EMS Agenda for the Future
 



LOCAL ACTION:
Develop collaborative strategies to identify and address community health and safety issues.

Representatives from Noblestown EMS call the public health department and the local hospital emergency department director to arrange a meeting. Over the course of several meetings they identify a population of people with chronic obstructive pulmonary disease (COPD) who are frequent emergency department patients. They develop a plan that has EMS intensifying the monitoring and treatment of these patients in their homes. Subsequently, their hospital emergency department visits decrease.

OBJECTIVES:

Short Term
Develop relationships between EMS agencies and other public/community health and safety organizations to identify community health and safety issues.

Intermediate Term
Use meetings and publications to disseminate information regarding successful strategies, projects and programs that address community health and safety issues and incorporate EMS participation.

Long Term
Ensure active collaboration among EMS agencies at local, state and national levels and public/community health and safety agencies and organizations in efforts to improve community health.


Potential Participants

Lead: EMS provider agencies, public/community health and safety agencies.

Contributing: AAA, AARP, ACEP, ACS-COT, ANA, APHA, ASTHO, emergency physicians, EMS medical directors, FEMA, health care networks, health plans, IAFC, IAFF, NACCHO, NAEMSE, NAEMSP, NAEMT, NASEMSD, NFA, NRHA, social service agencies, STIPDA.




NATIONAL AND LOCAL ACTION:
Align the financial incentives of EMS and other health care providers and payers.

Saltsville EMS administration establishes a dialogue with Healthy Folks Network. They discuss a model relationship that was proposed at a recent conference, and decide to develop a pilot project utilizing this approach. Parts of the project involve more prevention-related activities by EMS, expanded options for transportation destinations, facilitation of patient follow-up, and payment that is not dependent on transportation. The project also involves continuous assessments of EMS effectiveness and quality. The project's continuation depends on the results of regular systematic reviews.

OBJECTIVES:

Short Term
Initiate collaborative relationships between EMS provider agencies and other health care providers and payers.

Intermediate Term
Develop models for financial relationships between EMS and health care payers in urban, suburban, and rural communities.

Long Term
Implement pilot projects, involving collaboration of EMS and other health care providers and payers, that align financial incentives and improve the effectiveness and efficiency of efforts to address communities' emergency health care needs.


Potential Participants

Lead: EMS provider agencies, health care networks.

Contributing: AAA, AAHP, AAPPO, ACEP, AhA, colleges and universities, EMS researchers, HCFA, health care insurers, hospitals, IAFC, IAFF, local governments, NAEMSE, NAEMSP, NASEMSD, NCQA, state EMS lead agencies.




NATIONAL, STATE AND LOCAL ACTION:
Participate in community-based prevention efforts.

The state EMS lead agency and health department collaborate to distribute a profile of preventable injuries in the state to EMS agencies. The profile includes demographic and geographic breakdowns of specific problems, and a directory of various community agencies and organizations. Burgett EMS uses the information in the directory to identify potential community partners for its prevention program.

OBJECTIVES:

Short Term
Educate EMS provider agencies about the Safe Communities concepts, and identify possible community-based, prevention-oriented partnerships.

Intermediate Term
Collaborate with community agencies, organizations and health care providers to identify community prevention needs and the potential roles of EMS.

Long Term
Develop the resources necessary to support continuous EMS participation in community-based illness and injury prevention efforts.


Potential Participants

Lead: EMS medical directors, EMS provider agencies, HRSA/MCHB, NHTSA.

Contributing: AAA, AAP, ACEP, ACS, AHA, ATS, CDC, ENA, ENCare, governor's highway safety agencies, IAFC, IAFF, NACCHO, NAEMSE, NAEMSP, NAEMT, NASEMSD, NSC, NCSEMSTC, NFA, NHAAP, NRHA, public health departments, state EMS lead agencies, STIPDA, USFA.




