NATIONAL ACTION:
Identify and develop sources for EMS-related research funding.

The Society of Academic Emergency Medicine (SAEM) develops and distributes a catalogue of potential funding sources for EMS research. To assist grant writers, it includes information about the agencies and organizations. As awareness of the possibilities for research funding is enhanced, the volume of quality grant applications increases. The need for increased EMS research funds is further validated.

OBJECTIVES:

Short Term
Identify potential private and government funding sources for EMS research.

Intermediate Term
Develop and distribute a catalogue of potential EMS research funding sources, including profiles of pertinent agencies, organizations, and foundations, in order to stimulate research grant applications.

Long Term
Advocate for increased state and federal appropriations for health care research related to EMS issues.

Potential Participants Lead: ACEP, HRSA, NAEMSP, NHTSA, SAEM. Contributing: AAA, AAP, ACS-COT, AHA, AHCPR, CFSI, corporations, DHHS, ENA, foundations, HRSA/MCHB, IAFC, IAFF, medical device manufacturers, medical schools, NAEMSE, NAEMT, NASEMSD, NIH, physician organizations, USFA.

NATIONAL ACTION:
Enhance coordination of the federal government’s emergency health care research efforts.

A task force representing government agencies and several EMS-interested organizations is formed. It evaluates feasible options for improving coordination of federal EMS research assistance. The task force’s findings and recommendations are submitted to the U.S. Congress for action. Subsequently, an emergency health care study section is formed within NIH.

OBJECTIVES:

Short Term
Develop a clearinghouse for information about federal EMS research assistance.

Intermediate Term
Identify an agency or mechanism to coordinate federal government EMS research assistance.

Long Term
Designate an entity, such as a foundation, institute, agency or commission, to have responsibility for steering the federal government’s emergency health care research efforts.

Potential Participants Lead: AHCPR, HRSA, NHTSA. Contributing: AAA, AAP, ACEP, ACS, AHA, FEMA, FICEMS, IAFC, IAFF, MCHB, NAEMSE, NAEMSP, NAEMT, NASEMSD, NEMSA, NIH, NFA, SAEM, US Congress, USFA.

NATIONAL AND LOCAL ACTION:
Increase the number of physicians dedicated to EMS research.

The National Association of EMS Physicians (NAEMSP) and the Society for Academic Emergency Medicine (SAEM) develop a model research curriculum for EMS fellowships. The model is adapted within each fellowship program, and creates EMS physicians with research credentials. The number of academic emergency physicians with EMS research interests increases, and the quantity and quality of EMS research is enhanced.

OBJECTIVES:

Short Term
Emphasize research within the curricula of EMS fellowship programs.

Intermediate Term
Expand the number of funded EMS fellowship programs.

Long Term
Cultivate individuals dedicated to EMS research.

Potential Participants Lead: ACEP, EMS fellowship directors, NAEMSP, SAEM. Contributing: AACEM, AAP, ABEM, CORD.

NATIONAL AND LOCAL ACTION:
Cultivate EMS research within academic programs.

Several academic emergency medicine programs collaborate, and successfully complete a national multi-center study of automatic external defibrillation use by non-traditional first responders. Their efforts result in a stable alliance capable of securing funds to conduct future large-scale EMS research projects. These centers and investigators are now experienced enough to secure national funding as centers of research excellence. This provides a stable research network for ongoing and future EMS research.

OBJECTIVES:

Short Term
Include EMS research as a component of academic programs’ research agendas.

Intermediate Term
Develop and implement well-designed EMS research studies, including multi-center trials, which address national health care issues.

Long Term
Secure funding to support EMS research centers.

Potential Participants Lead: AACEM, ACEP, NAEMSP, SAEM. Contributing: AHCPR, colleges and universities, CORD, departments of emergency medicine, EMS fellowships, EMS provider agencies, EMS researchers, NAEMSE.

STATE ACTION:
Enhance the technical assistance provided by state EMS lead agencies.

