 24 federal entities for, 208, 214–217 development of EMS system, 36 funding, 13, 208, 210, 214–217, 218, disaster response readiness, 200 220–221, 224 disparities in care, 23–24, 62 goals, 207, 210 EMS workforce characteristics, 132, grant review process, 221–222 138 informed consent issues, 212–213, need for new workforce staffing models, 222–223 138–139 infrastructure for, 210 9-1-1 systems, 63 needs. See Research needs population trends, 138 practice applications, 211 regionalization of services, 65 prehospital care knowledge base, response times, 63 218–220 role of EMS in, 66 priority topics, 223–224 strategies to enhance EMS, 65–66 protections for human subjects, 213– transport costs, 48 214, 222 volunteer-based EMS systems, 60, 62 recommendations for, 13, 220–221, 223, 224, 226 S regulatory environment, 210, 212–214, 222–223 Safar, Peter, 32 strategies for improving, 27, 220–224 Safe, Accountable, Flexible, Efficient training for, 210, 211–212 Transportation Equity Act: A Legacy trauma care, 207–208 for Users (SAFETEA-LU) Read the entire page →
From page 284... ... , 190 2004 terrorist attacks in Madrid, 190 National Response Plan, 184–185 State governments research funding, 221 air ambulance regulation, 161–162, 170 threat types and characteristics, ambulance regulation, 159 179–182 Centers for Disease Control and training for EMS personnel, 43 Prevention block grants, 44–46 See also September 11, 2001, terrorist demonstration programs for enhancing attacks emergency care, 14, 96 Texas EMS and trauma system, 92–93 disaster planning and operations, 12, Tornadoes, 178 201–202 Training of EMS personnel, 27 Emergency Management Assistance accreditation, 9 Compact, 187–188 ambulance drivers, 159–160 EMS oversight, 50–53 disaster response readiness, 4, 13, 43, EMS personnel credentialing and 176, 195–196, 200, 202 certification, 122–123, 124, 126– dispatchers, 141 127, 201 efforts to standardize, 120–121 evolution of EMS system, 35 EMS subspecialty certification, 9, licensing reciprocity between, 123, 137, 143–144 201 first responders, 127 model EMS systems, 90–95 graduation trends, 135 recommendations for, 9, 11, 12, 123, historical development, 33 126, 144, 162, 170 medical directors, 64, 143 Structure of EMS systems model components, 120–121 barriers to research, 210–211 national certification, 126–127, 144 categorization of emergency providers, national core content, 120, 121–122 79–80 national standard curricula, 123–124 communications and, 10, 164 origins and development, 32 establishment of new lead agency, 106, recommendations for, 9, 125–126, 107, 108, 115 143–144, 144, 200, 202 federal oversight and funding, 6, 43–50, regional variation, 119, 125 99–101 for research, 210, 211–212 fire department–based, 56–57 scope of practice model, 120, 121, goals, 78–79 122–123 hospital-based, 58 settings for, 125 local decision making, 53 shortcomings of current system, 41 9-1-1 systems, 53–54 Transportation of patient prehospital care research, 219–220 cost per transport, 48 regional variation in EMS systems, 2, disaster response, 182 164 Read the entire page →
From page 285... ... INDEX W Emergency Medical Treatment and Active Labor Act requirements, Washington state, Seattle EMS system, 38 112–113 Wireless Public Safety Interoperable incentives for unnecessary transport, Communications Program 88–89 (SAFECOM) , 167 interfacility, 162–163 Workforce, 27 Medicaid reimbursement, 41, 52 ambulance working conditions, 159 Medicare reimbursement, 7, 47, 48 calls per week, 132 patient characteristics, 16–17 career development, 136 recommendations for protocol challenges for EMS system, 41–42 development, 8, 80–83, 115 compensation, 4, 42, 136 shortcomings of current system, 3, 10 demographics, 130–132 strengths of current system, 16 dispatchers, 141–142 See also Air medical services; efforts to standardize qualifications and Ambulance services; Prehospital care requirements, 120–121 Trauma care employment, 132, 134 definition, 25 future challenges, 119, 135 research, 207–208 job satisfaction, 135 Trauma center definition, 25 licensing reciprocity between Trauma system, coordination of care in, jurisdictions, 123, 137 76, 78–79 occupational fatalities, 137 Trauma Systems Consultation, 79 professional identity, 4, 42 Triage, 77, 81, 141, 190–192 projected growth, 134, 135 registration status, 130, 133, 134, 137–138 U roles and responsibilities, 127–130 Uniform Prehospital EMS Dataset, 168 rural EMS systems, 42, 63–64, 138–139 Uninsured patients, 48 safety concerns, 19–20, 41–42, 136–137 Urban Area Security Initiatives, 193, 194 size, 15, 132–135 URGENCY Decision Assist software, staffing models, 60 156–157 supply problems, 134–135 variations in education and training, 119 V volunteer-based EMS systems, 60, 137–139 Ventricular fibrillation, 21 See also Emergency medical technicians; Voice over Internet Protocol, 154 Medical directors, EMS; Scope Volunteer-based EMS systems, 60, 62, 188 of practice, EMT and paramedic; Training of EMS personnel World Wars I and II, 32 Read the entire page →

