Pre-hospital care and access is a critical component that will be further
enhanced in the trauma care system of the future. Currently, out-of-hospital
EMS provider agencies are predominantly isolated from other health services
and respond to acute illness and injury episodes. They are primarily
financed for service to individuals in need and are accessible through
fixed-point and wireless telephones, though there are deficiencies in
the current 9-1-1 emergency telephone system. EMS delivery is quite
diverse at the local level, including a variety of configurations, funding,
staffing, geography and mode of delivery (e.g., volunteer, municipal,
private, etc.).
There are clear inequities in distribution of EMS resources. The "rural
paramedic paradox" is a reality --- rural areas farthest from a hospital
have the greatest need for EMS yet have the most trouble maintaining
those services. Field stabilization in rural areas is particularly critical
because transport times can exceed 1 or 2 hours and total pre-hospital
times can exceed 3 or 4 hours. 26 Integration of Critical Access Hospitals
(CAHs) with the EMS system and regional trauma systems is also of paramount
importance for the rural health infrastructure.
In urban areas, there is an increasing problem of hospital overcrowding
and ambulance diversion throughout the country, and there have been
cases of inappropriate triage, both under and over-triage, to regional
trauma centers.
• EMS and first responders will be more integrated within
the health care system, with links to prevention and acute care, and
will be more focused on promoting overall community health, as described
more fully in the "EMS Agenda for the Future". 27 This will facilitate
faster access, improved pre-hospital care, and more seamless patient
care throughout the continuum of care. Critical Access Hospitals will
be better integrated with EMS systems. EMS will continue to serve as
the community's safety net and will be funded more reliably and appropriately
for service to the community.
• Trauma care will be coordinated and integrated using standard
protocols and triage. Triage criteria will be redesigned to produce
a more accurate predictive model, which facilitates direction of patients
to the most appropriate care setting.
• Transport vehicles (air and ground) will be strategically
placed rather than facility based and will be used appropriately to
facilitate timely access and response, especially in areas that are
least accessible.
• A national 911 system, covering both wireless and conventional
wireline telephone systems, will be developed and implemented, with
standard, seamless protocols that are evidence-based and that address
bystander interface. Rural addressing will be accomplished, where needed,
to enable enhanced 911 systems and to ensure that all citizens have
better access to EMS and other public safety resources. Dispatcher training
will be standardized and EMS response will be based upon medical priority.
• Access to prehospital trauma care in rural areas will
be greatly enhanced through development of consistent standards and
more efficient deployment of limited resources.
• Enhanced communications among all members of the trauma
care team during the pre-hospital phase will speed deployment of resources,
produce more appropriate triaging, and result in better patient outcomes.
Greater use of wireless technology should enable team members to speak
to other hospitals and providers in the field and to give direction
and assistance wherever the care is being provided. Discovery (Automatic
Collision Notification -ACN), Access (wireless), and Coordination (telemedicine)
all will be enhanced through improved technology.