The National Association of State EMS Directors (NASEMSD) develops a template for an EMS quality improvement tool. Several state EMS lead agencies adapt the model for their circumstances and distribute it. This provides guidance to EMS systems that implement the adapted model.

OBJECTIVES:

Short Term
Establish technical assistance standards, consistent with the EMS Agenda for the Future, for state EMS lead agencies, to be evaluated during the National Highway Traffic Safety Administration’s (NHTSA) state EMS assessments.

Intermediate Term
Disseminate information regarding successful EMS technical assistance projects and programs conducted by various states.

Long Term
Provide state EMS lead agencies with the authority and resources to perform technical assistance.

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

STATE AND LOCAL ACTION:
Reduce EMS providers’ risk of liability.

Avondale EMS providers treat a 16 year old, pregnant girl who is experiencing abdominal pain. She refuses to go to the hospital. The patient is a minor, and in this state she is not emancipated until she gives birth. However, no parents or guardians are available, and the patient cannot be convinced, short of using force, to be taken to a hospital. The EMS providers recognize this as a high-risk situation. They follow guidelines promulgated by the state EMS lead agency and the attorney general. Though the patient eventually has a sub-optimal outcome, EMS providers are protected from liability by having followed the established guidelines.

OBJECTIVES:

Short Term
Identify unusual situations that place EMS providers at higher liability risk.

Intermediate Term
Develop strategies to reduce EMS providers’ risk of liability, possibly including the development of model legislation that affords them limited protection.

Long Term
Implement programs, possibly including legislation, that reduce EMS providers’ risk of liability.

Potential Participants Lead: NAEMT, NASEMSD. Contributing: AAA, ABA, ACEP, AHCL, American Medical-Legal Foundation, ENA, IAFC, IAFF, medical device manufacturers, NAEMSP, NCSL, NFA, physician organizations, state attorneys general, state legislatures.

STATE ACTION:
Eliminate barriers and improve appropriate use of EMS.

Mary Hollis experiences a sudden onset of chest pain. Her husband summons EMS for help. The situation and the state’s “prudent layperson” law justify his actions. The law was passed after recommendations were made by the state EMS lead agency and several other EMS-interested organizations. Mary receives appropriate emergency care and is transported to a hospital affiliated with her health care network.

OBJECTIVES:

Short Term
Educate local, state, and federal elected officials regarding the importance of eliminating barriers to emergency medical care access.

Intermediate Term
Pass state legislation or adopt regulations that eliminate financial barriers to appropriate and timely emergency care, including EMS.

Long Term
Educate community members about appropriate use of the EMS system, and other points of access to health care.

Potential Participants Lead: ACEP, HRSA/MCHB, NASEMSD, NHTSA. Contributing: AAA, AAP, ACS, ATS, EMS provider agencies, EMS providers, ENA, health care insurers, IAFC, IAFF, NACCHO, NAEMSE, NAEMSP, NAEMT, NAHP, NCSL, NEMSA, NFA, physician organizations, SAEM, USFA.

NATIONAL, STATE AND LOCAL ACTION:
Ensure stable support for EMS infrastructure funding.

The National Highway Traffic Safety Administration (NHTSA) collaborates with the National Association of State EMS Directors (NASEMSD) and other organizations to develop an EMS infrastructure inventory tool. The tool is distributed by state EMS lead agencies to help EMS systems determine their future needs, and help them find appropriate resources.

OBJECTIVES:

Short Term
Develop a tool to inventory and assess the costs of EMS infrastructure components.

Intermediate Term
Assess the costs associated with providing an EMS infrastructure.

Long Term
Educate local, state, and federal government officials and their staff members about the importance of maintaining and improving an EMS infrastructure and the funding it requires.

Potential Participants Lead: EMS provider agencies, NASEMSD, NHTSA, state EMS lead agencies. Contributing: AAA, APCO, ASPA, ASTHO, CFSI, FEMA, FICEMS, IAFC, IAFF, NEMA, NENA, USFA.