From page 273...

... Index A Agency for Healthcare Research and Quality, 100, 105 Accidental Death and Disability: The research program, 208, 214–215 Neglected Disease of Modern Air medical services Society, 18, 32, 75, 81 accreditation, 85 Accountability capacity and access, 161 fragmentation of EMS system and, 6, 83 coordination of emergency response, importance of, 83 10, 162 model systems, 91, 93, 94, 95 current system, 11, 61 recommendations for performance dispatch decisions, 157–158 indicator development, 11–12, 85 effectiveness, 61–62 shortcomings of current system, 73, 83 government oversight, 11, 161–162, Accreditation 170 of EMS system components, 85 Hurricane Katrina response, 188 national standardization of EMS interfacility transport, 162–163 personnel training, 125, 144 Iraq War experiences, 191–192 of paramedic education, 9 lack of coordination, 74 Acute Injury Care Research Agenda, 217 origins and development, 160–161 Advanced cardiac life support, 32 recommendations, 11, 162, 170 Advanced emergency medical technicians, regional disparities, 24 123 roles and responsibilities, 161 Advanced life support (ALS) safety concerns, 61, 161 ambulance equipment, 158–159 Ambulance services effectiveness, 164 accreditation, 85 field application, 21, 80, 209–210 ambulance crashes, 20, 159–160 fleet characteristics, 55 ambulance design, 159 research efforts, 218 design and capabilities, 27, 33 research needs, 164, 209–210 disaster preparedness funding for, 176 training curriculum, 33, 124 diversion, 22–23, 40–41, 86 transport reimbursement, 47 driver training, 159–160

Read the entire page →

From page 274...

... in rural areas, 65 citizen first responders, 65–66, 140 utilization, 83 origins of EMS system, 1, 32 See also Prehospital care; prehospital care research, 219, 220 Transportation of patient Categorization American Board of Emergency Medicine, of emergency providers, 8, 79–80, 9, 144 114–115 American College of Emergency Physicians of trauma care capabilities, 78, (ACEP) , 35, 78–79, 208 114–115 American College of Surgeons, 35, 78–79, Causes of ED visits, 16–17 85 Centers for Disease Control and Prevention Anthrax, 181 (CDC)

Read the entire page →

From page 275...

... , 84 49–50, 113, 213 Defibrillators, automated external, 16, research and, 210, 213, 222, 223 140–141, 218–219 Congress, recommendations for, 6–7, Delayed treatment 13–14, 96, 115, 198, 202, 223, 224, ambulance diversion and, 40–41 226 field stabilization and, 21, 80 Coordination of care response times in rural areas, 63 air medical services, 10, 162 use of ambulance lights and sirens, 220 communication requirements, 76–77 Demonstration projects conceptual development, 34 funding levels, 98 current model systems, 90–91, 92, 93, granting agency, 98–99 94 purpose of grants for, 96–97 current shortcomings, 3, 10, 39–40, 73, rationale, 95–96 74–75 recipients of grants for, 96 demonstration projects to promote, 97 recommendations for, 13–14, 96, 115 disaster response, 201–202 Department of Health, Education and efficiency of care and, 23 Welfare (DHEW) establishment of national agency evolution of emergency medical care for regulation and support, 6–7, system, 33, 34 105–111 See also Department of Health and goals, 5, 9–10, 75–76 Human Services obstacles to, 6, 49 Department of Health and Human Services in pediatric intensive care system, 76 (DHHS)

Read the entire page →

From page 276...

