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Emergency Medical Services at the Crossroads
STRENGTHS OF THE CURRENT SYSTEM
The EMS system has a number of notable strengths. Prehospital EMS is far more sophisticated and far more capable than it was 40 years ago. The 9-1-1 emergency notification system is available to virtually all Americans and is regarded as highly responsive and reliable. The system enables rapid response to medical emergencies and facilitates crucial lifesaving care. In addition, the broad availability of cell phones has expanded 9-1-1 access to emergency and trauma scenes where no help was available before. The development of automatic crash notification technology, now becoming more widely available, has further improved emergency response, providing immediate and increasingly detailed crash information to dispatchers automatically, even before anyone on scene places a call.
In general, Americans have access to rapid ambulance response in emergency situations. While there are many glaring exceptions, first responders in urban and suburban areas are generally able to arrive on scene within minutes of notification, with ambulance crews close behind. Moreover, with greater emphasis now being placed on bystander care and prearrival instructions provided by dispatchers, care to patients can be initiated even more rapidly. In addition, air ambulance operations allow more advanced medical capacity to be delivered to patients directly and can often reduce transport times to medical facilities. In areas where trauma systems have developed, EMS and trauma providers are interdependent, working closely within an established protocol to help ensure that patients are transported to the most appropriate facility as quickly as possible.
EMS personnel form the backbone of the prehospital care system despite working under conditions that are stressful and at times dangerous. Many of them provide their services on a volunteer basis. The sophisticated equipment now at the disposal of many EMS providers, such as automated external defibrillators (AEDs) and 12-lead electrocardiographs (ECGs), as well as more effective medications, allow them to provide a much broader array of services than was available in years past.
Of the 113.9 million ED visits that occurred in 2003, an estimated 14 percent were made by patients who arrived by ambulance. The most frequent complaints included chest pains, shortness of breath, stomach pain, injury from a motor vehicle crash or some type of accident, convulsions, and general weakness. The majority of visits were for illness (59.3 percent), whereas 40.7 percent were for injury, poisoning, or adverse effects of medical treatment (Burt et al., 2006). Prehospital cardiac arrests occur at a rate of 250,000 per year or more than 650 per day across the country, and these cases are frequently handled by EMS providers (Zheng et al., 2001). While