ensure that each patient receives the most appropriate care, at the optimal location, with the minimum delay. Yet coordination among 9-1-1 dispatch, prehospital EMS, air medical providers, and hospital and trauma centers is frequently lacking. Moreover, EMS personnel arriving at the scene of an incident often do not know what to expect regarding the number of injured or their condition. EMS personnel are frequently unaware which hospital EDs are on diversion and which are ready to receive the type of patient they are transporting. In addition, deployment of air medical services often is not well coordinated. While air medical providers are not permitted to self-dispatch, a lack of coordination at the ground EMS and dispatch level sometimes results in multiple air ambulances arriving at the scene of a crash even when all are not needed. Similarly, police, fire, and EMS personnel and equipment often overcrowd a crash scene because of insufficient coordination regarding the appropriate response.

Many of these problems are magnified when incidents cross jurisdictional lines. Significant problems are often encountered near municipal, county, and state border areas. In cases where a street delineates the boundary between two municipal or county jurisdictions, responsibility for care—as well as the protocols and procedures employed—may depend on the side of the street on which the incident occurred.

Communications and Data Systems

Communication between EMS and other health care and public safety providers remains highly limited. Antiquated and incompatible voice communication systems often result in a lack of coordination among emergency personnel as they respond to incidents. Many EMS systems rely on voice communication equipment that was purchased in the 1970s with federal financial assistance and has never been upgraded. Similarly, technologies that enable direct transmission of clinical information to hospitals prior to the arrival of an ambulance have not been uniformly adopted. Consequently, there is a growing gap between the types of EMS data and information systems that are available and those that are commonly used in the field.

These problems are compounded by the significant variation in EMS operational structures at the local and regional levels. EMS agencies may be operated by local governments, by fire departments, by private companies, or through other arrangements. This makes communications and data integration difficult, even among EMS providers within a given local area. Communication among EMS, public safety, public health, and other hospital providers is even more problematic given the technical challenges associated with developing interoperable networks. As a result of these challenges and the need for improved coordination discussed above, the

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