... need for coordination, 9–10 evolution of EMS system, 33, 34, 43, prearrival instruction for bystanders, 99 140 recommendations for, 12, 196–197, 202 recognizing nonemergency calls, See also National Highway Traffic 141–142, 157 Safety Administration roles and responsibilities, 141 Disaster Medical Assistance Teams selection of equipment and personnel (DMATs) , 100, 186–187 for response, 157–158 Disaster response training for, 141 accidental man-made disasters, 179 See also 9-1-1 systems biochemical threats, 181–182, 193–194, Dumping of uninsured patients, 48 199–200 certification and licensure for EMS E personnel, 13, 201 challenges, 182, 192, 202 Earthquakes, 178 communications and information Economics systems for, 182, 198–199 challenges for EMS system, 41 coordination of, 201–202 cost-effectiveness of EMS interventions, current readiness, 4, 43, 192–194 23 definition of "disaster," 175 demonstration project grant funding, emergency support functions, 185 98, 115 EMS involvement in regional planning, disaster preparedness funding, 12–13, 176, 196–198 176, 192–193, 197–198, 202 establishment of new lead agency for dispatcher compensation, 141 oversight and support, 108–109, EMS workforce salaries, 4, 42, 136 115 evolution of EMS funding, 2, 18, 31, funding distribution, 12–13, 176, 33, 34, 35, 41 192–193, 197–198, 202 fire-based EMS funding, 57 goals for EMS systems, 27 funding of new lead agency for EMS homeland security funding, 43, 176 system, 110–111 local capacity, 194–196 homeland security funds, 43 National Incident Management System, 9-1-1 systems funding, 151 184 patient transport costs, 48 natural disasters, 178–179, 193–194 possible negative consequences of recent events, 177, 183–192 regionalization, 78 recommendations for, 12–13, 196–197, 198, 200, 202

Read the entire page →

From page 277...

... INDEX recommendations for research, 7–8, shortcomings of current system, 3–5, 114, 116 14, 31, 37–43, 73 research funding, 13, 208, 210, 214– strengths of current system, 3, 16 217, 218, 220–221 Emergency medical technicians (EMTs) , 2 state funding for EMS services, 52 compensation, 42 structure of federal support for EMS, credentialing and certification, 124 43–48 disaster preparedness, 176, 200 See also Costs education curriculum, 123–124 Education.

Read the entire page →

From page 278...

... EMERGENCY MEDICAL SERVICES AT THE CROSSROADS G Federal government air ambulance oversight, 161–162 Grant payments to emergency care system demonstration project granting agency, Centers for Disease Control and 98–99 Prevention block grants, 44–46 disaster preparedness funding, 176, demonstration programs for enhancing 192–193, 197–198 emergency care, 14, 96–99 disaster response, 184–185, 201–202 disaster preparedness funding, 12, 46, EMS research funding, 208 193–194, 198 establishment of new agency for federal block grants to states, 18 emergency care system integration, origins and early development, 34, 35, 6–7, 98, 105–111, 115 36 evolution of emergency medical care private funding, 34 system, 18, 31, 32–37, 41, 99 research grants, 221–222 fragmentation of EMS support and regulation, 99, 102 interagency collaboration in EMS, H 100–101 leadership in emergency care, 3 Health Insurance Portability and legislative framework of EMS system, Accountability Act (HIPAA) 48–53, 112–114 impediments to EMS in, 49–50, 113 to promote communications implications for research, 20, 113, 210, interoperability among EMS 213, 222, 223 systems, 166, 167 purpose, 49, 113 research support, 208, 214–217 recommendations for, 113–114, 115 structure of EMS oversight and funding, Health Level Seven, 84 43–48, 99–100 Health, Medical Care and Transportation See also specific goernmental entity of the Injured, 32 Federal Interagency Committee on EMS Health Plan Employer Data and (FICEMS)

Read the entire page →

From page 279...

