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EMS Agenda for the Future

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EMS Agenda for the Future EMERGENCY MEDICAL SERVICES AGENDA FOR THE FUTURE EMS Agenda for the Future MESSAGE FROM THE NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATOR As NHTSA embarks on 30 years of leadership As we look to the future it is clear that EMS must in the field of emergency medical services (EMS), be integrated with other services and systems that our goal for the future is to focus community at- are intended to main tain and improve community tention on the need to strengthen support for EMS health and ensure its safety. We must also focus on systems in an ever changing health care environ- aspects of EMS that improve its science, strengthen ment. Our partnership with the Health Resources its infrastructure, and broaden its involvement in and Services Administration, Maternal and Child enhancing the health of our communities. The Agenda Health Bureau provided us with this opportunity describes 14 EMS attributes and proposes continued to pursue that goal. development of them, enabling all of us to strive for a vision that empha- NHTSA realized the need for agen- sizes a critical role for EMS in caring cies, organizations, and individuals for our nation’s health. involved in EMS to evaluate their roles and chart a course to the future. The Our EMS experiences over the EMS Agenda for the Future provides past 30 years provide us with a basis an opportunity for all health care on which to create the future. It is providers to examine what has been important, however, not to be held learned during the past 30 years. hostage to the past, but to look freely Its purpose is to outline the most to the future. The EMS Agenda for the important directions for future EMS Future is an important tool for doing development. During the process that. It will be a valuable resource for of creating this document, the EMS Ricardo Martinez, M.D. government officials and all health Agenda for the Future Steering Com- care providers and administrators, mittee sought and incorporated input including EMS administrators, medical from a broad, multi-disciplinary spectrum of EMS directors, managers, and all EMS providers. NHTSA stakeholders. is proud to have co-sponsored the project that led to completion of this document, and is indebted As the Steering Committee points out, this agenda to the Steering Committee and all those who par- comes at an important time, when the nation’s ticipated. As both NHTSA’s administrator and an health care system is undergoing constant and rapid emergency physician, I wholeheartedly endorse the evolution. Resulting health care system changes vision and the convictions to be found within the will affect EMS and its health care delivery roles. pages that follow. i EMS Agenda for the Future: The Vision THE VISION Emergency medical services (EMS) of the future will be community-based health management that is fully integrated with the overall health care system. It will have the ability to identify and modify illness and injury risks, provide acute illness and injury care and follow-up, and contribute to treatment of chronic conditions and community health monitoring. This new entity will be developed from redistribution of existing health care resources and will be integrated with other health care providers and public health and public safety agencies. It will improve community health and result in more appropriate use of acute health care resources. EMS will remain the public’s emergency medical safety net. iii EMS Agenda for the Future: Contents EXECUTIVE SUMMARY uring the past 30 years, emergency medi- They are: cal services (EMS) in the United States have Integration of Health Services experienced explosive development and growth. DYet initiatives to create a system to provide emergency EMS Research medical care for the nation’s population began with Legislation and Regulation limited knowledge about what constituted the most efficient processes for delivering ideal resources to the System Finance spectrum of situations encountered by contemporary Human Resources EMS. Medical Direction The EMS Agenda for the Future provides an oppor- tunity to examine what has been learned during the Education Systems past three decades and create a vision for the future. Public Education This opportunity comes at an important time, when those agencies, organizations, and individuals that affect Prevention EMS are evaluating its role in the context of a rapidly Public Access evolving health care system. Communication Systems The EMS Agenda for the Future project was supported by the National Highway Traffic Safety Administration Clinical Care and the Health Resources and Services Administration, Information Systems Maternal and Child Health Bureau. This document focuses on aspects of EMS related to emergency care Evaluation outside traditional health care facilities. It recognizes This document serves as guidance for EMS providers, the changes occurring in the health care system of health care organizations and institutions, governmental which EMS is a part. agencies, and policy makers. They must be committed EMS of the future will be community-based health to improving the health of their communities and to management that is fully integrated with the overall ensuring that EMS efficiently contributes to that goal. health care system. It will have the ability to identify and They must invest the resources necessary to provide the modify illness and injury risks, provide acute illness and nation’s population with emergency health care that injury care and follow-up, and contribute to treatment is reliably accessible, effective, subject to continuous of chronic conditions and community health monitoring. evaluation, and integrated with the remainder of the EMS will be integrated with other health care providers health system. and public health and public safety agencies. It will im- The EMS Agenda for the Future provides a vision prove community health and result in more appropriate for out-of-facility EMS. Achieving such a vision will use of acute health care resources. EMS will remain the require deliberate action and application of the knowl- public’s emergency medical safety net. edge gained during the past 30 year EMS experience. To realize this vision, the EMS Agenda for the Future If pursued conscientiously, it will be an achievement proposes continued development of 14 EMS attributes. with great benefits for all of society. v EMS Agenda for the Future: Contents CONTENTS Introduction ......................................................................................................................................1 Emergency Medical Services Attributes ..........................................................................................7 Integration of Health Services ............................................................................................................................9 EMS Research ....................................................................................................................................................13 Legislation and Regulation ...............................................................................................................................17 System Finance ..................................................................................................................................................21 Human Resources ..............................................................................................................................................25 Medical Direction ..............................................................................................................................................29 Education Systems .............................................................................................................................................33 Public Education ...............................................................................................................................................37 Prevention ..........................................................................................................................................................39 Public Access ......................................................................................................................................................43 Communication Systems ...................................................................................................................................47 Clinical Care ......................................................................................................................................................51 Information Systems .........................................................................................................................................55 Evaluation ..........................................................................................................................................................57 Appendix A EMS Historical Perspectives .............................................................................................61 Appendix B Development of the Agenda ...............................................................................................65 Appendix C Summary of Recommendations ..........................................................................................67 Appendix D Glossary .............................................................................................................................71 Appendix E List of Abbreviations
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