NATIONAL AND STATE ACTION:
Educate government officials regarding EMS issues.

An annual meeting of representatives from federal agencies involved in EMS and EMS-interested organizations is established. On the agendas are issues of common interest, including the roles of federal leadership. Subsequently, a standing committee is convened to recommend ways in which government agencies might best fulfill these roles.

OBJECTIVES:

Short Term Enhance EMS awareness campaigns that are directed toward state legislators and U.S. Congress members.

Intermediate Term Create and maintain a program to track federal EMS planning and development efforts.

Long Term Organize a multidisciplinary task force to examine relevant EMS issues and make recommendations regarding federal EMS activities.

Potential Participants Lead: HRSA/MCHB, NAEMSP, NASEMSD, NHTSA. Contributing: AAA, AAP, ACEP, ACS, AHA, AHCPR, ATS, EMS provider agencies, ENA, IAFC, IAFF, NAEMSE, NAEMT, NCSEMSTC, NCSL, NFA, SAEM, state legislatures, US Congress, USFA.

NATIONAL ACTION:
Resolve conflicting EMS finance and reimbursement issues.

The American Ambulance Association (AAA), HCFA, and the International Association of Fire Chiefs (IAFC), with other input, collaborate to develop several pilot projects to evaluate innovative methods for paying for EMS. Knowledge gleaned from the projects is used to create a relative value system for paying for EMS. Reimbursement for services is not dependent on patient transportation. Soon, the system is implemented in areas across the country.

OBJECTIVES:

Short Term Promote awareness among government and health care finance officials regarding conflicting EMS finance and reimbursement issues.

Intermediate Term Develop pilot programs for the Health Care Financing Administration (HCFA) and Medicaid to reimburse EMS provider agencies on the bases of their response and medical treatment for perceived emergencies.

Long Term Create a relative value reimbursement system to be used by HCFA and Medicaid to pay for EMS without requiring patient transportation.

Potential Participants Lead: AAA, AAHP, HCFA, HIAA, IAFC. Contributing: AAP, ACEP, ACS-COT, health care insurers, IAFF, NAEMSP, NASEMSD.

STATE AND LOCAL ACTION:
Ensure that EMS personnel are optimally prepared.

Peach County EMS is planning to use its personnel to perform limited in-home health risk analyses during non-peak hours. Although personnel will be using standardized checklists, the administration and medical director invest a great deal of time anticipating the type of questions and ancillary tasks that might be requested of the EMS personnel, and cultural issues that might be factors during the home visits. Educational programs are then conducted to prepare the EMS personnel. They include lessons in the community’s culture taught by some of the neighborhood residents. When the health risk analyses begin, the EMS personnel are well prepared, and the feedback from the community is exceptional.

OBJECTIVES:

Short Term Prepare EMS personnel for all changes in expectations of them to provide health services.

Intermediate Term Identify the educational experiences and cultural sensitivity required by EMS personnel in order to meet the identified needs of the community.

Long Term Continuously ensure that all EMS personnel possess the requisite education, skills, and cultural awareness to meet community needs.

Potential Participants Lead: EMS provider agencies, NAEMSE, NCSEMSTC. Contributing: EMS education programs, EMS medical directors, EMS providers, IAFF, JRC, NAEMSP, NFA, state EMS lead agencies.

NATIONAL ACTION:
Update and adopt the National EMS Education and Practice Blueprint.

OBJECTIVES:

Short Term Develop a system to regularly update the National EMS Education and Practice Blueprint and use it to promote consistency in the levels of EMS practice.

Intermediate Term Ensure that EMS education core contents comply with National EMS Education and Practice Blueprint guidelines.

Long Term Authorize the practice of EMS personnel based upon National EMS Education and Practice Blueprint parameters.

Potential Participants Lead: JRC, NASEMSD, NHTSA, NREMT. Contributing: ACEP, EMS education programs, NAEMSE, NAEMSP, NCSEMSTC, NFA, state EMS lead agencies, USFA.

NATIONAL ACTION:
Improve our understanding of EMS occupational health and safety hazards.