NATIONAL ACTION:
Develop and pursue a national EMS research agenda.

The National Highway Traffic Safety Administration (NHTSA), the Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), and the Agency for Health Care Policy and Research (AHCPR), fund several meetings to develop a national EMS research agenda by organizational representatives. Standard outcome measurements and uniform reporting styles are also established. Subsequent federal funding for EMS research is directed toward agenda issues. This compels the use of standard outcome measurements and uniform reporting styles. The quality and comparability of EMS research increases.
OBJECTIVES:

Short Term
Develop processes to establish a national EMS research agenda, uniform reporting styles, and standard outcome measurements.

Intermediate Term
Establish a national EMS research agenda, guidelines for uniform reporting styles, and standard outcome measurements.

Long Term
Use conferences and publications to disseminate a national EMS research agenda, guidelines for reporting research results, and information about standard outcomes measurements.


Potential Participants

Lead: AHCPR, HRSA/MCHB, NAEMSP, NHTSA, SAEM.

Contributing: AAA, AACEM, AAMC, AAP, ACEP, ACS-COT, AHA, ANA, APHA, ATS, CDC, EMS researchers, IAFC, IAFF, NAEMSE, NASEMSD, NFA, public health schools, USFA.




NATIONAL AND STATE ACTION:
Pass EMS legislation that enables each state to support innovation and integration.

The National Association of State EMS Directors (NASEMSD) develops model state EMS legislation. The model is presented to the National Conference of State Legislatures (NCSL) and to state legislatures. Subsequently, the number of states with laws and regulations that support EMS innovation increases.

OBJECTIVES:

Short Term
Develop model legislation and regulations that designate a state EMS lead agency and support EMS innovation and integration.

Intermediate Term
Market model EMS legislation and regulations within each state.

Long Term
Pass legislation within each state that enables it to designate an EMS lead agency and is consistent with the EMS Agenda for the Future.


Potential Participants

Lead: NASEMSD, state EMS lead agencies, state legislatures.

Contributing: AAA, AAP, ACEP, ACS-COT, AHA, IAFC, IAFF, NAEMSP, NCSEMSTC, NCSL.




NATIONAL, STATE AND LOCAL ACTION:
Allocate adequate resources for medical direction.

As part of its budget, Moyer County EMS provides resources and a modest stipend to its medical director, an emergency physician at the regional hospital. When the medical director relocates, the EMS agency requests that its representatives be involved in the process of recruiting a replacement. Their efforts focus on identifying a new physician with expertise consistent with published guidelines, and the desire to be a qualified EMS medical director.

OBJECTIVES:

Short Term
Develop a multidisciplinary position paper with widespread endorsement, that provides guidelines for medical direction of EMS system activities.

Intermediate Term
Develop the resources and funding necessary to support appropriate EMS system medical direction.

Long Term
Require that all EMS provider agencies maintain a formal documented relationship with a qualified medical director.


Potential Participants

Lead: EMS provider agencies, EMS medical directors, NAEMSP, NASEMSD, state EMS lead agencies.

Contributing: AAA, AAP, ACEP, ACS, ASTM, IAFC, IAFF, JRC, NAEMT, NEMSA, NFA, USFA.




NATIONAL, STATE AND LOCAL ACTION:
Develop information systems that link EMS across its continuum.

The Western Region EMS Council creates an information system partnership among health and public safety agencies in the area. The partnership is responsible for developing a dynamic information system plan that will lead to multiple links, facilitating information exchange and a complete description of EMS care.

OBJECTIVES:

Short Term
Develop information system plans as living documents that address the need to generate and transmit valid, reliable, and accurate data.

Intermediate Term
Plan to link EMS information systems with those of other health care providers, public safety agencies, and community resources, taking into consideration hardware and software compatibility, and confidentiality issues.

Long Term
Complete the installation and training necessary to establish an EMS data system with links between EMS systems and other health care agencies and providers to track and report system utilization, patient care and outcomes, and link EMS across its continuum.


