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Emergency Medical Services at the Crossroads
and Control, the EMS-C program, and the National Bioterrorism Hospital Preparedness Program. These programs have made important contributions to emergency and trauma care despite inconsistent funding and the frequent threat of elimination. The Agency for Healthcare Research and Quality (AHRQ), another DHHS agency, has historically been the principal federal agency funding research in emergency care delivery, including much of the early research on management of out-of-hospital cardiac arrest. Recently, AHRQ has funded important studies of ED crowding, operations management, and patient safety issues. It is active as well in funding research on preparedness, bioterrorism planning, and response.
DHS also plays an important role in emergency and trauma care. The Federal Emergency Management Agency (FEMA), once an independent cabinet-level agency now housed in DHS, provides limited amounts of grant funding to local EMS agencies through the U.S. Fire Administration. DHS also houses the Metropolitan Medical Response System (MMRS), a grant program designed to enhance emergency and trauma preparedness in major population centers. This program moved from DHHS to DHS in 2003. In addition, DHS houses the Disaster Medical Assistance Team (DMAT) program, through which health professionals volunteer and train as locally organized units so they can be deployed rapidly, under federal direction, in response to disasters nationwide.
Efforts have been made to improve interagency collaboration at the federal level, especially in recent years. Over the last decade, federal agencies have worked collaboratively to provide leadership to the emergency and trauma care field, to minimize gaps and overlaps across programs, and to pool resources to jointly fund promising research and demonstration programs. For example, NHTSA and HRSA jointly supported the development of the Emergency Medical Services Agenda for the Future, as well as a number of other important EMS reports. This degree of collaboration has not been universal among federal agencies, however. Moreover, collaborative efforts are limited by the constraints of agency authorization and funding. At some point, agencies must pursue their own programmatic goals at the expense of joint initiatives. Furthermore, to the degree that successful collaboration has occurred, it has generally depended on the good will of key individuals in positions of leadership, which may limit the sustainability of these efforts when personnel changes occur.
In an effort to enhance the sustainability of collaborative initiatives, a number of agencies have participated in informal planning groups. For example, the Interagency Committee on EMSC Research (ICER), which is sponsored by HRSA, brings together representatives from a number of federal programs for the purposes of sharing information and improving research in emergency and trauma care for children.
A broader initiative is the Federal Interagency Committee on EMS