... INDEX J problems in coordination with prehospital care, 39–40 Joint Commission on Accreditation of structure and operations, 58 Healthcare Organizations (JCAHO) , Hurricane Katrina, 175, 176, 178, 182, 85 185–189, 193, 194, 199, 201 Jurisdictions of responders, 10, 23, 38–39 I K Infectious disease Korean War, 33 pandemics and outbreaks, 178–179 public health surveillance, 75 risks for EMS personnel, 20, 41–42, L 137, 159 Influenza pandemics, 178–179 Language barriers, 21–22 Information technologies and systems Leadership for ambulance services, 163, 164, 170 current federal, 43, 52, 99–102 for disaster response, 198–199 disaster response, 201–202 EMS system data, 168–169, 170 establishment of new agency for goals, 167–170, 170 emergency care system, 6–7, 105– Health Insurance Portability and 111, 115 Accountability Act and, 49, 50, 113, Federal Interagency Committee on EMS 210, 213, 222, 223 for, 104–105 interoperability among EMS systems, Hurricane Katrina response, 185, 187 164–165 to promote communications National Health Information interoperability among EMS Infrastructure, 11, 169, 171 systems, 166 9-1-1 caller identification and location, strategies for improving EMS system, 151–154 102–104 patient data, 169, 170 See also Medical directors, EMS for performance measurement, 86 Licensure and credentialing Wireless Public Safety Interoperable air medical services, 161 Communications Program, 167 ambulance services, 158, 159 See also Communications technologies Disaster Medical Assistance Teams, 187 and systems disaster response training, 13, 200–201, Informed consent, EMS research and, 202 212–213, 222–223 emergency medical technician training Injury, accidental requirements, 124 data sets, 169 EMS personnel registration status, 130 preventive interventions, 75, 217 EMS subspecialty certification, 9, as public health problem, 36 143–144 research needs, 19 national EMS certification, 126–127 Injury in America: A Continuing Health national scope of practice model, Problem, 36 122–123 Interagency Committee on EMSC Research reciprocity among jurisdictions, 123, (ICER)

Read the entire page →

From page 280...

... 0 EMERGENCY MEDICAL SERVICES AT THE CROSSROADS Longitudinal Emergency Medical Mortality Technician Attribute and air ambulance crashes, 61 Demographic Study (LEADS) , 215 ambulance crashes, 20, 159–160 ambulance diversion and, 40–41 automobile accident, 24 M EMS workforce occupational fatalities, 137 Maryland EMS and trauma system, 35, Mouth-to-mouth ventilation, 1, 32 90–92 Municipal EMS services, 59–60 Medicaid Mustard gas, 181 EMS reimbursement, 41, 46–48 EMS utilization, 52 payment incentives for performance N improvement, 89 state agencies, 52 National Association of Emergency See also Centers for Medicare and Medical Technicians, 35 Medicaid Services National Association of EMS Physicians, Medical directors, EMS 35 payment incentives, 89 National Association of State EMS potential problems, 143 Officials (NASEMO)

Read the entire page →

From page 281...

... , 44, compensation, 42, 136 208, 214, 221, 224 disaster preparedness, 176, 200 National Quality Forum, 85 recommendations for training National Registry of Emergency Medical standardization, 125–126, 144 Technicians, 124, 126, 130 roles and responsibilities, 127, 129–130 National Response Plan, 37 scope of practice model, 123 National Standard Curricula, 123–124, supply problems, 134–135 125 training for research, 211 National Trauma Data Bank, 169 Patient-centered care, 21–22 9-1-1 systems Patient characteristics automatic crash notification, 155–157 challenges of special populations, 22–23 caller identification and location, 23, demographics, 16–17 151–154 Medicaid utilization, 52 capacity and utilization, 2, 53, 63, 151 See also Elderly; Pediatric care cell phone calls, 151–154 Pediatric care, 24–25 enhanced, 151, 152–154 challenges in EMS care, 22 establishment of new lead agency for coordination in intensive care system, oversight and support, 108–109, 76 115 emergency transport patients, 16 funding, 151 EMS-C, 35–36, 98, 106, 216–217 next generation, 154–155 prehospital endotracheal intubation, nonemergency calls, 141–142, 157 209–210, 219 origins and development, 2, 150–151 research, 216–217 performance measurement, 86 Pediatric Emergency Care Applied Research prearrival instructions, 54–55, 140, 219 Network (PECARN) , 216–217 regional disparities, 23, 150 Performance measurement strengths of current system, 16 access to data, 12, 88 structure and operations, 27, 53–54, Cardiac Arrest Registry to Enhance 151 Survival, 87 Voice over Internet Protocol, 154 current efforts, 84–85 current EMS effectiveness, 20–21 demonstration project, 97 O information technologies for, 86 Obese patients, 22 key indicators, 86 Omnibus Budget Reconciliation Act (OBRA)

Read the entire page →

From page 282...