Potential Participants

Lead: AMIA, EMS provider agencies, NHTSA, state EMS lead agencies.

Contributing: AAA, AhA, colleges and universities, EMS researchers, FEMA, health care networks, IAFC, NAC, NACCHO, NLC, public health agencies, public safety agencies, social service agencies, state departments of transportation, USFA.




NATIONAL AND LOCAL ACTION:
Determine the costs and benefits of EMS to the community.

Mason County EMS begins the process of determining its value to the community. First it calculated its associated costs, using a model developed by a national working group. It uses similar models to continuously monitor its effect in the community, placing the identified costs into context.

OBJECTIVES:

Short Term
Determine the cost of providing communities with EMS.

Intermediate Term
Develop models for estimating the quantitative and qualitative benefits of EMS for communities.

Long Term
Determine and continually monitor the value EMS adds to the community's health care.


Potential Participants

Lead: EMS medical directors, EMS provider agencies.

Contributing: AAA, ACEP, AHA, AHCPR, APHA, ATS, CDC, colleges and universities, EMS researchers, HRSA/MCHB, IAFC, IAFF, NAEMSP, NASEMSD, NHAAP, NHTSA, SAEM, USFA.




NATIONAL, STATE AND LOCAL ACTION:
Ensure nationwide availability of 9-1-1 as the emergency telephone number.

When Sue and Dave Morris moved with their 14-month-old son, Derek, they could not afford telephone service immediately. Fortunately, they could still call 9-1-1. A state law requires telephone companies to always maintain 9-1-1 service for any pre-existing residential telephone connection. When Derek suffered a seizure and stopped breathing while Sue and Dave were unpacking boxes, they called 9-1-1 for help. EMS personnel arrived within minutes, and discovered that Derek's seizure was the result of asphyxia due to a marble lodged in his airway. The immediate availability of 9-1-1 led to the quick action that saved Derek's life.

OBJECTIVES:

Short Term
Continue to collect and disseminate information about the extent of nationwide 9-1-1 coverage, and identify and work to eliminate barriers to its use.

Intermediate Term
Promulgate laws or regulations that will ensure the availability of 9-1-1 to those who cannot afford routine telephone service.

Long Term
Educate consumers of the availability of 9-1-1, despite their possible inability to afford routine telephone service.


Potential Participants

Lead: CTIA, NASEMSD, NENA, public utility commissions, state legislatures, telephone companies.

Contributing: AAA, AAP, AARP, ACEP, ACS, AHA, APCO, CFSI, EMS provider agencies, IAFC, IAFF, NAC, NAEMSP, NAEMT, National Governors' Council, National Native American EMS Association, NHAAP, NLC, NRHA.




STATE AND LOCAL ACTION:
Ensure that all calls for emergency help are automatically accompanied by location-identifying information.

During the past year, Springer County ensured that all residences, businesses, and public places were assigned locatable addresses. In July, an out-of-state motorist stopped at a park along the county's scenic roadway. Moments later, she witnessed a car strike a pedestrian in the parking area. Even though she could not accurately describe her location when she called 9-1-1 from her wireless telephone, the caller's location was displayed on the screen of the answering point. The appropriate response was immediately put into motion.

OBJECTIVES:

Short Term
Educate state legislators and state and local government officials about the importance of addressing systems, including in rural communities.

Intermediate Term
Mandate, by statutes or regulations, that all residences, businesses, established public places, and permanent telephone locations must have assigned addresses.

Long Term
Employ automatic number identification and automatic location identification technology at all public safety answering points.


Potential Participants

Lead: APCO, CTIA, NENA, public safety answering points.

Contributing: AAA, FEMA, HRSA/MCHB, IAFC, IAFF, local governments, NAC, NAEMSP, NAEMT, NASEMSD, NHTSA, public utility commissions, state legislatures.