workgroup members, and voted on each and every one of the proposed recommendations. Written and verbal feedback, as well as web-based submissions, were collected. DEVELOPMENT OF THE DOCUMENT Following dissemination of conference proceedings, the steering committee members as well as other invited stakeholders continued to work in subgroups to explore issues and refine the recommendations ultimately included in this document. The draft recommendations were disseminated in January and February of 2016 for an initial public comment period. Over 150 responses were received. Most of the comments were favorable, while others raised new issues or perspectives. All were thoughtful and contributed to the iterative vetting process that has resulted in the recommendations contained in this document. Each comment was reviewed by the project team and steering committee as the group worked toward a near-final draft. Following a final open comment period in August of 2016, this final product was developed that we hope provides meaningful guidance on how to develop an infrastructure for states, communities, and agencies to promote, authorize, fund, regulate and evaluate innovative demonstration projects in emergency medical services. USING THE FRAMEWORK DOCUMENT As previously stated, we hope that the document can guide state and local EMS entities on the steps needed to unleash innovation in their communities. Along the way, we seek to inspire with examples of innovation in progress. There are numerous citations pointing to national reports, consensus guidelines, and even at times scientific results. However, the attempt was not to define the state of the scientific evidence, nor to report on the
results of policy changes already in effect. Rather, this document by its very nature is forward leaning. Its purpose is to promote innovation and therefore it recognizes that there is evidence for some policy recommendations but not for all. The formation of the recommendations in this document were, as described, formed through an iterative process of exploration, development, feedback, and refinement. The recommendations do not necessarily represent the views of any particular organization or government entity, nor do all of the people associated with the project agree with every single recommendation. The readers of this document should consider the many ideas, observations, examples, and recommendations and develop their own action plan as to what steps can be taken to promote innovation in their state or local community. STRUCTURE OF THE RECOMMENDATIONS We organized the recommendations in this document to be applicable at the local, state and national levels. We use this format, rather than naming specific groups of stakeholders, to acknowledge the diverse ways in which EMS systems operate and are regulated at the state and local level in the United States. For example, in one community for a given issue, the relevant state EMS authority might be the State Office of EMS, however in another community, the authority for the specific issues lies with the State Office of Education, the State Medical Board or with the legislature. Because of this, we sometimes use the labels of local agencies / authorities, state authorities / associations, and national associations / organizations to encompass all of the stakeholders that work at the local, state, and national levels, including providers, payers, and government agencies. The exact details and relationships between stakeholders may vary, but we encourage all users of this document to
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MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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