... EMERGENCY MEDICAL SERVICES AT THE CROSSROADS Q Prehospital care bystander care, 65–66, 140–141 Quality of care categorization of services, 79, 114–115 ambulance diversion and, 40–41 historical and technical development, current system, 4 32–37 financial incentives for performance jurisdictional issues, 10, 23, 38–39 improvement, 88–89 need for coordination, 9–10, 74 measurement, 4 participation in National Health out-of-hospital stabilization, 21, 80 Information Infrastructure, 11 regionalization of services and, 77 patient stabilization out of hospital, 21, 80 recommendations for protocol R development, 8, 80–83, 115 recommendations for research, 13, 221, Radioactive materials exposure, 181 224 Red Cross, 32 research efforts, 218–220 Regional flow of patients, 2 research needs, 42, 163–164, 209–210 Regional variation in EMS systems research rationale, 207 causes of, 95 in rural areas, 63–64 medical oversight and review, 9 safety risks, 19 9-1-1 systems, 23, 150, 153–154 scope of, 15 origins of, 2, 35, 41 strengths of current system, 16 response time, 22 transmission of clinical information, 10 role of demonstration projects, 95–96 See also Air medical services; scope of practice, 122–123 Ambulance services; Dispatch of shortcomings of current system, 2, 53 emergency services; Emergency strategies for enhancing emergency care medical services system; 9-1-1 and, 13 systems as strength, 53 Preventive Health and Health Services, 44 structure of state government EMS Preventive interventions oversight, 50–51 accidental injury, 36 training of EMS personnel, 9, 125 coordination of EMS with public health workforce qualifications, 119 agencies, 75 See also Rural areas Private EMS systems, 58–59 Regionalization of EMS system Public Access Defibrillation (PAD) trial, benefits of, 77–78 218–219 categorization of emergency Public health agencies, coordination departments for, 8 between EMS and, 75 characteristics, 99 Public involvement current model systems, 91, 93–95 citizen first responders, 65–66, 140–141 definition of "region," 26 goals for EMS system, 5–6 implications of Emergency Medical self-triage, 83 Treatment and Active Labor Act, Public perception of EMS system 112–113 performance, 18, 83–84 possible negative consequences of, 78 Public reporting rationale, 2–3, 8, 77–78 of aggregate performance data, 12, 88 recommendations for, 8 current state, 88 in rural areas, 65 forms of, 87 Reimbursement goals, 87–88 efficiency of care and, 23 importance of, 87 federal system, 46–48 Public safety answering points, 53, 141, 151, 154.

Read the entire page →

From page 283...

... INDEX incentives for unnecessary transport, Response times 88–89 ambulance diversion and, 22–23 Medicare and Medicaid, 44, 46–48 causes of delay, 22 payment incentives for performance current system, 4, 16 improvement, 89 determinants of, 4 recommendations for research, 7–8, performance measurement, 86 114, 116 in rural areas, 63 state role, 52 variation among EMS systems, 22 Research Rhode Island, 2003 nightclub fire in barriers to, 18, 210–217, 220, 222 West Warwick, 190 current EMS knowledge base, 207, Ricin, 181 208–210 Robert Wood Johnson Foundation, 34 data sources for, 210–211, 212–214, 223 Roles and Resources of Federal Agencies demonstration program for enhancing in Support of Comprehensie emergency care, 13–14, 95–96 Emergency Medical Serices, 19, 33 development of EMS system, 34 Rural areas disaster preparedness, 221 air medical services, 161 establishment of new lead agency for challenges for EMS systems, 42, 62–64 EMS system and, 109 crash fatalities, 24 federal entities for, 208, 214–217 development of EMS system, 36 funding, 13, 208, 210, 214–217, 218, disaster response readiness, 200 220–221, 224 disparities in care, 23–24, 62 goals, 207, 210 EMS workforce characteristics, 132, grant review process, 221–222 138 informed consent issues, 212–213, need for new workforce staffing models, 222–223 138–139 infrastructure for, 210 9-1-1 systems, 63 needs. See Research needs population trends, 138 practice applications, 211 regionalization of services, 65 prehospital care knowledge base, response times, 63 218–220 role of EMS in, 66 priority topics, 223–224 strategies to enhance EMS, 65–66 protections for human subjects, 213– transport costs, 48 214, 222 volunteer-based EMS systems, 60, 62 recommendations for, 13, 220–221, 223, 224, 226 S regulatory environment, 210, 212–214, 222–223 Safar, Peter, 32 strategies for improving, 27, 220–224 Safe, Accountable, Flexible, Efficient training for, 210, 211–212 Transportation Equity Act: A Legacy trauma care, 207–208 for Users (SAFETEA-LU)

Read the entire page →

From page 284...

