EXECUTIVE SUMMARY
The EMS system in the United States provides a critical foundation for our nation’s health care safety net. While there are many examples of how EMS has made impressive progress in the treatment of critically ill patients, our EMS system suffers from fundamental challenges and remains characterized by wide variations in the way care is delivered. There is enormous divergence at the local, regional, and state level in terms of regulations, educational standards, and availability or coordination of resources. Meanwhile, health care is changing dramatically and is increasingly focused on creating value through higher quality, lower cost care, and on promoting integration across the care continuum. While EMS has often been left out of national health policy discussions, now that health care is rapidly moving towards population-based care management, it potentially has much to contribute, especially given that EMS occupies a unique position at the intersection of public health, public safety and healthcare. Yet, this moment of healthcare transformation may not last forever, and the EMS industry should take steps quickly to promote the environment for innovation. Despite their differences, local and regional communities throughout our nation are facing similar regulatory, financial, and other barriers to promoting innovative models of out-of-hospital care that could better meet the unfilled gaps within our healthcare, public health, and public safety systems. The purpose of this document is to identify the most significant barriers that our local agencies face, to champion opportunities and
strategies to unleash innovation, and ultimately create a framework for local and state EMS entities to use to create a more dynamic EMS system that is more adaptive and responsive to society’s needs. While the federal government has an important role to play, this document seeks to describe how local stakeholders can promote innovation independent of federal action. The “Promoting Innovation in EMS” project leadership assembled a steering committee that included a diverse group of stakeholders including representation from state and local government officials, a disparate group of EMS agencies, health systems, payers, other healthcare professions, and experts in community paramedicine, health economics, public health, and political science. An iterative process of gathering data, soliciting input and providing opportunities for feedback was undertaken that included a national survey, two regional conferences, an open national steering committee meeting, posting of multiple drafts and a public open comment period. In the end, seven major themes of challenges to EMS innovation were identified: regulation, finance, education, regional EMS coordination, interdisciplinary collaboration, medical direction, and data and telecommunications. LAW & REGULATION Legal and regulatory barriers include prohibition of non-emergency use of EMS, limitations on scope of practice, overly burdensome processes to approve pilot programs, inadequate liability protections, lack of portability of EMS certifications or licensure, Emergency Medical Treatment and Active Labor Act
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MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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