a timely manner may be most important in ensuring good outcomes. Indeed, that was the conclusion of a recent World Health Organization report on prehospital trauma care systems (Sasser et al., 2005). In addition, research, including the Ontario Prehospital Advanced Life Support study, has raised serious questions about the value of ALS beyond early defibrillation and administration of aspirin and oxygen to patients suffering myocardial infarction. Technologies that simplify the job of the prehospital provider, such as AEDs and newly developed airway adjuncts, have been shown to improve outcomes. The appropriate roles of other, more complex technologies have not been well established (Bunn et al., 2001; Sasser et al., 2005).


Communications among EMS and other public safety and health care providers are still very limited. Antiquated and incompatible voice communications systems often result in a lack of coordination among emergency personnel as they respond to incidents. As mentioned earlier, many EMS systems rely on voice communications equipment that was purchased in the 1970s with federal financial assistance and has never been upgraded. This equipment frequently suffers from dead spots, interference, and other technical problems (Public Safety Wireless Network Program, 2005) (see Figure 5-1). However, upgrading to new equipment is often prohibitively expensive for local communities.

Advanced data and information systems are now available in the commercial market; however, adoption of these systems has been uneven across the country. Most ambulance systems continue to rely on paper-based run records rather than electronic systems. Similarly, technologies that enable direct transmission of patient information (e.g., vital signs) to hospitals prior to the arrival of an ambulance have not been uniformly adopted. Consequently, there is a growing gap between the types of EMS data and information systems available and those commonly used in the field.

These issues are compounded by the significant variation in EMS operational structures at the local and regional levels. EMS agencies may be operated by local governments, fire departments, private companies, or other entities. This makes communications and data integration difficult, even among EMS providers within a given local area. Communications among EMS, public safety, public health, and other hospital providers are even more problematic given the technical challenges associated with developing interoperable networks. As a result of these challenges and the need for improved coordination, the 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). Each

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