CHAPTER 1
INTRODUCTION
THE STATE OF EMS If one set out to design a prehospital care system for the United States from the ground up, it might look very different from the EMS system that we have today. While EMS has made impressive progress in many of the technical aspects of treating critical patients, our current EMS system suffers from some fundamental challenges that inhibit innovation in the industry. As the Institute of Medicine (IOM) explained in 2006, “Fragmentation, silos, and entrenched interests prevail.” 1 There are wide variations in regulation, system design and standards of care. There is suboptimal compliance with evidence-based medicine, national guidelines, and educational standards. Certifications vary greatly from state to state, and there is little collaboration between EMS and the academic community. While many EMS patients often suffer from non- emergent conditions, current models of financial reimbursement, medical direction, and EMS educational standards focus almost exclusively on emergency care. Furthermore, there is very little penetration of modern telecommunication technologies and EMS rarely makes effective use of data or shares information with other agencies, community health stakeholders, or patient care teams. As a result, EMS is neither designed to provide many of the services our communities need nor to adapt to new opportunities. While many barriers to innovation are external to EMS, others are the consequence of purely internal challenges. For
example, the culture of many EMS organizations is bound by traditions and often resistant to innovation. Such resistance has contributed to a lack of recognition of EMS and its integration within the larger health care system. Conformance to the status quo has prevented EMS from adapting to new public safety needs and has contributed to our services becoming a neglected area of public safety, public health, and especially health care in America. AN ALTERNATIVE VISION EMS was at one time on track to developing standardized, high quality, coordinated emergency care as the result of initial direct investments and federal leadership stemming from the 1966 National Highway Traffic Safety Act and the 1973 Emergency Medical Services Systems Act. However, EMS splintered when direct support dissipated in the 1980s. The current system haphazardly evolved in an age of fee-for-service medicine and a hospital-based health care system that promoted an uncoordinated, poorly funded, transportation- focused system that falls short of providing the services communities need. The EMS Agenda for the Future (1996) and the IOM Future of Emergency Care (2007) report proposed a very different EMS system- one that is proactive rather than reactive, and one that delivers necessary care rather than traditional care. According to the EMS Agenda for the Future , “In order to optimize the positive influence of EMS on community health we must move to a system of finance that is proactive, accounting for the costs
1 “Emergency Medical Services at the Crossroads.” In Future of Emergency Care Series edited by Gail L. Warden. Washington, D.C.: Institute of Medicine, 2006.
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CHAPTER 1
MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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