Bridgetop’s occupational health department realizes that the number of shoulder injuries experienced by EMS personnel has increased over the past three years. The department collaborates with the state university to study musculo-skeletal injuries among all EMS providers in the state. Using grant funds, they implement a surveillance system. Subsequently, a multi-center study is undertaken to determine the effectiveness of different strategies for reducing the incidence and severity of shoulder injuries.

OBJECTIVES:

Short Term Identify psychological and physical EMS occupational health and safety hazards.

Intermediate Term Collaborate with academic institutions and other interested experts to study occupational health and safety issues.

Long Term Conduct further research about EMS occupational health and safety issues.

Potential Participants Lead: IAFC, IAFF, NAEMT. Contributing: AAA, ACEP, APA, CDC, colleges and universities, EMS providers, EMS researchers, ENA, ICISF, NAEMSE, NAEMSP, NFA, NFNA, NFPA, OSHA, USFA, workmen’s compensation carriers.

LOCAL ACTION:
Increase the cultural sensitivity and diversity of the EMS workforce.

Caperton is a culturally diverse city, but its EMS workforce is not. Subsequent to a few problem cases, EMS administrators meet with representatives of several community groups. They identify several cultural issues that need to be addressed. The EMS workforce participates in an educational program that involves a culturally diverse group of community members. EMS providers also begin to attend civic meetings in neighborhoods other than their own. Greater visibility and accessibility of the EMS providers in different communities causes diverse young people to aspire to become EMS professionals.

OBJECTIVES:

Short Term Identify cultural issues that affect EMS.

Intermediate Term Implement programs that will enhance the cultural sensitivity of the EMS workforce.

Long Term Implement strategies, such as increasing access to EMS educational programs, that expand the cultural diversity of the EMS workforce so that it is representative of the population it serves.

Potential Participants Lead: Community organizations, EMS medical directors, EMS provider agencies. Contributing: AAA, ACEP, EMS providers, ENA, IAFC, IAFF, NAEMSP, NAEMT, NFA, NFNA, NFPA, NHTSA, state EMS lead agencies.

LOCAL ACTION:
Implement and evaluate stress management programs.

Matson County EMS offers in-kind services to the community mental health agency in exchange for an assessment of stress indicators among EMS personnel. Several factors are identified as contributing to moderately high levels of stress. Over the ensuing year, system changes are made, and a plan for addressing critical incident stress is implemented. Education programs are conducted. Follow-up assessments reveal fewer stress indicators among EMS personnel.

OBJECTIVES:

Short Term Develop and implement a plan for managing occupational stress among EMS personnel.

Intermediate Term Educate EMS personnel about stress management.

Long Term Evaluate and improve stress reduction and management programs.

Potential Participants Lead: Community mental health providers, EMS provider agencies. Contributing: ACEP, APA, EMS medical directors, ENA, FEMA, IAFF, ICISF, NAEMSE, NAEMSP, NAEMT, NFA, NFNA, NFPA, state EMS lead agencies, USFA.

NATIONAL AND STATE ACTION:
Create a system for reciprocity of EMS provider credentials.

Ryan Baum completes a paramedic-practitioner program that includes standard paramedic training plus additional locally adapted education and skills. The education program is accredited as a paramedic program. Four years later Ryan relocates to a different state. Although his academic credentials are valid there, the new EMS agency recognizes those components of his education that are “standard and accredited”. Since Ryan has demonstrated his competency by a national standard, his credentials are recognized in the new state by reciprocity, and he is eligible to seek employment as a paramedic.

OBJECTIVES:

Short Term Develop consensus regarding the educational requirements for EMS providers at standard levels.

Intermediate Term Standardize the mechanisms used to verify the competency of, and issue credentials to, EMS personnel.

Long Term Eliminate legal barriers to intra- and interstate reciprocity of EMS provider credentials.

Potential Participants Lead: NASEMSD, state EMS lead agencies. Contributing: AAP, ACEP, ACS, JRC, NAEMSE, NAEMSP, NAEMT, NCSEMSTC, NFA, NHTSA, NREMT, state legislatures.

NATIONAL AND STATE ACTION:
Provide qualified contemporaneous EMS medical direction.

Bob Klein, MD is an internist who does locum tenums work. He moves to Maury for two months, where he will work in a clinic and the emergency department (ED). While at the ED, he will be required to provide on-line medical direction to EMS providers. Before he can do so, he must earn the credentials that ensure he is familiar with the state’s laws, the EMS provider capabilities, and the local protocols.

