Administration, to promote coordinated, regionalized, and accountable emergency and trauma care systems throughout the country, and appropriate $88 million over 5 years to this program (3.4). Grants should be targeted at states, which could develop projects at the state, regional, or local level; cross-state collaborative proposals would also be encouraged. Over time, and over a number of controlled initiatives, such a process should lead to important insights about what strategies work under different conditions. These insights would provide best-practice models that could be widely adopted to advance the nation toward the committee’s vision for efficient, high-quality emergency care.

EMS is now at a crossroads. In the 40 years since the publication of the landmark National Academies report Accidental Death and Disability: The Neglected Disease of Modern Society, much progress has been made in improving the nation’s EMS capabilities. But in some important ways, the quality of the delivery of those services has declined. This report documents both strengths and limitations of the current prehospital EMS system. The committee’s overall conclusion, however, is that today the system is more fragmented than ever, and the lack of effective coordination and accountability stands in the way of further progress and improved quality of care. The opportunity now exists to move toward a more integrated and accountable EMS system through fundamental, systemic changes. Failing to seize this opportunity and continuing on the current path risks further entrenchment of the fragmentation that stands in the way of system improvement and higher-quality care.

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