... , 190 2004 terrorist attacks in Madrid, 190 National Response Plan, 184–185 State governments research funding, 221 air ambulance regulation, 161–162, 170 threat types and characteristics, ambulance regulation, 159 179–182 Centers for Disease Control and training for EMS personnel, 43 Prevention block grants, 44–46 See also September 11, 2001, terrorist demonstration programs for enhancing attacks emergency care, 14, 96 Texas EMS and trauma system, 92–93 disaster planning and operations, 12, Tornadoes, 178 201–202 Training of EMS personnel, 27 Emergency Management Assistance accreditation, 9 Compact, 187–188 ambulance drivers, 159–160 EMS oversight, 50–53 disaster response readiness, 4, 13, 43, EMS personnel credentialing and 176, 195–196, 200, 202 certification, 122–123, 124, 126– dispatchers, 141 127, 201 efforts to standardize, 120–121 evolution of EMS system, 35 EMS subspecialty certification, 9, licensing reciprocity between, 123, 137, 143–144 201 first responders, 127 model EMS systems, 90–95 graduation trends, 135 recommendations for, 9, 11, 12, 123, historical development, 33 126, 144, 162, 170 medical directors, 64, 143 Structure of EMS systems model components, 120–121 barriers to research, 210–211 national certification, 126–127, 144 categorization of emergency providers, national core content, 120, 121–122 79–80 national standard curricula, 123–124 communications and, 10, 164 origins and development, 32 establishment of new lead agency, 106, recommendations for, 9, 125–126, 107, 108, 115 143–144, 144, 200, 202 federal oversight and funding, 6, 43–50, regional variation, 119, 125 99–101 for research, 210, 211–212 fire department–based, 56–57 scope of practice model, 120, 121, goals, 78–79 122–123 hospital-based, 58 settings for, 125 local decision making, 53 shortcomings of current system, 41 9-1-1 systems, 53–54 Transportation of patient prehospital care research, 219–220 cost per transport, 48 regional variation in EMS systems, 2, disaster response, 182 164

Read the entire page →

From page 285...

... INDEX W Emergency Medical Treatment and Active Labor Act requirements, Washington state, Seattle EMS system, 38 112–113 Wireless Public Safety Interoperable incentives for unnecessary transport, Communications Program 88–89 (SAFECOM) , 167 interfacility, 162–163 Workforce, 27 Medicaid reimbursement, 41, 52 ambulance working conditions, 159 Medicare reimbursement, 7, 47, 48 calls per week, 132 patient characteristics, 16–17 career development, 136 recommendations for protocol challenges for EMS system, 41–42 development, 8, 80–83, 115 compensation, 4, 42, 136 shortcomings of current system, 3, 10 demographics, 130–132 strengths of current system, 16 dispatchers, 141–142 See also Air medical services; efforts to standardize qualifications and Ambulance services; Prehospital care requirements, 120–121 Trauma care employment, 132, 134 definition, 25 future challenges, 119, 135 research, 207–208 job satisfaction, 135 Trauma center definition, 25 licensing reciprocity between Trauma system, coordination of care in, jurisdictions, 123, 137 76, 78–79 occupational fatalities, 137 Trauma Systems Consultation, 79 professional identity, 4, 42 Triage, 77, 81, 141, 190–192 projected growth, 134, 135 registration status, 130, 133, 134, 137–138 U roles and responsibilities, 127–130 Uniform Prehospital EMS Dataset, 168 rural EMS systems, 42, 63–64, 138–139 Uninsured patients, 48 safety concerns, 19–20, 41–42, 136–137 Urban Area Security Initiatives, 193, 194 size, 15, 132–135 URGENCY Decision Assist software, staffing models, 60 156–157 supply problems, 134–135 variations in education and training, 119 V volunteer-based EMS systems, 60, 137–139 Ventricular fibrillation, 21 See also Emergency medical technicians; Voice over Internet Protocol, 154 Medical directors, EMS; Scope Volunteer-based EMS systems, 60, 62, 188 of practice, EMT and paramedic; Training of EMS personnel World Wars I and II, 32

Read the entire page →

Key Terms

← Previous Chapter Skim

This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More information on Chapter Skim is available.

Index Pages 273-286

Index
Pages 273-286