OBJECTIVES:

Short Term Determine the current local and state credential requirements for individuals who provide on-line (contemporaneous) medical direction.

Intermediate Term Develop credential standards for on-line medical direction providers.

Long Term Require appropriate credentials for all providers of on-line medical direction.

Potential Participants Lead: NAEMSP, NASEMSD. Contributing: AAP, ACEP, ACS-COT, EMS medical directors, EMS provider agencies, ENA, medical societies, NAEMT, state EMS lead agencies.

NATIONAL AND STATE ACTION:
Ensure that each state has a designated state EMS medical director.

The National Association of EMS Physicians (NAEMSP) and the National Association of State EMS Directors (NASEMSD) collaborate to develop a model state EMS medical director job description and position justification. They also investigate current funding strategies, and make alternative suggestions. The information is eventually disseminated and used to establish a state EMS medical director in each state.

OBJECTIVES:

Short Term Develop a model state EMS medical director job description and position justification.

Intermediate Term Disseminate information to state EMS lead agencies and legislators about potential funding alternatives for state EMS medical director positions.

Long Term Establish the position of, and provide the funding for, an EMS medical director in each state.

Potential Participants Lead: ACEP, NAEMSP, NASEMSD. Contributing: NCSL, state EMS lead agencies, state legislatures.

STATE AND LOCAL ACTION:
Ensure that EMS providers are prepared to perform their required tasks.

New Market EMS conducts a thorough analysis of the tasks required of its personnel, carefully evaluating the cognitive requirements for the duties they perform. The analysis reveals that the EMS providers are not well prepared for many of the patients they encounter, including their on-going therapy required during interfacility emergency transfers. Subsequently, the agency works with the community college to develop educational programs for newly hired personnel and to update continuing education offerings.

OBJECTIVES:

Short Term Conduct local task analyses to determine the cognitive and technical skills required for EMS providers functioning at various levels and environments, including interfacility patient transfers.

Intermediate Term Determine the structure and content of EMS educational programs, including initial and continuing education, and the appropriate staffing necessary to continuously meet the needs identified by local task analyses.

Long Term Evaluate and update initial and continuing education programs and staffing complements in order to meet the needs identified through local task analyses, and ensure that secondary patient transfers are conducted using appropriate staff and medical direction.

Potential Participants Lead: EMS medical directors, EMS provider agencies. Contributing: AAA, AAMS, AAOS, ACEP, ACS, AMPA, colleges and universities, EMS education programs, ENA, IAFC, IAFF, JRC, NAEMSE, NAEMSP, NAEMT, NASEMSD, NCSEMSTC, NFNA, NFPA, NREMT, state EMS lead agencies.

NATIONAL, STATE AND LOCAL ACTION:
Provide medical direction for EMS education.

A multidisciplinary group, comprised of representatives from several organizations, develops a position paper regarding the medical direction of EMS education. The paper is presented for endorsement by all EMS-interested organizations. EMS educational programs are encouraged to follow the established guidelines. Subsequently, the recognition and accreditation of EMS educational programs depend upon the inclusion of medical direction.

OBJECTIVES:

Short Term Develop and disseminate a multi-disciplinary position paper that provides guidelines for the role medical direction plays in EMS educational programs.

Intermediate Term Require EMS educational programs, including continuing education, to designate a medical director whose role is consistent with those described in a widely endorsed position paper.

Long Term Ensure that the medical direction of EMS educational programs includes active participation during the planning, implementation, and evaluation stages.

Potential Participants Lead: ACEP, EMS education programs, NAEMSE, NAEMSP. AAMS, AAOS, AAP, ACS, colleges and universities, ENA, IAFC, IAFF, JRC, NAEMT, NASEMSD, NCSEMSTC, NFA, NREMT, SAEM, state EMS lead agencies.

NATIONAL ACTION:
Require EMS education programs to be accredited.

OBJECTIVES:

Short Term Evaluate the cost-effectiveness and other potential benefits of EMS educational programs being accredited by a national body.

Intermediate Term Develop strategies to facilitate national accreditation of EMS educational programs.

