the potential to improve visibility and funding for EMS, and perhaps other aspects of emergency and trauma care, within the federal government.

While the committee applauds these positive developments, setbacks have occurred as well. As noted above, DHHS’s Division of Emergency Medical Services, its Division of Trauma and EMS, and most recently its Trauma/EMS Systems Program have been zeroed out of the federal budget. Federal funding for AHRQ, nonbioterrorism programs at CDC, and other federal programs related to emergency and trauma care at the federal level have been cut. These developments suggest that a fragmented organizational structure at the federal level would significantly hinder the creation of a coordinated, regionalized, accountable emergency and trauma care system. FICEMS can be a valuable body, but it is a poor substitute for formal agency consolidation. FICEMS is expressly focused on EMS, and ultimately has limited power even within this sphere. It is not a federal agency and therefore cannot regulate, spend, or withhold funding. It cannot even hold its own member agencies accountable for their actions—or lack of action.

Option 2:
Designate or Create a New Federal Lead Agency

The possibility of a lead agency for emergency and trauma care has been discussed for years and was highlighted in the 1996 report Emergency Medical Services Agenda for the Future. While the concept of a lead agency promoted in that report was focused on prehospital EMS, the committee believes a lead agency should encompass all components involved in the provision of emergency and trauma care. This federal lead agency would unify federal policy development related to emergency and trauma care, provide a central point of contact for the various constituencies in the field, serve as a federal advocate for emergency and trauma care within the government, and coordinate grants so that federal dollars would be allocated efficiently and effectively.

A lead federal agency could better move the emergency and trauma care system toward improved integration; unify funding and other decisions; and represent all emergency and trauma care patients, providers, and settings, including prehospital EMS (both ground and air), hospital-based emergency and trauma care, pediatric emergency and trauma care, rural emergency and trauma care, and medical disaster preparedness. Specifically, a federal lead agency could:

  • Create unified accountability for the performance of the emergency and trauma care system.

  • Rationalize funding across the various aspects of emergency and trauma care to optimize the allocation of resources in achieving system outcomes.

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