committee recommends that hospitals, trauma centers, emergency medical services agencies, public safety departments, emergency management offices, and public health agencies develop integrated and interoperable communications and data systems (5.2).

In addition, as the development of a National Health Information Infrastructure moves forward in the United States, representatives of prehospital emergency care should be involved at every level. The initial focus of this effort was on hospitals, ambulatory care providers, pharmacies, and other, more visible components of the health care system. Given the role played by prehospital EMS providers in providing essential and often lifesaving treatment to patients, however, their omission from this initiative has been a significant oversight. Therefore, the committee recommends that the Department of Health and Human Services fully involve prehospital emergency medical services leadership in discussions about the design, deployment, and financing of the National Health Information Infrastructure (5.3).

The number of air medical providers has grown substantially since they first emerged in the 1970s. Today there are an estimated 650–700 medical helicopters operating in the United States, up from approximately 230 in 1990. These air ambulance operations have served thousands of critically ill or injured persons over the past several decades. However, questions remain regarding the clinical efficacy and appropriateness of sophisticated air ambulance care, as well as its cost-effectiveness, given that the cost can be more than five times greater than that of ground ambulance service. In addition, in recent years there has been a significant increase in fatal crashes involving air ambulances, resulting in heightened safety concerns. While the Federal Aviation Administration is responsible for safety inspections, helicopter licensure, and air traffic control, the committee recommends that states assume regulatory oversight of the medical aspects of air medical services, including communications, dispatch, and transport protocols (5.1).

Accountability has failed to take hold in emergency care to date because responsibility for the services provided is dispersed across many different components of the system, so it is difficult even for policy makers to determine where system breakdowns occur and how they can subsequently be addressed. To build accountability into the system, the committee recommends that the Department of Health and Human Services convene a panel of individuals with emergency and trauma care expertise to develop evidence-based indicators of emergency care system performance (3.3).