Long Term Adopt accreditation by a national body as the standard by which EMS educational programs are evaluated.

Potential Participants Lead: JRC, NASEMSD. Contributing: EMS education programs, NAEMSE, NCSEMSTC, NREMT.

NATIONAL AND LOCAL ACTION:
Develop EMS education bridging programs.

Beth Christy wishes to advance her EMS provider credentials to the next level. She is able to complete coursework in her hometown via teleconferences and computer simulations. Material that was part of her previous educational experience was a prerequisite, and the current coursework is not redundant. At the conclusion of the coursework, she is prepared to begin an internship prior to receiving her new credentials.

OBJECTIVES:

Short Term Develop pilot bridging educational programs that enable EMS providers to move from one provider level to the next.

Intermediate Term Evaluate alternative education approaches to achieving bridging programs’ learning objectives, including distance learning and other innovative instructional techniques.

Long Term Integrate bridging educational programs into existing EMS educational programs.

Potential Participants Lead: EMS educational programs, NAEMSE, NCSEMSTC. Contributing: AAOS, AAP, ACEP, ACS, colleges and universities, ENA, IAFC, IAFF, JRC, NAEMSP, NAEMT, NASEMSD, NFA, NREMT, SAEM.

NATIONAL ACTION:
Ensure that all health professionals have basic knowledge of EMS issues.

The National Association of EMS Educators (NAEMSE) leads a multidisciplinary effort to identify EMS-related core content objectives that should be included in a health care professional’s education. Subsequent collaboration with colleges and universities leads to the inclusion of the objectives in other health care professional educational programs.

OBJECTIVES:

Short Term Survey other health care professional educational programs to determine the extent to which EMS-related objectives are included.

Intermediate Term Provide opportunities for all health care professionals to gain EMS exposure, and provide other health care professional educational programs with EMS core content objectives.

Long Term Incorporate EMS-related core content objectives in the curricula of other health care professional educational programs.

Potential Participants Lead: AAMC, CAAHEP, NAEMSE. Contributing: AAP, ACEP, ACS, Allied Health Dean’s Association, ANA, colleges and universities, ENA, JRC, NAEMSP, NAEMT, NASEMSD, NCSEMSTC, NFA, NHTSA, NREMT, SAEM.

NATIONAL AND LOCAL ACTION:
Engage in public education.

Paramedic Mark Gauther is particularly interested in public health issues and education. He capitalizes on his interests and ongoing education by becoming the Mahoning EMS Community Education Officer. His duties include planning, overseeing, and evaluating the agency’s public education efforts. Current projects are directed toward prevention and appropriate emergency care access.

OBJECTIVES:

Short Term Appoint an individual(s) within each EMS agency to be responsible for public education initiatives.

Intermediate Term Establish, within each EMS agency, a continuous public education program that includes prevention activities, and is distinct from public relations.

Long Term Include objectives in EMS education core contents related to EMS providers’ roles in public education.

Potential Participants Lead: EMS provider agencies, NHTSA. Contributing: AAA, AAOS, ACEP, ACS, EMS providers, IAFC, IAFF, JRC, NAEMSP, NAEMT, NASEMSD, NCSEMSTC, NFA, NREMT, SAEM, state EMS lead agencies, USFA.

LOCAL ACTION:
Conduct public education that is relevant and meaningful to the community.

Buckley EMS is planning next year’s public education program. As current projects are evaluated, they find that their “buckle up” project has been effective. The proportion of unrestrained occupants in motor vehicle crashes has decreased over the past few years. Since ten community members suffered significant head injuries as a result of bicycle falls during the past year, the EMS agency decides to also target bicycle safety. for the upcoming year.

OBJECTIVES:

Short Term Determine the incidence of relevant conditions and events in the community and the base knowledge of the community members prior to initiating specific public education projects and programs.

Intermediate Term Continuously evaluate the effects of public education and prevention efforts.

Long Term Revise and update EMS public education and prevention efforts as indicated by needs assessments and evaluation results, in accordance with contemporary quality improvement models.