NATIONAL ACTION:
Develop mechanisms for recognizing health professionals with expertise in EMS.

Susan Tyler is an emergency department nurse who is also responsible for her hospital’s interface with the EMS system. She participates in many aspects of medical direction, including quality improvement activities and continuing education planning and implementation. She wants to distinguish herself as a nurse with expertise in the area of EMS, so she completes the credentialling process to become a Certified Emergency Medical Services Nurse (CEMSN).

OBJECTIVES:

Short Term
Establish guidelines for creating EMS subspecialty credentials for registered nurses and other health care professionals.

Intermediate Term
Develop EMS subspecialty credentials for registered nurses and other health care professionals.

Long Term
Provide processes for registered nurses and other health care professionals to become credentialed as specialists in EMS.

Potential Participants Lead: ENA. Contributing: AAP, AARC, ACEP, ACS, AMA, ANA, AUPHA, NABN, NAEMSP, NFNA.

NATIONAL AND STATE ACTION:
Ensure that EMS medical directors are qualified.

The American College of Emergency Physicians (ACEP) and the National Association of EMS Physicians (NAEMSP) jointly develop a core content for EMS medical director education. The state adapts the core content, requiring evidence of its fulfillment for all new EMS medical directors. Dr. Doug Kaman, who just completed a pediatric-emergency medicine residency, attends an educational program that meets the requirements. He can now receive credentials for an EMS medical director in the state.

OBJECTIVES:

Short Term
Develop a national core content for EMS medical director education.

Intermediate Term
Provide ample educational opportunities that include the medical director core content.

Long Term
Provide EMS medical directors credentials based on their fulfillment of national core content objectives.

Potential Participants Lead: ACEP, NAEMSP, NHTSA Contributing: AAP, ACS, HRSA/MCHB, NASEMSD, NFA, physician organizations, state EMS lead agencies.

NATIONAL ACTION:
Work to designate EMS as a physician subspecialty.

A multi-organization EMS Subspecialty Task Force continues to work to fulfill the requirements of the American College of Emergency Physicians (ACEP), Society for Academic Emergency Medicine (SAEM), and National Association of EMS Physicians (NAEMSP) to support an EMS subspecialty status. ABEM ultimately petitions ABMS to designate EMS as a subspecialty. Other physician groups in addition to emergency physicians have the opportunity to co-sponsor the subspecialty board. Subsequently, greater numbers of physicians pursue EMS training, acquiring expertise in all of its facets.

OBJECTIVES:

Short Term
Continue to work to define the specific knowledge and expertise required of physicians who specialize in EMS.

Intermediate Term
Enable the American Board of Emergency Medicine (ABEM) to sponsor an EMS subspecialty.

Long Term
Petition the American Board of Medical Specialties (ABMS) to designate EMS as a physician subspecialty.

Potential Participants Lead: ABEM, ACEP, NAEMSP, SAEM. Contributing: AAFP, AAP, ABMS, ACS, AMA, EMRA.

NATIONAL, STATE AND LOCAL ACTION:
Provide EMS education based on national core contents.

OBJECTIVES:

Short Term
Commission the development of national EMS education core contents for EMS providers, consistent with the parameters established in the National EMS Education and Practice Blueprint.

Intermediate Term
Incorporate national core contents into EMS educational program curricula.

Long Term
Implement a process to regularly review the core content objectives to ensure they reflect the population’s dynamic health care needs and the needs of EMS providers.

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

NATIONAL AND LOCAL ACTION:
Include research, quality improvement, and management-related objectives in EMS education.

During a strategic planning exercise, Montgomery EMS realizes that its personnel lack adequate preparation in research, quality improvement, and management. This has hampered efforts to advance the system and provide opportunities for professional development. Work with the regional community college results in greater attention to these areas in initial and continuing EMS education programs. Eventually, Montgomery EMS personnel have a greater appreciation for the importance of research and quality improvement, and they are better prepared to participate in these activities.

