in which all communities are served by well-planned and highly coordinated emergency care systems that are accountable for their performance. The chapter establishes a vision in which the various components of the emergency and trauma care system are connected through improved communications networks and organized through a regionalized system of care. A national demonstration program is proposed in which states and communities would be able to create and test new models for the delivery of emergency and trauma care services.

Chapter 4 examines the EMS workforce, including EMTs and paramedics, volunteers, emergency medical dispatchers, and EMS physician medical directors. The chapter details the current education and training standards for EMS personnel and proposes the establishment of a national certification requirement. It also proposes the transition to a common scope of practice across states. In addition, the chapter addresses issues surrounding recruitment and retention of EMS personnel, including worker safety and pay.

Chapter 5 examines an array of issues relating to infrastructure and technologies employed by the EMS system, including 9-1-1, enhanced 9-1-1, and next-generation 9-1-1 capabilities; automatic crash notification systems; equipment-related issues, such as ambulance design and safety; and air medical capacity and operations. The chapter also describes the technology upgrades required to achieve the goal of interoperable communications among various public safety responders (EMS, fire, police), between EMS and medical facilities (including voice and video communications and electronic health records), and throughout the EMS system overall.

Chapter 6 reviews the steps needed to develop an emergency care system capable of meeting the challenge of a major terrorist event, unintentional man-made disaster, natural disaster, or other public health crisis. The chapter demonstrates that having an emergency care system that functions efficiently and effectively on a daily basis is fundamental to having a system that is ready to handle larger public health and public safety crises. In addition, the chapter describes EMS equipment and training needs, including greater distribution of personal protective equipment and development of more effective communications systems, as well as improved hospital surge capacity.

Chapter 7 examines the research required to support improvements in EMS. It reviews the need for data collection and outcome assessments and the mechanisms required to generate these data. In addition, the chapter describes enhanced research strategies, such as multicenter collaborations and support for talented investigators. The chapter also describes current data work now being conducted (e.g., the National EMS Information System [NEMSIS]) and steps required to change the regulatory environment (i.e., the Health Insurance Portability and Accountability Act) to make outcome assessments possible.

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