Potential Participants Lead: EMS provider agencies. Contributing: NHAAP, APHA, ATPM, Children’s Safety Network, Coalition for America’s Children, colleges and universities, EMS-C, EMS medical directors, Farm Safety for Kids, NASEMSD, NFA, Safe Kids Coalition, state EMS lead agencies, STIPDA, USFA.

LOCAL ACTION:
Incorporate innovative techniques and technologies in public education.

Keystone school district maintains an internet web page as a means of conveying important information to its students and their parents. The page includes announcements and up-to-date information about assignments and schedules. As a result of collaboration with the EMS system, the page also contains information about children’s safety issues, community class schedules and other important EMS news. The EMS information is updated frequently, and the number of readers is monitored.

OBJECTIVES:

Short Term Use the media to enhance public education efforts.

Intermediate Term Convene focus groups at national and community forums to evaluate tools and technologies for achieving EMS public education goals.

Long Term Incorporate state-of-the-art technology in EMS public education programs.

Potential Participants Lead: EMS provider agencies, media outlets. Contributing: AAP, ACEP, ACS, AHA, ATS, EMS medical directors, HRSA/MCHB, IAFC, IAFF, NAEMSE, NAEMSP, NAEMT, NASEMSD, NHAAP, NHTSA.

NATIONAL AND LOCAL ACTION:
Maintain a prevention-oriented atmosphere at the EMS workplace.

The National Association of Emergency Medical Technicians (NAEMT) coordinates a task force to develop a series of “Prevention Begins at Home” programs. The series provides information and models for prevention initiatives. The series is made available for EMS agencies to use in their workforce prevention programs.

OBJECTIVES:

Short Term Include topics related to preventing EMS workforce injuries and illnesses during the initial and continuing education of all EMS providers and managers.

Intermediate Term Maintain workplace programs to help prevent injuries and illnesses among EMS providers.

Long Term Develop health and safety guidelines for EMS providers.

Potential Participants Lead: EMS medical directors, EMS provider agencies, NHTSA. Contributing: AAA, continuing education accrediting bodies, IAFC, IAFF, JRC, NAEMSE, NAEMT, National Fire Protection Association, NSC, NIOSH, NREMT, OSHA, USFA.

NATIONAL ACTION:
Incorporate “prevention” into the education of EMS providers.

During Geoff Clarkson’s paramedic education, he learned about the principles of prevention, and he developed an appreciation for the role of prevention activities in the EMS system. Now he readily accepts prevention-oriented objectives as part of his mission as a paramedic. In fact, he is active in planning and evaluating the prevention initiatives, both for the community and the workforce.

OBJECTIVES:

Short Term Adopt “prevention” for both the EMS workforce and community members as a component of the National EMS Education and Practice Blueprint.

Intermediate Term Include prevention as part of EMS education core contents.

Long Term Include prevention-related material as part of EMS provider pre-credential examinations.

Potential Participants Lead: NCSEMSTC, NHTSA, NREMT. Contributing: AAA, AAMS, AAOS, AAP, ACEP, ACS, ENA, IAFC, IAFF, JRC, NAEMSE, NAEMSP, NASEMSD, SAEM.

NATIONAL ACTION:
Improve the abilities of personal communication devices to facilitate access to emergency help.

A motorist traveling on a highway witnesses a motor vehicle crash. He dials 9-1-1 on his cellular telephone. Although the cell he is in is extremely busy (a busy signal would normally be heard) the system recognizes his call as an emergency. The call is given priority over other cellular traffic, and is routed to the appropriate answering point. There, information from the telephone’s location identification system is automatically displayed and allows the call-taker to immediately determine the caller’s location, even though the caller himself is unsure.

OBJECTIVES:

Short Term Implement methods to provide emergency calls priority within networks for wireless telephones (e.g., cellular, digital personal communication systems).

Intermediate Term Incorporate automatic location identification technology in wireless communications systems to route emergency calls made from them directly to the appropriate public safety answering point, and facilitate a prompt response to the correct location.

Long Term Update public safety answering point technology to automatically receive geographic location data from wireless communications devices.

Potential Participants Lead: APCO, CTIA, FCC, NENA, NHTSA. Contributing: Cellular telephone manufacturers and service companies, NAEMD, public safety answering points.

NATIONAL ACTION:
Enhance mobile telephone services as resources for EMS system communication.