OBJECTIVES:

Short Term
Develop and provide EMS education that includes research, quality improvement, and management-related objectives.

Intermediate Term
Include research, quality improvement, and management-related objectives in the national EMS education core contents.

Long Term
Require accredited EMS educational programs to incorporate research, quality improvement, and management-related objectives, and include topic-related questions on credential examinations.

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

NATIONAL, STATE AND LOCAL ACTION:
Advocate for prevention-focused legislation and regulations.

The state EMS council organizes a communication network to relay information about state legislative activities that might affect emergency health care. When legislation that would repeal motorcycle helmet laws is proposed, an effective response from the state’s EMS organizations and agencies is organized via the network. The state senate votes against the proposed legislation.

OBJECTIVES:

Short Term
Inform EMS agencies and providers about legislative proposals that may affect illness or injury incidence or severity, or a community’s ability to access EMS care.

Intermediate Term
Engage in efforts to influence the course of legislative proposals that may affect the incidence or severity of illnesses or injuries, or a community’s ability to access EMS care.

Long Term
Develop and advocate for state and national EMS agendas for prevention-focused legislative and regulatory priorities.

Potential Participants Lead: HRSA/MCHB, NHTSA, state EMS lead agencies. Contributing:

NATIONAL, STATE AND LOCAL ACTION:
Improve prevention-related data collection and sharing by EMS.

Metro EMS collaborates with the area Agency on Aging to arrange follow-up for some of its patients who are not transported. The Agency on Aging, however, lacks up-to-date information on the incidence of various injuries occurring in the home. Subsequently, Metro EMS completes a domicile risk analysis for every elderly patient not being transported, and shares that information with the Agency on Aging. The risk analysis format was adopted from the Centers for Disease Control and Prevention (CDC).

OBJECTIVES:

Short Term
Collaborate with other community agencies, organizations and health care providers to determine how EMS might help fulfill their prevention-related data needs.

Intermediate Term
Develop model scene survey formats for risk assessments for various illnesses and injuries.

Long Term
Revise data collection tools, using evolving technologies and models, in order to improve prevention-related EMS data collection and sharing.

Potential Participants Lead: EMS provider agencies. Contributing: AAA, AAP, ACEP, AHCPR, APHA, CDC, EMS medical directors, FEMA, health care networks, hospitals, HRSA/MCHB, IAFC, IAFF, medical societies, NAC, NAEMSP, NASEMSD, NSC, NFA, NHTSA, NLC, public health agencies, social service agencies, state EMS lead agencies, STIPDA, USFA.

NATIONAL AND LOCAL ACTION:
Maintain up-to-date EMS dispatching and communications standards.

The public safety answering point for Prescott County recently established a standard process for providing pre-arrival instructions to EMS callers. Within days a child was saved from drowning because the new procedure helped the call-taker provide pre-arrival care instructions to another child; who was the only other person at the scene.

OBJECTIVES:

Short Term
Convene a multidisciplinary conference to develop consensus standards for EMS dispatching and communications.

Intermediate Term
Ensure that EMS communications centers provide appropriate medically-directed pre-arrival instructions to EMS callers.

Long Term
Evaluate and continually update nationwide EMS dispatching and communications standards.

Potential Participants Lead: APCO, ASTM, NAEMD. Contributing: AAP, ACS, AHA, ATS, EMS communications centers, EMS provider agencies, HRSA/MCHB, NAC, NAEMSE, NAEMSP, NASEMSD, NHAAP, NHTSA, NLC.

NATIONAL ACTION:
Optimize EMS data collection.

South Anthony EMS is participating in a pilot project to transmit video images of patients to its receiving hospital. The project uses the procedure in specific circumstances, and it includes evaluation of the related costs and outcome benefits.

OBJECTIVES:

Short Term
Convene a multidisciplinary panel to consider potential primary and secondary uses for the data captured during EMS encounters.

Intermediate Term
Implement research and pilot projects to determine the value of specific data acquisition and real-time data transfer.

