Because of the need for an independent, national process that involves the broad participation of every component of emergency care, the federal government should play a lead role in promoting and funding the development of these performance indicators. The indicators developed should include structure and process measures, but evolve toward outcome measures over time. These performance measures should be nationally standardized so that statewide and national comparisons can be made. Measures should evaluate the performance of individual components of the system, as well as the performance of the system as a whole. Measures should also be sensitive to the interdependence among the various components. For example, EMS response times may be related to EDs going on diversion.

Using the measures developed through such a national, evidence-based, multidisciplinary effort, performance data should be collected at regular intervals from all hospitals and EMS agencies in a community. Public dissemination of performance data is crucial to driving the needed changes in the delivery of emergency care services. Because of the potential sensitivity of performance data, the data should initially be reported in the aggregate rather than at the level of individual provider agencies. However, individual agencies should have full access to their own data so they can understand and improve their performance, as well as their contribution to the overall system.

Disaster Preparedness

Promoting an emergency and trauma care system that works well on a day-to-day basis is fundamental to establishing a system that will work well in the event of a disaster. But the frequency of ambulance diversions and extended off-load times for ambulance patients indicate that the current system is not well prepared for such events. Moreover, EMS and trauma systems have to a large extent been overlooked in disaster preparedness planning at both the state and federal levels. Although they represent a third of the nation’s first responders, EMS providers received only 4 percent of the $3.38 billion distributed by the Department of Homeland Security for emergency preparedness in 2002 and 2003, and only 5 percent of the Bioterrorism Hospital Preparedness Grant administered by the Department of Health and Human Services. The committee recommends that the Department of Health and Human Services, the Department of Transportation, the Department of Homeland Security, and the states elevate emergency and trauma care to a position of parity with other public safety entities in disaster planning and operations (6.1).

While significant federal funding is available to states and localities for disaster preparedness, emergency care in general has not been able to secure a meaningful share of these funds because they have been folded

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