North County EMS is caring for a cardiac patient in need of emergency interventions. His EKG must be transmitted to the medical control facility by cellular telephone. Although the cellular system is busy, it recognizes the EMS call and provides it priority routing. The ability to review the EKG prior to the patient’s arrival enables the medical control facility to order optimal care, and prepare critical therapy. The time saved by this preparation is crucial to the patient’s excellent outcome.

OBJECTIVES:

Short Term Evaluate the ability of wireless telephone (e.g., cellular, digital personal communication systems) companies to prioritize calls made from EMS system wireless telephones.

Intermediate Term Develop plans for prioritizing emergency calls made from EMS system wireless telephones.

Long Term Provide area-wide priority for emergency calls made from EMS system wireless telephones.

Potential Participants Lead: APCO, CTIA. Contributing: Cellular telephone manufacturers and service companies, FCC, NAEMD, NENA, NHTSA, public safety answering points, state EMS lead agencies, state telecommunications officials.

NATIONAL AND LOCAL ACTION:
Ensure that EMS communications personnel are optimally qualified.

City EMS officials, through quality improvement procedures, identify several concerns regarding their communications center. As part of their approach to improvement, they analyze the tasks required of their personnel. They subsequently develop a process for issuing credentials. They also ensure that all EMS communications personnel obtain the necessary credentials by that process. In part due to City’s success, the state adopts similar requirements for all of its EMS communication centers.

OBJECTIVES:

Short Term Perform task analyses to determine the desirable attributes for EMS communications personnel.

Intermediate Term Establish uniform education and credential requirements for EMS communications personnel.

Long Term Require emergency communications center personnel performing EMS-related tasks to acquire appropriate credentials.

Potential Participants Lead: APCO, NAEMD. Contributing: EMS communications centers, EMS medical directors, emergency medical dispatchers, EMS provider agencies, IAFC, IAFF, NAEMSP, NASEMSD, NHTSA, state EMS lead agencies.

NATIONAL ACTION:
Eliminate barriers to accessing EMS.

Ruth Thomas suffers from a condition that impairs her vision. She has difficulty doing things like dialing a telephone number. When her husband suffers a stroke, and she must call for help, she pushes the “emergency help” icon on her telephone. She is able to describe the situation to the call-taker so that an appropriate EMS response is initiated, and effective care for Mr. Thomas is facilitated.

OBJECTIVES:

Short Term Identify the potential barriers to accessing EMS.

Intermediate Term Establish a universal telephone symbol, that can also be identified by people with impaired vision, and evaluate other technologies to facilitate access to EMS.

Long Term Improve access to EMS for all community members, including children, the elderly and people with special needs.

Potential Participants Lead: APCO, EMS communications centers, EMS provider agencies, FCC, NENA. Contributing: AAHP, community organizations, EMS medical directors, HIAA, health care networks, HRSA/MCHB, medical societies, NAEMD, NAEMSP, public utility commissions, telecommunications companies.

NATIONAL AND LOCAL ACTION:
Provide an EMS response that is appropriate for the need.

Apple County EMS and Optimal Managed Care Plan establish a communications link. This link facilitates appropriate referral of some of the calls for EMS to the plan’s communication center and vice versa. Over the course of several months, a number of inappropriate EMS responses are avoided. Other calls are more expediently answered because of the plan’s link with the EMS system. All referred calls are scrutinized as part of an extensive continuous evaluation process.

OBJECTIVES:

Short Term Evaluate the ability of public safety answering points to reliably determine the appropriate level of response needed for EMS calls.

Intermediate Term Create communication networks that link EMS and other health resources to facilitate the appropriate transfer of calls for EMS to those resources in specific circumstances.

Long Term Conduct epidemiological and outcomes research to guide efforts to match health resource allocations to EMS callers’ needs.

Potential Participants Lead: Emergency communication centers, EMS researchers. Contributing: AAA, ACEP, APCO, EMS dispatchers, EMS medical directors, EMS provider agencies, health care insurers, health care networks, NAEMD, NAEMSE, NAEMSP, poison control centers, public health agencies, social service agencies.

NATIONAL AND LOCAL ACTION:
Establish communication links for exchanging appropriate patient information.