Long Term
Continuously evaluate the effects of real-time data transfer, including related costs, outcomes, and confidentiality issues.

Potential Participants Lead: NASEMSD, NHTSA. Contributing: AAA, AAP, ACEP, ACS, AhA, AMIA, APCO, APHA, ATS, CDC, EMS provider agencies, FEMA, IAFC, IAFF, medical device manufacturers, NACCHO, NAEMSQP, NAEMSP, NAEMT, NEMSA, NRHA, SAEM.

NATIONAL, STATE AND LOCAL ACTION:
Increase the utilization of a uniform data element set within EMS information systems.

The Southern EMS Council is pursuing a venture to allow all its area EMS provider agencies to electronically record patient care information. As part of the plan, national uniform data elements are included in the information system. This process creates opportunities to educate EMS managers about EMS data and information systems.

OBJECTIVES:

Short Term
Educate EMS managers about data and information systems through courses such as Emergency Medical Services Information Systems.

Intermediate Term
Incorporate uniform data elements and definitions into existing information systems.

Long Term
Review and periodically update the uniform pre-hospital data element set.

Potential Participants Lead: EMS provider agencies, NASEMSD, NHTSA. Contributing: AAA, AAP, ACEP, ACS, AMIA, IAFC, NAEMSP, NAEMT, NFA, state EMS lead agencies, USFA.

STATE AND LOCAL ACTION:
Ensure that EMS information systems serve their purposes.

Jarvis EMS is developing a new information system to help manage data that are currently lost and cannot be analyzed. Among their first steps is the creation of a task force that includes representatives from other area health and public safety agencies, to help determine the desired output of the system and how information will be shared.

OBJECTIVES:

Short Term
Determine the desired output before establishing an EMS information system.

Intermediate Term
Maintain the ability to query EMS information systems in order to maximize their potential usefulness.

Long Term
Provide reports to individuals who need information, including those who generate the system’s data, or enable them to query the EMS information system.

Potential Participants Lead: EMS provider agencies. Contributing: AMIA, ANA, FEMA, health care networks, hospitals, NAC, NACCHO, NLC, public health agencies, public safety agencies, social service agencies, state EMS lead agencies, USFA.

STATE AND LOCAL ACTION:
Evaluate EMS on a continuous basis.

Renona EMS is assessing its own evaluation processes. It subsequently adapts several evaluation models from the state EMS lead agency. These models are used as a basis for evaluating EMS providers and other aspects of the system. Evaluation results are used to develop continuing education programs and make system improvements.

OBJECTIVES:

Short Term
Ensure that every EMS provider knows the importance of, and has basic knowledge about evaluation principles and technologies.

Intermediate Term
Develop and disseminate EMS evaluation models.

Long Term
Adapt EMS evaluation models at both the state and local level, and use them for continuous evaluation of EMS.

Potential Participants Lead: EMS provider agencies, state EMS lead agencies. Contributing: AAA, ACEP, EMS medical directors, EMS providers, IAFC, IAFF, NAEMSE, NAEMSP, NAEMSQP, NAEMT, NASEMSD, NFA, NHTSA.

LOCAL ACTION:
Include the community in EMS evaluation.

Gulf Beach EMS representatives periodically meet with neighborhood civic groups. At these meetings, ideas for community involvement in EMS evaluation are discussed. The evaluation results are shared with the respective neighborhoods in the form of a report card. Advocated by the state EMS lead agency, report cards are eventually adapted by other surrounding communities.

OBJECTIVES:

Short Term
Solicit community-based groups and other community members for EMS evaluation support.

Intermediate Term
Use evaluation techniques that incorporate community input, and provide the community with the evaluation results.

Long Term
Develop and distribute EMS report cards to communities.

Potential Participants Lead: EMS provider agencies. Contributing: Community groups and organizations, EMS medical directors, medical societies, NAEMSQP, NASEMSD, NCQA, state EMS lead agencies.