EMS providers are called to the house of Dan Saylor by a neighbor who found him unconscious. The EMS communication center obtains critical portions of Mr. Saylor’s medical history from its health network database. While en route, the EMS providers are advised by their communications center that Mr. Saylor is routinely treated at University Medical Center for a rare endocrine disorder, and that he should be transported there. At the scene the EMS providers find Mr. Saylor unable to speak, but they now have sufficient background information to make informed decisions for him.

OBJECTIVES:

Short Term Convene a multidisciplinary conference to explore confidentiality issues, and develop guidelines for sharing information between EMS and other health care providers.

Intermediate Term Establish communication links with EMS communications centers and community health care providers and health data sources, in order to facilitate appropriate caller transfers and information exchange, and decrease health care networks’ motivation to create their own 9-1-1 alternatives.

Long Term Establish communication links between EMS and health care networks, and develop protocols for sharing information about patients with special needs, facilitating appropriate patient follow-up.

Potential Participants Lead: EMS communications centers, EMS provider agencies, health care networks. Contributing: AAHP, AHA, APCO, EMS medical directors, hospitals, NAC, NAEMD, NLC, public health services, social service agencies, state EMS lead agencies.

NATIONAL AND STATE ACTION:
Commit to a definition of essential EMS capacity.

The National Highway Traffic Safety Administration (NHTSA) and the National Association of State EMS Directors (NASEMSD) collaborate to convene a series of conferences to develop EMS capacity definitions and guidelines. The guidelines are then used as benchmarks. State EMS lead agencies use the guidelines to help develop local EMS systems, and to determine appropriate resource allocation.

OBJECTIVES:

Short Term Develop a blueprint to describe the functional attributes of community EMS systems with various levels of sophistication and clinical capabilities.

Intermediate Term Develop consensus regarding the attributes of essential community EMS capacity.

Long Term Ensure that all communities have essential EMS capacity available to them.

Potential Participants Lead: NAEMSP, NASEMSD, NHTSA, state EMS lead agencies. Contributing: AAA, AAOS, AAP, ACEP, ACS, ASTM, ENA, FEMA, HRSA, IAFC, IAFF, NAC, NAEMSE, NAEMT, NAFR, NCSEMSTC, NLC, NREMT, NRHA, SAEM, Wilderness Medicine Society.

National and Local Action:
Evaluate EMS care and technology.

Birmington EMS is contemplating strategic placement of automatic external defibrillators (AED) throughout its community. Before doing so, they carefully evaluate the likely influence the AEDs will have on survival. They consider the likelihood of the availability of a person able to operate the equipment and the current system’s performance, among other demographic factors. This evaluation enables them to make the appropriate decisions regarding the types, numbers and locations of the AEDs to be deployed.

OBJECTIVES:

Short Term Evaluate new roles, techniques, and technology before their widespread deployment by EMS.

Intermediate Term Evaluate the appropriateness and effectiveness of new or expanded EMS care before it is implemented on a routine basis.

Long Term Continue to evaluate the costs and effects of new or expanded EMS care and technology.

Potential Participants Lead: EMS medical directors, EMS provider agencies. Contributing: AAA, ACEP, AHA, EMS researchers, ENA, FDA, IAFC, medical device manufacturers, NAEMSE, NAEMSP, NAEMT, NASEMSD, NCSEMSTC, research funding organizations, SAEM.

LOCAL ACTION:
Use evaluation of multiple conditions and outcome categories to improve EMS quality.

Northport EMS develops an evaluation plan that is updated yearly. The plan uses models provided by the state EMS lead agency, and input from the community and area health care providers. The results of this continuous evaluation are used to determine EMS value to the community, and to make system improvements.

OBJECTIVES:

Short Term Implement continuous evaluation processes as part of EMS quality improvement efforts.

Intermediate Term Evaluate EMS using multiple conditions and outcome categories, including death, disease, disability, discomfort, dissatisfaction and destitution.

Long Term Update evaluation processes as new models are developed, and use evaluation results to improve EMS quality.

Potential Participants Lead: EMS medical directors, EMS provider agencies Contributing: AAA, AAMS, ACEP, IAFC, IAFF, NAEMSP, NASEMSD, NAEMSQP, state EMS lead agencies.